From the Congressional Record Online through GPO
The PRESIDING OFFICER. Under the previous order, the Senate will
proceed to executive session to consider the following nomination,
which the clerk will report.
The bill clerk read the nomination of Seema Verma, of Indiana, to be
Administrator of the Centers for Medicare and Medicaid Services.
The PRESIDING OFFICER. The Senator from Florida.
freedom for bob levinson
Mr. NELSON. Madam President, I come to the floor with a heavy heart
because 10 years ago today, Robert Levinson, a former FBI agent, was
detained in Iran on the tourist island of Kish Island in the Persian
Bob is a very respected, long-time FBI agent who had served his
country for 28 years and had since retired. He is the longest held
civilian in our Nation's history. He is a husband, a father of seven,
and now a grandfather of six, and he deserves to be reunited with his
Since Bob's detention, American officials have sought Iran's
cooperation in locating and returning Bob to his family. Of course,
Iranian officials have promised over and over their assistance, but
after 10 long years, those promises have amounted to nothing. Bob still
is not home.
The bottom line is, Iran is responsible for returning Bob to his
family. If Iranian officials don't have Bob, then they sure know where
to find him. So today we renew our call on Iran to make good on those
promises and return Bob, return him to where he ought to be, with his
Iran's continued delay in returning him, in addition to the very
serious disagreements the United States has with the Government of Iran
about its missile program, its sponsorship of terrorism, and its human
rights abuses, is just another obstacle Iran must overcome if it wants
to improve relations with the United States.
We also urge the President and our allies to keep pressing Iran to
make clear that the United States has not forgotten Bob and will not
forget him until he is home. Obviously, we owe this to Bob, a servant
of America, and we certainly owe it to his family.
To Bob's family, we recognize your tireless efforts over those 10
long years to bring your dad home, and we offer our sympathies.
Madam President, I yield the floor.
The PRESIDING OFFICER. The majority whip.
American Health Care Act
Mr. CORNYN. Madam President, this week the Senate continues to press
forward on a number of congressional review actions; in this case, a
disapproval that will roll back and repeal many Obama-era regulations
that have hurt people across the country and strangled our economic
By doing away with excessively burdensome rules and regulations, we
are delivering on our promise to the American people to actually do
what we can to help the economy, to grow the economy, to create jobs
and not hurt it with unnecessary, expensive, and burdensome redtape.
Earlier this year, we began the legislative process to deliver on our
biggest promise: repealing and replacing ObamaCare with more affordable
and more accessible healthcare options, options that will work for all
American families. The American Health Care Act, introduced in the
House on Monday, is the first step in fulfilling that promise.
ObamaCare is collapsing. It has already failed countless families
across the country, and it has forced people off good insurance plans
they liked and strong-armed them to sign up for plans that were more
expensive, offered less care, and didn't even let them use the doctor
of their choice. So we would be revisiting healthcare even if Hillary
Clinton had been elected President of the United States because
ObamaCare is in a meltdown mode.
ObamaCare has also saddled our economy with more than a trillion
dollars in new taxes. Most of those taxes are so hidden that most
Americans are probably not aware of the fact that there is even a tax
charged on the premium for their health insurance policy, for example.
Well, all of these taxes end up being absorbed and have to be paid by
At its very core, the individual mandate of ObamaCare was a major
power play and overreach by the Federal Government. Basically, what it
said was, if you don't buy the government-prescribed health insurance
plan, we are going to fine you; we are going to penalize you.
The government should not be able to force anyone to spend their own
hard-earned money for something they don't want but have to buy under a
threat of financial penalty. The American people have spoken up loudly
and clearly and rightfully demanded that Congress do better, and we
Since the 2010 timeframe--when our colleagues on the other side of
the aisle passed ObamaCare with 60 votes in the Senate, a majority in
the House, and with the White House--they have lost the majority in the
Senate, they have lost the majority in the House, and they have lost
the White House. I think ObamaCare has been one of the major reasons
why, because people, the more they learn about it, the less they like
it, and they don't appreciate Washington forcing them to do things they
don't want to do with their own money.
About 2 months ago, one of my constituents in Texas wrote me about
her skyrocketing healthcare costs. Before last year, her premium was
about $325 a month. A short time later, that was revised to $436 a
month. This same Texan later moved from one city to another and,
because of her change of address, her premium jumped to $625 a month.
It started at $325 and is now $625. In 2017, thanks to ObamaCare, her
premium went up again to an astronomical $820 a month. It started at
$325 before ObamaCare and is now $820 a month. I don't know many people
who could absorb that kind of increase in their healthcare insurance
In about a year, her monthly healthcare payment jumped by more
than 150 percent--150 percent. That is hardly what I would call
affordable; thus, the misnamed Affordable Care Act should be the un-
Affordable Care Act.
To make matters worse, she then found that her provider would be
putting a halt to individual plans in Texas, something that has been a
recurring theme in my State and across the country. So while President
Obama said: If you like your plan, you can keep your plan, as a result
of ObamaCare, she was not able to keep her plan so she had to find a
new plan and a new doctor, a plan ultimately with less care, less
flexibility, and even a higher price.
Suffice it to say, for this constituent of mine and for millions more
like her, ObamaCare is not working. ObamaCare is not affordable, and it
is hurting Texans. It is time for Congress to keep its promise that we
have made in every election since that given the privilege of
governing--of being in the majority, being in a position to change
things--we would repeal and replace ObamaCare with options that fit the
needs of all Americans and their families at a price they can afford.
Mr. SANDERS. Will my friend from Texas yield for a question?
Mr. CORNYN. I will not, not at this time.
Fortunately, we now have a President in the White House who clearly
sees the failure of ObamaCare and wants to do something about it.
Republicans in Congress have introduced a bill, which is now being
marked up in the House, that the President can actually sign, once it
is passed, to get us out of this mess. The American Health Care Act is
the vehicle to do just that, and I am glad President Trump endorsed the
plan earlier this week.
It is a work in progress. The House committees are marking it up as
we speak. There will be changes along the way, but, ultimately, the
House will pass the bill and send it to the Senate. Then we will have
an opportunity to offer our amendments during the course of its
passage. The important point to make, though, is that this legislation
will actually put patients first so they are not forced into a plan
that they don't want or that provides coverage they can't afford. It
does away with the outrageous new taxes and the penalties that have
made the economy worse off and have made life harder for American
The legislation will also give families more flexibility so they can
get the healthcare specific to their needs that actually works for
them. If they decide, for example, to get a major medical policy that
is relatively inexpensive and then use a health savings account to use
pretax dollars to pay for their regular doctors' visits, they will have
the flexibility to do that. So this legislation promotes sensible
reforms to ensure that big ticket items like Medicaid are put on a more
sustainable fiscal path.
I have heard some suggestions that this legislation actually guts
Medicaid. That is false. That is not true. It actually continues at
current levels in this shared State and Federal program, but it is
subject to a cost-of-living index that will actually put Medicaid on a
more sustainable path. Just as importantly, it will also return the
authority back to the States to come up with the flexible programs they
need to deal with the specific healthcare needs of the people of their
This legislation makes sure that Medicaid doesn't lose sight of its
design, which is to serve the most vulnerable among us who can't afford
access to quality healthcare. It provides them that access--and better
access--by providing flexibility to the States.
We know that the States and the Federal Government spend an awful lot
of money on Medicaid. In Texas, for example, my State spent close to
one-third of its budget on Medicaid last year--one-third of all State
spending--and it is uncapped, so it goes up every year by leaps and
bounds. Under the American Health Care Act, Medicaid will be tied to
the number of people in the State using it, a per capita rate, which
makes sense, and it represents the first major overhaul of the program
ObamaCare left us with unchecked government spending, more taxes, and
fewer healthcare options. This bill is the opposite of ObamaCare in
every way. It will control spending in a commonsense way, it will
repeal ObamaCare's taxes and the individual and employer mandate, and
it will provide more flexible free market options for families across
the country. That is not just a bumper sticker or advertisement; that
is actually what is contained in the legislation.
I look forward to working with my colleagues in the House, in the
Senate, and in the Trump administration to get this done in the next
Madam President, I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. MARKEY. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. MARKEY. Madam President, here we go again, debating the
nomination of a Trump candidate who is both unqualified and reflects an
extreme ideology for the Department she will hope to lead. In this case
it is Seema Verma, and the Department is the Centers for Medicare and
Medicaid, or CMS, as it is often called.
Why is CMS, an acronym for a department that most Americans don't
even know about, so important that its nominee would make it to the
floor of the U.S. Senate for debate? Because 100 million Americans
receive health insurance coverage under one of our Federal insurance
programs--Medicare, Medicaid, the Children's Health Insurance Program,
and the health insurance marketplace created by the Affordable Care
Act, all of which are under the jurisdiction of CMS.
CMS is the traffic cop of our Federal Government healthcare system.
It makes sure that Americans have access to affordable, quality
healthcare by administering and overseeing all aspects of our Federal
health program. It promotes healthcare innovation and works to reduce
waste, fraud, and abuse throughout our healthcare system.
Under the Trump administration and Republican leadership, which has
vowed to repeal ObamaCare and get rid of Medicaid as we know it, the
leader of CMS will be the person responsible for reducing Federal
spending on public insurance programs, particularly for the poor, the
elderly, and the disabled. Seema Verma is President Trump's nominee to
try to meet that misguided and heartless challenge.
Republicans have an ancient animosity toward Medicaid, and it would
seem that Ms. Verma shares that prejudice. Ms. Verma is most well known
for proposals that penalize and create roadblocks to coverage for low-
income Americans. She supports changes to Medicaid that would make it
harder for those who need Medicaid to access it. This stance is
fundamentally antithetical to the core principle of Medicaid, which is
providing coverage for those who cannot afford it. For the most part,
we are talking about poor people in the United States of America in
Despite the fact that research shows the onerous premiums or cost
sharing for low-income individuals served as barriers to enrolling in
and obtaining care, Ms. Verma supported a plan to require Medicaid
enrollees to pay premiums through monthly contributions to a health
savings account. Guess what. People who are poor enough to qualify for
Medicaid rarely have enough money to dedicate to savings accounts of
any kind. They are living day to day, week to week, month to month.
She also supports putting in place restrictions that put more burdens
on low-income Americans than even private insurance. It will be Grandma
and Grandpa who will pay the highest price.
Medicaid isn't just a line in our healthcare budget; it is a lifeline
for millions of seniors in every State of the country. Here are the
facts about the importance of Medicaid to our seniors. It is
anticipated that by 2060, there will be more than 98 million Americans
over the age of 65. The number of individuals over the age of 85 is
expected to reach 14.6 million in 2040--triple the number in 2014. Of
this population, 70 percent will likely use long-term services and
supports, of which Medicaid is the primary player. Medicaid spent $152
billion on long-term support services like nursing home care in 2014.
Let me say that again. The entire defense budget is about $550
billion. We spent as a nation $152 billion--a little less than one-
third of the defense budget--to take care of Grandma and Grandpa in
nursing homes in 2014. They may have Alzheimer's, they may have other
diseases, but, unfortunately, most families can't save $50, $60,
$70,000 for year after year of nursing home coverage; that is Grandma
The anticipated growth rate for Medicaid beneficiaries over the age
of 65 is four times the rate of growth for all Medicaid beneficiaries.
The only thing growing faster than the need for Medicaid is the number
of people who are opposed to repealing the Medicaid expansion under
ObamaCare. Medicaid pays for nearly two-thirds of individuals living in
Can I say that again? Medicaid pays for two-thirds of individuals
living in nursing homes in our country. So if you know a family member
who is in a nursing home who has Alzheimer's or some other disease, you
can just assume that Medicaid is helping that family to ensure that
Grandma or Grandpa is getting the care they deserve for what they did
to build this great country.
Fundamentally restructuring Medicaid will place additional strain on
already strapped State budgets because nursing facility care is a
mandated Medicaid benefit. States may offset the increased costs in
covering this service by further cutting payments to providers or
removing benefits that seniors want and need, like home- and community-
based services. It also puts more strain on working-class families
because if Medicaid isn't picking up the cost of putting your grandma
in a nursing home, that comes out of the pockets of other contributors
to the family.
Unfortunately, Republicans want to undermine the Medicaid expansion
under the Affordable Care Act, which is benefiting millions of seniors.
They want to force seniors to pay more out-of-pocket for healthcare or
forgo coverage because they cannot afford it.
What Republicans refuse to accept is that the Affordable Care Act is
the most important program we have put in place for seniors since
Medicare. The uninsured rate for Americans aged 50 to 64 dropped by
nearly half after the passage of the ACA. The uninsured rate for this
older population living in Medicaid expansion States was 4.6 percent
while the uninsured rate for the same population living in a non-
Medicaid expansion State was 8.7 percent--almost double.
Not only does the Republican proposal amount to an age tax by
substantially increasing the amount an insurance company can charge for
an older person, but it provides older Americans with fewer resources
than what is available under ObamaCare to help cover their increased
costs for care.
Unfortunately, as Republicans attempt to repeal ObamaCare, CMS is
authorized by President Trump's Executive order to “minimize the
unwarranted economic and regulatory burdens” of ObamaCare. In simple
terms, that means undoing and privatizing vital provisions of the
Affordable Care Act as soon as possible under the law.
CMS has also picked up a sledgehammer. It has already proposed new
rules of slashing open enrollment times for the exchanges by over a
month. It has proposed rules to relax the minimum standards for what
qualifying health plans sold on the exchanges have to cover.
Now, more than ever, we need a leader at CMS who understands and
respects the fundamental need for healthcare for our seniors, and for
so many of them, that need is met by Medicaid. Ms. Verma's disdain for
Medicaid is simply an insurmountable problem for the millions of older
Americans in this country who rely upon this fundamental program.
Given her lack of experience and extreme views, several major groups
that represent millions of working-class Americans have voiced strong
opposition to her confirmation.
This is what the American Federation of State, County and Municipal
Employees of the AFL-CIO said:
“Leading CMS is too important a role to be held by an individual who
is committed to policies so radical they would jeopardize the health
and lives of ordinary Americans.”
I could not agree more.
Seema Verma is the wrong person to run CMS at a time when millions of
Americans are relying on the dignity and coverage that Medicare and
Instead of cutting funding for defense, Donald Trump wants to cut
programs for the defenseless. The Trump administration would rather
bestow billions more to the Pentagon to pay for new nuclear weapons,
which we do not need and cannot afford, all the while supporting cuts
to Medicaid and senior health. We should be cutting Minuteman missiles
instead of Medicaid. We should be cutting gravity bombs instead of
The Trump administration's plan for Medicaid and our overall
healthcare system would be a nightmare for Grandma and Grandpa and
millions of middle-class Americans.
I am opposed to Seema Verma's nomination, and I call on my colleagues
to join me in voting no on her nomination when it is presented on the
I yield the floor.
The PRESIDING OFFICER (Mr. Sasse). The Senator from Colorado.
Nomination of Neil Gorsuch
Mr. GARDNER. Mr. President, I rise to support the nomination of Judge
Neil Gorsuch to the U.S. Supreme Court. Hopefully, we will see his
confirmation in the weeks to come.
