Executive Calendar - Continued

Floor Speech

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Mr. President, I rise to talk about a topic that is consuming much attention--our efforts to improve healthcare for Americans. Before the passage of the Affordable Care Act in 2010, Americans with preexisting conditions faced serious barriers. Since 2010, the rate of uninsured Americans has declined to a historic low, with 20 million more Americans--the combined population of 16 or 17 States--getting access to health insurance coverage.

Over 410,000 Virginians have received care through individual marketplaces just last year. An additional 400,000 would be eligible to receive Medicaid if Virginia ever chooses to expand it. Since being put on the HELP Committee or being notified I would be put on it in December, I visited community health centers, medical schools, behavioral treatment centers, nursing programs all across Virginia talking to people about their healthcare needs. I am committed to working together with my colleagues to improve the healthcare of Virginians and Americans. There is a right way and a wrong way to do it.

After there was the failure of an effort in late July or early August to pass a partisan repeal and replacement of ObamaCare using the budget reconciliation process, the success of which would have taken health insurance away from 20 million Americans, I am disappointed that we haven't learned the lesson about the right way to do this and are apparently poised to explore yet again doing it the wrong way.

There is a proposal on the table that is designated the Graham- Cassidy proposal, and it is just as threatening as the ACA repeal we voted on just 2 months ago. It restructures traditional Medicaid funding using per capita caps and block grants. The core of this bill is an effort to dramatically go after, restructure, and shrink Medicaid, which is critical to so many people.

It ends protections for people with preexisting conditions by allowing States to essentially rewrite essential health benefits. It would eliminate Medicaid expansion and the Affordable Care Act subsidies and replace them with a block grant that would be insufficient to cover the needs of Virginians. Even that block grant funding would end after 2026--as if the need to help low- and moderate- income people afford coverage would dramatically disappear overnight.

The proposal is new and is newly on the floor. There isn't a full CBO analysis of it, but initial indication has led groups like the American Medical Association and the AARP to come out against it. They are worried it will leave insurance out of the reach of millions of Americans. In Virginia alone, more than 301,000 marketplace enrollees would have their tax credits to help them afford insurance jeopardized.

What would it mean for the healthcare system? We are not completely sure. At least on the earlier versions we voted on, we had CBO scores telling us how many millions might lose insurance. There seems to be a desire to rush this through prior to a full CBO analysis. I can't understand why. But we do know it would be devastating to those on Medicaid. Sixty percent of those on Medicaid in Virginia are children, but the majority of spending on Medicaid is for our parents and grandparents, the elderly, and folks with disabilities.

I was just in Bristol, VA, on the Virginia-Tennessee border this weekend. I heard very palpable requests for the need for better healthcare, especially in rural Virginia.

Here is what we know about the Graham-Cassidy proposal, at least based on the analysis of it thus far by my State healthcare officials. We will see a $1.2 billion cut in Medicaid under this plan over the next number of years, and the cuts would impact families like those I visit as I travel around Virginia.

I recently had a roundtable in Northern Virginia with parents of children with severe disabilities who, though they have disabilities, are doing some remarkable things because they receive support from Medicare for assistive technologies and in school programs.

A mother, Corinne, told me about her son Dylan. Dylan has a very rare neuromuscular condition SMARD--spinal muscular atrophy with respiratory distress. He has a tracheostomy tube and relies on a ventilator to breathe. He also gets all of his nutrition through a G-tube. He requires in-home skilled nursing services, and he also requires a nurse to attend school with him. But he goes to public school, and he is a successful student because Medicaid funding enables him to go. Medicaid helps reimburse the school system for the services they provide him.

``For us, affordable and quality healthcare means that Dylan can lead a fairly normal life despite his medical issues.'' That is what his mom said. He can lead a fairly normal life on a ventilator with a tracheostomy tube in a wheelchair with a nurse. He can lead a fairly normal life, despite his medical issues. He can live at home, go to school, and participate in activities any kid his age enjoys. Without the assistance of Medicaid, he wouldn't be able to do those things. Reducing Medicaid spending would limit States' abilities to provide waivers for medically complex kids. The mother adds that ``the possible return of lifetime caps and limitations on preexisting conditions would be devastating.''

