Week, but really over the last year to constituents of mine in the state of connecticut. Emergency field hearings did because no hearing were held by the United States senate. No markups and no votes in committee, what we saw here was complete secrecy, a bill produced behind closed doors and being delighted day for thest first time last day. Republican colleagues have gone from total secrecy to total chaos. The reason for the chaos is the fact most dramatically revealed today, six hours ago when the Congressional Budget Office told us not surprisingly that 22 million americans would be thrown to the rules as a result of this and thrown to the wolves of no Health Care Coverage and 49 million americans eventually would be without Health Care Insurance by 2026. Next year alone, 15 million more people will be uninsured under the republican plan trump care to, low income americans would be able would be unable to afford any plan at all and anybody who does would be payinr higher cost for fewer services of lesser quality. The americans will pay a higher share of their income and receive less. A 64yearold will go from the paying 6800 on the Affordable Care act to 20,500 under the proposal before this body. This is absolutely staggering and it will destroy the Financial Wellbeing of the middleclass americans who also when they need nursing room care after their savings will be thrown to the wolves and i did have one such facility last friday for two thirds when middleclass families find their savings no longer covered. These facts are the reasons for the republican chaos. One of our former colleagues, my mentor, senator Daniel Patrick moynihan famously said everybodys entitled to his own opinion, but not to his own fact. The administration that this cbo is not to be blindly trusted. Nobody has to trust the cbo blindly. Those facts are driven by reality. The report speaks true to power and the American People and the American People get it. None of us can look our constituents in the eye, look ourselves in the mirror, look inside ourselves, in our hearts and justify the vote for this bill. The American People are angry, and many of them because we are even considering that. It is not in anger but its kind of a shrug of the shoulders. It is a deep, vocal or alec anger and i have seen it and heard it at those hearings were a listen to people coming forward and recognizing for what it is a Health Care Bill, a massive tax cut for the wealth we. Just friday afternoon, one of the folks who attended the mic hearing came to the microphone and said dont call us a Health Care Bill. It is a well scared bill and in fact, she is absolutely right. This bill cuts. Ichest so that they will do better, but it also cuts 800 billion in medicaid spending and investment to provide for that kind of tax cut. It is not a Health Care Bill. It is a wealth care bill. And for most americans, it is a for most americans, it is a a catastrophic, cool and costly insult to their intelligence, their health, and our american values. It is a sham. Making possible those cuts for the rich, tax cuts for them at the expense of our most vulnerable citizens and it is the result of a profoundly undemocratic process, secrecy and speed. Despite best efforts of our republican colleagues to keep americans in the dark, on what this proposal would do i have seen growing awareness, not only at these hearings but as we walk through the airport, as i marched in parades twice over this weekend. Whether it is boy state sponsored by the american legion, 16 and 17yearolds, nursing facilities, elderly citizens, a growing awareness that this bill is bad, profoundly bad for the American People. The people i have heard from have prescriptions to fill, appointments to make, but they have come on short notice in newhaven, literally filling rooms so that there was standing room only. I challenge my colleagues to hold the same kind of hearings, to delay this vote so they can go home at the end this weekend hold hearings in their state, listen to their constituents what they have to sayand what the consequences will be. One in ten veterans have medicaid coverage meaning a staggering 1. 75 million veterans including 18,000 veterans in connecticut will be impacted by these reckless cuts. Let me repeat that number. For all of us that rejoice in the recent accountability and whistleblowers act, 1. 75 million veterans, 18,000 of them in connecticut would be harmed by this reckless and needless, insult and injury. It would be harder for veterans with Mental Health disorders like posttraumatic stress to get care. To receive care for Mental Health disorders outside the va system meaning they rely on protections that guarantee their assets to Affordable Care. Those protections would be severely threatened and veterans who need that care would see that care at risk. Here we are talking about choice, enables veterans to seek care outside the va system, practicing and we are endangering care for millions of americans, veterans who need and seek it by using medicaid. Of my colleagues listen to their constituents, they will hear from many people who have come to my town hall, like christine, christina has two beautiful 4yearold twins named mckenzie and cameron. Mckenzie was born with willi syndrome, a rare genetic disorder that her mom described as, quote, including low muscle tone, seizures, temperature instability, fertility, infertility, ocd and developmental delay. In the first few weeks of her life mckenzie was in the hospital for 57 days accounting for 2 million in costs. The family was spending 30,000 a year to help their daughter thrive. When christine learned that her daughter had received a waiver to become a medicaid beneficiary, she was overjoyed. She told me, when we received mckenzies diagnosis we were told they would do a lot of things and that only 4 years old, already defying the odds. If we were able to continue down our current path of proper therapies and doctors, mackenzie will be able to have her fruitful life. Im terrified, if the rug comes out beneath her, just another statistic. Another statistic. There are enough statistics in that cbo report. We will hear a plethora of statistics on the floor. It is about more than words and many more than 1000 statistics and nose them, no one should be consigned to bea statistic. One of many faces, pictures and stories of medicaid, they deserve to be heard. If we strip away the Important Services we know all too well what will happen to mckenzie and her family as statistics. Medicaid has go to the record. And i will place kents testimony in the record along with all of the testimony that we heard last friday as i did the testimony from mondays Emergency Health i did the testimony from the Emergency Health care hearing. Thank you, mister president. Washington, please listen to me carefully. I end up in the hospital, the state and federal government much more money than it would be then going to the pharmacy, to pick up my medication. If there were ever a message, from kent obrien who closed by saying simply, quote, dont hurt the American People. If you met kent, you would wonder how he was capable of that. And ordinary american, someone who looks like all the rest of us but he said to this body what it needs to hear. Dont hurt the American People and he couldnt be more right. This proposal would cost our nation not just financially but morally. It would lead to a weakening of what makes our country strong and great in the first place. To fight for what is right and listen to the people we represent in the United States. First do no harm. That is the medical profession, what it is. And it ought to be our mantra as well. It out to be what my colleagues, if nothing else, if we reach this decision, to listen to people who send you hear and hear their story. Listen to the anxiety and fears and values of america. That will tell you what you need to know about this bill. He said the cost, the cost will be staggering. Not just in financial terms but human terms. This bill written behind closed doors away from the light of day, the realities of medical care, the voices and faces i brought to the floor today and i will continue to bring, ignore the most important thing we can do this week, as kent said, dont hurt the American People. First, do no harm. Thank you, mister president. Senator from maryland. Thank you, mister president. I want to start by thanking my colleagues from the state of connecticut for bringing those powerful testimonies to the floor of the United States senate. All of us, all 100 of us spend back home in our state listening to people telling us those kinds of stories. I have gotten over 2500 phone calls in my office since thursday, all of them strongly opposed to this healthcare proposal, socalled healthcare proposal. Some things improve with time. Some things improve with age like red wine. Some things get stinky or and smelly are the longer they sit out there. Like rotten things. That is the case with this series of republican socalled healthcare bills, healthcare 2. 