As I have come to the floor and talked about before, Judge Gorsuch is
a fourth-generation Coloradan who serves on the Tenth Circuit Court of
Appeals, which is the U.S. circuit court that is housed in Denver, CO.
It is the circuit court that oversees about 20 percent of the land mass
in the States of Colorado, Oklahoma, and places in between. Once he is
confirmed to the Supreme Court, Neil Gorsuch will become the second
Coloradan to have served on the Court.
We have a great history of another Supreme Court Justice who served
on the highest Court. Associate Justice Byron White had the distinction
of being the only Supreme Court Justice to lead the NFL in rushing, and
he was also from Colorado.
If Judge Gorsuch is confirmed, Justice Gorsuch will join Byron White
as another Coloradan on the High Court. Justice Rutledge also received
his bachelor's of law degree from the University of Colorado. So we do
have a great history of Colorado westerners joining our Nation's
Mr. Gorsuch was confirmed to the Tenth Circuit Court a little over 10
years ago--11 years ago--in 2006, by a unanimous voice vote. He was so
popular and so well supported that there was not even a rollcall vote
taken in this Chamber. It was a simple acclamation by a voice vote. In
fact, Gorsuch's nomination hearing was deemed so noncontroversial that
the last time, Senator Graham was the only committee member to attend.
One may ask oneself what made and continues to make Judge Gorsuch
such a mainstream nominee. I do not think we need to look any further
than his original Judiciary Committee questionnaire to see that Judge
Gorsuch possesses the right temperament and the right view of the role
I thought it was important that I read this from 11 years ago when
Judge Gorsuch was confirmed to the Tenth Circuit Court. The
questionnaire he filled out for the Judiciary Committee included then-
Neil Gorsuch's--trying to be Judge Gorsuch--response to judicial
activism and what it meant to Neil Gorsuch prior to his confirmation to
the Tenth Circuit Court.
Here is what he replied to the Judiciary Committee in that committee
The Constitution requires Federal judges to strike a
delicate balance. The separation of powers embodied in our
founding document provides the judiciary with a defined and
Judges must allow the elected branches of government to
flourish and citizens, through their elected representatives,
to make laws appropriate to the facts and circumstances of
Judges must avoid the temptation to usurp the roles of the
legislative and executive branches and must appreciate the
advantages these democratic institutions have in crafting and
adapting social policy as well as their special authority,
derived from the consent and mandate of the people, to do so.
At the same time, the Founders were anxious to ensure that
the judicial branch never becomes captured by or subservient
to the other branches of government, recognizing
that a firm and independent judiciary is critical to a well-
The Constitution imposes on the judiciary the vital work of
settling disputes, vindicating civil rights and civil
liberties, ensuring equal treatment under the law, and
helping to make real for all citizens the Constitution's
promise of self-government. There may be no firmly fixed
formula on how to strike the balance envisioned by the
Constitution in specific cases, but there are many guideposts
discernible in the best traditions of our judiciary.
A wise judge recognizes that his or her own judgment is
only a weak reed without being fortified by these proven
For example, a good judge recognizes that many of the
lawyers in cases reaching the court of appeals have lived
with and thought deeply about the legal issues before the
court for months or years. A lawyer in the well is not to be
treated as a cat's paw but as a valuable colleague whose
thinking is to be mined and tested and who, at all times,
deserves to be treated with respect and common courtesy.
A good judge will diligently study counsels' briefs and the
record and seek to digest them fully before argument and then
listen with respectful discernment to the arguments made by
his or her colleagues at the bar.
A good judge will recognize that few questions in the law
are truly novel, that precedents in the vast body of Federal
law reflect the considered judgment of those who have come
before us and embody the settled expectation of those in our
A good judge will seek to honor precedent and strive to
avoid its disparagement or displacement.
A good judge will listen to his or her colleagues and
strive to reach consensus with them. Every judge takes the
same judicial oath; every judge brings a different and
valuable perspective to the office.
A good judge will appreciate the different experiences and
perspectives of his or her colleagues and know that reaching
consensus is not always easy but that the process of getting
there often tempers the ultimate result, ensuring that the
ultimate decision reflects the collective wisdom of multiple
individuals of disparate backgrounds who have studied the
issue with care.
Throughout the process of adjudicating an appeal, a good
judge will question not only the positions espoused by the
litigants but also his or her own perceptions and
tentative conclusions as they evolve.
And a good judge will critically examine his or her own
ideas as readily and openly as the ideas advanced by others.
A good judge will never become so wedded to any view of any
case so as to preclude the possibility of changing his or her
mind at any stage--from argument through the completion of a
Pride of position, fear of embarrassment associated with
changing one's mind, along, of course, with personal politics
or policy preferences have no useful role in judging; regular
and healthy doses of self-skepticism and humility about one's
own abilities and conclusions always do.
This is the response that then-Neil Gorsuch, prior to his becoming
Judge Gorsuch, gave to the Senate Judiciary Committee and in response
to a questionnaire about judicial activism and about what makes a good
judge in his talking about fidelity to precedent, talking about the
ability to reach a conclusion that may be in disagreement with one's
own personal opinions, making sure that we respect the different
branches of government, making sure that one listens to one's
colleagues who are arguing a case and who have spent years in their
getting to know the case and its every detail, and scrubbing your mind
to question the positions that you thought you had to make sure that
they mesh with the law, not with opinion.
Judge Gorsuch, when he was introduced at the White House when being
nominated by the President, said that a judge who agrees with every
opinion he reaches is probably a bad judge.
The institution we serve has that fidelity to the Constitution that
we must preserve, that we must guard. Guardians of the Constitution,
which judges represent, is something we confirm. It is our job to make
sure the kind of judges we place on courts represent the kind of judge
Neil Gorsuch truly is.
It is this temperament, this fidelity to the Constitution, this
appropriate temperament, and remarkable humility that has made Judge
Gorsuch a consensus pick in the past and, I believe, that could be a
consensus pick in the near future.
It is reflected in the fact that, on February 23, Senator Bennet and
I, along with the Judiciary Committee, received a letter from
Colorado's diverse legal community in support of Judge Gorsuch's
nomination to the Supreme Court.
The letter reads as follows:
As members of the Colorado legal community, we are proud to
support the nomination of Judge Neil Gorsuch to be our next
Supreme Court Justice. We hold a diverse set of political
views as Republicans, Democrats, and Independents. Many of us
have been critical of actions taken by President Trump.
Nonetheless, we all agree that Judge Gorsuch is exceptionally
well qualified to join the Supreme Court. He deserves an up-
We know Judge Gorsuch to be a person of utmost character.
He is fair, decent, and honest, both as a judge and as a
person. His record shows that he believes strongly in the
independence of the judiciary. Judge Gorsuch has a well-
earned reputation as an excellent jurist. He voted with the
majority in 98% of the cases he heard on the 10th Circuit, a
great portion of which were joined by judges appointed by
Democratic Presidents. Seven of his opinions have been
affirmed by the U.S. Supreme Court--four unanimously--and
none has been reversed.
We ask that Colorado's Senators join together and support
this highly qualified nominee from Colorado. Regardless of
the politics involved in prior confirmation efforts,
including what many consider to be the mistreatment of Judge
Garland's nomination, a filibuster now will do Colorado no
Judge Gorsuch deserves a fair shake in the confirmation
process. Please vote against a filibuster and vote for Judge
Gorsuch's confirmation to the Supreme Court.
This letter from James Lyons is another such letter talking about the
importance of the confirmation of Judge Gorsuch. I couldn't agree more
with this letter and the letter that I read.
Judge Gorsuch is an exceptionally qualified jurist, to use their
words, and he deserves a fair shake in the confirmation process that
includes a timely up-or-down vote.
I ask unanimous consent that this letter be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
February 7, 2017.
Hon. Chuck Grassley,
Chairman, Committee on the Judiciary,
Dear Senator Grassley: I write this letter in strong
support of the nomination and confirmation of Judge Neil
Gorsuch for Associate Justice of the United States Supreme
Judge Gorsuch has been known to me professionally for over
twenty years, and his family even longer. In the mid-
nineties, we were counsel together in successfully
representing co-defendants in a major securities matter
involving class action and derivative lawsuits in several
jurisdictions across the country as well as SEC and
Congressional investigations. Over the course of that complex
representation in the following years, I came to observe
first-hand his considerable lawyering skills, intellect,
judgment and temperament. He was one of the finest trial
lawyers with whom it has been my pleasure to be associated in
my career. We also became personal and good friends which
continued during the following years at his firm, later
during his time at the Department of Justice and since
returning to Denver to serve on the bench.
I was delighted by his appointment to the U.S. Court of
Appeals for the Tenth Circuit based here in Denver. (He
honored me by having me be one of two lawyers to introduce
him to the court at his formal investiture.) Over his years
of service on that court, he has distinguished himself with
his work ethic, keen and thorough understanding of the case
under review, his formidable analytical ability, and the
clarity of his opinions. I have read many of his opinions and
watched him in oral argument. He is engaging, courteous to
counsel and demonstrates a full and unusual appreciation for
the human impact of his decisions on the people involved.
These are the qualities of an outstanding jurist.
Judge Gorsuch has been active and an important voice in the
legal community and academy. He has written extensively,
lectured and taught in continuing legal education seminars
and served on the important federal Rules Committee, among
others. He also has found time to sit on student moot courts
and teach both ethics and federal jurisdiction at the
University of Colorado Law School. He is regularly regarded
by his students as one of their very best law professors--
effective, challenging and personable.
Judge Gorsuch's intellect, energy and deep regard for the
Constitution are well known to those of us who have worked
with him and have seen first-hand his commitment to basic
principles. Above all, his independence, fairness and
impartiality are the hallmarks of his career and his well-
James M. Lyons.
Mr. GARDNER. Mr. President, I look forward to working with my
colleagues across the aisle to make sure we fill this vacancy on the
Supreme Court with one of this Nation's truly brilliant legal minds.
Mr. President, I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. MORAN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Kennedy). Without objection, it is so
Cuba Trade Act
Mr. MORAN. Mr. President, I come to the floor today to speak about
legislation I have recently introduced, although it is a follow-on to
legislation I pursued over a number of years.
We have now introduced in this Congress the Cuba Trade Act. This is
legislation which would lift the trade embargo to allow farmers and
ranchers and small businesses and other private sector industries to
freely conduct business, to sell products--agricultural products in
particular--to the nation of Cuba and to its people.
Last month, I spoke about the terrific difficulties our farmers in
Kansas and across the country are facing due to low commodity prices.
The farm economy has fallen by nearly 50 percent since 2013, and that
decline is expected to continue in 2017, making this perhaps, if not
the worst, certainly one of the worst economic downturns in farm
country since the Great Depression.
In 2016, harvests in our State and across much of the country were
recordbreaking yields and historic in their magnitude, in fact. What
that means is there are still piles of wheat, corn, and other grains
all across Kansas just sitting on the ground next to the grain mill
bins that are already filled to capacity. To sell this excess supply,
our farmers need more markets to sell the food and fiber they produce.
Approximately 95 percent of the world's customers live outside U.S.
borders. Markets in the United States will continue to grow, and they
will evolve and will continue to meet the domestic consumer demand,
providing the best, highest quality, safest food supply in the world,
but in order to boost prices for American farmers, we need more
markets. We need them now, we need them in the future, and we need to
be able to indicate to our farmers that hope is in the works in global
We have talked about the importance of trade, of exports from the
United States, and particularly for the citizens of Kansas. That is
particularly true for an agricultural State like ours where, again, 95
percent of the consumers live someplace outside of the United States.
Cuba is only 90 miles off our border. They offer the potential for
increased exports of all sorts of products but especially Kansas wheat.
In fact, while we are introducing this legislation now, we started
down this path to increase our ability to sell agriculture commodities,
food, and medicine to Cuba back when I was a Member of the House of
Representatives. I offered an amendment then to an appropriations bill
that lifted the embargo--the ability to sell; it would allow the
ability to sell those foods, agricultural commodities, and medicine to
Cuba for cash, up front. That bill was passed. It was controversial
then. This issue of what our relationship ought to be with Cuba has
always been contentious. But I remember the vote was about I think 301
to 116. A majority of Republicans and a majority of Democrats said it
is time to do something different with our relationship with Cuba.
This was a significant step in opening up the opportunity to the
products of American farmers and ranchers to that country. No longer
were food, medicine, and agriculture commodities prohibited from being
sold. And it worked for a little while, but unfortunately, in 2005, the
Treasury Department changed the regulations, and it complicated the
circumstances related to the embargo.
Cuba imports the vast majority of its food. In fact, wheat is Cuba's
second largest import, second only to oil.
A point I would stress is that this is a unilateral sanction. Keep in
mind that when we don't sell agricultural commodities to Cuba, somebody
else does. While our unilateral trade barriers block our own farmers
and ranchers from filling the market, willing sellers such as Canada,
France, China, and others benefit at American farmers' expense. When we
can't sell wheat that comes from a Kansas wheat field to Cuba, they are
purchasing that wheat from France and Canada and other European
countries. When the Presiding Officer's rice crop can't be sold to
Cuba, it is not that they are not buying rice; they are buying it from
Vietnam, China, or elsewhere.
It costs about $6 to $7 per ton to ship grain from the United States
to Cuba. It costs about $20 to $25 to ship that same grain from the
European Union. However, we lose this competitive advantage because of
the regulations in place that drive up the cost of Cuban consumers
dealing with the United States.
To understand what we are missing out on in Cuba, consider our
current trade relationship with the Dominican Republic. The DR is also
a nearby Caribbean nation with a population comparable to Cuba. Income
levels and diet are similar. Between 2013 and 2015, the Dominican
Republic imported an average of $1.3 billion of U.S. farm products.
During that same time span, Cuba imported just $262 million--over $1
billion in difference. That is right. That is $1 billion of exports
that U.S. farmers are missing an opportunity on because of the U.S.
trade restrictions on Cuba. This example helps illustrate the
substantial potential that exists for increased sale of agriculture
commodities to Cuba.
The Cuba Trade Act I just introduced simply seeks to amend our own
country's laws so that American farmers can operate on a level playing
field with the rest of the world. While boosting American exports
remains the primary goal of lifting the embargo, I also think there is
an opportunity for us to increase the reforms and to improve the lives
of the Cuban people as well.
I have often said here on the Senate floor and on the House floor and
back home in Kansas we often say: We will try something once. If it
doesn't work, we might even try it again. Maybe we will try it a third
or a fourth time. But after more than 50 years of trying to change the
nature of the Cuban Government through this kind of action, through
this embargo, many Kansans would say it is time to try something else.
The Cuban embargo was well-intentioned at the time it was enacted.
Today, however, it only serves to hurt our own national interests by
restricting Americans' freedom to conduct business with that country.
In my view, it is time to make a change, and we ought to be able to
sell wheat, rice, and other agricultural commodities from the United
States for cash to Cuba. This legislation would allow that at no
expense to the American taxpayer.
