Madam Speaker, after an extraordinarily lengthy recess that Speaker Johnson ordered at the third week of July, Congress is finally back in session with a huge to-do list. If there was any benefit in terms of having Members back home,…
Madam Speaker, after an extraordinarily lengthy recess that Speaker Johnson ordered at the third week of July, Congress is finally back in session with a huge to-do list.
If there was any benefit in terms of having Members back home, though, it was an opportunity to go out and listen to what is on people's minds. Townhall meetings and community gatherings offer, again, Members of Congress a chance to listen to people in terms of what they care about the most.
I had a number of those events, in Mansfield, Colchester, and Old Saybrook, Connecticut, with very packed rooms. The issue that was of most concern was H.R. 1, what President Trump calls the one big, beautiful bill.
While Congress was away, the Congressional Budget Office had a chance to finally zero in on final numbers in terms of the impact of H.R. 1, the one big, beautiful bill.
It was being written over and over again and changing up until the final minutes, but they finally got some clarity. What they determined was that the number of people who will lose their health insurance coverage because of H.R. 1 is 10 million, 7.5 million people on Medicaid and another 2 million people who get their insurance through private health plans on the exchange.
They also calculated the debt impact in terms of H.R. 1 because of the massive giveaway to billionaires and the top 1 percent of this country. They determined that the bill is going to add $3.4 trillion to America's deficits between 2025 and 2034.
The debt service on that additional debt is an additional $718 billion. That is just pure interest. It has no value in terms of services or programs that actually help the American people.
Because of that debt figure, the bill triggered another law called paygo, the pay-as-you-go law, which was passed in the 1990s to put pressure on Congress not to pass legislation with that big of a deficit impact. Unfortunately, the majority ignored the paygo rule.
What CBO told us on August 15 is that will trigger automatic cuts to other programs. That is the way the paygo law was designed to create some deterrent on Congress from excessive deficit spending.
Madam Speaker, the Medicare program, the program that helps people over the age of 65, will take the hit of 4 percent across the board. It will be a $45 billion paygo cut because of this measure.
In addition to those numbers, we are also hearing from the groups who are going to be impacted. Madam Speaker, in this morning's Connecticut press, there is a story titled: ``What worries CT hospital leaders about Trump's Big Beautiful Bill.''
Madam Speaker, I include in the Record the article from the CT Mirror.
[From CT Mirror, Sept. 2, 2025]
What Worries CT Hospital Leaders about Trump's Big Beautiful Bill
(By Katy Golvala)
Connecticut's health care leaders and state officials have
been warning for months about the potentially devastating
impacts of President Donald J. Trump's One Big Beautiful Bill
Act on access to care for millions of Americans.
Nearly two months after the law's passage, hospital
executives here say there are critical details still unknown
that make it difficult to determine exactly how it will
impact providers and patients.
``My best guess is it's not going to be good for hospital
providers and health care in general,'' Vincent Capece,
president and CEO of Middlesex Hospital, an independent
hospital located in Middletown, CT. ``There's going to be
less money available, but exactly how much and how that all
works out when the dust settles is really hard to
calculate.''
The law makes several changes to Medicaid, known as HUSKY
in Connecticut, that are projected to kick anywhere from
100,000 to 170,000 residents off the program in the next
decade. It also impose new limits on the amount of Medicaid
funding states can collect from the federal government
through what's known as the ``hospital provider tax.''
Those are just some of the policies that could spell
trouble for a hospital's bottom line.
Health care researchers predict the law's major components,
some of which aren't slated for implementation until 2027 at
the earliest, will pose the greatest challenge to rural
hospitals and those that serve a large share of Medicaid
patients. Hospitals that aren't performing well financially
might also be less poised to absorb potential revenue hits
that the law's measures could bring.
The Connecticut Mirror spoke with hospital executives from
around the state about how they're approaching major pending
federal changes.
Most of the hospital leaders who spoke for this article
said it's still too early to consider scaling back services
in response to the federal cuts.
Ben Wade, chief strategy officer at Stamford Health, said
he's hopeful they'll be able to manage costs without reducing
access to services.
``We have not identified any programs at this time for
closure,'' Wade said. ``We don't plan to do that.''
However, leaders at small community and rural hospitals
acknowledged that they may have to scale back the
availability of certain services.
``It's not necessarily cutting programs,'' Kurt Barwis, CEO
of Bristol Hospital, said. ``It's starting to look critically
and strategically at ``How do I retool these programs to
accomplish the same thing but at a lower cost?' ''
Barwis said he's established partnerships with larger
hospital systems, like UConn Health and Hartford HealthCare,
and expects to do more of these in the future.
Kyle Kramer, CEO of Day Kimball Hospital in Putnam, said
service changes are ``inevitable'' at rural community
hospitals like his, where they must always think about
whether there is enough demand for a particular service, he
said.
``There has to be a high enough level of volume to maintain
that proficiency,'' Kramer said. ``And if it becomes a
service that is too expensive to offer, we've got to think
about, `Okay, is this something that we should partner with
somebody else who has larger scale to provide it?' ''
While the federal changes directly impact people who get
coverage through Medicaid and state-based exchanges, the
ripple effects will be felt by everyone, health care leaders
warned.
``The impact goes far beyond those who lose coverage. Our
entire health system and every community we serve will feel
the effects. Reduced services, longer wait times, staff
reductions, and the potential closure of programs and
facilities,'' Daniel Keenan, vice president of government
relations at Trinity Health of New England, stated in emailed
comments.
