Mr. President, I ask unanimous consent that the order for the quorum call be rescinded. Madam President, on this matter of repealing the Affordable Care Act, soon the Senate is going to vote on just whether or not to repeal the Affordable…
Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.
Madam President, on this matter of repealing the Affordable Care Act, soon the Senate is going to vote on just whether or not to repeal the Affordable Care Act. I think it is important to note that this would walk back months and months of Republican promises to directly link repealing the Affordable Care Act with a replacement-- a replacement that would improve coverage, lower premiums, and be better for the American people. In fact, the President of the United States said repeatedly over the last few months that these would be inextricably linked, that repeal and replace would go hand-in-hand. That is not what is on offer right now. What is on offer are specific changes that would actually harm Americans.
For example, no more middle-class tax credits for healthcare--that is something that is critically important to the millions of middle-class folks who are walking on an economic tightrope every month, balancing their food costs against their fuel costs, their fuel costs against their medical costs.
I was struck this morning when I heard that, under this repeal approach, there is not going to be any real pain, that everything is just put off. Make no mistake about it. The pain for our families under this repeal measure is going to start right away. Nobody says they are going to be part of a marketplace if they believe it is not going to exist in a few years. Seventeen million fewer Americans are going to have healthcare 1 year from now. An analysis from the Congressional Budget Office--and this is only a week old--said that half of the country will have zero insurance choices in the private marketplace under this scheme.
I would like to repeat that so people understand that, as to this idea that there is really no pain here and that nothing starts for a long time, the Congressional Budget Office--our nonpartisan, impartial umpire--doesn't agree with that. They said just last week that half of the country will have zero insurance choices in the private marketplace under this scheme. That goes up to 75 percent of Americans with no options in later years.
So my view is that this is just legislative malpractice, first because of the pain and harm it is going to cause so many Americans. The Congressional Budget Office says that kind of misery is going to kick in quickly.
Second--and I don't think this has been discussed on the floor--this walks back months and months of Republican promises. The American people were told again and again that repeal and replace were going to be directly linked. The President said it multiple times. Then he went over the top and told people that they were going to have lower costs and better coverage.
I am happy to yield to my friend.
I would say to my colleague, the ranking member of the Budget Committee, that we are talking about one-sixth of the American economy.
My colleague is being logical, and heaven forbid that logic should be introduced into this, because we would automatically assume that on a matter like this--we are talking about one-sixth of the American economy--the Senate Finance Committee would have hearings. There have been no hearings.
None.
I can tell my colleagues that Senator Murray and I, the two of us--the ranking member on the Budget Committee and I--have actually made public the overwhelming opposition from providers on this. So, in effect, providers and patients are standing together in opposition to this.
They are opposed, as I have indicated. I think it is particularly important to see this provider-patient partnership that this time is saying the patients come first and this bill hurts patients.
That is correct.
What I can tell my colleagues is that, again, those hospitals have not been in front of the Finance Committee.
One of the things I appreciate about so many colleagues on this side of the aisle is that they said: Well, if we are not going to hear from these providers, like the hospitals, in the committee, we are going to go out to the country and listen to them. I have had townhall meetings throughout rural Oregon, as my colleague Senator Merkley has had. The rural hospitals, which are the economic engines of so many rural communities, are opposed to this legislation.
The AARP has also not been in front of the Senate Finance Committee. I want to say again that Senators have said: If they are not going to be in front of the Senate Finance Committee, where we ought to actually hear testimony in line with the regular order, we are going to go out to the country and listen to AARP members and organizations. They are overwhelmingly opposed to this because people between 55 and 64 would pay five times as much as younger people, and they would get fewer tax credits.
It is hundreds and hundreds of dollars and, in a number of instances, more. The reality is that I think they are going to have a lot of trouble getting coverage at all. The reality is, when you pour gasoline on the fires of uncertainty--and this is particularly important right now as plans are thinking about signing up--that makes it more likely you aren't going to have plans at all. The Congressional Budget Office has also found that the Paul legislation makes that worse.
While the senior groups have not been able to come before the Finance Committee to discuss this issue, I can say--and I have been working with a number of these organizations since my days with the Gray Panthers--that they are overwhelmingly opposed to this. I think, in particular, this idea that we heard from the Congressional Budget Office last week--that half of the country will have zero insurance choices in the private marketplace under this repeal scheme, and that it goes up--will just cause even more seniors to be against it.
Under this legislation, you would have a massive rollback of the Medicaid Program. So for all of those older people who scrimped and saved all of their lives--they didn't take that vacation; they tried to make sure they could educate their kids--Medicaid picks up the costs of two out of three nursing home beds in America. This legislation would produce a massive rollback of the Medicaid Program, and I believe so many older people are going to find long-term care unaffordable--millions.
That is correct.
