Transcripts For CSPAN2 U.S. Senate Democrats Call For Hearin

it is cruel beyond words and costly in lives and in dollars and cents because it will deepen and worsen health care issues that can be prevented and made curable or more palatable. let's be clear. this secrecy -- a small group of men making decisions about our entire health care system -- with no input from women, from medicare beneficiaries, from people with substance use disorders, from patients struggling with mental health illness, with any disease at all, is irresponsible and deadly -- truly cruel and costly to our democracy. the way these discussions have been done are a stain on this body and a slap in the face to every american that relies on us to make decisions that are in the best interests of their family as well as themselves. my colleagues seemingly would prefer to ram and rush a deeply flawed and unpopular bill through this body, ignoring the needs and will of the people they represent. that is a sad day in this chamber. we need public hearings, not for their own sake, not for our sake but more the individual recovering from substance use disorder -- thanks to medicaid -- for the mother of a little girl with a preexisting condition, terrified of how they'll pay for her care and able to do so now because of the affordable care act. the woman who is at a planned parenthood clinic today receiving mammogram and other cancer screenings and other preventive health care testing as well as men because of the coverage provided to them by medicaid and the affordable care act. defunding planned parenthood, risking again preexisting conditions, eliminating the guarantee of essential health benefits like maternity care is a war on women's health care and a disservice to our democracy done in secrecy. my colleagues across the aisle may succeed in gutting our nation's health care system, but the people who pay the highest price will be ordinary americans, working men and women and their families who now have health care coverage, to prevent more serious illness and who will now go without it. secrecy is the reasoning that i convened an emergency field hearing on health care today in connecticut on very short notice -- literally, 24, 48 hours -- people came from across connecticut at 9:00 a.m. my staff did yeoman's work putting together the logistics and the outpouring of anxiety and anger was remarkable. the eloquence and power of the insights offered by people about their own situations as well as about others whose interests they advocate. many decided to stay and stand, even though the room afforded inadequate numbers of seats for everyone. it was standing room only, and they literally streamed out the door. the stories they told are worth hearing, and we have an obligation to listen to these americans. i told them that i would personally bring their voices and their faces to this chamber, to the floor of the united states senate, and in the coming days that's exactly what i will do because people need to hear the story of justice, a beautiful young woman who now is incapacitated because she suffered from an overdose, after seeking treatment, and the affect on others similarly seeking treatment will be so dire and damaging if coverage for addiction treatment and abuse treatment is eliminated. they need to hear this treatment of sean who similarly sought to overcome a substance abuse problem. they need to hear about individuals who would suffer from preexisting conditions. those stories are what i will be recounting in the coming days, as i share word for word their fears, their anxiety and apprehension and their worry for america about what will happen if the affordable care act is repealed and gutted. we must build on that act. we must improve its defects and make sure that it's worthy of the great goals that we share but not destroy it or decimate it. and building on it, acting constructively, coming together is what we owe the american people. the folks who came today to the state capital in hartford, at my emergency health care hearing, recognized that if they fail to stand up for planned parenthood or mental health or those people with preexisting conditions or medicaid or their loved one who is battling a dreadful disease, no one will. i am so proud of them and the people of connecticut who spoken up and stood up for the affordable care act, and i'm proud to bring their voices here to the united states senate, literally bring their voices here, as i will do over coming days, as i read into the record and put in the record their testimony, and as i hold a second hearing, probably later this week, because we couldn't hear from everyone who came to speak out and stand up. i hope that my republican colleagues will stop their denial, cease ignoring and disregarding those voices and come to listen to them instead and recognize that they cannot conceal the fact that the affordable care act has helped our nation's health. gutting it without any hearings or public debate is unconscionable and reprehensib reprehensible. it is a move they will regret. i stand ready to build on the great strides made by the affordable care act, and i hope my colleagues are ready to do the same. but if -- if this chamber proceeds down this reckless and repre-hencable path of speed toward repeal and gutting the affordable care act, i promise to do everything in my power and use every tool at our disposal to stop this process. we cannot go about normal business in the united states senate while so many back in our states demand that we fight. and we must fight. i will stand with hundreds of thousands in connecticut who will lose their insurance -- more than 220,000. i will stand with the people of connecticut who will lose billions of dollars in investment in health care. i will stand with more than 20,000 people in connecticut and a million around the country who will lose jobs, according to a study recently done by the commonwealth fund. jobs althoughs are inevitably the result -- job losses are inevitably the result at some point in the future because of gutting this program. i will stand with the people who will resist, indeed resist, this secrecy and speed that so disserves the values and betrays the ethos and traditions of this body. thank you, mr. president. i yield the floor. a senator: plop? the presiding officer: the senator from washington. ms. cantwell: i come to the floor tonight to raise concern about a proposed senate health care bill that might move through the united states senate, as my colleagues are pointing out, without hearing, without attention to the details -- actually, almost in secret. i guess it would be secret if we didn't know exactly what was in the house bill. it would be even more secret. people have said it will be about 80% of what was in the house bill. i can agree with president trump. that was a mean bill. if it is just 80% mean, i can guarantee that you it's still going to be mean. i say that because i have been at home listening to my constituents. they do not appreciate one bit -- if you're harbor view hospital and you are going to cut $800 million out of their budget because of the cap on medicaid and you are going to leave a hospital without resources, they are mad. if you are talking about children's hospital and children's hospital sees children who are on medicaid and they're not going to be able to see those children or get coverage, they're mad. or just like yesterday -- or actually saturday i was with veterans in vancouver, washington. people don't understand, but veterans of the united states of america do not get all their health care coverage through the v.a. they get it with medicaid at individual clinics and services. the i have met several of these people in my state, and they've told me point-blank, without access to medicaid, they would not get the benefits they need as veterans to our country. so i think it's mean to break our promise to veterans and not give them access to medicaid. and i think this whole discussion is basically the fact that we're doing this, you know -- trying to box with these guys on a proposal. if their proposal was so great, come to the senate floor and just -- don't even talk about the bill; talk about the principles. i want to know in the republican proposal what ideas do you have to lower costs, increase the quality of care, or improve access? that's the milestones by which you should be debating health care. now, if your goal is just to cut medicaid and cut people off of medicaid and cut their benefits so you can give tax break to the rich, okay, you might -- you might convince me that, yes, you have a proposal, because i think that's exactly what your proposal is. but if your proposal is about reducing costs, then come out here and debate it. don't even tell me what's in the bill. just show up on the senate floor and debate us and say, here is our idea for reducing costs. i will tell you what my idea is, because i wrote it into the affordable care act and some states are doing it. it was a good idea. it was called give the individual who doesn't work for a big employer the ability to negotiate with clout and be buntled up -- and be bundled up with other people. that's what they did for the working poor in new york. 650,000 people in new york are now on something called the basic plan. why? because they didn't work for an employer that could negotiate a big discount for them. but we said on our side of the aisle, why would we let poor people just get thrown on the one hand'd around in the market and not be able to -- and -- get thrown around in the market and not be able to drive a decent price? you're going to be able to drive a decent price in the marketplace. that plan is giving a family at $40,000 a year of income and four individuals in the family a yearly annual premium about $500 instead of $1,500 on the exchange. that's so that's an idea. so come out here and discuss that. come out harder and discuss that. if you want to tell me you've figured out a wait to give better quality of care, i'd love to hear that." i'd love for you to come here and tell me how you're going to deliver better quality of care. there are great things in this bill that are about improving the way organizations deliver care so that they are rewarded for basically delivering better care. the whole idea of aaccountable care organizations are so that you put the patient at the center of the delivery system and you reward them for doing a good job of delivering better outcomes. we have innovated. we've innovated in this plan. if you're talking about access, come out and tell us what proposal do you have that's about increasing the access to health care? i'd love to hear it because in this bill we already do that, too. we said, you know what, it's kind of crazy and expensive to think that everybody who ages, particularly on a medicaid budget, should spend time in a nursing home. why? it's more expensive cost and i don't think i've met one washingtonian that told me they really wanted to go a nursing home. they wanted to stay at home.t so we wrote into the affordable care act incentives for states to change the delivery system like we had done in the state of washington and deliver affordable care at home in their communities. so deliver community-based care. and by gosh, actually some states -- texas, arizona, indiana, other states -- took us up on it. they said what a great idea. we want to reduce costs. so if that's such a great working aspect of the affordable care act and you think it works, and it increases access to care by giving people community-based care and reduces our overall medicaid costs, come out here and talk about it. talk about what you want to do to put that program on steroids so that more people