30 million americans losing their Health Insurance means more americans will die. Thats not a dramatic hyperbolic statement. That is the truth. When Health Care Coverage goes down, american mortality rates go up. What else do we know about this legislation is. Is that it still raises costs like the other versions of trumpcare. This version of this partisan repeal plan will still force hardworking americans to pay more for actually worse care. It would abruptly end the critical assistance subsidies that have allowed millions to afford care. It would end support for people in the very marketplaces that two other bipartisan senators through the help committee are trying to discuss how were going to stabilize those markets to give people that very access. And we know that as a result of this repeal plan, americans can see their deductibles increase by several thousand dollars, and we could once again once again with those increases see bankruptcy rates increase after dropping dramatically under the Affordable Care act. What else do we know about this legislation . This newest version of trumpca trumpcare. Well, it still ends federal protections like the other plans did, protections for people with preexisting conditions. This version of this repeal pl plan, trumpcares latest version, would still enable Insurance Companies to charge folks who have been sick or have been ill or have a preexisting condition it would be able to charge them for more care. States could waive that restriction on discrimination against people with preexisting conditions. This plan will still subject millions of americans with those preexisting conditions to price discrimination, meaning americans who may have had cancer, americans who are pregnant, americans with a child with autism could be forced to pay thousands and thousands of dollars more just to get coverage. What else does this newest piece of legislation, this attempt at trumpcare again, what else does it do . Well, it ends the Medicaid Expansion, and it establishes a per capita cap and reduction of medicaid. By ending medicaid as we know it, after over 50 years of this program, by suddenly capping it and ultimately giving block grants to states, we know that it will affect dramatically the people that this program and these expansions have covered. And who gets covered by medicaid . Who will be affected . Well, in america right now, over half of all lowincome families rely on medicaid. Two out of three of our seniors living in Nursing Homes rely on medicaid. Half half of all the births in the United States of america are children of america, our children, our future, our greatest natural resource, half are covered by medicaid. Here is our reality. We are getting a program that benefits us all our seniors, our children, as well as the disabled. The cruel medicaid cuts proposed in this bill, the cuts and the caps in this version, will still put those who have the most to lose in the most serious jeopardy those seniors in Nursing Homes, working families, communities of color, women, americans are disabilities, those folks who are struggling already with illness, elder americans, americans living in rural areas, americans living in our cities. This is not who we are. This is not our values. This kind of draconian action is unacceptable in a nation this great. What else does it do . This newest version of trumpcare, what else does it do . Well, this bill and this version, just like the ones before, still erodes critical patient protections critical patient protections established by the Affordable Care act. By allowing states to apply for a waiver to opt out of the a. C. A. s essential benefits requirement for things as basic as maternity care, Substance Abuse services, prescription drugs, emergency services, hospitalizations, and rehabilitation services. This repeal plan could essentially give insurers the green light to once again charge for junk insurance plans that dont actually cover needed care. You may have Health Insurance, but it may be so limited and so constricted that when you actually get sick, you find out it does not cover your illness, your health challenge, your injury. This newest version of trumpcare, this newest version of a partisan repeal plan, it also still threatens womens health. Women compromise comprise twothirds of all adult enrollees in medicaid, and they would be essentially hurt by the gutting of that program. And this repeal plan, like previous versions, would still cut off lowincome women from accessing critical, preventive and Health Care Services from planned parenthood, Health Centers that provide essential Preventive Care and often in many counties the only avenue to contraceptive services. It singles out planned parenthood by not allowing them to be reimbursed for basic health services, making it so much more difficult for women all around our country to access important care. What else does this most recent version of trumpcare, this partisan bill not going through regular orde well, just likee other ones, it would still weaken the federal prohibition on lifetime limits, lifetime caps on the insurance that one can receive. That means that americans with chronic diseases and conditions and children with unique medical needs and challenges who still need continued lifesaving care could be forced, once they hit that cap, to spend hundreds of thousands of dollars on continued care, even though they were insured. Thus devastating families, sending them into bankruptcy, spiraling them to financial catastrophe. A couple months back, one of my constituents tweeted me a photo of her sons medical bill after a recent surgery. The bill was for 500. But it showed that without the coverage she got because of the Affordable Care act, she would have owed over 230,000. That was just for her childs heart surgery, and her son ethan, who was born with a rare genetic disorder, has had four of those surgeries. Under this partisan plan, not only could essential Health Benefits like hospitalizations and prescription drugs be denied ethan, but lifetime caps on coverage would disqualify ethan from accessing the care needs. As ethans nominee put it as ethans mom put it to me, the lifetime cap is the equivalent of saying, so, youre not worth keeping alive now. Youre just too expensive. And thats what this planning would allow Insurance Companies to do, essentially saying to americans, if you had a problem when you were a child, if you had surgeries when you were a child, once you hit that cap, youre not worth covering anymore. We had a vote on the floor tod today. It was for National Defense. It was a major bill. There were strong statements and speeches on both sides of the aisle, but at the end of the day, the overwhelming majority of us joined together with great expense to provide for our Nations National defense. That is, to provide for our defense department. It is this common ideal in this body that this government, formed by our forefathers and mothers, the constitution upon which we stand proclaims that we are forming this government for the common good, for the common defense. But as weve seen in recent days, the idea of defense isnt just protecting us against the threat of north korea, isnt just protecting us from the efforts of the russians, its not just protecting us from terrorist organizations. Weve seen that the National Defense also means the challenges of Natural Disaster. It was profound for all of us to see the crisis faced from texas to florida and how we as a nation, hero after hero in communities large and small stood up in this time and were there for their fellow american, never asking their party, never asking or questioning what different religion they might have. People from all different ethnicities banded together because that is what americans do. When were threatened, when were attacked, whether it is a Natural Disaster or an enemy from afar, we stand up and take care of each other. The very formation and foundation of our government is based on these ideals that were stronger together when we stand together, when we fight together, when we invest in each other and sacrifice for each other. Im one that believes that our defense of this nation isnt just a powerful military abroad and at home. The defense of our nation also means for a vulnerable child that has a terrible disease; that we can cure, that our nation should take care of our own. The defense of our country means that our elder citizens, twothirds of whom in Nursing Homes rely on the Medicaid Program, that the defense of our nation, the preservation of our ideals is evidenced in the