[Congressional Record (Bound Edition), Volume 163 (2017), Part 3]
[Senate]
[Pages 4229-4231]
[From the U.S. Government Publishing Office, www.gpo.gov]




                               TRUMPCARE

  Mr. CARDIN. Mr. President, I take this time to talk about the 
Republican American Health Care Act that was released, I guess, about a 
week or two ago, affectionately known as TrumpCare. I start by saying, 
what is this legislation trying to achieve? When I listen to the 
Republicans talk about why they have introduced this bill, what their 
concern is with the Affordable Care Act, they usually mention their No. 
1 concern is to deal with the increased premium costs that Americans 
have had under the Affordable Care Act. They normally will point to the 
individual marketplace, where we have seen increases in premium costs 
as the market has adjusted to the ratings of those who entered the 
individual marketplace.
  So it was very interesting, as I took a look at the Congressional 
Budget Office analysis of what the Republican TrumpCare bill would do. 
The Congressional Budget Office, let me remind my colleagues, is the 
objective scorekeeper. The leader of the Congressional Budget Office 
was appointed by the Republican leadership. It is the professional 
career people who make their best judgment of the impact of legislation 
that we are considering.
  Remember, the Republicans have said their principal objective is to 
bring down the cost, particularly for those entering the individual 
marketplace, but according to the Congressional Budget Office, in 2018-
19, the average rate in the individual marketplace will increase by 15 
to 20 percent. Let me say that again. The Congressional Budget Office 
tells us the premium increases under TrumpCare will increase for the 
individual 15 to 20 percent.
  Now, that could be a lot higher. That is the average. So let me give 
you the number. If you happen to be 64 years of age, with an income of 
$26,500, under the Affordable Care Act, you would pay $1,700 in 
premiums. Under TrumpCare, you would pay $14,600, or a 750-percent 
increase. That would equal to about 55 percent of your income in the 
health insurance premiums. Obviously, that is not affordable. A person 
of that age and income would have no ability to purchase insurance at 
an affordable rate under the American Health Care Act or TrumpCare.
  Let me take a look at some other reasons why we may be looking at 
this repeal-and-replacement bill. I listened to the President. I 
listened to my colleagues, and they say, first, they want to make sure 
they do no harm, that everyone will be at least as well off as they are 
today, and that there would be more choice to the consumers in buying 
health insurance.
  Once again, I point to the Congressional Budget Office, the objective 
scorekeepers. What would happen if TrumpCare were enacted? What would 
happen as far as individuals who currently have health insurance today? 
According to the Congressional Budget Office, next year, 2018, there 
would be 14 million less people insured than there are under the 
Affordable Care Act. If you project that out to 2026, they indicate 
there would be 24 million more people who would lose their insurance.
  Let me quote from The Baltimore Sun in this morning's editorial, 
where they pointed out that number: Twenty-four million would equal all 
the residents of Utah, Mississippi, Arkansas, Nevada, Kansas, Nebraska, 
West Virginia, Idaho, Montana, North Dakota, South Dakota, Alaska, 
Wyoming combined would have no insurance coverage. That is what 24 
million represent in America. Clearly, this bill is not carrying out 
the commitment to do no harm because 24 million more Americans will 
certainly be in worse shape.
  Then I heard the President talk about the fact that he wants to do no 
harm to the Medicare Program or the Medicaid Program. I took a look 
again at what this bill does in regard to Medicare because the bill 
repeals the tax on high income; that is, there is currently in law a 
tax for unearned income above $250,000, a tax that goes into the 
Medicare trust fund, Part A. The TrumpCare repeals that tax. Therefore, 
the Medicare trust fund doesn't get the income. That would reduce the 
solvency of the Medicare trust fund by 3 years, jeopardizing the 
Medicare system. Clearly, if this bill was aimed at not hurting 
Medicare, it hasn't achieved that purpose.

