S3768 CONGRESSIONAL RECORD — SENATE June 26, 2017 ORDERS FOR TUESDAY, JUNE 27, and receive less as a result. A 64-year- The people I have heard from have 2017 old making almost $57,000 will go from prescriptions to fill, appointments to Mr. TILLIS. Mr. President, I ask paying $6,800 under the Affordable Care make, lives to live, but they have come unanimous consent that when the Sen- Act to $20,500 under the proposal before to these hearings on very short notice ate completes its business today, it ad- this body. This jump in cost is abso- in Hartford and in New Haven, literally journ until 2 p.m., Tuesday, June 27; lutely staggering. filling rooms so that there was stand- further, that following the prayer and It will destroy the financial well- ing room only. pledge, the morning hour be deemed being of middle-class Americans who I challenge my colleagues to hold the expired, the Journal of proceedings be also, when they need nursing home same kinds of hearings, to delay this approved to date, and the time for the care, after they have exhausted their vote so that they can go home at the two leaders be reserved for their use savings, will be thrown to the wolves. I end of this week and hold hearings in later in the day; finally, that following visited one such facility just last Fri- their State and listen to their constitu- leader remarks, the Senate be in a pe- day, where two-thirds of its 60 beds will ents about what they have to say and riod of morning business for debate be unaffordable when those middle- what the consequences will be. Nearly 1 in 10 veterans has Medicaid only, with Senators permitted to speak class families find their savings will no coverage, meaning that a staggering therein. longer cover it. These facts are the reason for the Re- 1.75 million veterans, including 18,000 The PRESIDING OFFICER. Without publican chaos. One of our former col- veterans in Connecticut, would be im- objection, it is so ordered. leagues, my mentor, Senator Daniel pacted by these reckless cuts. Let me f Patrick Moynihan, famously said: ‘‘Ev- repeat that number for all of us who re- ORDER FOR ADJOURNMENT erybody is entitled to his own opinion, joiced in the recent Accountability and but not to his own facts.’’ The adminis- Whistleblowers Act. Some 1.75 million Mr. TILLIS. Mr. President, if there is tration’s statement that the CBO is not veterans—18,000 of them in Con- no further business to come before the to be blindly trusted—nobody has to necticut—will be harmed by this reck- Senate, I ask unanimous consent that trust the CBO blindly. Those facts are less and needless insult and injury. it stand adjourned under the previous driven by reality. Their report speaks Put simply, this bill would make it order, following the remarks of our truth to power and to the American hard for veterans with mental health Democratic colleagues. people, and the American people get it. disorders like post-traumatic stress The PRESIDING OFFICER. Without None of us can look our constituents disorder to get care. Nearly a quarter objection, it is so ordered. in the eye, look ourselves in the mir- of all veterans receive care for mental The Senator from Connecticut. ror, look inside ourselves, in our health disorders outside the VA sys- f hearts, and justify a vote for this bill. tem, meaning they rely on protections The American people are angry, many that guarantee their access to afford- HEALTHCARE LEGISLATION of them because we are even consid- able care. Under this proposal, those Mr. BLUMENTHAL. Mr. President, I ering it. It is not an anger that is kind protections would be severely threat- am proud to be on the floor today, of a shrug of the shoulders; it is a deep, ened, and the veterans who need that proud to stand with my colleagues, and vocal, vehement, vitriolic anger. I have care would see that care at risk. I hope that at the end of this week, I seen it and heard it at those hearings, Here we are talking about a choice will be proud of all of my colleagues where I listened to people coming for- program that enables veterans to seek when we vote to defeat this measure, ward and talking about this bill, recog- care outside the VA system, privately, or at least to delay it, because we owe nizing it for what it is. It is not a and we are endangering care for mil- the American people the right to be healthcare bill; it is a massive tax cut lions of Americans—veterans—who heard. for the wealthy. need and seek it by using Medicaid. Our responsibility as elected rep- Just Friday afternoon, one of the If my colleagues listen to their con- resentatives is at the very least to lis- folks who attended the hearing came to stituents, they will hear from many of ten. I have been listening over the last the microphone and said: Don’t call it the people who have come to my town- week but really over the last year to a healthcare bill; it is a wealth care halls, like Christine Girassi. Christine constituents of mine in the State of bill. In fact, she is absolutely right. has two beautiful 4-year-old twins Connecticut and over the last week at This bill cuts hundreds of millions of named McKenzie and Cameron. two emergency field hearings that I dollars in taxes for the richest so that McKenzie was born with Prader-Willi conducted because no hearings were they will do better, but it also cuts $800 syndrome, a rare genetic disorder that held by the Senate and no markups and billion in Medicaid spending and in- her mom described as ‘‘including low no votes in committee. What we saw vestment to provide for that kind of muscle tone, seizures, temperature in- here in Washington was complete se- tax cut. It is not a healthcare bill; it is stability, sleep apnea, infertility, OCD, crecy, a bill produced behind closed a wealth care bill. And for most Ameri- intellectual disabilities, and develop- doors, only seeing the light of day for cans, it is a catastrophic, cruel, and mental delay.’’ the first time last Thursday. costly insult to their intelligence, their In the first few weeks of her life, Our Republican colleagues have gone health, and our American values. It is McKenzie was in the hospital for 57 from total secrecy to total chaos. The a sham and a charade, making possible days, accounting for $2 million in reason for the chaos is the facts that those cuts for the rich—tax cuts for costs. Their family was spending $30,000 were most dramatically revealed them—at the expense of our most vul- a year to help their daughter thrive. So today—just hours ago—when the Con- nerable citizens. And it has been the when Christine learned that her daugh- gressional Budget Office told us, not result of a profoundly undemocratic ter had received a waiver to become a surprisingly, that 22 million Americans process—secrecy and speed. Medicaid beneficiary, she was over- would be thrown to the wolves as a re- Despite the best efforts of our Repub- joyed. sult of this measure—thrown to the lican colleagues to keep Americans in Christine told me: wolves of no healthcare coverage—and the dark about what this proposal When we received McKenzie’s diagnosis, we eventually 49 million Americans would would do, I have seen growing aware- were told that she wouldn’t do a lot of be without healthcare insurance by ness, again, not only at these hearings things, and at only 4 years old she’s already 2026. but as I walk through the airport, as I defying the odds. I have no doubt in my mind that if we are able to continue down our cur- Next year alone, 15 million more peo- march in parades—twice over this rent path of the proper therapies and doc- ple will be uninsured under the Repub- weekend—as I attend public gath- tors, McKenzie will be able to have her fruit- lican plan, TrumpCare 2.0. Low-income erings. Whether it is Boys State, spon- ful life. I am terrified if the rug comes out Americans would be unable to afford sored by the American Legion for 16- beneath her that she will become just an- any plan at all, and anybody who does and 17-year-olds, or nursing facilities other statistic. would be paying higher costs for fewer for elderly citizens, there is a growing Another statistic? There are enough services of lesser quality. Americans awareness that this bill is bad—pro- statistics in that CBO report. We will will pay a higher share of their income foundly bad—for the American people. hear a plethora of statistics on the

VerDate Sep 11 2014 07:00 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00026 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.026 S26JNPT1 June 26, 2017 CONGRESSIONAL RECORD — SENATE S3769 floor, but a picture is worth a thousand ability to care about our neighbor, to Insurance companies currently are words and many more than a thousand fight for what is right, and to listen to not allowed to deduct the bonuses they statistics, and no one—no one should the people who represent here in the pay to their CEOs. Now you are going be consigned to being a statistic. Senate. to allow insurance companies to deduct This family is one of the many faces First, do no harm. That is what the the bonuses they pay to CEOs, and and pictures and stories of Medicaid. ethos of the medical profession is. It while tens of millions of Americans They deserve to be heard. If we gut this ought to be our mantra as well. It will lose access to affordable care, mil- program, if we strip away the impor- ought to be what my colleagues, if lionaires in America will get an aver- tant services it provides, we know all nothing else, heed as we reach this de- age annual tax break of $50,000 a year, too well what will happen to McKenzie cision to listen to people who sent us every year. and her family as statistics. Like her here and hear their stories. Listen to So make no mistake. You can call mother said, Medicaid has been the the anxieties and fears and value of this a healthcare bill, but it has noth- path to success for them, and that rug America. They will tell you all you ing to do with healthcare and every- will be pulled from that family, from need to know about this bill. Kent told thing to do with wealth care and trans- beneath McKenzie. me. As he said, the cost will be stag- ferring wealth from more struggling At the hearing on Friday in New gering—not just in financial terms but vulnerable Americans to the very Haven, I heard from Kent O’Brien, who in human terms. wealthy. If this were about healthcare, why is told me about the eight prescription This bill—written behind closed it that we have all received in our of- medications he takes—four for psy- doors, away from the light of day, fices long lists from patient advocacy chiatric reasons and four for medical away from the realities of medical care organizations that are dead-set against reasons. in the United States of America, away this legislation? These are organiza- Of course, mental health parity has from the voices and faces I have tions that have been dedicated to try- been one of the crusades of my life. brought to the floor today, and which I ing to improve healthcare for people When I was State attorney general, I will continue to bring to the floor—ig- and patients in our country: the Amer- worked with Senator Ted Kennedy and nores the most important thing we can do this week. As Kent said, don’t hurt ican Cancer Society, the American Di- Congressman Patrick Kennedy to help abetes Association, the American the American people. As the doctors advocate for that bill. As a Senator, I Heart Association, the American Lung tell us: First, do no harm. advocated for the regulations that were Association, National Alliance on Men- necessary for its enforcement, and we I yield the floor. The PRESIDING OFFICER (Mr. tal Illness, National Breast Cancer Co- finally got it done. alition, and National Multiple Scle- TILLIS). The Senator from Maryland. I want to quote what Kent said di- rosis Society. The list goes on and on rectly. He told me: Mr. VAN HOLLEN. Mr. President, I wish to start by thanking my colleague from organizations that have dedicated Hi, everybody, how are you today? I’m themselves to advancing patient going to keep this brief, because I know the from the State of Connecticut for bringing those powerful testimonies to health. senators are on a very strict time constraint On the other side, I haven’t seen a the floor of the Senate. It is really im- and I respect that. So I’m just going to talk single—not one—patient advocacy very quickly about my prescription medica- portant that all of us—all 100 of us— group that has come out to support tions; there are eight of them. Four of them spend time back home in our States this so-called healthcare bill. How can are for psychiatric reasons and four are med- listening to people who are telling us that be? If this is good for the health of ical. And if I lose my Medicare and Medicaid, those kinds of stories. I will be unable to pay for them obviously, our fellow citizens, why is it we have a I have received over 2,500 calls in my which in turn I will end up in the hospital. long list of organizations dedicated to office just since Thursday, all of them that cause against it and not one for Kent went on: strongly opposed to this so-called Now, for the Republicans who are seeing it? healthcare proposal. How about healthcare providers, the this in Washington, can you please listen to Some things improve with time. me carefully? folks who help provide the care to our Some things improve with age, like red constituents? They are all dead-set I am speaking to an empty Chamber. wine. Some things get stinkier and Let nobody make any mistake that Re- against it: the nurses, the doctors, the smellier the longer they sit out there, hospitals, the people who have that publicans are hanging on Kent’s words like rotten things. That is the case as I speak now, but every one of them network of care. with the series of Republican so-called I was just out on the Eastern Shore should go to the RECORD. Every one of healthcare bills, TrumpCare 1, of Maryland, a rural part of our State. them should be listening in their of- TrumpCare 2.0, and now, TrumpCare The National Rural Health Association fices. Every one of them should go to 3.0. They are all rotten to the core, and is opposed to this bill. They know the the RECORD. the more they sit out there, the people they serve are going to be badly Kent goes on: stinkier they get, and the American hurt, and, by the way, it is also going If I lose that medication, I will end up in people know it. to hurt the economies in those parts of the hospital, and it’s going to cost the state If you had any doubts, take a look at our State, especially the rural parts of and the federal government much more the most recent Congressional Budget the States, because those hospitals de- money than it would be to simply let me go Office report we got today. There is a to the pharmacy and pick up my medication. pend heavily on many of the people pretty clear pattern between all of who get help through the Affordable If there were ever a message that these Congressional Budget Office re- Care Act, whether through the ex- Washington should hear, it is from ports and the first bill we saw and the changes or through expanded Medicaid. Kent O’Brien, who closed by simply second bill and now on this latest As those patients come in the door and saying: version. no longer can pay for their care, those So I’m just going to close up with that, and Here is the pattern. Tens of millions hospitals said they may have to close don’t hurt the American people. Help them! of Americans will lose access to afford- down operations and lay people off. It If you met Kent, you would wonder able healthcare in the United States of is a double whammy—bad for patients how he was capable of that eloquence. America in order to provide tax breaks and bad for those who provide the care He is an ordinary American, someone for powerful special interests and rich- to our patients. who looks like all the rest of us. He has er Americans. That is the pattern. In That is why AARP has been all out said to this body what it means to this most recent report, we are told by against this, because they know that hear: ‘‘Don’t hurt the American peo- the nonpartisan professionals at the for Americans between the ages of 50 ple.’’ He couldn’t be more right. This Congressional Budget Office that 22 and 64, before you get on Medicare, this proposal would cost our Nation so million of our fellow Americans are is a total disaster. As they have said, much, not just financially—Kent had it going to lose access to affordable there is an age tax. If you are older, right—but morally. It will lead to a healthcare. For what? To give powerful you are going to pay a whole lot more weakening of what makes our country special interests and wealthy Ameri- under this Republican bill than you strong and great in the first place: our cans a tax break. pay today.

