Mr. President, I ask unanimous consent that the order for the quorum call be rescinded. Mr. President, I want to talk about the healthcare bill, the healthcare issue, and talk a bit about how we can find a solution and then what the…
Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.
Mr. President, I want to talk about the healthcare bill, the healthcare issue, and talk a bit about how we can find a solution and then what the solution should look like.
For the last 2 days, as a member of the Armed Services Committee, I have been in our markup. In that markup, we considered somewhere in the neighborhood of 250 to 300 amendments. Of those 250 amendments, approximately 210 of them were either compromised--an agreement was worked out between the proponents of the amendment and those who had reservations--and they were either withdrawn or became part of the bill by unanimous consent. Of the 25 or 30 that were left for votes, however, we had good debate. The members talked about their point of view. The people who opposed them gave their points of view. We had a vigorous discussion and debate and then we voted. The important thing to me--and I am pretty sure I am right about this, I kept a mental note as we went through the votes--I don't believe there was a single party- line vote in the Armed Services Committee on any amendment. The votes were sometimes more Republicans, more Democrats, but there wasn't a single party-line vote. In other words, the process worked as it was intended to work, as it should work, and as it can work.
So I have a radical suggestion for those who are seeking a solution to this healthcare issue; that is, submit a bill and put it before the requisite committees, have hearings, have debates, have information, get information from around the country, from experts, from people who know about the topic, and that is how we make good laws. A bill that doesn't go through any of that process, that is concocted in secret and sprung on the Congress at the last minute, almost by definition will not be a good bill. Bad process--bad bill, and that is what we had happen in this case.
I think this is a time--we are going into a recess at the end of this week. Let's take a deep breath, and instead of trying to tinker around and attract a few extra votes and find something that will barely pass by the skin of its teeth, let's step back and submit this issue to the Finance Committee and the HELP Committee. Let's try to work through to find a real solution involving both parties, involving all of the wisdom that has been accumulated in this country on this incredibly complex and difficult and incredibly important issue. We don't have to try to do it in the dark. Let's do it in the light of day. Let's have open hearings and considerations, votes and amendments, discussion and debate, and then as our system is designed, we can come to a good result.
Let's talk about the bill that is currently before us. I guess it is before us. It hasn't really been submitted to any of the committees, but I am told it is coming to the floor. It was going to be this week. Now it is going to be the week, I guess, after the recess--at least that is what we were told yesterday.
Why is this a bad bill? I have been watching some of the commentary on this bill, and there is a lot of discussion about the Congressional Budget Office analysis: Is it correct, did they use the right baseline, are they good at projecting how many people are going to sign up for healthcare, and all of those kinds of questions. People are questioning the Congressional Budget Office. I happen to think they tend to be pretty nonpartisan, straightforward, good, scientific, and quantitative analysts of these kinds of issues. They issued their report saying 22 million people lose their healthcare. This is about people. It is not about ideology. It is about real people.
There is a really easy way to cut through all of the questions about whether they analyzed it properly and who is going to lose and who is going to win; that is, to look at a simple chart that is on, I think, the third page of the Congressional Budget Office analysis. This is really all you need to know about this bill: Medicaid loses $772 billion over the next 10 years, and the tax credit and selective coverage provisions--that is the ACA--loses $400 billion. It is $1.1 trillion out of the healthcare system. You cannot take $1.1 trillion out of the healthcare system and not hurt people. You can't do it. We don't have to argue about how many here, what age, and all of that kind of thing. We are talking about a massive cut to the support that is enabling American people to get healthcare.
In Maine, if you cut all these numbers back, as near as I can tell, it is about $400 to $500 million a year. I was the Governor of Maine. I know that $400 and $500 million a year is huge. People talk about: Well, we are going to cut Medicaid back. We are going to trim the growth rate. We are going to lower the way it is calculated and make it a per capita cap, all of these things, and we are going to give the States flexibility. The magic word ``flexibility''--as if the flexibility enables you to somehow conjure up $1 trillion. What you are really giving the States is the flexibility to decide between the elderly and the disabled or children. That is what this is all about.
There is another option, by the way. The States can always raise taxes to make up for this difference, and that is one of the most frustrating things to me, again, as a former Governor. We are talking about this reduces the Federal deficit by $330 billion over 10 years. Yes, because you shifted almost a trillion dollars to the States. That is nice work if you can get it. That is balancing the Federal books on the backs of the States. If we want to make the Federal budget look better, why don't we just let the States pay for the Air Force? That is a Federal expenditure. Shift that to the States. That will help us with our budget deficit, but it is a fake balancing of the budget because you are simply shifting the cost over to somebody else--another level of government.
