June 12, 2019 - Issue: Vol. 165, No. 98 — Daily Edition116th Congress (2019 - 2020) - 1st Session

[Pages S3347-S3354]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                                Medicaid

  Mr. CASEY. Madam President, we are on the floor, and I will be joined 
by colleagues to talk about the program we know as Medicaid--a program 
that I think we are beginning to appreciate more, especially in the 
last couple of years--and the impact it has on the American people.
  Unfortunately, the debates on healthcare have resulted in Medicaid 
becoming a target. Too often, both in the Senate and in the other 
body--the other body, the House--the Medicaid Program has been the 
subject of attempts to do at least one of three things, if not all 
three.
  One is attempts to decimate the program by way of funding cuts over 
the next 10 years. We know the President's budget has proposed cutting 
Medicaid by $1.5 trillion over 10 years--that is with a ``t''--roughly, 
$150 billion each and every year for 10 years. That is a bad idea, and 
we are going to fight that with all we have.
  Other attempts to slash Medicaid have been perpetuated over time, 
either to cut it over 10 years or to cut it in a particular year.
  The third thing we have seen is sabotage efforts by the 
administration when it comes to the exchanges resulting from the 
Affordable Care Act but also attempts to sabotage the Medicaid Program 
itself. I will develop that in a moment in terms of the attempts by the 
administration.
  Medicaid is a program that, I think, tells us who we are as a nation. 
We are a great nation for a number of reasons. We all know we have the 
strongest military and the strongest economy. When we are at our best, 
we are an example to the world. We are also the greatest country in the 
world because of the way we attempt--don't always do the right thing 
and don't always do as much as we should--but because of our attempts 
to take care of folks who need help and to give opportunity to folks 
who might need a door to be opened or an opportunity to be presented to 
them.
  Medicaid is one of those examples of American greatness when we get 
it right. Medicaid is the program that we know is responsible for 
making sure seniors can get into nursing homes. Absent Medicaid, 
millions of seniors wouldn't be able to have the benefit of skilled 
care in a nursing home. Something on the order of 60 percent of seniors 
have an opportunity to get skilled care because of Medicaid. Absent 
Medicaid, it is highly likely they wouldn't be able to get that care, 
especially when you consider the cost of care to just one family. It 
would cost tens and tens of thousands of dollars.
  Medicaid is the program that takes care of a huge share of the 
Nation's children, and a subset of that, of course, is children with 
disabilities. We are told, just in Pennsylvania alone--the most recent 
number I have seen--54 percent of children with disabilities have their 
healthcare provided to them by Medicaid. Thank goodness that is the 
case, and we have to make sure that continues.
  Just consider the birth of a child. We know, whether it is 
Pennsylvania or the Nation, the number exceeds 40 percent. Forty 
percent of all the births in the country--more than 40 percent, I 
should say--are paid for by the Medicaid Program. So the Medicaid 
Program affects the family in so many different ways: the family, when 
it comes to a birth, in very high numbers across the country; the 
family, when it comes to providing healthcare for children and to give 
children the opportunity not just to have coverage and insurance but to 
have early screening, early diagnosis, and testing--the kind of 
preventive care, in a sense, that we hope anyone would receive but 
especially a young child.
  Medicaid, of course, goes from, to use Senator Hubert Humphrey's 
line, ``the dawn of life to the twilight of life''--from children all 
the way through to older Americans and folks in between there who might 
have a disability. Probably every Member of the Senate has received a 
letter from a family who has a loved one with a disability, especially 
a child, expressing how Medicaid is important to them.
  We all know these debates are critically important to what happens to 
Medicaid. If we allow the majority in the Senate, and if we allow the 
administration to have its way, we would have substantial cuts to 
Medicaid--maybe not a trillion and a half, as the administration has 
proposed, but substantial cuts that would hurt the American family.
  I wanted to highlight some of the ways I mentioned earlier that the 
administration has tried to sabotage Medicaid. That is my view of it. 
Here are some examples: Starting in January of 2018, the administration 
undertook an effort to allow States, for the first time, to take away 
Medicaid coverage from people who are not working or who are not 
engaged in work-related activities for a specific number of hours each 
month. In Arkansas, for example--this was the first State to implement 
this new policy by the administration--over 18,000 
Medicaid beneficiaries lost coverage in 2018 due to the new 
requirements. Almost one in four people were subject to the new rules.

  While a Federal district court recently struck down restrictive 
waivers in both Arkansas and Kentucky, the Centers for Medicare and 
Medicaid Services, the so-called CMS, continues to approve these 
policies in additional States.
  So that is one attempt to knock people off Medicaid in the calendar 
year 2018--18,000.
  Another attempt was in the State of Utah. HHS, Health and Human 
Services, a Federal agency, has also approved an unprecedented 
authority for States to deny coverage for people who otherwise would be 
eligible for Medicaid. This authority undermines Medicaid's guarantee 
of healthcare coverage to low-income people who meet the eligibility 
criteria set by Congress.
  Earlier this year, Health and Human Services approved a proposal to 
allow the State of Utah to cap enrollment based solely on State funding 
decisions. So, in other words, once the number of enrollees reaches the 
State's funding cap, other eligible people would be shut out of 
coverage. An arbitrary enrollment cap limits enrollment on a first-
come, first-serve basis and would treat similarly situated people very 
differently, depending on when they apply for coverage, effectively 
holding low-income people's healthcare coverage hostage--hostage to 
State lawmakers' annual budget decisions on how many people should get 
coverage. So this is another way to limit Medicaid coverage.

[[Page S3348]]