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00027 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.028 S26JNPT1 S3770 CONGRESSIONAL RECORD — SENATE June 26, 2017 Many people are just realizing now as our Republican colleagues talk about powerful special interests and million- they follow this debate that two out of premiums. Now, you have to translate aires. three Americans who are in nursing a little bit here because this is in the The PRESIDING OFFICER. The Sen- homes today are supported by Medicaid budgetese of the Congressional Budget ator from Hawaii. payments. So millions of our fellow Office. What they say on page 9 is this: Mr. SCHATZ. Mr. President, you Americans who now get their care in Some people enrolled in nongroup in- might think that for the last 7 years, nursing homes, where Medicaid is pro- surance—in other words, in the indi- the major complaint people had about viding support for two out of three, are vidual market, the people who are cur- the Affordable Care Act was that it going to be put at risk and made vul- rently in the Affordable Care Act ex- hurt rich people, because they seem to nerable because of this legislation. changes—would experience substantial be the only people who stand to gain Remember, Donald Trump said he increases in what they would spend on with this Republican Senate healthcare wasn’t going to cut Medicaid. This cuts healthcare even though benchmark plan. They get a giant tax break. The it by over $750 billion. Make no mis- premiums would decline on average in rest of America, on the other hand, is take, on this issue, this Senate bill is a 2020 and years later. in trouble. lot meaner than the House bill. We all So the translation is that in some With TrumpCare, healthcare will know that President Trump out in the cases the premium—that sticker cost more, and 22 million people are Rose Garden celebrated the passage of price—may go down, but you are going going to lose their healthcare alto- the House bill. But behind closed doors, to end up paying a whole lot more gether. Some healthcare bill. To put what did he call it? Mean. This Senate when it comes to your deductible and this in perspective, imagine if everyone bill, as time goes on, will cut Medicaid your copays. lost their healthcare in Hawaii, Maine, far more deeply than the House bill. As It goes on to say that because Nevada, Alaska, West Virginia, Ohio, Idaho, and Wyoming. That is what we look at this Congressional Budget nongroup insurance—in other words, TrumpCare does. That is 22 million Office report, it talks about how you the individual market—would pay for a Americans. It also devastates one of get to the end of year 8 and 9 and 10, smaller average share of benefits under the best healthcare programs this and you go beyond that. You are going this legislation, most people pur- chasing it would have higher out-of- country has. to have very deep cuts, much more With this bill, Medicaid is going to pocket spending on healthcare than painful, much meaner than in the Sen- lose nearly $800 billion. If your only under current law. It goes on and on. ate bill. worry is that your investment income We have heard a lot about pre- In other words, keep your eye on the ball, America, because when someone gets taxed at 3.8 percent every year, existing conditions. The reality is that you can breathe a sigh of relief. Let me tells you your premiums are going to the Senate bill is very devious in this drill down on that because one of the go down, watch what happens to all regard. It is a great sleight of hand. On most egregious tax breaks in this bill— your other healthcare costs. The Con- the one hand, it creates the impression and this is mostly a tax cut bill and gressional Budget Office, the non- that if you have preexisting conditions, not a healthcare bill—is the following: partisan analysts, are telling you they you are going to be all right. But what If you are making $200,000 as an indi- are going up. it pretends to give with one hand, it vidual or $250,000 as a couple, capital This brings me to my final point. I takes away with the other. It makes gains income is currently taxed at 3.8 said at the beginning that some things those Americans as vulnerable as they percent. If you are making $200,000 as get better with time and some things were before the passage of the Afford- an individual or $250,000 as a couple and get stinkier and smellier. We know able Care Act. you have capital gains, not regular in- that the more the American people get I am not talking about those who are come, it is taxed at 3.8 percent. This a look at this latest Senate Republican directly benefiting, like those on ex- bill zeros that tax out. This bill zeros proposal—TrumpCare 3.0—the less they panded Medicaid or those in the ex- that tax out. On top of that, it is retro- are going to like it. The more they see changes. I am talking about those who active. Think about the absurdity. are benefiting from the patient protec- it, the more they will hate it. Just like Here we are. I am looking at the Sen- tions in the Affordable Care Act. something that is rotten gets stinkier ator from Pennsylvania and how much I just got a note the other day from with time, this will get worse and he has advocated for children and espe- Mark in my State of Maryland saying: worse with time. That is why it is so cially for children with disabilities. I My son was diagnosed with Crohn’s disease important that we not try to jam this am looking at the Senator from Con- in 2008, at age 18. He was repeatedly denied through the Senate. necticut and the work he has done for insurance and was only able to cover part of I understand the Republican leader. people with chronic diseases and men- the cost of care through the Maryland high- He knows this is rotten to its core, and tal health challenges and the resources risk pool. Obamacare made it possible for he knows the more it sits out there, we need for that. And in the middle of him to be insured and care for this lifelong the more people are going to see what disease. a supposedly oriented toward it is all about and the more they are healthcare piece of legislation, we are It was ObamaCare that ‘‘will literally going to hate it. giving a retroactive capital gains tax save his life.’’ We have many stories Let’s have a full debate, and let’s cut to people who make over $250,000 a like this one from others who were de- make sure all of us go back to our year in combined income. It is absurd. nied access to care because of pre- States over the Fourth of July—to the It is not a healthcare bill. existing conditions before the Afford- parades, the barbecues, and the pic- If you have a loved one in a nursing able Care Act. nics—and look our constituents in the home, if you are pregnant or thinking There is another major sleight of eye and tell them that we are going to of having a baby, if your kid has a dis- hand in this Senate Republican pro- take healthcare away from tens of mil- ability that requires costly care, if you posal, and that relates to premiums. I lions of Americans, that we are going work two jobs but your employer have been listening. We have been to open up the discrimination once doesn’t provide health insurance, then hearing a lot from our Republican Sen- again to preexisting conditions. We are this bill does not take care of you. In- ate colleagues about how this is going going to increase their overall stead of less taxes, you get less care, to bring down the price of premiums. healthcare costs, even though we tell and you are going to pay more for it. We all know that what Americans care them we are going to be reducing them. This is what happens when legisla- about is what they are having to put Let’s look them in the eye and tell tors don’t have committee hearings or out in total for their healthcare. There them what this bill is all about rather they refuse to meet with patients, doc- are premiums. How much is the deduct- than trying to push it through in 24 or tors, nurses, advocates, their own con- ible? Great, I got a lower premium, but 48 hours or later this week. stituents. There have been so few town- my deductible is now $10,000. There are Our constituents deserve to know the halls about healthcare. There have copays. facts, and we need to make sure we been so few real Senate debates about Here is the dirty little secret if you vote to protect the interests of the healthcare. dig into the Congressional Budget Of- United States of America, not just pro- I have seen every single Democratic fice report, after listening to many of vide another round of tax breaks to Member of the Senate come here and

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00028 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.033 S26JNPT1 June 26, 2017 CONGRESSIONAL RECORD — SENATE S3771 talk about this piece of legislation. I public education, we had LAMAR ALEX- on the exchanges that doesn’t have all have seen every single Republican ANDER and PATTY MURRAY come to- the bells and whistles the existing Member of the Senate talk about legis- gether. Heck, in the last Congress, we plans do. But you get that we want sta- lation that they are proud of. I have had JIM INHOFE and Barbara Boxer do a bility in the exchanges. We want some seen very few people on the Republican bill together. It is possible for us to do certainty in the markets going for- side of the aisle come down and talk a bipartisan piece of legislation. ward. about this bill because they know it is The decision was made to go with There is an important conversation not a good piece of legislation. reconciliation, and that is backfiring to be had here. Our hope is that, with At this point, we are not even debat- because the problem with not involving this CBO score, maybe it will be the ing healthcare policy. It is not a ques- Democrats is that there are Democrats straw that breaks the camel’s back, tion of what is the best way to get peo- across the country. The problem with that will cause our Republican col- ple to sign up for insurance or how we not involving experts is that you end leagues to give up this nonsensical ap- can lower premiums and deductibles or up with a product you can’t defend. proach to healthcare reform and work how we can improve the delivery sys- What we really need to do is take a with us. tem; it is a question of how many peo- breath, take the Fourth of July week- I am going to repeat some of the ple are going to lose their healthcare end, and reconvene as a Congress—not ground that has already been covered so that insurance company CEOs can as Democrats and Republicans but as here in the next few minutes, but I continue to make millions of dollars a Americans who understand that our want to go over some of the highlights year. That is literally what is in this healthcare system is not perfect, that of this CBO report. bill. Those are the conversations we it is in need of improvement, but this Senator SCHATZ previewed this, but are having—nothing related to reform- bill doesn’t get it done. it is hard to get your head wrapped ing the healthcare system or getting I yield the floor. around what it means for 22 million people more coverage for less but, rath- The PRESIDING OFFICER. The Sen- people to lose insurance. er, tax cuts for people who are involved ator from Connecticut. This is an old chart from the CBO in the healthcare industry. Mr. MURPHY. Mr. President, I want score on the House bill that held that How many grandparents are going to to pick up where my colleague from under their approach, 23 million people get kicked out of nursing homes? It is Hawaii left off. There is a wonderful would lose insurance. I X’d that out. not a rhetorical question. My wife’s analogy that President Obama used We now have 22 million people who grandmother was in a nursing home 2 after the 2016 election. As you could would lose insurance under the Senate months ago. It was a beautiful facility. imagine, Democrats were pretty de- approach. That is the entire combined They took great care of her. They had jected the day after, and President population of Alaska, Delaware, Ha- three beds, three nursing home beds. I Obama put it pretty simply. He said: waii, Idaho, Kansas, Maine, Montana, think the normal reimbursement is Listen, just remember, these elections Nebraska, Nevada, New Hampshire, about $9,000 a month. They took won- are intramural scrimmages. We put on New Mexico, North Dakota, West Vir- derful care of my wife’s grandmother. temporary pinnies, Republicans and ginia, and South Dakota. All that hap- They won’t exist. That nursing home Democrats, but in the end, we all be- pened between the House Bill and the and all the nursing homes like it won’t long to the same team. We are all Senate bill is that the people of Rhode exist if there is an $800 billion cut to Americans. Island got saved. I X’d out Rhode Is- Medicaid. This is not a theoretical con- Elections and legislative fights are land