The peace of mind that they know they will get the health care that they need and that they wont go bankrupt in the process. Yet, here we are tonight debating a bill titled better care act. Better care. Has there ever been a bill in the history of the United States more perversely named than the better care act that strips care from 22 million americans . I was very struck by one equation of this bill, and that is that it provides to the richest 400 americans 33 billion over a tenyear period. Thats enough to pay for health care under medicaid for 700,000 individuals. It rips the Health Care Away from them to give 33 billion, the richest 400 families. That is obscene. That is certainly not better care. I i its hard for me to imagine that a Single Member of this body would vote to proceed to this bill, but here we are until we get agreement that were not going to proceed. We have to continue to carry on this fight. We know that 15 Million People c. B. O. Estimates will Lose Health Care in the next 12 months. That is even worse than the house bill. Last week i came to this floor to call the senate draft mean and meaner. The house bill was mean, the senate is meaner. Now we have the c. B. O. Estimate that says, yes, its worse. A million more people would Lose Health Care in a short period of time. Furthermore, the rate at which standard medicaid is compressed medicaid before obamacare, that rate is increased to further diminish health care, just to add to the cruelty of this bill. So millions lose but we deliver billions of dollars to the richest americans. In my home state of oregon, just the elimination of the expansion of medicaid the Oregon Health plan, just that would eliminate 400,000 oregonians. Imagine those individuals Holding Hands 400,000 orange orangians orange orangian oregonians. Anyone who has given across oregon realizes it is 400 miles across oregon. It is seven hours of driving if you did that, you would pass a stream of people who would lose their Health Care Just from an elimination of the expansion of medicaid. My colleagues across the aisle have crafted this so as to put it beyond the next president ial election beyond the 2018 election and beyond the 2020 election. Why . They are to terrified about the impact of this on the election, they decided postpone it after 2018, after 2020, as if that makes it acceptable to Rip Health Care from people. That type of cynical cynical act, purely political, is not going to be viewed well by the american public. If you are so ashamed of this bill if someone is so ashamed they want to postpone the effects beyond the next president ial election, 3 and a half and a half years from now, maybe you should not move to vote for the bill in the short term. One colleague across the aisle said i cant imagine its not exactly word for word, but its close i cant imagines anyone imagine anyone would have time to review this bill in time to proceed to it this week, including myself. Thats certainly true. Has there ever been a case where a bill profoundly affecting so many has not had the benefit of Committee Deliberation here in the senate . Are we a legislative body or are we a dictatorship where everythings done behind closed doors and then rammed through . Thats not the american way and thats in the the constitutional vision for how the senate should work. Theres supposed to be time to consult Health Care Experts and time to go home to disult our constituents consult our constituents and find out how they feel. What is so terrifying about this bill that you cant see if you are so terrified you cant consult with the experts, you shouldnt proceed to this bill. If you are so terrified that it will put you in an awkward spot, we shouldnt proceed to the bill. You have a responsibility to consult with Health Care Experts to understand every nuaunce of this bill. One of those facts will have a devastating impact on those who go to Nursing Homes. Folks who are under medicaid and in a nursing home, they have given up their entire income and their assets before they can get medicaid support. I was down in clammouth falls and went to a nursing home. They said almost 70 of those are on medicaid. I thought they would say 06 . In rural oregon, in clammouth, almost 100 . We heard how this will affect the seniors. The c. E. O. Said, quote, i was on a call early today looking at projections of how oregon and longterm care service would be hit. If this bill passes, these are his words, it could force the closure of the majority of nursing facilities in oregon by 2025. One thing i cant get out of my mind, at another nursing home i went to, is a woman named deborah. I explained i was coming by tubing to people because i wanted to understand better the impact on longterm care. She said, senator, im paid for by medicaid, and if medicaid disappears, im on the street and thats a problem because i cant walk. Thats exactly what deborah said and, of course, its a problem not only because she cant walk but because she needs extensive care which is why she is in longterm care to begin with. The anxiety was palpable among the longterm care residents because they have no backup plan. They had to spend their assets before they qualified for medicare. Dont think of this as ripping Health Care Away from millions of working families, millions of struggling families, millions of children, but also our seniors who are longterm care, who need extensive care and who have given up their assets in order to qualify for medicaid. They use those assets to pay for it as long as they could and now they are on medicaid. We are prepared to take those folks, many of them in wheelchairs, like deborah unable to walk, and throw them into the street and say, too bad. The president called the house bill mean and indicated he wanted a bill with more