HEALTHCARE LEGISLATION
(Senate - June 19, 2017)

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[Pages S3570-S3573]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HEALTHCARE LEGISLATION

  Mr. WYDEN. Madam President, the American people have spent the last 
several weeks hearing that the Senate will vote on its new version of 
TrumpCare by the end of the month. It is now June 19, and the American 
people are still in the dark about this bill. There is no text. There 
is no legislative analysis of this bill and no scoring of what the 
financial ramifications are. The American people--and much of this 
Senate--are in the dark. We are in the dark about how much costs are 
going to rise, in the dark about how many people are going to lose 
insurance, and in the dark about whether a preexisting condition will 
once again be used as a weapon against them by insurance companies.
  If news reports are to be believed--and that is all we have right 
now--a vote on this massive proposal affecting the lives of virtually 
all our people is days away. No one outside of a group of 13 men--all 
Republicans--knows what is being considered. In my view, this is as 
stark an example of legislative malpractice as I can remember.
  It is time for Americans to get loud, to do their part, and to make 
sure their voices are heard on an issue that is so personal and so 
vital to our people and their families.
  If and when this bill hits the floor, the debate is going to go by 
very quickly. By the standards of the Senate, it will be over in a 
flash. So this afternoon, I want to be direct with a few key points for 
those across this country to remember over the next two weeks.
  First, the Republican healthcare plan is going to raise costs for the 
typical American. If you are an older person nearing retirement--55, 
58, 61--you are going to get hammered with an age tax. You are going to 
be forced to pay several times as much as a younger person for health 
insurance.
  Under the House TrumpCare bill, 64-year-old seniors of modest means 
are going to see their premiums shoot up by 800 percent. I would like 
to hear somebody try to explain to a lifelong trucker or to someone who 
has spent decades cleaning offices to put food on their family's table 
why that is an improvement in American healthcare.
  These are older people who already struggle to make ends meet, and 
they have been told for the last 7 years that repealing and replacing 
the Affordable Care Act is going to lower their healthcare costs. Now 
they face the reality of TrumpCare, which says that they will somehow 
have to spend the bulk of their income on health insurance and, in some 
cases, it will take up nearly all of it.
  It is not just older people who face this age tax that will see their 
costs rise. TrumpCare cuts middle-class tax benefits for healthcare 
that were put in place under the Affordable Care Act, particularly in 
rural areas. That means premiums are going to be a much bigger burden 
on typical middle-class families.
  The Republican healthcare plan ends the air-tight, loophole-free 
guarantee that protects Americans from being discriminated against for 
a preexisting condition. Working adults--30, 40, 50 years old--who 
thought they were home free with employer-sponsored insurance, under 
this bill could, once again, face some of the worst insurance company 
abuses, including annual and lifetime limits on benefits.
  One new report says 27 million Americans could get hit by annual 
limits and 20 million could face lifetime limits.
  Here is what this means: A 35-year-old, for example, who develops 
cancer could bust that cap in a hurry. If you have to go through 
expensive surgeries and chemotherapy, busting those caps could mean 
facing decades--decades--digging out from medical debt.
  Second, TrumpCare is built around the $800 billion attack on 
Medicaid. Today, Medicaid comes with a guarantee: If you walk an 
economic tightrope, are sick or injured, you will get the care you 
need. You can't be denied benefits, but slashing the program by 
hundreds of billions of dollars ends that guarantee because States are 
going to have to cut benefits. The best way to understand the 
consequences of that plan is to look at seniors who need nursing home 
care.
  The Medicaid nursing home benefit helps pick up the tab for two out 
of three nursing home beds in America because, the fact is, growing old 
in America gets expensive. You can do everything right through a 
lifetime of hard work, scrimping and saving, putting off vacations or 
big purchases to be financially prudent, but still, a lot of people go 
through their savings. That is when Medicaid steps in for seniors to 
help cover the cost of nursing homes and other long-term care. One year 
in a nursing home now costs more