Mr. President, there is a lot to be proud about in being a Kansan. We
have lots of challenges in our State, and we are undergoing serious
ones at the moment. For those who have noticed on the news, although it
is not particularly a story here in the Nation's Capital, Kansas is
ablaze. Fires are devastating acres and acres. In fact, nearly 700,000
acres of grasslands in our State have been burned. Fires have started.
We have had winds for the last 3 days of 50 to 60 miles an hour, and
dozens of communities and counties have been evacuated. Lots of places
have been hard hit. My home county of Rooks experienced those fires.
Hutchinson, a community of 50,000 people, had to evacuate 10,000 people
in what we would consider in our State a pretty big place. So they have
been rampant and they have been real, and there have been significant
consequences to many lives in our State.
As people know, Kansas is an agriculture place. We raise lots of
crops, but we are certainly a livestock State, and our ranchers are
experiencing the significant challenges that come from loss of pasture,
the death of their cattle, and the burning of their fences.
On my way over here, I was reading a couple of articles that appeared
in the Kansas press that I wanted to bring to my colleagues' attention.
There is nothing here that necessarily asks for any kind of government
help, but it does highlight the kind of people I represent.
There is a farm in Clark County. The county seat is Ashland. It is on
the border with Oklahoma. Eighty-five percent of the county's
grassland, 85 percent of the acres in that county have been burned.
This means the death of hundreds, if not thousands, of cattle in that
county. That is the economic driver of the communities there. Ashland,
the county seat, has a population of
about 900 or 1,000--the biggest town in the county--and its future
rests in large part upon what happens in agriculture.
There are lots of great ranch families in our State. One of those is
the Gardiners. The Gardiner Ranch is in Clark County. Their story is
told a bit in today's edition of the Wichita Eagle. They are known as
some of the best ranchers in the country. For more than 50 years, they
have provided the best Angus cattle. They have customers across the
country. It is a family ranch. This is multigenerational, and three
brothers now ranch together. It is not an unusual way that we do
business in Kansas.
In addition to the economic circumstances that agriculture presents
in our State, it is one of the reasons I appreciate the opportunity to
advocate on behalf of farmers and ranchers. It is one of the last few
places in which sons and daughters work side by side with moms and
dads, and grandparents are involved in the operation. Grandkids grow up
knowing their grandparents. There is a way of life here that is
important to our country. Our values, our integrity, and our character
are often transmitted from one generation to the next in this
circumstance because we are still able to keep the family together,
working generation to generation. The Gardiners are an example of that,
but there are hundreds of Kansans who exemplify this.
I would like to tell the story of Mr. Gardiner, as reported by the
Wichita Eagle. Mr. Gardiner said that he was slowly driving by some of
his estimated 500 cattle that had died in this massive wildfire, and he
complained on their behalf that they never had a chance. The fire was
so fast. His ranch, as I said, is one of the most respected. The
quality of the family's Angus cattle has been a source of pride and
national attention for more than 50 years.
Like others, the Gardiners have endured plenty of bumps--and this is
him telling their story--over five generations of ranching. The drought
and dust of the 1930s was tough, he said, and there were even drier
times in the 1950s. About 5 years ago, there was another drought in our
State that was so devastating. He said his family lost 2,000 acres when
they couldn't make a payment to the bank. Blizzards in 1992 killed a
lot of cattle.
My point is that nothing is easy about this life, but there is
something so special about it. The point I want to make is that people
are responding to help, and I thank Kansans and others from across the
country who are responding to the disasters that are occurring across
our State throughout this week and into the future. This isn't expected
to go away anytime soon.
Mr. Gardiner said that more hay is on the way, and the process of
rebuilding fences will begin, hopefully, within a few weeks. He said he
was sent word that Mennonite relief teams were coming from two Eastern
States to work on his fences and to do so without pay. Truckloads of
hay are already en route and rolling in. This story indicates that many
of those truckloads of hay are coming from ranchers who in the past
have bought livestock from the Gardiners.
Mr. Gardiner's veterinarian, Randall Spare, said that the Gardiners
have long been known for taking exceptional care of their customers.
The veterinarian says, “Now it's their turn” for the customers to
repay them. “The Gardiners are the cream of the crop, like their
cattle. I'm not surprised so many people [from so many places] are
wanting to help them.”
The reporter says that while he was talking to Mr. Gardiner for this
interview, Mr. Gardiner answered his cell phone as his pickup slowly
rolled across a landscape that now looked so barren. The reporter said
that many of the calls were from clients who just called to send their
best or to be brought up to date and to ask the Gardiners how they
could help and how the Gardiners were holding up.
Mr. Gardiner said:
It's really something [special], when you hear a pause on
the other end of the line and you know it's because [the
person who called is] crying because they care that much. It
gets like that with ranching. It's like we're all family.
That is a great thing about our State. It is like that with Kansas.
We are all a family. But the fact is that his family is still alive. He
tells the story of not knowing whether his brother and his wife were
alive. The fire swept around them, but they found a place that avoided
the fire, a wheat field where the wheat was still green and so short
that the fire didn't intrude. But he stopped his truck to think a bit
and, the story indicates, to sob a bit.
He watched as his brother Mark and his wife Eva disappeared behind a
wall of fire as they tried to save their horses and dogs at their home.
Ultimately, the house was destroyed. Mr. Gardiner, the one the reporter
was talking to, said:
I had no choice but to turn around and drive away, with the
fire all around me. For a half-hour I didn't know if my
brother and his wife were dead or alive. I really didn't.
He said that then his brother and his wife and some firefighters
gathered in the middle of that wheat field. It was so short and so
green, it wouldn't burn. He said:
It was so smoky I didn't even know exactly where we were
at. But then a firefighter came driving by and told us
everybody made it out. That's when I knew Mark and his wife
were alive. That's when I knew everything would eventually be
all right. I am telling you, that's when you learn what's
So today I come to the Senate floor to express my gratitude for the
opportunity to represent Kansans like the Gardiners, farmers and
ranchers across our State but city folks, as well, who know the
importance of family, who know that living or dying is an important
aspect of life but that how they live is more important, and to thank
those people--not just from Kansas but from across the country--who
have rallied to the cause to make sure there is a future for these
families and for the farming and ranching operations.
It is a great country in which we care so much for each other, and
that is exemplified in this time of disaster that is occurring across
my State. I am grateful to see these examples, and I would encourage my
colleagues that we behave the way Kansas farmers and ranchers do--live
life for the things that are really meaningful and make sure we take
care of each other.
Mr. President, I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. MORAN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
The PRESIDING OFFICER. Pursuant to rule XXII, the Chair lays before
the Senate the pending cloture motion, which the clerk will state.
The bill clerk read as follows:
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
do hereby move to bring to a close debate on the nomination
of Seema Verma, of Indiana, to be Administrator of the
Centers for Medicare and Medicaid Services, Department of
Health and Human Services.
Mitch McConnell, Steve Daines, John Cornyn, Tom Cotton,
Bob Corker, John Boozman, John Hoeven, James Lankford,
Roger F. Wicker, John Barrasso, Lamar Alexander, Orrin
G. Hatch, David Perdue, James M. Inhofe, Mike Rounds,
Bill Cassidy, Thom Tillis.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call has been waived.
The question is, Is it the sense of the Senate that debate on the
nomination of Seema Verma, of Indiana, to be Administrator of the
Centers for Medicare and Medicaid Services, shall be brought to a
The yeas and nays are mandatory under the rule.
The clerk will call the roll.
The bill clerk called the roll.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Georgia (Mr. Isakson), and the Senator from Florida (Mr.
Further, if present and voting, the Senator from Florida (Mr. Rubio)
would have voted “yea.”
The PRESIDING OFFICER. (Mr. Perdue). Are there any other Senators in
the Chamber desiring to vote?
The yeas and nays resulted--yeas 54, nays 44, as follows:
[Rollcall Vote No. 85 Ex.]
The PRESIDING OFFICER. On this vote, the yeas are 54, the nays are
The motion is agreed to.
The Senator from Kansas.
Mr. MORAN. Mr. President, I ask unanimous consent that
notwithstanding the provisions of rule XXII, following leader remarks
on Monday, March 13, the Senate resume executive session for the
consideration of Executive Calendar No. 18, and that the vote on
confirmation occur at 5:30 p.m.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. MORAN. Mr. President, on behalf of the majority leader, there
will be no further votes this week in the U.S. Senate.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant bill clerk proceeded to call the roll.
Mr. WYDEN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WYDEN. Mr. President and colleagues, today the Senate turns to
consider the nomination of Seema Verma to be the Administrator of the
Centers for Medicare and Medicaid Services.
I would be the first to say that in coffee shops across the land,
people are not exactly buzzing about the office known as CMS, but the
fact is, this is an agency that controls more than a trillion dollars
in healthcare spending every year. Even more important and more
relevant right now, if confirmed, and if TrumpCare somehow gets rammed
through the Congress over loud and growing opposition, this is going to
be a major issue on her plate right at the get-go.
I thought it would be useful to just give one example of the
connection involved in this legislation. TrumpCare cuts taxes for the
special interests and the fortunate few by $275 billion, stealing a
chunk of it from the Medicare trust fund that pays for critical
services to the Nation's older people.
If TrumpCare passes and Ms. Verma is confirmed, under section 132 of
the bill, she would be able to give States a green light to push the
very frail and sick into the high-risk pools that have historically
failed at offering good coverage to vulnerable people at a price they
can afford. Under section 134 of TrumpCare, Ms. Verma would be in
charge of deciding exactly how skimpy TrumpCare plans would be and how
much more vulnerable people would be forced to pay out of their pockets
for the care they need.
Under section 135 of the bill, if confirmed, Ms. Verma could be
paving the way for health insurers to make coverage more expensive for
older people approaching retirement age.
Given all that, I want Members to understand there is a real link
between this nomination and the debate about TrumpCare, and this is, in
effect, the first discussion we have had about TrumpCare since these
bills started to get moving without any hearings and getting advanced
in the middle of the night.
The odds were against Republicans writing a single piece of
legislation that would make healthcare more expensive, kick millions
off their coverage, weaken Medicare and Medicaid, and produce this
Robin Hood in reverse, this huge transfer of wealth from working people
to the fortunate. Nobody thought you could do all of that at the same
time, but somehow the majority found a way to do it. Republicans are
rushing to get it passed before the American people catch on.
As part of this debate about Seema Verma, we are going to make sure
people understand this nomination is intertwined with what happens in
the discussion about TrumpCare and how these particularly punitive
provisions with respect to Medicare and Medicaid would affect our
For 7 years, my colleagues on the other side have pointed to the
Affordable Care Act as pretty much something that would bring about the
end of Western civilization and, at a minimum, would basically continue
a system responsible for every ill in our healthcare system. That was
the argument. The Affordable Care Act is responsible for just about
every ill and will practically be the end of life as we know it.
Their slogan was to “repeal and replace,” and it was a slogan they
rode through four elections to very significant success. The only
problem was, it was really repeal and run, and that replacement was
nowhere in sight. Now the curtain has been lifted. The lights are
shining on TrumpCare, and it sure looks to me like there are a lot of
people not enjoying the movie. TrumpCare goes back to the days when
healthcare in America mostly worked for the healthy and the wealthy.
We have a lot of debate ahead, so we are not going to just lay it all
out here in one shot.
I do want to mention some key points on the roll that Ms. Verma, if
confirmed, would play. I want to start by addressing what this means in
terms of dollars and cents.
If you look at the fact that the Medicare tax, which everybody pays
every single time they get a paycheck, and that money is used to
preserve this program that is the promise of fairness to older people--
the Medicare tax would be cut for only one group of Americans in this
bill. I find this a staggering proposition. The people who need it the
least, couples with incomes of over $250,000, people who need it the
least would be given relief from the Medicare tax--not working
families, just the wealthy.
As I indicated, we are talking all told about $275 billion worth of
tax cuts to the special interests and the fortunate few, and it is
largely paid for by taking away assistance to working people to help,
for example, pay for their premiums.
I brought up the ACA Medicare payroll tax for a reason because I
think when Americans look at their next paycheck--if you are a cop or a
nurse and you get paid once or twice a month and you live, say, in Coos
Bay, OR, or in Medford, another Oregon community, you will see it on
your paycheck. If you are a cop or a nurse, no tax relief for you, but
if you make over $250,000--on a tax that is used to help strengthen
Medicare's finances, at a time when we are having this demographic
revolution--the relief goes to people right at the top, and you reduce
the life expectancy of the trust fund for 3 years.
The first thing I will say with respect to what this means, the
provision I have just outlined breaks a clear promise made by then-
Candidate Trump not to harm Medicare.
I remember these commercials--we all saw scores and scores of them--
Candidate Trump said to America's older people--many of whom voted for
him, I think, to a great extent because they heard this promise--he
said: You know, you have worked hard for your Medicare. We are not
going to touch it. We are not going to mess with it.
When the President was asked about cutting Medicare, here is what he
said: Medicare is a program that works. People love Medicare, and it is
unfair to them. I am going to fix it and make it better, but I am not
going to cut it.
The President of the United States said he is not going to cut it.
Well, that promise not to harm Medicare lasted 6\1/2\ weeks into the
Trump administration so the wealthy--the wealthy--could get a tax
reduction, the fortunate few who need it least, and
the effect would be to cut by 3 years the life of the Medicare trust
I think that ought to be pretty infuriating and concerning for people
who work hard--cops and nurses and people who are 50, 55, 60 today.
They are counting on Medicare to be around when they retire, but
because TrumpCare made it a focus to give tax relief to the fortunate
few, that tax relief cuts 3 years off the life of the Medicare trust
If that wasn't enough, people who are 50, 55, 60, before Medicare,
they are going to get another gut punch. This one is in the form of
In parts of my home State--particularly in rural areas like Grant
County, Union County, and Lake County--I am sure I am going to hear
about this. I have townhall meetings in each one of my counties. A 60-
year-old who makes $30,000 a year--now those are the people we have
long been concerned about, particularly people between 55 and 65
because they are not yet eligible for Medicare.
A 60-year-old, in communities like I just mentioned, who makes
$30,000 a year, could see their costs go up $8,000 or more. The reason
that is the case is a big part of TrumpCare. It is based on something
we call an age tax.
Back in the day when I was the director of the Oregon Gray Panthers--
and I was really so fortunate at a young age to be the director of the
group for close to 7 years--we couldn't imagine something like the hit
on vulnerable older people that this age tax levies. Republicans want
to give the insurance companies the green light to charge older
Americans five times as much as they charge younger Americans. The
reality is that older people are going to pay a lot more under
TrumpCare. That is what we were trying to prevent all those years with
the Gray Panthers. We didn't want to see older people pay more for
their healthcare, the way they are going to under TrumpCare if they are
50 or 55 or 60.
I think the real question is whether they are going to be able to
afford insurance at all. The reality is that a lot of those older
people whom I have just described--and I have met them at my townhall
meetings--every single week they are walking on an economic tightrope.
