Republican Healthcare Bill (Executive Session)
Mr. President, last Friday, I went to Rockford, IL, and had a roundtable discussion about healthcare. There is a lot of debate about healthcare in the Congress and certainly in Washington. What I have tried to do is to take this issue home…
Mr. President, last Friday, I went to Rockford, IL, and had a roundtable discussion about healthcare. There is a lot of debate about healthcare in the Congress and certainly in Washington. What I have tried to do is to take this issue home and ask the people who actually are responsible for providing healthcare, and the people I represent, what they think about the new Republican alternative to the Affordable Care Act. What I found is that with virtually no exceptions, they are all gravely concerned that the changes that are going to be made to the healthcare system in America, which represents a dramatic portion of our economy, could have a very negative impact on the real lives of people across my State and across the Nation.
Hospital administrators were there to talk about this issue. Swedish Covenant is one of the hospitals well known and respected in the area; OSF as well, and the administrators of both of these hospitals talked about the negative impacts of cutting back Medicaid coverage.
What the Republicans are suggesting in their proposal is that the expansion of Medicaid to provide health insurance for low-income Americans would continue until 2020 and then be cut off, and, they would argue, we will make it more cost efficient. We will let the Governors come up with alternatives. Well, the Governors aren't very happy with this because they know the cost of healthcare continues to go up and they are fearful that when you try to put this all together, the net result is fewer people covered by Medicaid.
Over 600,000 people, because of ObamaCare--the Affordable Care Act-- in Illinois now have health insurance. Who are they? Well, I met Ray Romanowski. Ray, a big Polish American fellow from Chicago, is a musician, and he has made most of his income during his life doing work as a musician. Ray Romanowski, in his 60s today, has never had health insurance until now. Because of the Affordable Care Act, he qualifies for Medicaid, and because he has Medicaid--he patted his wallet and said: I finally have that card in my wallet where I can walk into a hospital or a clinic and get good treatment.
It is the first time in his life, and he is in his sixties.
Judy is a friend of mine in Southern Illinois, and she works at local motels there--in hospitality--at places where they serve breakfast to you. She gets up early in the morning. She is a hard-working lady. It is the kind of job she has had her entire life, and she never, ever had health insurance--not once. She worked 20, 30, 40 hours a week, sometimes two different jobs, but never with health insurance. Now she has it because of the Affordable Care Act, and thank goodness she does because she has been diagnosed with diabetes and she needs that kind of care.
So what happened before, when people like Ray and Judy got sick? Before the Affordable Care Act, they would show up in the hospital, go to the emergency room, and they would get treatment, but they wouldn't be able to pay for it. What happens to those expenses at hospitals, under the old way of doing things? They are passed along. The rest of us pay. Anyone who has health insurance and goes in for treatment, part of it is going to be what your treatment is or for your family; the other part is to make up the difference for charity care, uncompensated care.
Now the Republicans believe they have a new idea: Let's restrict access to Medicaid. Let's restrict the health insurance that is available to people like Ray and Judy. Well, they are still going to get sick, and they are still going to come to the hospital, and their costs are going to be passed along to others.
The Speaker of the House, Paul Ryan, a neighbor from the State of Wisconsin, said that it is all about competition and choice. Well, when it came to competition and choice, Ray and Judy didn't have a chance. They just didn't make enough money. But they did get coverage under the Affordable Care Act, and they stand to see that coverage endangered, if not lost, under this new approach.
We also had representatives of the nursing association in Illinois. These are women and men who are the most respected medical providers. Just take a look and ask whether people have higher respect for doctors or whomever; it is always the nurses, No. 1, because the nurses are the ones who are there day in and day out, hour after hour, in the hospital rooms with the people we love who desperately need medical care. The nurses are opposed to this Republican replacement plan as well.
The doctors--the American Medical Association and the Illinois State Medical Society--are also opposed to it because they looked at the Republican competition and choice alternative and said that at the end of the day, fewer people will have health insurance and the costs will go up dramatically for some. We had a representative of the American Association of Retired Persons there, and they are especially opposed to it. Why? We had a provision in the Affordable Care Act which said that the disparity in premiums can never be more than 3 to 1. Well, the Republicans decided as part of their replacement to make that 5 to 1. Who is going to pay five times instead of three times the base premium? Seniors, those over the age of 55. The Republicans built this into their proposal, and AARP has come out against it.