care of those elderly, the dignity that we acknowledge and afford them, that is the very definition of who we are as americans. Im one of those people that believes the ideals of this nation are evident not just in the strength of our military but also in the strength of our system of health care. And that it is a violation of our principles and values as a nation when our Health Care System breaks down to not the ideals of our military when we stand for everyone rich or poor, but suddenly with our Health Care System with accessing lifesaving medicines and procedures, critical Preventive Care, that that suddenly boils down to who is very wealthy gets access and people who are struggling at minimumwage jobs, fighting every day to raise their kids, that somehow that should not be covered in our ideals. We are a nation that professes the most profound values. The oldest constitutional democrats democracy that put the oldest constitutional democracy that put forth ideals that we are not a theocracy, that we are not a monarchy, that we are the oldest constitutional democracy that put ideals forward that became lights to other nations. This ideal that we believe in liberty and justice for all. What justice is there in a piece of legislation that would cast millions of americans, our poorest americans, our sickest americans, our elderly americans into a world where they no longer have the security of health care . Is that justice in this country . What is the conception of liberty in our nation if some people are shackled to fear and worry that if their child gets sick, they will not have access to care . What is freedom if people are imprisoned by an illness and disease that they cannot get adequately treated because they do not have Health Coverage . Essential to the ideals of our country, the ideals of life and liberty and happiness, is having a system of health care that provides a Stable Foundation for life. When half of the children born in this country are beneficiaries of a Medicaid Program, why would we slash that program that undermines the very start of the life of our children . That is against our values as a country. We are a nation that every generation has expanded access, has expanded opportunity. Over 50 years ago when medicare and medicaid, programs that were formed expanding access to health care for the elderly, expanding access to health care for the sick, expanding access to health care for hardworking, lowincome people, that was an advancement forward. When this bad passed the Affordable Care act be and 20 million more americans gave access to health care, to lifesaving procedures, to the stability that comes from having that security, we advanced this nation more towards its ideals. This body should be coming together to take the imperfections of the Affordable Care act, to find where its fallen short and to working together to build upon that foundation so that everyone in this nation can have justice and opportunity, that everyone when it comes to the grip of illness or disease can find the freedom that comes, security, ease of mind to knowing that they can afford to go to a doctor. Thats a national aspiration. That is National Defense. That is who we are and what we stand for. And so now here we are again. The most frustrateing moments of my time as a United States senator has seen legislation not in any way coming through the processes set up by our forefathers and mothers in this place, the traditions of the senate. To usurp them all, to rush to the floor, to vote on legislation that hasnt benefited from the wisdom and the genius and the experience of medical professionals, of experts, but just was pushed to the floor, that even nonpartisan experts would say would Rip Health Care from millions, would raise costs for elderly. How can we as a body do this to ourselves . Were in this situation again. Where legislation is being proposed, where votes are being counted. Where people are discussing, hey, can we bring a bill to the floor, another version of those that have fallen and been defeated, and we bring this version forward. And i just say its time we stop. Time we understand that in the same way we hammered out a bill for that past legislation, billions and billions of dollars to protect our country from threats abroad, that we take the same kind of effort to work together, to talk, to hold hearings, to listen to each other, to try to make sure that we are defending each other, supporting each other, helping each other, that we are a generation that like our forefathers and mothers is expanding conceptions of liberty and freedom and access for more people. And instead here we are with millions of americans now turning their attention back to the United States senate, americans with disabilities, parents with children like ethan who worry that should they need another operation, the rules change, the legislation changes, they wont have that access. Young people with parents in Nursing Homes wondering will Medicaid Expansion survive yet another attempt to gut the program . At the time we need to be encouraging each other, strengthening our commitments to one another, we face a time of jeopardy, a decision point, a crossroads, not just in the pragmatic realities of health care that will come forward but a crossroads of our values, a crossroads of our ideals. Will we go forward as a nation together, expanding opportunity, securing justice, defending each other, empowering each other, or will we go back . And i would say this. What i have learned is that the decisions made here are not always easy, and that they are often dependent upon the engagement of the nation as a whole. I stand here the beneficiary of courageous americans who stood and fought for all of our values, all of our ideals, expand access and equality and opportunity to fight to defend this nation at home and abroad, to insist that every child have certain basic rights and opportunity. This is yet another moral moment for our nation. I believe that every child should have act assess to affordable, Quality Health care. I believe that every senior Senior Citizen growing old should have the security, the dignity of healthy environments. I believe that people should not be denied the justice of health care because they have a preexisting condition. I dont think these are radical beliefs in any way that i think it was radical to stand up in the late 1800s and say women should have the right to vote. That it was radical to think that children should not have to experience child labor. It wasnt radical to say that black americans should have equal access to restaurants and hotels. Those werent radical ideas. The reason why this body stood up in generation after generation securing privileges and expanding opportunity and opening up access, the reason why this body did that was not just because of the decisions of the people on this floor. It was because americans stood up and demanded these changes, demanded this progress, fought for every inch of ground, and that is the moment were in right now. A call to the conscience of our country. I ask everyone, this is not a time to be silent. This is not a time to be indifferent. This is not a time for apathy. This is a time for all of us to make a decision about who will we be as a nation . Will we be a nation that provides affordable, Quality Health care to all or will we slide back into that basic right being only available to a smaller and Smaller Group of people . That is the decision, and the decision will be made not just by the votes on this floor or the decisions made by the 100 of this body. It must be made collectively through our engagement and our activism and what we demand from our representatives. So here we are in this moral moment, this decision for our country. My prayer and my hope is that all of us with a collective voice, with a chorus that resonates with that of our ancestors, that we fight for the defense of our nation, that we stand up and take responsibility for ideals of equal justice, ideals of liberty and freedom, ideals of life and liberty and the pursuit of happiness, ideals that have made this nation shine, that have shown our greatness and our character. That doesnt happen by accident with some inevitability of history. It happens because we fight for it and work for it. If theres any moment in American History where we need that spirit, that american grit, that toughness and that fight, it is this moment right now. Mr. President , thank you. I note the absence of a quorum. The presiding officer the clerk will call the roll. Quorum call a senator mr. President. The