0, trumpcare 3. 0. They are all rotten to the core and the more they sit out there, the stink years a guess and the American People know it. Take a look at the most recent Congressional Budget Office report we have today. And these Congressional Budget Office reports, and this latest version, and here is the pattern, tens of millions of americans will lose access to affordable healthcare in the United States of america in order to provide tax breaks for powerful special interests then richer americans, that is the pattern in this most recent report. We were told by the nonpartisan professionals at the Budget Office 20 million american will lose access to affordable healthcare. To give powerful special interests, a tax break and what the americans. Insurance companies, and the bonuses to their ceos. Tens of millions lose access to Affordable Care, millionaires in america, average annual tax break of 50,000 every year. And it has nothing to do with healthcare and everything to do with wealth care and transferring wealth from more struggling vulnerable americans to the very wealthy. If this was about healthcare, why is it we have all gotten in our offices long lists from Patient Advocacy organizations that are dead set against this legislation. These are dedicated to trying to improve healthcare for people and patients in our country, the american cancer society, the American Diabetes association, the american heart association, the American Lung association, National Alliance on mental illness, National Breast cancer coalition, National Multiple Sclerosis society, the list goes on and on from organizations the dedicated themselves to advancing patient health. On the other side i havent seen a single, not one, Patient Advocacy group that has come out to support the socalled healthcare bill. If this is good for the health of our fellow citizens why is it we have a long list of organizations dedicated to that cause against it and not one for it . How about healthcare providers, the folks who provide the care to our constituents are dead set against it. The nurses, the doctors, the hospitals, the people who have that network of care. I was on the Eastern Shore of maryland, rural part of our state. The world Hospital Association opposed to this bill. They know the people they serve will be badly hurt and it is also going to hurt the economies especially rural parts of the states, those hospitals depend heavily on many people who get help the Affordable Care act rather than the exchanges through expanded medicaid. As this patients come in the door and can no longer pay for their care, closing down operations. Lay people off, double whammy, bad for those provide the care. That is why aarp has been allout against this because they know that for americans between the ages of 50, and 64 before they get on medicare, this is a disaster, there is an age tax. If you are older you are going to pay a whole lot more under this republican bill then we pay today. Many people just realizing as they follow this debate that two out of three americans in Nursing Homes today are supported by medicaid payments. Millions of our fellow americans who now get their care in Nursing Homes where medicaid is providing support for two out of three are going to be put at risk and made vulnerable because of this legislation. Remember, donald trump said he wasnt going to cut medicaid. On this issue, this senate bill is a lot meaner than the house bill. We all know donald trump out in the rose garden celebrating the passage of the house bill, behind closed doors, what did he call it . Mean. This senate bill as time goes on will cut medicaid far more deeply than the house bill. As you look at his Congressional Budget Office reported talks about how you get to the end of your 8, 9, 10 and go beyond that you have very deep cuts, much more painful, much meaner than in the senate bill. And mister president , we have heard a lot about preexisting conditions. The reality is the senate bill is very devious in this regard, a great slate of hand. On the one hand it creates the impression that if you have preexisting conditions you are going to be all right. What it pretends to give with one hand it takes away with the other and makes those americans vulnerable as they were before passage Russell Senate Office Building the character. I am not talking about those who were directly benefiting, like those on expanded medicaid or the exchanges. Im talking about those benefiting from patient protections in the Affordable Care act. I just got a note from mark in the state of maryland saying my son was diagnosed with Crohns Disease in 2008 at age 18. He was repeatedly denied insurance and was only able to cover part of the cost of care through the maryland high risk pool. It was obamacare that made it possible for him to be insured and care for his disease. It was obamacare that, quote, will literally save his life and we have many stories like that from others who were denied access to care because of preexisting conditions before the Affordable Care act. Mister president , there is another major sleightofhand in this Senate Republican proposal. That relates to premiums. We have been hearing a lot from Republican Senate colleagues about how this is going to bring down the price of premiums. We all know what Americans Care about is what they are having to put out total for their health care. Premium this. How much is the deductible . I got a lower premium but my deductible is 10,000. Copays. Here is the dirty little secret if you dig into the Congressional Budget Office report after listening to Many Republican colleagues talk about premiums, got to translate a little bit because this is in the Congressional Budget Office, what they say on page 9 is, and i quote, some people and rolled in nongroup insurance, individual markets, people currently in the Affordable Care act exchanges would experience substantial increases in what they would spend on healthcare even though benchmark premiums would decline years later. Translation, in some cases the premium, the Sticker Price may go down but you will pay a lot more when it comes to your deductible and your copay. It goes on because nongroup insurance and individual markets would pay for a smaller average share of benefits under this legislation most people purchasing it would have higher outofpocket spending on healthcare than under current law and it goes on and on. In other words, keep your eye on the ball, america. When someone tells you your premiums are going to go down, watch what happens to your other healthcare costs in the Congressional Budget Office, the nonpartisan analysts are telling you they are going up. So mister president , this brings me to my final point. I said at the beginning that some things get better with time and some things get stinky her and smelly her. We know that the more the American People get a look at this latest Senate Republican proposal, trump care 3. 