[Pages H2191-H2197]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      GOP TAX SCAM HURTS EVERYONE

  (Under the Speaker's announced policy of January 3, 2025, Ms. Schrier 
of Washington was recognized for 60 minutes as the designee of the 
minority leader.)


                             General Leave

  Ms. SCHRIER. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material into the Record.
  The SPEAKER pro tempore (Mr. Hurd of Colorado). Is there objection to 
the request of the gentlewoman from Washington?
  There was no objection.
  Ms. SCHRIER. Mr. Speaker, I am here as one of the co-chairs of the 
Congressional Doctors Caucus in the House of Representatives. I am here 
to talk straight with you and with the American people and my 
constituents about this tax plan that is being worked on by my 
Republican colleagues.
  It will explode the deficit. It will also hurt every single person in 
this country by making the biggest cuts to Medicaid and to food 
benefits ever.
  I want to make clear, as I talk about this, how reckless it is and 
that even people who do not rely on Medicaid themselves will be 
impacted by this. I am outraged. We are talking about a cut of $715 
billion to Medicaid. That is the largest cut ever. It will kick 13.7 
million Americans off of their health insurance.
  Let's just be really clear about why they are doing this. This isn't 
to balance the budget. It is not to deal with the deficit. In fact, 
this bill is exploding the deficit. This is to pay for a gigantic tax 
break for the wealthiest people in this country a la Elon Musk.
  It is morally bankrupt to think about that, that transfer, about 
taking healthcare away from the people in my district and across this 
country and transferring it to the wealthiest Americans. It is also 
fiscally reckless.
  Doing this will essentially collapse our healthcare system in the 
United States of America. That is why just last week, we spent 26\1/2\ 
hours in the Energy and Commerce Committee discussing this very thing, 
telling the stories of our constituents, painting a picture of what it 
would mean to cut 13.7 million Americans off of their insurance.
  It is interesting that this whole discussion didn't start until 2 
o'clock in the morning because my Republican colleagues didn't want to 
have this discussion during the day when people would actually hear it. 
They waited until the dead of night to bring up this topic of taking 
healthcare away from our constituents.
  Mr. Speaker, in the State of Washington, one in three people rely on 
Medicaid. I am going to tell you that most people who do don't even 
know it because in Washington State it is called Apple Health. If 
people are asked if they are on Medicaid, they will say no. If they are 
asked if they are on Apple Health, they will say yes.
  This represents the most vulnerable people. These are kids, pregnant 
women, people with disabilities, and the elderly in nursing homes. 
These are the people who need our help the most.
  I think about my patients. I am a pediatrician. I think about the 
ones who have Apple Health. If they didn't have it, if they didn't have 
access to come see me, their primary care pediatrician, and get 
diagnosed early with a mild pneumonia or an ear infection or whatever 
the case may be, they would be forced to go to the emergency department 
for that care.
  It is not like they are not going to get sick. They are going to get 
sicker, and they are going to go later when things are more expensive 
and more complicated.
  Mr. Speaker, do you know what else? Even if you are not on Medicaid, 
as I think about my patients with private insurance, they are going to 
be waiting in that emergency department line, too. They will have 
broken an arm or have some other emergency. They are going to be 
waiting in a longer line. We all know that the lines are already long 
to be seen in the emergency department.
  The care there is the most expensive a person can get. The lines are 
the longest lines. Somebody is going to pay for that care. Otherwise, 
hospitals go underwater, and they go out of business.
  Who is that? That is the people who are not on Medicaid but who are 
paying private insurance premiums. Those premiums are going to go up. 
It will hurt individuals who buy their own insurance. It will hurt the 
businesses and the companies who employ those people. This hurts 
everybody.
  I want to tell you the story about Ayla. This is Ayla. She is 4 years 
old. She was born in 2021 in a rural part of my district after an 
uneventful pregnancy. Right after she was delivered, something went 
very, very wrong. She was in dire straits. She was clearly sick. She 
needed emergency care.
  Thank goodness, this rural hospital has a labor and delivery unit. 
They were well-equipped to resuscitate a baby, to stabilize her, and 
then to Life Flight her to a hospital that could provide the specialty 
care that she needed.

  Let's think about it for a moment. If Medicaid gets cut and these 
rural hospitals see a disproportionate share of patients on Medicaid, 
either those hospitals are going to close or they are going to start 
cutting back services. Mr. Speaker, I will tell you the first service 
to go will be labor and delivery.
  What if that had happened after these Medicaid cuts? What if Kittitas 
Valley Healthcare didn't have labor and delivery? What if Ayla had been 
born then? What if she had not had the specialists there and had not 
had the ability to be resuscitated there in the delivery room? She 
would not have made it.
  That is what we are going to see when they start cutting away at 
Medicaid. It will mean the closure of rural hospitals and fewer labor 
and delivery units. More people will get sicker. They will get poorer. 
Children like Ayla will not make it.
  That is what I mean when I say it collapses our whole healthcare 
system. Our healthcare system is like a three-legged stool. One of 
those legs is Medicaid. If we start taking that away, the whole system 
collapses.
  That is what we are talking about: Hospital closures, taking away 
services, long waits in emergency departments, and a population that is 
sicker and that needs more care. That care becomes more expensive. It 
hurts us all.
  That is why I am so outraged that this is the mechanism that my 
Republican colleagues want to use to pay for a tax plan that will give 
gigantic cuts to the wealthiest taxpayers in this country such as Elon 
Musk. That is unconscionable. I wanted to start with that.
  I am really honored to yield to our Speaker Emerita Nancy Pelosi from 
the great State of California.