in america can benefit from better access to care and don't think that they're going to spend their last days in a nursing home. so that's what we should be debating, but we can't even see or hear or have a hearing about what this proposal is. and yet, my colleagues can't even come out here and throw a concept on the table. but i tell you this, the fact that you want to affect over a million veterans who have fought for our country and you're going to cut them off of the medicaid care that they deserve to have access to, that is a broken promise. and it's just as broken a promise as what president trump said. president trump tweeted -- he tweeted this. he said i was the first and only g.o.p. candidate to state that there will be no cuts to social security, medicare, or medicaid. that's what he said. so i'm not surprised he calls it a mean budget, but he should also own up that it also cuts medicaid. now we all have an office budget here. i sigh me colleague from virginia -- i see my colleague from virginia here. if we took our office budget and said we're going to cut it and cap it and next year it's going to be lower and next year it's going to be lower and next year it's going to be lower and next year -- in perpetuity. that's what their idea is, is to put a cap on medicaid and cut it in perpetuity and basically cut it out of existence. i don't know why they're beating up on medicaid, because medicaid has provided great stability to so many people in our country. they've lifted people out of poverty, provided health care, stabilized communities and raised the economic standard of living in great places in our country. i received a letter from a superintendent from the vancouver school district. he wrote to me about the devastating impacts that capping medicaid would have on his students. he wrote our school based medicaid program serves as a lifeline to children who can't access critical health care services outside of their school. he goes on to say restructuring it to per capita would undermine our public school's ability to provide for the neediest children access to vital health care insurance. so why would we do this? as i mentioned, i mentioned -- met a veteran, christina. she's 46 years old and she's also a full-time student. she suffered from chronic and disabling physical injuries and needs a high level of care. but the care she gets from medicaid helps her access the medication that meantions her chronic -- manages her chronic care and keeps her going and is working towards that degree. why would we cut somebody like that, a veteran off of medicaid just because someone's idea over here is to cap and reduce medicaid. so these stories are all over the country, and people are wondering why would you take this level of investment in medicaid out of our entire economic system. why would you impact our school districts, our regional hospitals, our veterans, our medicaid population? why would you affect a community that has a large medicaid base and that is the way they serve them? our hospitals have told them we have stabilized the increase in health care costs because more of the population was covered and had access to medicaid. you rip that back and we will be back to skyrocketing costs with people in the emergency room, no access to care other than that facility with impacts to everybody on private insurance and on medicaid. so it's just not a good idea. so i ask my colleagues, come out here, don't say you won a patient-centered health care deliver system because we're all for that. and we actually put things in the affordable care act that did that and are working. so if you want to make that claim, come out here and say what is it that you don't like about the patient-centered delivery system that's here and how you want to change it. if you say your proposal increases access to americans, let's hear it. if it's about better quality. but i don't hear any of that. i just hear a dprumbeat by -- a drumbeat by some people who want to be heartless and cut people who have access to health care, people who are less fortunate in our society because you want to cut medicaid. the president promised he wasn't going to do that. i would ask my colleagues to live up to that and let's start talking about the substance that truly will increase access, lower costs, and give better care to our constituents and the people of the united states of america. i thank the president, and i yield the floor. a senator: mr. president. the presiding officer: the senator from virginia. mr. kaine: mr. president, i also rise to talk about the being h of every american. this is critically important to every person and every family in this country. it's critically important to every local, state, and federal budget in this country. and it's also critical to the economic productivety of our nation. the house barely, in a purely partisan move, passed a bill that would take health insurance away from 23 million american people over the next ten years. dramatically increase premiums to seniors, jeopardized coverage of people with preexisting conditions and imposed huge burdens on states. one of the reasons the house bill was so bad, condemned even by president trump who labeled it mean, was because it flowed from a bad process. the house held no hearings on the final bill. there was not meaningful testimony from patients or health care providers. they did not accept any amendments from democrats. and they rushed the bill through to vote before the congressional budget office could score the bill. so no wonder, no wonder that the house bill is opposed by the american medical association, the aarp, nurses, hospitals, patient organizations, democratic and republican governors. and yet, the senate is poised to make exactly the same mistake, preparing a secret bill with no testimony, no public scrutiny, no opportunity for meaningful amendments, no opportunity for democrats to participate. we have the opportunity to get this right, and we have the responsibility to get this right. there's so many problems with the house bill. as a member of the help committee, i went on friday to the culpepper free clinic about 75 miles from here to talk about the need for reimprovement in our health care system. not a repeal that would hurt vulnerable people. and at this clinic which is celebrating its 25th year i saw dedicated staffers and volunteers and i talked to patients. and i talked to them about how this organization has provided passion and care to working people in this region of northern virginia who don't have health insurance. the fact that virginia has refused to expand medicaid is one of the reasons that the need for their care is so significant, fully 70% of the free clinic patients in virginia would be eligible for medicaid if the state would just join the 35 other states that have expanded medicaid. and what i heard at the culpepper free clinic is this, they're already bursting at the seams because we have an expanded medicaid. if there are additional cuts to medicaid it would overwhelm the ability of the 60 free clinics in virginia to provide compassionate care. just a few hours ago, earlier today i went to albamarle county near charlottesville and had a round table discussion with educators, families and children's advocates to highlight another key problem with the republican approach. by dramatically cutting medicaid, who is the most likely victim? children. the most numerous victims of medicaid cuts are children. in virginia and nationally, nearly 60% of the recipients of medicaid are kids. and yet, the president, through the trumpcare bill, and the president's submitted budget proposes to cut medicaid by $1.3 trillion over the next ten years. $1.3 trillion over the next ten years. and this deeply frightens the parents and educators and kids i talked to today. i heard from parents of kids with cerebral palsy and autism, whose kids are receiving support through medicaid to buy a wheelchair or get services so that they can learn to adjust with autism. and this will help them grow into adults who have a chance of living independently. these parents had heartbreaking stories, often telling me -- and this is a quote -- i had no idea of the challenges of parenting a disabled child until i had one myself. they view medicaid as absolutely critical to their children's educational and life success. they talked about the current shortfalls in the medicaid funding that lead their kids to be put on waiting list for services. one mom with a child has been on a waiting list for a developmental disability waiver. and i asked her what have they told you about the waiting list? and this was her quote: they have told me my child will die before he is off the waiting list. and that's under the current program before you cut $1.3 out of it. i heard from school administrators who talked about the importance of medicaid funding for their programs that serve students. special ed teachers worried about the effect on their work if medicaid is slashed. local superintendents and school board members talked about the difficult challenges of funding their school budgets if medicaid funding is cut. they post it as a difficult choice. if the feds cut $1.3 million out of medicaid, do they reduce funding for students with disabilities or do they take local funds away from other important programs to back stop those programs? or do they have to raise their own state and local taxes to make up for the federal cuts? i heard from child service advocates today who would see their programs slashed if medicaid is cut. here's an example: many of them serve court-involved young people. not kids charged with crimes, but kids who are in court because of difficult home lives and challenging situations with their parents or guardian. and they're in danger of being pushed into the foster care system or into institutions because of problems at home. medicaid pays for support services to help stabilize their family lives. if these services are reduced and more children get institutionalized, how does that help anyone? how does it help these kids? how does it help society? how does it help our budget? it's much more expensive to put a child in a group home or institution than to provide a few hours of medicaid services in their homes once a week. the 60% of virginia medicaid recipients who are children and the parents and teachers and nurses and others who worry about them and help them don't see this as a partisan issue. it's fundamentally an issue of compassion. we will and should be judged by how we treat our children. why slash funds that are used to help our kids? is it really important to cut medicaid by $1.3 trillion, hurting millions of children so we can get a few adults a $900 billion tax cut? we had a budget hearing recently. i'm on the budget committee. with the o.m.b. director mulvaney. this was just within the last two weeks. and director mulvaney tried to reassure us in his opening statement that the medicaid cuts were really about doing people a favor. about doing people a favor. he testified, and i quote, we're no longer going to measure compassion by the number of programs or the numbers of people on programs like medicaid. we're going to measure compassion by the number of people we get off these programs and back in charge of their own lives. i want to repeat that. prt president's chief budget official. we're going to measure compassion by the number of people we get off these programs and back in charge of their own lives. what a cruel thought. that reads like something that a villain in a novel by charles dickens would say. but that is the philosophy of this administration and this effort. so what we now tell a kid who loses the wheelchair that is partly paid for