Madam President, I ask unanimous consent that the order for the quorum call be rescinded. Madam President, the hard numbers are now in on TrumpCare, and there is no sugarcoating them for the American people, as 24 million Americans get…
Madam President, I ask unanimous consent that the order for the quorum call be rescinded.
Madam President, the hard numbers are now in on TrumpCare, and there is no sugarcoating them for the American people, as 24 million Americans get kicked off their insurance plans, as $880 billion is slashed from Medicaid in the first decade, and as a payday worth hundreds of billions of dollars goes out to the wealthiest and the special interests. That is what is going to be dropped on Ms. Verma's plate if she is confirmed and if the bill passes. It is her nomination that is up for debate right now, and we should make no mistake that she is going to be in charge of the specifics.
If TrumpCare passes, under section 132, the new Administrator would be able to give States a green light to push sick patients into high- risk pools when the historical record shows that these high-risk pools are a failure when it comes to offering good coverage that is affordable.
The new Administrator would be in charge of section 134 and could decide exactly how skimpy TrumpCare plans would be and how many more Americans would be forced to pay out-of-pocket for the care they need.
The new Administrator would handle section 135, which paves the way for health insurers to make coverage more expensive for those who are approaching retirement age. That is just the start.
The fact is that TrumpCare is about enormous tax breaks for the fortunate few, financed by raiding Medicare, gutting Medicaid, and hurting older people and the sick and those who are of modest income. Ms. Verma would have the job of implementing all of this at the Centers for Medicare and Medicaid Services.
My view is that the Senate cannot debate this nomination without debating the matter of the TrumpCare program itself because it will be a very huge part of the job. Today, I am going to walk through some of the specifics with regard to TrumpCare, beginning with the scheme that I call ``Robin Hood in reverse.''
If you look at the funds, it is clear that this is an eye-popping transfer of wealth away from older people, from women and kids--from the most vulnerable--directly into the wallets of the fortunate few. No part of the TrumpCare bill shows this more clearly than the fact that it steals from the Medicare trust fund to pay for a tax cut that goes only to the most fortunate--only to those who make a quarter million dollars or more per year.
Everybody in America who brings home a paycheck has a little bit taken out each and every time for Medicare. It is right there on the pay stub. It is automatic. Under TrumpCare, the only people who are going to see a Medicare tax cut are the people who need it the least. I want to repeat that. Everybody in America, when one gets a paycheck, sees a Medicare tax, and everybody pays it, and we understand why it is so important. There are going to be 10,000 people turning 65 every day for years and years to come. The only people who are going to get that Medicare tax cut are the people who need it the least, and that tax cut that is going to go to the fortunate few will take 3 years off of the life of the Medicare Program, depleting the program in 2025 instead of in 2028.
That particular cut breaks a clear Trump promise not to harm Medicare. All through the campaign, then-Candidate Trump was very, very firm in his saying that he would do no harm to Medicare.
He said:
You can't get rid of Medicare. Medicare's a program that
works . . . I'm going to fix it and make it better, but I'm
not going to cut it.
The promise not to cut Medicare lasted about 6\1/2\ weeks into the Trump administration before it was broken. The bottom line is that TrumpCare raids Medicare. It raids Medicare and causes harm to Medicare in violation of an explicit Trump promise during the campaign, and it brings Medicare 3 years closer to a crisis to pay for a tax cut for the wealthiest in America.
So you have this enormous, eye-popping transfer of wealth from working people, seniors, and people of modest means to the most fortunate. Yet, somehow, people have the chutzpah to say it is a healthcare bill? I do not think so. It is a huge, huge tax windfall for the fortunate.
There is also the tax break on investment income. Once again, this is a break that is going to only go to the most fortunate among us, and, with the investment tax break, the overwhelming majority of the benefit--nearly two-thirds of it--will go to the top one-tenth of one percent of earners in America. That looks like an awful lot of money that is going to be going to the fortunate few, but we are not even done there.
On top of all of this, there is yet another juicy tax--this time for health insurance executives' salaries. It is another juicy tax cut for executives who are making over $500,000 per year.