heart. This is not a bill with more heart. We should not move to proceed to this bill. Thank you, mr. President. The presiding officer the senator from minnesota. Ms. Klobuchar mr. President , i want to thank my colleague from oregon for his words and i rise today to give voice to the concerns that im hearing from so many people in my state and across the country about this repeal bill. First i want to recognize may colleague from hawaii, senator hirono, who speak earlier tonight about her personal battle with kidney cancer. She is an example to all of us of the determination and grit when the going gets tough. She not only is going into the hospital for some surgery tomorrow, which isnt easy surgery, but shes decided she wanted to spend her night before she went into the hospital here because shes so passionate about this issue. I know shes going to fight this disease and win and come out stronger than ever. Ive been so moved by how shes taken on her personal fight against cancer at the same time that she has kept this fight going in the senate. And shes doing it not just for herself or for her state but for people all over the country. As senator hirono has said, her experience shows how quickly a routine visit to the doctor can turn into a serious diagnosis, a diagnosis that becomes a preexisting condition. Everyone who faces a serious illness, no matter who they are, should be able to focus all of their energy on getting better, not on how theyre going to pay their medical bills. Unfortunately, the bill we are considering doesnt allow everyone to do that. As a nonpartisan as the nonpart an Congressional Budget Office noted earlier today, this bill could mean the return of annual or lifetime limits on what insurance would cover for people with expensive conditions like cancer or alzheimers. And some Key Health Care benefits might be excluded from Insurance Coverage altogether. So its no surprise that the Minnesota Hospital Association has said that this proposal creates a lot of chaos. And i was just at Northfield Hospital this weekend, a college town, but that it is in the middle of a very rural part of our state with a lot of farms surrounding it. In fact, they call it cows, colleges, and contenement. And at a this town and in that hospital, there wasnt a lot of contentment during my visit. The c. E. O. Of the hospital told me that he was worried that this bill would drive more of its patients to bankruptcy. I met with a number of people that were on the board and work at the hospital, and they were all very concerned about what the bill would mean. Now, this did not mean that they didnt want to see changes to the Affordable Care act. They do. They see the issues with premiums in our state. Thats why our Republican Legislature worked with our democratic governor to pass a bill for reinsurance, to try to do something to leverage the risk for the people who are in the exchange. We could do something similar here on the federal level, and we should. But thats not what this bill is about. The head of another hospital in my state said that, quote, they are shortening up the money but not giving us the ability to manage the care. A minnesota Seniors Organization said that this bill, quote, feels like were pulling the rug out from underneath families and seniors. And thats why aarp strongly opposes the bill as well. So according to the c. B. O. Report that we got today, this bill would cause 22 Million People to lose their coverage over the next few years. 22 Million People. My republican colleague, senator heller, has said on friday he said he cannot support a piece of legislation that takes insurance away from tens of millions of americans. I agree. I hope that our republican colleagues will come to the negotiating table in a bipartisan way. I hope that this administration will not sabotage the bill that we have now and will work with states like mine that want a waiver to be able that want a waiver to be able to do the kind of costsharing and the reinsurance that i just described. During that time we can Work Together to actually make health care in america better and more affordable. We need to think about the real and devastating impacts on peoples lives that this piece of legislation would have, because thats what this debate is really about. Its not about all of us going back and forth and citing facts and figures. In the end, its about how this will affect people. Its about the lives of people like the mom in minnesota who has a child with downs syndrome. She told me how she has seen medicaid help parents of kids with disabilities avoid bankruptcy and how it helps School Districts pay for the therapy children like hers need. She said that this bill is unconscionable. Those are her words because of what it would do to adults and kids who have disabilities. Well, we have more thank half a million children we have more than half a million children in minnesota who rely on medicaid and the Childrens Health insurance program. This includes kids like that o f a teacher. The teacher wrote in saying that the bill was cruel and mean, especially for the families of students with special needs. This last weekend the president did in fact admit that he had called the house bill mean, after he had in fact celebrated its passage. But that is behind us. The president is someone who is known for speaking his mind and speaking directly. So he didnt need a poll or a focus group or an accountant to look at this house bill. He just called it what it was. Mean. In minnesota, people demint words either, and thats why that teacher told me exactly what the impact of this senate bill would be. And in fact today the Congressional Budget Office, the nonpartisan Congressional Budget Office, confirmed it earlier today with its estimate that millions of people 