The shorthand for that is shift and shaft. That is what we are talking about, either the State government is going to be shafted because they are going to have to raise taxes or the people who are going to lose the support are going to be shafted. We are talking about real people.
Let me talk about Medicaid for a minute. Medicaid is sometimes characterized--and I have even heard some of my colleagues use Medicaid and welfare in the same breath, as if Medicaid is a welfare program. It is not. It is a critically necessary support for healthcare for people who need it, many of whom are not welfare people--as we would denote them--not welfare recipients. They are getting a lifeline, a true lifeline that is actually keeping them alive.
In Maine, 70 percent of the people in nursing homes are on Medicaid. Nationwide, the number is 62 percent. So when you talk about Medicaid and cutting Medicaid, you are talking about Aunt Minnie in the nursing home. You are not talking about some welfare recipient who is ripping off the system. You are talking about your relatives who are in nursing homes, and 70 percent of the people in nursing homes are being supported by Medicaid. In Maine, we call it MaineCare.
So you can't shrink this amount of money and think it is not going to have impacts on people, and that is why this bill is so pernicious. Here is what the bill is all about: a one-half trillion-dollar tax cut to the top 2 percent of wage earners in America. Let's be clear what is going on here. There is an equation of one-half trillion dollars of tax cuts and more than one-half trillion dollars of cuts to benefits--money to the wealthy; healthcare away from those who need it. That is the equation. That is what this bill is all about. This isn't a healthcare bill. This is a tax cut bill dressed up like a healthcare bill, and it is also an ideological bill because people don't like Medicaid.
Here is the problem: Our healthcare system is the most expensive in the world. We pay the most per capita for healthcare as anyone on the planet, by far--just about twice as much as most other countries. If you do the math and you take the annual healthcare bill and divide it by the number of people in America, you get about $8,700 a year per person. That is what we spend on healthcare. So for a family of four, that is $35,000 a year. That is what healthcare costs us. By the way, that is the real problem. When we are talking about Medicaid and Medicare, Anthem and private insurance, and all of those things, we are really talking about who pays. The deeper issue is how much we are paying. The problem is--and the reason we need Medicaid and the reason we need Medicare and the reason we need the Affordable Care Act-- American people can't afford it without help. It is as simple as that. They can't afford it. The government has to provide some support. If it doesn't, it would break every family in America. We have to have the support. Right now, in the private sector, it is breaking our companies that are trying dutifully to keep up with the increase in costs of healthcare.
Don't fall for this idea that somehow the Affordable Care Act caused all the increases. I remember--again, harking back to when I was the Governor of Maine in the late 1990s, early 2000s--healthcare costs were going up 6 percent, 8 percent a year--10 years before the Affordable Care Act went into place. The private--the individual market for health insurance was already on a drastic upward climb. So to blame it somehow on the Affordable Care Act just doesn't wash in terms of the history.
The deep problem, as I say, is the overall cost of healthcare. We have to start talking about that issue. That is a separate issue from what we are talking about here as to who pays. We have to talk about different kinds of delivery systems. We have to talk about a huge increase in preventive care. We have to talk about helping people stay out of the hospital, stay out of the medical system. The cheapest medical procedure of all is the one you don't have to perform. So many of our diseases--our chronic diseases like diabetes--are based upon the choices people are making and their lack of adequate care early in the disease. That is a separate discussion. I think that is one we really have to look at. However this debate is resolved in the next few weeks or few days, we have to talk about the deeper issue of the overall cost. If we don't get a handle on that, then all of this other stuff is going to be--it is not going to solve the problem because the deeper issue is the enormous cost we pay in this country, which is almost twice as much as anybody in the world per capita.
You could say: But we have the best healthcare in the world. Yes, we do, for the people who can afford it. But for millions of people who can't afford it, who have either no or skimpy care, it is not the best healthcare system in the world.
There are no statistical indicators that tell us we are doing very well. On things like longevity, prenatal care, infant mortality, we are way down. We are like 17th, 20th. You would think that if we are spending the most money in the world, we ought to have great results. We don't. So that is something we have to talk about.
The cost of pharmaceuticals, the cost of drugs is higher here than anywhere else in the world. Why is that? That is a problem we have to discuss.
I had a tele-townhall Monday night. It was sponsored by the AARP of Maine. At the peak, they tell me there were 10,000 people on that call. I took questions, and the questions from seniors in Maine were full of concern--``fear'' may be too strong a word, although in several cases it wasn't, but very deep concern about what the effect of this will be on them, on their mothers, on people who are depending on Medicaid for their care.