They balance their food costs against their fuel costs and their fuel
costs against their rent costs. Along comes TrumpCare and pushes them
off the economic tightrope where they just won't be able to pay the
bills, particularly older people in rural areas.
So the reality is that it is expensive to get older in America, and
we ought to be providing tools to help older people. But what TrumpCare
does is, instead of giving tools to older people to try to hold down
the costs, TrumpCare basically empties the toolbox of assistance and
basically makes older people pay more.
Next, I want to turn to the Medicaid nursing home benefit. Working
with senior citizens, I have seen so many older people--the people who
are on an economic tightrope, who are scrimping and saving--even as
they forego anything that wouldn't be essential, burn through their
savings. So when it is time to pay for nursing home care, they have to
turn to Medicaid. The Medicaid Program picks up the bill for two out of
every three seniors in nursing homes.
Now, today the Medicaid nursing home benefit comes with a guarantee.
I want to emphasize that it is a guarantee that our country's older
people will be taken care of. All of those folks--the grandparents whom
we started working for in those Gray Panther days--had an assurance
that grandparents wouldn't be kicked out on the street. TrumpCare ends
You could have State programs forced into slashing nursing home
budgets. You could see nursing homes shut down and the lives of older
people uprooted. We could, in my view, have our grandparents that are
depending on this kind of benefit get nickeled and dimed for the basics
in home care that they have relied on.
When it comes to Medicaid, TrumpCare effectively ends the program as
it exists today, shredding the healthcare safety net in America. It
doesn't only affect older people in nursing homes. It puts an
expiration date--a time stamp--on the Medicaid coverage that millions
of Americans got through the Affordable Care Act. For many of those
vulnerable persons, it was the first time they had health insurance. So
what TrumpCare is going to come along and do is to put a cap on that
Medicaid budget and just squeeze them down until vulnerable persons'
healthcare is at risk.
If low-income Americans lose their coverage through Medicaid, it is a
good bet that the only TrumpCare plans they will be able to afford are
going to be worth less than a Trump University degree.
I want to move next to the effects of the bill on opioid abuse.
Clearly, by these huge cuts to Medicaid, TrumpCare is going to make
America's epidemic of prescription drug abuse-related deaths even
worse. Medicaid is a major source of coverage for mental health and
substance use disorder treatment, particularly after the Affordable
Care Act, but this bill takes away coverage from millions who need it.
We have had Republican State lawmakers speaking out about this issue as
well as several Members of the majority in the Congress.
Colleagues, just about every major healthcare organization is telling
the Congress not to go forward with the TrumpCare bill--physicians,
hospitals, AARP--that is just the beginning. But the majority is just
charging forward, rushing to get this done as quickly as possible.
We are going to have more to say about these issues.
I see my colleagues here.
To close, just by intertwining, how this appointment is going to be a
key part of the discussion of TrumpCare revolves around the questions
we asked Ms. Verma.
For example, I was trying to see if this bill would do anything to
help older people hold down the cost of medicine. Now we have heard the
new President talk about how he has all kinds of ideas about
controlling the cost of medicine. Here was a bill that could have done
something about it.
I see my colleagues, Senator Stabenow and Senator Cantwell.
I said to the nominee: I would be interested in any idea you have--
any idea you have--to hold down the cost of medicine. On this side we
have plenty of ideas. We want to make sure that Medicare could bargain
to hold down the cost of medicine. We have been interested in policy to
allow for the importation of medicine. We said: Let's lift the veil of
secrecy on pharmaceutical prices.
I asked Ms. Verma: How about one idea--just one--that you would be
interested in that would help older people with their medicine costs.
She wouldn't give us one example.
I am going to go through more of those kinds of questions, because
the reality is--and I see Senators Stabenow and Cantwell here--that
what we got in the committee was essentially healthcare happy talk.
Every time we would ask a question, she would say: I am for the
patients; I want to make sure everybody gets good care.
So I thank my colleagues, and I yield for Senator Cantwell.
The PRESIDING OFFICER. The Senator from Washington.
Ms. CANTWELL. Mr. President, will the Senator yield for a question?
Mr. WYDEN. Of course.
Ms. CANTWELL. Mr. President, I ask this of my colleague, the Senator
from Oregon, because Washington, Oregon, and so many other States spend
so much time innovating. The proposal we are seeing coming out of the
House of Representatives really isn't innovation. I like to say that if
you are looking at this, just at the specifics, the per capita cap is
really just a budget mechanism. It doesn't have anything to do with
innovation. It just has to do with basically triggering a cut to
Medicaid and shifting that cost to the States. My concern is that we
already do a lot with a lot less, and we know how to innovate. We would
prefer that the rest of the country follow that same model. I would ask
the Senator from Oregon: Do you see any innovation in this model, in
capping and cutting the amount of Medicaid and shifting that to the
Mr. WYDEN. My colleague from Washington is ever logical.
When I looked at this, I thought of it as an innovation desert
because I was looking for some new, fresh ideas. We have seen some of
them from Senator Cantwell's State, and I think the Senator from
Washington makes a very
important point with that poster because the reality is that this is a
cap. This is a limit on what States are going to get. As I touched on
in my comments, I think what is going to happen is this cap is not
going to be enough money for the needs. I think this is going to slash
the help for nursing home care under Medicaid, which pays two-thirds of
the bill, and I think the nursing home care under this flawed TrumpCare
proposal is going to get nickeled and dimed.
My colleague from Washington is right. I tried to read section by
section, and we have read it several times. But we wanted to make sure
to look--to my colleague's point--for innovation, and this proposal is
an innovation desert.
Ms. CANTWELL. I ask the Senator from Oregon this through the
Presiding Officer. The innovation that was already in the Affordable
Care Act really did address the Medicaid population, in which so much
of that cost is for long-term care and nursing home care. So Medicaid
equals long-term care for so many Americans. In the Affordable Care Act
we accelerated the process of shifting the cost to community-based care
because it is more convenient for patients and up to one-third of the
cost of a nursing home. So if we keep more people in their homes, that
is better innovation.
In the Affordable Care Act, we incentivized States. In fact, we had
21 States take us up on that--including Arkansas, Connecticut, Georgia,
Iowa, Kentucky, Louisiana, New Hampshire, Texas, Ohio, Nevada,
Nebraska. There are many States that are doing this innovation and
basically trying to move the Medicaid population to community-based
care so we can save money.
Savings from rebalancing could make up for a large portion of the
money the House is trying to cut in this bill. Basically, they are not
saving the money. They are shifting the burden to the States, instead
of giving innovative solutions to people to have community-based care;
that is, long-term care services and staying in their home longer. Who
doesn't want to stay in their home longer? Then we support them through
community-based delivery of long-term healthcare services, and we save
the Nation billions of dollars.
In fact, our State did this over a 15-year period of time, and we
saved $2.7 billion. That is the kind of innovation we would like to
see. But instead of implementing the innovation we started in the
Affordable Care Act, they are trying to cap the Medicaid funding, which
basically is changing the relationship from a mutually supported State
and Federal partnership to a capped federal block grant. They are just
saying: We are going to cost-shift this burden to you the States.
I saw that the Center on Budget and Policy Priorities analyzed the
current House proposal and found it would result in a $387 billion cost
shift to the States. Does the Senator from Oregon think that Oregon has
the kind of money to take its percentage of that $370 billion?
To my colleague from Michigan: Does the Senator think the State of
Michigan has the dollars to take care of that Medicaid population with
that level of a cut?
Ms. STABENOW. If I might lend my voice on this and thank both of my
colleagues. Senator Cantwell has been the leader in so many ways on
innovation in the healthcare system as we debated next to each other in
the Finance Committee on the Affordable Care Act.
I wanted to share that in Michigan, where we expanded Medicaid,
because of changes that have been made and work that is being done in
the budget going forward in the new year, there is now close to $500
million more in the State of Michigan budget than was there before
because of Medicaid expansion and the ability to manage healthcare
risk. People have more healthcare coverage. We actually have 97 percent
of the children in Michigan who can see a doctor today, which is
incredible. At the same time the State is going to save close to $500
million in the coming year's budget.
Mr. WYDEN. If I can add this, because I think my colleagues are
making a very important point. If you look at the demographics, there
are going to be 10,000 people turning 65 every day for years and years
to come. Senators Stabenow and Cantwell are making a point about
flexibility. The reality is, if I look at the demographic picture, we
are going to need more out of a lot of care options--institutional
care, community-based coverage. But I think the point Senator Cantwell
started us on is that, at a time when we have a demographic where we
are going to need more for a variety of care options--a continuum of
care--what my State is basically saying is that we are going to get
less of everything. There is going to be less money for the older
people who have nursing home needs. I am looking at a new document from
the Oregon Department of Human Services, and it indicates that we are
going to lose substantial amounts--something like $150 million for
community-based kinds of services. So I appreciate the point my two
colleagues are making.
Ms. CANTWELL. Mr. President, if I could, I will ask the Senator from
Oregon one more question, and maybe my other colleagues will join in.
When you do not realize the savings and you cost-shift to the States,
some of the key populations that you hurt are pregnant women and
children. We do not want to have less money. If you think about
Medicaid, pregnant women and children are a big part of the population.
I know our colleague from Pennsylvania has joined us, and he has been
a champion for the Children's Health Insurance Program--CHIP--and
everything that we do for women and children. I don't know if he has
seen this in his State. I don't know if the Senator from Oregon or the
Senator from Michigan or the Senator from Pennsylvania wants to comment
on this--on the notion that we are not realizing the savings from
delivery innovations like rebalancing, and then figuring out how to
best utilize those for the delivery of the services that so many people
are counting on. With a per capita cap, you are really going to be
starting in a very bad place with the people who need these resources
the most, and when it comes to Medicaid, women and children are front
and center in this debate.
I hate the fact that somebody is going to cost-shift to the States,
that the States are not going to have enough money, and then the very
people who would end up paying the price are the women and children. I
don't know if the Senator from Oregon, the Senator from Michigan, or
the Senator from Pennsylvania wants to comment on that.
Ms. STABENOW. I thank the Senator very much. I will say this briefly
and then turn to our colleague from Pennsylvania, who has been such a
champion for children.
I would say first--again, as I said a moment ago--that, because of
Medicaid, because of the healthcare expansion, 97 percent of the
children in Michigan now can see a doctor. That means moms who are
pregnant and babies, and moms and dads are less likely to be going to
bed at night and saying: Please, God, do not let the kids get sick,
because they can actually go to a doctor.
It reminds me, though, of the other thing happening on the floor and
the larger question of the nominee for the Centers for Medicare and
Medicaid Services. In the larger context, I asked her about whether or
not maternity care and prenatal care should be covered as a basic
healthcare requirement for women. I mean, it is pretty basic for us.
She wouldn't answer the question. Essentially, she said women can buy
extra if they want it. The new Secretary of Health and Human Services
said that we, as women, can buy extra coverage for basic healthcare
coverage for us. So it all comes together--Medicaid, the nominee on the
floor, and what the House is doing to take away maternity care. It is
really just bad news for moms and babies.
Mr. WYDEN. I would only add that what we learned in our hearings and
in our discussion is that women, particularly the women served by the
Medicaid Program, are really dealing with the consequences of opioid
addiction as well.
In our part of the world, I would say to Senator Stabenow and Senator
Casey--in Oregon and Washington--we feel like we have been hit with a
wrecking ball with this opioid problem. Again, when Senator Cantwell
talks about shifting the costs, she is not talking about something
is going to take away money for opioid treatment.
So I am very pleased that my colleague is making these points, and I
look forward to the presentation.
Mr. CASEY. Mr. President, I thank Senator Cantwell for raising the
issue about the impact of this decision that the Congress will make
with regard to a particular healthcare bill and then also,
particularly, the Medicaid consequences.
I was just looking at what is a 2-page report that was just produced
today and that I was just handed from the Center on Budget and Policy
Priorities. It is State specific.
In this case, looking at the data from Pennsylvania--I will not go
through all of the data on Medicaid--just imagine that three different
groups of Americans have benefited tremendously from the Medicaid
Program every day. That is why what is happening in the House is of
great concern to us.
We have in Pennsylvania, for example--just in the number of
Pennsylvanians who have a disability--722,000 Pennsylvanians with
disabilities who rely upon Medical Assistance for their medical care.
Medical Assistance is our State program that is in partnership with
Medicaid. There are 261,000 Pennsylvania seniors who get their
healthcare through Medicaid. Hundreds and hundreds of thousands of
people who happen to be over the age of 65 or who happen to have a
disability of one kind or another are totally reliant, on most days, on
Medicaid. The third group, of course, is the children, and 33 percent
of all of the births in Pennsylvania are births that are paid for
When we talk about this bill that is being considered in the House or
when we talk about the confirmation vote for the Administrator for the
Centers for Medicare and Medicaid Services, this is real life. What
happens to this legislation and what happens on this nomination is
about real life for people who have very little in the way of a bright
future if we allow some here to do what they would like to do,
apparently, to Medicaid.
It sounds very benign to say that you want to cap something or that
you want to block-grant. They are fairly benign terms. They are
devastating in their impact, and we cannot allow it to happen. That is
why this debate is so critical.
I have more to say, but I do commend and salute the work by Senator
Cantwell, Senator Stabenow, and Senator Wyden in fighting these
I will read just portions of a letter that I received from a mom in
Coatesville, in Southeast Pennsylvania, about her son, Rowan. The mom's
name is Pam. She wrote to us about her son, who is on the autism
spectrum. In this case, she is talking about the benefits of Medicaid--
Medical Assistance we call it in Pennsylvania.
Here is what she wrote in talking about the benefits that he
receives. After he was enrolled in the program, she said that Rowan had
the benefit of having a behavioral specialist consultant. That is one
expert who was helping Rowan, who was really struggling at one point. A
second professional they had helping him was a therapeutic staff
support worker. So there was real expertise to help a 5-year-old child
get through life with autism.
Here is what his mom Pam wrote in talking about, since he was
enrolled, how much he has benefited and how much he has grown and
He benefited immensely from the CREATE program by the Child
Guidance Resource Centers, [which is a local program in
Coatesville]. Thankfully, it is covered in full by Medicaid.
She goes on to write the following, and I will conclude with this:
Without Medicaid, I am confident I could not work full time
to support our family. We would be bankrupt, and my son would
go without the therapies he sincerely needs.
Here is how Pam concludes the letter. She asks me, as her
representative--as her Senator--to think about her and her family when
we are deliberating about a nomination like this and about healthcare
Please think of us when you are making these decisions.
Please think about my 9-month-old daughter, Luna, who smiles
and laughs at her brother, Rowan, daily. She will have to
care for Rowan later in life after we are gone. Overall, we
are desperately in need of Rowan's Medical Assistance and
would be devastated if we lost these benefits.
This is real life for people. Sometimes it is far too easy here in
Washington for people to debate as if these things are theoretical--
that if you just cut a program or cap a program or block-grant a
program, you are just kind of moving numbers around and moving policy
around. This is of great consequence to these families, and we have to
remember that when we are making decisions around here.