[[Page 4230]]

  Let's talk a little about Medicaid. What does this bill do to 
Medicaid? According to the Congressional Budget Office, it shifts 
hundreds of billions of dollars from the Federal Government to our 
States. Our States clearly cannot handle that. I have heard from my 
Governor. I am sure my colleagues heard from our other Governors. There 
is no possibility that they could pick up that. The Medicaid Program 
will be in very serious jeopardy of being able to continue anything 
like it is today. For Maryland--the State I have the honor of 
representing--the passage of TrumpCare would jeopardize the over 
289,000 Marylanders who have received insurance coverage as a result of 
Medicaid expansion under the Affordable Care Act. They very well would 
lose their coverage.
  What does that mean? Well, they better stay well because they are not 
going to get preventive healthcare covered by insurance. They are less 
likely to get their preventive healthcare services and the screenings, 
and, yes, they will return once again to use the emergency room of 
hospitals as their last resort in order to get their family's 
healthcare needs met--the most expensive way to get healthcare in our 
Nation.
  With the elimination of essential health benefits for Medicaid 
expansion enrollees, what does that mean? That means the Medicaid 
population--which in Maryland is hundreds of thousands of people--would 
lose their essential health benefits, which includes mental health and 
addiction services.
  We are in the midst of an opioid drug addiction epidemic in America. 
I have traveled my entire State and have had roundtables with law 
enforcement and health officials, and they tell me about the growing 
number of addictions in their community. One of the things they need to 
do is to be able to get people care and treatment, and we are saying we 
are going to cut off treatment for millions of Americans. That is what 
TrumpCare would do, cutting off those benefits.
  This bill would shift costs. What do I mean by that? Well, it adds 
costs to the healthcare system. If an individual stays healthy and uses 
our healthcare system the way they should, it is a lot less costly than 
entering our healthcare system in a more acute fashion or using our 
emergency rooms rather than using healthcare providers who are a lot 
less expensive and more efficient.
  So we are going to add to the cost of our healthcare system because 
of inefficiencies. Many times that extra cost is not paid for by those 
who have no health insurance; the fact is, it becomes part of what we 
call uncompensated care. We had that before the Affordable Care Act. 
With the increase in uncompensated care, all of us who have insurance 
will pay more because we are going to pay for the people who don't have 
health insurance, who use the healthcare system and don't pay for the 
healthcare system. That is a formula for extra costs for all of us.
  This legislation would be an attack on women's healthcare. It would 
attack and eliminate not only the funding for Planned Parenthood, which 
is critically important in many parts of our country where they are the 
only healthcare provider for women's healthcare needs, but also 
eliminate essential health benefits for Medicaid expansion enrollees, 
which include maternal health. Those guarantees that exist today would 
no longer be there. With the pressure on the States, it is unlikely 
that they would be able to maintain the same degree of coverage for our 
women. Women are more likely to be vulnerable and on Medicaid.
  It is an attack on our elderly. I have already talked about Medicare 
solvency, reducing Medicare solvency by 3 years, but there are more 
attacks than that. Over half--I think it is 60 to 65 percent of the 
cost of Medicaid goes to senior care, long-term care or to care for 
individuals with disabilities. Most families in America get their costs 
covered for long-term care through Medicaid. The States are not going 
to be able to maintain the same level of coverage with the loss of 
hundreds of billions of dollars of Federal funds. Our seniors and 
individuals with disabilities will be in jeopardy of losing a lot of 
their long-term care coverage.
  The legislation, TrumpCare, increases the loss ratios for older 
people from 3 to 1 to 5 to 1. That increases the cost dramatically for 
older Americans. That is one of the reasons the AARP opposes the 
legislation. Let me quote them:

       This bill would weaken Medicare's fiscal sustainability, 
     dramatically increase healthcare costs for Americans age 50 
     to 64, and put at risk the healthcare of millions of children 
     and adults with disabilities and poor seniors who depend on 
     the Medicaid program for long-term care services and support 
     and other benefits.