0, we know the more they get a look at it the less they are going to like it. The more they see it, the more they will hate it. Just like something that is rotten get stinky her with time, this will get worse and worse with time. And that is why it is so important we dont try to jim this through the United States senate. I understand the republican leader knows this thing is rotten to its core and the more it sets out there, the more people are going to see what it is about and the more they are going to hate it. Lets have a full debate and make sure we go back to our states after the fourth of july come of the parades and barbecues and picnics and look our constituents in the eye and tell them we are going to take away healthcare for tens of millions of americans, the we are going to open up the discrimination for preexisting conditions and increase their healthcare costs even though we tell them we are reducing assemblies lets look them in the eye and tell them what this bill is all about rather than try to push it through and 24, 48 hours, our constituents deserve to know the facts and we need to vote to protect the interests of the United States of america, not just provided on tax breaks to powerful special interests, and i thank you, mister president. Mister president. Senator from hawaii. You might for the last seven years the major complaint people had about the Affordable Care act was that it hurt rich people because they seem to be the only people who stand to gain with this Republican Senate health care plan. They get a giant tax break. The rest of america on the other hand is in trouble with trumpcare, it will cost more, 22 Million People are going to lose their healthcare altogether. Some Health Care Bill. To put this in perspective imagine if everyone lost their healthcare in hawaii, maine, nevada, alaska, West Virginia, ohio, idaho, wyoming. That is what trumpcare does. That is 22 million americans. It also devastates one of the best Health Care Programs this country has. With this bill medicaid is going to lose nearly 800 billion. If youre only worry is that your Investment Income gets taxed at 3. 8 every year, you can breathe a sigh of relief, let me drill down on that. One of the most egregious tax breaks in this bill, mostly a taxcut bill and not a Health Care Bill is the following. If you are making 200,000 as an individual, Capital Gains income is taxed at 3. 8 , making 200 as an individual or a quarter Million Dollars as a couple, you have Capital Gains, 3. 8 . This bill the euros that tax out. This bill zeros that tax out and on top of that it is retroactive. Think about the absurdity here. Here we are, looking at the senator from pennsylvania and how much he has advocated for children especially children with disabilities, the senator from connecticut, the work with chronic diseases. And the resources for that, and supposedly oriented towards healthcare legislation, we are giving a retroactive Capital Gains tax cut for people who make over a quarter of 1 million a year in combined income. If you have a loved one in a nursing home, if you are pregnant or thinking of having a baby, if your kid has a disability and requires costly care, and this bill does not take care of you. Instead of less taxes you get less care and you will pay more for it. This is what happens when legislators dont have Committee Hearings or refused to meet with patients, doctors, nurses, advocates, their only constituents, there have been so few town halls about healthcare. There have been so few real Senate Debates about healthcare. Every Senate Democratic member of the senate has come down and talked about this piece of legislation and every single republican member of the senate talk about legislation they are proud of. I have seen very few people on the republican side of the aisle come down and talk about this bill. Because they know it is not a good piece of legislation. At this point we are not even debating healthcare policy. It is not a question of what is the best way to get people to sign up for insurance or how can we lower premiums and deductibles, how can we improve the delivery system, it is a question of how many people are going to lose their healthcare so Insurance Company ceos can continue to make millions of dollars a year. That is what is in this bill, though the conversations we are having, nothing related to reforming the Health Care System or getting people more coverage or less but tax cuts for people who are involved in the healthcare industry. How many grandparents will get kicked out of Nursing Homes . It is not a rhetorical question. My wifes grandmother was in a nursing home two months ago, beautiful facility, took great care of her. Three nursing home beds, normal reimbursement 9000 a month, it took care of my wifes grandmother. They dont exist, that nursing home and all the Nursing Homes like it dont exist if there is an 800 million cut to medicaid. This is not a theoretical conversation or a partisan conversation. Everyone has nursing home beds in all of your home states and everybody at least ought to know some middleclass people who rely on medicaid for Nursing Homes. Cbo gave us the answer today. Too many people are going to be locked out of the Healthcare System if this bill goes forward and offer a giant tax cut. Our Healthcare System is not perfect. Changes need to be made, but this bill is not it. It has no clear guiding principle other than slashing medicaid to pay for tax cuts. We have to start over. Im looking at a presiding officer who is speaker of the house in North Carolina who understands how to do a bill on a bipartisan basis. I am thinking of numerous republicans capable of working on a bipartisan bill that can get 60 votes. The politics would change. If we worked on a bill that could get 60 votes we would be in a wonderful position, the senate is set up to encourage us to Work Together because if we abide by that 60 vote threshold and come up with a bill together we own the american Healthcare System together. We dont get to play this blame game about what is happening with premiums or coverage numbers. We, on the level, collaborate. When you think of an issue as partisan as Public Education you have Lamar Alexander and patty murray coming together. In the last congress, you had jim inhalf and Barbara Boxer doing a bill together. It is possible to do a bipartisan piece of legislation but the decision was made code to go with reconciliation and that has backfired because the problem with not involving democrats is there are democrats across the country. The problem with not involving experts is you end up with a product that you cant defend. What we really need to do is take a breath, take 4 july weekend and reconvene, as americans who understand the Healthcare System is not perfect, in need of improvement, but this bill doesnt get it done. I yield floor. Senator from connecticut. Thank you, mister president. I want to pick up where my colleague in hawaii left off, there was a wonderful analogy president obama used after the 2016 election as you can imagine. President obama, put it pretty simply, these are intramural scrimmages. Temporary pennies, republicans and democrats. We belong to the same team, legislative fights, temporary skirmishs and realize greater identity, we have this, now money. That is what the American People see, they think our primary identity is our partisan identity. There are a lot of days we give them fodder for that belief. It is amazing when it comes down to it, when you think about the Healthcare System, we do have the same goals in mind. There are lots of issues we dont have the same goals. We want to go left or right. We want to go left. On healthcare we all went to get to the same place which is more people have access to Health Insurance, the costs of their insurance is less than what it is today, the quality of the care is better. Underneath that it is mechanics. Is not actually ideology, it is a decision as to which lever you press and which you dont and i get that a lot of my republican colleagues dont think we are sincere. This monstrosity of a bill aside, we will work with you to do Something Better but it is sincere. We dont want to blow up medicaid, we had dont want to pass along big tax breaks, and we want more flexibility. You want an additional plan on the exchanges, all the bells and whistles the existing plans to. We want some certainty in the markets. Going forward. There is an important conversation to be had. It will be the straw that breaks the camels back that cause republican colleagues to give up this nonsensical approach to Health Care Reform and work with us. So many ground covered in the last few minutes, i want to go over the highlights of this cbo report. It is hard to get your head wrapped around what it means to 22 Million People to lose