Everyone who works in this building as an employee of the Federal
Government gets healthcare. We do not have someone else around the
country who is debating whether or not we are going to have healthcare,
like those families on Medicaid are having to endure.
I thank the Senator from Washington. I know that Senator Stabenow
from Michigan may have more to add on this. We have a big battle ahead,
but this is a battle that is not only worth fighting, but it is
absolutely essential that we win the battle to protect and support
Ms. STABENOW. Mr. President, as Senator Wyden's colloquy comes to an
end, I will make a few comments in addition to those of my colleagues,
and I very much appreciate all of their work.
There are so many different things to talk about as it relates to how
healthcare impacts people. As Senator Casey said, this is very
personal; it is not political. There are a lot of politics around this,
but it is very, very personal.
In Michigan, when we are talking about healthcare, in Medicaid alone
we are talking about 650,000 people who have been able to get coverage
now. Most of them are working in minimum wage jobs, and they now are
able to get healthcare but couldn't before, as well as their children.
That adds to the majority of seniors who are in nursing homes now,
folks getting long-term care, folks getting help for Alzheimer's and
other challenges and who are relying on Medicaid healthcare to be able
to cover their costs.
I want to share a letter, as well, from Wendy, a pediatric nurse
practitioner from Oakland County in Michigan. We have received so many
letters--I am so grateful for that--and emails.
As a pediatric nurse practitioner, I have seen so many of
my patients benefit from the Affordable Care Act. Physical
exams for the kids are now covered in full, with no co-pay.
This means the kids are in to see us, which means we catch
healthcare issues and early problems with growth or
development that otherwise might be undetected and left
untreated until it became a much bigger problem.
Isn't that what we all want for our children, to catch things early?
Immunizations are covered, which keeps everyone safer.
Screening tests are covered, so potential problems are caught
while they can still be managed. This better care keeps kids
healthier and happier and prevents longer term care costs.
She goes on to write:
The Medicaid expansion means even more kids are covered,
keeping not only those children healthier but keeping
everyone around them healthier. Previously, parents of
children who did not have insurance coverage would not seek
care until the children were so ill that they could not see
another option. Frequently, these children then utilized
emergency room care--
Which, by the way, is the most expensive way to treat health
[it was] not only a missed opportunity for complete and
preventative healthcare but at a cost passed on to the
On a much more personal level, in 2015, our granddaughter,
at age 3, was diagnosed with epilepsy related to a genetic
condition . . . which made her brain form abnormally. On top
of the epilepsy, she has developmental delays and autism, all
related to her double cortex syndrome. Although our daughter
and son-in-law are fully employed (teacher and paramedic),
she qualifies for Children's Special Health Care (under
Medicaid). This has been a huge blessing for us, and without
it our family would have been financially devastated.
We are hopeful that my granddaughter will continue to have
good seizure control and will develop to reach her full
potential, but without the care that her private insurance
and Children's Special Health Care provides, she would not
have much of a chance of getting anywhere near her potential.
I do not want to even consider how it will affect her future
if insurance companies can refuse to cover her care due to
her preexisting condition.
Please do not let partisan politics take precedence over
doing what is right and what is best for the health of every
I know we are all getting hundreds of thousands of letters and emails
and phone calls of very similar stories because healthcare is personal
to each of
us--to our children, our grandchildren, our moms, and dads, and
grandpas and grandmas. It is not political.
I am very grateful for my colleagues' being here today. I want to
speak not only about the importance of expansion under Medicaid but
also about the person who would be in charge of that very, very
important set of services. That is the nomination in front of us, that
of Seema Verma to be the Administrator of the Centers for Medicare and
This is a critical position, especially given the ongoing efforts
that we are seeing right now to repeal healthcare--the Affordable Care
Act--and replace it with legislation that would literally rip away
coverage for millions of people and pull the thread that unravels our
entire healthcare system. The decisions of the Administrator, both as
an adviser to the President and as someone with the authority to make
large changes in the implementation of existing law, will have far-
ranging consequences for all of us--certainly, for the people whom we
represent and especially for those who need healthcare, have begun
receiving it, and now may very well see it taken away.
In the Finance Committee, when I asked Ms. Verma about Medicaid, I
found that her positions would hurt families in Michigan, would hurt
seniors in nursing homes, and would hurt children. And looking at her
long record as a consultant on Medicaid, we know that Mrs. Verma's
proposals limit healthcare coverage and make it harder to afford
healthcare coverage, putting insurance companies ahead of patients and
families once again.
I am also very concerned about her position on maternity coverage.
During the hearing, I asked Ms. Verma whether women should get access
to basic prenatal care and maternity care coverage as the law now
allows--I am very proud of having authored that provision in the
Finance Committee--or whether insurance companies should get to choose
whether to provide basic healthcare coverage for women. I reminded her
that before the Affordable Care Act, only 12 percent of healthcare
plans available to somebody going out to buy private insurance offered
maternity care--the vast majority did not--and that the plans that did
often charged extra or required waiting periods. Her response indicated
that coverage of prenatal and maternity care should be optional--
optional. We as women cannot say our healthcare is optional.
The next CMS Administrator should be able to commit to enforcing the
law requiring maternity care to be covered and commit to protecting the
law going forward for women. Being a woman should not be a preexisting
condition. Getting basic healthcare should not mean we have to buy
riders or extra coverage because being a woman and the coverage we need
is somehow not viewed as basic by the insurance company. We have had
that fight. Women won that fight with the Affordable Care Act. We
should not go backward.
I followed up with Ms. Verma, along with many colleagues, but have
not received a response.
Over 100 million Americans count on Medicare and Medicaid. They need
a qualified Administrator who puts their needs first, and I cannot vote
for a nominee who does not guarantee that she will fight for the
resources and the healthcare that the people of Michigan count on and
Finally, I wish to take a moment to talk about the healthcare bill
that has now come out of committees in the House and will be voted on
in the House and then coming to us in the Senate. Frankly, let me start
by saying that this is a mess--it is a mess on process, and it is a
mess on substance.
As a member of the Finance Committee, I can tell my colleagues
firsthand that this was not rammed through the Senate Finance Committee
when we passed the Affordable Care Act. We had months and months and
months of hearings, of which I attended every one, I think, and after
that, the floor debate and that discussion and the discussion in the
House. We knew what it would cost before we brought it up, by the way,
which saved a lot of money by doing a better job of managing healthcare
costs and creating innovation for our providers.
But the truth is that when we look closely at what is being debated
in the House, for families in Michigan and across the country, it is
really a triple whammy: higher costs, less healthcare coverage, and
more taxes. Overall, it means more money out of your pocket as an
American citizen, unless you are very wealthy, and it means less
healthcare. This is not a good deal.
It cuts taxes for the very wealthy and for insurance companies. It
gives an opportunity for insurance company execs to get pay increases
and cuts taxes for pharmaceutical companies. Someone making more than
$3.7 million a year would save almost $200,000. Let me say that again.
Someone making more than $3.7 million a year would put $200,000 in
their pocket as a result of this healthcare bill, TrumpCare. To put
that in perspective, 96 percent of Michigan taxpayers would not qualify
for this. Ninety-six percent of everybody in Michigan who gets up every
day, goes to work, works hard--some take a shower before work, some
take a shower after work--they are working hard every single day, and
they would pay more, while the small percentage of those at the very
top would get $200,000 back in their pockets.
As I indicated, it provides a tax break for insurance company CEOs to
get a raise of up to $1 million but increases taxes and healthcare
costs for the majority of Americans. Middle-class Americans and those
working to get into the middle class would see tax increases and lose
healthcare coverage at the same time--such a deal.
For seniors, this would allow insurance companies to hike rates on
older Americans by changing the rating system. AARP, a nonpartisan
organization, has indicated that premiums would increase up to $8,400
for somebody who is 64 years of age earning $15,000 a year. So they
earn $15,000 a year, and their premiums could go up by more than half
of what they are making. To put that in perspective--again, a
comparison of who wins and loses under this plan--if you are 64 years
old and earn $15,000 a year, you pay more--$8,400 more. If you are 65
years of age and earn over $3.5 million a year, you put $200,000 more
back in your pocket. This is a rip-off for the majority of Americans
and should not see the light of day.
On top of that, TrumpCare creates Medicaid vouchers. We have been
talking with colleagues about the change in Medicaid. What does that
mean? Well, instead of being a healthcare plan that covers nursing home
care, whether that is someone who needs very little care or someone who
has Alzheimer's or other extensive needs, your mom and dad or grandmom
and granddad would get a voucher, and if it didn't cover the care in
the nursing home, as it does now, then your family would have to figure
out a way to make up the difference. We could very possibly have the
situation we had before the passage of the Affordable Care Act where a
lot of folks were going bankrupt trying to figure out--you use the
equity in your home, except because of what happened in the financial
crisis, you may not have much equity in your home anymore. So you
try to figure out, how do I make up the difference to help my mom or
dad or granddad and grandmom in the nursing home? That will be a very
common discussion, I would guess, if this passes. So turning Medicaid
into a voucher system would cut nursing home care and healthcare for
Let me also say that when there is a healthcare emergency like we had
in Flint, MI, with 100,000 people being poisoned with lead and over
9,000 children under the age of 6 with extensive lead poisoning, and we
had the President and the past administration step in to help those
children because of the health problems from the lead exposure, that
would not be possible under this new regime. It will not be possible to
step in when there is a healthcare emergency for children or for a
In Michigan today, 150,000 seniors depend on healthcare through
Medicaid for long-term care. Three out of five seniors in nursing homes
in my State--three out of every five seniors--count on Medicaid for
their long-term care. This radically changes and dismantles that
healthcare system. We have nearly 1.2 million children in Michigan and
380,000 people with disabilities who use this system.
So we have a situation where we would see a radically different
healthcare system for seniors and additional costs for seniors, which
is why the AARP is calling this the senior tax. We would see children
losing their healthcare. We would see insurance companies being put
back in charge of decisions--decisions about whether women can get
basic care and what, if any, kind of preexisting condition coverage
happens. What I have seen is something that doesn't work and is going
to put more costs back onto families.
There is mental healthcare and the ability to make sure that if you
have a healthcare challenge, such as cancer or some other kind of
challenge, your doctor is going to be able to treat you and give you
all the care you need, not just a lump sum that the insurance company
has decided that they are willing to spend. Then there is
accountability as it relates to how much of your healthcare dollars
that you spend goes into your medical care. There are a whole range of
things that have been put in place so that you have more confidence
that at least you are getting what you are paying for. Those things go
away and insurance companies are put back in charge. They are given a
big tax cut. The insurance company execs are given an opportunity for
big increases in their pay, while everybody else is paying more.
So let me go back to where I started. TrumpCare, the bill being voted
on in the House, is really a triple whammy for the people of Michigan:
higher costs, less coverage, and more taxes. It makes no sense. I will
strongly oppose it when it comes to the Senate. I am hopeful that we
can put this aside, stop all of the politics about repeal, and have a
thoughtful discussion about how we can work together to bring down
costs and to be able to address concerns to make healthcare better, not
take it away.
Thank you, Mr. President.
The PRESIDING OFFICER (Mr. Cassidy). The Senator from Rhode Island.
Mr. REED. Mr. President, I rise today in opposition to the nomination
of Ms. Seema Verma to be Administrator of the Centers for Medicare and
Medicaid Services, or CMS.
As a $1 trillion agency with oversight over Medicare, Medicaid, and
the Children's Health Insurance Program, as well as State health
insurance marketplaces, CMS is providing affordable health insurance to
100 million Americans, including nearly half a million Rhode Islanders.
Given the responsibility that this post entails of ensuring access to
health care coverage for our most vulnerable citizens, coupled with a
lack of commitment to fighting back against proposals by this
administration and some of my colleagues on the other side of the aisle
to dismantle these programs, I cannot support Ms. Verma's nomination to
be CMS Administrator.
CMS is responsible for a key aspect of the Affordable Care Act--the
health insurance marketplaces--which provide an avenue for all
consumers to shop for the health insurance options that fit their needs
and connect consumers with tax credits and subsidies that make the
President Trump and his new Health and Human Services Secretary Tom
Price are adamant about repealing the ACA and rolling back these
benefits. In her confirmation hearing, Ms. Verma was asked multiple
times to commit to protecting the ACA for the millions of Americans who
were able to access coverage for the first time because of the law, but
she would not do so. This, to me, is unacceptable.
CMS also works with States and other agencies at the Department of
Health and Human Services to ensure that the plans offered on the
exchanges are not only affordable but also provide real coverage for
when it is most needed. I am concerned with Ms. Verma's beliefs about
what health insurance coverage should look like.
During her confirmation hearing, she spoke at length about providing
consumers more choices about their healthcare. Yet she opposes many of
the protections the ACA provides for consumers. For example, she
implied that she thought maternity care should be optional. It seems to
me that for many families, they would be left with the choice to either
pay for maternity care entirely out-of-pocket--all the while paying
premiums and copays to the insurance company--or to go without care at
all. I don't think these are the kinds of choices we should be imposing
Turning my attention to Medicaid for a minute, I am deeply concerned
about the Republican proposals to fundamentally change Medicaid and
shift costs to States and to consumers. These proposals aren't new.
Year after year, Republicans--often under the leadership of then-
Congressman, now-HHS Secretary Tom Price--have proposed block-granting
Medicaid, cutting the program by hundreds of billions of dollars. While
Ms. Verma is not yet confirmed, she did express support in her
confirmation hearing for this very concept--block-granting or capping
Medicaid spending. Just this week, we saw a new version of this
proposal, which simply delays cuts to Medicaid until 2020. In my
opinion, this is just a veiled attempt to help gain support for the
effort now and then turn around and decimate Medicaid in a few years.
In my home State of Rhode Island, nearly 300,000 Rhode Islanders
access healthcare through Medicaid. That is about one-third of our
population, roughly. That is a significant number for a small State
like Rhode Island. Let's break down that number to see who would be
impacted by these across-the-board cuts to Medicaid.
One out of four children in Rhode Island gets care from Medicaid and
half of the births in the State are financed through Medicaid. One in
two Rhode Islanders with disabilities are covered by Medicaid, and 60
percent of nursing home residents in the State get their care from
Medicaid. Think about what would happen if this funding is cut--and
that is the trajectory of the Republican proposals--States would have
to decide, among these populations, who will get health care, children
or the elderly in nursing homes, the disabled or other Medicaid
recipients. If States try to make up the difference, that would result
in cuts elsewhere, such as education and infrastructure. Indeed, given
the demands for health care, given the tensions between seniors and
nursing homes, and children needing care, the States will try their
best to pull from other areas. What is the next biggest area of State
expenditure? Education. Now you will have pressure on State education
budgets. Higher education particularly will be pressured. All of this
will be the ripple effect from these proposed cuts to Medicaid. And
make no mistake, when Ms. Verma and my colleagues talk about converting
Medicaid to a block grant program or capping spending, it is not about
flexibility for the States, it is about reducing the Federal commitment
to providing funding to the States.