presiding officer the senator from pennsylvania. Mr. Casey thank you, mr. President. I would ask consent to vitiate the quorum call. The presiding officer without objection. Mr. Casey thank you, mr. President. I rise tonight to talk about yet another Health Care Debate that were having here in the senate. As many people know who have been following this over the last number of months, we had a long debate, and then a vote here at the end of july, and at that point, despite all of the conflict and all of the debate and arguing, really, about health care for not just months but for years, we moved to a new chapter, and that new chapter for a number of weeks has been very positive. When i went home to pennsylvania, i went to 32 counties in the month of august, and in a lost those counties, i tried to give a bit of good news on Health Care Despite all the conflict about it. Since july 28, when the vote was held, we have they bipartisan discussions. I was part of several of them. And the chairman of the health, education, labor, pensions committee, socalled help committee, senator Lamar Alexander of tennessee, announced with an agreement with patty murray of washington, that they were going to preside over Bipartisan Health care hearings in that committee. Probably the first bipartisan hearings in a long time. What that meant is we were going to finally have hearings and a thorough examination of a few issues. Not a sweeping bill that would repeal the Affordable Care act and decimate medicaid, like the prior bills were, but to take elements or pieces of some of the challenges that we have before us and try to fix those problems. And that took place over the last two weeks. Among the most positive health care moments weve had in the senate in a long, long time. What do we do . Well, were focused on making sure that the costsharing payments were made, hoping we can get a bipartisan bill on that in the next couple of days. And focusing on problems in the individual market, real problems, serious attention to serious issues, not a game, not a political exercise, not an ideological exercise. Democrats and republicans sitting down working together in the help committee, to solve some of not all of, but some of the problems in our Health Care System. It has been a very positive development for the committee, for the senate, and for the nation. Theres a little more good news. Both parties have come together to make sure that the childrens Health Insurance program continues, one of the most important programs i know in pennsylvania, these are approximate numbers, about 125,000 children in pennsylvania get their health care that way. So both parties were coming together on that as well. Very bipartisan. Chip, since its enactment way back in the 1990s, has been bipartisan. A couple of rocky roads here and there, but mostly for 20 years bipartisan, and it would be again in this at this time in the senate. And its very personal to me. My father was the governor of pennsylvania in 1992 when chip passed. I think we might have been the largest state with a childrens Health Insurance program. And those kind of state models became the basis for federal legislation. So deeply personal to families across pennsylvania who have who absent the chip program would not have health care. The same is true of medicaid, which of course is a much bigger number. A lot of children in pennsylvania have health care solely because of medicaid. Some adults have health care solely because of medicaid, millions of them. I think when we have these debates we should remind ourselves about the value, the importance, the significance of these programs and the consequence of undermining them or wiping them out. In the case of medicaid, what some earlier versions of the Republican Health care bills would do would be to decimate medicaid over time. Maybe not in year one or year two but over time would have a terrible devastating impact on medicaid. Whats medicaid . Well, just happens to be the program where 40 million children or i should say 40 of all children get their health care. 60 of all children with disabilities get their health care. About twothirds of nursin nurse care is paid for by medicaid. Ask a Family Member that has a loved one with a disability what medicaid means that family means to that family. It is life or death, medicaid is. The so i know we have debates here where people talk about medicaid as if it is just another program, just another budget matter, just another health care talking point, right . Well, one of the reasoning why these well, one of the reasoning why these bills have well, one of the reasons why these bills have not passed is that democrats and republicans out there far a way from washington realize what would have happened if we passed some of these bills, what would happen if we no one here would lose their health care, by the way. No senator, no house member, or their families would lose their health care. But folks here are perfectly willing to support legislation which would result in millions, not a few million, doublefigure millions, 15 million maybe lose their health care on medicaid if these bills had passed. And several million more in the exchanges or otherwise. Show thats what so thats what we were debating. But as i said, since july 28 weve had a lot of bipartisan work. And thats a good thing. So where are we right is now heres where we are. With a piece of legislation this a, the shorthand is cassidygraham, two senators who are leading the bill. What would it do . Well, it would do a couple things that we should never allow to pass, in my judgment. Establishing a per capita cap on medicaid. Thats a bad idea. We should reject that. Ends Medicaid Expansion as we know it. The part of medicaid that now covers 11 Million People and i hope that folks dont Start Talking about in the context of how difficult it is for states and counties and communities across the country to deal with the opioid crisis, i hope they dont say that were going to pass a bill that will end Medicaid Expansion as we know it because we know the biggest payer, the program that has the most impact on treating people who are in the group of the opioid epidemic, who are gripped by that addiction, Medicaid Expansion provides more help than any other program. 68,000 pennsylvanians at last count with an opioid issue got their help from Medicaid Expansion. Solely because of Medicaid Expansion they can get help for opioids. So ending the Medicaid Expansion as we know it is another bad idea. Rolls back protections for americans with preexisting conditions. I thought sweeted this, that this would be a i thought we settled this, that this would be a guarantee going forward. No matter what bill democrat, republican, or otherwise that we would make sure that was a standard, that no one would have to worry about preexisting conditions again. Well here we are again. States waive it and they are allowed it to waive it under these bills. Allowing states who require burdensome work requirements as a country of coverage. Thats another result. Taking coverage away from millions of americans. We mentioned that, but it bears repeating. This isnt just a policy debate. This is about folks that we all represent. I represent families in pennsylvania, many of whom wrote to me, have contacted me, telling me their stories. One of them was pam simpson. Shes from southeastern pennsylvania, coatsville, her son rowan was diagnosed on the autism spectrum a number of years ago. Prior to have the protection of medicaid, what we call in medicaid medical assistance, that family had a big challenge. Challenges continue even after coverage. But what pam said to me in a letter is how much benefit there was to her family in terms of getting the treatment and the help from medicaid. She said, and im quoting from her letter, without medicaid im confident i would not i could not work fulltime to support our family. We would be bankrupt or my son, meaning rowan, would go without the therapies he sincerely needs. So there is a child i think he was five years old when he was diagnosed there is a mother telling me that their life is a lot better because they have the protection of medicaid, because her son has a disability. And there are a lot of families that might have the child might have more than one disability. And even some families that have even wealth or really good Health Care Coverage. They still need medicaid if theyve got a child with a profound disability. So this isnt just about one group of americans. This cuts across all incomes, all regions, all parties, all beliefs. Thats