It is not just Medicare that is getting raided under this proposal. Some of those who are hit the hardest by TrumpCare are those who are approaching retirement age. If you are an older American and are of modest income--55 or 60--and you have to get insurance in the private market, TrumpCare is going to cause your prices to go through the stratosphere. In parts of my home State, especially in rural areas, a 60-year-old who brings home $30,000 a year could see his insurance costs go up by $8,000 or more.
Much of this is due to what we call an age tax. It is a key part of TrumpCare. It is another key part of what Ms. Verma will be in charge of implementing. The bill would give health insurance companies the green light to charge older people five times as much as they charge younger people. If you are a person of modest means, are a few years away from qualifying for Medicare, and your insurance premiums jump by $8,000, that means you are just out of luck. You are going to be locked out of the system. You are, basically, going to have to hope that you just do not get sick before you are eligible for Medicare.
Those tax credits that you hear so much about from TrumpCare advocates are not going to be of much consolation to you. That is because TrumpCare puts a hard cap on your tax credit as an older person--just $4,000--and the odds are good that it would not come close to covering the expense of a decent insurance plan.
Now, I am going to turn to Medicaid because TrumpCare does not just make little changes around the margins. It does not strengthen or preserve this program that covers 74 million Americans. TrumpCare hits Medicaid like a wrecking ball, and it has particular implications for seniors. I am going to walk through those.
The Medicaid nursing home benefit is very much at risk now because of the TrumpCare cuts as it relates to Medicaid. Medicaid picks up the bill for two out of three nursing home patients. These are the people who have worked a lifetime, raised kids, put them through school, and scrimped and saved all they could. These are the people who, in Kansas and in Oregon and across the country, never went on the special vacation, who never bought a boat. All they did was to try to scrimp and save and educate their kids. The fact is that growing old in America is pricey, and after a few years of balancing the rent bill against the food bill and the food bill against the medical costs, what happens is that a lot of seniors just exhaust their savings.
When I was director of the Oregon Gray Panthers, what I saw in my State--and it is duplicated everywhere--was older people walking every single week on an economic tightrope. They were balancing the food bills against the medical bills and the medical bills against the rent bills, and they just couldn't keep up. They burn
through all of their funds and they burn through their modest savings, so when it is time to pay for nursing home care, they have to turn to Medicaid.
Today in America, the Medicaid nursing home benefit is a guarantee that those vulnerable older people--the people who are walking on that economic tightrope--are going to be taken care of. TrumpCare breaks the Medicaid nursing home guarantee, and it goes even further than that. A lot of States--mine is one--worked hard to give more care choices to seniors as well as those with disabilities. Maybe instead of living in a nursing home or an institution, they would rather be in the community. Maybe they would rather live at home where they are most comfortable. TrumpCare could mean that those home- and community-based choices could disappear as well.
So what we are talking about is that with these cuts in Medicaid, at a time when, in Kansas and in Oregon and across the country--what we have tried to build for older people is a continuum of services. There would be help at home. There would be help in terms of long-term care facilities. There would be a wide array of choices. And because of Medicaid, there was enough money to fund these choices, to fund this continuum of care for vulnerable older people. Now, as a result of the Medicaid cutbacks, my concern is that there is not going to be enough money for any of these choices--not going to be enough money for the nursing home benefit, not going to be enough money for home- and community-based services. Suffice it to say that my own home State has indicated to me that they are very concerned about the cutback in home- and community-based services.
Nobody wants to see older people get nickled and dimed for the basics in home care they rely on and good nursing home benefits. Yet, when it comes to Medicaid, TrumpCare would effectively end the program as it exists today, shredding the healthcare safety net for older people and millions of others in our country.
It puts an expiration date on the Medicaid coverage that millions of Americans got through the Affordable Care Act. For many, it was the first time they had health insurance. It brought an end to an era where those individuals could turn only to emergency rooms for care. And now TrumpCare is going to cap the Medicaid budget and just squeeze it and squeeze it and squeeze it some more until vulnerable people will not be able to get care.
The program is particularly important for seniors and the disabled, and I want to make sure that people understand what it means for children as well, for those in the dawn of life as well as those in the twilight of life.
