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HEALTHCARE LEGISLATION
(Senate - June 19, 2017)

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[Pages S3608-S3612]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HEALTHCARE LEGISLATION

  Ms. BALDWIN. Mr. President, I rise tonight to join my colleagues in 
our fight to protect the health and economic security of the American 
people.
  I am here to express my deep concern, anguish, and disgust with the 
fact that instead of working across party lines, working together to 
protect healthcare, instead, the majority is writing secret legislation 
behind closed doors--legislation that is going to make the American 
people pay more for less care and take healthcare coverage away from 
millions of American families.
  I am disgusted because this issue is very personal to me. When I was 
9 years old, I got sick. I got very sick. I was hospitalized for 3 
months. I eventually recovered, but when it came to health insurance, 
it was as if I had a scarlet letter. My grandparents who raised me 
couldn't find a policy that would cover me, not from any insurer and 
not at any price. They had to pay for my healthcare out of their 
pockets, and they made incredible sacrifices to do so--all because I 
was a child who had been branded with those words ``preexisting 
condition.''
  No parents or grandparents should have to lie awake at night worried 
that if their child has an illness or an injury, they will have no way 
to pay to cover their care. No child should have to lie awake at night 
hearing the whispered tones of their parents wondering how they might 
pay the bills to care for an ill child. It is not right, it is not 
fair, and it is not fundamentally who we are, but that is exactly what 
people were wondering last night in America, and they will do so again 
tonight. Families across this country will go to bed anxious and scared 
because of the partisan politics happening right here in Washington--
the politics that is moving forward with a plan that will make things 
worse and not better for the American people.
  This isn't just personal for me, it is personal for the Wisconsin 
families I work for. I have listened to them, and I am here to give 
them a voice.
  This is personal for Jim from Appleton, WI, and for Jim's daughter 
who has multiple sclerosis. Jim told me that his family needs strong 
protections for people with preexisting conditions so that his daughter 
can continue to receive treatment that her family can afford.
  This is personal for Greg from Stoddard, WI, who has no idea how he 
and other older Wisconsinites will be able to afford higher costs for 
their healthcare and for Greg's two sons, both of whom have diabetes 
and are already struggling with skyrocketing prices for insulin.
  This is personal for Barbara from Madison, who is deeply concerned 
about cuts to Medicaid because her son has a disability and he relies 
on Medicaid to work and to live independently.
  This is personal for Chelsey from Shelby, WI, whose daughter Zoe was 
born with a congenital heart defect. Right now, Zoe is guaranteed 
access to coverage without being denied or charged more because of her 
preexisting condition. Chelsey wrote to me and said: ``I'm pleading to 
you as a mother to fight for the . . . kids in Wisconsin with 
preexisting conditions that are counting on you to protect that 
right.''
  Does the congressional majority really care more about finding 50 
votes for a secret plan than it does about the health and well-being of 
Zoe? Sadly, it appears they do. It appears they are more concerned with 
finding 50 votes for any legislation, no matter how harmful it is, just 
so they can notch up another partisan victory and so that they can move 
on to other things on their political agenda. They are not listening to 
American families or Wisconsin families, who will be left behind.
  I want to tell you what the consequences are going to be when 
Washington does not listen to Wisconsinites like Jim and his daughter, 
from Appleton, or Greg and his two sons, from Stoddard, or moms like 
Barbara, from Madison, and Chelsey, from Shelby. The consequences are 
that things are going to get worse, like they do under the House-passed 
Republican plan.
  If you are older, you are going to pay an age tax. A 64-year-old in 
Wisconsin might have to pay increases in excess of $10,000 more in 
premiums. If you have a preexisting condition, like I do or like almost 
2.5 million Wisconsinites do, the guaranteed protections and care that 
you have today may not be here tomorrow.
  If you live in rural Wisconsin, this plan will only make it harder to 
access affordable, quality healthcare. For some living in northern 
Wisconsin, this plan could cost them up to $6,000 more a year than they 
pay today.
  Our rural hospitals are already struggling to keep their doors open, 
and this plan could make those challenges even worse. By the way, rural 
hospitals are often the lifeblood of their communities, the largest 
employers in many counties in which they exist. So if rural hospitals--
even a few of them--are forced to close, it will not only make it 
harder for people to gain healthcare, it will also mean that people 
will lose their jobs.
  If you rely on Medicaid for nursing home care or if, like Barbara, 
you have a disabled child who relies on Medicaid to live independently 
in the community, the House-passed bill cuts Medicaid and puts that 
care at risk. If you are one of the 35,000 veterans in Wisconsin or 
nearly 2 million veterans across the country who rely on Medicaid for 
healthcare coverage, your care will be at risk.
  The House Republican proposal will both dramatically increase and 
shift healthcare costs to Wisconsin taxpayers and onto the shoulders of 
families for things like substance abuse treatment and mental health 
services.