One lady who called pays $8,000 a month for her chemotherapy drugs. If it weren't for her support under the Affordable Care Act and Medicaid, she said on the phone, ``I'd be dead.'' That is what we are talking about here. We are talking about real people.
The final sort of general point I want to make before I talk about some of the people who are going to be affected by this is that I hear sometimes the proponents saying: The free market is going to solve this problem. The free market is miraculous; it can solve all problems.
I am a huge believer in the free market. I am a thoroughgoing capitalist. I started a business. I ran a business. I understand the free market. The problem is that healthcare is not a free market. If you go to buy a car, that is a free market. You can go online and compare. You can test drive. You can find the prices at the four dealers that are in your neighborhood. You can do all of those things. That is a free market. You don't have that in healthcare.
No. 1, you don't know the price. You call your local hospital and say: What will it cost me to get my knee replaced? Nobody can tell you. You don't know the price.
No. 2, it is very hard to compare products. You can do it if you can really dig and get word of mouth on who is a good doctor and who isn't.
No. 3, you don't say what you want; the provider tells you what you need. Imagine going into a car dealership and the car dealer saying: I am going to tell you I think you need this Mercedes over here. I think that is what you need, and by the way, you pay for it.
Our system is set up such that providers are paid for delivering a service, not keeping you well. They get paid by procedures, fee-for- service, not for keeping you well. There is no money in prevention. We have to change that. We have to change that.
Now let me talk about people. These are some people I have talked about before, and I just want to sort of go through them.
You know who this is. This is a Maine lobsterman. This is a guy; his name is David Osgood. The ACA gave them a chance to get insurance. It gave them an opportunity to get insurance where before it was practically impossible. He said it has given them some comfort, some reassurance. He said: ``We'll be okay.'' That is the Maine way. ``We'll be okay.'' This is one of the most independent, toughest professions there is in this country, but he is not part of a big corporation, and he doesn't have somebody to pay part of his healthcare. He has to make it work, and the ACA gave him an opportunity that he didn't have before to give some confidence to his family and to his life.
By the way, there are about 75,000 people in Maine just like him who got coverage under the ACA, many of them for the first time, and those are the calls we are getting in my office.
This is Jonathan Edwards and Jen Schroth. This is sort of a funny story; it tells you what Maine is like. I know Jen's mother. I worked with Jen's mother in the early eighties. Maine is a big small town with very long roads. We all know each other. And it just happens that here we are, 25 years later, and I have become acquainted with Jen.
She and her husband are farmers. They are small farmers in coastal Maine. She thinks it is irresponsible to go without health insurance, especially when you have a family, but it was so expensive, they couldn't get it. They couldn't acquire health insurance in the individual market because they are not a member of a big corporation. The ACA gave them access to insurance for the first time--real insurance that covers what they need, not skinny insurance that only covers certain things and doesn't cover other things and just gives you the illusion of coverage until you go to make a claim.
Jonathan Edwards and Jen Schroth are farmers in Brooklin, ME--that is the real Brooklin, by the way, Brooklin, ME. Forget about that place in New York; this is Brooklin with an l-i-n. They are farmers in Maine to whom the ACA gave an opportunity to get insurance for the first time for their family.
Cora and Jim Banks from Portland raised four boys. This is amazing. They raised four boys, and every single one was an Eagle Scout. That is amazing. I mean, to be an Eagle Scout is a real achievement in this day and age. Cora worked at her home. She developed Alzheimer's in her late fifties. That is a tragic disease. When Jim could no longer care for her safely at home, she went to a nursing home, and Medicaid helped her be there. Medicaid helped her be there. If you start taking away Medicaid, what will become of Cora? What will become of Jim? He took care of her as long as he could. If she has to go home, if she has to leave that home, that will be a tragedy for her and for her family.
Again, as I mentioned before, 70 percent of the residents in nursing homes in Maine are on Medicaid. That is the kind of difference it makes in real life.
Here is Dan Humphrey. Dan Humphrey is a young man with autism who volunteers at local soup kitchens and delivers Meals on Wheels in Lewiston, ME. He depends on a Medicaid waiver to support his independent living. If it weren't for Medicaid, Daniel would be in an institution, or he would be with his parents. They wouldn't be able to work because he would need care 24 hours a day. He does need care and support 24 hours a day. Under Medicaid, he is able to lead a real life and feel good about it. You can tell he is a great guy; look at his smile. Medicaid is a lifeline.
I talked about Dan 2 or 3 weeks ago, and since then, I have had an outpouring from people across the country and especially in Maine, people who have children or relatives or friends with disabilities, on what this has meant for them and how terrifying it is that anybody wants to take three-quarters of a trillion dollars out of Medicaid, which is providing an opportunity for Daniel to lead a decent life. Why would anybody want to do that? I don't get it. I don't get it.
