[Congressional Record (Bound Edition), Volume 163 (2017), Part 3]
[House]
[Pages 4448-4455]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       CONGRESSIONAL BLACK CAUCUS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the gentlewoman from the Virgin Islands (Ms. Plaskett) 
is recognized for 60 minutes as the designee of the minority leader.


                             General Leave

  Ms. PLASKETT. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and 
include any extraneous material on the subject of this Special Order 
hour.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from the Virgin Islands?
  There was no objection.
  Ms. PLASKETT. Mr. Speaker, for the next 60 minutes, it is with great 
honor that I rise to coanchor this CBC Special Order hour. For the next 
60 minutes, we have a chance to speak directly to the American people 
on the issues of great importance to the Congressional Black Caucus, to 
Congress, and to constituents who represent all Americans.
  At this time, Mr. Speaker, we would like to use this time to talk 
about the Affordable Care Act. What do you have to lose? What do you 
have to lose, Mr. Speaker? Such was President Trump's constant refrain 
to the African-American community when rallying for their support of 
his administration's various policies.
  Mr. Speaker, today, I rise to say that with critical elements of the 
American healthcare policy on the chopping block, African-Americans 
have a lot to lose, possibly even their lives.

                              {time}  1930

  There is as much at stake if President Trump and the Republican-
controlled Congress healthcare policies take shape in their current 
form.
  By illustration, I want to address the impact on low-income families 
and individuals in the Virgin Islands who rely on Medicaid, and, 
presently, Medicaid is capped in the Virgin Islands. You can look at 
our territory as an example of what will happen when there is a cap on 
services, which could compromise a State or local government's ability 
to administer those most in need.
  Since its inception, Medicaid has been an open-ended program that was 
intended to expand and contract with need, especially when States and 
localities face crippling economic downturns of both manmade and 
natural origins. Medicaid covers one in five Americans, and of those, 
the majority of enrollees are children and individuals with 
disabilities.
  Under the Affordable Care Act, widely known as ObamaCare, millions of 
African Americans finally gained access to healthcare coverage. In 
2015, approximately 11.2 million African Americans became eligible for 
Medicaid through the expansion, health care that they previously did 
not receive and which would have cost this country much more if that 
early-warning health care was not taken care of.
  President Trump and Republicans in Congress propose converting 
Medicaid from a shared payment program between States and Federal 
Government to an arrangement much like a block grant, where the Federal 
Government puts a cap on its payment assistance, creating a huge cost 
shift to the States. If you want to know what you have to lose if caps 
on Medicaid are enacted nationwide, look no further than my home, the 
Virgin Islands. It is a grim outlook.
  Federal caps on Medicaid programs in the Virgin Islands are set on a 
per-enrollee basis. Unlike States in the mainland where Federal 
Medicaid spending is open-ended depending on the needs of the people, 
the Virgin Islands can only access Federal dollars up to an annual 
ceiling. Beyond that cap, the Virgin Islands' government is responsible 
for the remaining costs. That means many Virgin Islanders who would 
qualify in other States and in other circumstances don't get the 
healthcare coverage that they need now.
  Under the proposed fiscal arrangement, spending caps don't take into 
account the cost of providing services or unpredictable changes in a 
community--such as the closure of a major

[[Page 4449]]

