Healthcare

Floor Speech

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Mr. President, I have watched as this body has recently begun to really work in a bipartisan fashion on trying to stabilize the insurance markets under the Affordable Care Act.

Under the leadership of Senator Murray, the ranking member of the HELP Committee, and Senator Alexander, the chairman of the HELP Committee, efforts have been going on, and a number of hearings have been held on what needs to be done to stabilize and strengthen the Affordable Care Act. This is coming about because of a crisis.

In January of this year, leading from December, we have had people-- like Standard & Poor's--talking about how stable these exchanges were.

Over the last months, we have seen many actions--threatening cost- sharing, not advertising the markets--many actions taken by the Trump administration that have weakened the markets and put the markets in crisis. But it is actually not the markets that are in crisis; it is fellow Americans. People want the same thing. Whether Republican or Democrat, from the West, East, North, South, or the heart of our country, they want the same thing: They want quality, affordable care.

We have come a long way to where we are right now. Under the Affordable Care Act, we have increased the number of Americans with health insurance by over 20 million. We have been able to bend the cost curve.
The Affordable Care Act has taken us out of days that no American-- very few--wants us to go back to, the days where people could be denied coverage based on a preexisting condition.

The Affordable Care Act created an essential set of benefits, which Americans from both sides of the aisle think is very important. These essential benefits include such things as healthcare for women who are having children. They include things like putting parity between mental healthcare and what might be called physical healthcare.

There have been so many improvements because of the Affordable Care Act, and I have heard about them from constituents all over my State, as well as voices from around the United States of America, difficult stories about people who had lifetime caps; people who, because their child had an illness as a child--when that child became an adult, they couldn't find insurance; people who were being denied insurance because of a preexisting condition; people who were declaring bankruptcy in this country, at rates significantly higher than we are seeing now, because they could not afford their health insurance. In fact, personal bankruptcy in our Nation has been cut by about 50 percent. These are all gains we have achieved through the Affordable Care Act. There is the expansion of healthcare to millions more and the security of knowing that your health insurance won't be cut off because of a preexisting condition, knowing that when you pay for health coverage, it will carry essential benefits that every American should get. There are these gains and many more.

What has happened after the failure of TrumpCare, after the failure of Republican plans--what actually came out of that was something that was encouraging to me as a Senator who has been here for 3-plus years: seeing statespeople from our Senate--Lamar Alexander and Senator Murray--come together and say: Hey, we have a crisis in our country.

Some of these markets are losing stability. We should work together, put aside partisan differences, and try to find a pathway forward to make sure that in some States millions of folks don't lose health insurance.
We heard--at least I did--some of the best commentary in this body.

Perhaps most notable was a speech by John McCain, who stood up and strongly talked about regular order, talked about us doing things in the Senate in a way that brought us together, that invited in the public, that had a wide range of people participating in the crafting of policy--policy that affects nearly 20 percent of our economy, policy that affects hundreds of millions of Americans, policy that is critical to the success of our Nation.

I am grateful that Senators Murray and Alexander have been holding bipartisan hearings to try to stabilize the marketplace. Through this process, over the past month, we have had bipartisan Governors-- Governors from both parties--insurance commissioners, consumers--all have had the opportunity to come in and begin to weigh in on different proposals and their impact on the health insurance marketplace. This shows we can work together to try to improve the Affordable Care Act-- not this idea that we throw it out, hurting not just a few people but literally tens of millions of Americans. This is the way it should be done.

Past proposals that have failed in this body were done the wrong way--people crafting legislation behind closed doors in a noninclusive manner, in a partisan manner, not holding hearings, not bringing in experts. That is not the way this body was meant to work.

In fact, for those who criticized the Affordable Care Act, for the Affordable Care Act, there were dozens of bipartisan hearings. Over 100 amendments from the Republican Party were included in the ultimate legislation. It was a process that took months and months. The President of the United States even met with Republican Senators and Congresspeople to discuss and debate the legislation, and it was aired on C-SPAN. This showed the best of who we are, that when we come together as a body and go through a process, good legislation--not perfect legislation but good legislation--can advance us toward our principles. Those principles were principles that were discussed during the last Presidential campaign by both candidates. Donald Trump himself, our President, said time and time again: I want us to have a health system in which everyone is covered, in which everyone has affordable and quality healthcare.

These values aren't debatable, and I am disappointed, I am frustrated, and I am angry that we are here again while a bipartisan process is going on, and, as a great New Jerseyan, Yogi Berra, once said, it is deja vu all over again.