by medicaid, you're now back in charge of your own life. would we tell a single mom whose child is receiving services to help with autism but now loses access to these services, hey, guess what? you're back in charge of your own life. would we tell a teenager in a broken home whose medicaid services are the only difference between staying in the community and putting in an institution, guess what? you're now back in charge of your own life. and since medicaid also provides funding for our parents and grandparents, who can no longer care for themselves and have to be cared in nursing homes, will we go to those seniors who lose places in nursing homes and say guess what? now you're back in charge of your own life. slashing medicaid isn't about putting anybody back in charge of their own life. medicaid enables kids to go to school and succeed. medicaid enables disabled people to function well enough to go to work and pay taxes. medicaid enables seniors to receive compassionate care when they can't care for themselves, and cutting medicaid jeopardizes the ability of people to live with independence and dignity. no folks, let's not kid ourselves. this is not an effort to empower anybody. it's about casting them aside because they are too young or too old or too sick or too poor, and it's about giving a tax break to some people with the very funds we are taking away from the most vulnerable members of our society. that's why i oppose this mean effort by the majority to secretly craft a bill to repeal the a.c.a. we could improve health care if we work together. let the finance and the health committees discuss any bill, hear from patients and providers, allow amendments and debates before rushing anything to a vote that would so cruelly affect the lives of millions and millions of people. and with that, mr. president, i yield the floor. ms. warren: mr. president. the presiding officer: the senator from massachusetts. ms. warren: i get letters and e-mails every day from families begging me not to let republicans in congress tear up health care in this country. and people aren't writing because they find themselves with lots of extra time on their hands. they are not writing because they are professional activists or political organizers. they are not writing because they like writing letters and e-mails. they're writing because they're scared. they set aside all the other things they need to do in their days. the sink full of dishes, the load of laundry, the overflowing inbox, and they steal some time to write these letters. they write these letters because they are terrified, terrified down to their bones, that if they don't speak out, their family is going to lose their health care coverage, their children will be shut out from care, their elderly parents will lose the assistance they need to pay for nursing home care, their own insurance costs will be going up, their financial security could be hanging by a thread. a lot of people write letters and send e-mails, a lot of people make calls, too. every week since the republicans started their cruel effort to take away health care from tens of millions of people in this country, my office has been getting phone calls from worried constituents, but last week, something changed. we went from our regular quota of calls about this terrible republican health care bill to an avalanche of voicemails and phones ringing off the hook. since last week, i have gotten more than a thousand phone calls from people who are pleading with me to do whatever i can to stop republicans who are going forward with their brutal plans. people are literally in tears on the phone. they are scared and they are angry, and they are calling because they know that 13 senate republicans, 13 men are locked away in a secret room behind closed doors, writing a secret plan to trade their health insurance for tax cuts that will go to the wealthiest americans in this country. the bill the republicans are negotiating behind closed doors isn't a health care bill. it's a tax cut for billionaires bill, and it's paid for by cutting health care for tens of millions of other americans. the republican health care bill has $663 billion in tax cuts in it. $663 billion in tax cuts for the richest people in this country and for wealthy corporations, tax cuts that would blow a giant hole in the american budget. but the republicans didn't let that slow them down. they kept their eye on the prize, for the republicans, the most important thing about this health care bill is tax cuts for the rich. so they decided to cut medicaid by $834 billion in the same bill so they can pay for their tax cuts. you know, this is straight-up trade. the senate republicans say that americans should cut health insurance for little babies or for seniors in nursing homes or from people getting treatment for opioid addiction, all so that millionaires and billionaires can get their tax cuts. that's not a health care bill. that's a statement of values, and it says that tax cuts for a handful of millionaires and billionaires are more important than health care for millions of hardworking americans and their families. there's only one word for what the senate republicans are doing with this bill -- shameful. it is shameful. the republicans negotiate in secret behind closed doors, they refuse to allow anyone to see the bill, they won't tell anyone what's in it. more mccaskill asked chairman hatch on the finance committee if he would hold a hearing on the bill, and he said no. senator murray asked chairman alexander on the health committee if he would hold a hearing on the bill, and he said no, no plans to do so. no hearings, no reviews, no public look at what the republicans are up to. what's going on here? i'll tell you what's going on. senate republicans don't dare let the people back home see this bill. they don't dare let voters see this bill. instead, they have decided to try to ram this bill through with no hearings, no public discussion, and get it signed into law. they hope that once that's done, people won't see much point in learning about the details and holding republicans accountable. they hope that if they can do a quick vote, everyone else will just give up. well, i've got news for senate republicans. that's not going to happen. senate republicans may not want to hear from families who are worried about losing their insurance coverage in the middle of a battle with breast cancer. they may not have time for stories about premature babies who need medicaid so they can get lifesaving care. and maybe they don't want to hear about grandparents with alzheimer's who could get kicked out of nursing homes. senate republicans may not want to hear from these people, but i have a message for these senate republicans. we don't care how long we have to stand up here. we don't care how many times you try to dodge the question about what's in your secret health care bill. democrats are here to keep demanding that you show us this bill, and we're going to keep insisting that you account for its shameful contents. i know, you would prefer to take the phone off the hook so you don't have to hear it ring, and i know you would like to pretend that there aren't families in your state that would be hurt by this bill, but i'm going to take some time to read you just a handful of the letters i have been receiving about exactly what is at stake in this debate about health care. these families deserve to be heard. a few months ago, i received a letter from jenny in worthington, massachusetts. she wrote to me about how she and her husband got good health care coverage through the affordable care act. and how medicaid was there when they needed it most when jenny was diagnosed with breast cancer. a few days after president trump's inauguration, jenny's son liam wrote a letter to the president. liam asked president trump not to take away his mother's health care. i don't know if president trump ever read that letter, but i'm going to read it right now into the congressional record. dear president trump, my name is liam berry, and i am 10 years old. my mother has been very ill. thanks to the a.c.a., my mother has been able to have the care and medication she needs. if you repeal the a.c.a., my mother will not be able to get the care she needs. i know there are millions of kids in the same situation as me. please think of them when you read this. sincerely, liam berry. thank you for speaking out, liam. we are fighting for your mom and we are fighting for you. christine from cambridge also wrote to me about her fight against cancer. she wrote i ask that you and fellow senators please fight for the affordable care act. i am a cancer survivor. when i was 28 years old, i got the news no one ever wants to hear -- you have cancer. luckily for me, i had a job that had wonderful insurance, and i was able to get medication, surgeries and treatment to win the fight and not to go broke doing so. however, i know many young people and old people and children who would not be here today if it was not for the a.c.a. i know people who are still fighting their battles with cancer. they are frightened and losing hope, not because of cancer but because they don't know whether they will be able to continue to get treatments necessary to stay in this fight. i am now 30 years old, and i have my whole life in front of me. because of what president trump is proposing, i am now afraid that if i lose my job or if i wish to change jobs, i might not be able to get the necessary coverage because i no longer qualify. i really didn't think this is what i would be worried about two years ago after having been through eight rounds of chemo, 20 rounds of radiation and surgery to clear me of this disease. please, i ask that you fight for us, fight for those who are in the chemo chair right now at this very moment who are miserable, bald and bloated. fight for the cancer warrior who is now trying with worry because she doesn't know come a month from now if she will be able to continue to receive the lifesaving treatment she is entitled to. that's why we're here tonight. we are fighting for you, christine. we are in this fight. and thank you for speaking out about your own fight against cancer and for others who are currently battling cancer and worried about the future of their health care. i also heard from sara who lives in shrewsbury, massachusetts, and who wrote to me about her concerns that the republican health care bill would endanger coverage of birth control and access to services at planned parenthood. sara wrote me this past weekend while i was out dancing in the boston pride parade. as i type this, you are at boston pride, which i would have loved to be there to support my friends, but due to my endometriosis pain, here i sit. i am extremely concerned about the g.o.p. plan to reduce or strip away insurance coverage for birth control. as a 21-year-old woman suffering from endometriosis, a very common disease among young women, i know firsthand that birth control does more than just prevent pregnancy. in fact, for many, it is the only treatment for them. in ten days, i will be undergoing endometriosis surgery, and for the past six months, since i have been diagnosed until the surgery, birth control was the only thing enabling me to stand up straight most days. even while taking oral contraceptives, there were many days i was unable to get out of bed, today being one of them. i am so lucky to have access to an amazing endo specialist at brigham and women's hospital and to have access to the medication and surgery that i need, but every time i groan about having to go to an appointment, i think about how many women are suffering from the same debilitating pain but without the resources to overcome