[[Page S3609]]

It will make it harder in our State's fight and America's fight against 
the opioid crisis and could make the epidemic our country is facing 
even worse. Put simply, this plan will hand over more control to 
insurance companies, weaken health insurance protections, raise costs, 
and provide less care for the American people.
  The American people cannot afford to sell a home or take out a second 
mortgage or home equity loan or spend their life savings or max out 
their credit cards or go bankrupt just to get the healthcare they need. 
It is not right. It is not fair. It is not who we are.
  It is time to stop this partisan nonsense. The people of Wisconsin 
did not send me to the Senate to take away people's healthcare. They 
sent me to fight for people like Jim and Greg and Barbara and Chelsey 
and their children. Let's listen to these Wisconsinites. Let's take 
repeal off the table, and let's work in a bipartisan way. Let's work 
together to improve the healthcare people have today and make it more 
affordable, not more costly. Let's work in a bipartisan way. Let's work 
together to make things better, not pursue partisan plans to make 
things worse.
  I call on my colleagues on the other side of the aisle to come out 
from behind their closed doors to join us in this fight to stop leaving 
people behind and start helping them get ahead.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, I appreciate the remarks from my 
colleague from Wisconsin, who came here to champion the citizens of her 
State and the citizens of all of America. As she spoke so passionately 
about the need to make sure we have affordable, quality healthcare, 
that is really the theme that we are talking about. That is the value 
we are talking about, that in this great big, beautiful, wonderful 
Nation, the United States of America, everyone should have access to 
affordable, quality healthcare.
  There are some colleagues here who do not share that value. They 
consider healthcare to be a privilege for the wealthy--healthcare for 
the wealthy, healthcare for the healthy--but not healthcare for all 
Americans. They say: You can't afford healthcare? Too bad.
  They have a plan of 13 Republicans meeting in secret--the secret 13--
even meeting in a room to which the hallway is not accessible to press 
because they are afraid to have the cameras showing them as they go 
into the room and out of the room. If you are ashamed to see yourself 
going in and out of a room and for your constituents to see that, 
shouldn't you be ashamed of what you are concocting? Shouldn't you 
really wonder if you are doing the right thing in saying to your 
constituents: I am not going to show you the bill because I know you 
will not like it. I am going to keep it secret, and I am going to bring 
it out at the last minute. I am going to employ a tactic that does not 
belong in the Senate.
  This is supposed to be a deliberative body--once called the world's 
greatest deliberative body--but under this leadership, it is now the 
body of zero deliberation, zero committee meetings, zero markups, zero 
chance for the public to weigh in, zero chance of hearing the experts 
and taking their insights into account. That has to change.
  We need three of our colleagues who believe in this Nation, who 
believe in the Constitution, written with those beautiful three words 
``We the People.'' They need to stop thinking about ``we the powerful'' 
and ``we the privileged.'' They have to stop thinking about how they 
help their friends in the gated communities of America or in the 
corporate suites of America. How do you help working Americans? How do 
you help struggling Americans?
  Franklin Roosevelt said that the test of our progress should not be 
whether we do more--add to the abundance of those who have much--but 
whether we do enough for those who have little. Yet the philosophy of 
this bill that the secret 13 is cooking up is about giving more to the 
abundance of those who have much and taking away from those who have 
little. It is the opposite. It is government by and for the wealthy and 
government by and for the powerful and government by and for the 
privileged.