Lastly, I am concerned about Ms. Verma's ability to safeguard
Medicare for our seniors. Over 200,000 Rhode Islanders access care
through Medicare, a benefit they have worked for and earned over their
entire careers. I believe Medicare is essential to the quality of life
for Rhode Island's seniors and for seniors across the country, and
indeed for the children and families of these seniors. In fact, I
supported the ACA because it made key improvements to Medicare that
strengthened its long-term solvency and increased benefits, such as
closing the prescription drug doughnut hole and eliminating cost-
sharing for preventive services such as cancer screenings.
Over 15,000 Rhode Islanders saved $14 million on prescription drugs
in 2015, an average of $912 per beneficiary. In the same year, over
92,000 Rhode Islanders took advantage of free preventive services,
representing over 76 percent of the beneficiaries. Repealing the ACA
means repealing these benefits for seniors and shortening the life of
the Medicare trust fund by over a decade.
Unfortunately, Ms. Verma has little to no experience working with
Medicare, and in her hearing and written responses to questions, she
appeared to have very little to no familiarity with major aspects of
Medicare. In her confirmation hearing and accompanying documents, she
simply has not proven herself to be an effective advocate for
protecting these earned benefits for our seniors.
We need an Administrator for CMS who will work to safeguard health
care coverage for children, seniors, and people with disabilities, who
will seek to strengthen Medicaid, Medicare, CHIP, and our entire
healthcare system. For the reasons I have outlined, along with other
reasons some of my colleagues have raised, Ms. Verma, in my opinion,
is not up to this task. As such, I will oppose the nomination and
encourage my colleagues to do the same.
I yield the floor.
Mr. President, I request the ability to yield the remainder of my
postcloture time to Senator Wyden.
The PRESIDING OFFICER. The Senator has that right.
Mr. REED. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. WYDEN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WYDEN. Mr. President, here we are, with our colleagues on their
way home, and I thought it would be helpful to take a minute and give
an assessment of where the TrumpCare debate is at this point because we
have seen the two major committees in the House act. Some $300 billion
was slashed from safety net health programs, while insurance company
executives making over $500,000 annually were given a juicy tax break
as a bonus.
To put this into perspective, this tax break that the insurance
companies' CEOs seem to have after two committees in the other body
have acted on TrumpCare--the amount of the bonuses for the insurance
company executives would be enough to cover the TrumpCare-created
shortfall in Oregon's community-based services for the elderly and the
disabled two or three times over.
What we are talking about is how hundreds of billions of dollars in
tax breaks are going to the fortunate few and special interests, while
some of the money is coming from stealing a chunk of those dollars from
the Medicare trust fund. And this is very much intertwined with the
nominee's work because she would be overseeing Medicare payments to
rural hospitals in places like Louisiana and Oregon.
What I am going to turn to now is what TrumpCare, based on these two
committees, means for rural areas. And, of course, it repeals the
Medicaid expansion. It caps the Medicaid Program. In my own view, and I
know the Senator from Louisiana knows a lot about healthcare, in rural
communities--and most of our towns are under 10,000 in population. I am
from southeast Portland. I love southeast Portland. The only regret is
I didn't get to play for the Portland Trail Blazers. Most of the
communities in our State are under 10,000 in population. As the Senator
from Louisiana knows, we are talking about critical access facilities.
We are talking about sole community hospitals. We are talking about the
facilities that deal with acute care.
During the last major break over the President's holiday, I started
what is going to be a yearlong effort for me, and I called it the rural
healthcare listening tour. It is eye-popping to have those rural
healthcare providers who in my State have worked so hard to find ways
to get beyond turf and battles, to work together--the hospitals, the
doctors, the community health centers, and the like. They have built an
extraordinary effort that helps to wring more value out of scarce
dollars. Their programs are based on quality, not on volume.
By the way, they are a huge source of economic growth and jobs for
our rural communities. I spent the President's Day recess, and the next
major recess as well getting out and listening to them. The verdict
from Oregon's healthcare providers, who have worked very hard at being
innovative, trying to make better use of what are called nontraditional
services, said these kinds of cuts are not an option if you want to
meet the needs of so many who have signed up as a result of the
TrumpCare ends the Medicaid expansion, rolling back Federal matching
funds in 2020. The rural hospitals in my State are frequently the only
healthcare provider available for hundreds of miles. The Medicaid
expansion helped these hospitals keep their doors open.
I don't think it is hard to calculate why the hospitals are speaking
out against the flood approach of TrumpCare. They have a lot of
facilities in rural areas that are already on tight margins. If these
communities lose the ability to cover needy people, some of the
essential hospitals--and I just described three types of them--are
going to have to close, and the reality is going to be that patients
aren't going to have any doctor anywhere nearby.
Understand, if the majority insists on ramrodding TrumpCare through--
and at this point we have, I believe--staff just told me that there
aren't any budget estimates. As of now, the Congressional Budget Office
is tasked with providing accurate assessments of the budget
implications. There are not any budget implications.
So here is the latest. It comes from media that I think is not
considered by many Trump supporters to be a purveyor of fake news. This
comes from FOX News. They said: Unknown in the new healthcare plan,
unknown in TrumpCare--the cost. How many lose or gain insurance?
I am very pleased that my colleague from New Hampshire has come to
join me because some of this, I would say to my friend from New
Hampshire, leaves you incredulous because this comes from FOX News. FOX
News is hardly a source for what many Trump supporters would consider
fake news. FOX News is asking the question because they are saying it
is unknown. It is unknown in the new healthcare plan, Senator Shaheen,
according to FOX News. The cost is unknown, and how many lose or gain
insurance is unknown.
I would say to my colleagues, because my friend from Louisiana has
joined the Finance Committee, and I remember welcoming him and Senator
McCaskill, our new members. My colleague from Louisiana is a physician
and is very knowledgeable about these issues. I don't know how you have
a real healthcare debate in America--and I have been working on this
since I was director of the Gray Panthers at home back in the days when
I had a full head of hair and rugged good looks. When we would start a
debate, nobody would consider starting it without having an idea of
costs or how many lose or gain insurance. How much more basic, I say to
Senator Shaheen, does it get than that? Are these “gotcha” questions?
Are these alternative facts? Are these people who are hostile to
conservatives? I think not. FOX News--unknown in the new healthcare
I have been outlining what this means in terms of the transfer of
wealth from working families in New Hampshire and Oregon to the most
fortunate in our country--people who make $250,000 or more. They are
actually going to be the only people in America who get their Medicare
tax cut. So you have this enormous transfer of wealth, what I call the
reverse Robin Hood: taking from the working people and giving to the
After two committees have now acted in the other body--two committees
have acted--FOX News says the big questions are outstanding. The
Senator from New Hampshire knows a lot about rural healthcare. I was
just outlining to my colleagues what this means for critical access
hospitals, sole community hospitals, acute care facilities. These are
the centerpieces of many rural communities, the essence of rural life.
You can't have rural life without rural healthcare.
Here we are on Thursday afternoon--with many of our colleagues out
there tackling jet exhaust fumes heading home--and the big questions,
according to FOX News, are outstanding.
I am very pleased the Senator is here. As usual, she is very prompt
I look forward to her remarks.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mrs. SHAHEEN. Mr. President, before my colleague from Oregon leaves,
I want to ask him a question.
I am reminded, in 2009 and 2010, as we were working on the Affordable
Care Act, that the HELP Committee held 14 bipartisan roundtables, 13
bipartisan hearings, 20 bipartisan walkthroughs on healthcare reform.
The HELP Committee then considered nearly 300 amendments and accepted
more than 160 Republican amendments, and the Finance Committee--where
my colleague is the ranking member--held 17 roundtables, summits, and
hearings on the topic. The Finance Committee also held 13 member
meetings and walkthroughs, 38 meetings and negotiations, for a total of
53 meetings on
healthcare reform. During its process, the Finance Committee adopted 11
Don't you find it particularly ironic that we are seeing this
TrumpCare legislation being pushed through on the House side--and what
we are hearing, the rumors about what is going to happen in the Senate
is it is not going to have any hearings and it is going to be brought
to the floor and we are expected to vote on it without having a chance
for the public to know what is in it.
Mr. WYDEN. My colleague is making a very important point. I think we
all know the Senate budget process is a lot of complicated lingo.
People in the coffee shops in New Hampshire and Oregon don't follow all
the fine points of reconciliation.
As the Senator has just said, what they are using is a process that
is known as reconciliation. That is the most partisan process you can
come up with. There is no more partisan kind of process, and we were
talking about the tally. As of this afternoon, two committees in the
House have acted.
The Senator from New Hampshire just mentioned, I think, there were 11
Republican amendments in just one of the committees.
Mrs. SHAHEEN. Right.
Mr. WYDEN. As of this afternoon at 4, after hours and hours of
debate, I am of the impression that not a single significant Democratic
amendment has been adopted--so the Senator's point of highlighting the
difference in the process, where we had all of the hearings and all of
the opportunities that you have to have to get a good, bipartisan bill.
As my colleague knows, I don't take a backseat to anybody in terms of
bipartisan approaches in healthcare. I have worked with Republicans--
Chairman Hatch, chronic care. Senator Bennet and I worked on a bill
with eight Democrats and eight Republicans. I appreciate your making
As of this afternoon, as far as I can tell, no Democratic amendment
has been adopted. You highlighted 11 Republican amendments getting
adopted in just one committee. As we indicated, FOX News--not exactly
hostile to some of the ideas being advanced by the majority--has
certainly called them out on this.
Mrs. SHAHEEN. I appreciate the eloquent comments from the Senator
from Oregon and all of his efforts to make sure we don't take away
healthcare for so many people who desperately need it.
That is why I came to the floor today, because I spent the week we
were back home--not last week but the week before--talking to
constituents in New Hampshire and listening to what their concerns
What I heard was that people were deeply, deeply concerned and very
upset by the efforts here to repeal the Affordable Care Act, when they
didn't know what the replacement meant for them. In dozens of
conversations and roundtable discussions at a townhall forum, Granite
Staters shared stories of how the Affordable Care Act has been a
lifeline for them. I heard from people who say their lives have been
saved by the law.
In fact, we can see what is at risk in the State of New Hampshire,
where we have almost 600,000 Granite Staters who have preexisting
conditions. We have 118,000 people who could lose coverage. We have
50,000 Granite Staters with marketplace plans who are in the exchange,
42,000 who are enrolled in Medicaid, and 31,000 who have tax credits
that lower the cost of healthcare for them. If that is taken away, so
many of those people have no option for getting healthcare.
What we know now, after we have finally seen the plan Republican
leaders are talking about, we know those fears were well founded that
they were worried they were going to lose their healthcare. What we
have seen is legislation to repeal the Affordable Care Act that would
have catastrophic consequences not only for people in New Hampshire but
for people across this country.
It is especially distressing that TrumpCare--as it has been
introduced by the Republicans--would roll back expansion of the
Medicaid Program, which has, in New Hampshire and across this country,
been an indispensable tool in our efforts to combat the opioid
epidemic. In addition, we are seeing, as the Senator from Oregon
pointed out, that TrumpCare would terminate healthcare subsidies for
the middle class and for other working Americans, and it would replace
those subsidies with totally inadequate tax credits--as low as $2,000,
which doesn't begin to pay for healthcare coverage for an individual,
much less a family. This means as many as 20 million Americans could
lose their healthcare coverage.
Even as the bill makes devastating cuts to the middle class, it gives
the wealthiest Americans a new tax break worth several hundred thousand
dollars per taxpayer. I think this proposed legislation is totally out
of touch with the lives of millions of working Americans, people whose
health and financial situation would be turned upside down by the bill.
Last week, in his response to President Trump's address to Congress,
former Gov. Steve Beshear of Kentucky said something that really
resonated with me. He reminded us that people who have access to
healthcare thanks to ObamaCare are “not aliens from some other
planet.” As he described, “They are our friends and neighbors. . . .
We sit on the bleachers with them on Friday night. We worship in the
pews with them on Sunday morning. They're farmers, restaurant workers,
part-time teachers, nurses' aides, construction workers,
entrepreneurs,” and often minimum wage workers. “And before the
Affordable Care Act, they woke up every morning and went to work, just
hoping and praying they wouldn't get sick, because they knew they were
just one bad diagnosis away from bankruptcy.”
To understand why people in New Hampshire are so upset and fearful
about efforts to repeal the Affordable Care Act, we have to look again
at this chart because some 120,000 Granite Staters could lose their
health insurance. That is nearly 1 in every 10 people in the State of
In particular, repeal of the Affordable Care Act would very literally
have life-or-death consequences for thousands of people who are
fighting opioid addiction, who have been able to access lifesaving
treatment thanks to the expansion of Medicaid and the Affordable Care
Sadly, one of the statistics we are not happy about in New Hampshire
is that we have the second highest rate of per capita drug overdose
deaths in the country. We trail only West Virginia. The chief medical
examiner in New Hampshire projects that there were 470 drug-related
deaths in 2016, including a sharp increase in overdose deaths among
those who were 19 years old or younger. For a small State like New
Hampshire, this is a tragedy of staggering proportions, affecting not
just those who overdose but their families and entire communities.
I am happy to say, in the last couple of years, we made real progress
in combating this epidemic because we had the Affordable Care Act and
its expansion of Medicaid, which has given thousands of Granite Staters
access to lifesaving treatment. Over the past year, I had a chance to
visit treatment centers all across New Hampshire. I met with
individuals who are struggling with substance use disorders and
providers who are trying to make sure they get the treatment they need.
Last month, at a center in the Monadnock region of New Hampshire, I
had an amazing private meeting with more than 30 people in recovery
from substance use disorders. They are putting their lives back
together, hoping to reclaim their jobs, to get back with their
families, and they are able to do that largely because of treatment
that is made possible by the Affordable Care Act.
One patient shared her story with me. As with so many others in
treatment, her story is one of making mistakes, of falling into
dependency, of struggling with all her might to escape her addiction.
She is in recovery for the second time, and she said that this time for
her is a life-or-death situation. She has no family support. She
worries that she will be homeless when she leaves the treatment
program, but she is grateful for the Affordable Care Act because it has
given her one more shot at getting sober and the chance for a positive
At a forum in Manchester--New Hampshire's largest city--a courageous
woman named Ashley Hurteau said
that access to healthcare as an enrollee in Medicaid expansion was
critical to her addiction recovery. She had been arrested following the
overdose death of her husband. Ashley said an understanding police
officer and a drug court were key to her recovery. She added this:
I am living proof that, by giving individuals suffering
with substance use disorder access to health insurance, we,
as a society, are giving people like me the chance to be who
we really are again.
Without that access to treatment, where would Ashley be?
