Healthcare

Floor Speech

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Madam President, before the Senator leaves the floor, I just want to probe him for a moment on this question of process.

Listen, this is an affront to the Senate--a bill that reorders one- fifth of the U.S. economy and that is being delivered to us days or weeks before we are to vote on it.

The Senator may have covered this, and if he did, he may just reiterate it for me.

My understanding is that there is not going to be a CBO score before this bill is before us. For the folks who do not know what that means, that means that everyone who votes on this bill will have no clue as to how many people will lose insurance, how high premiums will go, or how much money their States will lose. I do not think that we have ever, ever voted on a bill of this scope and size without having an analysis from the CBO. My understanding is that, today, when you list or rank the affronts on the process involved in the debate over Graham-Cassidy, at the top of that list will be the fact that we are not going to see a CBO score.

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Madam President, if I may ask the Senator a follow-up question, we are in a different position today because, when we were taking these votes a month ago, there was only the faint talk of a bipartisan process to try to keep what works in the Affordable Care Act and fix what is not working.

It is another assault on the process, in my mind, and I ask for the Senator's thoughts on it. Literally, as we speak, Republicans and Democrats are talking to each other about the bipartisan bill that Americans in every State are begging for. Apparently, if this bill is going to be brought before the Senate, then that whole process was a fraud. It was a ruse to distract Democrats into thinking that there might be a bipartisan fix. It was pulling one over on the American public to give the impression that, maybe, Republicans were interested in a bipartisan compromise.

Right now, there is a process playing out, and if this bill comes up for debate with no CBO score, then, that bipartisan process, which was really hopeful for a lot of Americans, I assume just falls apart; right?

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Madam President, I thank the Senator. I know it is late, and I thank him for staying on the floor for a few moments.

You do not know what it is going to do to your own constituents. We do not have a CBO score telling us how many people will lose coverage, how high rates will go, what will happen to Medicaid. It is also another bill that has been written behind closed doors. Senator Cassidy and Senator Graham may have spent some time in thinking about what this legislation does, but virtually no one else has been let into the room.

Patients have not been in that room. Doctors have not been in that room. Hospitals have not been in that room. Do you know why I am pretty confident of that? It is because all of the groups that represent those populations oppose this legislation.

Potentially, we are going to vote next week on a healthcare bill that massively, massively reorders the American healthcare system and that is opposed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association. Those are the physician groups.

By the way, it is kind of hard to know for these groups whether they are for it or against it, as there is no CBO analysis of this, but the patient groups have weighed in. Basically, every group that represents patients who are sick in this country is begging this Congress not to pass this bill.

Also included is the ALS Association, the Cancer Society, the American Diabetes Association, the Heart Association, the Lung Association, the Arthritis Foundation, the Cystic Fibrosis Foundation, the Juvenile Diagnosis Research Fund, the Lutheran Services of America, the March of Dimes, the National Health Council, the National Multiple Sclerosis Society, the National Organization of Rare Diseases.

How do you pass a bill that has no CBO score, that has had no hearings, that is opposed by every single group that Republicans welcome into their office every year representing people with serious diseases?

There have been some really mean healthcare proposals, but Graham- Cassidy is the meanest version of TrumpCare yet. Let me walk you through why I say that.

Again, we don't have the numbers so we don't have a CBO analysis of how many million people are going to lose access to healthcare, but let me guarantee you it will be in the millions, likely in the tens of millions.

The bill radically--radically--trims the amount of money States will get in order to insure the population that has been insured by the Affordable Care Act. What this bill does is shrink the amount of money we are spending, then redistributes it out to States, and it will simply not be enough--not nearly enough money--in order to cover the 20 million people who have insurance today because of the Affordable Care Act; many of those through Medicaid, others through the healthcare exchanges.

An early analysis by an outside group that is trying to help us understand what this means suggests that for my little State of Connecticut, it will be a $4 billion reduction in healthcare dollars from the Federal Government to the State of Connecticut. We are a State that doesn't have a $20 billion annual budget. Four billion dollars means that we will either have to kick hundreds of thousands of people off of healthcare or we will have to dramatically raise people's taxes.

