Healthcare

Floor Speech

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Madam President, for the past several months, Republicans in Washington have done just about everything they can to hide their healthcare repeal bill. Remember that way back in the beginning they tried to actually move a bill without a CBO score. Then, they realized that even Republicans didn't want to vote on something without knowing how much it would cost or how many people would lose healthcare coverage. So they said the score didn't matter or that it was wrong, except for in the areas where they liked the numbers. They trashed the CBO even though, for the last 8 years, they referred to the CBO to make their argument against the Affordable Care Act.

When that didn't work, they tapped 13 men to draft a bill in secret.

It is no surprise that a bill crafted without women, without hearings, and without Democrats was not able to cross the finish line.

Now they are actually back to their original plan, which is to push legislation without a score from the CBO. In other words, we are going to go to next week, and we are going to vote without knowing how bad this bill is. This is not the way the Senate is supposed to work. If there is no score, there should be no vote.

Clearly, CBO got back to the Senate today and said that they will have enough time to analyze the fiscal impact of this proposal, but they will not be able to analyze the impact it has on our constituents.

So do you remember the last 2 or 3 iterations of this bill? People were concerned with the fiscal impact. But remember that the headlines were that 18 million people lose coverage, 26 million people lose coverage, and 32 million people lose coverage.

We are going to vote next week not knowing how many people are going to lose coverage. It shouldn't matter what side of the aisle you sit on. We should all be able to agree that something as complicated as healthcare needs as much debate as we could possibly get, and that is certainly more than the 90 seconds that procedurally we have left on this bill.

After all, this is one-sixth of the American economy, but for the third time this year, Republicans are going to do whatever it takes to pass a healthcare bill, even if no one knows what is in it or what it will do, even if this bill is very clearly bad policy. By doing this, they are letting down millions of Americans who were counting on the Senate to be the cooling saucer and to slow down and consider policy carefully.

There has been very little debate around this bill. We have not heard from doctors. We have not heard from patients or advocacy groups. We have not heard from healthcare administrators or economists. That is because we have had no hearings.

Just tonight, Senate Finance Chairman Hatch announced that on Monday at 10 a.m. his committee will hold a hearing on the bill, and I am hopeful that, through that process, we will begin to understand the damage that this bill will do. But right now, here is what we know.

This is actually the most extreme of all of the versions of TrumpCare that we have seen. Here is what it does. It eliminates everything in the ACA that was essential: tax credits and subsidies to help people to afford their insurance; the Medicaid expansion, which is very, very successful and very popular; and the protocols that we have in place for people with preexisting conditions.

It eliminates Medicaid as we know it. This bill eliminates Medicaid as we know it. So what they did was that they established block grants, which means you get a fixed amount. Each State gets a fixed amount for Medicaid. Then, those Medicaid block grants disappear after 10 years.

It is shocking to me that having failed to get the votes, they went further to the right, with deeper cuts to Medicaid--both to the Medicaid expansion program and to the Medicaid Program as it existed before the Affordable Care Act. They went ahead and said: You know, we only got to 49 votes last time. So I think what we should do is to eliminate all of the subsidies, all of the patient protections, all of the essential health benefits, and all of the Medicaid expansion, and let's take Medicaid as it exists and eviscerate it.
The latest version of TrumpCare will take healthcare coverage away from tens of millions of people.
Last week our country hit an important milestone. The number of Americans who do not have health insurance fell to a historic low of 8.8 percent. That means that 9 out of 10 Americans now have health
insurance. But instead of celebrating this milestone, Republicans are about to end our country's progress on healthcare.

Americans who don't lose their coverage will still get hurt with higher premiums or insurance plans that don't cover basic things like getting help for opioid addiction, pregnancy, hospital stays, mental health. So if this bill passes, healthcare will no longer be a right in this country. It will be a privilege. It depends on where you live,
where you work, and how much money you make.

This bill devastates one of the best and most successful programs this country has, and that is Medicaid. This is a program that helps one out of every five Americans and two out of every five children. It helps one out of every two families with a newborn baby, and it covers three out of every four long-term nursing home residents. Medicaid saves lives--nursing home patients, people struggling with opioid addiction, and people who are working two jobs but still don't have enough to cover their own healthcare.