[[Page S3571]]

than $90,000, on average. That is two or three times as much as a year 
of college education. If TrumpCare slashes Medicaid so deeply that 
seniors are in danger of losing the nursing home benefit, how are 
families, fighting hard to pay their own bills, going to be in a 
position to take care of older loved ones?
  Of course, Medicaid does a lot more than cover nursing home care. 
Thirty-seven million kids are enrolled in Medicaid, a vital source of 
support for kids and adults with disabilities.
  Medicaid is the only lifeline that thousands and thousands of 
Americans fighting opioid addiction have to be able to put their lives 
back together. No community anywhere in this country has escaped the 
opioid epidemic. Since Medicaid was expanded under the Affordable Care 
Act, it has been leading the fight against the opioid epidemic by 
improving access for millions of people for treatment of mental health 
and substance abuse orders, but with the Republican plan's enormous 
cuts, thousands of people could lose their best shot to recover from 
addiction and lead healthy lives.
  Finally, what is especially unfortunate about this legislation is the 
process for writing this bill. It is being written behind closed doors, 
no input from across the aisle and particularly from the American 
people.
  I serve as the ranking member on the Senate Finance Committee. Our 
committee has authority over hundreds of billions of dollars in 
payments for Medicare, Medicaid, and tax credits. We haven't had any 
hearings. We haven't seen a bill. There is not the traditional process 
of a committee markup to consider legislation. We are also the 
committee that on a staff level, always has tried to work back and 
forth between Democrats and Republicans to try to find common ground, 
but with the majority leader keeping the process locked behind closed 
doors, Chairman Hatch and I, along with all of the Democrats and most 
of the Republicans on our committee, have simply been cut out.
  Back in the runup to the Affordable Care Act--the one that President 
Obama was involved in, in 2009--the Finance Committee held more than 50 
hearings and roundtables, and we walked through carefully the 
healthcare reform bill. When the legislation was introduced, it sat 
online for 6 days before it was voted on in the committee, 564 
amendments were posted online, more than 130 amendments were considered 
during the markup, more than two dozen Republican amendments were 
adopted, and the bill passed on a bipartisan basis.
  Again, let me highlight: More than two dozen Republican amendments 
were adopted in the Finance Committee. As of now, there will not be a 
single Democratic amendment adopted in the Finance Committee. When the 
legislation went to the floor, the Senate spent 25 consecutive 
legislative days on healthcare reform--the second longest consecutive 
session in history.
  That is how the legislative process ought to look: The committees do 
the hard work in the open, gather input from the American people, have 
a chance--Democrats and Republicans--to work together. That is not what 
is happening on TrumpCare. This is a bill shrouded in secrecy and the 
public is kept in the dark. There aren't going to be any hearings on 
the impact it is going to have on the millions of people who rely on 
Medicaid for health insurance, no hearings on what it means if you have 
all these loopholes in the guarantee of protection Americans now have 
against discrimination for a preexisting condition, no hearings asking 
how a 64-year-old of limited means is supposed to deal with an age tax 
that swallows up most of their income. When the Senate Republican 
healthcare bill hits the floor, there will be a very short debate 
before time expires and the final votes are cast.
  I am going to close by saying now is the time for Americans to be 
heard on healthcare. It is the time for Americans to speak out. For 
those who have a story about how TrumpCare will affect their family, 
you can share it on my website at wyden.senate.gov or you can use the 
hashtag ``America Speaks Out.''
  I intend to be back on the floor with my colleagues, and many of us 
will be here often in the hours and days ahead, but I want to close by 