  Have they forgotten the first three words of our Constitution? Have 
they forgotten that the philosophy, as Jefferson put it, was that we 
would have outcomes that would reflect the will of the people? If you 
are afraid to share the bill with the people of America, you are 
certainly not pursuing the will of the people of the United States of 
America.
  What is really in this bill?
  On the one hand, we understand that it is going to take healthcare 
away from millions of Americans. They are saying that it might do it a 
little more slowly than did the TrumpCare bill.
  As for the TrumpCare bill, the President himself said it was 
``mean,'' and he used a derogative slogan, which I will not repeat on 
this floor, to say how terrible it was. Why did the President call it 
``mean''? Was it that it was taking away healthcare from an estimated 
23 million people? My colleagues, we understand, are going to do it 
more slowly, inflict that damage over a number of extra years. Does 
that make it right to hurt people? Does that make it right? In the 
meantime, they are going to hand out an insurance bag of goodies to the 
health insurers of $127 billion. Strip healthcare over here. Give 
goodies to the insurance companies over here.
  What happens to those who are in long-term care and nursing homes? 
More than 6 out of 10 Americans who are in long-term care are there 
because they are paid through Medicaid. They have to pay down all of 
their income and their wealth before they can use Medicaid. This is the 
last resort. It is the last thing they have. Medicaid comes to the 
rescue.
  I visited a couple of nursing homes over the weekend, one in an urban 
area and one in a rural area. I encourage my colleagues to go visit a 
nursing home and talk to the men and women who are there. They are so 
thankful that they have that care.
  One woman said to me: ``Medicaid is how I am paid for.''
  Her name is Deborah.
  Deborah said: ``Medicaid is how I can afford to be here. If you take 
it away, I am out on the street. Being on the street is a problem 
because my legs do not work.''
  Picture that individual being thrown into the street. She is in her 
wheelchair because her legs do not work. Where is she going to sleep? 
How is she going to feed herself? Where is she going to bathe?
  Then I went to a nursing home in rural Oregon, which was down in the 
south, Klamath County. At that nursing home, they told me that almost 
100 percent of their long-term care patients are paid for by Medicaid--
almost one 100 percent. Imagine that entire hallway of individuals 
swept out, tossed out.
  And why? What else do we have in this bill? Oh. Give tax deductions 
and gifts to the health insurance executives. First we have gifts to 
the health insurers and then another $18 billion to the health 
insurance executives.
  Then my colleagues say: Let's make insurance cheaper by getting rid 
of the essential benefits. That way, people can have an insurance 
policy for less.
  But unfortunately it is not worth the paper it is written on. We have 
been there. We have seen that. There is a reason you set a floor as to 
what the benefits are. It is so that when you actually get sick and 
need to go to the emergency room, you can actually go. When you 
actually get sick and need an operation, you can actually get it. When 
you break a leg, you can actually get it set. When you need treatment 
for a disease, you can actually get the treatment. When you are having 
a child, you can actually get maternity care. These are the 
fundamentals. They are not the fancy end of healthcare. It is not the 
fancy end that you might find with some executive healthcare packages. 
These are the basics, the essential basics. My colleagues want to strip 
that away.
  On the other hand, they say: Hey, we have so much money that we can 
give tax giveaways to the prescription drugmakers--$29 billion to the 
prescription drugmakers.
  Then they want to destroy the rural healthcare clinics and hospitals. 
I was in four of my rural counties this weekend. I was in Klamath and 
Lake, and I was in Grant and Wheeler. I held townhalls. People came out 
and spoke to me.
  These folks said: Do you know that our rural clinics are the heart of 
our