insurance, the cbo score on the house bill under their approach 23 Million People will lose insurance the x that out, we have 22 Million People that leaves insurance under the senate approach, that is the combined population of alaska, delaware, kansas, maine, montana, nebraska, nevada, new hampshire, new mexico, north dakota, West Virginia and south dakota. All that happened between the house and senate bill is rhode island, about 1 Million People so 1 Million People, more, will have insurance under the senate bill. That is humanitarian catastrophe. That is a big deal, that many people lose insurance. That is not what you set out to do. I know republicans did not set out to do this, i listen to senator cornyn complain on the senate floor relentlessly that the Affordable Care act still left people without insurance. He sent out a tweet today highlighting that the cbo does confirm if current law continues there will be a lot of people without insurance. The cbo says under the republican bill, 22 million more people lose insurance. That is a lot of people and by the way, in the first year, people lose insurance. That happens next year. In 12 months, 15 Million People losing insurance. All the folks that say the aca is in a death spiral the cbo says you are wrong. Very flatly. The cbo says existing law remains, even without any improvements the number of people without insurance effectively remains the same. If you make no improvements you will go from 26 Million People not having insurance to 28 Million People having insurance. Cbo it used to be 51 million under the house bill. Cbo says 49 Million People will lose insurance if you pass the bill the senate is going to consider this week. The death spiral happens if we pass the republican healthcare proposal. That is not a death spiral, that is stability, not an optimal result, 20 Million People having insurance but it is preferable to 49 Million People, republicans will quibble with cbos, even if they were 50 wrong, that is over 10 Million People losing insurance. For good measure cbo was right in their estimate of americans who have insurance under the Affordable Care act inside their estimate, the details worked out differently but they said by 2016, 89 of americans have Health Insurance up from 83 prior to the passage of the Affordable Care act. How many have Health Insurance . 89 of americans, 90 of americans. We all agree premiums should go down. If we pass something the results to be premiums go down. Premiums go up not by a little bit, they go up by 20 in the first year. After that, admittedly, i admit i am painting a partial picture here, after that, cbo says for certain populations premiums will go down but largely for the young, healthy and wealthy. Cbo says you have massive premium increases for older americans, lower income americans in the 50 to 54 age, your premium increases go up by at least two times, up to four times and cbo says if your lower income, youre not going to buy insurance because you cant afford it, it doesnt matter what your premiums are because it will be so high you cant afford it. Premiums go up for everybody off the bat and for lots of people after that. Who gets hurt . Everybody except for folks getting tax cuts. If your Insurance Company, or superrich, that is an unfair term for people making 200,000 or more a year get tax cuts but most tax cuts go to the superrich. Your Insurance Company, drug company or very wealthy, you get a great deal out of this legislation but everybody else gets badly hurt. One of our republican colleagues today said this to a reporter. I wont give you a name. One of our Republican Senate colleagues said when he was asked about the republican healthcare proposal, quote, i am not sure what it does. I just know it is better than obamacare. I am not sure what it does. I just know it is better than obamacare. That is as perfect an encapsulation of the republican positioning on this bill as i can imagine because if you did know what it did, if my republican colleagues to get deep into the cbo report it doesnt solve a single problem in the american Healthcare System. 26 Million People still dont have insurance. This bill makes it worse. People are paying too much for insurance. Especially those folks making committal incomes who are just outside of qualifying for aca subsidies, this makes it worse. Almost every problem is made worse by this piece of legislation and that is sort of what a lot of americans wonder. If our republican colleagues do know what is in this bill. I am not sure what it does, i just know it is better than obamacare. This solves one problem for republicans, a political problem. Republicans said for the last eight years you were going to repeal the Affordable Care act. My republican friends promised in every corner of this country at every opportunity they have, this does solve that political problem. If you pass this bill you can successfully claim that you have repealed the Affordable Care act but that is the only problem that it solves. It makes almost every other problem in the system worst. Number of people with insurance go up, premiums especially for the poor and vulnerable go up, nothing in this bill that addresses the costs of healthcare, of drugs, devices, procedures, nothing in this bill talks about the quality of healthcare. Every problem, virtually every problem in the Healthcare System gets worse. I just end by reiterating the offer, a lot of people of very good will that want to work with republicans, are sincere about it. I will be part of whatever group gets put together if this bill falls apart this week because i held an emergency hearing in newhaven, connecticut on monday just to explain to people what was in the Republican Senate proposal and get peoples feedback. It was hard to sit through, it was 21 2 hours of some really scared folks. I will be honest with the presiding officer, most of the people had disabled kids. Most of the people had disabled kids who relied on medicaid and they were scared to death about what was going to happen to their children. They also talked about problems that still exist in the Healthcare System, the fact their drugs were too expensive, that many paid too much for healthcare, wanted us to work with republicans on it. If we did this together we would own it together. It would stop being a political football. That would be a secondary benefit to the actual good that would come from a bipartisan piece of legislation that addresses the issues in the underlying Healthcare System it would be a pretty remarkable good. It is possible because we have the same goals in mind. We both want the same things. In the end, putting aside this bill that makes all of those problems worse instead sitting down together and deciding which leverage we want to push to make better. I yield the floor. The senator from pennsylvania. Thank you, mister president. I rise to talk about the issue of healthcare. I think my colleague from connecticut for looking down the road when we can Work Together on this issue. We are in conflict this week, that is not a place any of us want to be. I want to ask consent for two things this evening. One with regard to my staff, i ask unanimous consent the christopher freeze, congressional fellow on my staff be granted four privileges for the duration of the debate on the better reconciliation. Without objection. And additional consent request. We are in conflict because of the elements of this bill. I will make two basic points in my remarks, one about medicaid and one point about another provision in the bill which is particularly insulting. A lot of discussion start with policy and data and that is important, part of the debate about the bill and what impact on programs, part of this debate about people you represent, the presiding officer understands this, it is important to take attention to our arguments. Grateful for his attention. I talked on this floor over the past couple weeks, even months and i wont repeat the stories that have been told a number of times but simpson is a young man i recently met. His mom sent me a letter. Rowan is on the autism spectrum at his mom is worried about his future because of the potential impact on medicaid and the benefits he is getting from medicaid, just referred the other