Several weeks ago I received a letter from Nansie Feeny, who lives in
Concord, the capital of New Hampshire. She told me the Affordable Care
Act had saved her son's life. This is what she wrote:
[My son] Benjamin went to Keene State College with the same
hopes and dreams many have when building their American
dream. While there he tried heroin. Addiction overcame him
but did not stop him from graduating. After graduation he
suffered a long road of near death existence. After a couple
of episodes where he had to be revived (fentanyl) he chose
recovery. And it was due to ObamaCare that we were able to
get him insured so he could get the proper help he needed and
[into] a suboxone program that assisted him with staying
She wrote, and you could read between the lines how relieved she
it will be a year for Ben in his recovery. Without
ObamaCare, this would not have been possible. . . . I can't
find the words to define my gratitude to President Obama. I
believe my son would not be alive today if it were not for
this plan that provided the means he needed to get the help
he needed at the time he needed it. Ben still has a long road
ahead of him but I will see to it that he never walks it
I also want to share a powerfully moving letter from Melissa Davis,
an attorney in Plymouth, NH. Ms. Davis writes:
I am a lawyer who frequently works on behalf of clients who
are suffering from substance use disorder, mental health
conditions, or a combination of both. I have been working
with these clients for over 10 years and I can tell you that
access to health insurance has always been the biggest
obstacle in obtaining quality and consistent treatment. Since
passage of the Affordable Care Act and the expansion of
Medicaid, my clients are actually able to access real
treatment in ways they never were before. Before the ACA,
there were far too many times where my clients were unable to
afford private substance use disorder treatment, wait lists
at community mental health agencies were extremely long, and
AA and NA were not enough. Without treatment, these clients
often ended up in jail or worse, dead. I still have clients
who face obstacles to obtaining quality treatment, but the
ability to get insurance removes a huge obstacle.
Ms. Davis concludes with this warning:
I am sincerely afraid for what will happen to my clients
and my community if access to quality substance use disorder
and mental health treatment is taken away from those people
who need it most because they are unable to get insurance.
Please do everything you can to save the ACA.
In dozens of visits to New Hampshire during the campaign, President
Trump pledged aggressive action to combat the opioid crisis. In his
address to Congress last week, he once again promised action to expand
treatment and end the opioid crisis. But despite these bold words and
big promises, the President's actions have sent a totally different
signal. His actions threaten an abrupt retreat in the fight against the
By embracing the House Republican leadership's plan to repeal the
Affordable Care Act, President Trump has broken his promise to the
people of New Hampshire. This misguided bill would roll back the
expansion of Medicaid, and it could terminate treatment for hundreds of
thousands of people in New Hampshire and across America who are
recovering from substance use disorders.
Meanwhile, the President's nominee to serve as Administrator of the
Centers for Medicare and Medicaid Services, Seema Verma, has been an
outspoken advocate of deep cuts to Federal funding for Medicaid. As we
have seen with so many of the Trump administration nominees, Ms. Verma
has an underlying hostility to the core mission of the agency that she
has been asked to lead.
Seema Verma is currently a health policy consultant who has called
for less Federal oversight of the Medicaid Program and advocated for
policies expressly designed to discourage patients from seeking care--
for instance, by imposing cost-sharing burdens on Medicaid recipients.
In addition, she is a staunch advocate of block-granting Medicaid and
turning it into a per capita cap system. Over time, this would lead to
profound cuts to Medicaid, forcing States to raise eligibility
requirements and terminate coverage for millions of recipients.
Let's be clear as to who these recipients are. In 2015, the 97
million Americans covered by Medicaid included 33 million children, 6
million seniors, and 10 million people with disabilities. Seniors,
including nursing home costs, account for nearly half of all Medicaid
These are some of the most vulnerable people in our society, and they
will be the targets of Ms. Verma's determined efforts to cut funding
for Medicaid and terminate coverage for millions of current recipients.
I also have deep concerns about this nominee's commitment to
protecting women's healthcare. During her confirmation hearing in the
Finance Committee, Ms. Verma was asked if women should get access to
prenatal care and maternity coverage as afforded under the Affordable
Care Act or whether insurance companies should get to choose whether to
cover this for women.
Ms. Verma tried to clarify when she met with me that she hadn't
really meant what she said. But what she said was that maternity
coverage should be optional, that women should pay extra for it if they
want it. Of course, the problem with this position is that it takes us
backward to the days before the ACA, when only 12 percent of policies
on the individual insurance market offered maternity coverage.
In the State of New Hampshire, before the Affordable Care Act, you
could not buy an individual policy that covered maternity benefits.
They were not written. Insurers who offered coverage charged exorbitant
rates with high deductibles, plus benefit caps of only a few thousand
dollars. This is a major reason why, before the Affordable Care Act,
women were systematically charged more for health insurance than men.
In the eyes of insurance companies, being a woman was seen as a
preexisting condition, and they charged us more accordingly.
Well, the American people don't want drastic cuts to Medicaid, cuts
that will threaten coverage for children, for seniors, for people with
disabilities, and for those receiving treatment for substance use
disorders. That is why I intend to vote against the confirmation of
Seema Verma to head CMS.
In recent years, we have made impressive gains, securing health
coverage for millions of Americans and significantly improving the
health of the American people. I can't support a nominee who wants to
reverse these gains.
In recent weeks, all of our offices have been flooded with calls,
with emails, with letters opposing the Trump administration's plans to
repeal ObamaCare and undermine both the Medicare and Medicaid Programs.
We need to listen to these voices. We need to keep the Affordable Care
Act and the expansion of Medicaid.
There are things we can do to make it better, and we should work
together to do that. But we have heard from people loud and clear
across this country. It is time now to respect their wishes, to come
together to fix this landmark law, and to ensure that it works even
better for all Americans.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, before my colleague from New Hampshire
leaves, does she have a quick minute for a question?
Mrs. SHAHEEN. Absolutely.
Mr. WYDEN. I thank her for her presentation. It was factual and very
specific, and I think it really highlighted so many of the concerns
that we have at this point.
I want to see if I could get this straight on the opioid issue. Here
you all are in New Hampshire, right in the center of the Presidential
campaign. All of the candidates are coming through, and they are
practically trying to outdo each other in terms of their pledges to
deal with this wrecking ball that is the opioid addiction that has
swept through New Hampshire
and, of course, my own home State as well.
I remember then-Candidate Trump being particularly strong and
assertive about how he was going to fight opioids.
I think what my colleague said--and I am curious, so I am going to
ask a couple of questions because I don't think folks even in my home
State are aware of some of these things. So I am going to ask my
colleague about it.
Are folks in New Hampshire aware at this point--my colleague put up
that Trump chart, showing how the people didn't know what was being cut
and how much it was going to cost and all the rest. Are people in New
Hampshire at this point aware of the fact that this is essentially
after a campaign in their home State, which certainly put out a lot of
TV commercials and campaign rhetoric in the fight on opioids?
I think my colleague said that when people unpack this, they are
going to see that this is a major broken promise, that TrumpCare is a
major broken promise on opioids because, in terms of the time sequence,
they all had debates and commercials, then we finally got some money in
order to have treatment.
And I think what my colleague said is that now, as a result of
TrumpCare and the cap on Medicaid, there will not be the funds to get
the treatment to people who are so needy. Is that what this is going to
be about in New Hampshire?
Mrs. SHAHEEN. That is absolutely correct.
I remember meeting one young man early in the fall, in the middle of
the campaign early last year. He came up to me in Manchester and said:
I am so worried about what is going to happen in this election because
I am in recovery; I am an addict. He said: I am worried that whoever
gets elected is not going to continue to make sure that I can get the
treatment I need. He said: I am worried about Mr. Trump.
As my colleague pointed out, Donald Trump, when he was campaigning in
New Hampshire, made a lot of promises about how he was going to address
the heroin and opioid epidemic, how he was going to make sure that
people could get treatment, treatment at a cost they could afford.
Well, thanks to the Affordable Care Act and the expansion of Medicaid
and the great work by our Republican legislature and our Democratic
Governor--then-Governor Hassan, who is now in the Senate--we passed a
plan to make sure that people who had substance use disorders could get
Last year we had 48,000 applications submitted under the expansion of
Medicaid for treatment of substance use disorders. If we pulled the
plug on that Medicaid expansion so that people couldn't get that
treatment, they wouldn't have anywhere to go.
That is what I heard when I was at Phoenix House in Dublin, in the
western part of New Hampshire, a couple of weeks ago. I was sitting
around with about 30 people in recovery, people who are hopeful for the
first time in a long time because they are in treatment and they can
see they can put their lives back together.
I said to them: What happens if we no longer have the Medicaid
They said: We don't have any other options. We don't have treatment.
What we heard from President Trump is that he was going to introduce
a healthcare plan that was going to cover more people for less money
and better quality. Well, that is not what we are seeing.
The TrumpCare that was introduced in the House this week that they
marked up and that is going to be coming to the Senate doesn't do that.
It reduces coverage under the Medicaid Program. It would throw
thousands of people off of their treatment for substance use disorders,
and there is nowhere else for them to go.
This is not an acceptable plan. This does not do what the President
promised he was going to do. It is not what he promised in New
Hampshire, it is not what he promised in the campaign, and it is not
what he has promised since he became President.
Mr. WYDEN. I think my colleague's point is well taken.
As we have been saying, this is very much intertwined with the Seema
Verma nomination because what we learned in the committee is, in
Indiana, where she touts her pioneering work, if somebody had an
inability to pay for a short period of time, they would be locked out
of the program. So in terms of Medicaid, this is going to cause a real
I had already outlined that it is going to cause a hardship in
another program that is important to New Hampshire, and that is
Medicare, because we are implementing what is called the MACRA, the new
reimbursement system for doctors. We asked her questions about rural
care, and she didn't know the answer either.
I particularly wanted my colleague to walk us through this situation
with respect to how New Hampshire residents are going to see TrumpCare
as it relates to opioid addiction after they have all these grandiose
promises and the many debates and commercials.
I thought I would ask if my colleague has time for one other
In New Hampshire, as in Oregon, we have a lot of seniors. It looks to
me as if somebody who is, say, 58 years old or 62 years old is just
going to get hammered by what we call the age tax because in these
bills, which are now moving like a freight train with the House already
moving in two committees, Republicans want to give insurance companies
a green light to charge older people five times as much as they charge
younger people. So I cited a number of my small, rural counties--Grant
County, Union County, Lake County--and how a 60-year-old who makes
$30,000 a year can see their insurance costs, because of the age tax,
go up something like $8,000 a year.
I don't have the numbers as of now--Finance staff is still working on
that for every single State--but obviously that tax sure looks like it
is going to hit somebody in New Hampshire, an older person, people
before they are eligible for Medicare, and particularly in that 55-to-
65 bracket. It looks like it is going to hit them very hard. How is
that going to be received, because in my time in New Hampshire, we
talked about it, and a lot of those people really are walking on
economic tightropes. They are balancing their food bill against their
fuel bill and their fuel bill against their rent bill. I know my
colleague spends a lot of time trying to advocate for them, help them
through small business approaches. How are they going to be able to
absorb what is clearly going to be thousands of dollars in new out-of-
pocket health costs?
Mrs. SHAHEEN. I think that is a huge problem. New Hampshire has a
population that is one of the fastest aging in the country. As Senator
Wyden points out, not only does the TrumpCare legislation change how
people on Medicare are charged for their health insurance, but it also
would change the other aspects of the Affordable Care Act that have
been beneficial, such as preventive care under Medicare.
It would also change the effort to close the doughnut hole--the cost
of the prescription drugs that seniors buy. That has been a huge
benefit to people in New Hampshire over the last few years because they
are beginning to see their costs for prescription drugs affected
positively. So it will have a huge impact on seniors in New Hampshire.
The other issue that will have an impact not only on seniors but on
everybody is what will happen to our rural hospitals. In New Hampshire,
because we have a lot of rural areas in the State, we have a lot of
small towns. Most of our hospitals are small and rural. They have
benefitted significantly under the Affordable Care Act because they
have been able to get paid for people who come to the emergency room
for treatment. We have gotten a lot of people out of emergency rooms
and into primary care. Most hospitals have seen about a 40-percent
decline in people using emergency rooms for their healthcare. That has
been a huge, important benefit to our rural hospitals that are
operating on very thin margins that we need to keep open, not just
because of the healthcare they provide but because of the jobs they
provide. In most of our small communities, those hospitals are among
the biggest employers.
There are huge impacts if we repeal the Affordable Care Act and we
put in place this TrumpCare policy that doesn't cover as many people.
It is going to cost more, it is going to reduce the help people are
through their healthcare coverage, and it is going to have a
detrimental impact on people in the State of New Hampshire and across
Mr. WYDEN. I thank my colleague.
We have heard Republicans say repeatedly that anything they are going
to do with Medicare is not going to hurt today's enrollees or people
nearing retirement. The fact is, TrumpCare hurts both. It is going to
shorten the life expectancy of the Medicare trust fund, and those older
people--I will be curious, when my colleague returns--I will be very
interested to hear what seniors in New Hampshire who are 56 to 68 and
are walking on that economic tightrope are going to say.
I thank my colleague from New Hampshire for the excellent
Mrs. SHAHEEN. I thank the Senator, and thank the Senator for his
fight to help as we try to prevent people across this country from
losing their healthcare.
Mr. WYDEN. I thank my colleague, and we are going to prosecute this
I see that the chairman of the Finance Committee has arrived. He
graciously said I could take another 5 minutes or so of our time.
Before we wrap up this part of our presentation, I want to point out
that we have outlined how people who are dealing with the consequences
of opioid addiction would be hurt by TrumpCare. We have outlined how
seniors who are not yet eligible for Medicare are going to be hurt and
how seniors who are now on Medicare are going to certainly be hurt by
reducing access to nursing home benefits. Now I would like to wrap up
by going to the other end of the age spectrum and talk for a moment
Nearly half of Medicaid recipients are kids, and the program of the
Republicans--now that we have two committees in effect out of chute
with their proposals--restructures the program in the most arbitrary
way, using these caps, shifting costs to States. And the reality is
that Medicaid is a major source of help for children. There is early
and periodic screening, diagnosis, and treatment benefits. But with
reduced funding, the States are going to be forced to make difficult
decisions about which benefits they can keep providing. States are
going to be forced to reduce payments to providers, particularly for
kids, providers such as pediatric specialists, and limit access
to lifesaving specialty care.
My own sense is that this is shortsighted at best, and it is like
throwing the evidence about children and their health needs in the
trash can. Children receiving Medicaid benefits are more likely to
perform better in school, miss fewer days of school, and pursue higher
Before I yield the floor to my good friend and colleague Chairman
Hatch, I want to come back to what disturbs me the most about all of
this. All of these dramatic changes to Medicare and Medicaid that strip
seniors and some of our most vulnerable citizens are being made at the
cost of hundreds of billions of dollars to these programs while, in
effect, there is an enormous transfer of wealth given to the most
fortunate in America in the two bills that were passed by the other
body today in the committee. In effect, for example, people who make
over $250,000 will not have to make the additional payments under the
Medicare tax. If ever there were a group of people in America who
doesn't need additional tax relief, it is those people.
As we wrap up this portion of the presentation, I want people to just
think about looking at their paycheck. Every time you get a paycheck in
America, there is a line for Medicare tax. Everybody pays it. It is
particularly important right now because 10,000 people will be turning
65 every day for years and years to come.