way of saying political change doesn't start at the top and then 
trickle down. Political change is bottoms up, as Americans across the 
country speak out and speak loudly. Now is the time to do that because 
this debate is coming fast.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. FEINSTEIN. Madam President, I rise to speak on healthcare, but I 
ask unanimous consent that I be able to conclude my remarks prior to 
going into executive session.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mrs. FEINSTEIN. Madam President, I rise to speak against the 
Republican effort and what it appears to be thus far to repeal the 
Affordable Care Act and the process they are using to do it.
  I just have to say, this is the least transparent process for a major 
piece of legislation I have seen in my 24 years in the Senate. Former 
Senate Historian Don Ritchie said that you have to look back before 
World War I to find another example of such a secret, partisan process 
for passing a major bill.
  The Senate healthcare bill in fact is being written behind closed 
doors. There is no draft for public review. No Democratic Senator has 
seen the bill. Republican Senators all say they haven't seen the bill 
either.
  When Republican Senators are asked what is in the bill, unless they 
are the 13 privileged ones, they say they have no idea. Everyone except 
the 13 Republicans drafting this bill has been excluded, and these 13 
Senators represent just 10 States out of our 50. Health experts and 
health advocacy organizations have been shut out. No one representing 
doctors, nurses, patients, children, the elderly, hospitals, community 
clinics, or health plans is able to provide any feedback at all on how 
the bill would affect people.
  Over the weekend, the Los Angeles Times reported that a coalition of 
more than 15 patient groups, including the American Heart Association, 
the March of Dimes, and the American Lung Association, tried to get a 
meeting with Senator McConnell or his staff and were told no. That is 
unbelievable.
  Think of it. Think of the American Heart Association, the March of 
Dimes, the American Lung Association asking to meet with either the 
leader or his staff, and somebody says no. Do my Republican colleagues 
really believe that groups like the American Heart Association don't 
deserve an opportunity to weigh in on a healthcare bill when our 
healthcare system affects every single person in this country? 
Healthcare is the last subject that should be addressed behind closed 
doors, hidden from public view. Yet, apparently, Republicans intend to 
bring the bill to the floor without a single hearing. Senator McConnell 
wants to vote on a bill by next Thursday, I am told. That is 10 days 
from now. Well, if there is not going to be a hearing, we shouldn't 
vote. I think: no hearing, no vote.
  It is important to point out the contrast between what is happening 
now and our consideration of the Affordable Care Act, known as 
ObamaCare. There were 100 hearings, meetings, roundtables, and 
walkthroughs of the bill between the Senate Finance and the HELP 
Committees. There were 25 consecutive days and 160 hours of debate on 
the Senate floor. There were 300 HELP Committee amendments, including 
more than 160 Republican amendments.
  Was our process in 2009 and 2010 perfect? No, it wasn't, but it was 
infinitely better than what is happening now. This process is such an 
affront to our democratic system of government.
  Senator Harris and I represent California. We are the sixth largest 
economy in the world. We represent more than 40 million people. That is 
more than 22 other States combined.
  Fourteen million Californians are covered by the Medicaid Program, 
the program the House bill says we are going to stop the funding for. 
Fourteen million Californians are more people than the entire 
population of 9 of the 10 States represented in the secret healthcare 
negotiations. Four million Californians gained health coverage under 
the Affordable Care Act--more people than the population of 4 of the 10 
States represented in the secret negotiations. Despite the significant 
effects that any healthcare bill would have on California, both of its 
Senators have been shut out.