[[Page S3610]]

communities, and they are what allow people to live here with the 
confidence that they can get the healthcare they need instead of having 
to go to some city that is hundreds of miles away or maybe not even be 
able to get care at all on a timely basis?
  They love their hospitals that provide care in the bit larger 
communities in rural Oregon.
  Yet, as for the heads of these hospitals and the heads of these 
clinics, what do they say? They say that without the Affordable Care 
Act and the vast decrease in uncompensated coverage, they would have to 
fire a whole lot of employees and provide a whole lot less healthcare.
  One doctor from a clinic in the northeast corner of the State came to 
me and said: We doubled--roughly doubled--the amount of healthcare we 
are able to provide, and we are so remote, and it is so important to be 
able to have that nearby.
  So why do my colleagues really dislike healthcare in rural America? 
Why do they want to undermine it? Well, they can give away more money 
to medical device makers--$20 billion to medical device makers--and all 
of this is before we look at the fact that they are giving more than 
$200 billion away to the richest Americans. So over here, let's strip 
the essential benefits. Let's destroy the health clinics. Let's 
undermine the rural hospitals. Let's make it challenging for those with 
preexisting conditions. Let's take those in nursing homes and make sure 
they are not able to be in nursing homes and, magically, maybe they 
will get cared for some other way so we can give tax giveaways to the 
health insurers, tax gifts to the insurance executives, tax goodies to 
the prescription drug makers, and special tax provisions to the medical 
device makers, and then give $200 billion to the richest Americans. 
Isn't that the opposite of the test of our progress? Here, in the 
United States of America, under a system of government that is supposed 
to be of the people, by the people, for the people--this bill is by the 
privileged and powerful, for the privileged and powerful. And not just 
that, but let's really hurt ordinary working people and struggling 
Americans in the process right where it really gets them--right here--
at the fundamental heart of the peace of mind they get from knowing 
that currently they have access to healthcare.
  I don't know that anything is quite so disturbing as worrying about 
the fact that if your loved one gets sick, will he or she be able to 
get the care he or she needs? If your loved one gets sick, will he or 
she go broke? And what about your neighbor, and what about your 
extended family? This Republican bill is all about creating stress and 
anxiety and bad outcomes for ordinary working Americans, ordinary 
middle-class Americans, ordinary struggling Americans.
  They didn't send us here to the Senate to do this. That is why the 
secret 13 are meeting in secret. That is why they don't want to meet in 
a room that has a hallway where the reporters can be. That is why they 
don't want to answer the questions in the hallway about whether they 
will vote to proceed to a bill without letting the people of America 
weigh in on it.
  Shouldn't everyone here be willing to answer that question: Are you 
willing to vote to move to a bill that has had no public process? 
Aren't you working for the people of America? Or, as this bill says, 
are you just working for the companies and the rich? That is it, and 
too bad for everyone else.
  Aaron in Portland wrote to me. Because she has been diagnosed with 
diabetes, she is terrified that if TrumpCare goes through, her 
condition will be considered a preexisting condition, and she won't be 
able to afford the coverage she needs. She says: ``Although through 
committed lifestyle changes and family support, I have done well 
managing this condition, I will be marked as high risk along with my 
age.''
  Ellen from Medford, the southern part of our State, tells me that she 
has the challenge that her baby daughter was in a catastrophic accident 
just days before her second birthday. Her husband had just switched 
jobs and didn't have health insurance yet. But, fortunately, Medicaid--
that would be the Oregon Health Plan--was there for them, and her 
daughter got the lifesaving care she needed. That is anxiety for an 
ordinary person. Do you have health coverage when you are switching 
jobs? Is there one health insurance you can afford?
  My colleagues want to strip healthcare from Ellen in Medford so they 
can cut $800 billion in Medicaid overall, so they can give tax 
giveaways to powerful corporations and the richest Americans. It is 
just wrong, morally wrong, and wrong in every possible way.
  Marilyn from Ontario says that she is living with two autoimmune 
diseases--difficult to pronounce, so I won't. She was diagnosed before 
the ACA became law, but rather than be denied coverage outright by her 
insurance company, she was told she could be covered if she paid a 
monthly premium of about $1,000 with a $20,000 deductible--$20,000 
deductible. Needless to say, that wasn't helpful to her. Marilyn went 5 
years without insurance, and she ended up being very sick. She had to 
borrow against her home, leverage her home. She had to deplete her 
retirement savings. And she had to make payments on $64,000 worth of 
credit card debt, run up in order to cover her healthcare.
  Then the ACA came along, and Marilyn was able to afford insurance, 
and she got community pricing. In other words, despite these 
preexisting conditions, you pay the same price as everyone else. That 
is so important to peace of mind about healthcare. Just saying that you 
will have ``access to healthcare''--a favorite phrase some of my 
colleagues use--if you can pay extraordinarily high prices that I know 
you will not be able to pay, that is not access. That is teasing 
people. That is cruelty to say: Oh, yes, we are going to make sure you 
have access; as long as you are a millionaire and you can pay a ton 
every month, you have access. We have taken care of you. You have 
access. No, that is not access. Affordability is critical to having a 
functioning healthcare system, and Marilyn will probably be priced out 
of the market again with the Republican strategy.
  How about Lisa in Corvallis, a single parent of three children, two 
with serious medical conditions that have placed them on permanent 
disability. Lisa faces some hard times, and I will let her words speak 
for themselves. She says:

       Our family was very fortunate and eternally grateful that 
     the ACA passed while I held that job, because in 2015, my 
     middle child was hospitalized for the first of four times in 
     the last two years. And, in March of 2016, I developed a 
     serious heart condition which my doctor attributes in part to 
     stress.

  She goes on to say:

       In June of 2016, my employer declined to renew my contract, 
     and if it weren't for the ACA, I would have been out of a job 
     and completely without medical coverage, this time with a 
     serious and expensive preexisting condition.

  The stories are coming in through emails. They are coming in through 
my townhalls. They are coming in over the phones. They are letting us 
all know--and not just in States represented by folks on this side of 
the aisle, but every Senator here is getting these letters.
  So I say to my fellow Senators: Read these letters from your 
constituents because I know that your constituents are in the same 
position my constituents are in. Be a champion for them. Be a champion 
for struggling families, for working families, for middle-class 
families. Honor the role and responsibility of representing all of the 
people of your State, not simply powerful companies and your richest 
constituents but all of your citizens. That was the vision on which our 
country was founded, and that is the spirit in which Franklin Roosevelt 
said: This test of our progress is not whether we give more of the 
abundance to those who have the most, but enough to those who have 
little.
  Enough means affordable, accessible healthcare for every single 
person in America. Tearing that down is wrong morally and wrong to do 
it secretly and wrong in terms of the enormous damage that it will 
cause.
  I am pleased to see my colleague from Pennsylvania, who has been a 
champion for working Americans every day he serves in this Chamber. He 
particularly makes sure that all of us are thinking about the impact on 
children, and there is so much of this secret Republican plan that is 
going to hurt the children of America. I appreciate the insights that 
he shares with all of us as

[[Page S3611]]