it. many women rely on planned parenthood, not just for abortions but to provide them with the medicine that will enable them to stand up straight in spite of the pain they deal with every day. endometriosis doesn't discriminate, and it isn't be cured, only treated. until endometriosis becomes a prominent focus of medical research, which i feel it should be, we must protect the right to be treated for it, which means protecting insurance coverage of birth control and protecting planned parenthood. i know that you are a warrior for women's rights, and i know you are the patron saint of planned parenthood. i know these are issues you fight for, and i cannot even begin to thank you enough for all you have done thus far. i hope that by adding my voice and my personal story, i can fuel your fire and somehow be a small part in protecting my fellow females and my fellow endometriosis sufferers. that's one in ten women in the u.s. thank you for fighting for us. thank you from the bottom of my heart. and sara, thank you for writing, and thank you for fighting. we're going to fight to save your coverage, and next year i expect you -- to see you on the parade route at pride. i also heard from dr. hemmel sumper, who is doctor at m.g.h. hospital. he wrote in with his personal story, and i want to read parts of his letter. i actually grew up in a low-income family myself. my fairnts emigrated to the u.s. my mother is brilliant but had only a seventh grade education because my grandfather couldn't afford to send her to school. my father is college educated but struggled frequently with unemployment. my older brother has multiple disabilities. he's blind and brain damaged from stroke during childhood, epileptic, intellectually disabled and has a transplanted kidney. i am fortunate enough to have been healthy my entire life. for most of my life, my family was on medicaid, as well as other forms of public assistance. my brother additionally, due to his kidney disease, got medicare as well, but medicaid was always his secondary insurance. he sees multiple different specialists and has done very well over these years. in spite of us having multiple financial struggles we never had to worry about his health care being paid for his transplant from childhood lasted 19 years and then about ten years ago he was transplanted again and has done well with that. my parents still live in the same house i grew up in. right now they're cared for by medicare and medicaid. my brother lives with him, receives s.s.i. archgdz his health needs are met by medicare and medicaid. all those none of these chronic medical conditions can be cured, they're all well taken care of. in the meantime i grew up healthy, was able to attend georgetown through need-based financial aid and was able to get into medical school at the university of maryland and pay for it using federal student loans which i'm repaying through the public service loan forgiveness program. got into a dual specialty residency of internal medicine and pediatrics at penn state and i'm now working at harvard and m.g.h. my family struggled. goes to show that medicaid is about helping families that struggle, about helping children with complex medical needs, and about how providing for good health care of a family can achieve positive outcomes for the long-term future. today dr. sumput works at harvard and m.g.h. he makes sure his patients on medicaid get excellent care and he told me about one of his patients who came into urgent care in chelsea. this little girl wasn't 2 years old yet and she was freezing and had a fever. here's what the doctor said. this child and her mother were on medicaid through mass health. as i asked questions, i found out more about this mother. she was working two to three jobs in order to make ends meet. her daughter was in day care during the day and then the grandmother took care of the little girl most evenings. this mother took care of her daughter on the rare days she had off and clearly loved and care for her daughter. this girl's wheezing were probably some of the early signs of what would become asthma. her mother has asthma and it runs in the family. asthma is a completely controllable illness with medication but it requires monitoring by a doctor and access to medication. because the child has medicaid, i feel much more confident in spite of how much the mother is struggling financially that this child has a good shot at growing up healthy. without medicaid this child could live a life in poor health from a treatable condition. these are some of the people, the senate republicans want to kick to the curb so they can deliver a big tax cut for millionaires and billionaires. a 10-year-old kid with a sick mom, a cancer survivor, a woman with endometriosis, a boy kept healthy by medicaid so he could grow up to become a doctor at one of the best hospitals in this country and help a little girl with asthma. senate republicans are willing to tear away health insurance from these families, to deliver tax cuts for their buddies. but we're not going to let that happen. we can't let that happen. you're fighting back. we're fighting back. and we will keep right on fighting. mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from pennsylvania. mr. casey: thank you, mr. president. i will start tonight with one of the questions that we have and this will be a procedural question so i want to alert the chair that i'm going to pose this question initially before i make my remarks about the debate we're having on health care. is the chair able to confirm that the committee on finance considered s. 1796, the america's healthy future act which was ultimately incorporated into h.r. 3590, the patient protection and affordable care act in executive session on eight separate calendar days prior to reporting the bill favorably? the presiding officer: the secretary of the senate's office through the senate library confirms that. mr. casey: thank you. mr. president, i rise tonight to provide some context about what is at stake for children in the united states with regard to the debate we're having on health care and in particular what would happen, some of the adverse impacts on children with disabilities. i'll start with the broad view, but i think it's important to frame our discussion -- sometimes our debate on health care comes down to a discussion of big numbers, how many people will be impacted. for example, the congressional budget office told us that 23 million people would lose their health care coverage over the course of a decade if the house bill were to become law. so 23 million people ripped away -- health care coverage ripped away from 23 million people. or we hear about the impact on the deficit one way or the other. or we hear about broad numbers. but probably the best way to think about the impact of these policies, if the house bill were to become the law or some version of it because of what a few -- a small number, a few senate republicans are working on it right now. maybe a better way is in terms of a couple of individual, children. i'll give you two examples for now. angelica and rowan, two different children, two different stories. we received a letter in the last couple of -- in the near term -- i'm sorry. angelica is the parent. i should have said amaya, amaya. she's the child her mom wrote us about. but her mom is angelica. and she wrote to us and said i'm writing to you because i'm appalled by all that's happening, and i'm -- i have an amazing story about my daughter amaya. she was basically born with no bones and she received a miracle drug that regrew her bones. she will have to take this medicine for the rest of her life but the fact that she is doing so amazing has to do with all of the help she received from medicaid. she's the youngest patient in the united states to take the drug. she's the youngest -- the youngest patient to take the drug, but i don't only want to talk about her. but i'm concerned about the future as well. and she then says, i'm looking forward to hearing from you. so says angelica. and then later on she talks about what happened in her case to her child. she says, she decided with a counselor to check with the allegheny county officials about whether or not medicaid expansion would cover amaya's treatment. and she said they made an inquiry. then she said by the next day, i'm quoting from the letter, by the next day someone from the state had called me and later that week her treatment was approved. thanks to the medicaid expansion, my daughter receives her life-saving treatment. unquote. so i make that reference to one letter about one child, amaya. and then of course so many other letters -- i'll just highlight one that i received months ago now from pam simpson. she's from coatsville, pennsylvania, southeastern pennsylvania just in the -- just outside of the city of philadelphia. and so now you're talking about rowan in southeastern pennsylvania and amaya in southwestern pennsylvania, two corners of the state, two children facing challenges that most of us can't even imagine. but in this case pam simpson wrote to me about her son rowan and talked about his life before a diagnosis of autism. and before he was getting the help that he's getting now. pam talked about all of the challenges that she and families like her face. she talked about the fact that he was having all kinds of difficulties but then they finally got the word that rowan would be covered by medical assistance. that's the pennsylvania version of medicaid at the state level. she said she applied in january of 2016 and after she got -- after pam got the word that rowan would be enrolled, she said, quote, we were able to obtain wraparound services which included a behavioral health -- i'm sorry -- behavioral specialist consultant so-called b.s.c., and a therapeutic staff support worker. the wraparound services have been a godsend, unquote, referring to the services provided to her son rowan. then she goes on later in the letter and says without medicaid, i am confident that i could not work full-time to support our family. we would be bankrupt or my son would go without the therapies he sincerely needs. and here's how pam concludes her letter. she says, please think of my dear rowan and his happy face, big blue eyes and his lovely strawberry blond hair. please think of me and my husband working every day to support our family. please think of my 9-month-old daughter luna. and i'll stop there just to explain. we're talking about rowan who is a couple of years older. the reference here is to his younger daughter -- to his younger sister luna. just continuing with the letter, please think of my 9-month-old daughter luna who smiles and laughs at her brother daily. she will have to care for rowan later in her life when we are gone. overall we are desperately in need of rowan's medical assistance and would be devastated if we lost these benefits, unquote. that's what pam simpson wrote to me months ago. and after referring to her story and rowan's story over the last couple of months, i finally had the chance to meet her and to metro wan and to meet his -- meet rowan and to meet his dad and his sister luna. so i met this family, four people in a family. met them on friday. and it's one thing to read about and to get a sense of what a family is up against every day and it's another thing to meet them. right now that family, the simpson family, has what they need for rowan. it doesn't mean they don't have challenges. don't mean it won't be difficult in the years ahead. but they have the benefit of medicaid right now. medical assistance as we call it in pennsylvania. so rowan now because he has autism is -- has the benefit of those behavioral specialists and those assistants. in fact, there was a person with him the day i met them to work with rowan every day. so parents can work and have the peace of mind to know that they can go to work and they can raise their family with the benefit of the kind of health care that every child should have. so some might say well, you know what? if the republicans get their way on this bill, maybe the medicaid provisions won't apply to rowan. maybe he'll be protected. or maybe in allegheny county, amaya, maybe she'll be protected. maybe it won't reach that far. maybe when the congressional budget office -- and i'll read directly from that, page 17 of the report by the congressional budget office analyzing the house bill when it says, quote, medicaid enrollment will be lower throughout the coming decade culminating in 14 million fewer medicaid enrollees by 2026, a reduction of 17% relative to the number under current law, unquote. that's what the congressional budget office says about the impact of the house bill on medicaid. 