[[Page S3572]]

  I want to work to improve the Affordable Care Act. I know there are 
challenges we need to address, and I want to be part of the process, 
but there is no opportunity to do so.
  If the Senate bill is anything like the House bill, the effects would 
be devastating to my State. If the Senate bill is like the House bill, 
here is what it would do: It would take healthcare coverage away from 
23 million working and middle-class families to finance a tax cut for 
the richest 5 percent of Americans. This is indefensible. There is no 
justification for giving millionaires a $50,000 tax break by taking 
healthcare away from our most vulnerable citizens. I don't know of any 
who are asking for it. It is some kind of blighted political agenda 
that you could leave the elderly and the sick untended, and it 
justifies a $50,000 tax break for a millionaire.

  This would end Medicaid as we have known it for 50 years by cutting 
$834 billion. It eliminates protections for people with preexisting 
conditions. It defunds Planned Parenthood. It denies all Californians 
and New Yorkers--all of them--tax credits, unless the States change 
their laws requiring insurance companies to cover reproductive care, 
including abortion services. It is almost a blackmail provision.
  I am going to talk more about the potential changes to Medicaid, 
known as Medi-Cal, because they are startling. Everyone needs to 
understand that the changes Republicans have proposed--and we think are 
proposing for the Senate bill--go much further than repealing the 
expansion of the program, which was a big part of the Affordable Care 
Act.
  It has been reported in the media that Senate Republicans are looking 
at changes to Medicaid that are similar to what is in the House bill. 
There are rumors that the Senate bill would delay the drastic cuts by a 
few years. But, regardless, when cuts to the program come, they will be 
devastating.
  Whom does Medicaid provide healthcare for? It is not the wealthy. It 
is elderly people in nursing homes. It is pregnant women. It is 
children. It is people with disabilities, and it is low-income adults 
who typically work but don't get health insurance through their jobs.
  Medicaid covers one in three Californians; that is 14 million people. 
It covers one in two children. It covers three out of five residents in 
nursing homes. It covers one in two people with disabilities.
  Here is something the American people need to understand about 
Medicaid: The majority of Medicaid dollars are spent on elderly people 
and people with disabilities. They are the most in need, and they have 
the most serious health issues.
  Let me give you one story. A woman by the name of Kristen from 
Sacramento wrote to us about her daughter Riley, who is autistic. Riley 
is covered by Medi-Cal. It provides critical services that allow her to 
lead a more normal childhood. Here is what the mother said:

       When my daughter Riley was born we quickly learned that she 
     had difficulty with basic tasks like sleeping and eating.
       She developed pneumonia multiple times and was continually 
     sick.
       After turning three, she was diagnosed with autism. Riley 
     is now eight years old and is thriving thanks to Medicaid-
     funded support programs like physical therapy, speech 
     therapy, and feeding therapy.
       She is now verbal, learning to write, and reading above 
     grade level. She wouldn't be doing this well if it weren't 
     for Medicaid. I am counting on you to protect Medicaid.

  Every community in California depends on Medicaid. Let me give you a 
few examples.
  Members of both political parties go to Los Angeles to raise money. 
Forty percent of L.A. County is covered by Medicaid. Do you know how 
many that is? It is not a half a million. It is not a million. It is 
not a million and a half. It is not 2 or 3 million. It is 4 million 
people who could lose Medicaid funding.
  Twenty-eight percent of San Diego is covered by Medi-Cal; that is 
more than 900,000 people. And 37 percent of Sacramento County is 
covered by Medi-Cal; that is 560,000 people. Half of Fresno County is 
covered by Medi-Cal; that is one-half million people.
  I was in Fresno just a week ago. There is a wonderful children's 
hospital. The director of that hospital came over to me and was 
practically in tears. He said: We treat 300,000 children up and down 
this area of the State, and if we lose our Medicaid, we cannot continue 
to provide that treatment--if that takes place.
  Fresno has 31 assisted living facilities for the sick, for the 
elderly, and three out of five beds in that facility are Medicaid. 
Twenty-seven percent of San Francisco County, my home county, is 
covered by Medi-Cal; that is 230,000 people. What Republicans, we have 
learned, may likely propose would end the Medicaid program as we have 
known it for more than 50 years.
  Under current law, the Federal Government pays a certain percentage 
of all healthcare costs for Medi-Cal beneficiaries. We will likely see 
a phase-out of the current structure of the program that would amount 
to $834 billion, cut over 10 years, with 14 million people losing 
Medicaid coverage nationwide.
  They will be in your State, Madam President. They will be in every 
State on the Republican side of the aisle, and I don't know how a 
civilized society or a Senate of the United States could do that to 
people.
  The effects of this change could devastate access to healthcare for 
our most vulnerable citizens and crush State budgets nationwide if they 
try to replace those funds.
  Bottom line, in my State, by 2027, California would need to find $24 
billion to cover those who depend on Medicaid for their healthcare 
today.
  What is going to happen with preexisting conditions? We all know that 
the ObamaCare legislation covers preexisting conditions, so if you have 
breast cancer, you can get coverage. But you could be charged $28,000 
more per year if the preexisting condition of breast cancer isn't 
covered. It goes on and on like this. If you take away coverage for 
preexisting conditions and you have, as we have, 52 million people 
nationwide--including 6 million in California--who have preexisting 
conditions today, that will be a huge problem for them.
  Let me give you one case of a woman from Hesperia, CA. She wrote to 
us about her 37-year-old son. He has battled Crohn's disease for 28 
years. Lisa writes:

       My son was without insurance for 10 years because of his 
     pre-existing condition.

  That was before ObamaCare.