he urges us to ponder and do better every time we consider legislation.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I want to thank my colleague from Oregon 
for bringing the passion and the determination that he brings to his 
work, especially when it comes to healthcare.
  I spoke earlier tonight about the potential impact of any Senate 
bill, but of course the impact that we know already with regard to the 
House bill, because the House bill is legislation that passed and 
legislation that we can analyze as it relates to the impact on 
children, especially children with disabilities.
  Of course, when it comes to healthcare generally, but, in particular, 
Medicaid and what Medicaid provides to children, we know the impact 
nationwide. In my home State of Pennsylvania, we have 1.1 million 
children who are covered by Medicaid. So I am very concerned about any 
effort that would undermine or ultimately extinguish the ability of 
Americans--especially children--to have the benefit of Medicaid 
expansion, but, of course, the Medicaid program itself. It is 
especially insulting when some would support cuts to the Medicaid 
Program that would undermine or even threaten to undermine healthcare 
for children with disabilities. I spoke earlier of two children in 
particular.
  I will come back to children in a moment, but I wanted to go to the 
other end of the age scale--older Americans. So many people think of 
healthcare for people over the age of 65 to be solely limited to 
Medicare, not Medicaid. But, of course, we know that Medicaid plays a 
role as well.
  One of the parts of our healthcare infrastructure that may not be as 
well known is the impact that Medicaid has on supporting aging older 
adults, in particular, with regard to supports and services. We know 
Medicaid is critical to supporting aging older adults, providing them 
dignity and choice as they age. Medicaid covers long-term services and 
support for low-income, older adults and adults with disabilities, 
including nursing home and home community-based programs.
  Generally, health insurance does not cover long-term supports and 
service costs. Medicare coverage for those services can be limited, and 
private, long-term care insurance is unaffordable for many Americans. 
So spending on long-term supports and services for older citizens 
accounts for almost two-thirds of all Medicaid spending. I said 
Medicaid, not Medicare. A lot of people don't know that we spend that 
much in terms of long-term supports and services.
  To give this perspective, in 2016, the median annual cost for a year 
of home health aide services was over $46,000--for home health aide 
services. The median cost for a semiprivate room at a nursing facility 
was $82,000--a much greater cost. So we know the impact of those 
numbers. About a third of the people turning 65 will require nursing 
home care at some point during their life. So these are big costs, and 
we have to make sure that as we move forward, we can provide this kind 
of care for aging adults.
  Three-fourths of nursing home residents will eventually be covered by 
Medicaid. So if you are going to a nursing home and you spend down, the 
only option for you in most instances is Medicaid. We know that in 
about a 1-year timeframe, between July of 2015 to June of 2016 in 
Pennsylvania, 123,000 Pennsylvanians aged 55 and older received long-
term supports and services through Medicaid. One group of about 80,000 
Pennsylvanians received those long-term supports and services at a 
nursing home. Another group of about 50,000 Pennsylvanians 55 and older 
received Medicaid home and community-based services.

  There are lots of numbers there and lots of data, but the key thing 
is, we know the great dependence folks have on the Medicaid Program in 
addition to the obvious benefits provided by Medicare. So cuts or per 
capita caps on Medicaid would have a devastating impact on older 
Americans.
  I know the closed-door secret discussions taking place in the Senate 
between among only a small group of Republicans so far--we know those 
kinds of discussions are taking place. What will they do with regard to 
Medicaid? Will they cut it outright or will they put a per capita cap 
