Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material into the Record. Mr. Speaker, I am here as one of the co-chairs of the…
Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material into the Record.
Mr. Speaker, I am here as one of the co-chairs of the Congressional Doctors Caucus in the House of Representatives. I am here to talk straight with you and with the American people and my constituents about this tax plan that is being worked on by my Republican colleagues.
It will explode the deficit. It will also hurt every single person in this country by making the biggest cuts to Medicaid and to food benefits ever.
I want to make clear, as I talk about this, how reckless it is and that even people who do not rely on Medicaid themselves will be impacted by this. I am outraged. We are talking about a cut of $715 billion to Medicaid. That is the largest cut ever. It will kick 13.7 million Americans off of their health insurance.
Let's just be really clear about why they are doing this. This isn't to balance the budget. It is not to deal with the deficit. In fact, this bill is exploding the deficit. This is to pay for a gigantic tax break for the wealthiest people in this country a la Elon Musk.
It is morally bankrupt to think about that, that transfer, about taking healthcare away from the people in my district and across this country and transferring it to the wealthiest Americans. It is also fiscally reckless.
Doing this will essentially collapse our healthcare system in the United States of America. That is why just last week, we spent 26\1/2\ hours in the Energy and Commerce Committee discussing this very thing, telling the stories of our constituents, painting a picture of what it would mean to cut 13.7 million Americans off of their insurance.
It is interesting that this whole discussion didn't start until 2 o'clock in the morning because my Republican colleagues didn't want to have this discussion during the day when people would actually hear it. They waited until the dead of night to bring up this topic of taking healthcare away from our constituents.
Mr. Speaker, in the State of Washington, one in three people rely on Medicaid. I am going to tell you that most people who do don't even know it because in Washington State it is called Apple Health. If people are asked if they are on Medicaid, they will say no. If they are asked if they are on Apple Health, they will say yes.
This represents the most vulnerable people. These are kids, pregnant women, people with disabilities, and the elderly in nursing homes. These are the people who need our help the most.
I think about my patients. I am a pediatrician. I think about the ones who have Apple Health. If they didn't have it, if they didn't have access to come see me, their primary care pediatrician, and get diagnosed early with a mild pneumonia or an ear infection or whatever the case may be, they would be forced to go to the emergency department for that care.
It is not like they are not going to get sick. They are going to get sicker, and they are going to go later when things are more expensive and more complicated.
Mr. Speaker, do you know what else? Even if you are not on Medicaid, as I think about my patients with private insurance, they are going to be waiting in that emergency department line, too. They will have broken an arm or have some other emergency. They are going to be waiting in a longer line. We all know that the lines are already long to be seen in the emergency department.
The care there is the most expensive a person can get. The lines are the longest lines. Somebody is going to pay for that care. Otherwise, hospitals go underwater, and they go out of business.
Who is that? That is the people who are not on Medicaid but who are paying private insurance premiums. Those premiums are going to go up. It will hurt individuals who buy their own insurance. It will hurt the businesses and the companies who employ those people. This hurts everybody.
I want to tell you the story about Ayla. This is Ayla. She is 4 years old. She was born in 2021 in a rural part of my district after an uneventful pregnancy. Right after she was delivered, something went very, very wrong. She was in dire straits. She was clearly sick. She needed emergency care.
Thank goodness, this rural hospital has a labor and delivery unit. They were well-equipped to resuscitate a baby, to stabilize her, and then to Life Flight her to a hospital that could provide the specialty care that she needed.
Let's think about it for a moment. If Medicaid gets cut and these rural hospitals see a disproportionate share of patients on Medicaid, either those hospitals are going to close or they are going to start cutting back services. Mr. Speaker, I will tell you the first service to go will be labor and delivery.
What if that had happened after these Medicaid cuts? What if Kittitas Valley Healthcare didn't have labor and delivery? What if Ayla had been born then? What if she had not had the specialists there and had not had the ability to be resuscitated there in the delivery room? She would not have made it.
That is what we are going to see when they start cutting away at Medicaid. It will mean the closure of rural hospitals and fewer labor and delivery units. More people will get sicker. They will get poorer. Children like Ayla will not make it.
That is what I mean when I say it collapses our whole healthcare system. Our healthcare system is like a three-legged stool. One of those legs is Medicaid. If we start taking that away, the whole system collapses.
That is what we are talking about: Hospital closures, taking away services, long waits in emergency departments, and a population that is sicker and that needs more care. That care becomes more expensive. It hurts us all.
That is why I am so outraged that this is the mechanism that my Republican colleagues want to use to pay for a tax plan that will give gigantic cuts to the wealthiest taxpayers in this country such as Elon Musk. That is unconscionable. I wanted to start with that.