day, thursday on the floor to a letter from a dad about his son, anthony who has a number of challenges, one of them being one of several, one of four that he is on the autism spectrum. Another letter as well which i wont go through tonight, a mom in northeastern pennsylvania writing to me about two of her children, principally her son who has type i diabetes and what the loss of medicaid coverage will mean for that child. In this case just 4 years old. Everyone in this chamber in both parties has stories like this to tell, stories about people totally dependent because of a disability, medicaid, not unique to one state, to one party. One of the more egregious and objectionable parts of this 140 page bill is the impact on medicaid, the Medicaid Expansion, many people know represents on the order of 11 Million People that got healthcare coverage since 2010 got that coverage because medicaid was expanded, with the per capita, capping the dollars the federal government would provide in the future with regard to the federal state partnership on medicaid. These are big stakes. When it comes to a program that has been with us for 50 years and as everyone knows, medicaid is principally about individuals with disabilities and that is those children, folks who need help getting into a nursing home, senior citizens, and kids from low income areas that have no other healthcare, 1. 1 million kids on medicaid from low income families, disability number of children and adults by one estimate more than 722,000 people. Hundreds or thousands, as i refer to, the numbers are higher than that. Those stories and those pleas for help from those families obviously not just inform us but inspire us to keep working, keep fighting and as long as it takes, we will likely have a vote this week. Im assuming we will. We have hours and a few days to fight and point out what we believe to be the defects. One thing that is significant about this debate, we have people not just writing those stories but telling us their story, telling us and giving us ideas of how to conduct the debate, how to fight and oppose it. I will describe it first before offering a consent request but i have in my hand, several pages that list 600 names from people in pennsylvania have written to me over the past number of weeks and months and there is a legislative strategy to protect their health care. They are worried, these people are really worried, worried about those kids like rowan and anthony, and a 4yearold with type i diabetes or a long list of other disabilities a lot of kids have, worried about their parents who may not be able to get the longterm care they need if medicaid is capped. They are worried about their friends and families, they are worried as anyone has ever been about the healthcare of those they love and the healthcare of those they care about. Writing and going to meetings or making phone calls or engaging in such a robust way all these weeks and months. With regard to this particular list i ask consent that this list of 600 names from pennsylvanians be made part of the record. Without objection. I will make two final points about medicaid and juxtapose medicaid with another part of the bill. If you look at the bill, 142 pages, 60 pages deal with medicaid so this is principally a bill about medicaid. All the issues addressed on the exchanges and fundamentals of healthcare but mostly about medicaid and tax cuts and that is particularly objectionable to me, that you have a small group of very wealthy people that will make out in ways we cant even imagine, like a big bonanza for the superrich. Let me talk about the medicaid part of it and referred to a chart. Im holding in my hand the Congressional Budget Office report from today which came out, documents produced by the Congressional Budget Office as well as the joint committee on taxation, a joint effort. On the socalled cbo, Congressional Budget Office report from recently, a couple weeks ago on page 17 of that document there was an assessment made of the number of people who would lose medicaid as a result of the house bill and that number was 14 million americans would lose medicaid over the decade up until 2026. Unfortunately as of 4 something this afternoon, i guess 4 00 or 4 30 we got the Congressional Budget Office assessment of the senate bill so the senate bill was unveiled last week, on page 17 in this report, page 16, here is what the Congressional Budget Office and the joint committee on taxation says about enrollment in medicaid. The bottom of page 16. Enrollment in medicaid would be lower throughout the coming decade with 15 million fewer medicaid enrollees by 2026 then projected under current law in cbos march of 2016 baseline and they referred to a figure in the report. So house bill cbo assessment says 14 million will lose medicaid coverage, senate bill analyzed by cbo which is supposed to be a more moderate bill, better bill in the eyes of some republican members of the house and senate, that was supposed to be better but here is what we know, 15 Million People will lose medicaid. That alone should cause any senator to be very concerned about the impact of this legislation. That alone should, i hope, require some people to use an old expression. Examine your conscience about what will happen if you vote for this legislation. Lets say someone says i can put that into context and i think actually that wont happen or i have another explanation or whatever justification or rationale you use for boating the best voting for a bill that will result in 15 Million People losing medicaid coverage, lets just say you can analyze that a different way and come to a different conclusion. We will see how people deal with that numbers this week and when they go home and have to talk about this legislation over time but here is where it gets a lot worse. This is a chart that is rather simple even though it has a lot of data on it. Here is what it says at the top of. The center on budget policy priorities. You can go to see vpp. Org and see it. This is based upon the house bill. I just told you the Medicaid Enrollment number is 1 million higher, the number losing medicaid is 1 million higher under the senate bill and the tax cuts in the senate bill are almost identical. You can go down and count them, the house and senate will are virtually identical on tax cuts. Here is what the headline is. Tax cuts for top 400 roughly equal to federal spending cuts from ending Medicaid Expansion. I said before Medicaid Expansion is one problem that i see. The per capita is another, this chart deals with one of the medicaid problems, Medicaid Expansion. Ending Medicaid Expansion in nevada, West Virginia, arkansas, alaska, four states. Alaska, they project will lose 2 billion worth in medicaid over the decades. Arkansas would lose 7, West Virginia would lose 12, nevada would lose 12. That adds up to 33 billion, federal medicaid cuts from ending Medicaid Expansion. 33 billion just for states. Not really high population states, no california, new york, texas or big states like that. 3 billion lost in medicaid, 33 billion lost in medicaid, what is this . The orange bar graph shows the same number, 33 billion, tax cuts for the 400 highest income households in the country, the same number. So 400 households get a tax cut of 33 billion, not in some other bill down the road, not in some other year, not in the budget bill or tax bill, they get this massive tax cut in what is called the healthcare bill. At the same time, it is equivalent to the total medicaid loss in just four states, it gets worse if you add more states. Guess what . You can add 30 states in a different chart. It is about the same with all the taxcut together but here we are talking about four states, 400 families. I hope i am not offending anyone if they are in the top 400 households, who are making either billions or by one estimate, the average might be 300 million. It is difficult to make ends meat, you have been struggling, trying to pay the mortgage or the light bill when you are one of the top 400 richest households in the country. But this chart, when you juxtapose this chart especially the orange part, the taxcut for 400 families, the giveaway to families that dont need it, frankly they dont even want this tax cut but i