what medicaid does. Because you know what medicaid is . It is an american program. Were the greatest country in the world. We can have the strongest and we do economy in the world. We have the Strongest Military in the world. And we can do that you will and still have a program that says to any family that has a loved one with a disability, were going to help you. We dont care where you live. Were going to try to help you because your Family Member has a disability. Or if youre lowincome, were going to make sure that your child gets all the excellent screening and diagnoses that take place he recall any a childs life to take place he recall any a childs life. Because were a great country. Were called america. Thats what america does. We take care of people that need help. And if it costs some more, we find the money to do it. Just like we find the money when we have a conflict to protect our security. We all come together as a country and we protect the country. Well, it is about time washington came together to protect people that have the benefit of a Great Program called medicaid or other health care programs, because thats what a great country does. If we do to medicaid what some here have wanted to do, we will be diminished as a country. We will all be diminished. Do we want to live in a country where we just had 20 Million People gain Health Care Coverage and go backwards, have more people without Health Insurance, have more children lose their medicaid coverage . Is that the country we want to be . I dont think so. I dont think any republican believes that. I dont think any democrat believes that. You call yourself an american, because thats what america does. We take on big challenges and we solve problems. So medicaid is not the problem here. We got problems in our Health Care System. Medicaid is not one of them. Medicaid is helping a lot of people, and were going to protect it. This idea that weve come together in the help committee on fixing parts of the system we got to fix and do a thorough examination and have hearings, isnt that a radical idea . I know i just heard in the last couple of hours, there is a Health Care Hearing on monday. A Health Care Hearing on monday. Oh, my goodness. There is a Health Care Hearing on monday and i guess they want to pass the bill on thursday. Thats what counts for a thorough examination or regular order of one of the most complicated challenges we have. Why dont they agree to do it like Lamar Alexander did, as the chair of the help committee . He said were going to take these discrete individual challenges and examine them closely, come together on a bill and then pass the bill. And then were going to move to the next problem and the next challenge and solve them one at a time or two at a time not take a meat ax to medicaid and hope it works out for people that dont have any Health Care Coverage. Thats what a great senate would do. Weve been having months of hearings on this hearing that some people want to pass by the end of september. But ill go back to the positive plain that weve been on. Good help in the help good work in the help committee. Good help in the finance committee getting this reauthorized. While all of that collaboration is going on, all of those good discussions, all of that backandforth about policy, no yelling, no screaming, no fingerpointing, all the while, just in the last couple of days, this bill is moving through washington quietly, but its moving and its starting to pick up momentum like a snake in the grass. Thats what this bill is, like a snake in the grass. You may not see it yet, you may not know much about it, but its coming. And if they pass it next week, you may not feel the impact in 2017. You may not feel the bite of that serpent in 2018. You may not feel it in 2019. But youre going to feel it. And if we allow that snake in the grass to inject its venom into people, my analogy for losing your Health Care Coverage, then were not the senate we should be. Were not the government that we should be. We should be an institution, the United States senate, that protects people from those kinds of adverse consequences. And this bill is that kind after is that kind of a threat to people. It will bite, and that bite will have a lot of venom. Why do i say that . Well, think of what would happen to the Medicaid Program. By one estimate, starting in 2027, funding would be cut off completely completely leaving 32 million americans without access to Health Insurance of any kind and leaving states with zero federal dollars to replace Medicaid Expansion, marketplace tax credits and costsharing reductions. So please dont make the argument that medicaids going to be just fine. When youre block granting it, which is a rather benign description of giving a block of money to a state and hoping that it works out, hoping that its enough money, enough funding to pay for that states medicaid needs. What if you have more children with disabilities . What if that number grows . This bill basically says to the state good luck, state which has to balance its budget, by the way. The federal government doesnt do that. The state has to balance their budget, and they by definition will have to cap services and treatment to people with disabilities. So thats thats what this is all about in the end, about sending the problem back to the states, calling it flexibility. Isnt that a nice word . All these benign words. Flexibility, block granting, per capita caps. They all sound so benign. There is a lot of venom in those policies. What does it mean for one state . I will just give you one example. In pennsylvania, we had more than 700,000 people obtain Health Insurance through Medicaid Expansion. Over 700,000 people. In the marketplace, the exchange was just over 400,000 people. So more than 1. 1 Million People got health care through in one state through Medicaid Expansion or through the marketplaces. How about rural pennsylvania . We have 67 counties. How about the 48 Rural Counties in my state . How many of them how many People Living in rural pennsylvania got health care . At last count, it was over 278,000 people, almost 280,000 people. 180,000 obtained Health Insurance through the Medicaid Expansion, and the balance was through the exchanges. So what are we going to say to rural pennsylvania . I know 180,000 of your neighbors, friends and Family Members got Health Insurance through the Medicaid Expansion, but were going to wind that down. You will be just fine. Dont worry. Washington will guarantee that youre just fine. Thats a big lie if you try to make that argument to rural pennsylvania and to other parts of our state as well. What do we say to rural hospitals who have very thin margins already, some of them on the brink of having a major problem and depend upon the support they get from medicaid because in rural pennsylvania, we have got a lot of folks that have have illnesses and challenges that maybe some of the rest of us dont have. They tend to be older folks that have those challenges, too. What do we say to them . Were saying to them that were just going to just going to wind down the support that medicaid provides in a state like pennsylvania . So my plea to my colleagues is dont allow this snake in the grass to get close to anyone and to bite them and inject venom in them. Dont allow that to happen. Dont allow this bill to rip away health care from millions of people. Just like the bill before that and the bill before that. Work with people in both parties to do what were doing in the help committee, and to a certain extent, although very limited, in the finance committee. But i think we have a good model to work together, but i cant go back to pam simpson and say sam, you know what . I know youre happy with the medicaid that rowan is receiving, and i know its working out for you, but, you know, there are some people in washington that just had a different idea for you, so youre on your own. You and your family are on your own. I dont think thats what we do as americans. Forget being senators. I dont think thats an american thing to do. We help people that need help. All of us in our lives need help at some point or another. No one is immune from some of these challenges. Ill just read one one to two sentences from the end of the letter that pam simpson wrote me months and months ago, the early part of this year. She talked about how important medicaid was to her. And she is pleading with me at the end of this letter to protect her son and protect her family, and i would just ask that my colleagues consider this when youre considering how to