I am really honored to yield to our Speaker Emerita Nancy Pelosi from the great State of California.
Mr. Speaker, I thank Emerita Speaker Pelosi for her moral clarity and her fiscal pragmatism in painting a clear picture of what is going on right now.
Mr. Speaker, I yield to the gentlewoman from Vermont (Ms. Balint).
Mr. Speaker, I thank Representative Balint for that clarity. I appreciate drawing that distinction that Speaker Emerita Pelosi referred to as reverse Robin Hood. That is exactly what is going on here.
Who are you standing up for? We saw with the Republican 2017 tax cut that the vast majority of that benefit went to the wealthiest, and it did not trickle down to people. People are already having trouble affording rent, home prices, food, and other goods.
Putting this kind of financial pressure not just on Medicaid recipients but on everybody else, because insurance rates and medical costs are going to go higher, only makes that squeeze worse.
Mr. Speaker, I yield to the gentlewoman from Hawaii (Ms. Tokuda).
Mr. Speaker, I thank Representative Tokuda for bringing up that particular issue of children in the neonatal intensive care unit, where I have worked.
I think about this frequently. When over 40 percent of births in this country are covered by Medicaid, I think about what it would mean for a family
to be bankrupt for the rest of their lives if they had a premature baby or a baby with special needs. I also think about what would happen if those babies didn't get the right care.
Sometimes this is not a matter of life and death but a matter of life, death, and lifelong disabilities. That is what good NICU care will mean, and it makes a difference for these babies who are relying on Medicaid.
Mr. Speaker, I yield to the gentleman from California (Mr. DeSaulnier).
Mr. Speaker, I thank the gentleman for his comments and putting this in a very personal way.
I am wondering for people out there watching if they are thinking, gosh, I wonder is this really true? Are hospitals really going to close? Are we really going to lose labor and delivery and have to drive hours to get to the nearest hospital to deliver a baby?
In my district, the hospital that I talked about earlier is between two mountain passes. If it is snowing, there is really nowhere to go except by Life Flight, and that is not hyperbole. I have sat with the heads of school-based health clinics and community health centers, with heads of hospitals, with nursing homes--and, by the way, we have been referring to rural hospitals, but there are urban hospitals and suburban hospitals that are also highly dependent or have a very high percentage of Medicaid-dependent patients.
We are already seeing cuts in hundreds of employees in the Seattle area because of these impending cuts to Medicaid. I want to just be crystal clear; this is absolutely true. We are hearing this across the board that when Medicaid gets cut, we all lose.
We lose our local labor and delivery service. We lose our local emergency room. We lose the ability to be seen quickly in the event of an emergency because somebody who could have been taken care of by a primary care physician a couple of days earlier with an uncomplicated illness is now in the emergency room ahead of you in line, making you wait when you are having a heart attack. That is completely preventable by using the leanest, most efficient healthcare service and insurance that we have called Medicaid.
I want to tell another story. This is the story of Miguel. Now, we talked about Ayla before, a little 4-year-old girl. Miguel is at the other end of life. He is a senior. He is a constituent who is dependent on Medicaid. He is actually a 76-year-old widower who lives in Wenatchee, the apple capital of the world.
Now, after Miguel's wife passed away, he relied solely on his Social Security check to cover his living expenses. He is a retired orchard worker, and he worked hard to earn that Social Security. He spent decades doing physically demanding labor without access to a pension later, and private insurance was never affordable.
He still depends on Medicaid to stay in his modest home, receiving regular in-home nursing visits and help with daily tasks, like bathing, cooking, and managing his medications. Medicaid's coverage for home- based care is, by the way, far more affordable than nursing home-based care. He gets that home-based care, transportation, and care coordination through Medicaid. Without that, he would have no way to attend his checkups, manage his diabetes, and function through the limitations that he suffered because of a stroke.
Miguel fears losing access to the services that allow him to live at home with dignity, with independence, in familiar surroundings, and he deserves that. Frankly, that is the most cost-effective way to help Miguel.
For seniors like Miguel, Medicaid is not optional. It is their lifeline. It is how they keep dignity. It is how they stay at home. Unfortunately, Miguel's fears are not unfounded. The rural hospital that he depends on treats patients who are more likely to be on Medicaid or Medicare. In other words, they have a disproportionate share, and if these patients, these Medicare patients, lose their health insurance because of this bill, the cost of their care gets absorbed by the hospital.