[[Page H2192]]

  

  Ms. PELOSI. Mr. Speaker, I am pleased to receive time from the 
distinguished Congresswoman from Washington State (Ms. Schrier). She is 
a pediatrician. We have all learned a lot about how public policy has a 
direct impact on the health and well-being of the American people.
  When I hear them talk about cutting over $700 billion in Medicaid and 
that it is just waste, fraud, and abuse, this beautiful child is not 
waste, fraud, and abuse. I will talk about a little child in my remarks 
who is not waste, fraud, and abuse.
  This Special Order comes together to shine a bright light on the 
Republican plan to fund tax breaks for billionaires by making huge cuts 
to Medicaid.
  That is what it looks like. The fact is they will still with their 
tax bill add nearly $4 trillion to the national debt to cover their tax 
break for the wealthiest people in our country.

                              {time}  1940

  This is fiscal engineering to reduce the role of government in the 
lives of the American people where it is most needed. This is Robin 
Hood in reverse, taking resources from where it is most needed, from 
people who need it most, and giving it to those who need it less, the 
billionaires in America.
  This is shameful. It is a fraud, and it is a shame.
  When President Johnson signed Medicare and Medicaid into law, he 
traveled to Independence, Missouri, to be in the presence of former 
President Truman who had worked on this when he was President, but it 
came to fruition under President Johnson. President Johnson went there, 
and he signed the bill in the presence of Harry Truman. He reminded the 
American people of a shared tradition:
  ``Never to be indifferent toward despair. . . . never to turn away 
from helplessness. . . . never to ignore or spurn those who suffer 
untended in a land that is bursting with abundance.''
  Indeed, Medicaid saves lives and is a pillar of health, security, and 
justice for tens of millions of Americans.
  People often think of Medicaid as healthcare for poor children, and 
that would be justification enough, healthcare for poor children. 
However, it also is a middle-income benefit for nursing home residents 
and people needing it for long-term care services. They get that 
largely through Medicaid. It is also a benefit for people with 
disabilities.
  The Republicans' devastating budget plan would push about 14 million 
Medicaid recipients off lifesaving healthcare and leave countless 
vulnerable families exposed to catastrophic medical bills. This is 
terrible. This is about health and financial health that is being 
devastated.
  Working families and children from low-income households would face 
ruinous consequences as would rural hospitals--as the distinguished 
Congresswoman has mentioned--families seeking opioid addiction 
treatment for their loved ones, and middle-class Americans with long-
term care needs.
  Mr. Speaker, I ask unanimous consent to insert a statement from the 
California Medical Association into the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from California?
  There was no objection.


                               California Medical Association,

                                                     May 12, 2025.

     CMA statement on House Republicans' proposed cuts to Medicaid

       California Medical Association President Shannon Udovic-
     Constant, M.D., issued the following statement regarding 
     House Republicans' proposed cuts to Medicaid:
       ``The latest federal proposal to gut Medicaid is reckless. 
     Physicians and hospitals will be pushed to the brink, forced 
     to close their doors and unable to continue to care for their 
     patients.
       ``These would be the largest Medicaid cuts in history and 
     will leave veterans, seniors, the disabled, children and 
     working families without health care coverage--making 
     emergency rooms the only point of care for millions of 
     people. Communities will be devastated, and lives will be 
     lost.
       ``Congress must reject these cuts and instead focus on 
     strengthening the safety net that protects us all. Otherwise, 
     at least 13.7 million people will lose health care 
     coverage.''