Here we are now coming back this week, and we are hearing about another Republican bill that has not gone through regular order, that has not had hearings, that has not had a bipartisan process. Another bill is coming to the floor. People are whipping up votes, and we might have yet another dramatic moment in this body that millions of Americans will watch, holding their breaths because their families-- their children, their senior citizen parents--are being held in the balance on a decision this body will make--not going through regular order, not bringing in experts--on legislation that hasn't even been scored by the Congressional Budget Office.

The CBO hasn't scored this bill. We don't know what its total impact would be on health coverage or on costs. We don't know exactly how many people could lose their coverage, how much premiums could skyrocket for the middle class, and just how much Medicaid would ultimately be gutted.

This is the bill that is coming before us. This is the threat right now to our Nation and to millions of people. But we do know enough about this bill, and previous versions of the repeal plan that looked very similar to this bill give us many hints--more than hints--give us much evidence about what this bill would do and how this bill would cause millions to lose their coverage and premiums to skyrocket. And the millions who rely on Medicaid for everything from opioid addiction treatment to maternity care would suffer.

Let me go through some things we know about this legislation which is being threatened to be brought to the Senate floor and which now casts a shadow over the coverage earned and gained by millions of Americans.
This legislation would still take coverage away from millions of Americans. We know this destructive version--this partisan repeal plan--would take coverage away from millions of people. Experts have already projected that after 10 years, this partisan repeal plan could cause over 30 million Americans to lose their coverage--30 million Americans cast back into a world where one illness, where one injury could devastate their families, could send them into bankruptcy. That one illness, that one injury could have the worst of results; could cast us back to a time when so many Americans were using emergency room doctors as their primary care physicians; could cast us back to a time when many Americans were delaying seeing doctors because they couldn't afford to, allowing preventable diseases or treatable diseases to get worse and worse. Thirty million Americans losing their health insurance means more Americans will die. That is not a dramatic, hyperbolic statement; that is the truth. When health coverage rates go down, American mortality rates go up.

What else do we know about this legislation? It still raises costs like the other versions of TrumpCare. This version of this partisan repeal plan will still force hard-working Americans to pay more for, actually, worse care. It would abruptly end the critical assisted subsidies that have allowed millions to afford care. It would end support for people in the very marketplaces about which two other bipartisan Senators, through the HELP Committee, are trying to discuss how we are going to stabilize those markets to give people that very access.

We know that as a result of this repeal plan, Americans will see their deductibles increase by several thousand dollars. We could once again--once again, with those increases--see bankruptcy rates increase after dropping dramatically under the Affordable Care Act.

What else do we know about this legislation, this newest version of TrumpCare? It still ends Federal protections, as the other plans did, for people with preexisting conditions. TrumpCare's latest version would still enable insurance companies to charge folks who are sick or who have been ill or who have a preexisting condition for their care.

States could waive that restriction on discrimination against people with preexisting conditions. This plan will still subject millions of Americans with those preexisting conditions to price discrimination, meaning Americans who may have had cancer, Americans who are pregnant, Americans who have a child with autism could be forced to pay thousands and thousands of dollars more just to get coverage.

What else does this newest piece of legislation do? It ends the Medicaid expansion, and it establishes a per capita cap and reduction of Medicaid. By ending Medicaid as we know it after over 50 years of this program, by suddenly capping it and ultimately giving block grants to States, we know it will affect dramatically the people whom this program and these expansions have covered.

Who gets covered by Medicaid? Who will be affected? In America right now, over half of all low-income families rely on Medicaid. Two out of three of our seniors living in nursing homes rely on Medicaid. Half of all the births in the United States of America--our children, our future, our greatest natural resource--half are covered by Medicaid.

Here is our reality. We are gutting a program that benefits us all-- our seniors, our children, as well as the disabled. The cruel Medicaid cuts proposed in this bill--the cuts and the caps in this version--will still put those who have the most to lose in the most serious jeopardy: those seniors in nursing homes, working families, communities of color, women, Americans with disabilities, those folks who are already struggling with illness, elder Americans, Americans living in rural areas, Americans living in our cities. This is not who we are. These are not our values. This kind of draconian action is unacceptable in a nation this great.

What else does it do, this newest version of TrumpCare? What else does it do? In this version, this bill--just like the ones before-- still erodes critical patient protections established by the Affordable Care Act by allowing States to apply for a waiver to opt out of the ACA's essential benefits requirement for things as basic as maternity care, substance abuse services, prescription drugs, emergency services, hospitalizations, and rehabilitation services.

This repeal plan could essentially give insurers the green light to once again charge for junk insurance plans that don't actually cover needed care. You may have health insurance, but it may be so limited and so constricted that when you actually get sick, you find out it does not cover your illness, your health challenge, your injury.