  Now, Health and Human Services is reportedly working on a block grant 
guidance for States that could give States the latitude to cut coverage 
of services or provide payments in ways not allowed under Federal law.
  So here are just a couple of examples of what the administration is 
doing that I would argue is sabotage: cutting Medicaid by providing 
waivers that have not been provided before to the States. I don't think 
coverage of Medicaid should be determined by a purely budgetary 
decision at the State level. States have to balance their budget. They 
have constraints. The Federal Government should ensure that anyone who 
is eligible for Medicaid should receive it. There are those who say: 
Well, if you go down that path, the Federal Government will not be able 
to afford it.
  I have heard words used on this floor and other places around the 
Capitol that the cost of Medicaid is ``unsustainable.'' That is the 
word that is used over and over--unsustainable.
  I wonder if the same people, the same Members of Congress, use the 
word ``unsustainable'' for corporate tax cuts that went into effect 
starting in late 2017, where there was a corporate tax reduction voted 
on in the Senate where that reduction went from a 35-percent rate down 
to a 21-percent rate. The original idea was to go from 35 to 20, and it 
ended up at 21. So that is a 14-point reduction in the corporate tax 
rate. We were told, if we did that, if we all agreed to do that--I did 
not agree with it--but if we were to agree to do that and the bill went 
through and became law, which it did, that somehow wages would be 
increased for workers across the board. In fact, the White House, at 
that time, promised that wages would go up $4,000 per worker--$4,000. I 
haven't had a steady stream of workers coming to my office saying they 
got a $4,000 wage increase because of the December 2017 tax bill. In 
fact, they are telling me the opposite. Many of them are paying more 
than they were before that tax bill.
  I make that point and relate it to Medicaid very simply because the 
same folks who talked about and have advocated for and even voted 
repeatedly to cut Medicaid are the same folks who often supported a 
corporate tax cut that cost over a trillion dollars and was not paid 
for. Then the same people say: Oh, my goodness. We have a trillion-plus 
hole in the budget so we have to go and cut Medicaid or Medicare. So 
what results now is a little more than a year later--a year and a half 
later, after the tax bill passed, what do we have? We have the 
administration coming forward saying: We have to cut Medicaid by a 
trillion and a half over the next 10 years and Medicare by over $845 
billion over the next 10 years. That is the tradeoff: cut Medicaid and 
Medicare, in essence, to pay for a corporate tax cut.
  Remember, every point they reduce that corporate tax cut--when they 
went from 35 to 34, the cost of that is $100 billion over 10 years. 
Then, when it went from 34 to 33, another $100 billion is implicated in 
that cut, and you can see the reduction. For every point of the 
corporate tax cut, it will cost the Nation, over 10 years, $100 
billion.
  So when folks start talking about the cost of Medicaid being 
unsustainable, I just think that is a camouflage for what they really 
want to do, which is to cut Medicaid and reduce those who are eligible.
  I am going to try, with everything I have, to prevent them from doing 
that because last time I checked, Medicaid was a program about us. It 
is an ``us'' program, not a program for someone over there--someone who 
is distant from us. Medicaid, as we found out most recently in the 
debates about healthcare, is a program about us, about who we are. It 
is about babies being born. It is about kids with disabilities. It is 
about children who live in families who are very low income. The 
families are thereby eligible for Medicaid, and that child not only has 
coverage but has the kind of early preventive healthcare we would hope 
every child has.
  And Medicaid is also about the members of our family who are senior 
citizens trying to get skilled care.
  So we are going to have a long discussion today, at least for the 
better part of an hour, about Medicaid, and I am grateful that 
colleagues of mine are willing to come to the floor and talk about this 
critically important program and what is at stake for our families.
  Mr. BROWN. I want to join my friend Senator Casey today to talk about 
the importance of Medicaid. I want to echo his comments and Senator 
Wyden's comments, particularly given the attacks from the White House 
and State legislatures and, frankly, too many in this body.
  I am still incredulous when I think about what happened in this body 
and has happened many times. In my State, 900,000 people have insurance 
because of the Affordable Care Act. The expansion of Medicaid meant 
hundreds of thousands of families can rest easier knowing they will 
have health insurance when they need it.
  I have sat in this body a number of times and watched my colleagues--
mostly on that said of the aisle, well-dressed, well-paid, health 
insurance paid for by taxpayers--who are willing to cast a vote to take 
insurance away from hundreds of thousands in their States. Again, these 
are elected officials who have taken an oath of office, who have 
insurance paid for by taxpayers, and they are willing to take insurance 
away from others.
  I will illustrate with one story. Fourteen people in Ohio die every 
day from an overdose--more than any State in the country. I know it is 
a serious problem in Montana and a serious problem all over the country 
but more in Ohio than most places. Our State legislature wants to make 
it harder for Ohioans to get that care and so does President Trump. 
President Trump continues to try to take insurance away.
  These aren't people sitting at home. Most of these people under 
Medicaid expansion were workers making $10, $12, and $15 an hour, 
working every bit as hard as Senators do, but they don't have jobs that 
provide insurance so they depended on the expansion of Medicaid. These 
are people working hard.
  This President wants to take their insurance from them. Senator 
McConnell, down the hall, wants to take their insurance from them. They 
cast votes. This isn't hyperbole or me making this up.
  Let me tell you a story real quick. One of the best treatment centers 
in Ohio is called Talbert House. I was at Talbert House one day in 
Cincinnati. I sat with a man and his daughter. He turned to me, put his 
hand on his daughter's arm, and said: Without Medicaid, my daughter 
would be dead. How dare Members of this body--elected officials who are 
supposed to represent the public interest--take away insurance from 
people like his daughter. Every day I just can't believe it.
  Mr. CASEY. Mr. President, I will at this time yield the floor to my 
distinguished colleague from the State of Washington, Senator Murray. 
We are honored by her presence here on the floor. I will come back a 
little later.
  The PRESIDING OFFICER (Mr. Cramer). The Senator from Washington.
  Mrs. MURRAY. Mr. President, I want to thank my colleague for starting 
this really important discussion that all of us should be very well 
aware of, and I appreciate his leadership.
  People across this country have been absolutely clear. They want us 
to fight for families who are struggling with high healthcare costs and 
help to make sure that everyone in our country can get quality 
affordable care. But while Democrats have been coming forward with 
solutions and calling on Republicans to come to the table to address 
the healthcare sabotage they have helped President Trump accomplish, 
instead, they have been repeatedly on the other side, refusing to fight 
the fire and having only just shown real interest in fanning the 
flames.
  There are so many glaring examples about how President Trump has 
worked to sabotage families' healthcare. We are here today to focus on 
just one--the tireless efforts to undermine Medicaid.
  It is a program that helps people across the country get affordable, 
quality healthcare. State after State has now worked to expand Medicaid 
in recent years, and time after time, we have all seen the benefits of 
those efforts. Data shows us that Medicaid has helped reduce racial 
disparities in healthcare. It has helped us increase