  Ms. PELOSI. This is what they have said about this.
  California Medical Association issued the following statement 
regarding House Republicans' proposed cuts in Medicaid:
  ``The latest Federal proposal to gut Medicaid is reckless. Physicians 
and hospitals will be pushed to the brink, forced to close their doors 
and unable to continue care for their patients.''
  Mr. Speaker, that is because when this funding leaves those rural 
hospitals, then not only do the Medicaid patients lose, but all the 
patients in that rural area lose.
  ``These would be the largest Medicaid cuts in history and will leave 
veterans, seniors, the disabled, children and working families without 
healthcare coverage''--this is as the distinguished physician colleague 
has said--``making emergency rooms the only point of care for millions 
of people. Communities will be devastated; lives will be lost.
  ``Congress must reject these cuts and instead focus on strengthening 
the safety net that protects us all. Otherwise, at least 13.7 million 
people will lose healthcare coverage.''
  Republican attacks on healthcare impact real people, including little 
children. My guest at the President's State of the Union Address to 
Congress was Elena Hung, mother of Xiomara, a courageous Little 
Lobbyist, who is 11 years old.
  Xiomara has complex medical needs, including chronic lung disease, 
chronic kidney disease, and global development delays. She has a 
tracheostomy, is ventilator and oxygen dependent, and uses a feeding 
tube.
  Access to quality, affordable healthcare ensured that Xiomara 
received the care she needed during an extended hospitalization and can 
now live at home with her family.
  Medicaid has helped Xiomara receive the therapies she needs to catch 
up with her developmental milestones, including physical therapy, 
occupational therapy, feeding therapy, and speech therapy.
  However, these very lifelines, including Medicaid and more, are what 
Republicans are working to destroy to fund tax cuts for billionaires.
  Democrats are standing strong against the administration's many 
attacks against families' healthcare. This is just one of them.
  With this Special Order hour, we are calling out Republicans to 
either vote to protect their constituents' healthcare, or to vote to 
take it away. That is the choice.
  In stark contrast to the President and Republicans in Congress, 
Democrats will always fight to lower healthcare costs. We are unified 
and ready to use every tool to stop this GOP scheme. We will always 
work to strengthen pillars of health and financial security in America. 
That includes the Social Security, Medicare, and Medicaid. We will 
always fight for Medicaid.
  I just want to go back to that one thing. They are still adding 
nearly $4 trillion to the national budget to give tax breaks to their 
wealthy billionaire friends. When the Republicans passed that bill and 
the President signed it into law, 83 percent of the benefits went to 
the top 1 percent, adding $2 trillion to the national debt. They are 
doubling down on that, adding almost $4 trillion to the national debt 
and saying: We have got to give all this money to billionaires and call 
children waste, fraud, and abuse in our Medicaid system.
  It is really sinful, it is really sad, and it is something that I 
hope the Republicans will reject.
  I hope their constituents will call them, because these Medicaid 
people are in Republican districts. One of our colleagues in California 
has, out of all of our constituents, he has nearly 500,000 people on 
Medicaid. Yes, he voted with Republicans on this.
  Mr. Speaker, you can be sure he will be hearing from his constituents 
because people know.
  I will close by saying that Lincoln said:
  ``Public sentiment is everything. With it, you can accomplish almost 
anything. Without it, practically nothing.''
  However, for public sentiment to prevail, people have to know, and we 
are making sure that our constituents know and they are being informed 
as to our knowledge of what Republicans are doing. It is Republican 
reverse Robin Hood.
  Mr. Speaker, I am grateful for the opportunity to share the story of 
this beautiful little girl.

[[Page H2193]]

  

  Ms. SCHRIER. Mr. Speaker, I thank Emerita Speaker Pelosi for her 
moral clarity and her fiscal pragmatism in painting a clear picture of 
what is going on right now.
  Mr. Speaker, I yield to the gentlewoman from Vermont (Ms. Balint).
  Ms. BALINT. Mr. Speaker, I thank Representative Schrier, and I am 
happy to be here.
  Just this morning, President Trump said that the Republicans aren't 
cutting anything meaningful in their budget. What a thing to say. What 
a shocking thing to say when these cuts will hurt so many Americans. I 
am having a really hard time understanding how taking away healthcare 
from nearly 14 million Americans isn't meaningful.
  It is not meaningful that rural hospitals across Vermont and across 
this country are going to be at risk of closing?
  Just today I met with Vermonters from a little town called Coventry, 
and they are deeply concerned that they are going to lose access to 
labor and delivery healthcare at their local hospital.
  Republicans are so out of touch with the reality of American families 
right now, and it is shocking to call these cuts not meaningful when 
their bill will hurt working families.
  It takes away food and healthcare from millions and millions of 
people, their own voters, but yet they are not meaningful cuts.
  These cuts are certainly meaningful for all the kids and veterans who 
will go hungry because of this cruel and what I think is a very cynical 
bill.
  Why are my Republican colleagues making the cuts?
  That is what we all want to know.
  It is to give the very wealthy another big tax cut and deliver tax 
breaks to billionaires and corporations, people who absolutely don't 
need any more assistance.
  It is taking that money from people who desperately need help and 
giving away to the people who don't.