This bill destroys Medicaid as we know it. They start off by putting traditional Medicaid into what they call per capita caps or block grants. That basically means that, whatever money was spent last year, that is the amount the State gets in perpetuity until they just zero it out completely. What that means is that States will be left without adequate Federal funding for Medicaid. Think about what this means for the healthcare infrastructure in this country.

In many States hospitals and local governments have actually designed the healthcare system based on a certain amount of Federal funding coming in. If you take away that funding, hospitals will collapse. In rural areas, hospitals and clinics will close, and people will be left without options and ultimately without access. That is just the damage done by cutting Medicaid.

This bill also lets insurance companies opt out of covering what they call ``essential health benefits.'' This is a term of art, a piece of jargon. So I want to explain what this means. Under current law, there are certain things that have to be in any healthcare plan. Those are called essential health benefits. You buy a healthcare plan, wherever you buy it. If you get an employer-covered plan, if it is a DOD plan or a VA plan, or if you are on the exchange--whatever it is--it has to cover certain things. Let me list what is covered right now as an essential health benefit: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehab, lab services, preventive and wellness services, chronic disease management, and pediatric services. These are the things that actually have to be in your healthcare plan under ACA.

Yet do you know what this bill does? It says: No need. Configure your healthcare plan however you see fit.
If you are a health insurance company and if you are a for-profit health insurance company, you are going to pick and choose these things based on what is profitable, and if there is a certain thing that is costing you a lot of money, you are under no obligation to provide any of these health benefits because it is not in the law anymore. This eviscerates essential health benefits.

This bill will also take away protections for people with preexisting conditions. Nothing will hold States back from allowing insurers to charge people with diabetes more or people with cancer more for their health insurance. Experts have started to look at what this will mean for people with preexisting conditions, and they will pay thousands of dollars more. A patient with asthma will pay more than $4,000 a year extra if this bill passes, while a patient with metastatic cancer will pay $142,000 extra. If you have metastatic cancer, this bill will cost you $142,000. If you have a kid with asthma, that will be $4,000 a year. This is their healthcare bill--to charge people more who get sick. That is their healthcare bill.

Everything that is working under our healthcare system is being shredded by this bill. Take Planned Parenthood. These health centers serve millions of women and men across the country. They are part of the solution, not the problem, but this bill cuts funding to Planned Parenthood, which will cause many of these clinics to close.

I want you to think about how many people in this country are actually employed in the healthcare industry. When the Affordable Care Act started to kick in, research estimated that as many as half a million jobs were created. But if millions of people are to lose their insurance, that means that they will lose access. If fewer people can access healthcare, that means that we will have fewer doctors, nurses, and technicians. In other words, cuts to healthcare coverage are also cuts to American jobs.

I know that, in a lot of rural communities across Hawaii and across West Virginia and across the country, the community healthcare centers or the small rural hospitals are not just the centers of their communities in a social context or in a community context, but a lot of the time they are the economic drivers. So this will do great damage to rural America.

I end by making clear what this means for Americans and their healthcare. This is bad policy, plain and simple. It is bad if you live in a State like Ohio, where lives have literally been changed because people now have access to prescription drugs or to a primary care provider under Medicaid. It is bad for people who buy their insurance on the exchanges because their prices are going to go up.

It is really bad for people with disabilities. This is not unusual.

For whatever reason, people with disabilities are the first to be punished when the battle over healthcare comes up.

It is bad for people with preexisting conditions because States will no longer be required to protect their ability to get healthcare. This bill does not pass Senator Cassidy's own Jimmy Kimmel test. That is why more than half a million doctors in the United States have come out as being opposed to this bill, because it will take healthcare away from the people who need it, who are sick, and who will not be able to get healthcare if the bill goes into law.