       During this time the disease caused severe damage to his 
     small intestine. He was finally able to get insurance through 
     Covered California and received treatment.

  That was after ObamaCare passed.

       He had surgery to remove various blockages and scar tissue 
     and probably saved his life. I am so scared that his coverage 
     may be taken away.

  How can we do that?
  Sherry, from Sierra Madre, CA, wrote to me about her two sons. They 
both have preexisting conditions. She says:

       As a single mother of two young men just out of college, 
     each with pre-existing conditions, I fear they will not be 
     able to afford health care under the GOP plan.
       One son has Lyme disease and requires infusions every three 
     weeks.
       This is a huge expense that is currently manageable under 
     my health care plan and has been a life-saver for him as the 
     Lyme impacted his immune system.
       Under TrumpCare this treatment would probably not be 
     financially available for him. That would be devastating for 
     him.

  Let me tell you about something we have found out about. I look at my 
phone calls, and we get a lot of calls. I know something is serious 
when we get more than 100,000 calls, and we did on this subject. These 
were largely people between the ages of 50 and 64, and they weren't in 
the group market. They were in the individual market, which means you 
go out to find your own insurance company and you pay the premium.
  Under ObamaCare, there is a subsidy for these premiums if you earn 
under 400 percent of poverty; 400 percent of poverty is about $47,000 a 
year. If you earn under $47,000 a year, it is much easier to get 
healthcare. If you are at $50,000 a year, you exceed the 400 percent of 
poverty.
  I am told by Covered California that the current premium in my city 
for someone 50 to 64 would be $800 a month. That is 20 percent of 
someone's income--20 percent of an annual income.
  This is where the complaints are coming throughout the United States, 
and this is where we can make an easy fix. A number of us have 
submitted legislation to do just that. What it would do is take the 
subsidy, and instead of going off the cliff at $47,000 a year--so

[[Page S3573]]

that at $50,000 your premium costs 20 percent of your income--we 
changed it so that an individual would not pay more than 9.69 percent 
of their income toward the premium.
  This is one example of how we could improve current law and, I 
believe, take away one of the biggest criticisms and fix it rather 
easily.
  Here is another problem. I wish to share a story from Monica of 
Oceanside, CA. These are real cases. She was diagnosed with breast 
cancer shortly after gaining coverage through California's individual 
market. Her doctor told her she would have been dead, had she not been 
covered by her new plan. She had cared for her father 10 years prior to 
his death from Parkinson's disease. She didn't have access to employer-
provided insurance and wasn't eligible for Medicaid at the time.
  By the time the Affordable Care Act was implemented, she qualified 
for a plan through Covered California. She wrote: ``Without the ACA, I 
would not be alive to write this post.''
  I wonder if that means anything to anyone on the Republican side of 
the aisle. No one comes forward; no one says what they would need. This 
is such a big issue. It affects every single one of us and every single 
one of our constituents.
  Let me correct something. They also say: Well, ObamaCare is dead; it 
is imploding.
  They say this to build support for repealing the law, but they are 
wrong. In California, which has worked hard to implement the law 
effectively, the marketplace to buy health coverage functions at a high 
level.
  There are 1.5 million people signed up through the website Covered 
California. Enrollments have been stable, and there has been no uptick 
in healthy people leaving the insurance market.
  The general consensus among experts is that the Federal healthcare 
market is not collapsing. Standard & Poor's said that ``2016 results 
and the market enrollment so far in 2017 show that the ACA individual 
market is not in a `death spiral.' '' So, please, stop saying that.

  In closing, I would like to just say to my Republican colleagues: 
Don't do this. Don't write a bill in secret. Don't take healthcare away 
from millions of people to cut taxes for the rich. Don't undermine 
protections for people with preexisting conditions. Don't allow 
insurers to go back to the days of selling junk plans. Don't end 
Medicaid. We have known it for so long. It is working. It is covering 
poor and elderly all across this country.
  Those of us on this side of the aisle want to make the Affordable 
Care Act better. We want to work to improve our system. We stand ready 
to work together on behalf of our constituents, but if our colleagues 
continue down this path, we will fight this bill with all we have. The 
stakes are too high not to.
  Thank you. I yield the floor.

                          ____________________