employer or a natural disasters--forcing a cost obligation for critical 
support services onto the already strained budgets of the territory.
  As a result, States and local governments, increasingly, would have 
to make tough choices to either reduce services for recipients of 
Medicaid or restrict eligibility and enrollment of additional people 
who may need it. Those are the choices that Virgin Islanders must make. 
So the most vulnerable of our constituents--in this case, children--who 
need the safety net that Medicaid, by definition, is supposed to 
provide have that final option cut out from under them.
  When it comes to Medicaid coverage, the Virgin Islands struggles to 
provide low-income families with Medicaid services for three major 
reasons:
  First, while the Affordable Care Act raised the territory's Federal 
Medicaid assistance percentage up to 83 percent for newly eligible 
enrollees, this increase in Federal match funding did not apply to 
those previously enrolled, which the Federal Government only matched at 
55 percent in the Virgin Islands, requiring that the remaining costs be 
covered by the Virgin Islands government, a government already strained 
to meet basic needs.
  The Virgin Islands and the smaller territories are not included in 
the Medicaid Disproportionate Share Hospital, DSH, program, which would 
shoulder the unanticipated costs our hospitals must take on to provide 
adequate care for individuals who use hospitals for basic services 
since they have no insurance.
  Three, With no Affordable Care Act exchange and no Federal subsidies 
to create our own health exchange, many Virgin Islanders were only able 
to obtain coverage through the Medicaid expansion if they met the 
already strenuous requirements. That means that 30 percent of Virgin 
Islanders presently have no health insurance.
  This is what the rest of the States are going to have if this 
American Health Care Act, as it stands, is passed. A cap on Medicaid is 
a cap on medical services that our constituents just can't do without; 
and in poor communities, it is going to be even more impactful.
  When ObamaCare provided increased funding to expand Medicaid, the 
island of Saint Croix was able to start a monthly homeless clinic at 
the Frederiksted Health Care Center about 15 months ago. That clinic 
has been able to serve many people, providing them with medical care, 
showers, meals, and transportation.
  On St. Thomas, with the East End health clinic, they were able to 
expand their services and increase dental services to people who were 
sorely in need of that. If this funding decreases or is lost 
altogether, it is highly unlikely that this initiative can be 
continued.
  Our current healthcare struggle is set to become a future hardship 
for mainland American States that provide Medicaid to a significant 
number of their population should the current proposals to cap Medicaid 
nationwide become law.
  How do we avoid this? Do not place a cap on Medicaid. Too many in the 
African-American community have everything to lose if healthcare policy 
goes in this direction.
  At this time, I yield to my colleague, the distinguished gentleman 
from Pennsylvania (Mr. Evans).
  Mr. EVANS. Mr. Speaker, I would like to thank the gentlewoman from 
the Virgin Islands, my good colleague and good friend. I thank her 
sincerely.
  Last summer when speaking to the African-American community at a 
rally in Philadelphia, President Trump asked the question: What do you 
have to lose? Yes, he asked that question: What do you have to lose?
  President Trump, what don't we have to lose? The programs the 
President wants to cut is the Community Development Block Grant, Meals 
on Wheels, and funding for Medicaid. There are programs that help 
combat poverty by providing the resources for better schools and food 
nutritional programs. These are the programs that help provide for the 
most vulnerable Americans who are fighting every day to try to get 
ahead.
  What do we have to lose? Look at what the Republicans are trying to 
do with the Affordable Care Act. They say they want to cut costs and 
cover more Americans, but their plan doesn't do that. It does the 
opposite.
  Take, for example, how they want to change the core structure of 
Medicare. They want to shift the Medicare from an open-ended 
entitlement program to one with a limited lens that does not take into 
account individual needs on a case-by-case basis.
  What do we have to lose? All of the investments we have made to try 
to stabilize our cities, the budget cuts will have a direct impact. 
Take, for example, Temple University Hospital in the heart of the 
Second Congressional District. Temple University Hospital stands to 
lose $45 million in funding. This translates into less jobs for our 
city and reduces the capacity of quality patient care. The President's 
proposal takes our city backwards. It unravels all of our hard work to 
make our communities more stable.
  What do we have to lose? Everything that builds a brighter future for 
our neighborhoods, block by block. It is time step up, speak up, and 
speak out to hold our President accountable.
  President Trump, we have a lot to lose. We are going to make sure you 
hear our message and our voice.
  Ms. PLASKETT. Thank you so much to my distinguished colleague from 
Philadelphia (Mr. Evans) and for the information you have shared with 
us.
  Mr. Speaker, I yield to the distinguished gentlewoman from Chicago, 
Congresswoman Robin Kelly, who is also the chair of the Congressional 
Black Caucus Health Braintrust, so she can expound upon this question: 
What do we have to lose?
  Ms. KELLY of Illinois. Thank you to my distinguished colleague from 
the Virgin Islands. It is an honor to be with you this evening, and 
thank you for your hard work and helping us to keep families healthy. 
Thank you also to CBC Chairman Richmond for organizing this important 
Special Order.
  Mr. Speaker, I rise today to speak out for more than 975,000 
residents of Illinois, including nearly 240,000 children that my 
Republican colleagues are plotting to strip of their health insurance.
  This bill, the so-called American Health Care Act, ends the guarantee 
of quality, affordable, and accessible health care. This bill puts 
politics before people. But it isn't the politics that matters.
  Mrs. Johnson affording her cancer treatment matters. A 5-year-old 
dying because her parents can't afford a transplant matters. Keeping 
our neighbors healthy no matter what street they live on or what their 
ZIP Code is will keep us all healthy.
  So I must ask: What are my Republican colleagues thinking?
  This bill was introduced at night, but the cover of darkness cannot 
hide the fact that this bill will kill tens of thousands of Americans 
every year. The dark of night cannot hide the reality that, because of 
this bad bill, more Americans will die of cancer, nor can it conceal 
the fact that millions of older Americans will be punished by the 
Republican's new ``age tax.''
  Conversely, the Affordable Care Act protects older Americans from 
insurance companies who want to use their age as a reason to charge 
thousands and thousands more. While this bill from my Republican 
colleagues was written to empower insurance executives, the Affordable 
Care Act protects everyone. It includes unprecedented healthcare access 
safeguards for America's elderly, people living with disabilities, 
children, and young adults.
  Meanwhile, the GOP's American Health Care Act reduces consumer 
protections. The American people will be left with more expensive 
healthcare coverage plans, and 24 million will lose their healthcare 
insurance completely, 14 million next year.
  A disproportionate number of those losing insurance will come from 
African-American, Latino, Asian-American, and Pacific Islander 
communities. They will be women and children or older Americans, 
especially those living on the edge.

[[Page 4450]]