For hospitals in rural areas that are already struggling, barely keeping their heads above water, this could be the death blow. This will force them to first cut services. I talked about labor and delivery. I could also talk about mental health services and opioid treatment. Those are often the first to go. This would leave Miguel without access to care.
I am not trying to fearmonger or deceive Americans, but this is scary. It is real. I am simply saying what our community health centers, and our hospitals, and our nursing homes, and our school-based health clinics are telling me, that the Republicans' budget will take healthcare away, and health insurance away from 13.7 million Americans all while, therefore, increasing costs for everyone, decreasing access to care, and leaving us all sicker and poorer.
Now, we haven't even talked really about the impact on nursing homes and on our seniors. Speaker Emerita Pelosi touched on this, but I also want to be very clear that three out of five middle-class, working- class Americans in nursing homes depend on Medicaid to pay those bills.
We already say in Washington we don't have enough nursing homes. In fact, people who should be in nursing homes are now filling hospital beds because there is nowhere else to go. Just
imagine if more nursing homes close what that will do to hospitals, what that will do to those patients.
Then think about this: I am in the sandwich generation. If I had a parent who relied on Medicaid to be in a nursing home and could not otherwise afford that, I would need to leave my job to take care of my parents. That is not what they would want for themselves or for me or for my family. This is what millions of families out there will go through if these Medicaid cuts happen.
I yield to the gentlewoman from California.
Mr. Speaker, I so very much appreciate those comments and Speaker Emerita Pelosi's dedication to children in every way.
Just to put an even finer point on that, food is medicine, cutting SNAP benefits not only takes food away from hungry people, but it also undermines our economy because those dollars are spent at our local grocery store.
I also have to just mention that food banks, which are the next line of support, are also under threat because DOGE and Elon Musk and Donald Trump have cut the food going to those food banks, leaving shelves bearer and leaving food banks having to ration foods. They also canceled the program where local farmers can provide their food to the local food banks, which is the healthiest and local and fresh food.
All of this just adds up, once again, to hurting people in need in order to fund a tax cut for the billionaires in this country.
Mr. Speaker, I now yield to my colleague from Minnesota (Ms. Morrison) to give her perspective about Medicaid.
Mr. Speaker, I thank Representative Dr. Morrison for her perspective, from the perspective of an OB/GYN who has taken care of pregnant women and new babies and really
paints a very clear picture about maternal mortality in this country and what cuts to Medicaid mean for that.
It is interesting. All of us in the Doctors Caucus have been talking for years--in fact, for the whole time I have been in Congress--trying and trying to improve Medicaid reimbursement, to make it so that Medicaid reimbursement can match Medicare reimbursement so that more children can have a medical home. It is about expanding Medicaid care for pregnant women until 1 year postpartum to make sure that they are healthy and plan their pregnancies and that we can cut down this outrageous incidence of maternal mortality in this country.
Now we are just fighting to keep Medicaid. That is the situation we are in now because Republicans want to gut Medicaid and take health insurance away from 13.7 million Americans to pay for a tax cut for the wealthiest Americans. That is just plain wrong.
I will talk for a moment about another constituent of mine who paints just a different angle on what it looks like to cut Medicaid. I will tell you that our phones are ringing off the hook. People understand what is going on. They are worried for their health, for the health of their families, and for the health of their parents. They get what will happen to their local rural hospital if these go into effect.
I will tell you about Kathleen, who graciously shared a story about her own mother. Kathleen's mother lived to be 92 years old. She was a widow for 42 of those years and helped care for five of her grandchildren.
Kathleen's mom lived through the deprivations of the Great Depression and World War II and was never one to complain. She lived simply.
In the last decades of her life, she had a number of serious, complex medical conditions that presented real challenges for her medical team and specialists and, of course, for her. Medicaid supplemented her traditional Medicare plan in the last years of her life and allowed her to get the medical care that she needed. She was treated with care and respect.
When Kathleen's mom injured herself in a fall, Medicaid covered the rehabilitation facility and, later, in-home physical therapy and occupational therapy so she could be in her own home.
Later, she had a life-threatening event and was hospitalized. Eventually, she was well enough to move to an outpatient rehabilitation facility, followed by in-home care. Again, Medicaid was there for her. The care was safe, reliable, and appropriate, and it gave tremendous relief to her and her family.
In the last months of her life, Medicaid provided hospice care. The nurses, home health aide, OT, PT, and case manager were her guardian angels. They treated her with compassion and dignity.
Isn't this the type of treatment and care, the care made possible by Medicaid, that all of us deserve, that all of us want, and that we want for our friends, family, and ourselves?
For so many seniors in this country, this type of care is made possible thanks to Medicaid. It is unfathomable that my Republican colleagues want to deny our seniors the type of comprehensive, compassionate, and thoughtful care that Kathleen's mother received.