because Rhode Island has about 1 versation. This isn’t even a partisan temporary skirmishes before we recog- million people. About 1 million more conversation. Everybody has nursing nize and realize our greater identity, people will have insurance under the home beds in all of their home States. which is that we have this com- Senate bill, but that is humanitarian Everybody at least ought to know monality. Clearly, that is not what the catastrophe. That is a big deal, to have some middle-class people who rely on American people see here. They think that many people lose insurance. Medicaid for nursing homes. our primary identity is our partisan I know that is not what you set out CBO gave us the answer today. Too identity, and there is a lot of days in to do. I know the Republicans didn’t many people are going to be locked out which we give them fodder for that be- set out to do this, in part because I lis- of the healthcare system if this bill lief. tened to Senator CORNYN come down goes forward, and all for giant tax cuts. It really is amazing, when it comes and complain on the Senate floor re- Look, our healthcare system is not down to it, that when you think about lentlessly that the Affordable Care Act perfect. Changes need to be made, but the healthcare system, we do have the still left a whole bunch of people with- this bill is just not it. It has no clear same goals in mind. There are actually out insurance. In fact, he sent out a guiding principle other than slashing lots of other issues on which we don’t tweet today highlighting that the CBO Medicaid to pay for tax cuts. We have have the same goal. Republicans want does confirm that if current law con- to start over. to go left, and we want to go right. Re- tinues, there will still be a lot of people I am looking at the Presiding Officer, publicans want to go right, and we without insurance. He left out the fact who was a speaker of the house in want to go left. On healthcare, we ac- that the CBO says that under the Re- North Carolina and understands how to tually all want to get to the same publican bill, 22 million more people do a bill on a bipartisan basis. I am place: More people have access to will lose insurance, but that is a whole thinking of the numerous Republicans health insurance, the cost of that in- lot of people. who are capable of working on a bipar- surance is less than it is today, and the By the way, in the first year, CBO tisan bill that can get 60 votes. quality of the care people get is better. says 15 million people will lose insur- By the way, the politics would It is funny because underneath that, it ance. Fifteen million people is the en- change because if we worked on a bill is just mechanics. It is not actually tire population of 13 States. That hap- that could get 60 votes, we would be in ideology. It is a decision as to which pens next year. Emergency rooms in a wonderful position—the Senate is set lever you press and which you don’t. this country cannot in 12 months ab- up to encourage us to work together— I get that a lot of my Republican col- sorb 15 million people losing insurance. because if we abide by that 60-vote leagues don’t think we are sincere For all the folks who say that the threshold and we come up with a bill when we say: If you put this mon- ACA is in a death spiral, CBO says you together, we would own the American strosity of a bill aside, we will work are wrong. Very flatly, CBO says that healthcare system together. We don’t with you to do something better. But it if existing law remains, even without get to play this blame game about is sincere. We don’t want to blow up any improvements, the number of peo- what is happening with premiums or Medicaid. We are not with you on that. ple without insurance effectively re- what is happening with coverage num- We don’t want to pass along big tax mains static. Yes, at the end, if you bers. We actually, on the level, collabo- breaks, only going to the very wealthy. make no improvements, you will go rate. But we get that you want some more from 26 million people not having in- When you think about a bill or an flexibility for States. We get that you surance to 28 million people not having issue that used to be as partisan as want maybe an additional plan offered insurance.

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00029 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.034 S26JNPT1 S3772 CONGRESSIONAL RECORD — SENATE June 26, 2017 CBO says—I had to change this be- ObamaCare.’’ That is about as perfect While that would be a secondary ben- cause it used to be 51 million under the an encapsulation of the Republican po- efit to the actual good that would come House bill. CBO now says 49 million sitioning on this bill as I can imagine, from a bipartisan piece of legislation people will lose insurance if you actu- because if you did know what it did—if that actually addresses the issues in ally pass the bill the Senate is going to my Republican colleagues did get deep the underlying healthcare system, it consider this week. The death spiral into the CBO report, it doesn’t solve a would be a pretty remarkable good happens if we pass the Republican single problem in the American that is possible because we have the healthcare proposal. That is not a healthcare system. There are big prob- same goals in mind. We both want the death spiral; that is stability. It is not lems, such as 26 million people still same things. It is just, in the end, put- an optimal result, 28 million people not don’t have insurance. This bill makes ting aside this bill that makes all of having insurance, but it is far pref- it worse. those problems worse and, instead, sit- erable to 49 million people not having People are paying too much for in- ting down together and deciding which insurance. I understand that Repub- surance, especially those folks who are levers we want to push to make things licans will quibble with CBO and say making middle incomes who are just better. that maybe they didn’t get it exactly outside of qualifying for the Medicaid I yield the floor. right. Even if they were 50 percent subsidies. This bill makes it worse. Al- The PRESIDING OFFICER. The Sen- wrong, that is still over 10 million peo- most every problem is made worse by ator from Pennsylvania. ple losing insurance. By the way, just this piece of legislation. I guess that is Mr. CASEY. Mr. President, I rise, as for good measure, CBO was right in sort of what a lot of Americans won- well, to talk tonight about the issue of healthcare. I thank my colleague from their estimates of the percentage of der—if our Republican colleagues do Connecticut for looking down the road Americans who would have insurance know what is in this bill. ‘‘I am not to when, maybe, we can actually work under the Affordable Care Act. Inside sure what it does. I just know that it’s together on this issue. We are in con- of their estimate—the details worked better than ObamaCare.’’ flict this week, and that is not a place out differently—but they said that by This solves one problem for Repub- licans. It is a political problem. Repub- any of us want to be. 2016, 89 percent of Americans would We are in conflict because of the ele- licans have said for the last 8 years have health insurance, up from 83 per- ments of this bill. I will make two that they are going to repeal the Af- cent prior to the passage of the Afford- basic points in my remarks tonight, fordable Care Act. My Republican able Care Act. Guess how many people one about Medicaid and then one point friends promised it in every corner of have health insurance today: 89 percent about another provision in the bill that this country, at every opportunity they of Americans, 89 to 90 percent of Amer- I think is particularly insulting. icans. had, and this does solve that political A lot of our discussions start with We all agree that premiums should problem. If you pass this bill, you can policy and data, and that is important. go down. If we are going to pass some- successfully claim that you have re- That is obviously part of the debate thing, the result should be that pre- pealed the Affordable Care Act, but about the bill and what is in it and miums go down. Here is what CBO that is the only problem it solves. It what impact it will have on programs says: Premiums go up and not by a lit- makes almost every other problem in and people over a long period of time, tle bit. They go up by 20 percent in the this system worse. but part of this debate, of course, is first year. Admittedly, I am painting a The number of people without insur- about the people we represent. I know partial picture here. That is 2018. After ance goes up. Premiums, especially for the Presiding Officer understands this, that, CBO says for certain populations the poor, the vulnerable, go up. There and I am heartened that he is paying in this country, premiums will go is nothing in this bill that addresses attention to our arguments because down, but it is largely for the young, the cost of healthcare, of drugs, of de- sometimes—I have done it myself— the healthy, and the wealthy. vices, of procedures. There is nothing when you preside, sometimes you are CBO says that you will have massive in this bill that talks about the quality doing something else. So we are grate- premium increases for older Ameri- of healthcare. Every problem—vir- ful for his attention. cans. For lower income Americans who tually every problem in the healthcare I have talked on this floor a couple of are in that age bracket of 50 to 64, pre- system gets worse. times over the last couple of weeks— mium increases will go up by at least I will just end by reiterating the offer even months—and I will not repeat the two times, up to four times. that Senator SCHATZ made. I think you stories because they have been told a CBO also says that if you are lower have a lot of people of very good will number of times, but Rowan Simpson income, you are not going to buy insur- who want to work with Republicans is a young man whom I recently just ance because you can’t afford it. It and are sincere about it. I will be part met. His mom had sent me a letter. doesn’t even matter what your pre- of whatever group gets put together if Rowan is on the autism spectrum, and miums are because they will be so this bill falls apart this week. his mom is very worried about his fu- high, you can’t afford them. Premiums I held an emergency hearing in New ture because of the potential impact on go up for everybody off the bat—and Haven, CT, on Monday, just to try to Medicaid and the benefits he is getting for lots of vulnerable people after that. explain to people what was in the Re- today from Medicaid. So who gets hurt? Everybody, except publican Senate proposal and to get I just referred the other day—I guess for the folks who are getting tax cuts. people’s feedback. It was hard to sit it was Thursday on the floor—to a let- If you are an insurance company, a through. It was 21⁄2 hours of some really ter from a dad about his son Anthony, drug company, or you are super rich— scared folks. who has a number of challenges, one of maybe that is an unfair term—people I will be honest with the Presiding them being that he is on the autism making $200,000 or more a year get tax Officer. Most of the people who came spectrum. I have another letter, as cuts, but most of the tax cuts go to the had disabled kids. Most of the people well, which I will not go through to- super rich. People making over $1 mil- who came had disabled kids who were night, but it is from a mom in North- lion a year will do fine. If you are an on or relied on Medicaid, and they were eastern Pennsylvania, who wrote to me insurance company, a drug company, just scared to death about what was about two of her children—principally, or you are very wealthy, you get a going to happen to their children. But her son who has Type 1 diabetes and great deal out of this piece of legisla- they also talked about the problems what the loss of Medicaid coverage will tion, but pretty much everybody else that still exist in the healthcare sys- mean for that child, who, in this case, gets very badly hurt. tem—the fact that drugs are too expen- is just 4 years old. Today, one of our Republican col- sive. Many of them pay too much for Everyone in this Chamber in both leagues said this to a reporter—I won’t healthcare. They wanted those prob- parties has stories like this to tell— give you a name. One of our Republican lems solved, and they wanted us to stories about people who are, because Senate colleagues, when he was asked work with Republicans on it. of a disability, totally dependent upon about the Republican healthcare pro- Senator SCHATZ was right. If we did Medicaid. That is not unique to one posal, said: ‘‘I am not sure what it it together, we would own it together. State, and, of course, it is not unique does. I just know it’s better than It would stop being a political football. to one party.