havent found one person who came up to me in the last couple years and said i wish my taxes didnt go a. I was the taxes didnt go up while you were trying to help people in medicaid. That will get this tax cut would rather, would rather that we make sure that we take care of those children i mentioned with a disability or those families who need the protection of medicaid. When you put this chart next to the policy and those 60plus pages of the decimation of medicaid, there are a lot of words we could use that were not allowed to use on this not allowed to use on this on this floor, but one of the words we should use is obscene. Thats an obscenity, when you match these cuts for 400 families next to the cuts to medicaid. That is obscene and obnoxious and bad policy. It there were ever a reason to take this 142 page bill and throw it in the trash, throw it in a garbage pail as fast as we can come it would be this chart. Because thats not what thell American People are asking for. They actually think that some people in the senate are actually working on a Health Care Bill. Thats what they believe. A lot of people dont know about this yet, but they are going to know. Nd theyre going to know by the end of the week at least if not sooner. Its the 400 richest households in the country are getting that much money, 33 billion. Maybe in the senate bill its only 32 billion or 31 billion. So we will stand corrected if it goes down. But that is really an abomination. Thats an insult to the American People. People should be ashamed that this is part of that bill. I did it, we can have a debate about medicaid. I get that, but when youre taking medicaid dollars and transferring to wealthy people, no one should support that kind of a policy. But thats what we have. Thats what we are up against. And if there is ever a reason to fight to the end of the earth against a piece of legislation, it is this pic where going to continue to fight this. Were going to continue to point out this basic inequity, this insult for the rest of this week. We hope, we help that folks on both sides of the aisle will not only be listening but we hope our republican friends will take this understand how objectionable this is to so Many American families. All that worried that i talked about before is made worse, is y aggravated by this kind of result when it comes to tax a cuts. So we can do all that as a great nation. We can make sure that wealthyn a folks who need a break once in a while, they have gotten a lot of them in the last 25 years, that they can get a fair tax code. We can also make sure that kids with disabilities, seniors and kids in rural areas and big cities and small towns can get the health care they need from medicaid. C we are a great country. We can do that. We can have a growing economy and so support a criticallyy would medicaid. Mr. President , with that i would yield the floor. Mr. President . The senator from massachusetts. Thank you, mr. President. Mr. President , we just got the latest on the Senate Republicans reckless plan to take away Health Insurance for millions ol american families, taken away from sick and locates, away from seniors in Nursing Homes. And these numbers are worse than anyone expected. After weeks of secret work behind closed doors the republicans came up with a plan that will take away Health Insurance from 22 Million People, and slash the Medicaid Program by nearly 800 billion. All in exchange for shoveling hundreds of billions of dollars of tax cuts to the richest families in this country. You know, with results like the Senate Republicans should not still be trying to figure out the best way to ram this bill through the senate. They should just throw it in the trash your we dont have a lot of time left and i know its easy to tune out these debates, to assume this is all just a bunch of partisan games. If you are inclined to take my word for it, then dont. And dont take the republicans were for it either. Take a look at what the experts are saying about the republican bill. Because sense of this brutal bill was finally revealed on thursday, it is been denounced by nonpartisan doctors groups, Health Policy experts, and patient organizations. The American Medical Association says the bill violates the fundamental principle of medicine. First, do no harm. The childrens Hospital Association says it is quote a major step backwards for children and their health. At the National Council for Behavioral Health says, instead of repeal and replace, it is rack and recapping. D of lynn necklace, the head of the Massachusetts Health and Hospital Association has come up with a Pretty Simple test for the republican plan. I challenge any republican senator to name one thing in this bill that will make health care in the u. S. Better for patients or Health Care Professionals who care for them. Think about that. T she says you have to test one thing. Thats a pretty low bar, one thing. , and yet the republicans cant pass that test. They cant name one thing in this bill that will improve health care in america. Thats because this bill is not supposed to improve health care in america. Il it is not a Health Care Bill. It is a tax cut for the rich, paid for by guiding health care by millions of working americans. Doctors, patients, parents, families, experts, are terrified by this bill. Terrified because they have read it and it concluded that nearly every line in this bill would make life worse for young people and for old people and for families across this country. So i would to focus on just one major part tonight, part the ritz away that Medicaid Program. Lets do some basic medicaid fax. Who uses medicaid. 30 million kids, thats about four out of every ten kids in this country. Count on medicaid to help pay the medical bills. About six at ten children with complex medical needs, children who need breathing tubes and special therapies and multiple surgeries, six out of ten of those children count on medicaid to help pay their medical bill. Nearly two out of three seniors in Nursing Homes count on medicaid to help pay their bills. And one out of every three people dealing with addiction counseling medicaid to help pay for treatment. Who uses medicaid . America uses medicaid. Children, the elderly, hardworking families, people with disabilities, people struggling with addiction. At any given moment in thisvery country, one in every five americans is counting on medicaid to help pay the bills. So what are these people supposed to do when the Medicaid Expansion goes away . When this bills additional massive medicaid cuts go into affect . What are they supposed to do . What are their families supposed to do . Opioid one issue around this, digging on opioid induced. This is a problem that is growing around the country. Last year we lost 2000 people in massachusetts alone. Ts i hear from parents who have lost children from brothers and assisters who have watched a loved one disappear. I get from people who are desperate because their child or sister or brother cant get into a treatment facility. I hear from dedicated doctors and nurses and counselors who need more resources so they can expand treatment programs. Rep and now the republicans propose a bill that is like throwing gasoline on the bonfire. One in three people struggling with an addiction are counting on medicaid, and the republicans plan to cut nearly 1 trillion on the program. I do not understand. I cannot understand how the republicans could turn their backs on literally millions of people who need help. The cuts to medicaid are terrible, but there is more. The republican bill also slashes the tax credits that people used to help pay for insurance. The budget nerds at the Congressional Budget Office say that quote most people, most people would quote have higher outofpocket spending on health care than under current law. Think about that. Ts under the republican plan, Health Care Costs will go up fon most people. And even if someone can manage somehow to afford coverage under the republican bill, the republicans are willing to let Insurance Companies drop expensive benefits that they Companies Just dont want to cover, including, are you ready next opioid treatment. If this bill passes, it will devastate our ability to fightca opioid overdoses. This