Medicaid pays for half of all births, and kids make up half of Medicaid's enrollees. It is important to remember that in many cases, these are kids who already have the odds stacked against them. They are from low-income families. They are foster kids. They are kids with disabilities. We know they are already facing an uphill climb. Medicaid, though, has been there now with the Affordable Care Act to make sure they could see family practitioners and even pediatric specialists. That was just unheard of for these youngsters before the Affordable Care Act. And when a kid needs emergency care, Medicaid is what makes it affordable. TrumpCare puts that in danger.
I have talked about what it means for older people and what it means for the disabled and what it means for kids, and I am just going to keep on going because now that we have the hard numbers in--the hard numbers have arrived here in real time from the budget office that is charged with giving us this analysis--it is important to talk about what it means, because budgets are not just facts and figures and cold sheets of paper; they are about people's hopes and aspirations. And the hopes and aspirations that I have had since those days when I was director of the Oregon Gray Panthers were to make sure that people had affordable, quality, decent healthcare choices because in America, if you don't have your health, you really are missing much of what makes life so special in our country.
The bill also takes an enormous toll in other areas, and I want to mention next opioid abuse. By slashing Medicaid, TrumpCare is going to make America's epidemic of prescription drug abuse-related deaths even worse.
The papers this morning had accounts about how families were losing most of their children to opioid addiction--most of their children lost to opioid addiction--on the front pages of the papers. Medicaid is a key source of coverage for mental health and substance abuse disorder treatment, particularly after the Affordable Care Act, but this bill takes away the coverage for millions who need it.
Republican State lawmakers, to their credit, have spoken out about this issue. Frankly, it just ought to be a head-scratcher for anybody who remembers the last Presidential race when, in the primary race, a parade of candidates rolled through State after State that had been hit hard by the opioid crisis, and all of those candidates were trying to outpromise the one who had spoken previously in terms of how they would help solve the opioid crisis. Then-Candidate Trump was one of the most outspoken on saying that he would fix the opioid crisis. He said he was the guy who could end the scourge of drug addiction and get Americans the help they need. Instead, what we have is TrumpCare, which makes the opioid crisis worse, and there is no getting around it.
TrumpCare puts States in the unimaginable position of having to decide whose Medicaid to slash. Are they going to tell seniors that the nursing home benefit is no longer a guarantee and they are going to have to get in a long waiting line for an opportunity to get a place in the local nursing home? Should they tell pregnant women that births are no longer covered? What about telling mothers and fathers that their kids are cut off and they will have to hope for the best or make their way back to the emergency room?
I also want to touch on a final point that really deserves some discussion and hasn't gotten much, and the finance staff has been looking at it; that is, how TrumpCare really creates a disincentive to work, because I think TrumpCare and Ms. Verma's role implementing it are going to have a substantial effect on American workers and entrepreneurs.
It is my view that TrumpCare creates a substantial, significant disincentive to work. Today, if you are on Medicaid, you are able to pick up a few extra hours at work or go out and accept a higher paying job without the fear that you will lose access to care. That is because under the Affordable Care Act, low-income Americans get the most help when it comes to paying insurance premiums. A lot of persons can get health insurance for less than $100 a month.
Let's compare that with the TrumpCare approach. Under the TrumpCare plan, those who are walking an economic tightrope, bringing home barely more than the minimum wage, don't get the most help. They don't get the most help, and they could see their insurance costs go up by thousands and thousands of dollars each year, which would effectively mean they would be locked out of the healthcare system. So for millions of persons, staying on Medicaid would suddenly look a lot more attractive. Making a little more money and losing your Medicaid coverage could mean losing your access to high-quality healthcare altogether. So my view is nobody has been able to counter this. TrumpCare, in effect, would keep Americans trapped in poverty.
Entrepreneurs and Americans who want to go back to school to pursue a degree would face the same dilemma. Somebody who wants to quit their job and pursue their dream of starting their own business ought to be able to do it without a fear that they won't be able to any longer afford healthcare. The same goes for those who want to go back to school full time to pursue a degree or certification. TrumpCare makes insurance unaffordable for those persons.
TrumpCare is going to be the big issue on Ms. Verma's plate if she is confirmed this afternoon in the Senate to administer this office. We all understand that this bill has been taking a pounding from all sides. Moderate Republicans and those who consider themselves conservative Republicans are against it. Governors from both
parties are against it. Democrats are united. The AARP, the American Hospital Association, the American Medical Association, and the American Nurses Association have all come out against the bill--not any surprise to me. I don't think these groups think that healthcare and healthcare legislation is primarily about ladling out big tax breaks for the fortunate few, but that is what this so-called healthcare bill does. And it is financed by raiding Medicare, by gutting Medicaid, and by hurting older and sicker and lower income Americans.