22 Million People would lose their medicaid coverage because of the bill. Our debate here today is about the lives of people like the retiree with parkinsons in minneapolis who told me she is scared and worried. Shes not just worried about the cuts to medicaid but also about depleting the Medicare Trust fund to pay for tax cuts for the very wealthy. As she told me, the future of these vital programs that so Many Americans depend on is on the line. This Health Care Bill is also about the people who are worried about taking care of their baby boomer parents statement that they are caring fo for their children. One woman told me about her mom who died two years at 95 after suffering from dementia for more than 20 years. She had worked her whole life but as she got older she couldnt afford the nursing care she needed so much. Luckily, she was automobile to rely on she was able to rely on medicaid to pay for it. You know that more than half 54 of residents in Nursing Homes rely on medicaid. I think when this first came out, people thought, well, medicaid, what does that have to do with my life . Then they started talking to their parents or grandparents or their neighbors and thats when they realized, whoa, over 50 of people that go into assisted living and Nursing Homes, they end up relying on medicaid. This womans daughter told me that shes so worried that this bills cuts will put those Vital Services for seniors at risk for so many other parents and their kids. And even for older people who dont use medicare and medicaid, this bill could put Health Coverage out of risk. Thats because it has this age tax for seniors, allowing older people to be charged five times as much as younger people for insurance. As aarp has said, thats just not right. These are the concerns ive heard from seniors and their families in minnesota, and they are shared by people across the country, especially by people in our rural areas, where they tend to have a little older population. One reason for that is because the senate bill actually more than the house bill when this comes to medicaid makes even deeper cuts over the long term that will hurt seniors and rural hospitals along with children, people with disabilities, and people suffering from opioid addiction. We actually have such a strong Bipartisan Group working on the opioid addiction problem. Four of us two democrats, two republicans were the chief authors of the bill that passed last year that set the framework for the nation. We then put billions of dollars into treatment last year and we shouldnt blow it up now by passing a bill that, because of the medicaid cuts, would, in my state, a third of the people that get opioid Addiction Treatment a third of them get from medicaid. So it would actually be moving ourselves backwards. I know my colleague, senator collins, and senator murkowski, have expressed real concerns about these kinds of medicaid cuts in their states of maine and alaska, which also have big rural populations. In my state, medicaid covers onefifth of our total rural population, about 20 of our rural population. These cuts could cause the rural hospitals that serve this population to close. This doesnt just threaten health care coverage, it threatens the entire local economy. Thats a big deal for rural hospitals, which often have operating margins of less than 1 . And these rural hospitals are on the front lines of the Opioid Epidemic that is hitting communities across the country. Deaths from prescription drugs in my state now claim more lives than homicides. They claim more lives than car crashes. Well, there is more work to do to combat the epidemic. I want to recognize that progress. Yes, weve passed the blueprint bill that i just mentioned with the help of senator portman, whitehouse, and ayotte. But, unfortunately, were moving ourselves backwards. Medicaid expansion has helped 1. 3 Million People receive treatment for mental and Substance Abuse across the country. I know this bills cuts to those Important Services for people struggling with addiction have real concerns in states like west virginia, and states like ohio. And the problems with this bill, of course, go beyond medicaid cuts. As a mom from belgrade, minnesota, told me, she asked me to oppose this bill in honor of her daughter and the thousands of other children diagnosed with cancer each year. She worried that the waivers would undercut protections for people with preexisting conditions, threatening to make Health Insurance unaffordable for families like hers who have children or had children with cancer. One man from minneapolis told me that what this does is downright scary. Those were his word. He is scared because he is selfemployed. He has a preexisting condition, and gets his insurance on the individual manchet he is worried that under this bill his costs, which are already hikes would skyrocket. I am foyer i am the first toy that we need to fix the individual manchet but this bill is not the way to do it because as c. B. O. Said earlier today, it would actually cut assistance and increase deductibles for many people on the individual market. Based on c. B. O. s projections, the joint Economic Committee estimates that average premiums in minnesota would go up substantially next year, even more than theyve gone up already. People across the country are making their voices heard about these types of problems. According to the Kaiser Family foundation poll, that came out just last week, 30 of americans had a favorable view of the house bill of these concerns go across party lines. Only about half of republicans, 56 supported the house bill. I know this political has some differences from the house version but as speaker ryan said last week, the two are very similar. I hope that hearing from americans on both sides of