is an hypothetical. This isnt speculation. Before the Affordable Care act became law, onethird of individual Market Health plans, just didnt cover Substance Use disorder services. About one in five plans didnt cover Mental Health services. The Insurance Companies dont want to cover these services, mand but daca made coverage mandatory. And that meant that no one in a this country had to wonder when they showed up in a clinic whether or not their insurance would help them out. But the republican bill opens the door to dropping those requirements. Millions more people could be left out in the cold at a time when they most need help. This is cruel. Our country is already struggling with a treatment gap, and far too many patients facing addiction cant get the care l they need. The last thing, the last thing we should be doing is taking millions of these patients off the coverage they already have. Now, lets face it. The republicans realize they have a plan on this issue. They know that what they are doing is indefensible. So they have a plan. They propose to throw 2 billion into a special fund for opioid treatment and say problem solved. This is political spin at its worst. For every dollar the republicans propose to put into opioid treatment, they are taking out more than 100 from medicaid. The rock on which our ability to provide opioid Addiction Treatment is built. And why lex why treat our brothers and assisters, our chis elderly parents so shamefully . Why . Ns so that the republicans canut produce a giant tax cut for a handful of millionaires and billionaires. Thats it. Our friends, our families, our kids can struggle on their own. They can die on their own so the republicans can cut taxes for the richest people in this country. But the republicans propose is morally wrong. It is not too late to do the right thing. It is not too late to reverse course. It is not too late to jump this bill and start over. I hope the Senate Republicans have the courage to do exactly that. Mr. President , i yield. Mr. President . The senator from colorado. Thank you, mr. President. Coe i want to thank my colleagues from colorado and pennsylvania. U i noticed my calls on the other side of the aisle are not here tonight to defend this piece of legislation. It doesnt surprise me given whats in the legislation, and given what weve heard over the last week. The senator from massachusetts explaining what it was we were trying to do when we passed the Affordable Care act now yearse ago, and part of what were trying to do is extend coverage to a lot of americans that didnt have it, and colorado, my state that men over 600,000 coloradans who now have Health Insurance that didnt have it before the Affordable Care act was passed. Another thing were trying to do was say to Insurance Companies that its not okay to have this as your business practice takint month after month after month of premiums from people and then when they call you on the phone and say my kid was sick, my kid got struck by lightning, my kid had an accident, to then hold them on the phone as long as possible just as a way of denying their claim. Because most people in america are too busy trying to move the family a head, trying to get by, to stay on the phone all day with an Insurance Company. And while there at that we said its not fair to deny People Insurance in the richest country in the world because they have preexisting conditions. Its not fair that its a Business Plan in america to have lifetime caps on people in the richest country in the world who might hit those lifetime caps because they get cancer. Its not fair in america the i richest country in the worldav that some seniors have to cut their medicines and half every month just to get through the month and to pay their bills. O and these are some of the issues that were trying to address when we passed the Affordable Care act. And, mr. President , i am from their Western State like you. M i was out all those months in colorado having town hall after townhall, just and democratic parts of the state, but in republican parts of the state trying to explain what it was we were trying to do. Supposed to get even better coverage, more predictableo coverage, less costly coverage and also to try to do something to bring down Health Care Costs in this country. We succeeded at some of those things. We didnt succeed at other of those things. It was a legitimate attempt at trying to deliver something for the American People that people all over the industrialized world dont have to live with. Only in this country to people have to make choices about eating the family and taking care of their kid at the doctor. Only in this country to seniors have to make choices about cutting those pills in half. Only in this country to people have to make choices about paying the rent and taking care of their kid. It doesnt happen and the rest of the industrialized world. And before i hit on the other side tonight, let me say our results are getting worse, not better for populations across this country. Longevity is shorter, not longer. This is a difficult complex butr urgent question for our country. And thats what were trying to do with the Affordable Care act. Some succeed and some did. Ill talk more about that in a minute, but for years, for eighf years, republicans ran for election after election after election on obamacare. Obamacare is socialism. Obamacare is a socialist plot tb take over the United States. Obamacare is destroying jobs, just at a time when were coming out of the worst recession since the great depression. Growt and so uneven job growth in this country but undeniable job growth over the entire period of time they were saying obamacare was destroying the country. Destroying our economy. The recession was at the end of the last administration. This administration the Previous Obama Administration saw the largest job increase that weve seen in this country since world war ii. I know its inconvenient to believe that or to say that, and i know that in corners of the internet where false news really does dominate, people dont believe it but its true. And im the first to say that there are not enough good jobs and im the first to say that are not enough highpaying jobs, but compared to the record that was inherited, it was a success. All the while we had the Affordable Care act being implemented. All the while were extending oo coverage to millions of people in america, many of them children that didnt have adequate coverage for we passede the Affordable Care act. Its been called every name in the book, just like president obama was called every name in the book. And they link those two things, Health Care Reform, the Affordable Care act and obamacare. That making its name. And every single attack underha. The sun was levied on that. Why . Y is people really believed it wae destroying the Health Care System. As maybe some people did. Because it was destroying american businesses, maybe some people did. I suspect it was a much more simple reason, and i was to try to win elections. And by the way, while were on the subject, no matter whether t you support the Affordable Care act, and i support some things about it, there are other parts of the data been disappointing to me, whether you support the Affordable Care act or whether you dont, i think its fundamentally important for people to understand that the Affordable Care act is not our Health Care System. Its part of our Health Care System. The regulations and it placed on injured providers so that people with preexisting conditions could not be denied insurance is part of our system. The fact that it tried to create Accountable Care organizations so people got better primary care so we would reduce the amount of Hospital Readmissions from Something Like 1 1819 of wasted billions of dollars in this country down to two or 3 . T thats health care. Do but theres a lot of health care that is nothing to do with obamacare. Something to do with that but it wasnt the creation of obamacare. Theres medicare. There is medicaid. Thats patients. Thats our Health Care System. Ys and our Health Care System is a mess. It is a mess. Ve it and we tr tried to take somethig and improvement when we passed the Affordable Care act so that some of the work to, some of