This newest version of TrumpCare, this newest version of a partisan repeal plan, also still threatens women's health. Women comprise two- thirds of all adult enrollees in Medicaid. They would be essentially hurt by the gutting of that program. This repeal plan, like previous versions, would still cut off low-income women from accessing critical preventive and healthcare services from Planned Parenthood, health centers that provide essential preventive care and, often in many counties, the only avenue to contraceptive services. It singles out Planned Parenthood by not allowing them to be reimbursed for basic health services, making it so much more difficult for women all around our country to access important care.

What else does this most recent version of TrumpCare do, this partisan bill that is not going through regular order? Just like the other ones, it would still weaken the Federal prohibition on lifetime limits, lifetime caps on the insurance that one can receive. That means Americans with chronic diseases and conditions and children with unique medical needs and challenges who still need continued lifesaving care could be forced, once they hit that cap, to spend hundreds of thousands of dollars on continued care, even though they are insured, thus devastating families, sending them into bankruptcy, spiraling them into financial catastrophe.
A couple of months back, one of my constituents tweeted me a photo of

her son's medical bill after a recent surgery. The bill was for $500, but it showed that without the coverage she got because of the Affordable Care Act, she would have owed over $230,000. That was just for her child's heart surgery. Her son Ethan, who was born with a rare genetic disorder, has had four of those surgeries.
Under this partisan plan, not only could essential health benefits, like hospitalizations and prescription drugs, be denied Ethan, but lifetime caps on coverage would disqualify Ethan from accessing the care he needs.
As Ethan's mom put it, the lifetime cap is the equivalent of saying: ``Sorry, you're not worth keeping alive anymore. You're just too expensive.''

That is what this plan would allow insurance companies to do, essentially saying to Americans: If you had a problem when you were a child, if you had surgeries as a child, once you hit that cap, you are not worth covering anymore.

We had a vote on the floor today. It was for national defense. It was a major bill. There were strong statements and speeches on both sides of the aisle. At the end of the day, the overwhelming majority of us joined together to provide for our Nation's national defense; that is, to provide for our Defense Department.

It is a common ideal in this body that this government, formed by our forefathers and foremothers, the Constitution upon which we stand proclaims that this government was formed for the common good, for the common defense.

As we have seen in recent days, the idea of defense isn't just protecting us against the threat of North Korea, isn't just protecting us from the efforts of the Russians. It is not just protecting us from terrorist organizations. We have seen that the national defense also means the challenges of natural disaster.

It was profound for all of us to see the crisis faced from Texas to Florida and how we--as a nation, hero after hero in communities large and small--stood up during this time and were there for fellow Americans, never asking their party, never asking or questioning what different religion they might have. People from all different ethnic backgrounds banded together because that is what Americans do. When we are threatened, when we are attacked, when there is a natural disaster or an enemy from afar, we stand up and take care of each other.

The very formation and foundation of our government is based on the ideals that we are stronger together when we stand together, when we fight together, when we invest in each other and sacrifice for each other.
I am one who believes the defense of this Nation isn't just a powerful military abroad and at home. The defense of our Nation also means that for a vulnerable child, who has a terrible disease that we can cure--we, our Nation, should take care of our own.

The defense of our country means that our elder citizens, two-thirds of whom are in nursing homes and rely on the Medicaid Program--the defense of our Nation, the preservation of our ideals is evidenced in the care of the elderly, the dignity that we acknowledge and afford them. That is the very definition of who we are as Americans.

I am one of those people who believes that the ideals of this Nation are evident not just in the strength of our military but also in the strength of our system of healthcare. It is a violation of our principles and values as a nation when our healthcare system breaks down--not to the ideals we see in our military where we protect all of our country; we stand for everyone, rich or poor. But, suddenly, with our healthcare system, with accessing lifesaving medicines and procedures, critical preventive care, it suddenly boils down to those who are very wealthy getting access, and people who are struggling in minimum-wage jobs, fighting every day to raise their kids--somehow that should not be covered in our ideals.

We are a nation that professes the most profound values--the oldest constitutional democracy, which put forth ideals that we are not a theocracy, a nation based upon privilege, based upon how you pray. We are not a monarchy. We are the oldest constitutional democracy that put ideals forward that became lights to other nations.

This ideal that we believe in liberty and justice for all--what justice is there in a piece of legislation that would cast millions of Americans, our poorest Americans, our sickest Americans, our elderly Americans into a world where they no longer have the security of healthcare? Is that justice in this country?

What is the concept of liberty in our Nation if some people are shackled to fear and worry that if their child gets sick, they will not have access to care? What is freedom if people are imprisoned by an illness or disease that they cannot get adequately treated because they do not have health coverage? Essential to the ideals of our country-- the ideals of life and liberty and happiness--is having a system of healthcare that provides a stable foundation for life.