[[Page S3349]]

access to treatment for opioid use disorder. It is a critical need as 
our country confronts a nationwide epidemic. It has helped to improve 
maternal and infant health, another area where we desperately need to 
make progress.
  Medicaid expansion has helped tens of millions of people get quality, 
affordable healthcare. That is exactly why States that expanded 
Medicaid have seen their uninsured rates drop more than those that did 
not.
  Yet some Republicans have tried every trick in the book to try to 
undermine that progress. Back when Republicans were first calling for 
their harmful TrumpCare plan, they made clear that they wanted to put 
Medicaid on the chopping block in a very big way--not only rolling back 
Medicaid expansion but proposing deep cuts for moms and kids and people 
with disabilities and seniors who need those long-term services and 
support. Even after people across the country spoke up and pushed back 
and defeated that backward proposal, Republicans have still tried to 
take away care from millions of families across the country who rely on 
Medicaid.
  President Trump has called for enormous cuts to Medicaid in his 
budget proposals. He has pushed for burdensome paperwork requirements 
that serve no real purpose except to put up barriers that make it 
harder for people to get the care they need and easier for him to take 
their care away.
  Here in Congress, Republican leadership made clear that their 
preferred way to pay for the expensive tax breaks they gave to 
corporations and the wealthy was to cut programs like Medicaid that 
gave healthcare to those who struggle and are in need.
  Even as President Trump and Republicans fight against the wishes of 
people across the country for these backward proposals, they are 
fighting to dismantle Medicaid in court as well.
  If President Trump gets his way in his blatantly partisan lawsuits, 
not only will protections for people with preexisting conditions be 
struck down, not only will young adults be dropped from parents' plans, 
not only will essential health benefits that ensure coverage and that 
include prescription drug coverage and maternity care and more go away, 
not only will lifetime annual caps on coverage return--even for people 
who are insured through their employer, by the way--but if President 
Trump has his way in court, Medicaid expansion also will be struck down 
and tens of millions of families in this country will have the care 
that they rely on today taken away.
  That is wrong, and Democrats are not going to stand for it. We are 
going to be here to defend patients' care and look to expand coverage 
and improve quality for families.
  I am really proud that my home State of Washington is leading the 
way. In my home State, instead of taking Medicaid away from people, we 
are taking on even more challenges through the program. Our State is 
showing how Medicaid can help to provide people with long-term care 
benefits in their home, and how it can help address employment 
challenges and housing needs and other social determinants of health 
that improve the health of our entire communities.
  In short, we are showing how Medicaid can do more, while many 
Republicans here in the Nation's Capital are trying to get it so it 
does less.
  Enough is enough. It is time for Republicans to stop sabotaging our 
families' care, stop trying to take coverage away from families and 
make it more expensive and out of reach, stop trying to undermine 
Medicaid and the lives of the millions of people who rely on it and 
start working with Democrats to fight for patients and for families.
  If Republicans want to keep sitting by and cheering on the harmful 
healthcare sabotage proposals, they are going to keep seeing families 
and patients and Democrats standing up to hold them accountable.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President I want to thank my colleague from the State 
of Washington for outlining the challenges presented now to Medicaid in 
terms of efforts by Republicans, which I have described with three 
words: decimate, slash, and sabotage. I think all three are an accurate 
description of what they have tried to do.
  But I am also grateful that Senator Murray was highlighting some of 
the great benefits of the program in her initial remarks on the floor.
  We just had a report yesterday from a great organization called 
Protect Our Care. I will not read the entire report, but I was struck 
by a few findings that they summarized in that report, quoting from 
various studies about the impact of Medicaid. Here are just a few. A 
number of these findings relate to Medicaid expansion, which was the 
expansion of Medicaid that became law when the Affordable Care Act was 
passed back in 2010, but it is only now, years after Medicaid expansion 
has gone into effect, that the impact is being felt in a very positive 
way.
  For just a couple of highlights here on Medicaid expansion, for 
example, expansion was associated with lower rates of maternal 
mortality. In this case, the research was done by the Georgetown 
University Center for Children and Families. The research also found 
that States that had expanded Medicaid experienced 1.6 fewer maternal 
deaths per 100,000 women than States that refused to expand Medicaid.
  As folks might remember, the law allowed States to expand Medicaid, 
but a number of States had not taken advantage of that. There is a 
clear advantage for States that expanded on this indicator for maternal 
mortality.
  A second finding, in addition to reducing maternal mortality, is that 
Medicaid expansion has also been associated with a significant 
reduction in infant mortality.
  A study published in the American Journal of Public Health in April 
of 2018 found that the decline in infant mortality was more than 50 
percent greater in States that expanded Medicaid, compared to those 
that did not. So there is a second finding on infant mortality.
  Beyond improving health surrounding childbirth, Medicaid expansion 
improves access to family planning. A University of Michigan study 
found that one-third of women enrolled in the State of Michigan's 
expanded Medicaid Program reported that their coverage improved access 
to birth control and family planning services.
  Michelle Moniz, a doctor, the study's lead author, concluded that her 
team's findings ``suggest that the expansion provided an important 
service for populations with a high unmet need for family planning 
care.''
  So there are just three examples and three different studies, with 
one validating the benefit of Medicaid expansion to reduce maternal 
mortality. So fewer pregnant mothers are dying, in the case of one 
study, because of Medicaid expansion.
  The second study is talking about reducing infant mortality because 
of Medicaid expansion, and the third says that, because of Medicaid 
expansion, there is improving access to family planning.
  So those are just three examples in three different studies about the 
benefit of Medicaid expansion.
  Unfortunately--and it is important to put this on the record--when 
you see the Republican bills to repeal the Affordable Care Act, every 
one of them seems to have one thing the common: They don't simply talk 
about limiting Medicaid expansion. They don't just talk about cutting 
it back. A number of these proposals that we have debated here--and I 
guess we only had a vote in the Senate on one--they all have in common 
that they want to eliminate Medicaid expansion--not just cut it but 
eliminate it.
  Somehow, for some reason, and I will never understand this, my 
Republican colleagues want to get rid of Medicaid expansion. They seem 
to think it was a bad thing, that it was a bad result for the American 
people that Medicaid expansion became law and States were able to take 
advantage of it, increasing the number of people covered by something 
on the order, at last count, of 12 million people.
  Why is it a bad thing that 12 million people got healthcare? I will 
never be able to understand that, as long as I live. Why is it wrong, 
why is it bad that 12 million more people got healthcare through 
Medicaid expansion?
  Is it also then, by extension, a bad thing to reduce maternal 
mortality? Is that a bad thing as well? Is that a bad result? Is it 
also a bad result of Medicaid expansion that we were able to