I also met with a mother, Amy, from Richmond, who has a son, Declan. Medicaid covers her son's care, therapy, and medical supplies. Medicaid helps her son have the best quality of life possible and helps him with the prospect she prays deeply for--that one day, despite his medical condition, he can live independently as a productive adult. The Graham- Cassidy funding cuts to Medicaid could take away this protection for countless Virginians, especially these children.

Here is what I ask for: Why don't we have an open process to truly debate improvements to our healthcare system, instead of a rushed, closed, secretive process that threatens mothers like Amy and children like Declan?

After the efforts last summer, I hoped that the colleagues in the world's greatest deliberative body would stop a secretive, harmful rush and, instead, embrace dialogue, hearing from experts and witnesses as we would improve healthcare, attempting to stabilize the individual marketplace, lower premiums, and expand care rather than reduce it.

We gave a standing ovation on the floor of the Senate in late July when our colleague, Senator John McCain, returned from a very difficult diagnosis of brain cancer. We gave him a standing ovation after he spoke to us, and here is what he said. He talked about the fact that we had a challenge on healthcare. He talked about the skinny repeal bill that was on the floor of the Senate. He said:

We've tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it's better than nothing, asking us to swallow our doubts and force it past a unified opposition. I don't think that is going to work in the end. And it probably shouldn't.

Why don't we try the old way of legislating in the Senate, the way our rules and customs encourage us to act. If this process ends in failure, which seems likely, then let's return to regular order.

Let the Health, Education, Labor, and Pensions Committee under Chairman Alexander and Ranking Member Murray hold hearings, try to report a bill out of committee with contributions from both sides. Then bring it to the floor for amendment and debate, and see if we can pass something that will be imperfect, full of compromises, and not very pleasing to implacable partisans on either side, but that might provide workable solutions to problems Americans are struggling with today.

To my great satisfaction, after the skinny repeal bill went down--and this body decided that it didn't want to precipitously take healthcare away from 20 million people--that is the course that this body embraced. It is what our heroic colleague suggested that we embrace. The HELP Committee--which, as a member of this, I am very aware had refused to hold a hearing on any of the proposals in the House or in the Senate around the repeal of ObamaCare--decided finally to do what the HELP Committee should do. The ``H'' is for ``Health.'' To pass a bill reorienting one-sixth of the American economy around the most important expenditure that anybody ever makes in their life without letting the HELP Committee hear from it was foolish to start with.

So now we have embraced doing it the right way. Under the leadership of Senator Alexander and Senator Murray, we have had four robust bipartisan hearings. We invited Governors to come from around the country. They had to turn their schedules topsy-turvy to do it-- insurance regulators, insurance executives, patients, doctors, hospitals. There were four hearings, each with multiple witnesses. We turned their schedules topsy-turvy. We had them here. We had coffees before each hearing and invited all Members of the Senate, not just those on the HELP Committee, to interact and hear from these experts. We have gotten advice from them on what we need to do to stabilize the individual insurance market and what we can do in the long term to make healthcare better for everyone. We should take advantage of those recommendations.

When the fourth hearing was completed last week, the chairman of the Committee, Senator Alexander, and the ranking member, Senator Murray, with the support of this very diverse committee--left, right and center, Democrats and Republicans--have embarked on a bipartisan process to find, after a full and transparent airing of the issues, a way to stabilize the individual insurance market. We are on the verge of doing that.

Yet what we are told is, instead of going through our committee process and hearing and airing it before the public, now there is a new bill that has just recently come out with no full CBO score. The idea is to force that through, with no CBO score, with no full committee process that would enable us to hear from witnesses, with no opportunity for members of any of the committees--Finance or HELP--to offer amendments, with no meaningful floor debate, and with no opportunity for amendments on the Senate floor.

Why did we give Senator McCain a standing ovation just 6 weeks ago when he suggested that when it comes to something as important as healthcare, we should treat it with seriousness, so we can get it right and not rush and get it wrong?