  As chair of the Congressional Black Caucus Health Braintrust, I am 
working to close the gap in healthcare disparities that is plaguing 
these communities. This bill will make these disparities even worse.
  And for the record, the ACA more than halved the uninsured rate in 
the African-American community and halved the national uninsured rate.
  But the recent Congressional Budget Office report makes it clear that 
this will not continue in a positive way. In less than 10 years, 52 
million Americans will be uninsured under the GPO's plan. The majority 
of these will be our grandmothers, grandfathers, great-aunts, and 
great-uncles.
  Under the Speaker's plan, my State, Illinois, will have to cut 
Medicare eligibility. More than 53,000 constituents will lose their 
health care just because of this provision. The GOP also plans to 
defund Planned Parenthood, a decision that means 60,000 residents of 
Illinois will go without lifesaving cancer and STI screenings.
  The list of the not very good, very bad things from the Republican 
healthcare bill go on and on and on. It will make us sicker.
  It also raises the national debt, and it kills at least 1.2 million 
American jobs. And it stops us from reaching what should be our 
ultimate goal: the ability of every American to live a long, healthy 
life.
  Mr. Speaker, can we finally get serious and call this bill, your GOP 
healthcare bill, what it really is: the Trump don't care bill.
  Well, the Congressional Black Caucus cares. The House Democrats--and 
hopefully some House Republicans--care, and they will care enough to do 
the right thing and will oppose this bill.
  Ms. PLASKETT. Thank you so much, Congresswoman Kelly, for that 
information that you are sharing and for the work of the Congressional 
Black Caucus Health Braintrust and for the information that you are 
giving in the seminars and the groups, the different experiences that 
you have had throughout the country.
  I yield to the gentlewoman from Illinois (Ms. Kelly) so that she can 
tell us about some of the places that the Congressional Black Caucus 
Braintrust has had workshops or townhalls when sharing information with 
Americans.
  Ms. KELLY of Illinois. Besides the District of Columbia, we have been 
to South Carolina. We have been to a couple of places in Los Angeles as 
well as Oakland to deal with the issue of AIDS. Also, of course, in my 
town of Chicago, we have had healthcare seminars; and, actually, we 
have had big health fairs so we can make sure that people get back-to-
school checks, mental health checks, and AIDS checks. We gave food to 
people that might be in food deserts.
  So we really tried to be well-rounded and also tried to educate 
people. And going forward this week, we do plan to be on a call with 
ministers all across the United States so they know exactly what is 
going on and how they can help their constituents in this fight against 
this new healthcare bill.

                              {time}  1945

  Ms. PLASKETT. Mr. Speaker, I know the work that the gentlewoman from 
Illinois has done in health disparities that African Americans face. We 
disproportionately are struck with hypertension, high blood pressure, 
and diabetes, which are some of the things that we are concerned about. 
Lapse in coverage under the Affordable Care Act will affect African 
Americans in a large way because then those will become preexisting 
conditions, which are not covered under this healthcare plan.
  Mr. Speaker, I yield to the gentlewoman from Illinois (Ms. Kelly).
  Ms. KELLY of Illinois. Mr. Speaker, actually, of the top 10 diseases 
African Americans die from, African Americans die more from 8 out of 
the top 10.
  So this new bill is not going to send us in a better direction, and 
we don't want to keep those statistics. We want to do better, and we 
were doing better, especially around the area of cancer. We want to 
keep going in the positive direction, not the negative direction.
  So we don't want to see this bill passed, and we want to educate as 
many people as possible and encourage them to call their Congressperson 
and Senator.
  Ms. PLASKETT. Mr. Speaker, I thank the gentlewoman from Illinois for 
the information and for being with us.
  I also thank Chairman Richmond for providing this opportunity for the 
Congressional Black Caucus to speak before all of you and let you know.
  I yield to the gentleman from Texas (Mr. Veasey), my distinguished 
co-chair, who has some great information to share with us about what do 
we have to lose under the new Health Care Act that is being considered 
by the Republicans at this time.
  Mr. VEASEY. Mr. Speaker, I thank the gentlewoman from the Virgin 
Islands. And I always enjoy hearing from the gentlewoman from the 
Chicago area, and I appreciate everything that she is doing as well.
  It is interesting the President posed that question: What do you have 
to lose?
  What he was referencing to was the African-American community. 
Instead of offering anything of substance, he just put out that very 
simple question.
  I have got to tell you that it is pretty evident what we have to lose 
now. It is not only a lot of the gains that were made under the Obama 
Administration, but something that is near and dear to all of us, and 
that is health care.
  I think about the district that I represent, and 40,000 people or 
more have actually been covered because of the Affordable Care Act. 
They will probably lose that insurance if TrumpCare were to become law. 
And if you represent low-income families and workers out there, that is 
a scary prospect.
  It is already bad enough that the State of Texas made probably what 
is considered one of the biggest policy blunders in Texas State 
legislative history when they decided not to expand Medicaid, which 
left so many others statewide, including in the district I represent, 
again, off of the insurance rolls.
  What do you have to lose?
  God, there are so many ways and so many areas that I can sort of 
describe what you would have to lose. The first thing I think about is, 
in the Dallas/Fort Worth area, if you lose your insurance, of course, 
that means that the burden is going to fall back on John Peter Smith 
Hospital, which is one of our county hospitals in the north Texas area, 
and Parkland Hospital in Dallas.
  So instead of people having insurance that they pay into, that they 
have where they can go and see a doctor, they will end up back in the 
county hospital rolls and, of course, that will end up costing the 
taxpayers more money.
  During President Trump's first 50 days, the Republicans introduced 
this legislation that, again, will just decimate the progress that so 
many people around the country have seen under the Affordable Care Act.
  This Thursday, as we actually mark the seventh anniversary of the 
signing of the Affordable Care Act, the House is set to vote on the 
Republicans' healthcare replacement. Ironically, on a day that we 
should be celebrating the tremendous progress our country has made 
since this landmark law's passage, we will be defending the merits in 
our continued battle to fight its repeal.
  So what does the Black community have to lose?
  Again, we pose that question. The Congressional Budget Office--and 
there is a Republican appointee that runs that office, by the way--says 
that 24 million people are going to lose their healthcare insurance. Of 
those 24 million who are set to be kicked off of their healthcare plan 
and sent out to nowhere, African Americans are going to be hit the 
hardest.
  The ACA boosted the African-American insured rate from 79 percent to 
88 percent, just slightly below the 91 percent national figure. Some of 
those gains stem from Medicaid expansion under the ACA, where nearly 15 
million of the nearly 40 million African Americans gained coverage.
  That is what I was talking about a little bit earlier, Representative 
Plaskett. In Texas, we did not get to benefit from that. That would 
have been a huge benefit to us. Again, it is