14 million people lose their medicaid. so some might say well, you know what? let's assume for purposes of this argument that those two children that we just spoke about might be protected from those cuts. we don't know that, of course, and they can't guarantee that. because w what they're doing whn they go a the these medicaid provisions is take away the guarantees that we been there for 50 years, okay. and over time eliminating the medicaid expansion. that's what we expect to happen. that's certainly what the house bill did. but let's assume for the sake of argument that they could come in here and make an ironclad guarantee that those two children, rowan and amaya, won't be affected. you no he what? that's not good enough. that's not good enough because there are a lot of other children who will be affected, children who might have a disability. 60% of kids with disabilities are enrolled in medicaid. we know that. we know that -- we know that millions of other children who come from low-income families get the benefit of medicaid. we know that a lot of seniors depend upon medicaid to get into a nursing home. but no family that has a child who benefits from medicaid, who has a disability, no family should have to worry for 15 minutes that what would happen in this chamber because a small group of republican senators are meeting in secret, and they're supposed to produce a bill that we're all supposed to consider in a short time frame. no product of that secret process should in any way give any parent that has a child with a disability any concern at all that that benefit will be taken away. that's not who we are as a country. we're america. we take care of people that need those kinds of services, that kind of benefit. so if a child like rowan, who is receiving the benefits of medicaid today because of his disability, if a child like that is receiving those services today, we should guarantee that he will receive those benefits for as long as he needs those benefits, even if it goes the length and breadth of his life. we should guarantee that. take it off the table so that family doesn't have to worry. that, i hope, would be the result of this process undertaken by a small group of republican senators. and i've been waiting to hear that, waiting to hear whether or not they will guarantee that to that child, to give that family some peace of mind with all the challenges they have, even with medicaid, even with the great support that they get. it's not easy. it's a very difficult life that many families lead when they have a child with a disability. but we should do everything we can to make sure that if a child with a disability debaters -- disability, one category of people that benefit, any child with a disability with medicaid should have that protection for as long as they need it. and i'll be waiting to hear that from our colleagues when they finally emerge from this secretive process with a bill. so i hope, i hope that's what they're working on in their meetings, because we know that it affects a lot of children. as i said before, medicaid covers 60% of all children with disabilities ranging from autism, like rowan, to traumatic brain injuries. we know that children on medicaid receive what many consider the gold standard for children's health care, early and periodic screening, diagnosis and treatment benefits, so-called epsdt. so they get the screenings they need, so they can get preventive health care when they need it. so all of these protections should be not just a goal, should be guaranteed for those children. so i'm hoping that our friends who are working on this right now would consider rowan and amaya and children like that. and we'll come back to it later. we'll have other stories to tell about children and what they're up against. but i'm -- on a night like tonight i'm thinking about those children and worried about some of the headlines we're seeing on some analysis. and i'll wrap up with this, mr. president. the center for american progress report dated may of 2017, quote, cuts to medicaid would harm young children with disabilities. that's one report. another report for the center on budget and policy priorities, may 18, 2017, medicaid cuts in house a.c.a. reveals bill will limit the availability of home and community-based services. that's another headline and we won't get into the details of those reports now. so we have a lot to work on here to make sure that nothing that happens in this process will rip away health care for children with disabilities. mr. president, with that i would yield the floor. mr. merkley: mr. president, i commend my colleague from pennsylvania who is putting forth our values and that is every child in america should have access to health care. and no one in this chamber should vote in a process or for a bill that eviscerates that coverage. in fact, our values that no one in america, including our adults, including our older americans, including our seniors, and including our children for sure, everyone should have access to affordable care act. and never have the stress of being worried that if their loved one gets sick, that they might not receive the care they need. never have the stress of concern that their family member might go bankrupt because they need medical care. it's that value that we're here tonight fighting for and it's that value that the republican bill will destroy, whipping away health care from millions of americans. so we come here tonight with a battle cry, and that cry is no hearing, no vote. no hearing, no vote. we are a democratic republic. we are a legislative chamber. have members of this chamber forgotten that we are a we, the people form of government, where the people are in charge. the people are not in charge if a secret 13 group of senators is hiding in the basement crafting a bill to rip health care away from millions of people. the people are not in charge if they're afraid to show their bill to everyday americans. they're not in charge if they're planning to destroy health care so those with preexisting conditions can't gain access to care. never have we seen a group in the majority so against the fundamental principles of our democratic republic, so against the we, the people vision of our constitution. and that's why we're calling on them to stop, rethink, remember, absorb the values embedded in our beautiful we, the people constitution. they want no public disclosure. fear of how the public will respond. they want no committee hearings. fear of how the people of america will respond. they want no committee amendments because that will take time in which the people can see what's going on and respond. and they want no substantial floor consideration in order to shove this through so they can go then celebrate the 4th of july with their constituents while having eviscerated the constitution of the united states in the process of attending that gathering, that 4th of july gathering. this has been called the vampire bill, the republican vampire bill. why? because the writers of it, the secret 13 writers, they're afraid for the bill to see the light of day. it's hiding in the darkness. and it's called the vampire bill because its general intent is to suck the life out of the health care system for struggling families, suck the life out of the health care system for working families and for middle-class families. now this is quite different than the consideration bhe -- when we created the system that we have now back in 2009. in that year, in the help committee, health, education, labor, and pensions committee, 47 hearings, round tables and walkthroughs, a markup that went for more than a month, the longest markup in that committee in the history of the united states of america, a markup that considered over 300 amendments. a markup is in fact a group of senators, bipartisan, sitting around the table with the television cameras rolling while they debated those amendments, voted on those amendments. and in that committee, they accepted or approved by vote more than 100 minority amendments. and then there's the finance committee which held 53 hearings and round tables. in fact, the minutes of the round table are available, and if you want to print them out and read them, they go for 800 pages. just the round table minutes. and then they had their own finance committee markup where they considered 135 amendments. and then the bill came to the floor december of 2009. 25 days of debate on the floor. well, let's compare that to the plan of the majority leader and the secret 13. well, how many hearings do they want? they want zero in the health committee. how many hearings do they want in the finance committee? they want zero. how many democratic amendments do they want to consider, or republican amendments in the health or finance committee? the answer is zero. and how much floor time do they want to have? they want to have just one day. just one day. introduce it as an amendment to the house trumpcare bill and pass it on the same day. and how many days do they want for experts to be able to weigh in on a health care system? zero. but here is the most important zero of all. how much time do they want for the american citizens to be able to see this bill and respond to this bill? they want zero time. that is completely against all the premises of our responsibility as legislators. it's against all the fundamental vision of a body that will deliberate and debate and take into account the opinions of a people and the insights of the experts. well, we can turn the clock back not so long ago to the majority leader who said, and i quote, fast-tracking a major legislative overhaul such as health care without the benefit of a full and transparent debate does a disservice to the american people. that was majority leader mitch mcconnell speaking not so long ago. and what happened to that value? now that was being said when we had 25 days of debate here on the floor, when we had over 100 minority amendments, that is republican amendments accepted, when we had a lengthy debate in the finance committee and health care committee. but the majority leader wanted more time. but here he is today leading the effort to have zero input from the american public. zero input from health care experts. zero committee deliberation. zero bipartisan discussion of the pros and cons. well, we can turn to paul ryan. what did he think back in 2009? and he said congress is moving fast to rush through a health care overhaul that lacks the key ingredient, the full participation of you, the american people. and he went on to write, congress and the white house have focused their public efforts on platitudes and press conferences, while the substance of details have remained