So all of the reductions in insurance are in this bill. We will just have millions of people losing access to health insurance under this bill.

The specific, targeted harm to women is in this bill. Planned Parenthood is one of the country's biggest providers of primary care and preventive healthcare services to women. I get that many Republicans have a problem with Planned Parenthood because they also provide abortion services, but the majority of their work is, in fact, providing basic preventive healthcare to women in this country.

My wife, when she was a low-income twenty-something, could only afford to get her healthcare through Planned Parenthood. That is where she went for her preventive healthcare, for her wellness checkups, and there are millions of women just like her. This bill is particularly cruel and particularly mean to all of the women in this country who, without access to a Planned Parenthood clinic, may not be able to get quality, affordable, preventive healthcare.

This bill is perhaps the meanest, though, to individuals who are sick or individuals who have been sick because at least in prior versions of TrumpCare that came before this body, there was at least a meager attempt to try to preserve protections for people with preexisting conditions. It wasn't workable, but at least there was a face-saving gesture by Republicans and by the Trump administration to try to at least claim there was language to protect people with preexisting conditions.

Senator Cruz stood on this floor a few years ago during his long overnight filibuster. I sat in the chair listening to him explain how everyone knows, including him, that you cannot protect people with preexisting conditions without requiring, in some way, shape, or form, that healthy people buy coverage. Why is that? Let me walk you through it for a minute because it is not hard to understand, but it is really important to understand because people don't like the individual mandate. They are not going to understand that. Nobody likes to be required to do something, but you cannot protect people with preexisting conditions if you don't require people to buy insurance.

The logic goes like this. If you say to insurance companies that you cannot charge people who are sick more than people who are not sick, if you say to an insurance company that you cannot charge someone with cancer more than someone who is healthy and you don't require that healthy people buy insurance, then what does the rational individual do? The rational individual, in that case, says: Why would I buy health insurance while I am healthy? If I will not be charged anything more for it when I become sick, then there is no rational economic reason for me to be covered when I am healthy.

So what insurance companies tell you--what every insurance expert tells you is, if you require insurance companies to charge the same between sick people and healthy people, then healthy people will not buy insurance. If I were advising someone, I am not sure I would tell them to buy insurance if they didn't have to until they were sick. So the pools get so skewed with sick people and no healthy people that rates dramatically rise for everyone. Some estimates suggest that the rate increases would be 20 percent per year, compounding year after year after year.

In the last version of this bill, Republicans knew that so they included a version of the individual mandate in their bill. Now, it wasn't the same mandate, but it was a mandate nonetheless. The mandate under the Affordable Care Act says that if you don't buy insurance, you will pay a fee on your taxes.

What the Republican bill said--the version of TrumpCare that came very close to getting a vote on this floor--is that if you go without insurance, you will pay a penalty when you try to get back on. The timing of the penalty was just different. Under the Affordable Care Act, you pay it when you lose insurance. Under the first version of TrumpCare, you would pay the penalty when you try to get back on insurance. It is a mandate. It is a penalty. It is just in a different place.

Republicans did that because they knew that was the only way to require States or give States the option to continue to require insurance companies to treat sick people the same as healthy people.

So why am I talking about this? Because in Graham-Cassidy, the individual mandate is totally gone--gone--replaced with nothing. Thus, even though it says that States, if they wanted to, could preserve protections for people with preexisting conditions, States did not do that because the Federal Government does not require healthy people to have insurance. If you think that States are going to reimpose an individual mandate, A, there will be some real question as to whether they can do that, and, B, they will not. They will not because that issue has become, thanks to my Republican friends, so politically toxic around the country.

You will be left with massive discriminatory treatment of people with preexisting conditions, and nowhere for them to go because Medicaid is obliterated under this bill. Medicaid dollars get lumped into all the rest of the money. It gets sent to States, and then Medicaid dollars are capped going forward--intentionally capped--at a number that is well below what the general rate of increase in the Medicaid Program is. There is intentionality to the underfunding of Medicaid here.

Now, the old bill would have taken, I think, 15 million people off of the rolls of Medicaid. I think I am getting that number right, and we will never know what this number is before the vote happens. It is likely around the same number because this bill treats Medicaid in roughly the same way, in terms of capping the amount of money States get.

