[Pages S3538-S3540]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         ONE BIG BEAUTIFUL BILL

  Ms. CANTWELL. Mr. President, I rise today to urge my colleagues, my 
Republican colleagues, to reverse course on their proposal that would 
take affordable healthcare away from the many patients across the 
United States who will suffer, I believe, financial strain and the 
financial strain will be put on the rest of us in our healthcare 
system.
  Despite the talking points that you hear from our colleagues, they do 
propose on Medicaid to really make cuts that will hurt us. This isn't 
about waste, fraud, and abuse. Their plan is to allow enhanced premium 
tax credits to expire. That has really nothing to do with lowering 
costs on average Americans. And this whole idea, in my mind, is a 
veiled attempt to repeal the expanded coverage that we saw for Medicaid 
under the Affordable Care Act. Why is that important?
  Well, it is critically important because Medicaid has been the 
cornerstone of, in the Affordable Care Act, expanding care to working 
families that could not find an affordable insurance policy. Medicaid 
gave them that coverage.
  And now, with the proposal by our Republican colleagues, they are 
going to cut Medicaid and thus cut families who need the assistance to 
cover insurance to get the coverage they deserve. The result will be 
that Medicaid is stripped away. Coverage in the ACA marketplace will 
become more unaffordable, and premiums for even employer-based 
insurance will go up. But that is what happens when you take dollars 
out of the system. In fact, we are already seeing some of these prices 
start to go up.
  Our healthcare system relies on people being insured so that they can 
pay for care, and when you dismantle that, the medical costs for 
everybody goes up. It only makes sense. Uncompensated care gets cost 
into the system that is passed on to the rest of us.
  Earlier this month, the Congressional Budget Office confirmed that 
the House's reconciliation bill, if enacted, would cause 16 million 
people to become uninsured--so that is the Congressional Budget 
Office--so again, 16 million people currently insured. Now, all of a 
sudden, uninsured, means cost to the system, to say nothing of the cost 
to these individuals. Just as eye-popping is the projection that this 
proposal will drive up premiums and out-of-pocket spending for millions 
of people struggling to afford private insurance plans through the ACA 
marketplace or those with employer provided coverage.
  A new analysis by the Center for American Progress proves that 
working-class families and people with all types of insurance will have 
to foot the bill for these harmful policies. For Medicaid, a family of 
four making $33,000 per year could see additional costs and copayments 
up to $1,600 in annual out-of-pocket spending. I guarantee you, these 
are people that already have had a tough time finding affordable 
insurance.

[[Page S3539]]

  For an ACA market plan, a 60-year-old couple making $85,000 a year 
who want to keep the same plan could see their annual premiums 
increase--and these are numbers according to the Center for American 
Progress--and you could even see the cost of an annual premium increase 
by as much as $15,000 a year. So these are all costs that we don't need 
to see increased. But if you are taking people who have affordable 
insurance and displacing them, according to CBO, 16 million of them, I 
guarantee you that cost will be absorbed by the rest of us. For 
Medicare, which President Trump pledged not to cut, low-income seniors 
who qualify for both Medicare and Medicaid will see their out-of-pocket 
expenses rise.
  For example, an older couple on Medicare, living on an annual income 
of $21,000 could face an additional $8,340 in annual healthcare costs. 
So this just shows that cutting almost $1 trillion in healthcare from 
funding and making millions of people be uninsured does not save the 
money. It basically gets into the system, and other people are paying 
the cost. The Affordable Care Act lowered the individual uninsured rate 
from 17.8 percent in 2010 to a historic low of 9.5 percent in 2024. So 
we significantly decreased the number of uninsured. This drop in 
uninsured Americans improved people's health. Saved money for 
individuals, saved money for families. It helped States. It even helped 
our State government.
  According to the Kaiser Family Foundation, thanks to improved access 
to general health services, cancer screenings, and other forms of 
preventative care, Medicaid expansion alone lowered health-related 
mortality rates by 3.6 percent. So funding available insurance under 
the Affordable Care Act drove down the mortality rate and helped 
substantially save money. By contributing to a more robust economy, 
better societal well-being, lower mortality rates, it also helps States 
generate more than $20 billion in increased tax revenue and welfare 
savings.
  So covering people--I like the best example of this, is the former 
Vice President of the United States. As a Congressman, Mike Pence 
didn't vote for the Affordable Care Act, but when he became Governor of 
Indiana, everybody in Indiana, the healthcare providers and others 
convinced him--oh, it is a good idea, you should get people covered in 
your State. And they did. So this is about a smart way of providing 
healthcare, and we have done it.
  So States who were smart about this realized that their economy was 
better, their access to affordable insurance was better, that revenue 
stimulating the economy was better. They knew that the Medicaid 
expansion literally kept people alive. We should not reverse that. We 
have made great progress in the past 15 years to keep Americans 
healthier and financially secure. Allowing 16 million people, including 
306,000 people from the State of Washington, to become uninsured is a 
bad idea.
  Without any alternatives, this will be a shock to our healthcare 
system. It will bring it to the breaking point and threaten the very 
lives of our constituents. I would like to take a moment to read a 
letter from my constituent highlighting the concerns and fears about 
the impacts of the budget reconciliation bill.
  Britton Winterrose from Richland, WA, is father to a joyful 5-year-
old girl named Leda. He said he wrote to me because ``Without Medicaid, 
my daughter's next nap could be her last.''
  So now I want to read a letter from the Winterrose family:

       Leda entered the world at the height of the pandemic and 
     spent the first 45 days of her life in the NICU. Doctors 
     finally identified a rare form of congenital central sleep 
     apnea.
       If she falls asleep without oxygen, she simply stops 
     breathing, and will die.
       The only path out of the hospital was a Medicaid waiver 
     that paid for in-home nursing and life-support equipment.
       Medicaid gave us the opportunity to bring her home, 
     surrounded by her siblings, surrounded by the normalcy and 
     safety of parents that love her.
       Since that day Medicaid has kept up with Leda's needs as 
     she has grown. A toddler who once needed a walker now sprints 
     across the yard because the program funded the therapy and 
     walker that strengthened her legs.
       It's provided her with a bed, that keeps her secure so her 
     equipment stays connected and we can sleep at night.
       Each stage of development adds new hardware, new supplies, 
     and new specialists. Feeding supplies, feeding pumps, G-
     tubes, sensors, diapers, respite care, and an AEC device to 
     help my non-verbal autistic daughter communicate.
       Private insurance, even the platinum plan that comes with 
     my job, rarely covers it.
       There is not a private health insurance on the planet that 
     covers the edge cases of human existence for somebody with 
     medical complexities like Leda.
       Tonight, like every night, my wife and I will hook our 
     daughter to an oxygen concentrator and a pulse oximeter, then 
     we will lie down and ``say no to death.''
       The only reason we can sleep at all is because Medicaid has 
     provided the durable medical equipment and supplies needed to 
     support her.
       From the days at the NICU until now, one thing has become 
     obvious: the last question on anybody's mind when they are 
     trying to keep their child or loved one from dying should be, 
     How can we afford these things?
       I do not speak only for Leda. The bill before Congress 
     would strike thousands of Washingtonians from the rolls, and 
     when that happens clinics and long-term-care facilities 
     collapse.
       That blow lands on veterans, on cancer patients, and on 
     newborns in rural counties as surely as it lands on my 
     family.
       No one wakes up and decides, ``Oh, I want to be disabled 
     today.'' Everyone's health is a roll of the dice; Medicaid is 
     how we make sure the roll is not fatal.
       I still lose sleep over what will happen when I am gone. As 
     a tired Dad, help me rest.
       Please defend and strengthen Medicaid so that Leda, and 
     every child like her and those who are rightfully dependent 
     on this system can live and thrive.