the gore. Some people would argue we went too far. Some people had said we didnt go enough. But i can tell you this. S. Ive been doing these town halls again in colorado and what i know is that people feel defeated. Not by obamacare but by the american Health Care System. But by our Health Care System which is less predictable, lesss affordable than many countries around the world. Now, President Trump knew this. Hes a smart politician. I never thought he was going to win. Never thought he was going to win. On a campaign that on so many dimensions was out of step with conventional american political thought. And i was wrong. He won. I dont think he represents the traditional republican view, and that made one reason he won. In no sense do i think of donald trump as a conservative. I think of him as quite radical in his proposals. I think of him as a reactionary force on a political system that the American People, for whatever reason, some of them probably good reasons, was losing patience with. But you cant deny that the guy some out in the far reaches of trump tower, somehow had his finger on the pulse of what was going on in this country, in some parts of this country work i dont know if its because he was a reality tv star or what it was, but one of those things was health care, and he understood the American Peoples dissatisfaction with our Health Care System, just as seven years and eight years of Republican Campaign have understood it, and they said, majority leader mcconnell made it clear when were passing the bill, you own it. You own it. He said in a book later that it was very important to him that they were able to come to American People were able to demarcate between the democrats responsibility for the Health Care System as it was and thes i republicans willingness to take no responsibility for it. Even though we had hundreds of hours of hearings lasting more than a year, and we had, not countless, but more than 100, 1, well over 100 republican amendments that were made in committee and on the floor and incorporated in the legislation. In the end not a single republican voted for the bill. De and may be that was a principal reason, not just a politicaln. Reason. Because maybe theres some people who have the view in the Republican Party that the federal government shouldnt have any increase involvement in their Health Care System. Ov in fact, i for some people say that federal government should play no role in the Health Care System. But whatever the reason, not a history obamacare. And then the rest of the history writes itself. Which is that every premium increase in america, whether its related to obamacare or not, becomes part of obamacare. Every drug biggest increase in price becomes obamacare. Everybody loses their insurance, thats obamacare. When whats really happening is something far more complex thanr that. They are very legitimate critiques of obamacare but it is at the same thing as our entirea Health Care System began to think its important to make that point because whether wee are considering the republicans propose bill tonight or some elses propose bill tonight, we would have to understand that it wasnt going to fix the whole problem all at once. And people in my state are deeply dissatisfied with our Health Care System. I say that is somebody who voted for the Affordable Care act. I have said it before. People have tried to make a political issue out of it, the right ads, look, bennet said the Health Care System is not perfect. I will go far the net. Em it is a crying shame that people in this country have to spend their lives wrestling with Insurance Companies, to lay up awake wonder not if the cable with dental care, or cancer care if they get sick. That keeps families up every night in my state. Not so much the people that are on medicare but a lot of other other so candidate trump saw this unease in the American People, this concern that the American People had with our Health Care System, which i share. And in his campaign, in his very populist campaign for president , he promised to provide quote such a Great Health Care at a tiny fraction of the cost. Those knuckleheads in washington dont know what they are doing. Im going to deliver you such Great Health Care at a tiny fraction of the cost. That was his promise to the American People. Thats what he said that he was going to deliver. He just ratcheted himself and other republicans by running who were saying i will never cut medicare. I i will never cut medicaid. Those ar of the republicans say they will. Im not going to do that. But i am going to supply Better Health care that youre getting now at a tiny fraction of the cost. He said quote everybody is going to be taking care of better than they are taken care of now. Everybody is going to be taken care of much better than they are taken care of now. No cuts to medicare, no cuts to medicaid. And so we had our election, andt people voted for this nomineepr who made not just of these promises but many other promises about what he was going to do for our economy based, i think, largely a complete fiction about whats actually going on in our country, for that matter, in the world with respect to oure economy. So he won. And he didnt just win. The senate is republican, and the house of representatives is republican. And now after running elections for eight years to get rid of that scourge on america, that stain on america, that legislation that destroyed our economy and destroyed our Health Care System, they wrote a bill. Took them a long time really to get it through the house of representatives, which was shocking because they had eighte years to figure out what was wrong with the current system. How to address the currentcouldn system. And they tried it once and they couldnt even bring it to a vote in the house. Could not even bring it to a vote. And then understandably, peoplee who sent those republicans tore the house and office at what yod talking about you said you were going to repeal obamacare. You told us all these terrible things that obamacare had done. Your first order of business was to repeal obamacare. How dare you not have a vote . Im glad they said that because people should keep their promises. I have believed for a long time that people want consistency out of their politicians. He that they will put up with inconsistency if you say to them the facts are different than i thought they were, and thats why i changed my view. In these times of take news, of the media having the challenges that they are fake news, thea rest of things that aor system, consistency is not something that a lot of politicians Pay Attention to and i think they think thats because voters dont Pay Attention to them. Ci but in this case they did. They said you said you would repeal obamacare. You didnt just say it once. You said it year after year after year after year. And then finally they pass a bill in the house, not a single democrat voted for it. And we learned from that process, which took place before the Congressional Budget Officee had even scored the bill. Imagine that come all these people that criticized the Affordable Care act, proponents are rushing the bill through, ai bill that had come as i said, between one and i think closer to 200 close amendments adopted, a bill that had almost countless Committee Hearings in the Senate Finance committee and the senate help committee, a bill that consumed, mr. President , 25 days of legislative process on this floor, a modern record in terms of time. In fact, we had all that i process, and is what senator mcconnell, ill come back to this, heres what senator mcconnell said about that come all that process. He said on this floor i think that americans were quote tired of giant bills negotiated inat secret. That deal was negotiated completely in public, painfully in public. I used to come over and people in my n we are going to leave this here to go live to the steps of use capital. Senate democrats this afternoon holding a press conference to voice their opposition to the sent health care low replacement bill. We could see action on the bill we are known as early as two more career altering the House Republicans are prepared to what we concessions had into the jule bill. This is live from capitol hill here on cspan2