There has been a lot of happy talk about why we ought to support this bill, but what I have tried to do this afternoon is lay out the broken promises. This weekend, for example, the new Secretary of Health and Human Services said: ``I firmly believe that nobody will be worse off financially in the process that we're going through, understanding that they'll have choices, that they can select the kind of coverage they want for themselves and for their family.'' That statement from the Secretary of Health and Human Services is disconnected from the facts. The simple math shows that TrumpCare forces millions of people-- particularly older people and less affluent people--to pay thousands of dollars more for their health insurance.
The OMB Director, Mick Mulvaney, was pressed on why TrumpCare breaks the President's promise of ``insurance for everybody.'' His response was that TrumpCare is about access, and the bill ``helps people get healthcare instead of just coverage.'' But we all understand that access doesn't mean a lot if people can't afford to get coverage. That is the future that TrumpCare is going to bring for millions of Americans.
I asked Ms. Verma the most basic questions during her confirmation hearing so we could get even a little bit of an insight into how she would approach these issues. I asked for one example--these are not ``gotcha'' questions; these are the questions you ask if you want to know about running a program involving $1 trillion. I asked Ms. Verma for one example of what to do to bring down the cost of prescription medicine. I gave her three or four to choose from. I particularly would like to see more transparency by lifting this cloud of darkness surrounding how medicines are priced. She didn't have any answers to any of these questions.
So here is where this nomination stands. Ms. Verma gave the Finance Committee and the public virtually nothing to go by in terms of how she would approach this job, but the fact is that, if confirmed, she would be one of the top officials to implement TrumpCare--a bill that raids Medicare, slashes Medicaid, and kicks millions of Americans off their health plan to pay for a tax cut for the wealthy.
I am unable to support this nomination, and I urge my colleagues to oppose it.
Mr. President, over the past decade, the Trump administration's nominee to be CMS Administrator, Seema Verma, has demonstrated a conflicting pattern of working directly for the State of Indiana on its health programs while also contracting with a handful of companies that provided hundreds of millions of dollars in services and products to the very same programs she was helping the state manage.
Those companies are Hewlett Packard, Health Management Associates, Milliman, Inc., Maximus, and Roche Diagnostics. All were vendors to the State's Healthy Indiana Program agencies, while Ms. Verma helped design and direct that Program--first for Governor Daniels and then for Governor Pence. As she describes her role on her company's website, ``Ms. Verma is the architect the Healthy Indiana Plan (HIP), the Nation's first consumer directed Medicaid program under Governor Mitch Daniels of Indiana and Governor Pence's HIP 2.0 waiver proposal. Ms. Verma has supported Indiana through development of the historic program since its inception in 2007, from development of the enabling legislation, negotiating the financing plan with the state's hospital association, developing the federal waiver, supporting federal negotiations and leading the implementation of the program, including the operational design.''
Ms. Verma collected more than $6 million from Indiana taxpayers while overseeing the State's Medicaid reform and ACA implementation. At the same time, while under contract with the State as a consultant, Ms. Verma also collected more than $1.6 million from Milliman Actuaries, more than $1 million from Hewlett Packard, $300,000 from Health Management Associates, and tens of thousands of dollars from Roche Diagnostics and Maximus. All while these companies held important contracts with the State.
In addition to being on ``both sides of the table,'' in at least two cases involving her contracts with Hewlett Packard and Health Management Associates--her duties for the State of Indiana overlapped directly with the tasks those firms were also billing the state to complete.
While there are questions about Ms. Verma's work for the several companies above, I want to focus for the moment on what I believe to be the clearest conflict: her work on behalf of Hewlett Packard.
Hewlett Packard Conflicts. In 2014, the Indianapolis Star newspaper reported:
``Verma's work has included the design of the Healthy
Indiana Plan, a consumer-driven insurance program for low-
income Hoosiers now being touted nationally as an alternative
to Obamacare. In all, Verma and her small consulting firm,
SVC Inc., have received more than $3.5 million in state
contracts. At the same time, Verma has worked for one of the
state's largest Medicaid vendors--a division of Silicon
Valley tech giant Hewlett-Packard. That company agreed to pay
Verma more than $1 million and has landed more than $500
million in state contracts during her tenure as Indiana's go-
to health-care consultant.''
