President told republican colleagues that the house passed version of the Health Care Repeal of the Affordable Care act was mean. White House Press Secretary sean spicer said the president would like to see a Health Care Bill from the senate it. What didt in we get . We got a bill from my Senate Republican colleagues that is identical to and in some cases, even worse than the disastrous American Health care act that would rip coverage away from 23 million americans and gut medicaid by more than 800 billion. Nothing changes the fact that this undemocratic, secretive process has resulted in legislation that is so meanspirited, it would make the wicked witch of the west cringe. The Senate Republican bill will rip away at economic security. For young families. It would make grandma and grandpa pay more for insurance because they are older. It would tear away coverage for opioid addiction patients desperate for treatment. And punish americans with preexisting conditions like cancer and diabetes and alzheimers. For once, i agree with President Trump. This bill is mean. Abouttake a closer look what is really inside of the senate gops proposal on health care. Lets start by looking at the lower quality coverage. First, this bill will roll back the clock to the days before the Affordable Care act when an insurance card did not guarantee coverage. Because of the Affordable Care act, there are certain things in Insurance Plan just past to cover just has to cover. Care, prescription drugs, Mental Health services. There is security in knowing that if you pay your premiums, this sort of basic, minimum coverage is in place when you need it. But republicans want to rip that away. They want to give states and Insurance Companies the option to not cover these things. This would make it so that a consumer could easily be faced with an unexpected medical bill for services they assumed were covered with their Health Care Plan. Independent analysis from the Congressional Budget Office estimates that outofpocket costs for Maternity Care or Mental Health and Substance Abuse this Order Services could increase by thousands of dollars in a given year under trump care. That is not increasing quality. As President Trump promised. That is lower quality. Inequalitycreases, between the healthywealthy who can pay outofpocket for their care and everyone else. Coverage lower quality , that is mean. Tax. D, and age since the Affordable Care act became law, the uninsured rates for americans age 5064, decreased by one half. Those are the baby boomers. It is estimated that more of 28 million of these baby boomers will develop alzheimers disease age, the agend the the year of 2050. The uninsured rates came about because of the Affordable Care act expanding medicaid and preventing insurers from charging exorbitant prices because of age. For our family and friends as they can afford quality coverage on a dwindling income. Trumpcare punishes you for achieving your milestone 50th birthday. Republican health care proposal, Insurance Companies can charge Older Americans five times more than younger americans for the same coverage. That is unconscionable. It does not matter if you are a 50yearold marathoner in the best shape of your life, you will still be paying at least five times more for your insurance than your 40yearold neighbor who smokes. As a result, americans over the age of 60 could see their premiums increase by an average of 3200 or 22 . That might not sound but that might not sound like a lot to withpeople but for those decreasing incomes it is the difference between being able to eat or being kicked out on the street. To add insult to injury, the subsidies in trumpcare to help individuals purchase insurance are far less generous than what is currently available under the Affordable Care act. Result inhat will premiums which are higher, the tax credits wont keep pace to help pay for more expensive insurance and as a result, this age tax is going to be mean. To those who are older in our country. Number three, medicaid cuts. Helperd is a lifetime for families across our country. ,ore than 70 million americans nearly half of which are children, depend upon it. It is clear that trumpcares cuts to the program, that republicans want medicaid to flatline. For a program that covers more than 1 5 of the nations population including the sickest, the oldest, and the poor amongst us, medicaid is especially irreplaceable. Have an ancient animosity towards medicaid. Restructureneed to medicaids financing to help control the programs spending and make it more efficient. That is another way of saying to americans most vulnerable, that you are not just as important as those who donate to our campaigns. Rating the medicaid coffers achieves two goals for republicans and President Trump. It tears holes in a critical social safety net for more than 70 million low income and workingclass americans. Second it provides the gop with an open checkbook to pay back their donors with huge tax breaks. To referns might want to these changes as capping the Medicaid Program but dont be fooled, what that means is decapitating access to primary care. Decapitating the ability of grandma and grandpa to secure a nursing home bed. Decapitating access to treatment for Substance Abuse and Mental Health