the aisle prompts my colleagues to start working together to make our system better in a bipartisan way. Heres some ideas. I would love to include, if we worked in a bipartisan basis together, not only the work what needs to be done on the individual market, on the exchanges, to the rates, for small businesses, but id also like to work on prescription drugs. I have a bill that would harness the negotiating power of 41 million seniors on medicare to bring drug prices down. We have a number of senators on the bill. And right now, medicare is actually banned from negotiating with 41 million seniors. That is just wrong. Our seniors should be able to use their market powers to negotiate. I would also love to see more competition in this market. There are several ways we can do it. One is by bringing in less expensive drugs from other countries. When we have drug shortages now in this country, we worked on this, senator collins and i did, and the bill passed this senate and got signed into law. Now the secretary of Human Services can actually bring in drugs that are safe from other countries when we have a drug shortage. We refined some of the language with the rules already allowed the secretary to do that. Now, they could do the same thing right now, but we could make it even more clear if congress got behind it. Senator mccain and i have a bill to bring in less expensive drugs from canada, which is very similar to the american market, and we have a provision in the bill that they would be safe. Many people in my state are doing this now. We once had bus rides of seniors going up there to get less expensive drugs. We could do it with other countries as well, as long as they are certified as safe. One of the ways you can do it, we have a bipartisan bill, is that if you have less competition in the market, less competitors, that would trigger the bill to bring in more drugs. You could do it based on the price. If it goes up high and you find the secretary or someone else that we could put in its place, find that its not because of input costs, you could allow this competition to come in from other countries. It would be a trigger. And i would bet you right now that if you did that, that would create incentives on American Drug companies to not jack up the prices like they have been doing. Four of the top ten selling drugs right now in america have gone up over 100 , things like insulin up three times. Things like in a naloxone that we rely on for overdoses. It seems like when these Drug Companies get a monopoly in their lap, they go for it. The second way you get more competition is by encouraging more generics. Senator grassley and i have something called pay for delay. Big pharmaceutical companies are actually paying off Generic Companies to keep their products off the market. The nonpartisan Congressional Budget Office has found that this would save Something Like 3 billion over a number of years if we passed our bill. Thats for the government. Thats for taxpayers. But you could save an equal amount of money for consumers who are paying for this in premiums. How could you ever explain that pharmaceuticals are actually paying generics to keep their products off the market . Thats a vote i would like the senate to take and i would like to challenge anyone to explain why they would vote against that. We also have another bill called the creates act with senator grassley, leahy, lee and myself that makes it easier to get generics to market by sampling and other things. These are just a few of the examples of bills that i think would be very good if we would consider them, but so far we have done nothing. We have banned seniors from negotiating. There is nothing in the house or Senate Repeal bill that does nothing about, anything about these pharma issues. And that again is one reason alone to be concerned about these bills. So i was at that baseball game a few weeks ago and saw firsthand that incredible bipartisan spirit, at the womens softball game as well, but the mens baseball game where the players played together and at the end of the game, when one team won, the democratic team, they took their trophy and they gave it to the republican team, and they asked them to put it in representative scalises office. Thats what we need to see more of. Not just two teams, but one team. And certainly on an issue as complex as health care, we just cant be playing in our separate ballparks. This is a time to come together, and we have changes that we must make to the Affordable Care act. I said that the day it passed, that it was a beginning and not an end, and i also thought it was unfortunate that it was more of a democratic bill than it was a bipartisan bill. So we have an opportunity now to fix that and to make fixes to the bill, to Work Together, but this bill is not the answer. This bill that we were not allowed to take part in, where the doors were closed, not only the Democratic Senators but to americans themselves. So i hope, mr. President , that as we go forward, that our colleagues on the other side will work with us on a truly bipartisan bill that would make some of the changes we need to bring down Health Care Costs instead of moving forward with this bill. Thank you, mr. Mr. Markey mr. President. The presiding officer the senator from massachusetts. Mr. Markey mr. President , i would like to thank my friend and colleague, senator hirono, for her words and her willingness to share how this bill could impact the millions of americans with preexisting conditions. And i along with everyone else in this chamber wish her the best and speedy recovery so that she can continue to fight for the people of hawaii and the people of the United States. After weeks of secret meetings, Senate Republicans released their Health Care Legislation last week, and