[[Page S3350]]

show in States that expanded Medicaid that infant mortality goes down? 
Is that a bad result? Is it a bad result in States that expanded 
Medicaid, as opposed to States that did not, that in addition to the 
reduction in maternal mortality and infant mortality, that there was 
access to family planning? Is that a bad thing as well?
  I don't think many Americans would reach that conclusion. They would 
argue, I think, just upon the coverage question, that 12 million people 
or more getting healthcare is an advancement--that we are all better 
off when 12 million get healthcare coverage.
  There seems to be a prevailing point of view here among some that if 
the guy next to you gets healthcare, somehow that diminishes you. That 
is contrary to all the evidence, contrary to all the studies about 
coverage. But in the case of Medicaid expansion, it is not simply that 
12 million more Americans got coverage, but now there is empirical data 
and empirical results that tell us that maternal mortality is likely to 
go down and infant mortality is likely to go down. That is a good 
result.
  That is why, when people talk about cutting Medicaid by a trillion 
and a half over the next 10 years, or eliminating Medicaid expansion, 
they have some explaining to do.
  Now, maybe if they have a study showing that in States that did not 
expand Medicaid they have a strategy to get infant mortality numbers 
down and maternal mortality numbers down, let's hear the competing 
argument. I haven't heard that, though. I am still waiting for it.
  Here is another good result of Medicaid expansion. It has also proven 
to be a potent tool for reducing--this is according to the Protect Our 
Care report from yesterday. Again, I am still quoting from it. Medicaid 
expansion has proven to be a potent tool for reducing racial 
disparities in healthcare. Black babies are twice as likely, according 
to this report, as White babies to be born at low birth weight, and are 
1.5 times as likely to be born prematurely.
  One study published in the Journal of the American Medical 
Association in April 2019 found that when considering low birthweight 
babies and preterm birth outcomes overall, Medicaid expansion was 
associated with significant improvements in relative disparities for 
Black infants compared with White infants in States that expanded 
Medicaid versus those that did not--significant improvements in 
relative disparities. That is a good result we know about now--not a 
theory, a good result from Medicaid expansion.
  I will give you another one. This is about opioid use disorder. I 
have no doubt that the problems we have had all across the country--the 
epidemic of substance use disorder, a subset of that being the problems 
with opioid addiction--and all of the horror and misery and 
skyrocketing deaths from that scourge, that public health emergency--I 
have no doubt that the concern about that is bipartisan. We have done a 
lot of bipartisan work here in the Senate to dedicate new dollars--
billions and billions of dollars--to help on that. The only problem is, 
we need many billions more just to meet the treatment needs of those 
who are already in that awful grip of an opioid addiction.
  We have bipartisan concern and bipartisan action. That is good. I 
want to acknowledge that. But here is the problem: When it comes to 
Medicaid expansion's role, there seems to be a little disconnect 
between and among Members of the Senate on that.
  Here is what Protect Our Care tells us: Multiple studies suggest that 
Medicaid expansion plays a crucial role in improving access to 
treatment for opioid use disorder.
  A February 2018 Center on Budget and Policy Priorities analysis of 
data from the Federal Agency for Healthcare Research and Quality found 
that Medicaid expansion dramatically reduced--I will say it again--
dramatically reduced the share of opioid-related hospitalizations in 
which patients were uninsured, so making sure that more people in the 
grip of that addiction who present themselves for help actually have 
insurance coverage.
  Here is a quotation from the Center on Budget and Policy Priorities 
study: ``The share of hospitalizations in which the patient was 
uninsured fell dramatically in states that expanded Medicaid: from 13.4 
percent in 2013 (the year before expansion took effect) to just 2.9 
percent two years later.'' So it went from roughly 13 percent down to 
basically just 3 percent. So that is another result.
  I have to ask the question again. Why is it a bad thing that roughly 
12 million people got health insurance through Medicaid expansion? Why 
is it a bad thing that Medicaid expansion now has a demonstrated track 
record on reducing infant mortality and maternal mortality and helping 
begin to bridge a racial disparity between a child who happens to be an 
African American child versus a child who is not? Why is that a bad 
thing?
  Why would you propose, with that track record--and I am only 
mentioning a few--why would you propose eliminating the program? That 
seems to be the prevailing point of view in virtually every healthcare 
bill that is offered on this side of the aisle--to take Medicaid 
expansion and eliminate it over time. Why would you do that?
  I could understand better the argument where they said: Well, look, 
we have a new idea. We have an idea that will reduce infant mortality, 
maternal mortality, bridge some of those racial gaps, and cover 12 
million people with a new program, a new approach. I would listen a 
little then and maybe consider their ideas. But when you call for the 
elimination over and over again of a program with that track record in 
just a couple of years--and this isn't longitudinal data over decades; 
we know right away the benefits of more people getting coverage, more 
children getting treatment, and people in the grip of an opioid 
addiction having insurance and therefore having coverage.
  In Pennsylvania, there are tens of thousands of people--not 
thousands, tens of thousands--who are getting treatment for an opioid 
or substance use disorder condition solely because they happen to live 
in a State that expanded Medicaid. If they lived in a State that didn't 
expand it, they would be pretty much on their own when it comes to 
getting treatment or services for that kind of an addiction.
  I really have trouble understanding what my colleagues have 
presented. If you want to introduce a bill to change healthcare, I 
think it is incumbent upon you to have an alternative, have a better 
way of covering as many people, have coverage that is affordable, and 
have a strategy that will accomplish what we have already accomplished 
through the Affordable Care Act. That number is even bigger. It is the 
Medicaid expansion number plus folks who get their coverage through the 
exchanges. That number is above 20 million.
  So if you have a better proposal, you ought to present it. But they 
haven't. That is unfortunate because now we are facing the prospect of 
not just proposals that could pass and be signed into law by this 
President that would destroy the opportunity for 20 million people to 
have healthcare, but a big share of that would be cutting Medicaid 
expansion.
  The other part that is a direct threat to Medicaid itself is the 
lawsuit making its way through a Federal court. I have heard a number 
of my colleagues say: Oh, no, we want to preserve protections for 
preexisting conditions. We want to preserve most of Medicaid. We want 
to cut the costs, and we want to preserve it.
  Well, if you have those goals, if you say you are really for having 
all those consumer protections from the Affordable Care Act, and if you 
really care about seniors getting into nursing homes because of 
Medicaid and you care and you want to preserve that, and you care about 
kids with disabilities who have their healthcare through Medicaid and 
you want to preserve their healthcare, and you want to preserve 
healthcare for kids from low-income families through Medicaid--if you 
believe all that, you have to oppose the lawsuit. You can't make the 
argument that you care about those Americans and you care about 
healthcare and protections and all of that and then say you support the 
lawsuit. You have to come out against the lawsuit.