conditions. Ting the Medicaid Program that is mean. They will reduce access to care. This one is simple. Less Insurance Coverage equals less access to care. To get ais possible dr. Appointment and treatment without Health Insurance it is usually at prices that are impossible to afford for a typical uninsured person. Most working americans cannot conceive of paying more than 150 every time they want to orit a primary care doctor footing the bill for a couple of thousand dollars in the event they need more specialized care. Best medicines and most effective treatments are only as good as the Insurance Coverage people have to help them to access to it. How will these 23 million americans who lose insurance under trumpcare get the care which they need . They wont get the care. Unfortunately when patients do try to access care, it will be because if illness has progressed to the point where it can no longer be ignored. Instead of seeking care with a primary care doctor in a less Expensive Health care setting, most uninsured patients will end up going straight to the emergency room. The most expensive site for care. The cost for that uninsured patient, that will get absorbed by everyone else in our country and our rate for treatment and tourance coverage increase make up for this uncompensated care. Care,duced access, to that is mean. And then, we move on. To higher premiums. Higher premiums are going to be the new rule in our country. Happensgoing to be what if the republicans are successful in repealing the Affordable Care act. According to the nonpartisan Congressional Budget Office, trumpcare would increase 20 ins by an average of 2018. In massachusetts alone, premiums for next year could increase by 600, threatening coverage for more than 180,000 of my constituents with private insurance. Because of Everything Else in trumpcare, even though you are paying more, you will be getting less. It is like paying for a cadillac but only getting a tricycle. This will only prevent americans from securing access, through the care and treatment, that they need and they deserve. Less care for more cost. That will be mean or. That will be meaner. Premiums will go up for everyone. Finally, threatening although those in america who have the existing conditions. Allowingny americans, Insurance Companies to refuse coverage or charge more because of a preexisting condition is inhumane and immoral. Tries to buy individual Health Care Insurance before the Affordable Care act remembers this problem. Before the act passed in most states, if you had a preexisting condition you could either be denied coverage, charged a higher premium, or forced to wait for years for the treatment of the condition to be covered. For many people this meant they either had to go without care or spend their entire savings. For those with the most serious conditions it was the difference between life and death. The anxiety of suffering from an illness was only exacerbated by financial insecurity, it was a cruel and unusual form of punishment. Sadly, the republicans want to take us back to this era. Threatening preexisting conditions that might be the meanest of them all. Protections for families that have preexisting conditions is something that goes right to the heart of what the Affordable Care act provided as protections. Why would millions of americans have to suffer these cruelties, these punishments . That that is the most outrageous part of all of this. President trump and the Congressional Republicans are proposing this health care heartlessness so they can give tax breaks to the wealthiest in our country. We heard from President Trump himself last night when he talked about the people he hired for his cabinet. I just dont want a poor person, he said. But who does he want running the government and our economy . He wants the wealthiest people in america. He wants people who are billionaires to be making the decisions of how we run our economy. Place at trump has in goal of turning over to the richest people in our country, the responsibility for putting together the plan to cut the programs for the poor and the working families in our country. The republicans and their wealthy planners have put together a very simple, one step program. The rich get richer and the rest get sicker in the United States. Make no mistake, this Health Care Plan is of the rich, by the rich, and for the rich. It is giving billions in tax breaks to people who dont need or deserve them. Paid for by people who cant handle or afford it. That is cruel, inhumane, immoral, just plain wrong. I and my democratic colleagues will not stand for it. We are standing up to say no, to ripping away coverage for millions of americans. We are raising our voices to say no to increasing costs for middleclass families. We are saying here today that we are going to say no to this legislative malpractice. The health of the American Public is too important for us to be so mean, callous to the people we were elected to serve. This republican proposal has never been about policy. It has always been about politics. It is time to stop playing political games with peoples lives. With health care. Health care is a right and not a privilege. That is the promise we made to the American People with the Affordable Care act and it is a