This may feel like the zombie bill we have killed several times already. I know it feels like that for me. I am sure that people are exhausted. I am sure that people thought this was over. We had that magnificent moment on the Senate floor when John McCain walked over to that well right there and did a thumbs down. I tell everybody back home that it is so rare that politics is just like the movies, but that night was just like the movies. John McCain saved healthcare for the American people and put us on a path toward regular order. What does ``regular order'' mean? I did not know what that phrase meant until I came to this institution. Regular order just means that the Senate understands that it has a special obligation in American society--that we are the place in which we are supposed to handle tough issues.

Chairman McCain pricked our consciences as Senators. Forget Democrats and Republicans; forget Liberals and Conservatives. We are all here because we want to try to make a difference. So there we were with Lamar Alexander, the chairman of the Health, Education, Labor, and Pensions Committee, and Patty Murray, the top Democrat on that committee. They were ready to work on a bipartisan basis. Lamar had held hearings and, by all accounts, they had had tough negotiations and difficult challenges, not as much progress as you would want or as quickly as you would want. That is the way legislating works. They are in a bipartisan process, and we show up here, and that process is in danger of being blown up.

This bill is a rotten piece of legislation. It is not like this thing has been vetted by experts. It is not like this thing is bipartisan. It is not like this thing will help. It would be one thing if this were absolutely necessary. Then, you could make some procedural accommodations because you just must. This is a political necessity for a party that has not yet had a legislative win. That is why they are doing this. They are in a hurry because they have until September 30 to check a box called ``We repealed and replaced the Affordable Care Act.'' They have no new ideas. So what they did was to take all of the bad ideas from all of their previous bills and put them into one bill, and they are going to take one last swing at it.

I cannot tell you how disappointed I am, not just on policy but on process. I was never prouder to be in the Senate than on that early morning, after a long session, when John came in and, in my view, saved the Senate and put us on a path toward regular order. Do not blow that up. We have a chance to do things in a bipartisan way and restore the dignity of this institution, but what we are fixing to do next week will take us in a very, very dark direction.

I yield the floor.

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Madam President, I thank the Senator from Connecticut.

That is right. I would just point out that they are going to get the fiscal impact from the CBO in order to comply with the terms of reconciliation, but that is, actually, not what impacts the American people the most.

When you get a CBO score--and it is exactly right, what the Senator from Connecticut said--you find out what impact it has on your home State. You find out the number of Americans who are going to be harmed by this bill or helped by this bill. What we do know is that, basically, this contains elements of all of the previous pieces of legislation. It, actually, just kind of combines them all and puts them in a pile. So it is very hard for me to imagine, when they do come back with their analysis, that it will not be 20, 30, 35 million people who will lose healthcare.

The craziest thing about this is that these Republicans who will vote yes are going to vote yes and then find out 10 days later that 25 million people are going to lose their healthcare. Why they will not wait is beyond me, except that they have a deadline to deliver a win for the President. As near as I can tell, that is the only reason that they are in such a rush.

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Madam President, I think the Senator is right. I agree with him.

I think that one of the most encouraging things over the last 5 weeks has been Lamar Alexander and Patty Murray and their ability to work together. I mean, if you had told, I think, either of us that we were going to repeal and replace No Child Left Behind with 77 votes in the Senate, I would have said: I don't know. That seems like it is going to get into some pretty difficult, partisan, thorny territory.

Yet what Lamar and Patty were able to do is to conduct hearings and bring us through a process by which we acted like a Senate, and we got all the votes.

Now we are in that process when it comes to healthcare, and I think some people feel deeply uncomfortable with empowering the chair men and women of this body. They feel deeply uncomfortable. They talk about the regular order, but they really just want to get their way on the floor.

I will just make one other point here. As people on the Republican side were justifying their ``yes'' votes in BCRA and whatever the other one was called before that, they were always talking about advancing the conversation and bringing us into a conference committee negotiation. Now, because September 30 is the deadline, there will be no negotiation. If Graham-Cassidy passes the Senate, it will pass the House, and it will be enacted into law. Nobody will get to hide behind: Well, this is not perfect, but I want to advance the conversation, and maybe we can fix this in the House or fix this in the conference committee.
This is the bill. The bill that gets voted on next week is the bill.

Everybody owns it, and you own the fact that you don't even know what it is going to do to your own constituents.

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