behind closed doors. it's kind of a rewriting in history even if at that moment in time when he said that, when there was a record-setting debate in the health committee, the second longest debate in history in the finance committee. television cameras running the whole time. 100 republican amendments adopted. more than 100 meetings rand walk throughs and round tables and committee meetings and 25 days on the floor. but paul ryan said what it was lacking was full participation of you, the american people. well, if it was lacking in 2009 , what do we say about this? when the majority deliberately wants to exclude the american people or the american people are standing at the door and they're standing at the windows and leaning in and saying what's in this bill? we want to have a say because it's so important to our families, and the republican is slamming the door. and they're shuttering the windows and saying we will not share one word with you because we know you won't like what we're doing. that is not the way democracy is supposed to work. aaron from portland wrote, because she has been diagnosed with diabetes and is terrified if the republican plan goes into effect and she won't be able to afford coverage because of her preexisting condition. and jeannet from portland wrote -- she's in her 60's and desperately waiting to turn 65 and qualify for medicare. she's on the oregon health plan and terrified she'll lose that plan before she qualifies for medicare. and the list goes on and on and on. this weekend i was out conducting town hall meetings in four different counties of my 36 counties. i go to every county every year. and these four counties are counties that voted, i'm sorry to say, overwhelmingly against me when i ran for the u.s. senate and overwhelmingly against me when i ran for reelection. they are red counties. they are republican counties. and folks came out to my town halls this weekend, and they said one message to our republican leadership in the senate. we, the american people, demand the chance to participate in this debate. it so profoundly affects our quality of life. so i carry their messages from klamath county and lake county. i carry their messages from grant county to the republican majority. listen to the american people. listen to rural america. listen to the families that will be devastated by the plan you're concocting with the secret 13. it is not right. it is not moral. in fact, we need to work together to improve health care, not to devastate it. thank you, mr. president. ms. klobuchar: mr. president? the presiding officer: the senator from minnesota. ms. klobuchar: mr. president, i rise today to join my colleagues to speak out and ask for a normal process here, to ask for hearings, to ask for a debate, to ask for amendments because the house health care repeal bill is a major step backwards throwing over 20 million people off of health insurance, strongly opposed by aarp. we don't know what is being concocted here in the senate, but clearly something is going on, and we would like to have a say. and, most importantly, the people of my state would like to have a say. look at laura from north st. paul who wrote to me about her concerns about that bad house. laura has recently retired but won'ting eligible for medicare until next year, and she has a daughter with several chronic health conditions. laura is worried that if the proposal goes through this chamber, she will end up paying far more for her health insurance and her daughter might lose her coverage altogether. like so many others, laura asked that we work across the aisle to make improvements to the bill that her family needs and that foam families across the -- and that so many families across the country need. or take mike in grand marier, up in the tip of our state, not too far from canada. there in canada, mike knows the kind of they can they have across the border. he knows what the prices are for the prescription drugs. but here in america, that house health care bill, it doesn't do mig to bring down the cost of -- it doesn't do anything to bring down the cost of prescription drugs. mike has been self-employed his whole life and is now approaching retirement. he told me he is very worried that just as he is about to retire, he will not be able to afford health insurance because of premiums that under that bill minnesota's -- older minnesotans like him would skyrocket. or take a woman from andover, minnesota. she wrote to me 10 say she is so worried, quote, about the g.o. g.o.p.'s slamdunk approach to check off a box their to-do list, end quote with the health care proposal. she asked me to put a face on the type of person that's a checklist on that to-do list and that would be her 28-year-old son. she says that medicaid coverage has been a lifesaver for her son because it helps him afford the treatment he needs to strive for an independent, productive life. the truth of the matter is, i've heard from so many people like these three, from all corners of my state -- the old to the young to the middle-i am aned. i have heard from -- to the middle-aged. i have heard from so many people from the rural parts of my state about the bill. they are especially worried go the $834 billion in cuts to medicaid. medicaid covers more than 1.2 million minnesotans including more than one-fifth of our rural population. you any that. 20% of our rural population. this funding is vital for our rural hospitals and the health care providers' ability in those parts of our state to stay open and serve their patients. many, many people who work in rural hospitals, who are serve the by rural hospitals, have come up to me to talk about their concerns. and these hospitals are not like big urban hospitals. they're not. one of my rural hospitals -- i see the senator from hawaii here. i thank him for organizing this along with senator murray. our rural hospitals, they actually treat a lot of accidents. people out snowmobiling or on a.t.v.'s. in fact, one of them has a chart every summer showing all the places, the fishhooks -- they've had to remove fishhooks from people's hands. they have more than 100 of them by the end of the summer. you wouldn't see this in an urban area. it just shows, different parts of the country, different parts of our state have different issues that they're dealing with. these hospitals are particularly concerned about these cuts. these drastic cuts would cause many of our hurl hospitals to close -- of our rural hospitals to close, forcing families to drive 60, 70, 80 miles or more when they need the health care the most. the other issue that this bill brings up to me when you look at rural areas is the opioid epidemic. that is hitting communities across the country. in my state, deaths from prescription drugs now claim more lives than homicides or car crashes. while there is more work to do to combat this epidemic, i want to recognize that we have made meaningful progress so far in a bipartisan way. we passed a framework bill, the cara bill. we passed the cures act last december as well as money to fund treatment. unfortunately, just as we're starting to move forward on this issue, the health care repeal bill passed by the house would put us at the risk of moving backwards. there is money in that for opioid treatment, but guess what? medicaid and children's health insurance cover three out of every 10 people with an opioid addiction. but according to the nonpartisan congressional budget office, mental health and substance abuse benefits could be hut under the house bill increasing out-of-pocket costs. it is clear this legislation pass -- it is clear that this legislation has massive life-changing implications for families across this country, yet we haven't even seen a draft in the senate. what we do know is that just last week the president of the united states, who's known for not really mincing words, known for using very directly language, called the house bill mean. he called it mean. he didn't need a poll or a focus group. didn't need to know every detail of the bill. but when you hear that over 20 million people can lose their health insurance, that's a pretty good word to describe it -- mean. so what we don't want to have here out of the senate is that we bring forward the son of mean, or mean ii. we don't know what we have because we haven't seen it, because the legislation is being drafted behind closed doors. most of us agree that we must make changes to the affordable care act. i certainly think so. i would love to pass my bills or include them in amendments to the affordable care act to bring down the cost of prescription drugs. my bill to allow 41 million seniors to harness their negotiating power to bring drug prices down. right now they're banned to do that. that's wrong. i would love to see more competition come in the market in the form of less expensive drugs from other countries like canada. a bill i have with senator mccain. or make it easier to get general makers on the market -- generics on the market. or pay for delay. i think the american people would be surprise fundamental they found out that the big pharmaceutical companies are paying their generic competitors to keep their products off the market. we can make improvements to the exchanges, just as we've done some of that work in the state of minnesota, we can do that nationally. we can make improvements to change the small business rates. there are things we can do. but we can't do it if we're not in the door because the door is closed. and when the door is closed, it is not just closed for the democrats in the senate. the door is closed to the american people. when it all comes down -- what it all comes down to is we need-to-work in a bipartisan way to make health care better and less expensive for the people in our country. last week we all came together -- i was at that congressional baseball game. it was such an amazing moment, 25,000 people in the stands, all four leaders out there looking like they actually liked each other. there they were, and there our teams were, two teams -- a republican team and a democratic team. in the end, it was a hard-fought game. one team won -- the democratic team. but they handed their award to the republican team. they said, put it in representative scalise's office. we want to take that spirit and go even further. instead of two teams, one team for america. and the way we make changes to an issue that has been long fought on both sides -- both sides. i know republicans weren't happy with everything that happened during the debate on the affordable care act. they have made that clear. but now we have a moment in time where we can come together, make some sensible changes, and make things better for the people of this country. let's do it. thank you, mr. president. i yield the floor. mr. franken: mr. president? the presiding officer: the senator from minnesota. mr. franken: thank you, mr. president. i rise today to talk about the republican effort happening in total secrecy behind closed doors under the direction of leader mcconnell to repeal the affordable care act and gut medicaid in order to give huge tax breaks to the wealthiest georgians, the wealthiest americans. just about five monthsing a ago i came -- just about five months ago came before this body. i i should a simple request to republicans. i asked you to show me your plan to repeal and replace the affordable care act, mr. president. i asked you to show me the plan that was going to be, quote, terrific, end quote. the bill that president trump promised during his campaign, the one republicans had seven years to come up with -- i asked you to explain how you would meet the standards set by one of president trump's top advisors, kelley anne conway, who