I stand here--and I hope I am on my feet a good bit more between now and the end of the month--to ask this question: Why backslide? Why go backward when we had embraced a process of bipartisan discussion?

I am fully aware that as a Member of the minority party, I have no power except my ability to convince Republicans that I actually have a good idea. But a one-party process on the floor that tries to end run the relevant HELP Committee is guaranteed to fail. It might pass, but it is guaranteed to fail because it is guaranteed to hurt people. It is guaranteed to have some consequences that are harmful and known and other consequences that are harmful and unknown because it has been rushed, and it hasn't been done in the view of the public with the ability to fully listen to them. Just think about it this way: What does it say about your commitment to your legislation if you are not willing to have it subjected to a normal review by the committees that have jurisdiction over it?

The Graham-Cassidy bill has some provisions in it that are relevant to the Finance Committee's jurisdiction, but Finance is apparently not going to do a markup of the bill, and they are not really going to hear from experts about the bill.

There are other provisions in Graham-Cassidy dealing with essential benefits that are squarely within the jurisdiction of the HELP Committee, but the HELP Committee isn't going to have a hearing either.
So in spite of the good recommendation we were given by our senior colleague who was just on the floor--who was characteristically here to talk in kind words about the public service of someone who has worked with his staff for 30 years--we gave him a standing ovation, and we are prepared to violate everything that he just suggested we do.

As I conclude, I will just say this. This isn't about healthcare. Healthcare is important enough. No one ever spends a dollar on anything that is more important than their health. It is the most important thing that anyone ever spends a dollar on--health, my health, the health of my family. I think we can all share that. Nothing is more important. It also happens to be one of the largest sectors of the American economy. Between 15 and 20 percent of America's GDP is healthcare. This is a very important issue. If you are trying to reorient one-sixth or one-fifth of the economy, if you are touching the expenditure of priority that is the single most important priority in anyone's life, that is important enough.

I would argue, in closing, that there is something I think is equally important; that is, this body. We celebrated the 230th anniversary of the Constitution this past Sunday. James Madison and others in Philadelphia, tried to figure out how this government should work. They made a very unusual decision that would be different from the decisions that are made in many countries; that is, they put the legislative branch first.

There are three coequal branches. In most societies, the executive is first, but not here--first among equals. We are meant to really play an A game. We are really meant not to be an article-II-and-a-half branch reacting to a Presidential tweet or encouragement; we are supposed to be an article I branch.

In the legislative branch in article I, the Senate is given a very particular role. We are called the world's greatest deliberative body. We are the saucer into which the partisan heat of the day is poured and allowed to cool, so the decisions made in the Senate are supposed to be more careful and more deliberate.

This is a great body that has been sadly hobbled by partisan gridlock, and we have not achieved what the Senate should achieve. We learn in math as we grow up that the whole is equal to the sum of the parts, but what you find in life is that often the math doesn't work out. Sometimes the whole can be equal to or greater than the sum of the parts in life if teams work well together. But sometimes--and this describes the Senate now--there are 100 wonderful, accomplished people in this body. Yet again and again, and now for years, the whole has been equal to less than the sum of the parts.

We have done very little of meaning, very little of substance. Yet now we are poised to tackle the most important issue that most affects people and the biggest sector of the American economy. If we get it right, we can send a message to the public that the Senate will once again be the Senate. We will once again be a deliberative body. We will once again do what we are supposed to do.

I think this country now needs to see some adults in the room, some group of people willing to work together--Democratic and Republican--to solve problems and do the right thing for the American public. If we do this right, we can send that message. If we do it wrong, we will hurt people, and we will also hurt the credibility of this institution in a way that I think will last for years.

We have a choice. It is up to us. We either follow the advice that our colleague gave us on the floor 6 weeks ago, which we gave him a standing ovation for, and we gave him the ovation because we knew he was right--we either follow that advice or we decide to ignore it and continue the downward spiral of a great body.

With that, I yield the floor.

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