The formula by which States get this money is so wildly complicated that no one could understand it between now and next week. I would challenge any Republican, other than Bill Cassidy and Lindsey Graham, to come down and give us an explanation as to how this formula works.

It is the most bizarre Rube Goldberg scheme you could ever imagine, but in it is a dramatic reduction in Medicaid payments to the State over time.

So think about this little boy Deacon. Deacon is 10 years old, and he lives in Ohio. I am just looking here at a picture of him clutching a Pokemon character. I know what Pokemon character this is. It is Pikachu. I know that because I have a 9-year-old who is the same age as Deacon, but, for the grace of God, my 9-year-old is not going through what Deacon the 10-year-old is going through.

I will just read a little bit about Deacon. He loves playing baseball, playing video games, volunteering at animal shelters. He loves being a patient champion for children's hospitals, spending time with his friends and family, being a big brother, raising money and awareness for heart disease and defects.

Now, my 9-year-old doesn't enjoy raising awareness for heart disease and defects. The reason Deacon enjoys doing that is because he has a condition called hypoplastic left heart syndrome. That is combined with asthma and acid reflux. It essentially means Deacon has half a heart.

We have whole hearts. Deacon has half a heart.

Right now, everything is controlled for Deacon by medications. He has had six heart surgeries to get to the point of stability. His heart will fail--not may fail. His heart will fail. He will go into heart failure, requiring a heart transplant. That is Deacon's future. The heart cannot last on the two-chamber system that Deacon's surgeons put into place.

Affordable, quality insurance means everything to Deacon. Strep throat could be a death sentence for him. Any little virus that gets into him and goes into his bloodstream, that is it--game over for 10- year-old Deacon.

His parent writes:

My child is alive because he has Medicaid. That allowed for him to have the doctors, the surgeons, and the care he has always needed. Deacon had 6 heart surgeries before 3 years of age. He has continued medications as well as regular doctors checkups as he needs them. Because of his diagnosis, he even has a specialist for simple things like dental care. If he had not had Medicaid coverage, there is no way I could have afforded his care. By his first surgery at 10 days, he was over the million dollar mark. I would have lost our house easily, quickly. I am a single mom. Medicaid helps keep my son alive and healthy, and it has given me my best friend to love and watch grow up.

Medicaid helps a boy live a normal life. Where we would have never thought that it would be possible, Medicaid lets a boy with half a heart be on a baseball team with his friends, a best friend.

This is not hyperbole. This isn't a game. It is not about scoring political points just because you made a promise that you were going to repeal the Affordable Care Act in the first year that you had control of this body. This is about this little boy who lives in a State that had the wisdom, on a bipartisan basis, to expand Medicaid.

Ohio would be one of the biggest losers under this bill--a massive withdrawal of billions of dollars away from Ohio's healthcare system, simply to fulfill a political promise Republicans made.

We are not making this up. We are not trying to tug your heartstrings just for our own political purposes. Kids are going to die if they don't have access to healthcare. If 20 million people lose insurance, as may be the case under this legislation, thousands of people will not be able to survive. That is $1 million of care. I can guarantee you that this single parent's home is not worth $1 million. At some point you just stop being able to provide the care necessary to keep people alive.

Republicans are treating this like it is a game, talking about taking a vote next week when no one in this country has looked at this legislation. Not a single townhall has been held in which your constituents can weigh in. No Member of this body will have looked at an analysis by the Congressional Budget Office to know what its impact is. This bill will be rammed through in the dead of night, I guarantee you, without any input from people like Deacon and his family.

This is the meanest version of TrumpCare yet, in part because of what is in it, in part because of the butchered process, but in part because Deacon's family will not get to come down here and talk to you about it because you are going to rush it through next week, if reports are to be believed.

What a great trick Republicans will have pulled on this country.

Everyone said that the repeal bill was dead, that we were going to move on to a bipartisan process in the HELP Committee, that the Senate was going to move on to another issue of tax reform. What a great head fake that would be if it were all a lie, if it were all a ruse just to be able to give cover for Republicans to quietly muster support for another devastating assault on America's healthcare while Democrats were looking hopefully at a bipartisan process playing out in the HELP Committee that was never intended to result in an outcome.

