[Pages S3526-S3528]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         One Big Beautiful Bill

  Mr. President, on another topic, school may be out for the summer, 
but I have a pop quiz for the American people who are following us at 
home. The following statements are about President Trump's so-called 
Big Beautiful Bill. Try to guess whether a Senate Democrat or a Senate 
Republican made the following statement:
  Statement No. 1:

       If we don't watch out, people are going to get hurt, people 
     are going to be upset. It's going to be the number one thing 
     on the nightly news all over the place.

  Statement No. 2 in reference to the Big Beautiful Bill:

       I'm concerned that if there are cutbacks in some of the 
     Medicaid programs it could have an adverse effect on our 
     rural hospitals . . . Many of them are barely making it now 
     financially.

  Statement No. 3 on the subject of slashing Medicaid payments:

       This is a whole new system that is going to defund rural 
     hospitals.


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  If you guessed that all three statements were made by Senate 
Republicans about the Republican reconciliation bill, you are right. 
Even my Republican colleagues know that, under Trump's plan, 
billionaires will win, and American families will lose. The more we 
learn about this bill, the worse it looks. Perhaps that is why the 
Senate Republican leader is anxious to pass the bill before the 
arbitrary Fourth of July deadline.
  It is expensive. Yesterday, the Joint Committee on Taxation estimated 
that the Republican proposal will add $4.2 trillion to our national 
debt. In Trump's first term--in that 4-year period of time--he added 
more money to the debt of the United States than any President in 4 
years in history. Now he is going to top that number with this new Big 
Beautiful Bill in adding to our national debt.
  Does the proposal borrow against the future to lift millions of 
children out of poverty or invest in clean energy jobs of the future 
that will grow our economy? Think again. This bill provides tax breaks 
to the ultrawealthy.
  One of my colleagues did a calculation here. If you make the cutoff 
point in income of $400,000 a year and say you won't give any of the 
new Trump tax breaks to people making more than $400,000 a year, you 
eliminate 60 percent of this tax proposal, as 60 percent of it goes to 
people making over 400,000 a year.
  What about the highest level, the 0.1-percent income? The tax break--
the permanent tax cut annually--is nearly $350,000. Come on.
  Do you really believe Elon Musk is waiting to see whether this goes 
through so he can take this tax break and spend it on something 
worthwhile? Not at all. The richest people in the United States--God 
bless them--don't need this tax cut. Working families do.
  And it is unpopular. A recent FOX News poll--did I say ``FOX''?--
found that 38 percent of registered voters supported the House-passed 
bill, and 59 percent opposed it. It is downright mean. This measure 
will be the most significant healthcare cut in American history as 16 
million Americans would lose their health insurance.
  I heard one Republican Senator on the news say: Well, that is just 
health insurance that we are providing for illegal aliens.
  He is wrong. Medicaid doesn't cover that. Under Medicaid, of the 
people who will be denied coverage, 16 million of them are American 
citizens.
  Medicaid cuts will lead to higher copays, longer emergency room wait 
times, and skyrocketing nursing home expenses.
  So many of our senior citizens in my State and in other places or the 
places that take care of them need a helping hand--nursing facilities 
and the like. The majority of that is being paid for by Medicaid, and 
the Republicans want to cut that Medicaid reimbursement. What is that 
going to do when you are trying to take care of your mom or your 
grandmother if you can't afford to keep them in a good place? In an 
extreme situation, they may have to move in with you, and you would 
have to change your own lifestyle and your own relationship within the 
family.
  One provision in particular in the Republican bill will cripple the 
funding mechanism used to keep hospitals afloat. According to the 
Children's Hospital Association, this provision in the Republican bill 
will cut funding for most children's hospitals by 42 percent. So, if 
you have a children's hospital in your town, in your State, at 42 
percent, ask them what that will mean in terms of services for the kids 
they are helping.
  Take Children's Mercy. It is the children's hospital in Kansas City 
serving kids in Missouri and Kansas. Thirty-five percent of its revenue 
is from Medicaid, and the hospital operates with a 5-percent margin. If 
you take a chain saw to Medicaid, families with sick kids who trust 
Children's Mercy will have another worry on their minds, and in red and 
blue States, rural hospitals will be in jeopardy of closing. For what? 
For a tax cut for the wealthiest people in America? Really?
  Don't take it from me. I recently spoke with the CEO of BJC 
Healthcare, the largest hospital system in Missouri. A third of their 
patients are from Illinois, I might add. I asked them about their 
concern with people losing insurance under this Republican bill. This 
is BJC out of St. Louis, MO.
  BJC Healthcare cares for more Medicaid patients than any other health 
organization in the region. More than a third of their patients are 
covered by Medicaid paying for 1 million visits a year. It is the same 
story for SSM Health, headquartered in St. Louis, operating nine 
hospitals in Missouri, including the famous hospital, Cardinal Glennon 
Children's Hospital.
  SSM's CEO expressed her ``deep concerns about the proposed Medicaid 
changes'' in the Republican bill, stating that the Republican bill 
``threaten[s] coverage for millions of people and jeopardize[s] 
financial stability of safety net providers like SSM Health.'' For 
what? For a tax cut for the wealthiest people in America?
  Sixty percent of this tax cut goes to people making over $400,000 a 
year and, at the highest levels, a $346,000 annual cut in taxes for the 
richest people in America. So do we cut back on these hospitals?
  In Missouri, 250,000 individuals are expected to lose coverage under 
the Republican plan, resulting in Missouri hospitals facing an increase 
of $430 million in uncompensated care costs in a single year.
  I know these numbers are numbing, so many of them are so big. But 
let's get down to the basic message. Hospitals that are hanging on--
rural hospitals, hospitals in the inner city, children's hospitals--are 
the ones that are making it barely each and every year. They are the 
ones who will lose replacement of funds by Medicaid under the 
Republican plan.
  What would the cuts mean for rural hospitals in Missouri? Already, 10 
rural hospitals are in jeopardy of closing. This Republican bill could 
be the final straw. I hear exactly the same message across the river in 
Illinois.
  I heard this message from UnityPoint Health, which has hospitals in 
Illinois and in Iowa. They told me that Medicaid covers nearly 40 
percent of the children born at their hospital, and they rely on 
provider taxes to offer maternal, emergency, and behavioral health 
services. If Republicans have their way, these critical services are in 
jeopardy, and some will go away.
  Todd Patterson, the CEO of Washington County Hospital in Iowa, said:

       Medicaid is not a line item--it is a cornerstone. . . . 
     When policymakers in Washington . . . slash Medicaid funding 
     . . . they are turning off the oxygen for rural health care.

  I will tell you, I grew up in Downstate Illinois, and I have 
represented them in Congress and in the Senate. These hospitals are 
critical to the economy in these communities. You take a hospital out 
of a community, and you have taken out a major employer and a major 
economic factor. Try to attract a new business and explain a hospital 
is 2 hours away. Try to keep a new business in town when the hospitals 
are going down.
  Currently, 107,000 people in Iowa are projected to lose health 
insurance under this plan. It would increase annual uncompensated care 
costs for hospitals by nearly $190 million.
  Republicans in Iowa and Missouri get sick and rely on their 
hospitals, just like Democrats. My colleagues know these Medicaid cuts 
would be devastating, and no bandaid hospital grant fund that 
Republicans are frantically trying to create will make up for this 
seismic hole.
  While President Trump said he would protect Medicaid, he is now 
pressuring Republicans to make deep cuts in the program. He is asking 
Republicans to choose billionaires over hard-working American families.
  Now is the real test for Senate Republicans.
  I can remember when it occurred during Trump's first term--another 
tax bill, another massive increase in the national debt. How were they 
ever going to pay for it? Well, there was a proposal that they would 
cut back on the Affordable Care Act, ObamaCare. That cutback was 
hanging by one vote in the balance. I was sitting here at this chair 
and watched as John McCain came through those Senate doors at 2 o'clock 
in the morning. He was the deciding vote. John McCain walked to the 
well and gave a ``no'' and saved the Affordable Care Act from Trump's 
first term.
  Now we are going through this scenario again--again--another Trump 
tax cut, more cuts when it comes to

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medical care, particularly for families who are the most vulnerable.
  Will anyone rise to the occasion as John McCain did?
  We need four Republicans to stand up and say: Enough. Stop penalizing 
the families of America and the rural hospitals of America and the 
smalltown hospitals of America for a tax break for wealthy people. We 
are better than that in America. It is time. We need four Republicans 
with good sense to step up before it is too late.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.