Keenan pointed to emergency rooms as an example. When
people don't have coverage, they turn to emergency
departments for basic care, resulting in crowding, service
delays and staffing issues that impact the entire system, he
said.
The changes could drive UP costs for people with private
insurance, as well.
Leaders at both Stamford and Middlesex hospitals say the
reductions in government Medicaid payments will likely force
them to negotiate increased payments from commercial
insurers, which could result in higher premiums for those
with private coverage.
``We will need to think about the upcoming commercial
insurance negotiations that we have to make sure that we have
the resources that we need to cover our expenses,'' Wade
said, adding that if insurers and employers don't opt to
absorb these costs, they will end up hitting people's
premiums.
One of the big areas of uncertainty lies with the hospital
providers tax, several hospital executives said. The provider
tax is an arrangement that allows states to increase the
amount of federal Medicaid dollars they get from the federal
government by collecting taxes from hospitals and then
redistributing those funds back to the facilities. The
exchange counts as Medicaid spending by states and entitles
them to extra reimbursements from Washington.
The federal budget bill decreases the ``safe harbor
limit''--or the rate at which states can tax hospitals--from
6 percent to 3.5 percent by 2031, with a phased-in reduction
beginning in 2028.
Even though the new limit won't take effect for several
years, federal waivers for the tax rate will pose an issue as
soon as next year, when the current provider tax agreement
between the state and hospitals expires. In advance of a new
agreement, approved by the legislature this year and slated
to take effect in July 2026, Connecticut will have to reapply
for a federal waiver to tax the hospitals above the safe
harbor limit in order to go ahead with its plan to increase
hospital taxes by $375 million.
In the past, states have been permitted to apply for
waivers to tax hospitals at rates exceeding the safe harbor
limit. Connecticut, for example, taxes hospitals at the
maximum
6 percent for inpatient revenues, but received a federal
waiver to tax outpatient revenues at slightly over 10
percent, said Paul Kidwell, senior vice president at the
Connecticut Hospital Association. It's unclear whether the
federal government will continue to grant such waivers, he
added.
``It's a big question mark,'' Kidwell said. ``We're
proceeding as if we can continue, with the knowledge that we
need more information from CMS in order to be certain.''
Capece, CEO at Middlesex Hospital, said the tax change
could be the biggest financial disruptor for his hospital,
even more so than changes to Medicaid eligibility.
``The risk really lies with regard to the provider tax
issue,'' Capece said. ``It's a huge amount of money.''
Barwis, of Bristol Hospital, called the expiration of the
agreement at the end of this fiscal year a looming ``day of
reckoning'' for Connecticut.
``Will [the Centers for Medicare and Medicaid Services]
grant a new waiver to keep it at 10.5 percent? Or will CMS
say, `No, no, no, we're not going to grant this waiver again.
You need to go down to 6 percent.' And how will that affect
hospitals in the state of Connecticut?'' Barwis said.
At least some Connecticut hospital leaders hope the most
potentially damaging effects of the bill could get scaled
back or repealed before they go into effect.
Wade, who oversees strategy at Stamford Health, said
there's a chance that, if Democrats take control of Congress
in the midterm elections, some of the changes could be
``pushed off or unwound entirely,'' he said.
``We're still doing a lot of advocacy at the federal level
because this is still a moving target,'' Wade said.
Kramer, who heads up Day Kimball, agreed that there's still
time for things to change. Capece from Middlesex said he,
too, is ``cautiously optimistic.''
CHA's Kidwell is less convinced the law could be scaled
back but, he said, he's grateful to be facing these federal
changes in a state that wants to help as many people as
possible keep their health coverage.
``We all have this goal of making sure as many people stay
insured as possible and that compliance with federal rules is
not so onerous that people fall off because of paperwork,''
Kidwell said. ``I don't think that's the same in other states
where they might have a different motivation.''
Madam Speaker, again, this journalist went out and interviewed hospitals across the State. This included urban, rural, and suburban hospitals. What all of them are reporting is that the hit of $1 trillion of Medicaid is going to ripple through the system and cause impact for everybody who relies on those critical services.
Daniel Keenan from Trinity Health Of New England, Saint Francis Hospital of Hartford is one of their big members. I was born there a number of years ago. He stated: ``The impact goes far beyond those who lose coverage. Our entire health system and every community we serve will feel the effects. Reduced services, longer wait times, staff reductions, and potential closure of programs and facilities.
``Keenan pointed to emergency rooms as an example. When people don't have coverage, they turn to emergency departments for basic care, resulting in crowding, service delays and staffing issues that impact the entire system.''
That affects everyone, and it will spill over into other people's employment-based insurance premiums, which the article goes through in great detail.
Madam Speaker, President Trump the other day said he actually doesn't think he wants to call the bill the One Big Beautiful Bill Act anymore. As he said, it was good for getting it approved, but it is not really good for explaining it to people. People have figured out enough in terms of deficit impact, taking away people's health insurance coverage, and the impact on services, particularly in the hospital sector, which they warned us about before the bill was passed. Yet, the majority and the White House turned a deaf ear.
We have a lot of work to do when we get back into town, starting tonight. Again, what would be nice is if all of the Members who had townhalls--and I know Republicans heard about this as well as Democrats--recognized that this bill is not the Ten Commandments.
Madam Speaker, we have the ability and the legal authority to make changes and listen to the people who are warning us that it is actually going to harm the American people, and there is nothing beautiful about it.