When half of the children born in this country are beneficiaries of a Medicaid Program, why would we slash that program if doing so undermines the very start of the lives of our children? That is against our values as a country. We are a nation in which every generation has expanded access, has expanded opportunity.

Over 50 years ago, when Medicare and Medicaid Programs were formed, expanding access to healthcare for the elderly, expanding access to healthcare for the sick, expanding access to healthcare for hard- working, low-income people, that was an advancement forward. When this body passed the Affordable Care Act--and 20 million more Americans gained access to healthcare, to lifesaving procedures, to the stability that comes from having that security--we advanced this Nation more toward its ideals.

This body should be coming together to take the imperfections of the Affordable Care Act, to find where it has fallen short, and work together to build upon that foundation so everyone in this Nation can have justice and opportunity; that everyone, when it comes to the grip of illness or disease, can find the freedom that comes with the security and the ease of mind in knowing they can afford to go to a doctor. That is a national aspiration. That is national defense. That is who we are and what we stand for.

So now here we are again. The most frustrating moments of my time as a U.S. Senator were to have seen legislation not in any way coming through the processes set up by our forefathers and foremothers in this place. How can we usurp the traditions of the Senate and rush to the floor to vote on legislation that hasn't benefited from the wisdom and the genius and the experience of medical professionals or experts? It was just pushed to the floor. Even nonpartisan experts say it would rip healthcare from millions and would raise costs for the elderly. How can we as a body do this to ourselves?

We are in this situation again, where legislation is being proposed, where votes are being counted, where people are discussing if can we bring a bill to the floor, another version of those that have fallen and been defeated. Can we bring this version forward? I say it is time we stop. It is time we understand that in the same way we hammered out a bill today and passed legislation--billions of dollars to protect our country from threats of wrongdoing--that we make the same kind of effort to work together, to talk, to hold hearings, to listen to each other, to try to make sure we are defending each other, supporting each other, and helping each other so that we are a generation, like our forefathers and foremothers, expanding concepts of liberty and freedom and access for more people.

Instead, here we are, with millions of Americans now turning their attention back to the U.S. Senate--Americans with disabilities; parents with children like Ethan who worry that should they need another operation, if the rules change, if legislation changes, they will not have that access; young people with parents in nursing homes, wondering will Medicaid expansion survive yet another attempt to gut the program.
At a time when we need to be encouraging each other and strengthening our commitments to one another, we face a time of jeopardy, a decision point, a crossroads--not just in the pragmatic realities of healthcare that will come forward but a crossroads of our values and a crossroads of our ideals. Will we go forward as a nation together, expanding opportunities, securing justice, defending each other, empowering each other, or will we go back?

I end with saying this. What I have learned is, the decisions made here are not always easy, and they are often dependent upon the engagement of the Nation as a whole. I stand here, the beneficiary of courageous Americans, who stood and fought for all of our values and all of our ideals, fought to expand access and equality and opportunity, fought to defend this Nation at home and abroad, and to insist that every child have certain basic rights and opportunities.

This is yet another moral moment for our Nation. I believe every child should have access to affordable, quality healthcare. I believe every senior citizen growing old should have the security and the dignity of healthy environments. I believe people should not be denied the justice of healthcare because they have a preexisting condition.

I don't think these are radical beliefs in any way. I don't think it was radical to stand up in the late 1800s and say women should have the right to vote, that it was radical to think children should not have to experience child labor. It wasn't radical to say that Black Americans should have equal access to restaurants and hotels. These are not radical ideas. The reason this body stood up, generation after generation, securing privileges and expanding opportunities and opening access--the reason this body did that was not just because of the decisions of the people on this floor, it was because Americans stood up and demanded these changes, demanded this progress, and fought for every inch of ground.

That is the moment we are in right now, a call to the conscience of our country. This is not a time to be silent. This is not a time to be indifferent. This is not a time for apathy. This is a time for all of us to make a decision about who we will be as a nation. Will we be a nation that provides affordable, quality healthcare to all or will we slide back into that basic right being only available to a smaller and smaller group of people? That is the decision, and the decision will be made, not just by the votes on this floor or the decisions made by the 100 in this body, it must be made collectively, through our engagement and through our activism and what we demand from our representatives.

Here we are in this moral moment with this decision before our country. My prayer and my hope is that all of us, with a collective voice, with a chorus that resonates with that of our ancestors--that we fight for the defense of our Nation, that we stand up and take responsibility for ideals of equal justice, ideals of liberty and freedom, ideals of life and liberty and the pursuit of happiness, ideals that have made this Nation shine and have shown our greatness and our character. That doesn't happen by accident or some inevitability of history. It happens because we fight for it and work for it.

If there is any moment in American history where we need that spirit, that American grit, that toughness and that fight, it is this moment right now.

Mr. President, thank you.

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