                              {time}  1950

  People who are just struggling to get by are having precious 
resources taken away from them.
  Right now, across this country, Americans are trying to figure out 
the math. Are they going to be able to afford groceries for their kids? 
They are trying to decide whether they can afford to go to the doctor.
  While that is happening, in real time, my colleagues are spending 
time demanding more work requirements for Medicaid recipients when we 
know that almost half of adults on Medicaid are already working. They 
act like they are not working. They are working, and 27 percent of 
those working-age adults on Medicaid are disabled. They are doing the 
best they can here.
  It couldn't be more obvious that they are just looking to remove more 
people from the Medicaid rolls in order to have more money to give tax 
breaks to billionaires and corporations. It is sick.
  These are real people who we are talking about tonight in every 
congressional district who cannot handle these cuts. It is as simple as 
that.
  The reality is that Americans can't pay for their rent right now. 
They can't pay for their groceries. They are too high. Prescription 
drug prices are too high. Costs for consumers and small businesses are 
just going to go up because of the asinine tariff regime that we have 
been dealt.
  Of course, Americans feel like it is rigged against them because it 
is. That is why we have to be here fighting for them. That is why we 
have to be here, raising the alarm about what is happening in this bill 
with Medicaid.
  What Americans want is fairness. What they need is fairness. We owe 
them that. They want and need affordable healthcare, and we owe them 
that. They want and need a fair shot, a better life for their kids, and 
we owe them that.
  This bill that cuts Medicaid is a statement of values. It shows 
exactly what and who the Republicans are caring about. It is not you 
and your family. It is not me and mine. It is about propping up 
billionaires and kicking the rest of us in the teeth while they do it.
  What kind of leaders take away healthcare and food from working 
people so that the wealthy can get even more money? What kind of 
leaders? Not strong leaders, not leaders of conscience.
  It is shameful.
  Ms. SCHRIER. Mr. Speaker, I thank Representative Balint for that 
clarity. I appreciate drawing that distinction that Speaker Emerita 
Pelosi referred to as reverse Robin Hood. That is exactly what is going 
on here.
  Who are you standing up for? We saw with the Republican 2017 tax cut 
that the vast majority of that benefit went to the wealthiest, and it 
did not trickle down to people. People are already having trouble 
affording rent, home prices, food, and other goods.
  Putting this kind of financial pressure not just on Medicaid 
recipients but on everybody else, because insurance rates and medical 
costs are going to go higher, only makes that squeeze worse.
  Mr. Speaker, I yield to the gentlewoman from Hawaii (Ms. Tokuda).
  Ms. TOKUDA. Mr. Speaker, I rise today with a warning--no, a plea.
  Rural America is already in crisis. People there die younger. Mothers 
face greater risks when giving birth. Hospitals teeter on the edge of 
collapse.
  Medicaid is the thin lifeline holding together that fragile system. 
Cut it and people will die.
  At Adventist Health Castle in Kailua, 75 percent of patients rely on 
Medicaid and Medicare. They have already weathered the storm of COVID. 
With new GOP-led cuts to provider fees, they may be forced to shut down 
essential services--obstetrics, pediatrics, and emergency services, 
care that literally keeps babies and people alive.
  This is not just about one hospital in Hawaii. This is a national 
crisis. Rural Americans face significantly worse health outcomes and 
health disparities. In too many rural counties, life expectancy is a 
decade shorter than that of their urban neighbors.
  Maternal mortality in rural areas is nearly double that of urban 
areas, and more than 200 rural hospitals have closed their doors since 
2005. Over 450 more are currently at risk of shutting their doors.
  This isn't hypothetical. It is happening right now. Let's be clear: 
When these providers and hospitals close their doors, everyone in those 
communities, including, by the way, some Members of Congress and their 
families, will lose their healthcare. It won't bring me or anyone 
impacted any comfort or peace to say, ``I told you so.''
  Suma Metla, a pediatric physical therapist and mom, treats kids with 
complex needs. Forty percent of her patients are on Medicaid. She told 
me plainly, as she sat in my office today with her 1-year-old, Kashi: 
If these cuts pass, we will not survive past this year.
  Already, speech therapists and other specialists are shutting their 
doors in Hawaii and across the country. Her own practice is buried in a 
2-week backlog. One of two hospitals that offer similar care, and we 
only have two throughout the State, has a 100-child waiting list right 
now.
  Suma has traveled to Lanai to treat children no one else could reach. 
She tried to keep care going through telehealth, but when Congress let 
those tools expire, families were left stranded.
  Let's talk about the preschool teacher in my district whose son was 
born weighing less than 2 pounds--5 months in the NICU, emergency 
surgery, feeding tubes, with a hospital bill 50 times more than she 
will make in a single year covered by Medicaid.
  That little boy is now 3 years old, full of life, laughter, and love 
and obsessed with music and trucks. He is alive only because Medicaid 
was there.
  We cannot forget what is at stake. These are not just numbers on a 
page. They are real lives, real children, real families, and real 
communities, people like you and me.
  Slashing Medicaid won't balance a budget. It will close hospital 
doors. It will rip care from those who need it most. It will end lives.

  We must not let this happen. Find the courage. Have a conscience. 
Vote ``no.''
  Ms. SCHRIER. Mr. Speaker, I thank Representative Tokuda for bringing 
up that particular issue of children in the neonatal intensive care 
unit, where I have worked.
  I think about this frequently. When over 40 percent of births in this 
country are covered by Medicaid, I think about what it would mean for a 
family

[[Page H2194]]

to be bankrupt for the rest of their lives if they had a premature baby 
or a baby with special needs. I also think about what would happen if 
those babies didn't get the right care.
  Sometimes this is not a matter of life and death but a matter of 
life, death, and lifelong disabilities. That is what good NICU care 
will mean, and it makes a difference for these babies who are relying 
on Medicaid.
  Mr. Speaker, I yield to the gentleman from California (Mr. 
DeSaulnier).
  Mr. DeSAULNIER. Mr. Speaker, I am reminded of the first oath the 
gentlewoman took before she got here: First, do no harm.
  I wish my Republican colleagues would take that oath because the harm 
that this proposal does to the least amongst us in this country is 
unfathomable, cruel, and madness from a financial perspective.
  When everyone is cut off from Medicaid, where will they go? They will 
go to public hospitals that are already underfunded and trying to serve 
the least among us.
  After all the stories you have heard, I want to put in some numbers. 
Think of multiplying these numbers to the stories you have heard, 
particularly for people who are the least among us as Americans.
  There are 78.5 million people enrolled in Medicaid and the Children's 
Health Insurance Program across America. This is 10 percent higher than 
in February 2020, pre-COVID.
  One in three people with disabilities, 15 million, have Medicaid. 
Comparatively, 19 percent of adults without disabilities have Medicaid. 
These are the people who Republicans and Democrats in the past have 
tried to protect. Now, we are being cruel and dismissive of their 
needs.
  One in five Medicaid enrollees has a disability. Two-thirds of 
Medicaid enrollees do not receive SSI benefits.