I hope that is not the case. I really do. I have put enormous faith and trust in Senator Alexander. Admittedly, I gave him a very hard time over the course of the first 6 months of this year because I could not understand what the point was of being on the HELP Committee if we weren't going to debate a reordering of one-fifth of the economy: the healthcare system. Why be a member of the HELP Committee if the biggest reform to the healthcare system during my tenure in the Senate wasn't going to be debated in the HELP Committee? I thought that was an abomination.

I have been very pleased that in the last 2 weeks Senator Alexander has convened a bipartisan process, which I have invested in. I have shown up to all of those hearings. I have talked to him over and over again on the floor of the Senate and in these committee meetings. I have offered constructive suggestions about how we can come up with a bipartisan fix to the parts of the Affordable Care Act that aren't working as well, while maintaining the parts that are working. As I sit here today, I hope and I pray this wasn't all one big ruse to distract me and the Democratic Members of the Senate while Republicans quietly worked on building support for the meanest version of TrumpCare yet.

That would be a deceit, and I hope it is not going to be the case.

This isn't a game. People are going to be really, terribly, badly hurt if this bill becomes law. I don't even know what the effects will be because we don't have the analysis. We don't have a score. I can guess. But I have never been part of anything like this in my 20 years of public service. I have never seen a group of public officials so hell-bent on achieving a political goal as to throw out decades of precedent on how this body has normally worked on major pieces of legislation, shown such casual disregard for good, old-fashioned nonpartisan analysis as is happening if this bill comes to the floor without a CBO score.

We can do something together. We can continue the work of the HELP Committee to pass a truly bipartisan product that admittedly would just be a start, that could involve real compromise on both sides.

Republicans could compromise by saying: We know we need to have some stability in these healthcare exchanges, and, thus, we are going to make sure that President Trump can't take away payments from insurers or threaten to take them away on a month-to-month basis. Democrats can recognize that Republicans want flexibility in these exchanges--want the ability for States to do a little bit more innovation, whether it be with benefit design or reinsurance pools. We can both give, and we can get a product that would build trust between both sides, that might allow us to do something bigger later on.

I have no idea whether Deacon's family is Republican or Democrat. I have no idea whether his single mother--who is so deeply fearful today of what Republicans are about to do to her and her child, her best friend, her 10-year-old son--voted for Donald Trump or voted for Hillary Clinton. When it hits you--when that heart defect or that schizophrenia or that heroin addiction or that lung cancer strikes you, it doesn't discriminate as to whether you are a Democrat or Republican. It hits you hard no matter who you voted for.

That is why, when we go back home--I know what Republicans hear because I hear it in Connecticut. They want us to work together. They are sick and tired of healthcare being a political football that just gets tossed from one party to the other. We used it to bludgeon Republicans, and Republicans used it to bludgeon us, and we used it to bludgeon you, back and forth, and back and forth.

We are on the verge of passing a bill, getting a bill out of the HELP Committee that might begin to end the use of healthcare as a simple political bludgeon. That is what our constituents want. We are not going to have time to get any public polling on this because no one is going to be able to understand it by next week, but I will guarantee you, it will poll at the same rate that previous versions of TrumpCare have polled--in the teens and the twenties, with base Trump voters being the only folks who support it. That is because people have gotten hip to what is in here. They don't actually think it is a good idea to take healthcare away from tens of millions of Americans, but they also don't like the fact that this has been done behind closed doors. This has been done with Republicans only. They want this debate to occur in the open.

Whether they are Republican or Democrat, they want both sides to be a part of it, and we are closer to that reality than ever before. Pulling the rug out from under the bipartisan process is not the meanest or cruelest part, but it is pretty high on the list.

Think about Deacon. Think about the tens of thousands of little boys and girls like Deacon who live in your State. Don't do this to the people of America. Don't do this to the U.S. Senate. Don't break this place beyond recognition by ramming this through without any process or without any CBO score next week. Let this bipartisan process play out.

Let us build some good faith together. That is what the American people want, and that is what the American healthcare system needs.

I yield the floor.

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