  Make a statement--you should if you are serious about it, if you are 
honest about it--or maybe file something with the Federal court, maybe 
a formal filing to say: Here is why I oppose the

[[Page S3351]]

lawsuit. File a brief. Do something. But at least tell the American 
people the truth. If you are going to be for preserving these kinds of 
protections, you can't be for the lawsuit. In fact, you would have to 
be unalterably opposed to the lawsuit if you really care about those 
kinds of major healthcare issues, including Medicaid.
  If you were really concerned about Medicaid and you wanted to 
preserve most of it and you had ideas about how to change it for the 
better, you can't support the sabotage by the administration because 
the effect in a number of these States with these waivers is that 
people lose their Medicaid coverage--as I said, we now know that in 
2018, 18,000 people in Arkansas lost coverage. That will be replicated 
in other States. Tennessee now is one of the States considering a 
block-grant proposal. Utah--I mentioned what they are doing--tying 
Medicaid to the State budget, instead of covering folks who are 
eligible as opposed to tying coverage and care to how much money is in 
the State budget.
  I think that if you are going to make an argument in favor of 
Medicaid, you have to oppose the lawsuit and you have to stop the 
sabotage.
  The third thing you can do to be honest about what you say you 
believe in--and constructive here--is to say we shouldn't cut Medicaid 
by $1.5 trillion over the next 10 years, as the administration 
proposed. Just say you are against what the administration proposed and 
you don't think we should cut it by $1.5 trillion. And you should add 
your opposition to the cuts to Medicare. The administration proposal is 
to cut Medicare by $845 billion over 10 years. You should oppose that 
as well.
  If you do that--if you oppose the sabotage, oppose the lawsuit, and 
oppose the budget cuts--then we can have a conversation about lowering 
the cost of healthcare, lowering the cost of prescription drugs, and 
preserving Medicaid as much as humanly possible even when costs go up. 
It is pretty apparent to me that a lot of Americans rely upon Medicaid.
  How about if you represent a State, for example, that has a 
substantial rural population? I represent the State of Pennsylvania, 
which has 67 counties, but 48 of them are considered rural. We have a 
lot of rural communities, a lot of counties where there may not be 
agriculture in every corner, but there are a lot of small towns and a 
lot of rural communities, and they tend to be one and the same. These 
are communities that are faced with several levels of challenges. They 
often have job loss because a substantial employer has left. They often 
have infrastructure problems because they have a lot of bridges that 
are structurally deficient. They have all kinds of other economic 
challenges that sometimes relate to the markets and agriculture and so 
many other problems. Many of these communities also have a so-called 
digital divide--they are living in a county where 40, 50, 60 percent of 
the people who live in that county don't have access to broadband, 
high-speed internet.
  In addition to all those problems in some rural areas, they also have 
a problem with healthcare access. The good news here is that there are 
a lot of kids in rural areas who get their healthcare through--guess 
what--Medicaid. Big numbers. In some places, the numbers of children 
covered by Medicaid and the Children's Health Insurance Program are 
much higher than in urban areas.
  In a rural area, if you start cutting Medicaid and eliminating 
Medicaid expansion, as many around here want to do, you are not only 
going to hurt a child in an urban community or in a small town, but you 
are also going to hurt a child in a rural community very badly.
  It gets worse from there. If you cut Medicaid, rural hospitals that 
are already on the brink of failure or bankruptcy or at least downturn 
in their ability to balance their budgets--a lot of those rural 
hospitals will fail. We know that. The data is pretty clear on that.
  If all of your focus is on a rural area and you think rural children 
should have the chance for good-quality healthcare, and if you think 
rural hospitals--sometimes the biggest employers in a community--should 
remain open, you should really care about Medicaid. You should really 
be worried about proposals to cut it by $1.5 trillion over a decade, as 
the administration proposes. You should be very concerned about 
proposals to eliminate Medicaid expansion because guess what is another 
challenge in a lot of these communities--the opioid substance use 
disorder crisis.
  My colleagues are here, and I want to make sure they have an 
opportunity to weigh in as well. We are privileged to be joined by two 
colleagues.
  I yield the floor to my colleague from the State of Oregon, the 
senior Senator from the State of Oregon.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before Senator Casey leaves the floor, I 
just want to make a couple of remarks, as the senior Democrat on the 
Finance Committee, a ranking member. I particularly want to praise 
Senator Casey for being our go-to person on the whole issue of 
Medicaid.
  Ever since we began to see the substantial cuts in 2017, as Senator 
Casey knows, he has been the person we have said is our go-to leader 
for the most vulnerable Americans who count on Medicaid being there for 
them.
  I want to tell a short story about one of Senator Casey's many 
contributions to those who find Medicaid to be just a healthcare 
lifeline. When the Trump administration began its attack on Medicaid 
benefits, I had been the director of the Gray Panthers at home before I 
got involved in public service, and a lot of folks came to me. They 
said: Ron, that probably isn't a big deal for seniors because Medicare 
covers most of those nursing home bills. And I had to say: Gosh, that 
is really not the case. Medicare really covers only a small fraction of 
nursing home bills. It covers the bills that are essentially for 
hospital-like services, and most of nursing home care in America really 
ends up getting picked up by Medicaid. Something like two out of every 
three beds in long-term care facilities, which are custodial 
facilities, end up being funded by Medicaid.
  Senator Casey basically took it upon himself, as part of this effort, 
to lead the Democrats on the Finance Committee and to lead the 
Democrats in our caucus to go out and talk about what this really means 
to the most vulnerable people in America. As my colleagues know, 
probably 4 or 5 months into this debate with this relentless attack on 
Medicaid coming week after week after week, most Americans began to 
understand a little bit about what was on the line for millions of 
senior citizens.
  I thank my colleague because he really began the effort to make the 
point that growing older in America is really an expensive proposition. 
Even when you save and you scrimp, you don't go on a vacation, you 
don't buy the boat, and you don't do the extra, growing older is really 
an expensive proposition. So if you have a widower on the corner in 
your neighborhood, and he always mowed his lawn, and he always helped 
with the sports teams and the like, and now he is getting kind of frail 
and may need some nursing home care, now we still have a safety net, an 
essential safety net for those people.
  I am going to talk a little bit about some of the challenges of 
Medicaid. But I would like particularly to begin my remarks--Senator 
Cardin has been an advocate in the Finance Committee, as well, on 
Medicaid--by pointing out that Senator Casey, really, at the very 
outset of this discussion, began the effort to make the case that a lot 
of people weren't aware of, and that is that Medicaid is a safety net 
for millions of older people.
  Here is the story of Medicaid in 2019. For the vulnerable in America, 
our people want to make sure that there is more access to Medicaid. 
Unfortunately, on the other side of the aisle, Republicans are taking 
that very access away. Just for a few minutes, I am going to draw out 
this contrast because there is quite a difference of opinion between 
how the majority party in the Trump White House are working against the 
interests of vulnerable folks across the country.
  As I mentioned, 2016 saw the beginning of this all-out attack by 
Republicans on Medicaid--hundreds of billions of dollars in cuts, 
proposed caps, block grants, basically an unravelling of the program as 
we know it today.
  Essentially, from Portland, OR, to Portland, ME, people said: No way. 
We