promise that we must keep. The president is keeping his promise to the rich in our country. They have now written a Health Care Plan for 1 6 of our economy that slashes 800 billion that would be used for the poor, for seniorg class citizens and Nursing Homes by 800 billion in order to give an 800 billion tax break to the wealthiest people in our country. That is wrong. This is a critical moment in our countrys history and we as democrats are going to battle every single day here, on the senate floor, and across the country to make sure that every person understands what the consequences of this incredibly mean formean bill will lower quality coverage. An age tax on the elderly, medicaid cuts that hurt families , reduced access to care, threatening the print threatening the protections for preexisting conditions and higher premiums. It will be a disgrace. I yield back the balance of my time. The senator from maryland. Senator cardin i want to thank senator markey for his comments. I share his concerns. I agree with what he has said. The risk factors of the bill that was announced this morning. Y the republican leader what it could do to millions of people around this country. What it will do for coverage for hundreds of thousands of people in my state of maryland who will lose coverage and just about every maryland or whose whose health care would be impacted. I want to start madam president by saying this is a shameful moment for the united date senate. The senate the United States senate. The most delivered a body in the world, the senate which has been known as a body that allows for , benefits from the views of all 100 members, that each of us have opportunities to have our voices heard, that tradition has been damaged by what the majority leader has done in bringing a bill that affects 1 6 of the economy of our country to the floor of the United StatesSenate Without the eration by committees without transparency to the American People. Madam president when i got to the senate i worked hard to get onto the Senate Finance committee. I did that because the jurisdiction in the committee contains areas that i have devoted a good part of my career too. Anduding issues of taxation social programs in our state. It also included health care. An area that i worked on when i was first in the maryland state legislature. I wanted to be on the committee that had a role in developing Health Policy of the nation and thought i could add to that debate with my experience and i wanted to make sure the people as weyland had a voice developed Health Policy in america. President , that role was being denied by what the republican leader is doing in bringing this bill to the floor without the benefit of hearings. Let me repeat that. There has not been one hearing beingn the legislation brought forward by the majority leader. There hasnt been one Committee Markup of the bill. Let me explain to the general public what a markup is. Thes when the bill, committee that has expertise on it, in this case it would be the Health Education and Pensions Committee and the Senate Finance committee, have had the chance to bring the public and to get their views on the legislation. The Committee Staff go through it and explain the aspects to the members of the committee. An opportunity for us to offer billments, to improve the and then ultimately to take a vote on the recommendations of the full senate. That is the regular order on legislation. The regularularly order on complex pieces of legislation. I dont think there is a member of this body who would say this is not a complex field it when we are dealing with health care, 1 6 of our economy. The process that was used denied the people of maryland, the people of this nation, the opportunity to have their voices heard through their elected representatives. It is a shameful moment. President , i know this has been done before, i will repeat it one more time. Compare this to how the Affordable Care act was passed by the United States senate. Transparency, opportunities for the public to have input, hearings, many rings that took place there were around 50 hearings and roundtable discussions. We had 26 consecutive days of senate debate. Were hundreds of amendments offered by democrats and republicans that were before thethe bill bill reached the floor of the United States senate. That took place before we started the debate on the bill. You cannot justify this process. This is an abuse by the majority and it will affect the functioning of the United States senate. More of concerns of what this bill will do. A process terrible, the impact on the senate terrible, but the real tragedy here is the impact if this bill were to become law, the impact it would have on health care in america. Let me talk a little bit about my state of maryland. It has been projected under this bill, that those who will not have Insurance Coverage, will go back to basically what it was prior to the passage of the Affordable Care act. 400,000a little over people who are at risk of losing coverage. As many as 400,000 are in jeopardy of losing their insurance because of what it has alliancesgards to the and Medicaid Program itself. Many more will lose quality coverage. Senator markey talked about preexisting conditions. You claim there is protection