                              {time}  2000

  Mr. Speaker, 10.3 million people would lose Medicaid coverage in the 
next 10 years if the budget reconciliation bill of the Republicans 
passes because of its punitive work requirements. Most of these people 
are already working.
  In 2022, Medicaid covered two-thirds of all home-care spending. 4.5 
million people receive Medicaid-covered home-care services each year in 
America.
  Medicaid cuts as proposed under the Republican budget threaten 
optional benefits the most, including long-term services and supports 
that help the disabled and the elderly in home- and community-based 
services that help protect these Americans who need our help. They live 
with disabilities in their own communities and get the support, love, 
and affection of those communities and their families.
  In California alone, almost 15 million Californians are on Medicaid. 
1,906,300 Californians on Medicaid have a disability. Of those, 992,000 
people are working, aged 19 to 65. A million people in California with 
disabilities who get Medicaid are working, and now they are going to be 
forced to go through a bureaucracy that supposedly the majority wants 
to make more efficient. That is not efficiency. That is cruelty to the 
least amongst us.
  Mr. Speaker, 68 percent of California adults on Medicaid have a job. 
In just my district, which is the fifth wealthiest district in the 
House, 131,634 people are on Medicaid and are at risk of losing care 
under the Republican budget. 45,916 of those are children, 19,000 are 
seniors, 10,000 are people with disabilities, 48,300 adults are on 
Medicaid due to ACA expansion.
  Mr. Speaker, this is madness. I thank my colleague for bringing this 
to the floor, and I thank her for her spirit and her personal testimony 
to what this will mean to millions of Americans who are the least 
amongst us.
  Ms. SCHRIER. Mr. Speaker, I thank the gentleman for his comments and 
putting this in a very personal way.
  I am wondering for people out there watching if they are thinking, 
gosh, I wonder is this really true? Are hospitals really going to 
close? Are we really going to lose labor and delivery and have to drive 
hours to get to the nearest hospital to deliver a baby?
  In my district, the hospital that I talked about earlier is between 
two mountain passes. If it is snowing, there is really nowhere to go 
except by Life Flight, and that is not hyperbole. I have sat with the 
heads of school-based health clinics and community health centers, with 
heads of hospitals, with nursing homes--and, by the way, we have been 
referring to rural hospitals, but there are urban hospitals and 
suburban hospitals that are also highly dependent or have a very high 
percentage of Medicaid-dependent patients.
  We are already seeing cuts in hundreds of employees in the Seattle 
area because of these impending cuts to Medicaid. I want to just be 
crystal clear; this is absolutely true. We are hearing this across the 
board that when Medicaid gets cut, we all lose.
  We lose our local labor and delivery service. We lose our local 
emergency room. We lose the ability to be seen quickly in the event of 
an emergency because somebody who could have been taken care of by a 
primary care physician a couple of days earlier with an uncomplicated 
illness is now in the emergency room ahead of you in line, making you 
wait when you are having a heart attack. That is completely preventable 
by using the leanest, most efficient healthcare service and insurance 
that we have called Medicaid.
  I want to tell another story. This is the story of Miguel. Now, we 
talked about Ayla before, a little 4-year-old girl. Miguel is at the 
other end of life. He is a senior. He is a constituent who is dependent 
on Medicaid. He is actually a 76-year-old widower who lives in 
Wenatchee, the apple capital of the world.
  Now, after Miguel's wife passed away, he relied solely on his Social 
Security check to cover his living expenses. He is a retired orchard 
worker, and he worked hard to earn that Social Security. He spent 
decades doing physically demanding labor without access to a pension 
later, and private insurance was never affordable.
  He still depends on Medicaid to stay in his modest home, receiving 
regular in-home nursing visits and help with daily tasks, like bathing, 
cooking, and managing his medications. Medicaid's coverage for home-
based care is, by the way, far more affordable than nursing home-based 
care. He gets that home-based care, transportation, and care 
coordination through Medicaid. Without that, he would have no way to 
attend his checkups, manage his diabetes, and function through the 
limitations that he suffered because of a stroke.
  Miguel fears losing access to the services that allow him to live at 
home with dignity, with independence, in familiar surroundings, and he 
deserves that. Frankly, that is the most cost-effective way to help 
Miguel.
  For seniors like Miguel, Medicaid is not optional. It is their 
lifeline. It is how they keep dignity. It is how they stay at home. 
Unfortunately, Miguel's fears are not unfounded. The rural hospital 
that he depends on treats patients who are more likely to be on 
Medicaid or Medicare. In other words, they have a disproportionate 
share, and if these patients, these Medicare patients, lose their 
health insurance because of this bill, the cost of their care gets 
absorbed by the hospital.
  For hospitals in rural areas that are already struggling, barely 
keeping their heads above water, this could be the death blow. This 
will force them to first cut services. I talked about labor and 
delivery. I could also talk about mental health services and opioid 
treatment. Those are often the first to go. This would leave Miguel 
without access to care.
  I am not trying to fearmonger or deceive Americans, but this is 
scary. It is real. I am simply saying what our community health 
centers, and our hospitals, and our nursing homes, and our school-based 
health clinics are telling me, that the Republicans' budget will take 
healthcare away, and health insurance away from 13.7 million Americans 
all while, therefore, increasing costs for everyone, decreasing access 
to care, and leaving us all sicker and poorer.