[[Page 4451]]

really considered one of the biggest policy blunders in the country.
  As you see, Republican governors are actually afraid right now that 
the Medicaid expansion that has benefited their States that they are 
going to lose out on that because of this repeal that is going to take 
place. They are pushing back. They are saying this whole TrumpCare and 
RyanCare plan is a hot mess and that they absolutely want nothing to do 
with it.
  It is also important to remember, under the Republican plan, the 
decision to cut $880 billion from Medicaid over the next 10 years will 
translate into millions of African Americans potentially losing health 
care. While these numbers are alarming, it is the human impact that 
cannot be lost on GOP colleagues.
  I have heard directly from constituents that I serve how the ACA has 
improved or saved their lives, and I would like to actually share some 
of those stories with you today.
  One of the constituents that I serve worked for the same company for 
35 years but was forced to retire because of declining health before he 
was eligible for Medicare. He faces drug costs of over $500 per day and 
requires a lifesaving procedure four times a year that costs $14,000 
per treatment. You can imagine what $14,000 per treatment would do, and 
that is four times a year. Overall, his medical costs per month is 
$15,000.
  With the implementation of the Affordable Care Act, he had access to 
quality care that helped ease his financial burden. Under the 
Republican plan, this hardworking man, this taxpayer, this person that 
has worked hard, that worked for one company for 35 years--that used to 
mean so much in this country when people would give 35 years to one 
company and expected to be treated right--under the Republican plan, 
this hardworking man would pay thousands of dollars in out-of-pocket 
medical expenses for lifesaving care that would not be covered by this 
disastrous plan that we are actually going to have to take a vote on on 
Thursday.
  It is stories like that that I think are really sad and why we need 
to tap the brakes and see what we can do to help make the current 
healthcare plan that we have, the ACA, stronger and better, to help out 
people like this gentleman who are going to be left out in the cold.
  You have to really be wondering what our Republican colleagues are 
thinking, because it is not just the constituents that I represent. It 
is many of the constituents that they represent, too. I can tell you 
that out in the Dallas/Fort Worth metroplex, while I do represent 
largely urban areas--Dallas, Fort Worth, Irving, Grand Prairie, 
Arlington--I know that there are a lot of people that live out in these 
rural areas, that live outside of Dallas and Fort Worth, that live 
outside of Dallas County and Tarrant County. They consider themselves 
conservatives, and I can tell you that they cannot afford $14,000 per 
treatment; but if the Republicans pass their plan, that is what they 
are going to be left with and they are not going to be able to afford 
it. They are not going to get the care that they need, and that is what 
they need to understand tonight and that is what the Republicans need 
to understand tonight.
  The only thing that they can guarantee individuals, like I just 
talked about, is that they are going to be paying a whole lot more for 
a lot less coverage. I think that is really a shame.
  Another constituent was forced to pay $100 per month for medically 
necessary birth control pills after her husband lost his job in 2010. 
Luckily, the Affordable Care Act provided access to health care, and 
now her birth control that she needs is covered in full. And that is 
important, too.
  We have actually seen teen pregnancy rates in this country drop all 
over the country, which is good. Because when people can afford to 
start a family when they are ready, when they are financially ready to 
start a family, those kids are more likely to do better in school. They 
are more likely to be in a stable household. They are more likely to 
get the education that they need to be able to achieve the things they 
want to achieve when they leave the house. So there are a lot of these 
initiatives around the country where we have really seen teen pregnancy 
rates drop 20, 30 percent or more. It has been great.
  I can tell you that in Dallas County, while the teen pregnancy rate 
is dropping all over the country, we have actually seen it rise at an 
alarming rate.
  So what does that tell me?
  That tells me that if you see the teen pregnancy rate going up and 
that you are going to kick all these people off their health care, that 
is going to be more of a strain on the social service system.
  Republicans used to pretend like they were for people to have an 
opportunity to get off the system. But once you take people's birth 
control away and not give them the options that they need for family 
planning, you are increasing the social services. The Republican CBO 
report actually points that out, and they are still going ahead with 
this. So I think that that is really what is sad.
  I think overall what we want to get at tonight is that the Affordable 
Care Act has been a lifeline for African Americans and African-American 
families. The full repeal will snatch the safety net out from under the 
Black community.
  Despite the lies that our colleagues across the aisle and in the 
White House want to spread about the ACA, my colleagues and I will 
continue to defend it to the very end because it turns out that the 
Black community has a lot to lose under the Republican healthcare plan.
  I am so glad that so many of our colleagues came out tonight. I am 
glad that you are here helping lead this hour because we need to get 
the word out. We can stop something really devastating from happening 
here. The thing about it is that we really need to try to stop 
something devastating from happening on a bipartisan basis, such as 
people losing their health care, getting left out in the cold, being 
kicked off of their health insurance; trying to figure out, if they 
have a preexisting condition, how they are going to afford being pushed 
back into a high-risk pool.
  What is this going to do to so many Americans? We are here focusing 
on the African-American community tonight with the Congressional Black 
Caucus, but what is this going to do to all Americans?
  It is going to hurt them. It is going to hurt their bottom line. It 
is going to hurt their families. It is going to leave them in financial 
disrepair. I think it is going to be a sad day for our country.
  Instead of trying to destroy something, we need to be trying to work 
together to try to strengthen the current system and make sure that all 
Americans have the opportunity to be covered.
  Ms. PLASKETT. Mr. Speaker, I agree very much with everything that the 
gentleman from Texas (Mr. Veasey) has said. I thank him for the stories 
of individuals because it is individuals that the Affordable Care Act 
was meant to cover, not groups of people, but everyday Americans, 
children, disabled, our elderly.
  Some of the reports say that TrumpCare would be the largest transfer 
of wealth from working families to the rich in our Nation's history; 
that the Republicans are handing $600 billion in tax breaks to rich and 
big corporations through this bill while taking money away from those 
Americans who have been able to have their healthcare needs taken care 
of in an affordable manner.
  You have families that are going to be paying more for less under 
TrumpCare. Deductibles and out-of-pocket costs are going to skyrocket, 
leaving sick people unable to afford the care that they need. Premiums 
will soar and quality coverage is going to be priced out of reach for 
many families.
  We also heard earlier about the middle-aged American paying an age 
tax that is going to come from this, that older Americans are going to 
be forced to pay premiums five times higher than what others pay for 
healthcare coverage.