[[Page S3352]]

are not going to support this kind of attack on Medicaid. So in some 
States, like Utah, they chose the ballot box to actually expand 
Medicaid under the Affordable Care Act. The voters chose more access to 
Medicaid, not less. But Republican lawmakers in Utah had decided to 
deny them their choice. Just think about that one.
  I sure hear a lot of talk on the other side of the aisle about 
States' rights and empowering people at home. This is an example of 
where voters chose more access to Medicaid, not less. The Republican 
lawmakers said: Hey, we know better than that. We are not going to give 
folks that choice. So Utah lawmakers took a hatchet to the plan that 
voters approved on election day and started carving it out. The only 
expansion they would allow is a lot smaller than what voters wanted--
spending more money to cover fewer people.
  Then lawmakers in Utah followed a path cleared in other Republican-
controlled States, and that was to punish those who were enrolled in 
Medicaid with essentially bureaucratic water torture, with such a 
barrage of paperwork that it was almost impossible to penetrate what 
was really necessary to get through the program. This has been seen in 
Arkansas, Kentucky, and elsewhere.
  All of this, of course, is not couched in the bureaucratic maze of 
redtape it actually is. The discussion is always: Well, this is just 
about work. That is just not true. It is about getting people kicked 
off their healthcare.
  When you talk about Medicaid patients, you are talking about people 
who are working and people who want to work. What we are up against are 
a host of Republican schemes that are basically putting stacks of 
paperwork between those who need healthcare and their doctors.
  These are busy working people with kids to raise, older parents to 
care for, and bills to pay. Yet lawmakers are trying to force them to 
fill out stacks and stacks of paperwork just to make sure that somebody 
can actually find their way through the maze and see a doctor.
  If you look at what happened in Arkansas in 2018, you get a sense of 
how destructive these bureaucratic schemes are to people's healthcare. 
There were 18,000 people who lost their Medicaid coverage--18,000 
people. Trump officials swore up and down that those paperwork 
requirements wouldn't hurt anybody, but as we saw when the Secretary of 
Health and Human Services came before the Finance Committee earlier 
this year, they shrugged when you asked why so many people lost their 
coverage in Arkansas after the paperwork requirements were put in 
place.

  A Federal judge even weighed in, blocking all of this paperwork, 
while the Trump administration continued to push the States to take 
them up. The schemes spread to States across the country, and it was 
not just paperwork.
  With the Trump administration's blessing, Tennessee is the first 
State trying to turn its Medicaid Program into a block grant. This 
basically takes a sledgehammer to Medicaid as we know it now. Medicaid 
block grants mean putting nursing home care--which I just outlined 
earlier in discussing Senator Casey's important role here--at risk for 
millions of seniors. You risk children and people with disabilities 
having to be cut off from their healthcare. But block-granting Medicaid 
is one of the top goals for Republicans in the Trump administration.
  Finally, Trump administration budget slashers are trying a new, 
additional scheme that is going to hurt so many people across the 
country. In this particular area, they basically are trying to bring 
some mathematical sleight of hand so they can change key economic 
measures in ways that boot vulnerable people off Medicaid and off food 
stamps.
  What they are doing here--again, this is all shrouded in language 
that just sounds eminently reasonable--is basically talking about where 
the poverty line ought to be, and then they want to find an artificial 
way to push the poverty line down without doing anything to lift people 
out of economic hardship. So you are talking about parents who work 
long, hard hours and still struggle to make ends meet, people who are 
trying to find affordable housing, who have practically given up the 
idea of being able to save for retirement, and who are still trying to 
pay college tuition. What does the Trump administration say? These 
people just have life too easy.
  The impact of this change would be enormous. Three hundred thousand 
children could lose comprehensive health coverage, and a quarter 
million adults could lose their coverage.
  Colleagues, this is the Medicaid agenda for Senate Republicans and 
the Trump administration: Let's go out there and look under every 
possible rock to find a scheme to restrict access to Medicaid. That is 
the agenda. Find a way to cut the funding, to deny expansion after the 
voters approved it.
  We now have two members of the Finance Committee with a long, long 
history of advocating for vulnerable people facing health challenges, 
so I am going to close and just say this: Ever since I was director of 
the senior citizens--the Gray Panthers--I always said that the single 
most important issue in America is healthcare. Whether it is North 
Dakota or Michigan or Maryland, if you and your loved ones don't have 
your health, everything else pretty much goes by the board. Somehow 
that message has not gotten through to the majority here in the Senate 
because under this majority and under the Trump administration's 
healthcare agenda, they are buying into a completely different set of 
principles. They are willing to set millions of Americans back with 
respect to their healthcare needs. On this side of the aisle, we are 
going to keep fighting to protect Medicaid.
  As I indicated, our next two speakers have a long track record of 
advocating for the vulnerable. I am just going to make a unanimous 
consent request. Senator Cardin has been very patient with respect to 
waiting to speak.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, I thank Senator Wyden for his 
extraordinary leadership on the Senate Finance Committee as our ranking 
Democratic member, who recognizes the importance of healthcare. To 
Senator Casey, who has been our companion in regard to Medicaid, in 
regard to children, and in regard to the basic importance of healthcare 
as a matter of right, to Senator Stabenow, who has really led our 
efforts on behavioral health, incredible efforts that have been made to 
provide community services, particularly to those who are most 
vulnerable, we recognize the importance of moving forward and advancing 
healthcare for all Americans. That is why we are taking this time to 
express our real concern about President Trump's proposal, his budget 
proposals, which would cut Medicaid by $1.5 trillion, the effort to 
repeal the Medicaid expansion that we saw under the Affordable Care 
Act, the thought of turning Medicaid at the Federal level into a block 
grant, capping our participation and putting the burdens on our States.
  It is a direct attack on vulnerable Americans, jeopardizing their 
access to healthcare. There are 70 million Americans that depend on 
Medicaid. There are 1.2 million Americans who are veterans and who are 
women, children, and seniors.
  In Maryland, almost half of our Medicaid population are children. For 
seniors, one out of every five Medicare-eligible beneficiaries also 
needs Medicaid. They are dual eligible. And 60 percent of the adult 
Medicaid enrollees are workers, and 70 percent are from communities of 
color.
  Medicaid expansion has made a big difference in access to healthcare. 
It has reduced health inequalities. The uninsured rate in the State of 
Maryland has dropped from 10.2 percent to 6.6 percent. That is 
important not just for the individuals who now have health coverage. It 
stops the cost shifting and the distortions in our healthcare system 
with people who do not have health insurance.
  If we were to eliminate Medicaid expansion, 289,000 Marylanders would 
lose their coverage--the essential health coverage that it provides for 
our children in the early periodic screening and diagnostic treatment 
so that we can help children live healthier lives through correction of 
healthcare problems and prevention of more serious healthcare issues.
  As Senator Wyden pointed out, in long-term care, three out of five of 
our