  Now, we haven't even talked really about the impact on nursing homes 
and on our seniors. Speaker Emerita Pelosi touched on this, but I also 
want to be very clear that three out of five middle-class, working-
class Americans in nursing homes depend on Medicaid to pay those bills.
  We already say in Washington we don't have enough nursing homes. In 
fact, people who should be in nursing homes are now filling hospital 
beds because there is nowhere else to go. Just

[[Page H2195]]

imagine if more nursing homes close what that will do to hospitals, 
what that will do to those patients.
  Then think about this: I am in the sandwich generation. If I had a 
parent who relied on Medicaid to be in a nursing home and could not 
otherwise afford that, I would need to leave my job to take care of my 
parents. That is not what they would want for themselves or for me or 
for my family. This is what millions of families out there will go 
through if these Medicaid cuts happen.
  Ms. PELOSI. Will the gentlewoman yield?
  Ms. SCHRIER. I yield to the gentlewoman from California.
  Ms. PELOSI. Just briefly, I want to make this further point. Ms. 
Schrier has been so eloquent, and all of us associate ourselves with 
her remarks and the professional knowledge that she brings, the 
intellectual resource she is on all of this.
  I just want to add one thing. At the same time as the Republican 
reverse Robin Hood plan is going, taking it from those who need it 
most, giving it to those who have the most, they are also taking nearly 
$300 billion from SNAP.

                              {time}  2010

  SNAP is for food. Food is medicine. You are going to make people even 
more sick if those children don't have food.
  There was one time when Medicaid first began that one of the people 
who was starting community health centers around the country insisted--
insisted--with the Federal Government that food be counted as medicine 
because it is about health. Children who do not have access to food are 
the ones who suffer the most.
  I see that our colleagues have arrived.
  Let me just add one thing. People ask me: What is your why? Why did 
you ever decide to leave home and come to Congress? I have five 
children. The idea that one in five children in America lives in 
poverty and goes to sleep hungry at night in the greatest country that 
ever existed in the history of the world, I just couldn't handle that. 
That is what took me from kitchen to Congress and housewife to House 
Speaker, to feed the children.
  When Matthew says: ``When I was hungry, you fed me,'' in the Gospel 
of Matthew, what do we do with that? Just tear it up. This is immoral. 
It is sinful for us to be taking food out of the mouths of babies to 
give tax cuts to rich people.
  Yet, do you know what? It isn't about that. Republicans are giving 
those tax cuts anyway. The majority is fiscally engineering the 
shrinking of the compact that we have with the American people and that 
developed countries have with their constituents.
  We are behind the rest of them in many of these regards when we have 
to take food out of the mouths of babies to say that we are going to 
give a tax cut to the wealthiest, but we just really are taking food 
out of the mouths of babies because we don't want to feed them. That is 
what this is about, $1 trillion: $700 billion or more for Medicaid and 
$300 billion for SNAP. It is reverse Robin Hood a la Republicans.
  Ms. SCHRIER. Mr. Speaker, I so very much appreciate those comments 
and Speaker Emerita Pelosi's dedication to children in every way.
  Just to put an even finer point on that, food is medicine, cutting 
SNAP benefits not only takes food away from hungry people, but it also 
undermines our economy because those dollars are spent at our local 
grocery store.
  I also have to just mention that food banks, which are the next line 
of support, are also under threat because DOGE and Elon Musk and Donald 
Trump have cut the food going to those food banks, leaving shelves 
bearer and leaving food banks having to ration foods. They also 
canceled the program where local farmers can provide their food to the 
local food banks, which is the healthiest and local and fresh food.
  All of this just adds up, once again, to hurting people in need in 
order to fund a tax cut for the billionaires in this country.
  Mr. Speaker, I now yield to my colleague from Minnesota (Ms. 
Morrison) to give her perspective about Medicaid.
  Ms. MORRISON. Mr. Speaker, I thank Representative Schrier for 
yielding me time.
  Mr. Speaker, I rise today alongside my colleagues in the Democratic 
Doctors Caucus and as the first and only pro-choice OB/GYN here in 
Congress to speak out against the Republicans' disastrous budget 
proposal and to fight for our women, children, and families.
  For more than 20 years, I have had the honor and privilege of taking 
care of OB/GYN. One of the great joys of my job is caring for my 
patients during their pregnancies and helping them grow their families. 
I carry my patients and their stories with me, and they inform my work 
here in Congress.
  I think about them and all of the challenges that new parents face 
during pregnancy and then after they head home with their new baby: 
recovering from the delivery, adjusting to life with a little one, 
accessing the care they and their family need, balancing caregiving and 
work, making ends meet, and the cost of raising children in the United 
States. It is a lot.
  I think about all of the babies I have delivered whose moms got their 
healthcare through Medicaid and how critical that was to help them get 
off to the best possible start.
  It is because of those patients and patients all across the country 
that I stand here today both incredulous and outraged that the 
Republican majority in Congress is shoving a budget through that will 
gut Medicaid, the very health insurance program that covers 40 percent 
of all births and insures almost half of all children in our country. 
As an OB/GYN, as a mother, as a Member of Congress, and as an American, 
this is unconscionable to me. We already have a maternal health crisis 
in our country.
  Let's look at the facts about that maternal healthcare crisis that we 
face now and remember that this is before we gut Medicaid. In more than 
half of our country, women do not have a place to go to get obstetric 
care. Among our peer nations, the United States has the highest rate of 
both maternal and infant deaths.
  In 2022, there were more than double and sometimes triple the rate of 
maternal deaths in the United States compared to most other high-income 
countries, and unacceptable disparities exist. Black, American-Indian, 
and Alaska-Native women are three to four times more likely to die from 
a pregnancy-related cause compared to White women. Most of these 
deaths, more than 80 percent, are preventable.
  What is the Republican majority doing to address this unacceptable 
crisis? Instead of working to find ways to improve women's health and 
to help moms and babies, they are shoving a budget through that will 
devastate our Nation's maternal healthcare and decimate many of our 
hospitals and clinics. It will unequivocally make our Nation's maternal 
health crisis worse.
  Why in the world are they doing this? Why are they choosing to harm 
women and children? They are doing it to pay for tax cuts for the 
ultrawealthiest among us. That is literally why. To make the math work 
to cut taxes for billionaires, they are choosing to sell out the health 
of women, moms, new babies, and the future of our country to pay for 
tax cuts for billionaires, choosing to take healthcare away from moms 
and their babies.