[[Page 4452]]

  I yield to the gentlewoman from Florida (Mrs. Demings), the 
distinguished freshman Congresswoman from the 10th District of Florida, 
so she can explain to us how TrumpCare and the new Health Care Act is 
going to affect her constituents and all Americans and, particularly, 
African Americans in this country.
  Mrs. DEMINGS. Mr. Speaker, I thank the gentlewoman from the Virgin 
Islands (Ms. Plaskett), Mr. Richmond, and all of the distinguished 
members of the Congressional Black Caucus for leading this very 
important and critical conversation and discussion this evening.
  President Trump said it couldn't get any worse for the African-
American community. He asked the question: What did we have to lose by 
supporting him?

                              {time}  2000

  Well, it is even clearer now that we have everything to lose, 
starting with health care.
  Marian Wright Edelman said: ``The question is not whether we can 
afford to invest in every child, but it is whether we can afford not 
to.''
  Health care, we all know, is one of the most important investments we 
can make in our children. Nearly 12 million African Americans are 
insured through Medicaid. In Florida, 41 percent of children, in my 
home State of Florida are covered through Medicaid.
  This GOP healthcare plan guts Medicaid, cutting funding by $880 
billion over the next 10 years. It also eliminates Medicaid expansion, 
which covers 1.5 million African Americans.
  So what do we have to lose?
  Families, children, will lose their health care. For those who do not 
lose health care, they will be forced to pay higher premiums. That, for 
some families, could mean the difference between a doctor's visit and 
food on the table.
  Since the ACA was signed into law 7 years ago this Thursday, our 
community has seen its insured rate increase to the highest number in 
recent history. For a community that has long faced increased barriers 
to healthcare access and delayed doctor visits because of the cost, the 
ACA has meant the difference between life and death.
  There is no question, we can make the Affordable Care Act more 
affordable for all Americans, but this bill doesn't do that.
  So what do we have to lose?
  President Trump, and to my GOP colleagues, I tell you the stakes 
could not be higher. Progress will be lost--progress that took many 
years to make, progress could be lost--by repealing the ACA.
  The most vulnerable of people, the people we really should be taking 
care of in a country that we say is the greatest country in the world--
I do believe that to be true--people that we should be taking care of, 
including our children, will be hurt the hardest.
  Florida has the Nation's highest enrollment number in the ACA, at 
1.67 million sign-ups for 2017. But not only does repeal hurt children, 
but, in my home State of Florida, it also hurts millions of seniors.
  A recent analysis from AARP shows that Florida will be ``Ground 
Zero'' for the Republicans' health plan's effects. They found that 
nearly a half a million Floridians between the ages of 50 and 64 would 
face higher premiums under the GOP plan, more than any other State; the 
people affected the most, low-income seniors.
  So here is what is at risk in Florida's 10th Congressional District. 
The district's uninsured rate has gone from 22 percent to 15 percent 
since the ACA was implemented. 343,000 individuals in the district who 
now have health insurance that covers preventative services like cancer 
screenings and flu shots, without any copays, coinsurance or 
deductibles, stand to lose this access if the Republican Congress 
eliminates the ACA provisions requiring health insurance to cover 
important preventative services without cost-sharing.
  392,000 individuals in the district with employer-sponsored health 
insurance are at risk of losing important consumer protections. 64,000 
individuals in the district who have purchased high-quality marketplace 
coverage now stand to lose their coverage if the Republican Congress 
dismantles the marketplaces.
  Over 60,000 individuals in the district who received financial 
assistance to purchase marketplace coverage in 2016 are now at risk of 
coverage becoming unaffordable if the Republican Congress eliminates 
the premium tax credits.
  So what do we have to lose?
  The evidence could not be clearer.
  Ms. PLASKETT. Congresswoman Demings, in fact, you do have a lot to 
lose. We see how Florida, with its elders, its senior citizens, will 
really take a major hit if this law is passed. And our colleagues have 
been giving us examples all the time.
  I am always trying to let them know that the Virgin Islands stands as 
an example of what it will look like if the Affordable Care Act is 
repealed because the Virgin Islands doesn't have the expansion. We were 
not put in the mandate for the exchange, and that has led to 30 percent 
of Virgin Islanders having absolutely no health insurance, which then 
means that our hospitals are strained because the hospitals have to 
pick up costs for individuals who are without health care.
  Listen, if your child is ill or sick, or you are dying, you are going 
to go to the hospital whether you can take care of it or not, whether 
you can pay the bill or not; and that has put a tremendous burden on 
our hospitals for them to meet the costs of those 30 percent of 
individuals living in the Virgin Islands who do not have health 
insurance, are not covered by either the government group insurance for 
the local government or by the Medicaid money that we utilized because 
we did not have the expansion.
  And even that is scheduled to leave after the fiscal year 2019, and 
we are going to have to make choices of removing people from Medicaid, 
of removing care from children, removing care from elderly and from 
individuals with disabilities. That is not a choice that Americans 
should have to make in this day and age, that individuals do not 
receive health care.
  I know, Congressman Veasey, that you are hearing from people in your 
own district who are giving you these same stories: What is going to 
happen if I don't have healthcare coverage? What is going to happen to 
my children if they are not able--they have asthma, they have juvenile 
diabetes, they have these issues, and I am not going to be able to take 
care of them because I am not going to have this insurance. Or the 
Medicaid is going to have to be pulled back in our State because we are 
going to have it capped; and our State is not a wealthy State and is 
not going to be able to make up the difference.
  I know that the gentleman has examples from other Members who have 
come and given statements for us to bring to the Record about what is 
going to happen.
  Mr. Speaker, I yield to the gentleman from Texas.
  Mr. VEASEY. Absolutely, Representative Plaskett. And one of our 
colleagues, who also happens to be my neighbor, Eddie Bernice Johnson, 
you can easily make the argument that she knows something about health 
care, considering that she worked in the healthcare arena before she 
came to Congress. And not only did she work in the healthcare arena, 
she has a lot of people that were uninsured that live in her district 
that are now insured because of the Affordable Care Act.
  So, again, not only does she have that healthcare experience, she has 
been out in the community and has met with people for many years now on 
health care, even before she came to the Congress, when she was in the 
State Senate; so she has sat down and she has talked to people. She 
understands why it is important for people to have health care. She 
understands why it can be financially hard on people when they are hit 
by a catastrophic illness.
  She gave a speech on the House floor--or she has a speech that she is 
going to submit--where she talks about the fact that the district that 
she represents, the uninsured rate dropped 27.3, all the way down to 
20.8 percent; and that was a huge benefit for the constituents that she 
serves on a daily basis.