  That is the end of the letter from my constituent from Richland, WA. 
What an incredible story of how a family has depended on Medicaid.
  Today, I met with an organization and individuals from it, 
MomsRising, where families from Washington State and all over the 
country came to protest the cuts to Medicaid and SNAP. I heard myself 
countless examples of how these programs are critical to families, to 
their well-being, and how this program, if cut, would be devastating.
  There is a common theme on all these stories; these families are 
scared they will not be able to afford or get the care that their 
family really relies on. They are also concerned that there is nowhere 
to turn, even if the coverage is taken away. Does this mean these 
patients will no longer need care, or their illnesses will just 
magically go away? We all know that doesn't happen. This means that 
uninsured patients will wait to see a doctor until they are so sick 
they have to go to the ER, which costs more. This will lead to 
increased costs across the board.
  Specifically, it is estimated that 5.4 million Americans will incur 
medical debt because they will become uninsured, and the total medical 
debt that Americans owe will increase by $50 billion. I think this is 
numbers from The Third Way. Hospital providers will have to shoulder an 
additional $36 billion in uncompensated care costs, and a portion of 
the costs will be recouped by increased premiums on employment-based 
insurance coverage. As a result, people with employment-based insurance 
will also see an additional anywhere from $182 to $485 in annual cost 
increases.
  That is what happens when you increase the cost of uncompensated 
care, and the system has to make up for it somewhere; you increase 
everyone's cost.
  This is particularly damaging in the area of certified community 
behavioral health. I am sure the President knows that behavioral 
health--very tough challenge, particularly with the fentanyl epidemic 
in our country.
  I met with representatives of Peninsula Behavioral Health in Port 
Angeles, WA, and Sound Health in King County, who told me that clinics 
are already operating on narrow margins and have already sustained a 1-
percent budget cut this year at the State level. If Congress passes the 
budget reconciliation bill and enacts policies like the suggestion on 
the State Directed Payment Caps, they will have to reduce their budget 
by 20 percent, meaning they will have to cut staff and lay off people.
  As a result, patients who rely on them for substance abuse treatment 
will be left out in the cold. We literally will see an increase in 
overdose deaths, law enforcement run-ins, and incarceration rates. 
Where do you think these people go when they don't have behavioral 
health treatment for fentanyl?
  All this costs taxpayers more, actually, a lot more, a lot more than 
just covering Medicaid. It would be better if we just kept the Medicaid 
Program and funded patients so they could get the

[[Page S3540]]

care when they needed it. My Republican colleagues know that this bill 
will cause harm; hospitals and physicians and various leaders across 
the industry are at their doorsteps, telling them not to hollow out our 
healthcare system.
  But I beg my colleagues to drill down and listen to the fact that the 
revenue that rural hospitals particularly live on are huge Medicaid, 
Medicare budgets. That means there is no margin to have a 20-percent 
decrease in funds. Spending money to fix a problem caused by not 
spending money doesn't seem the smart thing to do; the logic doesn't 
make sense. In fact, it sounds to me like waste and fraud to say to 
people that you are going to somehow make this a better system, when in 
reality, you are going to cut care and increase costs on all of us.
  Passing this bill and enacting these policies will only hurt working-
class and middle-class Americans. Americans are still reeling from the 
effects of inflation, to say nothing about the tariffs. This is not the 
time to be taking away healthcare coverage or increasing premiums on 
anyone. We have already seen enough inflation. For most families, any 
extra money from a tax cut will be swallowed up by these higher 
healthcare costs. And every time a new report or analysis is done on 
this bill, the outlook gets more challenging for people at home.
  If we really had this serious of a waste, fraud, and abuse problem in 
Medicaid, why haven't we had hearings on it? Why haven't we had 
legislation trying to fix it? Why haven't we had communication that 
this is a real issue? Because it is not a real issue. What is a real 
issue is Congress has been trying to fix the uninsured problem by 
passing the Affordable Care Act. It has worked successfully, and now 
our colleagues on the other side of the aisle want to try to repeal it.
  I hope that my colleagues will realize the only thing that you can 
know for sure about this proposal that cuts Medicaid--the only thing we 
know for sure is that thousands of Americans will become sicker and 
will become poorer because, without the access to care, that is exactly 
what is going to happen.
  I urge my colleagues to really understand the harmful effects of this 
legislation, understand the harmful health effects on the citizens of 
our country, and I ask them to reject these Medicaid cuts.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.

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