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00030 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.035 S26JNPT1 June 26, 2017 CONGRESSIONAL RECORD — SENATE S3773 One of the more egregious and objec- they have been writing and going to Sack, Glynnis Arnold, Ruth Lawson, tionable parts of this 140-plus page bill meetings and making phone calls and Michelle LeMenager, Iris Valanti, Danielle is the impact it will have on Med- engaging in such a robust way, all Callahan, Frederick Ward, Martha Haines, icaid—the Medicaid expansion, which these weeks and months. Audrey Marsh, Lynn Campbell, Kristen Cochran, Judith Brennan, Michael McCabe. many people now know represents Mr. President, I ask unanimous con- Joshua Miner, Jaime Bassman, Rachel probably on the order of 11 million peo- sent that this list of almost 600 names Murphy, Elena Knickman, Nelson Vecchione, ple who got healthcare coverage since from Pennsylvanians be printed in the Daniel Laurison, Karen Osilka, Roger 2010 and got that coverage because RECORD. Knisely, Theresa Baraldi, Holly Best, Thom- Medicaid was expanded. But the bill There being no objection, the mate- as Baraldi, Patricia Walsh, Michelle Herr, also speaks to the Medicaid Program rial was ordered to be printed in the Karen Heenan, James Paul Johnson, Alex- itself by the so-called per capita cap, RECORD, as follows: ander Kimball, Sigal Ben, Leah Durand, In- capping the dollars the Federal Gov- grid Gustafsson, Mary Jo Maggio. Ashley De Padua, Carol Ribner, Lisa Ken Hardis, Lisa DeAngelis, Mary Jo Har- ernment would provide in the future Brown, Adam Huard, Julie Strauss, Amy ris, Alice Ung, Lance Flowers, Deborsh with regard to the Federal-State part- Reynolds, Dianne Spatafore, Pamela Nolan, Hoelper, Joel Cardis, Georgine Dongillig, nership on Medicaid. These are big Karin Fox, Claire Witzleben, Wendy Albert- Renee Donahey, Anna Payne, Hallie stakes when it comes to a program son, Laura Rose, John Mack Jr., Elizabeth Kushner, Linda Cortese, Mark Vecchione, that has been with us for 50 years. Failor, Lisa Bargielski, Peg Welch, Jason Natalie Garner, Rachel Marx, Janet Cavallo, As everyone knows, Medicaid is prin- Carnahan, Robert Perry, Morgan Adrianne Gunter, Heather Turnage, Kenneth Vinokurovi, Melissa Byrne. Reisman, Flora McGettigan. cipally about individuals with disabil- Patricia DeWald, Kristin Kondrlik, Mi- ities, and that is obviously those chil- Tricia Connell, Nicole Conley, GiGi chael Crane, Diane Smith-Hoban, Diane Malinchak, Ellen Toplin, Eileen Brumbaugh, dren I mentioned. It is about folks who Sayre, Benjamin Andrew, Janice Diehl, Rob- Theodore Fallon, Elizabeth Dooley, Stacy need some help getting into a nursing ert Bahn, John Bair, Angela McClain, David Klein, Deena Thornton, Barbara Stephan, home, senior citizens. Of course, it is Cassiday, Dara Bortman, Judi Reiss, Nich- Cheryl Dungee, Louisa Alexander, Brett about kids from low-income families olas Marritz, Amber Blaylock, Tina Krasnov, Mary Gallant, Kathy Gardian, who have no other healthcare, absent Nightlinger, Lisa Bradshaw, Kimber Irene Lin, Colleen Dunn, Liane Norman, Medicaid. In our State, there happen to Schladweiler, Michael Dwyer, Vashti Bandy. Susan Yerk, Ann Telford. Christine Russell, Mary Farrington, Ralph Leslie Elder, Sheri Utain, Christine Hoo- be 1.1 million kids on Medicaid who are Mcdermott, Anna Cunningham, Linette from low-income families. The dis- per, Teri Vanore, Paula Baxter, Mordecai- Schreiber, Barbara Powell, Shelley Francies, Marl Mac Low, Nicolette Byer, Donna Vito, ability number in both children and Joyce Fentross, Shannon Bearman, Jocie Michele Forbes, Rebecca Kane, Katherine adults is, by one estimate, more than Dye, Ina Martin, Mary-jo Tucker, Bracken Fein, Sue Meyers, Deb Yohman, Sherri 722,000 people. These are big stakes, Babula, David Mosenkis, Martha Franklin, Suppa, Jim Greipp, Jeffrey Bussmann, Ra- even if it is just involving one of those Nathaniel Missildine, Kristin Nielsen, Maria chel Smith, Eileen Reed, Louise Beer, Mary individuals or hundreds or thousands. Duca, Erica Bartlett, Irina Pogrebivsky. Reichart. Stephanie Romano, David Hincher, Diane Tesia Barone, Nicole Gilchrist, Richard But as I will refer to later, some of the Holland, Tracy Krider, Michelle Nutini, numbers are, of course, a lot higher Greenstein, Amy Levengood, Judith Max, Anne Martin, Tracey Miles, Alexis Lieber- James Walton, Mary Widing, En B, Mary Jo than that. So those stories and those man, Dorothy Posh, Thomas Hennessey, Harris, E. E. Zachai, Tammy Harkness, Tim- pleas for help from those families obvi- Cynthia Mould, Jennifer Kunkle, Ann othy McCormick, J Pensiero, Betty Fisher, ously do not just inform us, but they Calamia, Jennifer Zoga, Barbara Turk, Ray- Cindy Shannon, Elisabeth Whyte, Carmela inspire us to keep working, to keep mond Hopkins, Carol Proud, Alex Hesten, Daniels, Amy Felton, Judith Gold, Jack fighting. I will be fighting against this Kimberly Jones, Richard Pavonarius. Guida. bill as long as it takes. Robert Huff, Klvdiya Vasylenko, Mike Sarah Gaffen, Linda Bullock, Pamela It is likely that we will have a vote Kass, Bernadette Flinchbaugh, Jo Johnson, Woldow, Katherine Kurtz, Lisa Harrison, Es- Carolyn L. Johnson, Abby Godfrey, Mark this week. I am assuming we will, so ther Wyss-Flamm, Catherine Roundy, Jim Herr, Jeri Sebastian, Lisa Hartjen, Anne Barlow, James Schreiber, Dave Carlton, An- we have only hours and a few days to Smith, Melissa Nurczynski, Christine drew Famiglietti, Maria Catrambone Rosen, fight and point out what we believe to Crooke, Ellen Garbuny, Harry Richards, Breanna Jay, Bethany Altieri, Alicia Olivant be the defects. One of the things that is Ruth Hetrick, Carolyn Rahe, Stephanie Fisher, Chris Braak, Jessica Atchison, Eliza- significant about this debate is that we Moats, Sally McAfee, Abigail Gertner. beth Dennis, Elizabeth Cates, Elizabeth have had people not just writing those Stacey Smith, Davinica Nemtzow, TC Reilly. stories and telling us their story but DeAngelis, Shelley Schwartz, Lisa Keppeler, James Berry, Marita Scheibe, Sheila also telling us and giving us ideas Katie B, Joseph Willard, Maryam Deloffre, Thomas, Randy Sarner, Alyson Kathie Brown, Ellen Catanese, Cynthia about how to conduct the debate and D’Alessandro, Suann Snavelt, Chantal Donahue, Porter Hedge, Gretchen Bond, McKelton, Theresa Glennon, Josie Byzek, how to fight and how to oppose it. Mary Dallas, Fae Ehsan, Kathy Goldberg, Marlene Katz, Deborah Grill, John Moffa, I have in my hand—I will describe it Jennifer Jarret, Dan Potter, David Anne Coles, Liane Norman, Chanda Law- first before I offer a consent request. I Dutkowski, Rich DeAngelis. rence, Norma Kline, Colleen Kessler, Maria have in my hand several pages that list Patricia Kay, Sharon Doros, Stephanie Catrambone Rosen, Laurence Coles, Kate almost 600 names from people in Penn- Doyle, Lynn Loomis, Elizabeth Adams, Wallis. sylvania who have written to me over Kathryn Petz, Agatha Andrews, Alex Carol Harris-Shapiro, Briana Latta, the last number of weeks and months, Lombardi, Erin Gautsche, Marie Turnbull, Melanie B, Charlotte Ridge, Nathan Carol Sinclair, Robert Turnbull, Elisa actually. What they are urging me to Krisanda, Meredith Sonnen, Margaret Wal- Bermudez, Marie Vincent, Florian Schwarz, ter, Hallam Carrie, Leslie Richards, Jenny do is to pursue a legislative strategy to Daniel Pencoske, Ina Shea, Beth Collins, Anne Horst-Martz, Karen Roberson, Richard protect their healthcare. Why are they Meenakshi Bewtra, Jillian Bosmann. Vanore, Susan Devenny, Rhana Cassidy, doing that? It is not because they have Mari Greipp, Michael DiEva, Andrea Ep- Maria Golden, Kathy O’Brien, Vanessa nothing else to do. They are worried. stein, Fredrica Friedman, Starla Crandall, Baker, Robert Brucicman, Sarah Smith, These people are really worried. They Stanley G., Cindy Fogarty, Ron Ashworth, Yuliya Benina. are worried about those kids like Trudy Watt,Kristen King, Kathleen Sheehan, John Ascenzi, Melanie Cichy, Paul Gott- Rowan and Anthony, whom I just men- Ryan Brown, Kevin Collins, Kelly Collister, lieb, Shannon Browne, Jen Britton, Erin Ambry Ward, Joseph Melchiorre, Catherine Dunke, Debi Seltzer, Anna Edling, Brianna tioned, and a 4-year-old with Type 1 di- Abrams, Michael Bourg, Ed Gragert, Hien Wronko, Francis Palombaro, Katie Morrison, abetes or a whole long list of other dis- Lu. Jennifer Hombach, Jessica Lennick, Ellen abilities a lot of kids have. They are Jo Johnson, Cody McFarland, Maggie Toplin, Charlene Kurland, Joanne Mahoney, worried about their parents, who may Deptola, Sandra Blair, Zoe Soslow, Yoko Sherry Greenawalt, Abigail Hyde, Sara not be able to get the long-term care Takahashi, Anna Drallios, William Sierschula, Amy Leddy. they need if Medicaid is capped and cut Dingfelder, Shawna Knipper, Cheryl Brandt, Emmy S, Renee Broxk, Kimberly Winnick, and decimated. They are worried about Larissa Mogano, Linda Bishop, Lital Levy, Melissa Reed, Lisa Jaremka, Karen Shelly- their friends and their families. They Laurie Pollack, Judith Navratil, Natalie Genther, Melissa Welshko-Williams, Naomi Duvall, Richard Owens, Elaine Giarusso, Pliskow, Joan Susski, Rachael Pinsley, are, in a word, as worried as anyone David Thomas, Leslie Collier. Lindsay Friedman, Shari Johnson, Melanie has ever been about the healthcare of Nicole Seefeldt, Jonathan Lipman, Ellen B, Keith Adams, Lynn Martin, Anastasia those they love and the healthcare of Gallagher, MaryAnn Black, David Hughes, Frandsen, Brooke Petry, Tamara Davis, Mar- those they care about. That is why Michael Niemeyer, Pegene Watts, Kelly tha Posnet, Phoebe Wood.