That is correct. It would be accompanied with further misery because it would leave the millions suffering from opioid addiction with nowhere to turn for coverage as a result of this massive rollback in Medicaid coverage under this amendment.
Yes, the fortunate few would benefit under the House bill. There is no question about it.
To give my colleagues an idea of how regressive those efforts are, they would actually be retroactive. So this idea that these tax cuts for the well-to-do were in some way going to create jobs is just absurd. They are made retroactive. So they aren't going to be creating jobs going forward.
A few hundred families benefit so greatly that it could actually cover Medicaid expansion in several States.
That is correct. The special interests get very, very substantial tax breaks. Those working-class people lose tax credits, so they actually lose, and, in effect, those dollars can be used for the tax cuts for the fortunate.
There is nothing that would give Medicare bargaining power to make sure seniors get a better deal. There is nothing for the kind of effort our colleague from Vermont and Senator Klobuchar have pursued, which would allow, under circumstances where there were safety precautions, for pharmaceuticals to come from other countries. There is nothing to go after pharmaceutical middlemen. So, yes, there is nothing in these bills to hold down the cost of pharmaceuticals.
My colleague is right. There is a very regressive effort going forward in the House, the House Budget Committee, and, clearly, this is to try to set up tax cuts for the fortunate few.
I was struck by the fact that the President has talked about a 15- percent corporate rate. You lose $100 billion for every point you lower the corporate rate. The corporate rate is now 35 percent. If you move it to 15, that is $2 trillion that goes out the door.
Yes, I am very troubled that the House effort plus this legislation is really an effort to begin the unraveling of America's social safety net, and the funds that provide for those very vulnerable people would be used for these additional tax breaks.
I think my colleague is making an important point, as well as my friend from Vermont.
Part of the reason that many Republicans want these tax cuts for the fortunate few is arcane to people, pretty complicated. What they really want to do is get them now, to put them in the budget baseline in order to open up the opportunity when tax reform comes along to have even more tax breaks for the fortunate few. So, yes, Medicare and Medicaid are going to face real challenges.
In fact, as my colleagues know, the Affordable Care Act had a modest additional tax on people who earn over $250,000 a year, and it was to go just to Medicare. You see your paycheck--everyone gets a paycheck-- and the Medicare tax is right on it. The only people under these Republican plans who would get the Medicare tax cut would be couples who make over $250,000 a year.
When my colleague from Vermont asks ``What does this mean for Medicare?'' it isn't necessarily about some bill far off in the future. It is about right now. By the way, taking that money away--the money that comes just from the modest additional tax on couples over $250,000--reduces Medicare solvency by several years. It actually reduces Medicare solvency, which breaks yet another Trump promise not to in any way injure Medicare.
Two points are raised by my colleague--very good points. First, in the immediate, those people will go to the hospital emergency room, which means that, once again, we are turning back the clock toward approaches that don't provide better care at lower costs.
I wish to also mention, when we are listening to folks at home-- because they don't get to testify here in the Senate--people appreciate the part of the Affordable Care Act that ensures their lifetime limits on what they can be charged by insurers. Almost all of these Republican bills create an arrangement where a State could waive that protection. Not only would people who are facing cancer and serious illnesses and probably have to go to the hospital emergency room a fair amount be hurt now, but people who have employer-based coverage are going to be hurt in the future. So 160 million people don't even know what is coming out.
My colleague has described how the Senate works best when she says: Look, bipartisanship is not about taking each other's lousy ideas. Bipartisanship is about both sides getting together, having hearings, listening to all alternatives and ideas, and often coming up with something no one has thought of.
My colleague knows a lot about bipartisanship in healthcare because my colleague was part of our effort in 2008 when we put together the first bipartisan universal coverage bill in the history of the Senate-- seven Democrats, seven Republicans. By the way, a number of those Republicans are still serving in the Senate today. We know that is a better path.
To wrap up this portion of the debate, I wish to say to my colleagues that the best way to proceed is with a kind of two-part effort. The first is to say that we all agree the Affordable Care Act is not perfect. We are going to take steps immediately to stabilize the private insurance market.
We have a number of our colleagues--Senator Shaheen, with her effort to make sure people can get some help when they have deductibles and copayments; our colleague from Virginia, Senator Kaine, with reinsurance; Senator McCaskill with a fine idea to help areas that are bare in terms of no coverage. We have to move to stabilize the private market quickly because at the end of August, the plans are essentially signing contracts for premiums for 2018.
My colleague is absolutely right. We ought to knock off this partisan our-way-or-the-highway approach, move on a bipartisan basis to take steps to improve the Affordable Care Act now after we have hearings, input, and the opportunity to have people in front of the committees of jurisdiction. After that, we then move to the broader array of issues, starting with the immediate challenge my colleague has led on, which is clamping down on the cost of pharmaceuticals. You take steps to stabilize the market immediately, and then you move again in a bipartisan way on what our constituents are talking about at every community meeting, which is that their Social Security checks, the benefits they get, aren't coming close to keeping up with the rise in the cost of prescriptions.