said, quote, we don't want anyone who currently has insurance to have no insurance -- to not have insurance, end quote. i asked you all to show me the plan that retains coverage for the nearly 20 million people who have gained it, continues to contain health care costs and ensures that nobody gets denied or has to pay more because of their gender or because of preexisting conditions. i never got that plan from you. instead, what we received was the american health care act, or the ahca, a heartless, terrible bill that passed the house in early may, a bill that president trump heralded in the rose garden after its passage as, quote, great, end quote. the ahca -- sorry, the ahca is a far cry from what president trump and his allies promised. if the ahca becomes law, 23 million more people would be uninsured. the bill ends protections for people with preexisting conditions and drives up health care costs dramatically for older, sicker folks. worse still, the ahca would end the medicaid expansion and slash medicaid by $834 billion over ten years, and for what? to offer massive tax breaks to the wealthy americans, for the wealthiest georgians in the presiding officer's state. the average tax savings for the 400 richest savings under this plan: $7 million apiece each year. $7 million. -- $7 million each for every year. you know, because they need it. no wonder people are outraged. just 8% of americans think the senate should pass this bill into law unchanged -- 8%. that has to be a new low. americans do not want trumpcare. three in four americans want president trump and his administration to do what he can to make the a.c.a. work rather than undermining it. even president trump reportedly now considers the house bill, quote, mean. it went from great to mean. in the rose garden, it was great. now just a few weeks later, that same great bill is mean. instead of listening to the american people, republicans are pursuing a strategy that former acting administrator of c.m.s. andy slavett has described as sabotage, secrecy and speed. up first, sabotage. a few years republicans choked off the risk corridor program which was designed to help stabilize premiums in the first years of the new exchanges. the trump administration has gone even further. it has stopped enforcing the individual mandate, undermined outreach efforts to help people sign up for health insurance, and cut the amount of time people have to sign up for health insurance coverage in half. but perhaps most troubling of all, republicans have refused to commit to funding cost-sharing reduction payments. these payments help low-income families cover their out-of-pocket costs. since insurers aren't sure if they can count on the administration to continue to provide these payments, some are pulling out of the individual market or dramatically increasing their premiums to account for this instability, its uncertainty. there is much more that we can do to shore up the individual market, but my colleague, senator stabenow, had it right when she say to secretary price, of the presiding officer's state, regarding the administration's sabotage efforts that, quote, it's like pulling the rug from under somebody and going oh my gosh, they fell down. end quote. from debbie stabenow of michigan. the next tenet of the republican approach is secrecy. a group of 13 men have been meeting in secret to draft the senate version of the ahca. what little we do know is that senator cornyn estimates that there will be about 80% overlap between the senate and house bills. prior to now our understanding was that the senate republicans, that you would completely rewrite the bill. senator burr even saying that the house bill was, quote, dead on arrival. end quote. it sounds like that plan has been jettisoned. but we can't be sure because the senate has had precisely zero hearings. zero days of public floor debate. and we have yet to see or hear about the revised draft of the ahca, despite the forthcoming vote. i urge my republican colleagues to recall that during the long debate over the affordable care act, the senate held nearly 100 bipartisan hearings, round tables and walkthroughs, and had 25 consecutive days of public floor debate. let me repeat that, mr. president. nearly 100 bipartisan hearings, round tables and walk-throughs. and the senate alone, 25 consecutive days of public floor debate on a bill that affects one-sixth of our economy. in the senate health committee, democrats considered nearly 300 amendments during a 13-day markup, one of the longest in congressional history, and ultimately accepted more than 160 republican amendments in the process. in 2009, then-house budget committee ranking member paul ryan argued that, quote, before congress changes health care as the american people know it, we must know the likely consequences of the house democratic legislation, including the number of people who would lose access to their current insurance. end quote. the irony is palpable. feel the palpable irony. you feel it, mr. president? does everybody feel it? that brings me to the final component of the republican approach, and that is speed. leader mcconnell would prefer to have a vote on the senate plan before the july 4th recess or shortly thereafter. that timing only leaves us a few days to go. there just won't be enough time to truly understand how this bill would affect the health care system which, again, is one-sixth of our economy, mr. president. it affects all the millions of americans who rely on it. republicans plan to schedule the vote in such a way as to keep the american people in the dark about this bill as long as possible. the american people deserve a chance to weigh in on a bill that would affect their lives and those of their friends and families in my state of minnesota and the presiding officer's state of georgia. my office has received over 15,000 letters from very worried minnesotans these past few months, and i've gone to visit rural health care facilities that would be among the hardest hit by the ahca. my constituents, the people of minnesota, are, frankly, scared about what will happen to them or their families if they lose their health insurance. i am too. as i did in january, i would like to encourage my republican colleagues to join me on a trip to minnesota to meet leeanna. leeanna's three-year-old son henry has been diagnosed with acute lymphoblastic leukemia. in his treatment, mr. president, will last until at least april of 2018. mr. president, he needs around-the-clock care to manage his nausea, vomiting, pain and sleepless nights. henry's immune system is so compromised that he's not supposed to go to day care, so leeanna left her job to care for him. henry and leeanna are supported by lee anna's spouse, but they can't pay for his treatment on one salary. leeanna says, and i quote, it is because of the a.c.a. that henry gets proper health care. henry can get therapy and the things he needs to maintain his health and work towards beating cancer. henry is still with us because of the a.c.a. end quote. he's three. let me say that again. henry is still with us, mr. president, because of the a.c.a. i will do everything i can to fight the republican effort to repeal the affordable care act, strip away consumer protections and gut medicaid. to all of my constituents who care about this, i need you to keep fighting. now is the time to make your voices heard. thank you, mr. president, for your attention, and i yield the floor. a senator: mr. president. the presiding officer: the senator from rhode island. mr. whitehouse: mr. president, i'm pleased to follow the senator from minnesota because i had the chance because of him to be on the help committee during all of those hearings, all of those dozens and dozens of republican amendments that took place during the vibrant, robust, bipartisan process in the help committee. senator franken was still in litigation over his election, and so his seat on the help committee was vacant, and harry reid asked if i would take that seat. so my senior senator, jack reed, and i, both of rhode island, were there in the room day after day, week after week while this exhaustive public bipartisan process went forward. i can even remember senator isakson of georgia working with him and supporting his amendment that would allow a doctor to be paid for having a conversation with a very ill patient about what their desires were if their condition didn't get better. what type of end-of-life care did they want. did they want every possible intervention or did they want a dignified time at home with their family? what were their desires? that's a conversation that is important for doctors to have with those patients. in the environment at the time, that became the death panel phony story. so i was there. i saw it happen, thanks to senator franken's delay in getting here. jack reed and i were in the room. and why does this matter? this matters because like the story of leeanna and henry, there are people on the other side of what is for apparently for our republican colleagues, a purely political piece of parliamentary chicanery. i've got a woman named pamela, lives in jamestown, rhode island. she works with people in nonprofit organizations that advocate for people who have very rare diseases. so she has seen in her work the before and after of the affordable care act. before the affordable care act, she wrote me, i saw many patients and families distraught by medical bankruptcy. then it came even closer home to pamela as she was diagnosed with stage 4 breast cancer. if there were an annual or lifetime limit on health benefits, she would be in deep trouble. if the protection for people with preexisting conditions were undone, that would imperil her ability to get insurance in the future. she wrote to me as a patient myself, with a chronic, costly medical condition, i'm very worried that these protections will be taken away, making my life-sustaining care unaffordable. pamela deserves to be heard, but nobody can speak up for her with a bill that nobody can see. from cumberland, marilyn wrote to me. marilyn is a family physician. she knows the health care system. she also has severe asthma. she's had asthma since she was a little child. and she manages her severe asthma with medication. her husband is retired and she purchases health insurance through health source rhode island, our obamacare health insurance marketplace which, by the way, is working very well. there is no need to undo what's going on in rhode island. it gives her peace of mind, and she wrote to me to say that she was terrified by the possibility that the preexisting condition clause will be allowed back in. she wrote to me, i'm not a specialist, but a family medicine physician, doing the best i can to pay my student loans and daily expenses. i could not afford the lifesaving treatment i require to function. i do not know how i would survive financially if the current legislation the house has approved is allowed to become law. gina wrote to me from lincoln, rhode island. gina's daughter sophia is six. sophia has cerebral palsy. we think we have problems here? i'll tell you, whatever the political problems we have over the affordable care act, have a 6-year-old with cerebral palsy and then come hell me about how -- and then come tell me about how big a problem not liking obamacare is. sophia needs round-the-clock care and gets it because of medicaid. from her home nursing care to her wheelchairs, we could not live without medicaid. before sophia came along, gina and her husband never imagined that they would need medicaid. it never crossed their mind. but now the welfare of their little daughter is entirely dependent on medicaid. depending on what we do here, gina