VerDate Sep 11 2014 07:00 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00031 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.037 S26JNPT1 S3774 CONGRESSIONAL RECORD — SENATE June 26, 2017 Lindee Fitting, Isabelle Mahoney, Tamar icaid. There are some other issues, ob- though it has a lot of data on it, it is Granor, Nancy Berman, Karen Jensen, Katie viously, addressed on the exchanges rather simple. Here is what it says at Haurer, Beth Collins, Catherine Budd, Mir- and the fundamentals of healthcare. the top. First of all, this isn’t my iam Phillips, Christine Bradley, Michelle But it is mostly about Medicaid and chart; it is the Center on Budget and Gorski, Chris Gorski, Sophie Taylor, Cath- erine Borges, Mary Alice Clevenger, Nick tax cuts, unfortunately; and that is Policy Priorities’ chart. You can go to Ingram, Brenda Scholtz, Melissa Miller, particularly objectionable to me that cbpp.org to see it. Jeanne Burd, Nad Rosenbe. you have a small group of very wealthy This is based upon the House bill, but Joanna Kempner, Maria Boyd, David Shen, people who are going to make out in I just told you that the Medicaid en- Sara Sobel, Jessica White, Jennifer Pen- ways we can’t even imagine, like a big rollment number is 1 million higher— nington, Margot Keith, Catherine Sunnen, bonanza for the superrich. or that the number losing Medicaid is 1 Naida Reed, Ashley Morgan, Beth Brindle, Now, let me just talk about the Med- million higher under the Senate bill, Amy Friedlander, Millicent Wilson, Richard icaid part of it first, and then I will and the tax cuts that are in the Senate Baron, Max Ray-Riek, Ruth Cary, Sandy Heisey, Sharon Furlong, Laura Tilger, Don- refer to a chart. I am holding in my bill are almost identical. You can just key Dover. hand the Congressional Budget Office go down and count them. The House Lynn Jones, Kaytee Ray-Riek, Janice report from today, which came out. It, and Senate bill are virtually identical Test, Mary Terp, Faith Cotter, Sarah Camp- of course, is a document produced by on tax cuts. bell-Szymanski, Frank Wallace, Judie the Congressional Budget Office as well Here is what the headline is: Tax cuts Howrylak, Minna Ltumey, Erin Hetrick, as the Joint Committee on Taxation so for the top 400 roughly equal to Federal Melinda Kohn, Jenny Stephens, Susan Gam- it is a joint effort. spending cuts from ending Medicaid ex- bler, Olivia Landis, Terry Hirst-Hermans, On the CBO—so-called CBO Congres- pansion. Jill Hall, Roseanne Mulherin, Susan Miller, sional Budget Office report, recently— Julie Platt, Lori Spangler. Now, remember, I said before that Hiro McNulty, Greg Carey, Amanda a couple weeks ago now—on page 17 of Medicaid expansion is one problem I Fogarty, Sissy Gault, Mona Callahan, Meryl that document, there was an assess- see. The per capita cap is another. This Mintzer Puller, John Hoetzel, Stacey ment made of the number of people chart just deals with one of the Med- Kallem, Thomas Paquette, Karen Clark, who would lose Medicaid as a result of icaid problems—Medicaid expansion— Paige Wolf, Patricia Scanlon, Ellen Reese, the House bill, and that number was 14 so ending Medicaid expansion in Ne- Rosalind Bloom, Gary Stein, Eric Berue, million Americans would lose Medicaid vada, West Virginia, Arkansas, and Jenn Hrehocik, Tamara Myers, Mara Kaplan, over the decade up until 2026. Alaska, just four States, right? Alaska, Amanda Cranney. Well, unfortunately, as of 4 p.m. or Deborah Miller, Debra Nathans, Paul they project, will lose $2 billion worth Stockhausen, Johanna Hollway, Leah Hol- something this afternoon—I guess of Medicaid over the decade, Arkansas stein, Susan Robbins, Roger Latham, Alison about 4 p.m., 4:30—we got the Congres- would lose $7 billion, West Virginia Yazer, Melissa Marshall, Mary Lynn sional Budget Office assessment of the would lose $12 billion, and Nevada Colabrese, Harry Mclaughlin, Samantha Senate bill, the Senate bill that was would lose $12 billion. That adds up to Payne, Elizabeth Hawkins, Julie Krug, Lisa unveiled last week. Not on page 17 of $33 billion Federal Medicaid cuts from Heinz, Shoshana Kaplan, Corrine Richter, this report but actually on page 16, ending Medicaid expansion. So $33 bil- Lee Baer, Eve Glazier, JoEllen Bitzer. here is what the Congressional Budget lion dollars just for States. By the way, Judith Cardamone, Hilary Schenker, Faye Office and the Joint Committee on Clawson, Caren Leonard, Carol Feldhaus, Ju- these are not really high-population dith Moyer, Sharyn Feldman, Jessica Taxation says about enrollment in States. There is no California, New Martucci, Mike Kutik, Marylou Streznewski, Medicaid. I am quoting from the bot- York, Texas or big States like that. So Ann Baker, Abby Martucci, Dennis Cusin, tom of page 16: $33 billion lost in Medicaid in just Marie Norman, Debra Brokenshire, Martha Enrollment in Medicaid would be lower those four States. Cornell, Maria Swarts, Sherell Chambers, throughout the coming decade, with 15 mil- What does this orange bar graph Suzan Hirsch, Alison Wojtkowiak. lion fewer Medicaid enrollees by 2026 than Patricia Carbone, Marcella Glass, Ben- projected under current law in CBO’s March show? The same number, $33 billion tax jamin Mills, Peg Welch, Rita Shah, Marcia 2016 baseline. cut for the 400 highest income house- Gever, Karen Phoenix, Tabitha Felton, Caro- Then, they refer to a figure in the re- holds in the country. It is the same lyn Stillwell, Katherine Parys, Roxanne port. number. So 400 households get a tax O’Toole, Harold Love, Nicole Jaffe, Steven So the House bill CBO assessment cut of $33 billion, not in some other bill Weitzman, Meredith Brown, Lauren Lewis, says 14 million will lose Medicaid cov- down the road, not in some other year, Sarah Wheeler, Maria Lauro, Jason not in a budget bill or a tax bill. They Magidson Lorette Lefebvre. erage. The Senate bill, analyzed by Denise Marcolina, Eric Krewson, Joseph CBO, which is supposed to be a more get this massive tax cut in what is Bosh, Joan Stein, Kami Schaal, Melissa moderate bill, a better bill in the eyes called a healthcare bill. At the same Nerino, Dorothy McFadden, Heather of some Republican Members of the time, it is equivalent to the total Med- muntean, Donna Devonish, Gloria Rohlfs, House and the Senate, that was sup- icaid lost in just four States. Terry McIntyre, Kaitlin Marks-Dubbs, Fred- posed to be better, but here is what we It gets worse if you add more States. erick Page, Douglas Graham, Sarah McKay, know now: 15 million people will lose Guess what. If you add up about 30 Zack Greenstein, Janice Nathan, Michel Medicaid. That alone should cause any States in a different chart, it is about Wilcox, L Roulston, Laura Wukovitz. the same as all the tax cuts together, Andrew Wilson, Amy Moulton, Christina Senator to be very concerned about the VanSant, Donna Bullard, Nancy Entwisle, impact of this legislation. That alone but here we are just talking about four Tessa Lamont-Siegel, Ben Cocchiaro, should, I hope, require some people to States and 400 families. Yasmeen Ali Khan, Rachel Amdur, Amalia use an old expression: Examine your I hope I am not offending anyone if Shaltiel, Sara Stetler, Bruce McDowell, Pat conscience about what will happen if they are in those top 400 households Hanahoe-Dosch, Mara Rockliff, Tristan you vote for this legislation. who are making either billions or, by English, Ryan Bross, Lynn Rubenson, Eliza- Let’s say someone says: Do you know one estimate, the average might be $300 beth Cheney, Regina Vicoli, Vicki Hewitt. what? I can put that into context, and million. I know it has been difficult to Kelli Servello, Charles Ang, Kierstyn make ends meet. You have been strug- Piotrowski Zolfo, Leah Bailis, Tom Peter- I think actually that will not happen sen, Pamela Magidson, Kathleen Morrison, or I have another explanation or what- gling and trying to pay the mortgage Genevieve Coutroubis, Susan Rubinstein, ever justification or rationale you use and the light bill when you are one of Ruth Ann Davidson, Frances Winsor, Janis for voting for a bill that will result in the top 400 richest households in the Rainer, Margaret Grubbs, Anna Kuhnreich, 15 million people losing Medicaid cov- country. Melissa Melan, Wendy Forman, Kristina erage. People are very vulnerable. Let’s But this chart, when you juxtapose Witter, Joan Kwortnik. just say you can analyze that a dif- this chart—and especially the orange Mr. CASEY. Mr. President, I will ferent way and come to a different con- part, the tax cut for 400 families, the make two final points about Medicaid clusion. We will see how people deal giveaway to families who don’t need it. and then juxtapose Medicaid with an- with that number this week when they Frankly, they don’t even want this tax other part of the bill. If you look at the go home and when they have to talk cut. I haven’t found one person who bill—it is about 140, I guess, 142 pages— about this legislation over time. came up to me in the last couple of more than 60 pages deal with Medicaid. Here is where it gets a lot worse. This years and said: You know what, I wish So this is principally a bill about Med- is a chart that is rather simple. Even my taxes didn’t go up. I wish those

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00032 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.015 S26JNPT1 June 26, 2017 CONGRESSIONAL RECORD — SENATE S3775 taxes didn’t go up while you were try- Ms. WARREN. Mr. President, we country count on Medicaid to help pay ing to help people on Medicaid. Not a have just gotten the latest numbers on the medical bills. About 6 out of 10 single person said that. the Senate Republicans’ reckless plan children with complex medical needs— Most people who will get this tax cut to take away health insurance from children who need breathing tubes, spe- would rather that we make sure we millions of American families, take it cial therapies, and multiple surgeries, 6 take care of those children I mentioned away from sick, little kids, take it out of 10 of those children count on with the disability or those families away from seniors in nursing homes. Medicaid to help pay their medical who need the protection of Medicaid. These numbers are worse than anyone bills. Nearly two out of three seniors in When you put this chart next to the expected. nursing homes count on Medicaid to policy and those 60-plus pages of the After weeks of secret work behind help pay their bills, and one out of decimation of Medicaid, there are a lot closed doors, the Republicans came up every three people dealing with addic- of words we could use that we are not with a plan that will take away health tion counts on Medicaid to help pay for allowed to use on this floor, but one of insurance from 22 million people and treatment. the words we should use is ‘‘obscene.’’ slash the Medicaid Program by nearly Who uses Medicaid? America uses That is an obscenity. When you match $800 billion, all in exchange for shov- Medicaid—children, the elderly, hard- these cuts for 400 families next to the eling hundreds of billions of dollars of working families, people with disabil- cuts to Medicaid, that is obscene, ob- tax cuts to the richest families in this ities, and people struggling with addic- noxious, and bad policy. country. tion. At any given moment in this If there was ever a reason to take You know, with results like these, country, one in every five Americans is this 142-page bill and throw it in the Senate Republicans should not still be counting on Medicaid to help pay the trash, throw it in a garbage pail as fast trying to figure out the best way to bills. What are these people supposed as we can, it would be this chart be- ram this bill through the Senate. They to do when the Medicaid expansion cause that is not what the American should just throw it in the trash. goes away, when this bill’s additional people are asking for. They actually We don’t have a lot of time left, and massive Medicaid cuts go into effect? think some people in the Senate are ac- I know it is easy to tune out these de- What are they supposed to do? What tually working on a healthcare bill. bates and to assume these are all just are their families supposed to do? That is what they believe. A lot of peo- a bunch of partisan games. So if you Dig in on one issue around this. Dig ple don’t know about this yet, but they aren’t inclined to take my word for it, in on opioid abuse. This is a problem are going to know. They are going to don’t, and don’t take the Republicans’ that is growing around the country. know by the end of the week, at least, word for it either. Take a look at what Last year we lost 2,000 people in Massa- if not sooner, that the 400 richest the experts are saying about the Re- chusetts alone. I hear from parents households in the country are getting publican bill because since this brutal who have lost children, from brothers that much money—$33 billion. Maybe bill was finally revealed on Thursday, and sisters who have watched a loved in the Senate bill it is only $32 billion it has been denounced by nonpartisan one disappear. I hear from people who or $31 billion, so we will stand cor- doctors groups, health policy experts, are desperate because their child or sis- rected if it goes down, but that is real- and patient organizations. The Amer- ter or brother can’t get into a treat- ly an abomination. That is an insult to ican Medical Association says the bill ment facility. I hear from dedicated the American people. People should be violates the fundamental principle of doctors, nurses, and counselors who ashamed this is part of that bill. medicine: ‘‘First, do no harm.’’ The need more resources so they can ex- I get it. We can have a debate about Children’s Hospital Association says it pand treatment programs. Now the Re- Medicaid. I get that, but when you are is ‘‘a major step backward for children publicans propose a bill that is like taking Medicaid dollars and transfer- and their health.’’ The National Coun- throwing gasoline on a bonfire. One in ring to wealthy people, no one should cil for Behavioral Health says, ‘‘In- three people struggling with an addic- support that kind of a policy, but that stead of ‘repeal and replace,’ it is tion are counting on Medicaid, and the is what we have. That is what we are ‘wreck and wreak havoc.’’’ Republicans plan to cut nearly $1 tril- up against. Lynn Nicholas, the head of the Mas- lion from the program. I do not under- If there was ever a reason to fight to sachusetts Health and Hospital Asso- stand. I cannot understand how the Re- the ends of the Earth against a piece of ciation, has actually come up with a publicans could turn their backs on lit- legislation, it is this. We are going to pretty simple test for the Republican erally millions of people who need help. continue to fight this. We are going to plan: ‘‘I challenge any Republican Sen- The cuts to Medicaid are terrible, but continue to point out this basic in- ator to name one thing in this bill that there is more. The Republican bill also equity, this insult for the rest of this will make healthcare in the U.S. better slashes the tax credits that people use week. for patients or healthcare professionals to help pay for insurance. The budget We hope folks on both sides of the who care for them.’’ nerds at the Congressional Budget Of- aisle will not only be listening, but we Think about that. She says use that fice say that ‘‘most people’’ would hope our Republican friends will take as the test, one thing. That is a pretty ‘‘have higher out of pocket spending on another look at this bill and under- low bar—one thing. Yet the Repub- healthcare than under current law.’’ stand how objectionable this is to so licans can’t pass that test. They can’t Think about that. Under the Repub- many American families. All of that name one thing in this bill that will lican plan, healthcare costs will go up worry I talked about before is made improve healthcare in America. That is for most people, and even if someone worse, is aggravated by this kind of re- because this bill is not supposed to im- can manage, somehow, to afford cov- sult when it comes to tax cuts. prove healthcare in America. It is not erage under the Republican bill, the We can do all that as a great nation. a healthcare bill. It is a tax cut for the Republicans are willing to let insur- We can make sure wealthy folks who rich, paid for by gutting healthcare for ance companies drop expensive benefits need a break once in a while—they millions of working Americans. that the companies just don’t want to have gotten a lot of them in the last 25 Doctors, patients, parents, families, cover, including—are you ready?— years—that they can get a fair tax experts, they are terrified by this bill opioid treatment. If this bill passes, it code. We could also make sure kids because they have read it, and they will devastate our ability to fight with disabilities, seniors, and kids in have concluded that nearly every line opioid overdoses. This isn’t a hypo- rural areas and big cities and small in this bill would make life worse for thetical. This isn’t speculation. Before towns can get the healthcare they need young people and for old people and for the Affordable Care Act became law, from Medicaid. We are a great country. families across this country. one-third of individual market health We can do that. We can have a growing I want to focus on just one major plans didn’t cover substance use dis- economy and still support a critically part tonight, the part that rips away order services, and about one in five important program like Medicaid. the Medicaid Program. Let’s do some plans didn’t cover mental health serv- I yield the floor. basic Medicaid facts. Who uses Med- ices. The insurance companies don’t The PRESIDING OFFICER. The Sen- icaid? Thirty million kids. That is want to cover these services, but the ator from Massachusetts. about 4 out of every 10 kids in this ACA made coverage mandatory. That

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00033 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.040 S26JNPT1 S3776 CONGRESSIONAL RECORD — SENATE June 26, 2017 meant that no one in this country had hold them on the phone as long as pos- we have seen in this country since to wonder when they showed up at a sible just as a way of denying their World War II. I know it is inconvenient clinic whether or not their insurance claim. Most people in America are too to believe that or to say that. I know would help them out, but the Repub- busy trying to move their family that in corners of the internet where lican bill opens the door to dropping ahead, trying to get by, to stay on the false news really does dominate, people those requirements. Millions more peo- phone all day with an insurance com- don’t believe it, but it is true. I am the ple could be left out in the cold at a pany. While we were at that, we said: It first to say there are not enough good time when they most need help. This is is not fair to deny people insurance in jobs, and I am the first to say there are cruel. Our country is already strug- the richest country in the world be- not enough high-paying jobs, but com- gling with a treatment gap, and far too cause they have preexisting conditions. pared to the record we inherited, it was many patients facing addiction can’t It is not fair that it is a business plan a success, all while we had the Afford- get the care they need. The last thing in America to have lifetime caps on able Care Act being implemented, all we should be doing is kicking millions people in the richest country in the while we were extending coverage to of these patients off of the coverage world who might hit those lifetime millions of people in America—many of they already have. caps because they get cancer. It is not them children who didn’t have ade- Now, let’s face it. The Republicans fair that in America, the richest coun- quate coverage before we passed the Af- realized this, and they have a plan on try in the world, some seniors have to fordable Care Act. this issue. They know that what they cut their medicines in half every It has been called every name in the book, just like President Obama was are doing is indefensible. So they have month just to get through the month called every name in the book, and a plan. They propose to throw $2 billion and to pay their bills. These were some they linked those two things— into a special fund for opioid treatment of the issues that we were trying to ad- healthcare reform, the Affordable Care and say: Problem solved. This is polit- dress when we passed the Affordable Act, and ObamaCare. That became its ical spin at its worst. Care Act. For every dollar the Republicans pro- Mr. President, I am from a Western name. Every single attack under the sun pose to put into opioid treatment, they State, like you. I was out all those was levied on that. Why? Because peo- are taking out more than $100 from months in Colorado, having town hall ple really believed it was destroying Medicaid, the rock on which our ability after town hall, not just in Democratic the healthcare system? Maybe some to provide opioid addiction treatment parts of the State but in Republican people did. Because they believed that is built. Why? Why treat our brothers parts of the State, trying to explain it was destroying businesses? Maybe and sisters, our children, our elderly what it was we were trying to do—both some people did. I suspect there was a parents so shamefully? Why? So that to give people better coverage, more much more simple reason, and that was Republicans can produce a giant tax predictable coverage, and less costly to try to win elections. cut for a handful of millionaires and coverage and also to try to do some- By the way, while we are on the sub- billionaires. That is it. Our friends, our thing to bring down healthcare costs in ject, no matter whether you support families, and our kids can struggle on this country. We succeeded at some of the Affordable Care Act—and I support their own. They can die on their own so those things. We didn’t succeed at oth- some things about it; there are other that Republicans can cut taxes for the ers of those things. It was a legitimate parts of it that have been disappointing richest people in this country. attempt at trying to deliver something to me—I think it is fundamentally im- What the Republicans propose is for the American people that people all portant for people to understand that morally wrong. It is not too late to do over the industrialized world don’t the Affordable Care Act is not our the right thing. It is not too late to re- have to live with. healthcare system. It is part of our verse course. It is not too late to junk Only in this country do people have healthcare system. The regulations this bill and start over. I hope the Sen- to make choices about feeding their that it has placed on insurance pro- ate Republicans have the courage to do family and taking care of their kids at viders so that people with preexisting exactly that. the doctor. Only in this country do sen- conditions couldn’t be denied insurance I yield the floor. iors have to make choices about cut- is part of our system. The fact that it The PRESIDING OFFICER (Mr. ting those pills in half. Only in this tried to create accountable care orga- ROUNDS). The Senator from Colorado. country do people have to make nizations so people got better primary Mr. BENNET. Thank you, Mr. Presi- choices about paying their rent and care so we would reduce the amount of dent. taking care of their kids. It doesn’t hospital readmissions from something I appreciate very much the com- happen in the rest of the industrialized like 18 percent or 19 percent, which ments from my colleague from Massa- world. Before I hear it from the other wasted billions of dollars in this coun- chusetts and my colleague from Penn- side tonight, let me say: Our results try, down to 2 percent or 3 percent, sylvania. are getting worse, not better. For pop- that is healthcare. I notice my colleagues from the other ulations across this country, longevity But there is a lot of healthcare that side of the aisle are not here tonight to is actually getting shorter, not longer. has nothing to do with ObamaCare or defend this piece of legislation. It This is a difficult, complex, but urgent that has something to do with it but it doesn’t surprise me, given what is in question for our country. was not the creation of ObamaCare. this legislation and given what we have That is what we were trying to do There is Medicare and Medicaid. There heard over the last week. with the Affordable Care Act. Some of are doctors. There are nurses. There The Senator from Massachusetts was it succeeded and some of it didn’t. I are patients. There are drug compa- explaining what it was we were trying will talk more about that in a minute. nies. That is our healthcare system, to do when we passed the Affordable For 8 years Republicans ran for elec- and our healthcare system is a mess. It Care Act, now years ago. Part of what tion after election after election on is a mess. It is a mess. We tried to take we were trying to do was to extend cov- ObamaCare: ObamaCare is socialism; this thing and improve it when we erage to a lot of Americans that didn’t ObamaCare is a Bolshevik plot to take passed the Affordable Care Act. Some have it. In my State of Colorado that over the United States; ObamaCare is of it worked; some of it didn’t work. meant over 600,000 Coloradans who destroying jobs—just at a time when Some people would argue we went too didn’t have it before the Affordable we were coming out of the worst reces- far. Some people would say we didn’t Care Act was passed. Another thing we sion since the Great Depression. We go enough. were trying to do was to say to insur- saw uneven job growth in this country But I can state this. I have been ance companies that it is not OK to but undeniable job growth over the en- doing those town halls again in Colo- have as your business practice that you tire period of time they were saying rado, and what I know is that people take month after month after month of ObamaCare was destroying the country feel defeated not by ObamaCare but by premiums from people and then when and destroying our economy. the American healthcare system—by they call on the phone and say: My kid The recession was at the end of the our healthcare system, which is less was sick; my kid got struck by light- last administration. The Obama admin- predictable and less affordable than in ning; my kid had an accident, to then istration saw the largest job increases many countries around the world.