The second thing to go is--the Affordable Care Act has really brought some savings to healthcare; we wish there were more. But that savings in healthcare is translated into 10 more years of solvency for Medicare. Medicare is a lifeline for 40 million or 50 million Americans. So we gave it 10 more years of solvency with the changes in the Affordable Care Act. Now we are waiting for a score from the Congressional Budget Office, but the early indications are we are going to lose 4 years of solvency in Medicare because the Republicans want to bring in ``competition and choice.'' It turns out that phrase is not going to be good for the future of Medicare--one of the other reasons the American Association of Retired Persons opposes the Republican proposal to replace the Affordable Care Act.
This bill will be scored this week by the Congressional Budget Office. It was interesting to watch the Sunday shows and watch the procession of Republicans calling themselves fiscal conservatives who came in and discounted any conclusions from the Congressional Budget Office. Interesting.
When we wrote the Affordable Care Act, we waited sometimes for weeks for the Congressional Budget Office to give us a score: Is this bill going to add to the deficit or reduce the deficit? We had to wait to find out. Is this bill going to cover more people with health insurance or not? We had to wait to find out. But the Republicans went ahead with their proposal without a Congressional Budget Office score, and what they have done over the weekend is downplay the credibility of an office which Democrats and Republicans have relied on for decades. It shows that they are very concerned. I think they know what they are going to find. They are afraid it is going to add to the deficit and it is going to dramatically reduce health insurance for Americans.
There are some who estimate that 10 million to 15 million Americans could lose their health insurance. That is half of all of those in the past 6 years who have gained health insurance. It would also increase out-of-pocket healthcare costs for the average person--the Republican plan would--by $1,500 a year, seniors paying approximately $5,000 more a year because of that 5-to-1 premium change that I mentioned earlier. It would basically end Medicaid as we know it.
The Governors are telling us that this is a bad idea because it would shift the cost onto the families and to the Governors to find ways to save money.
It would shorten the solvency of the Medicare trust fund by 4 years.
It would allow insurers to once again charge older people significantly more than younger people for health insurance.
And--Republicans added a little grace note there--they defund Planned Parenthood and cut 12 percent of the funding for the Centers for Disease Control and Prevention.
Here is something my colleagues may not know. Because of family planning efforts in America, in the last 30 years, we are now at the lowest point in teenage pregnancies and the lowest point in unplanned pregnancies. So information and education are paying off to reduce unwanted pregnancies, unplanned pregnancies, and, I might add, the likelihood of abortions. So now, as the Republicans say we are going to defund Planned Parenthood for hundreds of thousands of women, that means stopping their access to the healthcare they trust across America. So in the name of choice, the Republican plan reduces choices for women when it comes to healthcare by defunding Planned Parenthood.
To top it off, the bill cuts taxes for the very wealthy. Those making over $1 million a year in income get a $50,000 tax cut because of the Republican proposal for this new health insurance approach. If you happen to be in the wealthiest 0.1 percent of Americans, the average tax cut is nearly $200,000. They just can't help themselves.
We put together a revenue source so that we could dramatically expand health insurance coverage in this Nation. We now have the lowest percentage of uninsured Americans in our history, and the Republicans-- because they are opposed to it--have said: We are going to cut the taxes that help people pay for their health insurance, and we are going to reduce the options that are available to them. So for Americans, it means less coverage, higher costs.
We will see when it goes to the House of Representatives on the floor. The most conservative Republicans don't like it; certainly the Democrats don't like it. The question is whether Speaker Paul Ryan has enough votes. It has united America. The Republican approach has united America, in opposition. I don't know of a major health-providing group that supports it--not one; not doctors, not hospitals, not clinics, not AARP. Patients' groups all say the same thing about TrumpCare.
The American Medical Association said:
We cannot support the [bill] as drafted because of the
expected decline in health insurance coverage and the
potential harm it would cause to vulnerable patient
populations.
The American Medical Association goes on to say:
We are concerned with the proposed rollback of the Medicaid
expansion. . . . Medicaid expansion has proven highly
successful in providing coverage for lower income
individuals.
The AMA cannot support provisions that repeal the
Prevention and Public Health Trust Fund . . . and we cannot
support provisions that prevent Americans from choosing to
receive care from physicians and qualified providers . . .
[including] those associated with Planned Parenthood
affiliates.
The American Medical Association is saying to the Republicans that they reject their proposal for healthcare and is warning them not to cut off funding for Planned Parenthood.
What does the American Hospital Association say?
We cannot support the [bill]--
the Republican bill--
in its current form.
In addition to the lack of a CBO score, we have some
additional policy concerns with the proposal.
For example, it appears that the effort to restructure the
Medicaid program will have the effect of making significant
reductions in a program that provides services to our most
vulnerable populations.