I thank my colleague for her very helpful questions and our colleague from Vermont, Senator Sanders.
I yield the floor.
Mr. President, I thank my colleague for an excellent statement and for appealing to the better angels.
Mr. President, I am rising to speak about the Donnelly amendment, which is very much needed because the President--and now Republicans-- are walking back a clear commitment.
The President said in the campaign that he would not cut Medicaid, he wouldn't touch it, but even before the inauguration, the Trump team eagerly signed on to a Republican plan to slash it by more than $700 billion. They stared into television cameras, looked American voters in the eyes, and said that somehow these massive cuts to Medicaid wouldn't in any way harm the seniors. Medicaid picks up 2 out of 3 dollars with respect to seniors in nursing home beds and special needs kids and disabled youngsters.
When we hear that Medicaid picks up the cost of two out of three nursing home beds and compare that to the President's statement that he wouldn't cut Medicaid--wouldn't cut it--when we are now faced with a plan to cut it by more than $700 billion, one, that is walking back the President's solemn pledge in the campaign, and, two, it is going to make it harder for older people in this country to be able to afford long-term care.
The majority has brought the TrumpCare debate and the extreme Medicaid cuts that I just described directly to the floor of this Senate without a single committee hearing to justify this ill-advised policy.
Our colleague from Indiana, Senator Donnelly, has put forward an important amendment to stop this ideological crusade to unravel the Medicaid safety net. Senator Donnelly's proposal would send this partisan attack on Medicaid back to the Senate Finance Committee, where it should have been raised and struck down in the first place.
Mr. President, I am the ranking Democrat on the Senate Finance Committee. My focus in public life has always been to try to find common ground with people of common sense. And I wrote with colleagues--many of whom still serve on the Republican side and on the Democratic side--a universal coverage bill that pulled together both sides of the political spectrum.
So unless you provide an opportunity to have a discussion about the Medicaid safety net in the Senate Finance Committee, you are not going to be able to have policies that get to common ground on this vital issue. What you are going to have is what is really on offer now--an anti-Medicaid crusade that is a grave threat to the health and well- being of tens of millions of Americans.
Over the last few months, I have heard Republican colleagues say that Medicaid is a disincentive to work and that there are too many able- bodied adults enrolled. If you look at the facts, that is not what the program is all about. Medicaid is a vital source of coverage for our neighbors and friends who live in poverty. It tells those families that healthcare is covered while they work to climb the economic ladder in the private sector.
In addition to that, for the older people I have mentioned--these are the folks who have done everything right in life. They went to school, they found jobs, they worked hard in their careers, they raised families, and they scrimped and saved all through their lives. Growing old in America is pretty costly. So what happens is that millions of seniors who have done everything right spend down their savings, and that is when Medicaid steps in to help. It covers two out of three seniors living in nursing homes. It is a major source of funding for community-based care, and people generally don't know that. Now they may have heard about nursing homes, but it also picks up the costs for community-based care, where older people are more comfortable, and it often costs less than institutional care.
Seniors who lose those benefits due to TrumpCare Medicaid cuts are going to have to find somewhere else to live. A lot of families want to be able to help elderly parents and grandparents. It is going to be pretty hard because a lot of them are walking on an economic tightrope, and if they go looking
for nursing home care, it is going to cost on average more than $90,000.
So it is seniors, and it is disabled folks who count on Medicaid to have a chance to be productive. With the Medicaid benefits under threat, people with disabilities are going to find it hard to be able to attain the productive role in our society that they so fervently want to have. Our communities are so much better off when folks with disabilities can contribute, and Medicaid makes that possible. It covers services that many private insurers don't. It helps people make it out of bed and provides safe transportation to jobs. It helps them avoid unnecessary illnesses. It is not a disincentive for people with disabilities to work; having the support of Medicaid is what makes it possible for disabled folks to work.
Across the country, there are millions of kids with special needs who rely on Medicaid every day for services--behavioral care services, mental health services. Mom or dad might have good insurance through work, but private plans don't always cover the care those vulnerable kids need.
Mr. President, I ask unanimous consent for 1 additional minute.
Mr. President, I have commented on the secret process that went on in this discussion, but I will close with this: One version of TrumpCare has already been voted down here in the last day. Nobody knows where this debate will wind up, but what is important now is that Senators support the Donnelly motion. The Donnelly motion is going to ensure that the Finance Committee, where Senator Enzi serves so admirably, and all of our colleagues, Democrats and Republicans, is going to be able to look at this issue in a way that is going to bring the Senate together, not divide it, as we would be without the Donnelly motion.
Mr. President, I yield the floor.