While this in and of itself is deeply concerning, Indiana state contract records show that Ms. Verma was instrumental in helping the state determine this contract was even necessary in the first place.
Let me say that again: Ms. Verma, in her role of advising Indiana, helped the state determine there was a need for the services of a vendor like Hewlett Packard. She then joined the company on a bid to provide those services, received a contract, and was ultimately paid more than $1 million. Hewlett Packard bought the company that originally contracted with the state, Electronic Data Systems in 2008. That company, in a January 2008 press release characterized the Indiana contract in this way:
`` `The EDS solution will provide Indiana with enhanced
transparency as it implements Gov. Mitch Daniels' package of
Medicaid reforms such as the Healthy Indiana Plan . . .' `At
the conclusion of the procurement process, it was evident
that EDS was able to bring great value and experience to the
taxpayers of Indiana,' said Mitch Roob, Family and Social
Services Administration Secretary. `The technology and
insight that EDS has to offer will be a tremendous asset as
we continue to make great strides in new, innovative
programs, such as the Healthy Indiana Plan.' ''
Ms. Verma helped Indiana outline Medicaid reform policy goals as State contractor before joining a vendor in its bid to fulfill those duties--and then remained a paid participant on both sides. Furthermore, it appears that Ms. Verma was billing Hewlett Packard and Indiana, in some cases, for the same work she was already performing under her own contracts with the State. In written responses for the record to the Finance Committee, Ms. Verma provided a 2013 presentation from Hewlett Packard and herself to Indiana health program executives.
The presentation identified several functions that Ms. Verma would provide to the State through the Hewlett Packard contract. Many of those duties are exceptionally similar to duties the State had already contracted with her directly to provide in 2012 and 2013.
For example, that 2013 presentation outlined specific duties HP was paying her to perform that included: monitoring the Federal regulatory environment, providing Medicaid policy expertise, and supporting Indiana's State Plan Amendment waivers and process. These were things Verma was already under contract to provide the state directly.
On February 21, 2012, Verma's firm was contracted by the State to review Federal regulations that would impact Indiana's Healthy Indiana Plan.
On May 13, 2013, she was contracted to provide the State with advice on the impact of new ACA regulations related to Medicaid.
To me, that sounds a lot like monitoring the federal regulatory environment in the HP presentation.
Under the February 21, 2012 contract, Verma's firm was contracted by the State to provide general policy expertise to the Healthy Indiana Program--also known as Indiana's Medicaid program.
To me, that sounds a lot like providing Medicaid policy expertise in the HP presentation.
Under this same February 21, 2012 contract, Verma's firm was contracted by the State to develop State Plan Amendments and waivers-- these are the agreement between the State and Federal Governments that ensures the State adheres to Federal rules for Medicaid and CHIP.
To me, that sounds a lot like supporting Indiana's State Plan Amendment waivers and process in the HP presentation.
Ms. Verma has not addressed how being paid twice for what appears to be largely similar work was ethical. She has, however, consistently denied that any conflicts of interest existed while she worked both sides of these deals in Indiana. During her confirmation hearing before the Senate Finance Committee on February 16, 2017, Ms. Verma claimed she had her staff recused themselves when potential conflicts arose:
``When there was the potential or when we were working on
programs, we would recuse ourselves. So we were never in a
position where we were negotiating on behalf of HP or any
other contractor with the state that we had a relationship
with.''