vote. Pam talked about all the benefits that medicaid provides for some because of his disability and her family. She said please think of rowan, my son, please think of my husband and me. But then heres how she concludes. Please think of my 9 month old daughter luna, rowans younger sister. Please think of my 9 month old daughter luna who smiles and laughs at her brother daily. She will have to care for rowan later in her life after we are gone. Overall, we are desperately in need of rowans medical assistance, medicaid, and would be devastated if we lost these benefits. I hope we can all say to pam simpson and her family and any family that benefits from medicaid or Medicaid Expansion or the protections of the Affordable Care act, were guaranteeing that youre going to have those protections. Were going to guarantee that those protections are going to be there for you. I hope that every member of the United States senate can say that and vote in accordance with that promise. And i would use an old expression, ask members of the senate to examine your conscience. Is this what you want people to remember you for, this kind of a vote, where rowans mother has to worry or rowan has to lose his medicaid coverage or a poor child in a big city has to lose their Health Care Coverage or a child in a rural area or someone working at a rural hospital loses their job because of these massive ideologically driven cuts to medicaid . I hope i hope you can answer the call of your own con shens when you vote that way. Mr. President , i would yield the floor. Mr. Schatz mr. President. The presiding officer the senator from hawaii. Mr. Schatz thank you, mr. President. For the past several months, republicans in washington have done just about everything they can to hide their Health Care Repeal bill. Remember way back in the beginning, they tried to actually move a bill without a c. B. O. Score, and then they realized even republicans didnt want to vote on something without knowing how much it would cost or how many people would lose Health Care Coverage so that they said that the score doesnt matter or that its wrong, except for in the areas that they like the numbers, they trashed the c. B. O. Even though for the last eight years they referred to the c. B. O. To make their arguments against the Affordable Care act. When that didnt work, they tapped 13 men to draft a bill in secret, and no surprise, a bill crafted without women, without hearings and without democrats was not able to cross the finish line. So now theyre actually back to their original plan, which is to push legislation without a score from the c. B. O. In other words, were going to go to next week and were going to vote without knowing how bad this bill is. This is not the way the senate is supposed to work. If there is no score, there should be no vote. Now, clearly, c. B. O. Got back to the senate today and said that they will have enough time to analyze the fiscal impact of this proposal, but they will not be able to analyze the impact it has on our constituents. And so remember the last two or three iterations of this bill, people were concerned with the fiscal impact, but remember the headlines were 18 Million People lose coverage, 26 Million People lose coverage, 32 Million People lose coverage. Were going to vote next week not knowing how many people are going to lose coverage. Now, it shouldnt matter which side of the aisle that you sit on. We should all be able to agree something as complicated as Health Care Needs as much debate as we can possibly get, and thats certainly more than the 90 seconds that procedurally we have left on this bill. After all, this is onesixth of the american economy, but for the third time this year, republicans are going to do whatever it takes to cast a Health Care Bill, even if no one knows whats in it or what it will do. Even if this bill is very clearly bad policy. By doing this, they are letting down millions of americans who are counting on the senate to be the cooling saucer, slow down and consider policy carefully. But there has been very little debate around this bill. We have not heard from doctors. We have not heard from patients or advocacy groups. We have not heard from Health Care Administrators or economists, and thats because we have had no hearings. Now, just tonight, Senate Finance chairman hatch announced that on monday at 10 00 a. M. , his committee will hold a hearing on the bill, and im hopeful that through that process, we will at least begin to understand the damage that this bill will do. But right now, heres what we know. This is actually the most extreme of all of the versions of trumpcare that weve seen. And heres what it does. It eliminates everything in the a. C. A. That was essential. Tax credits and subsidies to help people to afford their insurance. The Medicaid Expansion, which is very, very successful and very, very popular, and the protections that we have in place for people with preexisting conditions. It eliminates medicaid as we know it. This bill eliminates medicaid as we know it. So what they did was they established block grants which means you get a fixed amount, each state gets a fixed amount for medicaid. And then those medicaid block grants disappear after ten years. It is shocking to me that having failed to get the votes, they went further to the right with deeper cuts to medicaid. Both the Medicaid Expansion program and the Medicaid Program as it existed before the Affordable Care act, and they went ahead and said, you know, we only got to 49 votes last time. What i think we should do is eliminate all of the subsidies, all of the patient protections, all of the essential Health Benefits and all of the Medicaid Expansion, and lets take medicaid as it exists and eviscerate it. The latest version of trumpcare will take Health Coverage away from tens of millions of people. Last week, our country hit an important milestone. The number of americans who do not have Health Insurance fell to a historic low of 8. 8 . That means nine out of ten americans now have Health Insurance. Instead of celebrating this milestone, republicans are about to end our countrys progress on health care. Americans who dont lose their coverage will still get hurt with higher premiums or insurance plans that dont cover basic things like getting help for opioid addiction, pregnancy, hospital stays, mental health. So this bill passes health care if this bill passes, health care will no longer be a right in this country. It will be a privilege. It depends on where you live, where you work, and how much money you make. This bill demonstrates one devastates one of the best and most successful programs that this country has, and thats medicaid. This is a program that helps one out of every five americans and two out of every five children. It helps one out of every two families with a newborn baby, and it covers three out of every four longterm nursing home residents. Medicaid saves lives. Nursing home patients, people struggling with opioid addiction, people who are working two jobs but still dont have enough to cover their own health care. But this bill destroys medicaid as we know it. They start off by putting traditional medicaid into what they call per capita caps or block grants. That basically means whatever money was spent last year, thats the amount that a state gets in perpetuity until they just zero it out completely. And what that means is that states will be left without adequate federal funding for medicaid. Think about what this means for the Health Care Infrastructure in this country. In many states, hospitals and local governments have actually designed the Health Care System based on a certain amount of federal funding coming in. If you take away that funding, hospitals will collapse. In rural areas, hospitals and clinics will close, and people will be left without options and ultimately without access. Thats just the damage done by cutting medicaid. This bill also lets Insurance Companies opt out of covering what they call essential Health Benefits. This is a term of art. Its a piece of jargon, so i want to explain what this means. Under current law, there are certain things that have to be in any Health Care Plan. Those are called essential Health Benefits. You buy a Health Care Plan wherever you buy it. If you get employer covered, if you get a d. O. D. Plan, a v. A. Plan, if youre on the exchange, whatever it is, it has to cover certain things. Let me list what is covered right now as afn essential an essential health benefit. Ambulatory patient services, hospitalization is covered. Maternity and