[[Page S3353]]

residents in nursing-type, long-term care facilities are Medicaid 
payments. It would be devastating with that type of cut on their long-
term care needs.
  We made major advancements in Medicaid on covering behavioral health 
and addiction. One out of every three individuals who are part of 
Medicaid expansion have a behavioral health issue. The opioid crisis is 
well known to all of us. We know that part of the solution is getting 
people help and treatment through Medicaid expansion and the Medicaid 
Program providing that safety net to millions of Americans.
  The expansion of dental services is something I have been engaged in 
ever since the tragedy in 2007 in my State, when a youngster died from 
lack of access to dental care, Deamonte Driver. Medicaid is a lifeline 
for dental services.
  So in the United States of America, the wealthiest Nation in the 
world, healthcare should be a right, not a privilege. We made progress 
in the Affordable Care Act. Let us build on that success but not move 
in the wrong direction. Rather than cutting Medicaid, we should be 
looking at ways to work together to improve coverage and affordability. 
Rather than eliminating the Medicaid expansion, we should be looking at 
additional ways to cover those who have no health coverage or 
inadequate health coverage. Rather than limiting the Federal program as 
part of Medicaid for our States, we should be looking at ways to 
strengthen the Federal-State partnership so that we work together so 
that every American has access to affordable, quality care.
  I urge my colleagues that that should be our goal. Let's work 
together. Again, I thank Senator Casey for bringing us here today under 
this issue.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, I was looking to my colleagues because I 
think we all understand and are trying to accommodate each other's 
schedules and have the opportunity to speak on the floor. So I 
appreciate the opportunity to say a few words. I first thank Senator 
Casey for organizing this very important discussion on the floor, and 
Senator Cardin and Senator Wyden for their passion, and I want to join 
them in speaking out about protecting Medicaid.
  We are talking about people, the majority in nursing homes. We have 
three out of five seniors in Michigan who have nursing home care and 
get that through Medicaid, which is critically important, as well as 
children and families. So I want to lend my support to them, and then I 
wish to expand the talk about another very important piece of 
healthcare and how we bring down costs for people.
  I have always believed that healthcare is a basic human right and 
everyone should be able to afford the medicines they need. We have 
seniors in nursing homes that are there. We talked about Medicaid. In 
fact, they are more likely than not going to be involved in needing 
prescription drugs, some kind of medicines, and I am deeply concerned 
that people are not able to get their medications at a price they can 
afford to get what they need. Unfortunately, that is certainly 
happening in Michigan right now.
  As we know, over the past decade or so, the costs of medications have 
really skyrocketed. It is actually shocking to see the numbers going 
up. Between 2008 and 2016, prices on the most popular brand-name drugs 
have gone up over 208 percent. I know that in Michigan most people's 
salaries haven't gone up 208 percent. And if someone is living on a 
pension or Social Security, that certainly hasn't gone up 208 percent.
  So these are huge increases. And according to AARP, the average price 
of brand-name drugs that seniors often take rose at four times the rate 
of inflation just in 2017--four times the rate of inflation. So even if 
you are getting a small little increase, an inflationary increase in 
your salary or in a pension, your medicines could have gone up four 
times higher.

  I hear from seniors all over Michigan about what a struggle this is. 
I know we all hear this. Some people are forced to cut back on other 
necessities, like groceries or paying their bills. Others cut their 
pills in half or skip doses. You know, this has gone on and on for too 
long. Some folks stop filling their prescriptions altogether, risking 
their health.
  Suzanne lives in Howell, MI. She takes several medications, including 
insulin, and she shared her story with me. Unfortunately, for Suzanne, 
the price for insulin has gone from $21 a month to $278 a month to $410 
a month--the same medicine. The same medicine was $21 a month and now 
is up to $410 a month.
  Suzanne isn't alone. In fact, insulin prices overall have tripled in 
the past 15 years, and let me just add that insulin was discovered over 
100 years ago by two Canadian doctors who felt they should not be 
reimbursed for their patent because this discovery was so important for 
changing people's lives and the quality of their lives. They actually 
gave the patent to the University of Toronto for three Canadian dollars 
over 100 years ago, and yet we are now seeing the price triple just in 
the past 15 years.
  This places a real burden on people with diabetes and their families.
  Suzanne said this:

       I don't even take the amount that I'm supposed to take. . . 
     . We can't put money into our retirement. My husband has to 
     work past [retirement age] because we can't afford to live.

  She added:

       This is a life or death drug. I have to have this drug to 
     live.

  Suzanne doesn't take insulin because she wants to. She takes insulin 
because she will die without it. Nobody should be forced to risk their 
health or their life by cutting back on the medications they need to 
survive.
  Unfortunately, the pricing of prescription drugs in this country is 
the ultimate example of a rigged system. In 2018, there were 1,451 
lobbyists for the pharmaceutical and health product industry. That is 
almost 15 lobbyists for every Member of the Senate. Their job is to 
stop competition and keep prices high. Our job is to unrig that system 
and bring prices down. The No. 1 way we can bring prices down is to let 
Medicare negotiate.
  Currently, Medicare is prohibited, as we know, from harnessing the 
bargaining power of 43 million seniors in America to bring down 
prescription drug costs. Why aren't we harnessing the market price 
through negotiation? That doesn't make any sense.
  When Medicare part D became law in 2003, that language was put in 
there to stop negotiation. It didn't make sense in 2003, and it doesn't 
make sense today.
  We know negotiation can work because it works for the VA, or the 
Veterans' Administration. The Veterans' Administration negotiates 
prices, and they save about 40 percent compared to Medicare. In fact, 
according to a recent AARP analysis, Medicare could have saved $14.4 
billion on just 50 drugs--$14.4 billion on just 50 drugs--if they had 
had the same prices as the VA, and this was in 2016--$14.4 billion.
  In 2016, Medicare Part D plans spent $3 billion on a hepatitis C 
treatment, HARVONI. Under VA pricing, that cost would have been $1.7 
billion. These are differences that are related to real money coming 
out of people's pockets when they are trying to just put food on the 
table and live their lives and be able to survive in many cases.
  Medicare Part D plans spent $1.8 billion on REVLIMID, which treats 
multiple myeloma, a type of blood cancer. Under VA pricing, Medicare 
Part D and American taxpayers could have saved more than half a billion 
dollars. Given the potential for such huge savings, it is no surprise 
that the American people support allowing Medicare to negotiate drug 
prices.
  I hear it everywhere I go: Why can't Medicare just negotiate and get 
a better deal--commonsense?
  One recent poll showed that 92 percent of voters support allowing 
Medicare to negotiate with drug companies. Only Republicans in Congress 
and pharma lobbyists are stopping negotiation from moving forward. We 
need to change the system and put people before profits. We need to put 
people before profits.
  The best way to do that is to allow Medicare to negotiate with the 
drug companies. That could make a big difference for people like Jack, 
who lives in Constantine. Jack was diagnosed with stage IV prostate 
cancer late last year. His oncologist wanted him to start taking a drug 
called Zytiga. It

[[Page S3354]]

was going to cost an astonishing $15,000 for the first month.
  A generic medication had become available, but after Medicare and 
supplemental insurance, Jack still would have to pay $3,400 the first 
month and more than $400 each month after that.
  In his letter to me, Jack wrote this:

       I just retired in June, moving back to Michigan to be 
     closer to my family, and this cost . . . is an extreme 
     hardship.