That is from the American Hospital Association. They estimate that in our State of Illinois, we could lose up to 90,000 jobs by repealing the Affordable Care Act without a suitable substitute--90,000 jobs in my State. President Trump made a lot of news when he went to visit one of the manufacturing companies after he was first
sworn in and saved a couple hundred jobs. Well, I am glad he saved those jobs. I hope he saves a lot more. But if he is going to eliminate 90,000 jobs in my State--people who work at hospitals, some of the best-paying jobs in downstate communities--for goodness sake, that isn't hiring American. It isn't really focusing on creating jobs in this country. It is just the opposite.
Here is what the American Nurses Association says about the Republican bill:
[The bill] threatens health care affordability, access, and
delivery for individuals across the nation. . . . [T]he bill
changes Medicaid to a per capita cap funding model,
eliminates the Prevention . . . Fund, restricts millions of
women from access to critical health services, repeals income
based subsidies that millions of people rely on. These
changes in no way will improve care for the American people.
What about the U.S. Conference of Mayors? Here is what they said:
States will be forced to end coverage and eliminate health
care for low-income seniors, people with disabilities,
children, and working families.
The GOP plan is bad for cities, bad for people who live in
cities and bad for people who provide healthcare in
cities.
It is interesting. We had a representative at a Rockford meeting of the disabled community. They are scared to death of this Republican alternative because these folks many times are in serious need of very expensive healthcare. If they are pushed off into these so-called money-saving insurance plans that really are empty inside and don't provide coverage, it could be devastating to these families. They have been through it over and over.
The American Association of Retired Persons said:
This Republican bill would weaken Medicare's fiscal
sustainability, dramatically increase health care costs for
Americans aged 50-64 and put at risk the health care of
millions of children and adults with disabilities, and poor
seniors who depend on the Medicaid program for long-term
services and supports.
It could hasten the insolvency of Medicare by up to 4 years
and diminish Medicare's ability to pay for services in the
future.
I remember when Candidate Donald Trump was telling us he would do nothing to hurt Medicare. Now the first major piece of legislation that comes up threatens the solvency of Medicare.
Here is what the National Committee to Preserve Social Security and Medicare said:
[We] oppose the . . . bill to repeal the Affordable Care
Act because it would weaken Medicare's solvency . . .
threaten access to Medicaid long-term care benefits, and
require ``near seniors'' to pay more for less health care
coverage. The . . . bill puts seniors and people with
disabilities at significant risk of ending up uninsured or
losing access to needed care.
In my own State, the Illinois Health and Hospital Association says:
[This organization] has serious concerns with the direction
of the [bill]. It would cut coverage for hundreds of
thousands of Illinoisans and impose a cap on . . . federal
Medicaid funding--our state is unable to absorb funding cuts
without impacting healthcare for all patients.
I was surprised last week when the Republican Governor of Illinois, Bruce Rauner, said of the Republican plan: ``My first blush read is Illinois won't do very well under the changes that they're recommending.''
He is very careful not to say things about Federal legislation. This he understands: Cutting back on Medicaid is going to impose a new debt on our State and reduce coverage for hundreds of thousands of people in our State.
So we said to the Republicans: You want to repeal the Affordable Care Act; you have been dead set on doing this for 6 years. Please come up with an alternative that at least expands the coverage of health insurance and makes it more affordable. They tried, and they failed. But now they are going to push it through as a matter of showing political purity. They don't care that there is not a single group of medical providers in this country who support their plan. They obviously don't care that the American Association of Retired Persons believes this is not good for seniors across the board.
I heard the Director of OMB say: Oh, that group--they are going to end up opposing this and then they are going to ask people to donate. Well, it is true that they live on donations. But they are taking a bold position in saying that the Republican approach is going to hurt seniors across America. Talk to the disability community, and you will hear exactly the same thing. Talk to the advocates for children.
I am really looking for the first group to stand up and say that this new Republican approach is good for this country or good for people when it comes to the cost or availability of health insurance, and I haven't found it yet. I don't know what they are waiting on, but they can't produce it.
What we are looking for is just the opposite. If you will take repeal of the Affordable Care Act off the table, I will pull up a chair. It is not perfect, it can be improved, and I am ready to sit down and do it on a bipartisan basis. But it is ``our way or the highway'' when it comes to the Republican majority on this bill. I hope we can do better. I think the American people expect us to do better.
At the end of the day, they want a better healthcare system, not one that is worse--not one that supposedly gives them ``competition and choice,'' yet they have less coverage in their insurance policies and end up paying more for it.