[[Page 4453]]

  I mentioned Parkland Hospital a little bit earlier. Parkland Hospital 
is a Dallas County public hospital. Parkland Hospital provided $1 
billion in uncompensated care in 2015--$1 billion. And if this 
RyanCare-TrumpCare bill were to become law, you can imagine what a 
large system like Parkland, that already provides so much in 
uncompensated care, what they are going to be hit with. It is going to 
be absolutely devastating.
  I already talked about the fact also that Texas--and Representative 
Johnson mentions Medicaid in her letter. I have already talked about 
the fact that Texas made a big public policy blunder and decided not to 
take the money that the Federal Government was going to give them to 
help expand Medicaid coverage. They just prefer to just leave all those 
people uninsured.
  So now one of the things that will happen under this GOP bill that 
the Congresswoman points out is that the money will be sent to people 
in a block grant; and you can imagine the shortfalls that that would 
create, particularly in a large State like Texas, because there are 
going to be shortcomings. So hospital systems like Parkland, like John 
Peter Smith, they are really going to be hit with a hammer were this 
ever to pass and become law just because they are already being pushed 
so much.
  Again, what just doesn't make any sense is that the Republicans so 
prided themselves for so many years about being the party that was 
about self-empowerment and helping people out, so now they want to kick 
people off of their insurance and leave them out in the cold and have 
them start going back to Parkland, start going back to John Peter Smith 
because they are not going to be able to afford their insurance anymore 
under this. It doesn't make any sense.
  Ms. PLASKETT. From our experience in the Virgin Islands, that is what 
you do not want to happen.
  People talk about: Who is on Medicaid? Who are these types of 
individuals? Why don't they get jobs?
  I mean, in the Virgin Islands, when we had our largest employer, 
Hovensa, an oil refinery, close, of course, then our unemployment rate 
went up. And these are families in need, families who need the support.
  With a cap on Medicaid, we were only able to have 55 percent of 
individuals who would qualify for Medicaid with that cap, with that 
ceiling that was in place from the Federal Government. It means that a 
tremendous amount of children, homeless individuals, people, families 
that are out of work for a period of time, are not covered. That, then, 
creates this huge burden on a hospital for those families to be taken 
care of, for individual care and individual need.
  Particularly in the African-American community, when you have things 
like diabetes, hypertension, all of these diseases which need constant 
monitoring and primary care physicians to take care of and to ensure 
that they do not become life-threatening, and come to a place where 
then they are coming to the hospital, it is in the millions of dollars 
that you are going to need support and care for the servicing of 
individuals with these diseases.
  So I know that we are pushing that there be an expansion of Medicaid, 
that the cap not be put on Medicaid services, not because we want to 
coddle people who are poor, but because we know it is necessary. And 
the cost of not taking care of them on the front end of health care, 
with Medicaid, is an astronomical cost on the back end when they have 
diseases that have just gone out of control because they have not been 
able to go to primary care physicians and get the health care that they 
need.
  Mr. Speaker, I yield to the gentleman from Texas.
  Mr. VEASEY. All of those are absolutely good points, and I was 
talking about the uncompensated costs there for public hospitals. The 
one thing that I did not mention--and everybody knows this--is that if 
you don't have insurance and you do find yourself having to depend on 
the county hospital system or the public hospital system in your area, 
and those lines get longer and longer, which is what would happen if 
this bill were repealed--people have to remember that if someone is 
having an emergency and they know that the lines at the county hospital 
are just out of control and long, they are going to go to the private 
hospital.