  He added:

       Getting pharmaceutical companies to reduce their price so 
     an average retiree can afford to use them would be a great 
     place to start. I hope and pray you and your colleagues on 
     both sides of the aisle would be able to get something done 
     so people who need the medication that they need to thrive 
     and survive are able to get it.

  Jack is right. He and Suzanne and other people like them across 
Michigan and across the country deserve better than what is happening 
right now. I could go on, and I will not, through price after price 
after price. The reality is prices are too high. We pay the highest 
prices in the world. Every other country gets involved in negotiating 
prices on behalf of their citizens.
  The drug companies told me at a hearing that they make a profit in 
every other country but they make more here. They charge more here. 
Why? Because they can.
  So it is time for us to work together to allow Medicare to negotiate 
drug prices and put people before profits.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mrs. CAPITO. Mr. President, I stood before this body on December 11, 
exactly 6 months ago, to discuss what I called then ``an escalating 
crisis on our southwest border.'' Well, 6 months later, I don't think 
this is a subject for debate anymore. Not only is this a crisis, but it 
is one that has escalated and continues to do so. Congress must take 
action or I feel it will come to deeply regret our inaction.

  When I called it a crisis in December, 50,000 migrants had been 
apprehended crossing our southwest border during the previous month of 
November. It is now June, 6 months later, and we are looking at the 
numbers for May that approach over 133,000 apprehensions--the highest 
1-month total in 13 years.
  In 6 short months, the numbers of encounters on the border have 
increased by more than 156 percent. Over the past 12 months, the number 
has increased by more than 229 percent. Those are staggering figures.
  To put this in context for my fellow West Virginians, in the month of 
May alone, the Border Patrol apprehended a population that is larger 
than our capital city, Charleston; Huntington, WV, our neighbor; and 
Morgantown, WV, combined--three of our largest cities in 1 month.
  As I said standing at this desk in December, the flow of people 
across the border is not only larger but is also changing. Twenty years 
ago, the vast majority of those crossing our border illegally were 
adult men from Mexico. In fact, in fiscal year 2000, 98 percent of 
those people caught at our border were Mexicans. Under U.S. law, 
migrants from Mexico can be immediately returned to Mexico by the 
Border Patrol, but today we are seeing families and not just adults.
  Last month, of the over 133,000 people, nearly 64 percent of those 
who crossed our borders did that as a family unit, and the vast 
majority of them are from other places than Mexico. They are 
Guatemalan, Salvadoran, and Honduran. Of the more than 84,000 members 
of family units apprehended by Border Patrol last month, only 547, less 
than 1 percent, were from Mexico.
  So unlike folks from Mexico, these folks who are coming cannot be 
sent home immediately under U.S. law. They remain in our country often 
for months or years as their cases work their way through the system.
  To summarize, today we have significantly more people crossing our 
southern border, and because of who they are, whom they are traveling 
with, and where they are traveling from, each of these individuals 
causes us to have a more significant strain on our system. Our system 
makes it advantageous for migrants from places other than Mexico to 
cross the border with children. So more people than ever are making 
absolutely sure they are accompanied by a child on their long and often 
very dangerous journey from those places through Mexico.
  All of these factors I have discussed have completely overwhelmed our 
system. Everybody in this Chamber ought to believe that and know it is 
true. Conditions at Border Patrol stations that were never intended to 
be used as migrant shelters are stunning. These facilities are bursting 
at the seams, and our Border Patrol agents are spending more time 
caring for these migrants than they are patrolling our border, which is 
their core function. At any given time these days, somewhere close to 
20,000 individuals are being housed in Customs and Border Protection 
facilities not at all conducive to extended stays. In other words, 
these facilities were not meant for long stays.
  People are upset. It is unsettling seeing pictures of people sleeping 
on concrete floors under Mylar blankets. I have been to these 
facilities and, yes, it is heartbreaking to see, but when drug lords 
are dropping off busloads of migrants in secluded parts of our 
southwest border, where there is virtually no infrastructure, there is 
not much to be done to improve the situation, unless we provide the 
resources to deal with this crisis.
  So what is happening? In the last 5\1/2\ months, more than 22,000 
family units that crossed our border illegally have been released into 
the United States--often without any place to go--and told to come back 
when their case comes up, which could be years. I am encouraged by the 
President, and I am very supportive of the President's plan and his 
administration's, where they successfully negotiated an agreement with 
Mexico that will lead to more migrants waiting outside the United 
States while their asylum claims are being processed. I believe the 
agreement will improve the situation on the southern border when it is 
fully implemented.
  While we have to work to improve the situation going forward, we have 
to address the problem we have right here today. I am the chairman of 
the Appropriations Subcommittee on Homeland Security. I must repeat to 
this body what I repeated here before, 6 months ago. We do not have a 
choice. We do not have a choice, but we must get this emergency 
supplemental done. It is the only choice we have from a humanitarian 
perspective. It is the only choice we have from a border security 
perspective.
  If we fail, the Department of Homeland Security will be faced with 
even more difficult choices. It will either have to stop their efforts 
to improve these horrible conditions on our border or it will have to 
raid other agencies that are vital to our national security.
  I don't want to see that happen. There was a very robust debate a few 
months ago about the crisis on our border. Was it real or was it 
manufactured? I stood here 6 months ago and said it is real and, quite 
frankly, I don't hear that topic up for debate much anymore. I think we 
all know it is real. It is tragic, but we can do something about it.
  The New York Times, no less, is now deciding the situation is ``a 
nightmare'' and is imploring Congress to stop ignoring this crisis.
  It was 103 degrees this past weekend at one of our entry points at 
McAllen, TX, which is the epicenter of this crisis. We know it is only 
June, and it is only going to get hotter. I hate to see what the 
situation will look like this summer if we fail to act.
  I will end with this. The men and women of the Department of Homeland 
Security who work our border and are trying to process this influx of 
people are doing incredibly tremendous work. It is stressful, it is 
hard, and in many cases it is not the mission they signed up for when 
they joined the Department of Homeland Security, but they have stepped 
up to address a national need, and it is past time that we stepped up 
for them and for these children and these families in need.
  Thank you.
  The PRESIDING OFFICER. The Senator from Ohio.