on it or will they send it back to the States and tell the Governors 
and State legislatures they have to balance their budget: It is up to 
you to provide most of the Medicaid services. The Federal Government is 
getting out of that business or at least transferring substantial 
responsibility to the States.
  So we have to be vigilant about that and make sure we do everything 
we can to put the interests of older citizens and the priority of 
taking care of them at the front of the agenda.
  Research also shows that Medicaid dollars play a role in supporting a 
lot of good-paying jobs in a State like Pennsylvania. We are told that 
over a quarter of a million jobs in the long-term care field--meaning 
long-term supports and services--are Pennsylvania jobs right now. So 
any change there could have an adverse job impact. The Commonwealth 
Fund and George Washington's Milken Institute released a report 
projecting 942,000 fewer jobs in 2026 and that nearly every State would 
experience an economic downturn if the Republican bill were to become 
law based upon the House bill as we know it. As we were told most 
recently by a Republican Senator, the Senate bill will reflect the 
House bill about 80 percent. So we have a sense of the outlines of the 
Senate bill, if not all the details yet.
  In Pennsylvania, this same report by George Washington University's 
Milken Institute said that just in Pennsylvania, the job impact would 
be 85,000 fewer jobs by 2026, and of those 85,000, more than 52,000 of 
those jobs would be healthcare jobs which would be lost if the 
Republican bill were to be enacted into law.
  We get a sense of the job impact, we get a sense of the healthcare 
impact when it comes to cuts to Medicaid that are substantial. As we 
know, the Congressional Budget Office told us that were the House bill 
to be enacted into law, in that decade, 14 million folks on Medicaid 
would lose their coverage. That is on page 17 of the CBO report.
  When we look at it by county in Pennsylvania, we can see the impact 
in this age category of 55 and up. Allegheny County--our second largest 
county by population--over 10,000 Pennsylvanians over the age of 55 
receive care in a nursing home or at home because of Medicaid. That 
generated nearly $360 million in payments to providers in the county, a 
huge impact in addition to the impact on the care people receive.
  I will not go through every county, of course, but just to give a 
sense of it. Cambria County, a much smaller county by way of 
population--where Johnstown is in the southwestern corner of our 
State--1,100 individuals in Cambria County age 55 and older receive 
care in a nursing home or at home because of Medicaid. That is about a 
$36 million impact on that county. In my home county, Lackawanna 
County, where Scranton is located, 2,500 Pennsylvanians over the age of 
55 receiving nursing home care because of Medicaid, a $96 million 
impact just in Lackawanna County. I will not go through all the 
counties, but we can see the impact on both care and jobs when it comes 
to the impact of Medicaid on long-term care, support, and services.
  We talked earlier about Medicaid and the impact on children. I don't 
think it has been at all clear until recently the reach and scope of 
Medicaid when it comes to children. Forty percent of every child in the 
country is covered by Medicaid. I mentioned earlier tonight, and I will 
say it again: Sixty percent of all children with disabilities ranging 
from autism to traumatic brain injury, and a lot of disabilities on 
that list in between, rely upon Medicaid.
  I said the Republican plan at the bare minimum should guarantee every 
child with a disability who has Medicaid coverage today would in fact 
have that coverage going forward for whatever time they need it because 
I think that is part of who we are as a country. When a child has a 
disability that is so substantial in terms of the impact on that child 
and his or her family and they have Medicaid, nothing the U.S. Senate 
should do should undermine that in any way. I would hope, at a minimum, 
our Republican colleagues would ensure that. I think it is insulting to 
even create doubt or uncertainty or create any degree of anxiety for a