  That is AARP. I already talked about the Congressional Budget Office 
being a neutral observer. The AARP, of course, is interested in what 
impact it has on our elderly population. They very clearly say that 
they are being put at risk.
  Let me also talk about affordability. When you have a person who can 
no longer afford coverage--I already mentioned that person 64 years of 
age who would have to pay 55 percent of their income in order to get 
health coverage. That person can't afford coverage. Let's say that 
person is relatively healthy, so they go without insurance. Well, they 
need insurance. Maybe someone is young and decides not to get health 
coverage; they will get it when they need it. There is a 30-percent 
surtax if you don't keep insurance. That is going to keep people out of 
the health insurance marketplace who desperately need healthcare.
  Once again I am going to quote from the Sun paper. The Baltimore Sun 
really summed it up fairly well, particularly with their attack on the 
Congressional Budget Office. I think that is a very unfair attack. We 
all obviously take issue at times with the estimates of the 
Congressional Budget Office, but it is the objective scorekeeper. It 
has the most accurate assessments we get on legislation we consider 
here. That is why we created the Congressional Budget Office--to give 
us that advice.
  The Sun paper, in their editorial this morning, said:

       Small wonder that President Donald Trump and certain 
     Republican leaders were busy bad-mouthing the CBO even before 
     its report came out. The last thing they needed is the 
     nonpartisan number crunchers to offer an informed view 
     instead of the usual political caterwauling about the 
     ``failings'' of the Affordable Care Act. And this is 
     particularly rich: Republicans say the CBO blew ObamaCare 
     estimates years ago when it was circumstances well beyond the 
     CBO's control that caused analysts to incorrectly predict 
     ObamaCare enrollment. Should analysts have expected the 
     Supreme Court to deem the Medicaid expansion optional and 
     GOP-controlled States to refuse to accept it? Were they 
     mistaken to assume Congress could actually follow the law and 
     fund programs to stabilize state insurance exchanges?
       Might the CBO be off-target again? Absolutely. But it's at 
     least as likely that the office is low-balling the most 
     damaging effects of TrumpCare as it is potentially over-
     stating the harm. The Congressional Budget Office is as close 
     to an umpire as exists in Washington. It has certainly been a 
     lot more on target than the Trump administration, which has 
     consistently misled Americans on almost everything from the 
     definition of ``wiretapping'' to the claims of ``millions of 
     illegal voters'' casting ballots in the last election. Even 
     those overstated ObamaCare enrollment estimates were closer 
     to being on the nose than those produced by the CBO's fellow 
     forecasters at the Centers for Medicare and Medicaid Services 
     and RAND Corporation.
       Once again, Mr. Trump and his minions have been caught 
     making up facts. The President promised the ObamaCare 
     replacement would provide insurance for everyone and it would 
     be less expensive. Nobody can make that claim about 
     TrumpCare. As the CBO points out, premiums will rise 15-20 
     percent overall for the first two years, and more for older 
     Americans.

  The American public expects us to work together to improve our 
healthcare system. Instead of repealing and replacing the Affordable 
Care Act with this legislation that will put us in much worse shape, we 
should be looking at how we can build on the progress we have made 
under the Affordable Care Act.
  Yes, we can bring down costs. Let's bring down costs by taking on the 
cost of prescription drugs. We know that Americans overpay on 
prescription drugs. There is bipartisan support in the Senate to pass 
legislation using America's buying power to help our consumers pay less 
for prescription costs.

[[Page 4231]]

  Yes, we should have more competition with insurance carriers. Why not 
have a public option and see how well the private companies can compete 
with a public option?
  Yes, we can improve the way we deliver care and make it more cost-
effective. We, in a bipartisan manner, went down that path in the last 
Congress under the Comprehensive Recovery and Addiction Act and the 
21st Century Cures Act, where we looked at ways that we can collaborate 
on care for addiction services and mental health so people can get the 
care they need in the setting they need, whether it is an emergency 
room or a primary care physician's office.
  We have made progress making our healthcare system more cost-
effective and efficient. That is what we should be doing--building on 
the Affordable Care Act rather than taking away critically important 
benefits. The Republican plan moves us in the wrong direction, and it 
should be rejected.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Flake). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. McCAIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. Mr. President, I ask unanimous consent that I be allowed 
to speak as in morning business for as long as I want.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Arizona is recognized.

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