wrote, will there even be a medicaid then? this administration is stripping benefits from the most vulnerable in our society. how will they survive? the last story i'll share is tony and his family who live in north kingstown, rhode island. tony has a son, his name is michael. michael right after he was born was diagnosed with something called mitochondrial disorder. it is a severely catastrophically debilitating illness. it left michael severely disabled. michael is 10 years old now, but developmentally, he's more like a three-month old. he can't walk, he can't talk, he can't feed himself, but he is happy and he is sweet, and he is a source of joy for his parents and his four siblings. through medicaid, michael can receive up to 30 hours per week of care from a certified nursing assistant. it is this program -- it is medicaid supporting the certify nursing assistant, those 30 hours a week, that lets michael live at home with his parents and those four siblings. otherwise he'd have to be institutionalized. somebody explain to me why a political victory shoved through this body after secret proceedings is worth explaining to michael's parents that he's at risk of losing that coverage. when president trump said that the house bill was mean, he was not kidding around. it is mean, mean, mean, dirty, rotten mean. and if you think the one on the senate side is going to be any better, there's one little phrase i'd like to bring to your attention. "we're not stupid." "we're not stupid" is what a republican staffer said when he was asked, why aren't you guys having a public process, why are you trying to jam this through in secret? his answer: "we're not stupid." well, what can you logically deduce from that? what kind of bill would be stupid to show the american public? if this was a bill that was going to be greeted with great applause and joy and relief and satisfaction by the american public, would you hide it? no. if it were terrible, if it would threaten people all across this country, then you wouldn't want them to see it. that would be stupid. so that's what they're up to. they know perfectly well that this bill is not good for america. that is why showing it to the american people would be, by their own words, stupid. let me switch to my geek point before i go, because this is something i talk about a lot, and it bothers the heck out of me. this is a graph that shows health care in most of the countries that compete with us, the oecd nations. this shows life expectancies in years. where you fall in this is where the average life expectancy is in most of the countries. life expectancy is a pretty good measure of how good the health care system is. here is the cost of health care per capita, averaged across the population. and as you'll notice, most everybody is right up in here -- japan, switzerland, netherlands, united kingdom, mos most of our competitors, france, germany, they're all up in higher. where are we? we're out here. the most other expensive country in the world is switzerland which doesn't break $6,000 per person. we are over $8,000. the average in here where japan comes in above where the united kingdom comes in is $4,000 per person. we're above $8,000. we are 100% more expensive than the average and more than 50% more expensive than the least efficient other country in the world. so there is progress to be made at bringing costs down. if we would pay attention to this real problem instead of the imaginary problem of americans having too much health care. and over here, look at the life expectancy in years. look where we come in. we watch the czech republic -- we match the czech republic. so there is progress to be made on cost and on outcomes in this country, and believe it or not, we're actually starting to make a little progress. let me take you through this graph and then i will he leave you be. this -- and then i'll leave you be. this top line was drawn by the congressional budget office. back here in 2010, what they do is they project forward into the future where they think health care costs are going to go. these are all federal health care costs, the whole federal health care cost, all them piled up -- medicare, medicaid, veterans veterans, all of it. so here is what they projected it would be, this top line, in 2010. then they got to 2016, i guess, and they did another projection because they realized that as of 2014, things were coming in below their expectations. after the affordable care act, things started to change. so they did another projection in 2016, and they projected this line right here. now, those of us who serve on the budget committee know that we think in 10-year increments. so-- so here's a 10-year incremt from 2017 to 2027. if you look at just at the difference between what c.b.o. predicted in 2010 before the affordable care act, and what they projected in 2016 after the affordable care act, $3.3 trillion in savings. $3.3 trillion in savings. think of what a difference that makes for our country if you can save $3.3 trillion in our health care costs. health care cost is what's driving most of our debt and our deficit. $3.3 trillion in savings. i tell you what, i want to see this bill because i want to know what cbo thinks about what happened 20 that $3.3 trillion in savings. because if the cost is going to be losing $3.3 trillion in savings, the american people ought to know about that. so i call on my republican colleagues to have a process. i don't know if the presiding officer has seen the bill yet. it's so closely held, i don't know if all the republicans have even seen it. but for gosh sake, when you've got these stories from rhode island and from all the other states around the country, when you've got real fellow americans counting on the health care that the affordable care act made possible, the idea that you'd throw that out to score political points and to give superrich people a tax break is disgraceful. it is a disgrace. and i yield the floor. a senator: mr. president? the presiding officer: the senator from hawaii. mr. schatz: thank you, mr. president. i'd like to give a status report on this bill. right now we think it's within a 13 men who are working on it in men. they will show it to republican lobbyists and then they will send it over to the c.b.o. for a score and eventually the american public and the senate will be able to see the bill, and we will have a process called vote a marks which is mostly -- vote-a-rama, which is mostly nonsense and there will be lots of opportunities to offer amendments. the leader will offer an amendment in the nature of a substitute. so what does that mean? that means that all of the amendments that were adopted along the way get taken out with one 51-vote margin and all of that -- all of that vote-a-rama was for show because mitch mcconnell will put his bill on the floor that was negotiated in secret with those 13 people. if there was any question that our democracy is being rolled over by senate republicans, i want you to think about these 13 men. they are drafting a bill without any input from women, from democrats, from experts, and by working in secret, they are cutting out about 250 million people who are from the 40 states who aren't represented among those 13 men. and you can bet that those 40 states have unique health care needs and unique health care laws, and without the right language, the bill could throw health care in each of those states or any of those states into total chaos. they've also cut out senators on the health, education, labor, and pensions committee and the finance committee, even though these committees are actually constructed for the purpose of working on legislation like this. they know how to get things done like this. there are members of the help committee and the finance committee that are among the experts on this issue, and yet they don't get a chance to seen even see the bill -- to even see the bill. these senators have jurisdiction over this legislation, but they're being left out. and this is just not the way it's supposed to work. we need transparency, we need bipartisanship, but now the republicans will try to tell you that, you know, hearings are bypassed all the time. that's not true. that's not true. in fact, this body will hold a hearing on almost anything. in 2017 alone, the senate has had hearings on hottub safety, self-driving cars, a treaty for out-you are space, multimodal ships and the maritime administration, and dozens of other issues. look, those are actually not to be trivialized. it is important for the senate to have hearings. it is important for subcommittees to do their work. but nobody can tell me that hot tub safety, self-driving cars, a treaty for outerspace, multimodal shipping, the maritime administration, are more important than one-sixth of the american commitment of it is a joke. we're talk about one-sixth of the american economy. about millions of jobs, and people with life-threatening diseases and life-changing medical bills and so we know how important hearings are to do legislation when the senate took up a.c.a., there were almost 100 hearings. think about that. 100 hearings versus zero. there were round tables, walk-throughs held by the two committees. we considered hundreds of amendments and accepted more than 150 amendments from republicans. but for this bill, no markup, no transparency, no bipartisanship -- just 13 men meeting in secret outside of the regular process. and the only thing that has changed is now the market is under siege but the market is under siege because of the republican administration. they are purposefully creating uncertainty, and that's not a rhetorical fluor identifiability they're saying they're doing that. president trump actually said he wanted to create uncertainty in the health care market in order to create leverage with democrats. think about how unusual that is. think about how offensive that is. it is perfectly appropriate for one party to try to generate leverage in a negotiation against the other. that's part of politics. either in an election context or in the public policy context. but the way that this president and tom price are trying to generate leverage is by raising health care premiums in order to force democrats to buckle. that's unheard of. it really is unheard of. and it hurts everybody across the country to create this uncertainty. it's bad enough that the republicans are trying to take health care away from 23 million people, from nursing home patients and their families, from women who are pregnant or fighting breast cancer, from sons and daughters and moms and dads who struggle with opioids, but toed a insult to injury -- but to add insult to injury, they are going to jam it down your throat. you don't get to read what it's about before it passes, or hear from doctors or nurses or experts about how it will affect you. so why are they working on this bill in secret? and the answer is very simple. the bill stinks. they're ashamed of it. the bill itself is an embarrassment. the process is an embarrassment. they've said so themselves. no matter how you look at it, this bill is disaster for people and their families. it will be a disaster for anyone who relies on medicaid, which will be cut by at least $800 billion. medicaid is a safety net for people who need care but can't afford it. look at nursing home care. medicaid covers three out of every four long-staying nursing home residents. medicaid covers three out of four long-stay nursing home residents. my wife's grandmother was just in a nursing home and just passed away and had great care. and wouldn't have been able to get the care that she needed were it not for medicaid. and this isot

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