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00034 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.042 S26JNPT1 June 26, 2017 CONGRESSIONAL RECORD — SENATE S3777 Now President Trump knew this. He People in my State are deeply dissat- these terrible things that ObamaCare is a smart politician. I never thought isfied with our healthcare system. I say had done. Your first order of business he was going to win. I never thought he that as somebody who voted for the Af- was to repeal ObamaCare. How dare was going to win on a campaign that fordable Care Act. I have said it before. you not have a vote? on so many dimensions was out of step People have tried to make a political I am glad they said that because peo- with conventional American political issue out of it. They write ads about it: ple should keep their promises. thought, and I was wrong. He won. I Look, Bennet said the healthcare sys- I have believed for a long time that don’t think he represents a traditional tem is not perfect. people want consistency out of their Republican view, and that may be one I will go further than that. It is a politicians, that they will put up with reason he won. In no sense do I think of crying shame that people in this coun- inconsistency if you say to them that Donald Trump as a conservative. I try have to spend their lives wrestling the facts are different than I thought think of him as quite radical in his pro- with insurance companies, lying they were and that is why I changed posals. I think of him as a reactionary awake, wondering whether their kids my view. Yet, in these times of fake force on a political system that the are going to be able to get primary news, of the media having the chal- American people, for whatever reason— care or dental care or cancer care if lenges it has, and the rest of the things some of them are probably good rea- they get sick. That keeps families up that ail our system, consistency is not sons—were losing their patience with. every night in my State, not so much something that a lot of politicians pay You cannot deny that the guy, some- the people who are on Medicare but a attention to. I think they think that is how, in the far reaches of Trump lot of other people. because voters do not pay attention to Tower, had his finger on the pulse of So Candidate Trump saw this unease it, but, in this case, they did. They what was going on in some parts of this in the American people, this concern said: You said you would repeal country. I don’t know if it was because that the American people had with our ObamaCare. You did not just say it he was a reality TV star or what it healthcare system, which I share, and once. You said it year, after year, after was, but one of those things was in his campaign—in his very populist year, after year. Finally, they then healthcare. He understood the Amer- campaign for President—he promised passed a bill in the House. Not a single ican people’s dissatisfaction with our to provide ‘‘such great healthcare at a Democrat voted for it. healthcare system, just as these 7 tiny fraction of the cost.’’ Those We learned from that process, which years and 8 years of Republican cam- knuckleheads in Washington do not took place before the Congressional paigns have understood it. Majority know what they are doing. I am going Budget Office had even scored the Leader MCCONNELL made it clear when to deliver you ‘‘such great healthcare bill—imagine that. There were all of we were passing the bill: You own it. at a tiny fraction of the cost.’’ That these people who criticized the Afford- You own it. He said in a book later was his promise to the American peo- able Care Act, and proponents were that it was very important to him that ple. That is what he said he was going rushing the bill through. As I said, I the American people were able to de- to deliver. think there were 200 Republican marcate between the Democrats’ re- He differentiated himself from other amendments adopted. It was a bill that sponsibility for the healthcare system Republicans by saying: ‘‘I will never held almost countless committee hear- as it was and the Republicans’ willing- cut Medicare.’’ ‘‘I will never cut Med- ings in the Senate Finance Committee ness to take no responsibility for it. icaid.’’ He said: Those other Repub- and the Senate HELP Committee. It Even though we had hundreds of licans say they will. I am not going to was a bill that consumed 25 days of leg- hours of hearings that lasted more than a year and even though we had— do that, but I am going to supply bet- islative process on this floor, a modern they are not countless—well over 100 ter healthcare than you are getting record in terms of time. In fact, we had Republican amendments that were now at a tiny fraction of the cost. He all of that process, and I will come made in committee and on the floor said: ‘‘Everybody is going to be taken back to this. Here is what Senator MCCONNELL that were incorporated in the legisla- care of much better than they’re taken said about that. After all of that proc- tion, in the end, not a single Repub- care of now’’ with no cuts to Medicare ess, he said on this floor, I think, that lican voted for the bill. and no cuts to Medicaid. Maybe that was a principled reason, We had our election, and people voted Americans were ‘‘tired of giant bills not just a political reason, because for this nominee who made not just negotiated in secret and then rammed maybe there are some people who have these promises but many other prom- through on a party-line vote in the the view in the Republican Party that ises about what he was going to do for middle of the night.’’ Oh, that bill was the Federal Government should not our economy based on, I think, largely, negotiated completely in public, pain- have any increased involvement in a complete fiction about what is actu- fully in public. I used to go home, and their healthcare system. In fact, I have ally going on in our country—for that people in my townhalls literally had heard some people say the Federal Gov- matter, in the world—with respect to copies of the bill. Do you remember the ernment should play no role in the our economy. So he won. He did not chant: ‘‘Read the bill. Read the bill’’? healthcare system. Yet whatever the just win—the Senate is Republican, That is because everybody had the bill. reason, not a single Republican voted and the House of Representatives is Re- On the House side, it is important for for ObamaCare. publican. people to understand that they passed The rest of the history writes itself, Now, after running elections for 8 the bill without even getting a score which is that every premium increase years to get rid of that scourge on from what is called the Congressional in America, whether it was related to America, that stain on America, that Budget Office. The head of the Congres- ObamaCare or not, becomes part of legislation that has destroyed our sional Budget Office is appointed by ObamaCare. Every drug that gets in- economy and destroyed our healthcare Republicans when the Republicans are creased in price becomes ObamaCare, system, they wrote a bill. It took them in the majority, not by the Democrats. and for everybody who loses his insur- a long time, really, to get it through It did not even get a score. We had a ance, that is ObamaCare when what is the House of Representatives, which score on the Affordable Care Act before happening is really far more complex was shocking, because they had 8 years we passed the bill. We had a score that than that. to figure out what was wrong with the every single American could see about There are very legitimate critiques current system and how to address the what it would cost and what money it of ObamaCare, but it is not the same current system. They tried it once, and would spend, what money it would thing as our entire healthcare system. they could not even bring it to a vote save, how many people would be added I think it is important to make that in the House. They could not even to the insurance rolls. We had that. point because, whether we are consid- bring it to a vote. They did not have the decency to do ering the Republicans’ proposed bill to- Then, understandably, the people that in the House. night or someone else’s proposed bill who sent those Republicans to office in They should have because—guess tonight, we would have to understand the House said: What are you talking what happened—when the score came it was not going to fix the whole prob- about? You said you were going to re- out, it said that 24 million people lem all at once. peal ObamaCare. You told us all of would lose their health insurance after

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00035 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.043 S26JNPT1 S3778 CONGRESSIONAL RECORD — SENATE June 26, 2017 a candidate for President said that you hall meeting and said the key to suc- ings for the privilege of being in a nurs- are going to have ‘‘such great cess here is in cutting those taxes. Just ing home paid for by Medicaid. There is healthcare at a tiny fraction of the to be clear, I should mention that $82.5 not a townhall I have where there cost.’’ ‘‘Everybody is going to be taken million is over a 10-year period. It is aren’t sons and daughters or grandsons care of much better than they’re taken about $8.25 million a year. and granddaughters of people who are care of now,’’ unless you are one of As Senator CASEY, from Pennsyl- in nursing homes paid for by Medicaid those 24 million and, I would argue, vania, noted, that $33 billion adds up to after they had to spend their whole life many of the rest as well. I will come to be the equivalent of what it would cost savings down to be there. What a ter- that. to pay for the Medicaid of 772,000 peo- rible system it is that a family has to So they passed that bill, a terrible ple who live in just four States—the be near bankruptcy before we say: We bill. I think that bill has the lowest ap- entire Medicaid population of four will give you a helping hand. It is a ter- proval rating among the American peo- States. rible system, but it is what they have. ple of any piece of legislation that has But what they would consume in And they can’t work. They are in a existed in the time I have been in the healthcare to try to support them- nursing home. They are in long-term Senate. It is still not as low as the ap- selves and their family is not $8.5 mil- care. proval rating of this place, which used lion a year; it is not $85 million over 10 Then there are a whole bunch of peo- to be 9 percent, but it is low because years; it is, on average, $4,500 a year on ple in my State and in other States— people know it does not really address healthcare. That is the first part of and this may be the greatest insult of their healthcare problems. It is not a this bill—a massive tax cut that is not all—who are working at one job or healthcare bill. going to benefit anybody in my State sometimes at two jobs, and in the rich- Then the President found out what who earns below $200,000. est country in the world, they are was in the Congressional Budget Of- The second element of this bill is a working and are getting paid and are fice’s score, and he had some Repub- massive cut to Medicaid, which is one not getting paid enough to be off the of the fundamental safety net pro- lican Senators over to the White House Medicaid rolls. They are working, and grams in this country. The cut, wheth- and said: I hope you will not pass a bill they are still on public assistance. And er you look at the House cut or the like that. That is a mean bill. we are cutting a quarter of the Med- Senate cut, is massive. It is about a That is not my description. That is icaid Program because people need to quarter of the program. It is about $840 President Trump’s description of the go to work. House bill. That is a mean bill. billion. And in the Senate bill, the cuts I am not making this stuff up. I He said: I want a bill with a little are even deeper than they were in the asked Secretary Price, who is the Sec- House bill. I wonder what the President more love in it than that bill out of the retary of HHS, Health and Human would say about that. The House bill Senate. Services—he is in charge of the was mean. I bet he would say the Sen- He has to be disappointed tonight be- healthcare for this administration—I ate bill is cruel because it perpetuates cause the Congressional Budget Of- said: Mr. Secretary, let me take you fice’s score came back and said that those cuts. I have heard the rhetoric from politi- through the faces of the people in my under the Senate’s version of the bill— State who are on Medicaid. And not the less mean bill—only 22 million peo- cians in Washington about why it is so important to cut Medicaid. They need only did they confirm that