for preexisting conditions, but it does not guarantee that the services will be provided. Because the states are given tremendous discretion as to what would be a required benefit, essential benefits within the Health Care Plan. If someone has a mental illness, or someone has a drug addiction, is there a guaranteed coverage that that person would be able to get services . If that person has a preexisting condition, it may very well not be covered because of the absence of essential Health Benefits. Let me give you another example of what could happen under this bill. This is a real example of gender discrimination. For age is critical childbearing woman. If that becomes an optional coverage because of the state isns and the discretion it given, obviously only those women who are planning to have why would someone who does not need that coverage, take the coverage . What are the consequences of allowing that type of choice . It is very clear. Younger women are going to pay a lot more for their Health Insurance then they otherwise would. Is that fair . I think not. Consequences of the type of changes being made in the Affordable Care act. I was very instrumental in making sure that we had full coverage for pediatric dental. Why . Unfortunately, in my state, in 2007, the year i first started in the u. S. Senate, we had a youngster who died because of an untreated tooth decay. Sed and went toyoungster who did his brain and lost his life. What was needed was 80 of dental care. He could not get coverage for it. He had no access to that care. He lost his life in the Health Care System had to pay a lot of when it only needed to spend 80 to keep them healthy. We took care of that with the essential Health Benefits including pediatric dental. Is that protected under the republican bill . The answer is, unclear. Probably not. Up to the states. Different from one state to the other. We do not have the protection. Then, we get to the affordability issue. For marylanders to be able to insurance. Under this bill, there will be discrimination for those that are older who will have to pay more for their Health Insurance. Is that right . No. I heard the majority leader this morning. Give it examples of how the Affordable Care act is in danger. No. And he cited high premium increases. When of the states he quoted was maryland. Which was very misleading the way he did that. He was talking about the individual marketplace and about one segment of that. Andand he what he did not tell s that care first, the insurance proposing that rate increase, indicated that half of the increase is a result of action taken by the Trump Administration. The Trump Administration has not made it clear whether they will fund the costsharing provisions. Which keeps the costs down and affordable in the individual marketplace. That is a self inflicted increase in premiums by the Trump Administration. And the second issue that care first mentioned. President sthe insistence on not enforcing the individual mandate which is in the republican bill that younger, healthier people will choose not to have Health Insurance. Now, if they happen to ride a motorcycle, wrap themselves around a tree and flowed to shock trauma in baltimore, we will treat them but guess who will pay the bill . All of us will through uncompensated care. It will raise everyones insurance policies. That person should have had insurance. But that person thought he or she did not need it. They did not take out the policy. Who willind that those take out the insurance policies are the higher risks because they know they need the insurance. Those with high risk issues will be in the will raising the costs and that is why carefirst has a higher because they know it is less likely that healthier people will be in the pool than under protected under the original Affordable Care act. Why . Because of President Trump. When the leader says the Affordable Care act is falling apart, the Affordable Care act is drawn but it has been made vulnerable i actions of the Trump Administration and provisions in this bill will make it even weaker. Lendersion a maryland 1. 2 million marylanders are in our program. Many of these people are working families. Many of these people are our seniors who need longterm care and are in the Medicaid Program because it pays for their longterm care expenses. Many of these people are veterans who are under the Medicaid Program. Under the republican released bill, they may make it a gentler slope before we get to the full impact of the medicaid reductions but the medicaid reductions, if i understand correctly, are even worse than under the house passed bill. I can speak for merrill lynch. I know our legislature. We will try to do what is right. But they have limited resources to meet the needs that are out there. It is just not right to say that we are passing these problems onto the states when the states do not have the fiscal capacity to deal with it. Who gets hurt . That. 2 million marylanders rely on the Medicaid Program and all marylands and all marylanders that do not want to see cost shift sharing. Why are we doing this . What is the reason why we have gone through this pain . I have heard my colleagues talk about this and it is true. The republicans need to make room for the tax cuts. They are