                              {time}  2015

  They are going to go to the nonprofit hospital like in Dallas County 
that could be Baylor, that could be Huguley, and those hospitals are 
going to take on uncompensated costs. That is what is going to end up 
happening. They can't get a regular appointment there without 
insurance, but if they go to the hospital emergency room, they can't be 
turned away. Not only is it going to be a burden on our county hospital 
system, it is going to be a burden on our nonpublic providers as well.
  Again, one thing to remember is that, before the Affordable Care Act, 
we had over 1 million people in Dallas-Fort Worth that did not have 
insurance. Just in the congressional district, alone, that I represent, 
I have the largest uninsured rate out of any congressional district in 
the entire country. That surprises a lot of people just because of the 
growth and the opportunities that the Dallas-Fort Worth area have been 
blessed with. But I actually have the largest uninsured rate out of any 
congressional Member in the country.
  So when you think about the district that I represent and then you 
expand that across the Dallas-Fort Worth metroplex, you are talking 
about 1 million people in a very prosperous area that still find 
themselves without insurance. That is scary.
  I mentioned a little bit earlier the district I represent, the 
uninsured rate has gone from 37.9 percent to 31.4 percent since ACA was 
implemented; 2,003 individuals in the district now have health 
insurance that covers preventive services like cancer screenings and 
flu shots.
  When you start talking about kidney dialysis, for instance, I visited 
a kidney dialysis center in Dallas County shortly after I was first 
sworn in. I was taking a tour of the kidney dialysis center, and I 
asked the doctor who was in charge of the center, I said: Wow, there 
are a lot of younger people in here.
  About 60 percent of the patients were African American. About 40 
percent were Hispanic. There was one White patient that was in there.
  The lady said: It doesn't matter where you go. If you go to visit any 
of our clinics or any of our kidney dialysis centers, this is what a 
typical day looks like.
  I asked her: Is it hereditary? What is going on? I don't understand 
what the problem is here.
  She said: No. A lot of it is because they weren't receiving the care 
that they needed.
  The sad part about that, she went on to explain to me, is sometimes 
it can be a person who has high blood pressure issues, and if they had 
just gotten those high blood pressure issues addressed, it could have 
been the difference between them taking some high blood pressure 
medicine instead of them basically having to give up their careers and 
go and sit in a chair to receive dialysis treatment 3, 4 days a week, 2 
to 3 hours each time. That is sad.
  She also talked about diabetes and how some people have diabetes, and 
they don't get that diabetes treated in time. Maybe they didn't even 
know they had diabetes. Again, type 2 diabetes is something very 
treatable. You can imagine the difference between treating somebody, 
giving them a prescription to treat their type 2 diabetes or their high 
blood pressure versus your earning capacity being greatly diminished by 
you having to go sit in a chair 2, 3, or more times 3 or 4 days a week 
versus if they had just been able to go see a primary care physician.
  That is the type of thing that the Affordable Care Act is doing, 
giving people the opportunity to go and get those things treated before 
they become more costly to the system. That is something that is being 
missed.
  The other thing that I think scares everybody--and it doesn't matter 
if you, again, live in my district or you live in the one of many 
districts in the Dallas-Fort Worth metroplex, when

[[Page 4454]]