That brings us full circle to how these cuts to Medicaid, Apple Health in Washington State--something a lot of people out there think is that they are not relying on Medicaid, so maybe it doesn't affect them.
The message I really want to deliver, Mr. Speaker--and I am actually going to look at the camera to speak directly to the American people-- is that cuts to Medicaid, or to Apple Health, impact every single person in this country.
They impact you if you are the son, daughter, or spouse of a senior who needs to be in a nursing home because nursing homes will close, and you will have to leave your job to take care of your ailing parent or spouse.
They impact everybody who lives in a rural community or in an urban community where there are a lot of patients who rely on Medicaid insurance, because when Medicaid doesn't pay the bills for those people, the hospital gives away that care for free. Then, they either cut services or close--or, more likely, a combination of them--and your insurance premiums go up because somebody has to pay. Who is going to make up the difference? Private insurance. That means your insurance rates go up, and they are already high.
Everybody hurts from this, even if you are not paying for your own health insurance. I bet, at some point, you are going to the emergency room, and those patients who don't have Medicaid are now getting sicker, waiting longer, and getting their care late in an emergency department.
If you think the waits are bad now because hospital beds and ER beds are full of patients in mental health crises or with fentanyl overdoses or with nursing home patients who don't have a nursing home to go to, if you think the waits are bad now, just wait till 13.7 million Americans lose their health insurance.
We are all impacted. If you live in a rural area and have private insurance, you are doing fine, but if the labor and delivery department closes at that rural hospital and maybe you have a high-risk pregnancy and need obstetrics care and might have a complication with that delivery, you might have to go live in a more urban area for the month before that delivery just to make sure that you are safe and that your baby is safe.
This is something that none of us should have to worry about in the United States of America. This is a prosperous country. We have excellent healthcare here, and to think that my Republican colleagues want to cut Medicaid, a lifeline for the patients who depend on it and for our entire healthcare system, that they want to cut what the people most in need depend on--again, we are talking about the elderly, people with disabilities, pregnant women, children. To think that they would cut care for them in order to pay for gigantic tax cuts for billionaires--it is a backward transfer of money. It is Robin Hood in reverse. It is just plain wrong. I have explained now that, in addition to being morally bankrupt, it is also fiscally reckless.
It is irresponsible, and I just don't understand how this is the plan that my colleagues came up with. Their constituents are going to hurt every bit as much as mine and, statistically, with more rural areas and already more vulnerable rural hospitals, chances are their constituents are going to hurt even more.
I sure hope that people out there are paying attention. Call the people who represent you. Tell them what your fears are. I know people are calling me, and I am standing up here to appeal to my Republican colleagues and let the American people know what is going on right now, why they should be concerned.
This is a democracy. Call the people who represent you. Tell them what you think. Tell them what it would mean for you, for your family, for your neighbor.
Again, when it is one out of three in Washington State, what would it mean if these largest-ever cuts to Medicaid transpired?
Here is what is going to happen tonight. At 1 o'clock in the morning, the Rules Committee is going to meet. They are going to craft the rules for Trump's so-called big, beautiful bill, which would be a travesty for the people I represent. They are going to do this at 1 o'clock in the morning when everybody else is asleep, not watching, not paying attention, not watching the nightly news. This is not prime time because, I think, they are embarrassed about what they are doing, but they are going to do it anyway. They are going to do it for the people who were in the front row at President Trump's inauguration. That is who they are going to do it for.
This is not helping their constituents. It is not helping my constituents. America, it is not helping you.
It is morally bankrupt. It is fiscally irresponsible. It is just plain cruel. That is why I, along with the rest of the Doctors Caucus, have spent this evening talking about what this means for our patients and for our healthcare system.
We understand it on a visceral level because we have lived in and worked in this healthcare system. We have worked in crowded emergency departments, seeing people who, if they had health insurance, wouldn't need to be
in the emergency department. We have taken care of patients who didn't have insurance like Medicaid, so they delayed care or they didn't pick up a medication because it was too expensive and they didn't have coverage.
We have seen these things. Dr. Morrison and I have both seen complicated pregnancies and neonatal resuscitations. These are patients who rely on Medicaid. We are here as doctors who swore an oath to our patients to protect them, to stand up for them. This is us standing up for our patients, to plead with my Republican colleagues not to cut Medicaid.
Mr. Speaker, I will let them know and will let my constituents and the American people know that I will continue to fight every minute to make sure that these cuts don't happen and that we keep this oath to our patients.
Mr. Speaker, I yield back the balance of my time.