pretty clear about it. Close to 1 trillion in tax cuts. Who benefits from those . The wealthy. Those who have access to health the d to will pay for and who will pay for the tax cuts . The most vulnerable in our community. That is just wrong. My staff has put together a lot of individual letters that have been sent to us. I dont need to go through them. I can tell you experiences i have had walking on the streets of baltimore or quite frankly anywhere, including here in washington. People come up to me and say senator cardin, keep up the fight. Do you know what will happen if the Health Care Bill becomes law . We have done some test and we have certain genes we are in a high risk pool for cancer but we will not be able to get coverage. If you let Insurance Companies go back to their practices from before the Affordable Care act. This is not hypothetical. The leading cause for that was unpaid medical bills before the Affordable Care act. I talked with a parent who has a child with a disability. They go over the costs of that child in the Health Care System. They do not possibly have the means to be able to afford that if they did not have access to Health Coverage without discrimination. Discretions to how the Insurance Companies respond, their business, they will figure out a way that the family with the disabled child will not have adequate coverage. Is at risk. Senator markey is right. Health care should be a right to and not a privilege and we are moving in the wrong direction. Maryland, we have hospitals located throughout our state to meet the needs of the people of maryland. We have hospitals located in areas where they have a lot of elderly or poor people. Because of the way that we deal with our hospital reimbursements, we do not have Cost Shifting. All payer rage. Whoever goes into the hospital pays the same rate. So hospitals can locate in the innercity or a poor neighborhood. If you increase the Cost Shifting and people do not have insurance, Health Care Facilities will not located in those communities. Adding to the costs of everyones health care. One of the great benefits and achievements of the Affordable Care act is we now have facilities more conveniently located to people in this country in rural settings or urban. Some are Health Clinics. But they are located there because more people have thirdparty coverage. They have insurance to pay the bills. I read with interest that certain segments of the Advocacy Community think they will be ok. Medically complex children. Children i assume that have special needs. If i understand the bill correctly, it will be a carveout in the medicaid system so these for a while, will be reimbursed. Where will they get care . Right now, they are getting care in a Health Clinic that will be closed under the republican bill out here. They are not qualified to to receive reimbursement. The expansion will be in deep jeopardy. I have met with the ceos of our that is iners jeopardy of being contracted if you do not have the reimbursements for the people that live in that community that are under medicaid expansion. That is in jeopardy. Do not believe you are protecting any vulnerable populations when you do not provide the structure in which you can have reasonable reimbursements so that doctors, hospitals, and clinics can locate in communities and be treated fairly under our reimbursement structure. Madam president , i am deeply disappointed. I am deeply disappointed in what we have done to this great an importantn such subject. I am deeply concerned that the on regarding the impact that this will have on our nation. And i will join my colleagues to do everything we can during the limited opportunities we have, only on the floor of the senate, to do everything i can to protect the interests of the people of maryland and our nation so health care can be a right to and not a privilege. And with that, metapresident , i yield the floor. Senator from washington. Fromnk my colleague washington for so articulating the issues regarding this draft released this morning as i hear him talking about these complex ,ids and healthy cap will work it reminds me of the book the smartest guys in the room. People cook up schemes they think other people cannot understand or the broader public catch on to, and hope that they can pass something. That is what is going on here a hoax and a scheme that is not costeffective for the american taxpayer, will cut people off of access to the health care, and if this if the house bill is mean, this is doubling down on me. Concepts, if this is a discussion draft, i would hope my colleagues would come to the floor to discuss the concepts in this bill and debate them. But that is not what is happening. In fact, we know very little detail at this point because people are assessing the formation and trying to read and assess between the lines. Well, i can tell you what i know and have gleaned so far by the accounts and that this is a continuation on the war on medicaid. I say that because this war on medicaid, we know what the house decided to do, the premise and structure of the house bill is to cut medicaid by capping it and continually driving down the amount of federal obligation to this program. Notll tell you that it is even a smart idea. If you want to reform and deliver