  Let's be clear. This won't just be devastating to the moms and new 
babies who get their healthcare coverage through Medicaid. It will be 
devastating for maternal healthcare across the country. All of this is 
coming from the party that calls itself pro-life and profamily. It is 
hard to imagine a more antifamily policy.
  Instead of wasting time musing around ridiculous ways to persuade 
women to have more children, like giving medals for having six or more 
babies, I would remind my Republican colleagues that they could start 
with something real, meaningful, and impactful right now by not gutting 
the health insurance program that covers almost half of all births and 
half of all children in our country. The Republican majority needs to 
make their profamily rhetoric match their policy, put America's moms 
and babies first, and stop these proposed cuts to Medicaid.
  Ms. SCHRIER. Mr. Speaker, I thank Representative Dr. Morrison for her 
perspective, from the perspective of an OB/GYN who has taken care of 
pregnant women and new babies and really

[[Page H2196]]

paints a very clear picture about maternal mortality in this country 
and what cuts to Medicaid mean for that.
  It is interesting. All of us in the Doctors Caucus have been talking 
for years--in fact, for the whole time I have been in Congress--trying 
and trying to improve Medicaid reimbursement, to make it so that 
Medicaid reimbursement can match Medicare reimbursement so that more 
children can have a medical home. It is about expanding Medicaid care 
for pregnant women until 1 year postpartum to make sure that they are 
healthy and plan their pregnancies and that we can cut down this 
outrageous incidence of maternal mortality in this country.
  Now we are just fighting to keep Medicaid. That is the situation we 
are in now because Republicans want to gut Medicaid and take health 
insurance away from 13.7 million Americans to pay for a tax cut for the 
wealthiest Americans. That is just plain wrong.
  I will talk for a moment about another constituent of mine who paints 
just a different angle on what it looks like to cut Medicaid. I will 
tell you that our phones are ringing off the hook. People understand 
what is going on. They are worried for their health, for the health of 
their families, and for the health of their parents. They get what will 
happen to their local rural hospital if these go into effect.
  I will tell you about Kathleen, who graciously shared a story about 
her own mother. Kathleen's mother lived to be 92 years old. She was a 
widow for 42 of those years and helped care for five of her 
grandchildren.

