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Floor Speech

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Mr. WYDEN. Mr. President, as chairman of the Senate Finance Committee, I am pleased to be joining my colleagues on the Senate floor today to discuss the importance of Medicaid to American families.

Right now, Republicans in the House of Representatives are pushing a scheme that threatens Medicaid coverage for over 20 million Americans.

Over the course of the evening, my colleagues on the Senate Finance Committee and I will make clear why this is a bad deal for all Americans. Democrats in the Senate won't stand for it.

Now I am going to turn it over to Senator Casey for his remarks, and I believe we will have other Senators from the Finance Committee coming next. And I will wrap it up.

Senator Casey.

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Mr. WYDEN. We are going to recognize next our distinguished colleague from Massachusetts. I just want to say, Senator Casey has made, as is usually the case, an eloquent argument that preventing default and standing up for the most vulnerable people, those two are not mutually exclusive. You can do both.

And Senator Casey's arguments, as is usually the case in our Senate Finance Committee, really strike home to this Senator. And I want to thank him for day in and day out talking common sense and making it clear that default is unacceptable and harming so many vulnerable Americans, in Pennsylvania, Oregon, Massachusetts, and elsewhere, is also unacceptable. And I thank my friend.

And we have another passionate advocate for people who are vulnerable from the Senate Finance Committee, our friend from Massachusetts Senator Warren.

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Mr. WYDEN. Mr. President, before she leaves, I would like to thank my colleague for an eloquent statement that really lays this case out, and I am going to try to pick up now where you left it, and I thank you for it.

These compelling arguments from the Senators from Pennsylvania and Massachusetts show the importance of Medicaid to all of us on our side, and I am just going to wrap up by laying out three key laws in the House Republican proposal to cut Medicaid.

First, most Americans with health coverage through Medicaid are already working if they are able.

Second, the House Republican plan to cut Medicaid is going to put millions of Americans at risk, including seniors in nursing homes. And I am going to describe a little bit later how that happens.

And, third, the track record laid out by Senator Warren shows that working requirements have been a bureaucratic nightmare for Americans.

It is hard, Senator Warren, to figure out how the so-called ``small government'' Republicans have become so fond of bureaucracy and redtape.

Here is why House Republicans want to slash Medicaid by billions. They say it is about work. It is really about securing an ideological trophy on the evidence-free proposition that Americans near the poverty line are actively choosing to stay there instead of working.

So what has this work reporting requirement really been about? It has been about ripping away health coverage from Americans who Republicans have judged to be unworthy.

Don't take it from me. An analysis from the Kaiser Family Foundation paints a pretty clear picture of who is going to be at risk of losing coverage.

As of 2021, there are 25 million adults ages 19 to 64 who are enrolled in Medicaid. Forty-three percent are working full time, and 18 percent are working part time. I will stop right there and note that that is equal to the national labor force participation rate at 61 percent.

For the remainder with Medicaid coverage who are not working, 13 percent are caregiving for a child or relative; 11 percent are unable to work because of illness or disability; 6 percent are attending school. The remaining 9 percent of Americans are not working because they are retired or unable to work.

Here is the catch. Under the House Republican scheme, the majority of these Americans would be forced to report to the States whether they are working and how much, each and every month, under the threat of losing their health insurance. My Republican colleagues are fond of sharing their small government bona fides, but to me that sounds like a lot of bureaucratic redtape. What is worse, the Congressional Budget Office found in an analysis just last year that these work requirements that we are talking about did not increase employment.

Mr. President, now I am going to explain how this ill-conceived proposal is going to hurt more Americans than those who are subject to work requirements.

The House Republican bill cuts Medicaid by over $100 billion. It comes from one source: Americans getting kicked off Medicaid. The only way for Americans to retain Medicaid coverage would be for States to pick up the whole bill. That means you are just shifting the Federal share of Medicaid on to States that don't want to saddle their health programs with more bureaucracy and bureaucracy that has never been shown to increase employment.

Shifting Medicaid costs to States has real consequences. This is not some kind of abstract theory. When the Federal Government reduces how much it contributes to a State's Medicaid Program, the State has to make up the difference. That means States face tough choices about which Americans will have health coverage and whether hospitals and nursing homes are going to face funding cuts which threaten their ability to stay open. Doctors could see their pay cut. State options, like a full year of postpartum care, which Congress created on a bipartisan basis, something which has been of special importance to the Presiding Officer, would be subject to cancellation.

These cuts will jeopardize our parents' or spouse's access to Medicaid nursing home benefits or cut resources for home care, which allows people with disabilities and the elderly to receive care in their homes instead of moving into an institution.

Unfortunately--and I will close with this--there are real-world examples to illustrate what happens when a State conducts counterproductive bureaucratic requirements. During the Trump administration, Federal health Agencies allowed Arkansas to conduct this work reporting experiment. Within the first year, 18,000 people lost Medicaid coverage, about a quarter of those subject to work reporting. A year later, nearly 90 percent of those who lost coverage had not reenrolled. Those who were enrolled in the Arkansas Works, as it was titled, program painted a very bleak picture. Reporting their work was all kinds of redtape. The website was down nights and weekends, supposedly for maintenance, and plagued by errors, difficult to access on mobile devices. Calling the help line resulted in an endless parade of robotic questions and dead ends.

These are just some of the hoops that bureaucrats designed primarily to keep Americans from health coverage. Keep in mind that these are families who walk an economic tightrope every week, balancing food against housing, housing against transportation. Many don't have reliable access to the internet or a cell phone, especially true in rural areas.

It is no secret that affordable health coverage is critical to staying healthy and financially stable. If you need medical treatment but you can't afford it, getting or keeping work up is going to be that much harder. That is why this policy envisioned in the House is upside down and cruel. It slams the door and throws away the key on Americans trying to get back on their feet. The reality is that having Medicaid health coverage supports Americans' ability to join the workforce. It doesn't deter them from working.

And it is not just Medicaid that the House Republicans want to come after. My colleagues talked about food assistance, like SNAP. I mean, you talk about food assistance, a real lifeline to people staying healthy.

Even in the early months of this Congress, I want to say tonight that it is possible to find lots of room for bipartisan agreement on healthcare. Right now, I am working closely with my partner on the Senate Finance Committee, my colleague from Idaho Senator Crapo, to take on the drug middlemen known as the pharmacy benefit managers. I am confident that we can find common ground, and we will be on the Senate floor with this idea to make a positive, bipartisan change for American families.

For everybody who is paying attention to this, it is not a big secret that there are other ways to save taxpayer dollars. You know, last week, the Senate Finance Committee dug into the question of how the big pharma companies generate their sales. Almost all of them are in the United States, and then for purposes of paying taxes, they race overseas for lower rates and hiding their profits.

I will close by saying that, in cutting vulnerable people, like I think is going to happen with all of this back-and-forth in States that are trying to figure out how to pay their bills, it is going to hurt nursing home patients.

What this is all about is the House is going to create an entirely new level of bureaucracy and paperwork, all in the name of taking away health coverage for more Americans. This is not a proposition that colleagues on this side of the aisle are going to support.

I want it understood as we wrap up, as chairman of the Senate Finance Committee, I am going to work with my colleagues on our committee and throughout this side of the Chamber to fight these policies that come after Medicaid. We will fight them every step of the way because they are wrong, wrong, wrong.

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