Better Health care at lower costs, there are many ways to do that and save dollars and give better patient care. But that is not what the house proposal is. It is a budget mechanism. I am talking to my Health Care Providers at home. I am talking to university professors. What the house did, and now the senate is doubling down on, is nothing but a budget mechanism to cut people off of health care. Theas my colleagues said, most vulnerable of our population. Idea thatongheaded will not help us control costs. Medicaid reduces bankruptcy rates, helps people stay employed, and boosts our gdp. Want a draconian idea like cutting medicaid as the centerpiece of a Budget Proposal by our colleagues on the other side of the aisle . As people have said a draconian idea like cutting medicaid as the centerpiece of a budget it is because they want to take that revenue and give it away as tax breaks to the wealthy. I guarantee you that is not what we should be doing. Is socess to medicaid important. Our veterans access to Health Care System through medicaid. Many through the v. A. But Many Services also through medicaid. They would be impacted in veterans would lose care. Our children seen at hospitals, Childrens Hospital in seattle, the medicaid population would not have the resources to get access to care. Our institutions covering individuals at the medicaid rates, would take a hitch. All of the all the Senate Proposal does is basically move att cap but at a steeper gap a point in time that makes and exacerbates this problem of cutting people off of access to care. If the house bill was mean, this is doubling down on mean. There is nothing about distracting the safety net that is so important to americans that goes hand in hand with the philosophy about how to drive down costs of health care. They do about it if we came out here and had a discussion with 100 state senators and we said a great way of driving down the cost of health care is to cut people off, most of my colleagues would say that is not a good idea. When people are cut off from health care, we know that uncompensated care, exacerbated health needs, challenges with other parts of our system, delivering care to them, makes it more expensive. When we have had roundtable discussions about the proposal the house put out, providers in my state told me point like covering the medicaid population down andd drive controlled the rates of insurance in the private markets. Now, all we are doing, down and controlled the rates by saying were going to cut medicaid at a more drastic rate, is you are just going to send a signal to that rates for the private insurers should go up. I dont think that is what my constituents want. To innovate, drive quality care and managed care into parts of the United States where it does not exist. They want us to take care of our most vulnerable populations and they want to make sure that we are not delivering that off of people going into the emergency room 50 times in a year because they do not have insurance. Rateow that the medicaid is critically important. To onedicaid costs up quarter of the costs of private insurance. It is a way to deliver care. Intoow that things we put the Affordable Care act like moving people off of nursing home care to communitybased care, has saved medicaid dollars. More states should do it. We know plants like bundling up the individual market into larger programs so they can have clout like others who work for a larger employer, has also driven down costs. Those are the things we should be accelerating. Not the notion that we move forward as a country by cutting the most vulnerable off of health care. I asked my colleagues to come out and discuss this concept, this idea of how it will affect the Health Care Providers in their stage. I plan to do that with my state. I hope they will come out here and tell us why it is a smart strategy to cut people off of medicaid. I know no state that has the money to make up for the federal share of medicaid that will be doubled down in this bill. So, i do not want to see a war on medicaid. What i want to see is innovation. What i want to see is that covering people with some level of insurance basically helps save everybody on their insurance bills as well. Will takecolleagues this discussion draft and be proud to come out and discuss it. But we have heard very little of that thus far. Let us look at the real numbers and i guarantee you that we will hear from governors, states, providers, businesses, we will hear from people who do not think this is a good idea. Already, there are National Associations of area aging saying that this will put consumers on a fiscally precarious path. We have heard from other people that the medicaid cap is up to twice as worse for states and will cause problems. And also, from Childrens Health care groups converting medicaid into a per capita cap would dismantle critical protections to care for all enrollees. These are just partisan comments these are not partisan comments but the facts. Chunk out ofuge medicaid, you are taking a huge chunk out of the safety net that so Many Americans depend on. It will not help us lower costs. It will exacerbate and next to an escalation of rates for everyone in the market. I think the president and i yield the floor. We finally got a