newborn care. Mental health and Substance Abuse services, prescription drugs, rehab, lab services, preventive and wellness services, chronic disease management, pediatric services. So these are the things that actually have to be in your Health Care Plan under a. C. A. You know what this bill does . It says no need. Configure your Health Care Plan however you see fit. And if youre a Health Insurance company and if youre a forprofit Health Insurance company, youre going to pick and choose these things based on whats profitable. And if there is a certain thing that is costing you a lot of money, you are under no obligation to provide any of these Health Benefits because its not in law any more. This eviscerates essential Health Benefits. This bill will also take away protections for people with preexisting conditions. Nothing will hold states back from allowing insurers to charge people with diabetes more, with cancer more for their Health Insurance. Experts have started to look at what this will mean for people with preexisting conditions, and they will pay thousands of dollars more. A patient with asthma will pay more than 4,000 a year extra if this bill passes. While a patient with metastatic cancer will pay 142,000 extra. If youve got metastatic cancer this bill costs you an extra 142,000 a year. This is their Health Care Bill. You charge people who get sick more. Thats their Health Care Bill. Everything that is working under our Health Care System is being shredded by this bill. Take planned parenthood. These Health Centers serve millions of women and men across the country. Theyre part of the solution, not the problem. But this bill cuts funding to planned parenthood which will cause many of these clinics to close. And i want you to think about how many people in this country are actually employed in the health care industry. Research estimates that as many as half a million jobs were created when it started to kick in. If millions of people lose their shiewrns that means they will insurance that means they will use access. That means you will have fewer doctors, nurses and technicians. In other words, cuts to Health Care Coverage are also cuts to american jobs. And i know that in a lot of Rural Communities across hawaii and across west virginia, across the country, the Community Health care center or the small rural hospital is not just the center of the community in a social context. In a community context. But a lot of times its the economic driver. And so this will do great damage to rural america. I want to end by making clear what this means for americans and their health care. This is bad policy, plain and simple. Its bad if you live in a state like ohio where lives have literally been changed because people now have access to prescription drugs or primary care provider under medicaid. Its bad for people who buy their insurance on the exchanges because their prices are going to go up. Its bad, really bad for people with disabilities. And this is not unusual. For whatever reason, people with disabilities are the first to be punished when the battle over Health Care Comes up. Its bad for people with preexisting conditions because states will no longer be required to protect your ability to get health care. This bill does not pass senator cassidys own jimmy kimel test. Thats why more than a half a million doctors in the United States have come out opposed to this bill because it will take Health Care Away from the people who need it, who are sick and who will not be able to get health care if the bill goes into law. This may feel like the zombie bill weve killed several times already. I know it feels like that for me. Im sure people are exhausted. Im sure people thought this was over. We had that magnificent moment on the senate floor when john mccain walked over to that well right there and did a thumbs down. And i tell everybody back home, you know, it is so rare that politics is just like the movies, but that night was just like the movies. And john mccain saved health care for the American People and put us on a path towards regular order. And what does regular order mean . I didnt know what that phrase meant until i came to this institution. Regular order just means that the senate understands that it has a special obligation in american society. We are the place where were supposed to handle tough issues. And chairman mccain pricked our conscience as senators. Forget democrats and republicans. Forget liberals and conservatives. Were all here because we want to try to make a difference. And so there we were with Lamar Alexander, the chairman of the health, education, labor and pensions committee; and patty murray, the top democrat on that committee, and they were ready to work on a bipartisan basis. Lamar held hearings and by all accounts tough negotiations, difficult challenges, not as much progress as you want as quick as you want. Thats the way legislating works. But theyre in a bipartisan process, and we show up here and that process is in danger of being blown up. And all for this bill, which is a rotten piece of legislation. Its not like this thing has been vetted by experts. Its not like this thing is bipartisan. Its not like this thing will help. It would be one thing if this were absolutely necessary, and then you can make some procedural accommodations because you just must. This is a political necessity for a party that has not yet had a legislative win. Thats why theyre doing this. They are in a hurry because they have until september 30 to check a box called we repealed and replaced the Affordable Care act. They have no new ideas, so what they did was they took all of the bad ideas from all of their previous bills and put it into one bill, and theyre going to take one last swing at it. I cannot tell you how disappointed i am not just on policy but on process. I was never prouder to be in the United States senate than that Early Morning after a long session when john came in and, in my view, saved the senate and put us on a path towards regular order. Do not blow that up. We have a chance to do things in a bipartisan way, to restore the dignity of this institution. But what we are fixing to do next week will take us in a very, very dark direction. I yield the floor. A senator madam president. The presiding officer the senator from connecticut. Mr. Murphy the gentleman, before he leaves the floor, i just want to probe the gentleman for a moment on this question of process, because this is an affront to the United States senate, a bill that reorders onefifth of the u. S. Economy being delivered to us days or weeks before were to vote on it. But you may have covered this, and if you did just reiterate it for me. My understanding is there is not going to be a c. B. O. Score before this bill is before us, and for folks that dont know what that means, that means that everyone who votes on this bill will have no clue how many people lose insurance, how high premiums are going, how much money their state will lose. I dont think we have ever, ever voted on a bill of this scope and size without an analysis from c. B. O. And my understanding is today that when you list or rank the affronts on the process involved in the debate over grahamcassidy at the top of the list is that we arent going to see a c. B. O. Score . Mr. Schatz i thank the senator from connecticut through the chair. Theyre going to get the fiscal impact from c. B. O. In order to comply with the terms of reconciliation but thats not actually what impacts the American People the most. When you get a c. B. O. Score and its exactly right, what the senator from connecticut said is you find out what impact it has on your home state. You find out the number of americans that are going to be harmed by this bill or helped by this bill. And what we do know is that this basically contains elements of all of the previous pieces of legislation. It actually just kind of combines them all and puts them in a pile so its very hard for me to imagine that when they do come back with their analysis that it wont be 20 million, 30 million, 35 Million People having lost health care. And the craziest thing about this is these republicans who will vote yes are going to vote yes and then find out ten days later that 25 Million People are going to lose their health care. And why they wont wait is beyond me except that they have a deadline to deliver a win for the president. And thats as near as i can tell, the only reason that theyre in such a rush. Mr. Murphy were in a different position today, if i can ask you a followup question, because when we were taking