                              {time}  2020

  Kathleen's mom lived through the deprivations of the Great Depression 
and World War II and was never one to complain. She lived simply.
  In the last decades of her life, she had a number of serious, complex 
medical conditions that presented real challenges for her medical team 
and specialists and, of course, for her. Medicaid supplemented her 
traditional Medicare plan in the last years of her life and allowed her 
to get the medical care that she needed. She was treated with care and 
respect.
  When Kathleen's mom injured herself in a fall, Medicaid covered the 
rehabilitation facility and, later, in-home physical therapy and 
occupational therapy so she could be in her own home.
  Later, she had a life-threatening event and was hospitalized. 
Eventually, she was well enough to move to an outpatient rehabilitation 
facility, followed by in-home care. Again, Medicaid was there for her. 
The care was safe, reliable, and appropriate, and it gave tremendous 
relief to her and her family.
  In the last months of her life, Medicaid provided hospice care. The 
nurses, home health aide, OT, PT, and case manager were her guardian 
angels. They treated her with compassion and dignity.
  Isn't this the type of treatment and care, the care made possible by 
Medicaid, that all of us deserve, that all of us want, and that we want 
for our friends, family, and ourselves?
  For so many seniors in this country, this type of care is made 
possible thanks to Medicaid. It is unfathomable that my Republican 
colleagues want to deny our seniors the type of comprehensive, 
compassionate, and thoughtful care that Kathleen's mother received.
  That brings us full circle to how these cuts to Medicaid, Apple 
Health in Washington State--something a lot of people out there think 
is that they are not relying on Medicaid, so maybe it doesn't affect 
them.
  The message I really want to deliver, Mr. Speaker--and I am actually 
going to look at the camera to speak directly to the American people--
is that cuts to Medicaid, or to Apple Health, impact every single 
person in this country.
  They impact you if you are the son, daughter, or spouse of a senior 
who needs to be in a nursing home because nursing homes will close, and 
you will have to leave your job to take care of your ailing parent or 
spouse.
  They impact everybody who lives in a rural community or in an urban 
community where there are a lot of patients who rely on Medicaid 
insurance, because when Medicaid doesn't pay the bills for those 
people, the hospital gives away that care for free. Then, they either 
cut services or close--or, more likely, a combination of them--and your 
insurance premiums go up because somebody has to pay. Who is going to 
make up the difference? Private insurance. That means your insurance 
rates go up, and they are already high.
  Everybody hurts from this, even if you are not paying for your own 
health insurance. I bet, at some point, you are going to the emergency 
room, and those patients who don't have Medicaid are now getting 
sicker, waiting longer, and getting their care late in an emergency 
department.
  If you think the waits are bad now because hospital beds and ER beds 
are full of patients in mental health crises or with fentanyl overdoses 
or with nursing home patients who don't have a nursing home to go to, 
if you think the waits are bad now, just wait till 13.7 million 
Americans lose their health insurance.
  We are all impacted. If you live in a rural area and have private 
insurance, you are doing fine, but if the labor and delivery department 
closes at that rural hospital and maybe you have a high-risk pregnancy 
and need obstetrics care and might have a complication with that 
delivery, you might have to go live in a more urban area for the month 
before that delivery just to make sure that you are safe and that your 
baby is safe.
  This is something that none of us should have to worry about in the 
United States of America. This is a prosperous country. We have 
excellent healthcare here, and to think that my Republican colleagues 
want to cut Medicaid, a lifeline for the patients who depend on it and 
for our entire healthcare system, that they want to cut what the people 
most in need depend on--again, we are talking about the elderly, people 
with disabilities, pregnant women, children. To think that they would 
cut care for them in order to pay for gigantic tax cuts for 
billionaires--it is a backward transfer of money. It is Robin Hood in 
reverse. It is just plain wrong. I have explained now that, in addition 
to being morally bankrupt, it is also fiscally reckless.
  It is irresponsible, and I just don't understand how this is the plan 
that my colleagues came up with. Their constituents are going to hurt 
every bit as much as mine and, statistically, with more rural areas and 
already more vulnerable rural hospitals, chances are their constituents 
are going to hurt even more.
  I sure hope that people out there are paying attention. Call the 
people who represent you. Tell them what your fears are. I know people 
are calling me, and I am standing up here to appeal to my Republican 
colleagues and let the American people know what is going on right now, 
why they should be concerned.
  This is a democracy. Call the people who represent you. Tell them 
what you think. Tell them what it would mean for you, for your family, 
for your neighbor.
  Again, when it is one out of three in Washington State, what would it 
mean if these largest-ever cuts to Medicaid transpired?
  Here is what is going to happen tonight. At 1 o'clock in the morning, 
the Rules Committee is going to meet. They are going to craft the rules 
for Trump's so-called big, beautiful bill, which would be a travesty 
for the people I represent. They are going to do this at 1 o'clock in 
the morning when everybody else is asleep, not watching, not paying 
attention, not watching the nightly news. This is not prime time 
because, I think, they are embarrassed about what they are doing, but 
they are going to do it anyway. They are going to do it for the people 
who were in the front row at President Trump's inauguration. That is 
who they are going to do it for.

  This is not helping their constituents. It is not helping my 
constituents. America, it is not helping you.
  It is morally bankrupt. It is fiscally irresponsible. It is just 
plain cruel. That is why I, along with the rest of the Doctors Caucus, 
have spent this evening talking about what this means for our patients 
and for our healthcare system.
  We understand it on a visceral level because we have lived in and 
worked in this healthcare system. We have worked in crowded emergency 
departments, seeing people who, if they had health insurance, wouldn't 
need to be

[[Page H2197]]

in the emergency department. We have taken care of patients who didn't 
have insurance like Medicaid, so they delayed care or they didn't pick 
up a medication because it was too expensive and they didn't have 
coverage.
  We have seen these things. Dr. Morrison and I have both seen 
complicated pregnancies and neonatal resuscitations. These are patients 
who rely on Medicaid. We are here as doctors who swore an oath to our 
patients to protect them, to stand up for them. This is us standing up 
for our patients, to plead with my Republican colleagues not to cut 
Medicaid.
  Mr. Speaker, I will let them know and will let my constituents and 
the American people know that I will continue to fight every minute to 
make sure that these cuts don't happen and that we keep this oath to 
our patients.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Members are reminded to direct their remarks 
to the Chair and not to a perceived viewing audience.

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