[[Page S3612]]

family to have to watch this bill proceed--either the House bill that 
was passed or the Senate bill which is in formation right now. For any 
family who has the benefit of Medicaid and has a child with a 
disability to in any way be anxious or uncertain because of what might 
happen here, I think is an insult to them and to our values as 
Americans.
  We are a great country. We can make sure children with disabilities 
have the benefit that comes from the early periodic screening and 
diagnosis, preventive care, the quality care that comes from services 
provided by Medicaid for kids with disabilities. We are a great 
country. We can pay for that and still be a growing economy, still have 
the greatest military in the world, still have the strongest GDP in the 
world. We can do all of that and still take care of the children.

  I guess some believe the only way to prosperity is to say we have to 
substantially cut back on Medicaid, to the point where 14 million 
Americans lose their coverage over 10 years, but we still, at the same 
time, have to give tax cuts to the very wealthy. One estimate showed 
the original House bill--the one that didn't get a vote but was 
substantially similar to the one that did get a vote--the first bill 
gave to 400 Americans a tax cut of some $7 million each. How does that 
make the country stronger when you are cutting back on Medicaid and 
giving gross substantial tax cuts to people who already are worth 
hundreds of millions of dollars or maybe even billions of dollars? I 
don't see how that moves the country forward to shortchange folks on 
Medicaid, especially if it were to adversely impact a child with a 
disability.
  We mentioned all of those impacts, but I think it is especially 
devastating when it gets down to an individual family. I talked earlier 
about Rowan Simpson whose mom wrote to me months ago. I had the chance 
to meet Rowan and his mom and dad just last week for the first time in 
person, but the idea that Pam Simpson--or any parent--would be at all 
uncertain or worried about what would happen here in the next couple of 
days or weeks is really an insult to who we are as a people.
  I hope those who are behind closed doors making decisions as we 
speak--maybe they are done for the day now, but I hope they will be 
thinking about Rowan and his mom and their family.
  I mentioned the overall impact of Medicaid on children. In 
particular, we know the Medicaid Program, of course, in addition to 
covering children with disabilities, covers adults with disabilities as 
well. In my State, by one estimate, it is over 720,000 people. Across 
the country, in 2015, there were 15 million people with disabilities 
who were Medicaid beneficiaries. Through Medicaid, those 15 million 
people receive assistance with their healthcare. They get the benefit 
of durable medical equipment, such as wheelchairs or assistive speaking 
devices. They get long-term supports for daily living, such as personal 
care attendance because of their disability. So Medicaid is now the 
primary payer for healthcare services for those with disabilities. It 
is also the primary payer for long-term supports and services that help 
people with disabilities live independent lives.
  In many cases, these long-term care supports and services also make 
it possible for a person with a disability to hold down a job because 
of the support they get from Medicaid.
  We know that in 2014, across the country, the average spending for a 
person with a disability enrolled in Medicaid was a little more than 
$19,000. In Pennsylvania, it was a little more than 18,300. The average 
annual growth in enrollee spending for persons with a disability 
between 2000 and 2011 was 4.5 percent. In my State, it is a little more 
than that almost. It is almost 5.7 percent, and we have seen the 
outline of a proposal that would limit that annual growth to about 2.4 
percent. I would hope those who are working on the Medicaid provisions 
would take into account the reality of what it costs to provide help to 
someone with a disability and not come up with some arbitrary number to 
cap or limit what an individual with a disability would have available 
to them, especially by way of Medicaid or otherwise. They are dependent 
upon and have a right to expect that kind of healthcare would continue 
to be provided.
  We will see what happens. I know those who are behind closed doors 
have a sense of those numbers. I hope they would be very determined to 
make sure no one with a disability is worse off as a result of their 
efforts, but that is the reality people with disabilities live with. I 
think when we consider what some families are up against right now, 
many families have just barely come out of the last recession. Some 
families lost their home, some families lost their home and their job 
or even if they lost a job and have since recovered because they are 
employed or partially recovered, sometimes the job they have isn't the 
job they had prior to the recession.
  I can only imagine what it is like to have the kind of economic 
stress some live with because they have lost a job or the job they have 
now doesn't pay what their old job paid. On top of all that, if your 
son or daughter or someone in your family has a disability and the only 
thing that has kept you above water or allowed you to get from one day 
to the next to make ends meet is the availability of Medicaid for that 
individual and the family who needs that kind of help--we will see what 
the bill drafters come up with. Every indication so far has been very 
negative and very much adverse to the interests of those families--
those millions of families who depend upon Medicaid for basic 
healthcare, especially the basic healthcare that would be connected to 
a disability, whether that disability is a physical disability of one 
kind or another or whether it is a disability because that child or 
adult is on the autism spectrum or whether it is a child with Down 
syndrome who is dependent upon Medicaid or is dependent upon some other 
healthcare program that would be adversely affected.
  We can debate the outlines and the broad numbers of this legislation, 
but what I hope would not be up for debate is that those who now have 
the benefit of Medicaid because of a substantial burden in their life--
meaning a disability because of circumstances that require one 
individual to have the benefit of long-term care, where the family has 
spent down their assets to such an extent that only Medicaid can allow 
that loved one to get into a nursing home--I would hope that it would 
not be much of a debate that we should continue to help those families 
and those individuals.
  At a minimum, I think we can agree between the two parties that 
vulnerable Americans who depend upon Medicaid and other healthcare 
programs will be protected. I think that is something on which both 
parties should be able to agree. Unfortunately, the House bill in no 
way agreed with that assertion. That is why it was particularly 
objectionable, and that is why you have an array of organizations 
across the country that came out against the bill, those who have 
experience delivering healthcare to the vulnerable, those who have 
experience making sure people with disabilities are given that kind of 
help and that kind of care. If the Senate bill is substantially similar 
to the House bill, those with disabilities will be substantially and 
adversely and, I am afraid, irreversibly impacted to such an extent 
that we wouldn't be the same country we are today if those individuals 
lost their healthcare and lost the benefit of those healthcare 
services.
  Mr. President, with that, I yield the floor.

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