these votes a month ago, there was only faint talk of a bipartisan process to try to keep what works in the Affordable Care act and fix what isnt working as well. And another assault on the process, in my mind, and i ask for your thoughts on it, is that literally as we speak, republicans and democrats are talking to each other about the bipartisan bill that americans in every state are begging for. And apparent if this bill is going to be brought before the senate, that whole process was a fraud. It was a ruse to distract democrats into thinking that there might be a bipartisan fix, into pulling one over the American Public as to give the impression that maybe republicans were interested in bipartisan compromise. Right now there is a process playing out, right . And if this bill comes up for debate with no c. B. O. Score, then that bipartisanship process which was really hopeful for a lot of americans, i assume it just falls apart; right . Mr. Schatz i think youre right. Through the chair, i agree with you. I think that one of the most encouraging things over the last five weeks is Lamar Alexander and patty murray and their ability to work together. I mean if you had told, i think, either of us that we were going to repeal and replace no child left behind with 70something, 77 votes in the United States senate, i would have said i dont know. That seems like its going to get into some pretty difficult partisan, thorny territory. But what lamar and patty were able to do is conduct hearings and bring us through a process where we acted like a senate and we got all the votes. And now were in that process when it comes to health care, and i think some people feel deeply uncomfortable with empowering the chairmen and women of this body and they feel deeply uncomfortable they talk about the regular order but they really want to get their way on the floor. Ill just make one other point here because as people on the republican side were justifying their yes vote in bcra and whatever the other one was called before that, they were always talking about advancing the conversation and bringing us into a Conference Committee negotiation. Now because september 30 is the deadline, there will be no negotiation. Grahamcassidy passes the senate, it will pass the house, it will be enacted into law. So nobody gets to hide behind this isnt perfect but i want to advance the conversation. And maybe we can fix this in the house or fix this in the Conference Committee. This is the bill. The bill that gets voted on next week is the bill and everybody owns it. And you also own the fact that you dont even know what its going to do to your own constituents. Mr. Murphy you dont know what its going to do to your own constituents. I thank the gentleman. Its late and i thank him for staying on the floor for a few moments. You dont know what its going to do to your constituents. We dont have a c. B. O. Score telling us how many people lose coverage, how high rates go, what happens to medicaid. But its also another bill thats been written behind closed doors. So senator cassidy and senator graham may have spent some time thinking about what this legislation does. Virtually no one else has been let into the room. Patients havent been in that room. Doctors havent been in that room. Hospitals have not been in that room. And you know why im pretty confident of that . Because all of the groups representing those populations oppose this legislation. Were going to potentially vote next week on a Health Care Bill massively, massively reordering the american Health Care System that is opposed by the American Academy of family physicians, American Academy of pediatrics, the American College of physicians, the American College of obstetricians and gynecologists, the american osteopathic association, the American Psychiatric association. Those are the physician groups. By the way, its kind of hard to know for these groups whether theyre for it or against it because there is no c. B. O. Analysis of this. But the patient groups have weighed in. Basically every Group Representing patients who are sick in this country are begging this congress to not pass this bill. The a. L. S. Association, the cancer society, the American Diabetes association, the heart association, the lung association, the arthritis foundation, the Cystic Fibrosis foundation, the juvenile Diabetes Research fund, the Lutheran Services of america, the march of dimes, the National Health council, the National Multiple Sclerosis society, National Association of rare diseases. How do you pass a bill that has no c. B. O. Score, that has had no hearings, thats opposed by every single group that republicans welcome into their office every year, representing people with serious diseases . There have been some really, really mean health care proposals. Grahamcassidy is the meanest version of trumpcare yet. And let me walk you through why i say that. Again, we dont have the numbers here, so we dont have a c. B. O. Analysis of how many Million People are going to lose access to health care, 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 that states will get in order to ensure the population that has been insured by the Affordable Care act. What this bill does is shrink the amount of money that were spending, then redistribute 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 health care exchanges. An early analysis by an outside group who 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 Health Care Dollars from the federal government to the state of connecticut. Were a state that doesnt have a 20 billion annual budget. 4 billion either means we will have to kick hundreds of thousands of people off of health care or we will have to dramatically raise peoples taxes. So all of the reductions in insurance are in this bill, were having millions of people losing access to Health Care Insurance under this bill. The specific targeted harm to women is in this bill. Planned parenthood is one of the countrys biggest providers of primary care and preventative Health Care 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 Preventative Health care to women in this country. My wife, when she was a lowincome 20something could only afford to get her health care through planned parenthood. Thats where she went for her Preventative Health care, 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 Preventative Health care. This bill is perhaps the meanest, though, to individuals who are sick, or individuals who have been sick, because at least in prior investigators 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 wasnt workable, but at least there was a facesaving gesture by republicans and by the Trump Administration to try to at least claim that there was language to protect people with preexisting conditions. Senator cruz sat on this floor a few weeks 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. Its not hard to understand but its really important to understand because people dont like the individual mandate. I can understand that. Nobody likes to be required to do something. But you cannot protect people with preexisting conditions if you dont require Healthy People to buy insurance. And 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 dont require that Healthy People buy insurance, then what does the rationale individual do . The rationale individual in that case says why would i buy Health Insurance while im healthy . If i wont 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 that if you require Insurance Companies to charge the same between sick people and Healthy People, then Healthy People wont buy insurance, and if i was actually advising someone, i dont think i would tell them to buy insurance if they didnt have to until they were sick, and 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 per year compounding year after year after year. And so in the last version of this bill, republicans knew that, and so they included a version of the individual mandate in their bill. Now, it wasnt the same mandate but it was a mandate, nonetheless. The mandate under the Affordable Care act says that if you dont 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, it said that if you go without insurance, youll 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 mandate, a penalty, its just in a different place. And republicans did that because they knew that 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. Okay. So why am i talking about this . Because in grahamcassidy, 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 cannot do that because the federal government