Of course it can be made more efficient. Of course the ACA can be made more efficient but not three-quarters of a trillion dollars more efficient. That is a huge amount--$450 million a year in Maine.
Daniel waited 8 years, under the current program, for the services he gets now. And if we put in caps and block grants--that sounds good in Washington: We are going to put in caps. Caps mean Daniel may not get his services next year or the year after or another guy like Daniel in Peoria or Philadelphia or San Francisco. That is a tragedy. These are real people. We are not talking ideology; we are talking real people.
Here is Lydia Woofenden. She lives near where I live. She just graduated from Mount Ararat High School in Topsham. Two of my boys graduated from Mount Ararat. She even has a job she was offered after years of volunteering. Everything she has achieved has been accomplished with help from her family and dedicated teachers and therapists almost exclusively funded through special education in the public schools and Medicaid.
By the way, having a child with disabilities has nothing to do with your income. You could be high income, low income, middle income. It has to do with the luck of the draw. It has to do with bad fortune, and it could hit anybody. So, again, this idea that Medicaid is some kind of welfare program is just not true. It is not true.
So, Mr. President, the reason I am here is because of these people. The reason I am here is to stand up for these people because they can't be here to do it themselves.
We can do better. The failure to get the votes to vote on this bill this week gives us all a chance to take a deep breath, to step back and say: Sure, there are things wrong with the Affordable Care Act. There are things we can debate. There are things we can argue about. We can have amendments. We can do what we did in the Armed Services Committee over the last 2 days and have a real discussion and debate. I know it is possible because I sat there and saw it happen. It can be done, and we can do it here.
Let's take a week not to try to browbeat and push and make special deals
to try to get 51 votes or 50 votes and then the Vice President breaks the tie. It goes to the House, and they don't even look at it--they will pass it. And then we will be embarked on a path that is really going to hurt the American people.
We have to have help. Healthcare is too expensive, and regular people in this country can't afford it. We have to have help, and this is the place where people are looking to find that help. Let's try to work together. I am certainly willing to work with anybody who will listen. But if they are starting from a premise of gutting Medicaid and giving somebody else a huge tax cut, that doesn't work. Let's talk about the real problem. You want to talk about healthcare, let's talk about it. Let's talk about how we can lower the cost of healthcare, how we can lower the cost of deductibles, how we can lower premiums, and how we can provide new options to people in the health insurance system. But let's not talk about what we are going to do that is going to have such tragic results on individuals and families and on the fabric of our society.
Mr. President, I believe we can do better. I believe we can do better, and we have an opportunity to do so. It sort of dropped into our laps this week. We have 10 days to work on this, to think about it, to try to come up with a solution or at least begin the process of a solution. There is no deadline here next week, but let's begin the process.
As we begin, I have this radical idea of referring these bills to committees here in the Senate, having hearings, getting expert opinions, listening to the country, listening to the hospital association that says this is a terrible bill. The American Medical Association says this bill violates the basic principle of the medical profession: First, do no harm. This bill will do harm.
There is no group whom I have heard of who is for it--only people who have an agenda to cut Medicaid because they don't like Federal support or people who have an agenda to change the Affordable Care Act because it has Obama's name on it. That is not a good enough reason to strike at the heart of our people, our communities, and our society.
One final point. I have been talking about people; let me talk about jobs. In Maine, in 8 of our 16 counties, the hospital is the largest employer. I talked to a hospital director an hour ago. They are desperate about what is going on down here because it is going to make it difficult for them to survive and serve their communities--the rural hospitals especially. I have met with them across Maine--in Farmington, Bridgton, Skowhegan, Lincoln. Maybe you haven't heard of those towns because they are small towns in Maine, but they have a hospital that is the heart of the community and the biggest employer in the community. They all told me the same thing. This idea of this bill, this approach, is going to kill them. It is going to cause them to at least shrink their services or close. In Maine, because we are a rural State with far-flung communities, that means people are going to be a long way from available care--1 hour, 2 hours--and that is a tragedy for our communities in terms of economic development, in terms of jobs, but mostly, as I keep saying, because of people.
People say: Why are you so impassioned about this, Angus?
It is because this is what the people of Maine sent me to do. They sent me down here to help them, not hurt them. They sent me down here to speak for them, not stifle their voices. They sent me down here to do the right thing, to do the ethical thing, to protect them when nobody else will. That is why I am here, and I believe that this Senate, this Congress, this government, can do better, and I hope we will.
Thank you, Mr. President.
I yield the floor.
I suggest the absence of a quorum.