you start talking about people who have preexisting conditions and you 
start talking about the fact that people are going to lose consumer 
protections that have been put in place under the Affordable Care Act 
and that they are going to see those consumer protections killed--like 
the prohibition on annual and lifetime limits, protection against 
unfair policy rescissions and coverage of preexisting conditions--
again, if you see the ACA repealed, it is people like that who, for the 
first time, didn't have to worry about those limits, and they are going 
to see that snatched away from them. That is just really one of the 
tragedies.
  Mr. Speaker, 27,000 people in the district that I represent, again, 
received financial assistance to purchase marketplace coverage in 2016. 
Now they are going to risk being uninsured again, and the insurance is 
going to be unaffordable under the Republican plan. There are just so 
many stories like that.
  One of the things that I didn't point out about some of the people 
that are going to lose some of these consumer protections is that some 
of those people have worked really hard on their jobs, they are still 
working on their jobs, and they are going to be hit with those lifetime 
limits. It is going to be completely unfair to them while they are out 
there working hard every day. It was something they didn't have to 
worry about before, or at least when the ACA was put in place. If the 
ACA is repealed, they are going to be subject to that, too.
  I think the narrative that has been put out there by the Republicans 
is that, no, it is just people that are taking advantage of the system. 
But understand, there are people that fall into these categories that 
we are talking about right now that get up and they go and work hard 
every day--every single day--and they have health insurance on their 
jobs, and they are going to be greatly impacted by this.
  Speaking of people who go and work hard on their job every day, one 
of the things that I know that a lot of Democrats would like to see put 
in place--and even some Republicans have said they would like to see 
put in place--is they want to see the Cadillac tax repealed. That is 
not happening under this Republican plan. That is completely out of it.
  So, again, there are a lot of problems with this and a lot of 
unfairness about this, about the people that are going to be harmed and 
affected. I hope that we can work in a bipartisan manner to really stop 
this from happening. And again, like we are here talking about tonight, 
the African-American community, in particular, will really be hit very, 
very hard.
  Ms. PLASKETT. I thank the gentleman for all of the examples that he 
has given, real-world, real-people examples. I think it is important 
that all of us, as Members of Congress, really take to heart the words 
that we are hearing from Americans that are going to be affected by 
this.
  Particularly in the African-American community, this is going to have 
a devastating affect on them to have this Affordable Care Act be 
repealed and this replacement. It does not take into account the lives 
that people are really living.
  This is really a tax break bill. That is what this boils down to in 
many respects, because the individuals who are going to be displaced 
from this are those individuals who are the poor.
  I just want to thank Congressman Veasey for the time that he has 
given us this evening and all of our colleagues who are here and spoke 
about the Affordable Care Act and what the African-American community 
and what many Americans have to lose from this bill.
  At this time, I conclude this CBC Special Order hour.
  Mr. Speaker, I yield back the balance of my time.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise in opposition 
to the American Health Care Act. As a member of the Congressional Black 
Caucus, I would like to answer President Trump's repeated question to 
the black community; ``what do we have to lose?'' Our healthcare, Mr. 
President. The Affordable Care Act has been working.
  The Affordable Care Act brought my district's uninsured rate from 
27.3 percent down to 20.8 percent, and insured 265,600 individuals who 
didn't have health insurance before. While the main safety net provider 
in my district, Parkland Hospital, provided $1 billion in uncompensated 
care in 2015, Parkland and the other safety net providers faces severe 
financial burdens in the House GOP proposal. One of my main concerns 
with this bill is that it punishes people who get their coverage 
through Medicaid by capping and slashing the program. With 70 million 
Americans and 5.2 million Texans who currently rely on Medicaid, per 
capita caps on the program would not meet the needs of the population 
and people would suffer.
  Under the Republican proposal, millions of Americans will lose their 
coverage and families will pay more for fewer protections. To put this 
into exact numbers, according to a Congressional Budget Office report, 
24 million people would lose coverage by 2026, and 7 million people 
would lose employer-based coverage. This bill includes an $880 billion 
cut to Medicaid, then cuts and caps the program so that it cannot 
expand and contract as needed. Medicaid covers 1 in 5 Americans and in 
2015, Medicaid covered 11.2 million African Americans. This is a 25 
percent cut to the program and it is harmful and unsustainable.
  This piece of legislation forces Americans to pay more and get less. 
The average subsidy under the American Health Care Act will likely be 
about 60 percent of the average subsidy under current law. Deductibles 
and out-of-pocket spending in the individual market will have to 
increase due to the elimination of requirements that insurance plans 
cover a certain value. Americans will pay more for their premiums, more 
for their care, more on out-of-pocket expenses and deductibles; all the 
while giving tax breaks to the wealthy and the tanning industry.
  I urge my colleagues to consider the harmful effects of this bill. 
Your constituents are asking you to work with Democrats to repair the 
Affordable Care Act. We are ready to work.
  Ms. LEE. Mr. Speaker, first let me thank Congressman Veasey for his 
tireless work to protect healthcare for all people.
  Also to Congresswoman Plaskett, I thank the gentlewoman for 
continuing to speak out, to organize us, and for her stellar 
representation of her district.
  Let me also thank Congressman Richmond, Chair of the CBC, for his 
steadfast leadership on so many issues.
  Mr. Speaker, 2 weeks ago Republicans unveiled their dangerous plan to 
repeal the Affordable Care Act.
  A plan the CBO confirmed would rip healthcare away from 24 million 
Americans.
  This week--on the 7th anniversary of the Affordable Care Act--their 
terrible plan will make it to the House Floor.
  Mr. Speaker, one thing is clear: the proposal Republicans wrote in 
secret backrooms would be a disaster for struggling families, seniors, 
and people with disabilities.
  Their proposal would mean 24 million fewer people with health 
insurance and 2 million jobs lost.
  Their plan defunds Planned Parenthood and rations healthcare for low-
income Americans.
  It would make working people sicker, in order to provide a $600 
billion tax giveaway for billionaires.
  We know who this plan will devastate the most: communities of color, 
especially African Americans.
  By ending Medicaid as we know it, at least 1.5 million low-income 
African Americans could lose their coverage.
  And millions more would lose access to high-quality healthcare with 
the elimination of the ACA's marketplace.
  Mr. Speaker, this is outrageous.
  We know that African Americans already suffer from shocking health 
disparities, including diabetes, heart disease, and cancer.
  And sadly, these disparities are all too often fatal.
  Mr. Speaker, when we wrote the ACA, we worked hard to ensure that our 
healthcare bill would help end these disparities.
  I was Chair of the CBC at the time and addressing harmful health 
disparities--especially for African Americans--was at the top of our 
priorities in drafting the ACA.
  The final legislation was a huge step forward for underserved 
families--particularly communities of color.
  Through the exchanges and Medicaid expansion, millions of African 
Americans gained the insurance that they needed and they deserved, 
including those living with pre-existing conditions.
  Take the issue of HIV/AIDS for example. Although they represent only 
12% of the population, African Americans disproportionately account for 
44% of new HIV cases and 40% of those living with HIV in the U.S.

[[Page 4455]]

  Before the ACA, many African Americans living with HIV didn't have 
any insurance at all.
  Through the exchanges and Medicaid expansion, millions of African 
Americans gained the insurance that they needed and they deserved.
  Let me be clear: For people living with HIV in this country--
repealing the ACA could mean a death sentence.
  Without the Affordable Care Act, people living with HIV are at risk 
of losing access to the medicine and doctors that keep them healthy.
  Clearly, health insurance is critical to keeping people healthy and 
reducing health disparities.
  Mr. Speaker, we know that the ACA works.
  It has provided healthcare for over 20 million Americans--7.8 million 
of whom are African American--since it was signed into law.
  And because of this bill, young people, working class people, and 
people of color now have high-quality, affordable healthcare.
  But Republicans don't seem to care.
  They are on a rampage to make America sick again--and we must stand 
in their way.
  Mr. Speaker, millions of Americans are making their voices heard in 
protests, in town halls and in the streets.
  And their message is simple: ``Keep your hands off of our 
healthcare.''
  I'm standing with the millions of Americans who are in opposition to 
this disastrous healthcare bill.
  The fight to protect affordable healthcare is on.
  We will not rest until Republicans and Trump end their cruel campaign 
to kick American families off their healthcare.

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