That all sounds well and good but that claim has been disputed by the former head of Indiana's Family and Social Services Agency. As first reported in 2014 by the Indianapolis Star,
``Verma's arrangement with HP also came as a surprise to
former FSSA Secretary Debra Minott, who said she learned
about it sometime in 2013. `We had delayed paying an HP
invoice because of an issue we were trying to resolve, and HP
sent Seema to our CFO to resolve the issue on their behalf,'
Minott said. `I was troubled because I thought Seema was our
consultant.' ''
Ms. Minott made this allegation again just last month in a February 14, 2017 story by the Associated Press about Ms. Verma's conflicts,
``There was at least one instance where Verma crossed the
line in Indiana when she was dispatched by HP to help smooth
over a billing dispute, said Minot. `It was never clear to me
until that moment that she, in essence, was representing both
the agency and one of our very key contractors,' said Minot,
who was removed as head of the agency by Pence over her
disagreements with Verma. `It was just shocking to me that
she could play both sides.' ''
Additionally, in response to questions for the record that I submitted to Ms. Verma, she said that her firm worked directly with HP for the state, and that representatives from SVC participated in meetings between the state and HP,
``SVC worked with the State of Indiana and its vendors,
including HP, to design systems for implementation of the
Healthy Indiana Plan. We helped vendors translate the policy
and waiver language into system operations. We did not
oversee HP or any other vendor in this regard, and did not
negotiate or participate in change orders or contract
amendments. To the best of my recollection, State officials
participated in all meetings with HP regarding the Healthy
Indiana Plan work at which SVC representatives were also
present.''
That sounds to me like Ms. Verma and her team were in meetings with both HP and the State discussing issues where her duties clearly overlapped and when she was being paid by both parties. In fact it sounds like the only safeguard in place was that State officials sat in on these meetings between her firm and HP.
Finally, with regard to her claim that she always recused herself, I specifically asked her to provide for the record any documentation that she had of the process for determining when she needed to recuse herself and documentation of the recusals actually taking place. She replied that there were none.
Consequently, it's hard to believe Ms. Verma was truly able to avoid very real conflicts of interest while she and/or her firm were guiding HP's work on behalf of the State and sitting in on meetings with both the state and HP while being paid by both.
In the case of Health Management Associates, Verma also had contracts with the state that covered the exact same work HMA was separately being paid by Indiana to fulfill and while she was also being paid by HMA. For example, in 2007, the State awarded Verma's firm a non- competitive contract to develop the Request for Proposal for a company to implement the Governor's Healthy Indiana Program. On the same day, Indiana gave HMA its own non-competitive contract to develop the very same proposal. This occurred while HMA was also paying Verma's firm on a separate but related contract. Again, as in the case of HP, she was helping the State manage key programs while being paid by contractors performing work for those programs. In this case, what she was doing for the State was essentially the same thing that the contractor was being paid to do--develop a Request for Proposal to implement the Healthy Indiana Plan.
Ms. Verma claims there was no conflict because she did not directly oversee these two contractors--HP and HMA--in her role with State. She also points to the fact that in 2012 she received an opinion from the Indiana Ethics Commission that stated her work for HP was not in violation of state conflict of interest laws because she was a consultant, not a State employee.
I do not believe that her work for the State and her work for these contractors was a true arms-length relationship. As the Associated Press recently highlighted, Ms. Verma maintained an office in the State government center and that the AP characterized her work as ``usually reserved for state administrators.'' The existence of this opinion, in my view, does not absolve Ms. Verma from what look to be very clear and obvious conflicts of interest.
I am not alone in this opinion, as President George W. Bush's ethics lawyer Richard Painter--hardly a liberal partisan--said Ms. Verma's consulting arrangement in Indiana, ``clearly should not happen and is definitely improper.'' Ms. Verma helped the State decide it needed a vendor like HP, and then went to work for HP on the resulting contract. She was also under contract with yet a third company--Health Management Associates--which was being paid to develop the Request for Proposal for the same contract. That certainly seems like a conflict of interest to me.
When I asked her in writing whether she had obtained similar ethics opinions with regard to her work for any of the other state contractors who had hired her--Milliman, Roche Diagnostics, Maximus, or Health Management Associates, she said she hadn't.
All of these companies continue to do business with the State of Indiana and with other State and Federal health programs that will be under Ms. Verma's purview at CMS. Maximus, for example, is the largest provider of enrollment services for these programs in the U.S.
Just because Indiana chose to play fast and loose with conflicts of interest doesn't mean that these practices were right.
I have no confidence that Ms. Verma will take her responsibilities to avoid such conflicts at CMS any more seriously than she did in Indiana.
Mr. President, I ask unanimous consent to have the following documents printed in the Record.
Mr. President, I yield the floor.
Mr. President, I ask for the yeas and nays.