that is who ple will lose their health insurance and is on Medicaid in my State, he said that far from having better insurance to cut Medicaid so they can pay for the tax cuts for people who are so wealthy, that is the way it looks all over the at a lower price, half of the country— most of them probably don’t even need country. literally half the country—is going to to mess around with insurance to pay What an insult to justify a massive pay thousands more in out-of-pocket for their healthcare or their doctors. tax cut for the richest Americans by expenses because of what has become Now they are going to have another taking away poor people’s healthcare; known as TrumpCare. $8.5 billion a year. Now they are going by saying they are not working for it, There are three principal parts to the to have another $85 million over 10 when they are children, when they are bill in the Senate and in the bill that years if they want to spend it not on in nursing homes, when they are work- has passed the House. There are some insurance but on whatever else they ing one and sometimes two jobs in the differences, but I would say they are want to spend it. richest country on the world. differences without a distinction. They So on the one hand, they had to find So that is the second part of this are immaterial distinctions. There are the money to pay for this tax cut. They healthcare plan—tax cuts for wealthy three major components to these so- found it from some of the poorest people and cutting Medicaid for poor called healthcare bills. Americans there are. How do they jus- people. And in the middle of that is the The first is a massive tax cut for the tify that? They justify it by painting a only thing that could fairly be de- wealthiest people in America. If you picture that says that there are Med- scribed as a healthcare plan; it is just are making $200,000 or less in Colorado icaid recipients all over America who a terrible plan. or in any State in the country, you will are receiving Medicaid but not work- Senator PAUL from Kentucky—one of not get a penny from this tax cut—not ing, and therefore we should cut the the more principled people in this a penny. As my colleague from Penn- program because if we cut the program, Chamber—said it very well when he sylvania said, if you are one of the top they will know they have to get a job called it, not politely, ‘‘ObamaCare 400 taxpayers in America, together, in order to buy health insurance, and lite.’’ He is absolutely right. If you you are going to get $33 billion in tax they won’t be on the Federal Medicaid hate ObamaCare, you are really going cuts. That is an average tax cut for Program. They say to go to work, and to hate ObamaCare lite. It is the same each of those 400 Americans of $82.5 that is why we can cut this program. structure, which amazes me because all million. There is not a person in Colo- Keep people out of that hammock they of the people who said we should repeal rado at any one of my townhalls who are lying in instead of working for ObamaCare are now preserving the has said to me: MICHAEL, the key to their healthcare. very basic structure of how the pro- doing a better job with our healthcare What an insult to the almost 50 per- gram worked, but the problem with it and the key to fixing ObamaCare—and cent of Medicaid beneficiaries in Colo- is that they have cut the subsidies. I am talking about the critics of rado who are poor children. Are they They have turned them into tax credits ObamaCare. There is not a one who has supposed to go to work, or can they go and cut the value of the subsidies. If said to repeal those taxes on the top 1 to school? And while we are at it, you think insurance is expensive now percent of taxpayers in America at a maybe we should think about giving in the individual market, wait until time when our income inequality has them better schools so they can actu- you meet ObamaCare lite, in the words not been greater than in 1928 and at a ally compete in this economy. But are of RAND PAUL. time when we are collecting in revenue we really going to take away their So those are the three components of only 18 percent of our gross domestic healthcare? the bill. And it is not surprising to me product and spending 21 percent. Not a Then there are a whole bunch of peo- that for those reasons, Senator MCCON- single person has stood up in a town- ple who have spent down their life sav- NELL has written this bill in secret. It

VerDate Sep 11 2014 05:51 Jun 27, 2017 Jkt 069060 PO 00000 Frm 00036 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.045 S26JNPT1 June 26, 2017 CONGRESSIONAL RECORD — SENATE S3779 is not surprising to me that he hasn’t quire people in America to buy health around here—and dramatically cut ac- wanted to have a committee hearing. It insurance and then not have a market cess to healthcare by poor children. is not surprising to me that he brought that gave them quality health insur- I know there are people who are hear- the bill here on the floor last Thurs- ance at an affordable price is ridicu- ing this will not believe what I am say- day, then accused people on the other lous. ing is true. It is true. I hope you will side of not having read the bill and still I have had people in rural Colorado familiarize yourself with the facts. I wants us to act on the bill this Thurs- say to me: MICHAEL, look, why are you hope, in particular, people who feel the day so he can go home before July 4th requiring me to buy something where last bill we considered on this floor and say to the American people: We did there is not enough competition, so the didn’t get the process it deserved—peo- it. We kept our promise. We repealed premium is high and the deductible is ple who quite rightly wanted to make ObamaCare. We may have written a ridiculous. So it is of no use to my fam- sure Members of the Senate and the terrible piece of legislation that has ily, and you are requiring me to buy House had actually read the bill, people nothing to do with improving your something that is useless to me. We who wanted to know what it was like healthcare, but we repealed should have more competition to drive to live in a country where your health ObamaCare. And he is hoping the down price. insurance is uncertain from month to American people won’t notice. I say: You are 100 percent correct. month, where you have to decide be- Let me tell you something. The And if we had a functioning Congress tween paying the rent, buying the food American people are noticing. There is that wanted to take a bipartisan ap- or being on health insurance; people a reason why the House bill has the proach to fixing that problem, we could who are dealing with and whose fami- worst approval rating of any piece of fix it, and there are probably 15 or 20 lies are dealing with the effects of this legislation in modern American his- other things along those lines. But the terrible opioid crisis that wasn’t even tory. The American people are not stu- Republican healthcare bill—so-called really a gleam in our eye when we pid. healthcare bill—does none of that. It passed the Affordable Care Act. I was in Frisco, CO, not that long does none of that. I especially say to people living in ago, which is a place that everybody So to the extent that you don’t like rural America how sorry I am that peo- should visit from all over the country. ObamaCare because you feel as though ple aren’t paying attention to your There is tremendous skiing, and there your premiums are going up and you needs; that your hospitals may be cut is tremendous hiking, wonderful peo- are not getting enough for it, as op- because of an ill-considered piece of ple. And before I had the townhall posed to the millions of people who legislation which has nothing to do meeting, I went and visited a have gotten insurance as a result of it, with delivering healthcare in rural Col- healthcare center there that they are some for the first time—to the extent orado or rural America. justifiably proud of. It turns no one you are worried about that, the House We can do so much better than this, away. It gives phenomenal primary bill makes it worse and the Senate bill but to get to a place, unfortunately, care. It gives phenomenal dental care. makes it worse. where Democrats and Republicans have They have to figure out every week There is a projection in the CBO re- the opportunity to work together, the how to get through, but they always port that says that at a certain point first order of business has to be to de- figure out how to get through so that in time, your premiums might come feat the bill on the floor. I hope people people in Frisco and in the surrounding down under the Republican bill, but know this is the week when it is crit- area have healthcare. the reason for that is because you will ical to call and let your voices be This is not a poor community by be buying lousy insurance. It is not be- heard, let people know you expect American standards. It is a resort com- cause Donald Trump, as he said to the something better than what we are get- munity, but there are people who live country, has provided such great ting, and that Americans ought to have there year-round. I asked the people healthcare at a tiny fraction of the a healthcare system that is affordable, who run the clinic: Who are the payers cost. That is not the reason. It is be- that is predictable, and that actually for healthcare in your clinic? Who are cause they provided terrible healthcare creates stability instead of instability they? What pays for healthcare here? at a fraction of the cost. That is not a for their families. And she said: Well, MICHAEL, the Med- benefit to anybody. If an insurance Mr. President, I yield the floor. icaid is 33 percent. That shocked me company can put you on lifetime caps, I suggest the absence of a quorum. because if you are in rural Colorado, of course they are going to charge you The PRESIDING OFFICER. The the Medicaid number is usually a lot less. clerk will call the roll. higher than that because people don’t I am all for working together in a bi- The legislative clerk proceeded to have access to a lot of resources, and partisan way to address the issues in call the roll. we all know they don’t have access to our healthcare system that, frankly, go Mr. BENNET. Mr. President, I ask a robust insurance market. Thirty- far beyond the Affordable Care Act to unanimous consent that the order for three percent was Medicaid, 53 percent make sure people in America don’t the quorum call be rescinded. was uncompensated care, and the rest have to continue to make the choices The PRESIDING OFFICER. Without was private insurance companies that people all over the world don’t have to objection, it is so ordered. pay for the insurance. That shocked make about having to stay in a job f they hate because they have to keep me. ADJOURNMENT UNTIL 2 P.M. the insurance or being able to quit a I said: Fifty-three percent is uncom- TOMORROW pensated care, people with no insur- job and do something else because they ance? How can that be? know the insurance will be there. No- The PRESIDING OFFICER. Under She said: These are people in our body else has to make those decisions. the previous order, the Senate stands community who make too much money And nobody else in the world goes adjourned until 2 p.m. tomorrow. to be eligible for Medicaid, but they bankrupt because of healthcare, but Thereupon, the Senate, at 9:55 p.m., can’t afford private insurance. that is still a problem in America. adjourned until Tuesday, June 27, 2017, They are working full time; that is I think fundamentally the problem at 2 p.m. not the problem. They are not even—as we have here tonight is proponents of f I described before in a case where this legislation didn’t set out to fix our NOMINATIONS somebody is paying them too little, so healthcare system; they set out to re- they are eligible for Medicaid; their peal ObamaCare or the cartoon of Executive nominations received by problem is that they are being paid too ObamaCare they have been running on the Senate: much, and they are not eligible for for the last 8 years. That is what they DEPARTMENT OF TRANSPORTATION Medicaid as a result, but they can’t af- set out to do. Along the way, they ob- MARK H. BUZBY, OF VIRGINIA, TO BE ADMINISTRATOR OF THE MARITIME ADMINISTRATION, VICE PAUL NA- ford private insurance. I think that is scured it all so they could have the op- THAN JAENICHEN, SR. an indictment of the Affordable Care portunity to cut taxes on the wealthi- DEPARTMENT OF STATE Act that I accept as somebody who est Americans—which, for some reason, MARIA E. BREWER, OF INDIANA, A CAREER MEMBER OF voted for it. The idea that we would re- is an obsession with some people THE SENIOR FOREIGN SERVICE, CLASS OF MINISTER–

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