does not require Healthy People to have insurance. And 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 wont, they wont because that issue has become, thanks to my republican friends, so politically toxic around the country. And so 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, get sent down to states, and then medicaid dollars are capped going forward, intentionally capped at a number that is well below what the generate of increase in the Medicaid Program is. Theres an intentionality in the underfunding of medicaid here. The old bill would have taken, i think, 15 Million People off of the rolls of medicaid i think im getting that number right and well never know what this number is before the vote happens. Likely around the same number because this bill treats medicaid in roughly the same way, in terms of capping the amount of money that 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 here and give us an explanation as to how this formula works. It is the most bizarre Rube Goldberg scheme that you could ever imagine. But in it is an overtime dramatic reduction in medicare, in medicaid payments to the state. So think about this little boy deacon. Deacon is 10 years old, and he lives in ohio. And im just looking here at a picture of him clutching a poke pokemon character. I know which character this is. Its pikachu. I know that because i have a 9yearold that is the same age as deacon. But there for the grace of god, my 9yearold is not going through what deacon the 10yearold is going through. I will read you a little bit about deacon. He loves playing baseball, playing video games, volunteering at animal shelters. He loves being a patient champion for childrens hospitals, spending time with his friends and family, being a big brother, raising money and awareness for Heart Disease and defects. My 9yearold doesnt enjoy raising awareness for Heart Disease and defects. The reason that deacon enjoys doing that is because he has a condition called hypoplastic left heart syndrome. Its combined with asthma and acid reflux. It essentially means that deacon has half a heart. We have whole hearts. Deacon has half a heart. Right now, everything is controlled for deacon by medications. Hes 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 deacons future. A heart cannot last on the twochamber system that deacons 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, thats it. Game over. For 10yearold 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 six heart surgeries before 3 years of age. He has continued medications and as well as regular doctor checkups, he needs them. With his diagnosis, even as a specialist for simple things like medicare. If he had not had medical coverage, there is no way i could have afforded his care. By his first surgery at ten days, he was over the milliondollar mark. I would have lost our house easily, quickly. Im a single mom. Medicaid helps keep my son alive and healthy. Its given me my best friend to love and watch grow up. Medicaid helps a boy live a normal live 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. Its a this isnt hyperbole. This isnt a game. Its 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 ohios Health Care System, simply to fulfill a political promise that republicans made. Were not making this up. Were not trying to tug your heartstrings just for our own political purposes. Kids are going to die if they dont have access to health care. 20 Million People lose insurance , as may be the case under this legislation. Thousands of people wont be able to survive. Thats a Million Dollars of care. I can guarantee you that this Single Parents home is not worth a Million Dollars. At some point, you just stop being able to provide the care necessary to keep people alive. And 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 town hall has been held in which your constituents can weigh in. No member of this body would 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 i in part because of what p is in it and part because of the process and they cannot come down here and talk to about it because that will be rushed through next week. What a great trick republicans will pull of this country. Everybody said the repeal bill was dead and they would move on to a bipartisantt Health Committee and the senate would move onto another issue of tax reform. That was all a lie just to give coverage to quietly muster support while democrats were looking at a bipartisan process that never intended to result trust in senator alexander. Admittedly i gave him a very hard time over the course of the First Six Months of this year because i could not understand what the point was of being on the Health Committee if we were going to debate onefifth of the american economy, the Health Care System. Why be a member of the Health Committee if the biggest reform to the Health Care System during my tenure in the senate wasnt going to be debated in the committee. I thought that was an abomination. And i have been very pleased that in the last two weeks senator alexander has convened a bipartisan process that i have invested in. Ive showed up to all these hearings. Ive talked to him over and over again on the floor of the senate and in these committee meetings. Ive offered constructive suggestions about how we can come up with a bipartisan fix to the parts of the Affordable Care act that arent working as well while maintaining the parts that are working as well. And as i sit here today, i hope and i pray this wasnt 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. I hope its not going to be the case. This isnt a game. People are going to be really terribly badly hurt if this bill becomes law. I dont even know what the effects will be because we dont have the analysis. We dont have a score. I can guess but ive never been part of anything like this in my 20 years of public service. I have never seen a group of Public Officials so hellbent on achieving a political goal as to throw out decades of precedent on how this body was normally worked on major pieces of legislation, shown such casual disregard for good oldfashioned nonpartisan analysis as is happening if this bill comes before the floor without a c. B. O. 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 health care exchanges, and thus, were going to make sure that President Trump cant take away payments from insurers, or threaten to take them away on a monthtomonth basis. And democrats can recognize that republicans want flexibility in these changes, 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 even bigger later on. I have no idea whether deegans 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 for her and her child, her best friend, her tenyearold son, voted for donald trump or voted for hillary clinton. Because when it hits you, when that heart defect or that schizophrenia or that heroin addiction or that lung cancer strikes you, it doesnt discriminate whether youre a democrat or republican. It hits you hard no matter who you voted for. And thats 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 health care 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. It happens back and forth and back and forth. Were on the verge of passing a bill, getting a bill out of the Health Committee that might begin to end that use of health care as a simple political cudgel. And thats what our constituents want. Were not going to have time to get any public polling on this because no ones going to be able to understand it by next week, but ill guarantee you it will poll at the same rate that previous versions of trumpcare have polled, in the teens, in the 20s, trump voters being the only folks who support it, and that is because people have gotten hip to whats in here. They dont actually think that its a good idea to take Health Care Away from tens of millions of americans. But they also dont 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. Its not the meanest, the cruelest part, but its pretty high on the list. Think about deeg an. Think about the tens of thousands of little boys like deegan that live in your state. Dont do this to people of america. Dont do this to the United States senate. Dont break this place beyond recognition by ramming this through without any process or without any c. B. O. Score next week. Let this bipartisan process play out. Let us build some good faith together. Thats what the American People want and thats what the american Health Care System needs. I yield the floor. The presiding officer under the previous order, the Senate Stands adjourned until 10 00 a. M. Tomorrow