What the tax provisions of this legislation mean--and they are part
of hundreds of billions of dollars of tax cuts--for insurance
executives making over $500,000 annually, there are yet additional
juicy writeoffs, while seniors and those of modest means are going to
bear the brunt of those reductions. Nothing illustrates it more than
cutting the Medicare tax, colleagues.
I don't know how anyone can go home in any part of the country and
say: You know, we are going to have to charge older people between 50
and 65 a lot more for their coverage, and by the way, insurance company
executives making $500,000 a year are going to get more tax relief. I
don't think it passes the smell test in America. It is reverse Robin
Hood. There is no other way to describe it. It is transferring wealth
from working families and those who are the most vulnerable. When
working Americans see their paycheck and see the Medicare tax, I hope
they remember that in this bill, the Medicare tax is reduced for only
one group of people--people making more than $250,000 a year.
I want tax reform. The chairman of the Finance Committee knows that.
I have introduced proposals to do that. But I don't know how we get tax
reform when they are giving the relief to the people at the top of the
economic ladder and it is coming out of the pockets of working people
and working families. Everybody is going to be able to see it right on
their paycheck, right there with the Medicare tax.
I think we will continue this debate, but on issue after issue, with
the nominee on the floor, Ms. Verma, what she will do if confirmed is
directly related to TrumpCare. For example, we told her in the
committee that we wanted her to give one example--just one--of an idea
to hold down pharmaceutical prices, which is something else that is
important to older people.
TrumpCare, by the way, could have included proposals to try to help
hold down the cost of medicine. Guess what, folks. On pharmaceutical
prices, there is no there, there either. It doesn't do anything to help
This vote we will have on Tuesday is the first step in the discussion
of how this particular nominee would handle the implementation of
TrumpCare. Her job oversees Medicare payments to hospitals. It is
really intertwined, this nomination and TrumpCare, and we couldn't get
any responses to how she meets the needs of working families, as I just
mentioned, with respect to pharmaceuticals, and we are pretty much in
the dark with respect to how she would carry out her duties. As of now,
we don't see how she is going to do much to try to eliminate some of
the extraordinary harm that is going to be inflicted on the vulnerable
and seniors on Medicare and Medicaid as a result of TrumpCare.
I reserve the remainder of my time, and I yield the floor.
The PRESIDING OFFICER. The Senator from Utah.
Republican Healthcare Bill
Mr. HATCH. Mr. President, I rise today to speak once again on the so-
called Affordable Care Act and the ongoing effort to repeal and
replace. We all know the House of Representatives has produced a repeal
and replace package, and both the Ways and Means and Energy and
Commerce Committees have been marking it up. We don't know what it is
right now. In other words, the endeavor to right the wrongs of
ObamaCare is moving steadily forward on the other side of the Capitol,
and soon it will be the Senate's turn to act. I commend my colleagues
for introducing this legislation and moving it forward. This is an
important step, and I don't think I am alone when I say that I am
watching the progress in the House very carefully to see how things
proceed and what the final House product will look like.
Of course, virtually all Republicans in Congress want to repeal and
replace ObamaCare. We are in unison there. While there are some
differences of opinion on how best to do that, there is generally
unanimity on that point. I am confident that whatever differences exist
among House Members will be worked out through the House's legislative
In addition, whatever passes in the House will be subject to the
input and review of the Senate and to the rules of the budget
reconciliation process. I want to note that I have heard from a number
of Senators who have items they would like to see included when the
bill comes before the Senate. I actually have several ideas of my own.
However, there are limits as to what we can do under the budget
reconciliation rule. Many of the proposed policy changes I have heard,
although they have merit, would be banned by the rules and subject to
the 60-vote threshold. That said, I am committed to working with my
colleagues on both sides of the floor to ensure that the
Senate process on this bill is productive and that it yields a result
we can support.
Long story short: This process is far from over. We have a lot more
work to do. It is worth pointing out that the vast majority of the
policies at play in this discussion and virtually all of the spending
fall under the exclusive jurisdiction of the Senate Finance Committee,
which I chair. Make no mistake. The Finance Committee is already hard
at work and has been for some time. In many respects, I suppose you
could say we have been working on this effort since the day ObamaCare
was signed into law. However, for obvious reasons, our work has
intensified over the past several months.
In working through this process, I have been in constant contact with
Chairmen Brady and Walden, who head up the relevant committees in the
House. I have also been working closely with the Speaker's office, and
I have been gathering input from Governors around the country. In
addition, I have been working closely with the distinguished chairman
of the Senate Budget Committee, Senator Enzi, who has the chief
responsibility of navigating the budget process and shepherding a final
repeal-and-replace bill through all the necessary rules and
In all of those conversations, we have been talking about the
process, and we have been talking about the timing. Most importantly,
we have been talking about the substance of the healthcare reforms and
how we can best serve the interests of the American people.
Throughout this effort, we have been reminded that Republicans
currently control the White House and both Chambers in Congress due, in
large part, to our stated commitment to repeal and replace ObamaCare,
and we intend to deliver on that promise.
I would like to take a few minutes to talk about some of the policies
we will need to tackle as we take up the House healthcare bill in the
Once again, the vast majority of the policies and virtually all of
the spending involved in this effort fall under the Finance Committee's
exclusive jurisdiction, and I intend to make sure all of my colleagues
are well informed on the issues and that in the end whatever version of
the bill we pass in the Senate reflects the collective will of a
majority of Senators.
All told, there are five major policy areas that are addressed in the
House bill that fall under the Finance Committee's purview.
First, there are the provisions to repeal the ObamaCare taxes. This
is big. If one recalls, I came to the floor a few weeks ago and pointed
out how misguided it would be, in my view, to start picking and sorting
through the ObamaCare taxes to decide which to keep and which to leave
in place. The House bill repeals them, along with the individual and
employer mandates, both of which reside in the Tax Code. I have been
working with Chairman Brady on this issue. In the end, I believe the
Senate version of the bill should do the same, and I am going to
continue to push to ensure it does.
Second, there is the issue of premium tax credits. Chairman Brady and
I have been working extensively on this issue as well. The House bill
replaces the ObamaCare premium subsidies with a refundable tax credit
for the purpose of State-approved health insurance, limited to those
who do not qualify for other governmental healthcare programs and who
have not been offered insurance benefits from their employers. Most
major ObamaCare replacement proposals that we have seen contain some
version of health insurance tax credits. The House approach represents
a significant improvement over the ObamaCare premium subsidies. The
Senate, when it takes up the bill, will have to consider how best to
implement the tax credits. I will continue to work with my House and
Senate colleagues to ensure that the tax credits are designed to help
those lower and middle-income Americans who are the most in need.
Third, there are the issues surrounding Medicaid. Chairman Walden and
his predecessor, Chairman Upton, and I have been working extensively on
this matter. As we know, the vast majority of the newly insured people
who the proponents of ObamaCare have cited as proof that the system is
working have been covered by the expanded Medicaid Program.
The problem, of course, is that the Affordable Care Act did not do
anything to improve Medicaid, which was already absurdly expensive for
States, and ultimately unsustainable, not to mention the fact that it
provides substandard healthcare coverage.
The House bill draws down the ObamaCare Medicaid expansion and makes
a number of significant changes to the underlying program. Most
notably, it establishes per capita caps on Federal Medicaid spending,
which are intended to give States more flexibility and predictability
while also controlling Federal outlays related to the program.
We have received substantial input on this matter from Governors
around the country, and virtually all of them agree changes need to be
made. Given these concerns and the sheer vastness of the Medicaid
Program under ObamaCare, the Senate will have to tackle this issue when
it takes up the budget reconciliation legislation in the next few
I am confident that in working with my colleagues in the House and
Senate and with the Governors, we can find the right solution.
Fourth, there is the issue of savings accounts for healthcare costs.
I have long been an advocate for the expanded use of HSAs and FSAs.
Needless to say, I was particularly opposed to the ObamaCare provisions
that limited the use of these savings accounts and essentially
marginalized their usefulness for consumers and patients.
The House bill removes a number of restrictions on these accounts
that have been imposed by ObamaCare, and it goes further to remove
longstanding restrictions on HSAs in order to expand their use and give
patients and consumers more options to pay for health expenses.
I am very supportive of this approach. In fact, the language from the
House bill mirrors the legislation I introduced this year--the Health
Savings Act of 2017.
Fifth, there are some important transition issues that need to be
To get at these issues, the House bill creates a Patient and State
Stability Program, under the Social Security Act, that would distribute
$100 billion to States over 10 years to enhance flexibility for States
in how they manage healthcare for their high-risk and low-income
For example, the funds could be used to, among other things, help
individuals with cost-sharing. This program was proposed with the idea
of giving States an expanded role in the healthcare system, a goal that
is shared by most Republicans in Congress and something that almost all
of the Governors have told us they want to see.
There are other issues from the House bill in the broader healthcare
debate that will demand some attention when we consider the bill in the
Senate. However, almost all of them fall under these general
categories. Once again, the vast majority of them fall under the sole
jurisdiction of the Senate Finance Committee, the primary committee.
There are other critical issues out there which do not involve the
Tax Code, the Social Security Act, or Federal health programs. Yet they
are extremely important.
The biggest mistake made by those who drafted ObamaCare and forced it
through Congress was their failure to address healthcare costs in any
meaningful way. After all, cost is the largest barrier preventing
people from obtaining health insurance coverage, and the increasing
healthcare costs are among the most prominent factors leading to wage
stagnation for U.S. workers. Yet ObamaCare did little to address this
problem, and in fact it has made things worse.
If we are going to fully keep our promises to the American people
with regard to ObamaCare, we are going to have to eventually address
these issues. After all, most people's negative interaction with the
Affordable Care Act has come in the form of increased healthcare costs.
If we are going to truly right all of ObamaCare's wrongs, we need to
tackle the costs head on.
This will mean, among other things, fixing the draconian regulatory
regime in our health insurance markets and giving individuals the
ability to select only the coverage they want and need.
Many of these types of issues fall far outside of the Finance
Committee's jurisdiction and are under the watchful eye of the
distinguished chairman of the Senate HELP Committee.
The House bill also includes some provisions that are intended to
address these concerns. I assume our distinguished colleague running
the HELP Committee is working tirelessly to address the issues, and
others, both through the reconciliation exercise or some alternative
Ultimately, if our goal is to place the healthcare system in a better
position than it has been under ObamaCare, costs will have to factor
heavily into the equation. I am looking forward to receiving guidance
and leadership on the HELP Committee on these important market reform
Overall, I believe we can and will be successful in this endeavor to
fix our broken healthcare system. The American people are counting on
us to do so. At the end of the day, success in that endeavor is, in my
view, going to require a robust Senate process that allows this Chamber
to work its will.
We have two Chambers in Congress for a reason. The House
reconciliation bill needs 218 votes to pass. The Senate will also have
to act when we receive the bill, and we will need to produce a package
that can get at least 51 votes in this Chamber and hopefully more. That
may mean some differences between the Senate and the House versions of
the bill, but that is not problematic in my view. It is not
particularly novel or unusual for different views and ideas to be
resolved through the legislative process rather than simply dissipating
when a bill is introduced. It seems to me that is not novel, and I am
not the only one who has this view.
Earlier this week, Secretary Price sent a letter to the chairmen of
the House Ways and Means and Energy and Commerce Committees. The letter
commended the chairmen for their work and praised the legislation they
unveiled to repeal and replace ObamaCare.
The Secretary also noted that this was not the end of the process but
that the introduction of the House bill was a “necessary and important
first step” and that the administration anticipated that the Congress
would be “making necessary technical and appropriate changes” to get
a final bill to the President that he can sign, which reminds us of the
other important advocate in this endeavor. President Trump ultimately
needs to support the bill that is passed by each Chamber of Congress,
and his support for our efforts is paramount.
While, at this point, it may not be entirely clear what the final
bill will look like, we do know two things for certain. First, we know
that ObamaCare is not working. As the majority leader said yesterday,
ObamaCare is a direct attack on the American middle class. Thanks to
skyrocketing premiums, shrinking options in the health insurance
market, burdensome mandates, and harmful taxes, millions of Americans
are dealing with the failures of ObamaCare on a daily basis. We need to
act now to fix these problems.
Second, we know that by introducing its bill and moving it through
the legislative process, the House has taken significant steps in
advancing this effort, and the leaders in the House should be commended
for doing so.
Long story short, I have nothing but praise for the leaders in the
House this week for the work they have done on these issues. Remember,
this is just the beginning. I look forward to working with my
colleagues in both Chambers to get this over the finish line so the
Republicans can collectively make good on our promises with regard to
Nomination of Neil Gorsuch
Mr. President, I rise to speak on the nomination of Neil Gorsuch to
the U.S. Supreme Court.
Later this month, Judge Gorsuch will come before the Senate Judiciary
Committee for his confirmation hearing. I wish to speak today on what
we can and should expect to happen during that hearing.
First, some background. This will be the 14th Supreme Court
confirmation hearing I have participated in. I have seen some truly
outstanding hearings in which both the nominee and the Senators
acquitted themselves well. I have also seen some hearings that have
gone far off the rails, in which some Senators hurled unfounded
allegations or sought to twist the nominee's clearly distinguished
record. I am hopeful Judge Gorsuch's hearing will be the former type.
We have before us a supremely qualified, highly respected, and
extremely thoughtful nominee. Judge Gorsuch has had a stellar legal
career, and by all accounts, he is a man of tremendous integrity,
kindness, and respect. He is the sort of person all Americans should
want on the Supreme Court. He does not approach cases with preconceived
outcomes in mind. He seeks to apply the law fairly and impartially in
line with what the democratically elected representatives who enacted
the law had in mind. He will be a truly outstanding Justice.
Judge Gorsuch's hearing will focus on his background, his
temperament, and his approach to judging. So let's talk a little about
what we know about Judge Gorsuch. We know he has an outstanding
academic record. He graduated from Columbia University and Harvard Law
School and obtained a doctor of philosophy in law from Oxford
University. We know he had a highly successful legal career before
becoming a judge.
He clerked for two Supreme Court Justices before entering private
practice here in Washington. He made partner in only 2 years, which
shows how highly his colleagues at the firm thought of him and his
Following a decade in private practice, Judge Gorsuch was appointed
Principal Deputy Associate Attorney General at the Department of
Justice, where he oversaw the Department's antitrust, civil, and
environmental tax units.
In 2006, President Bush nominated Judge Gorsuch to the U.S. Court of
Appeals for the Tenth circuit--the circuit in which I reside. The
Senate confirmed Judge Gorsuch unanimously by voice vote a short 2
months later. At Judge Gorsuch's investiture, then-Senator Ken Salazar,
who later served as President Obama's Interior Secretary, praised Judge
Gorsuch's “sense of fairness and impartiality.” That fairness and
impartiality, which was evident to my colleagues even then, was a large
reason why Judge Gorsuch won confirmation without a single dissenting
Judge Gorsuch's hearing will also affect us on his temperament and
approach to judging. No one can seriously doubt that Judge Gorsuch has
an excellent judicial temperament. A recent article in Slate--no
rightwing paper, by any means--described the judge as “thoughtful and
fair-minded, principled, and consistent.”
The Denver Post, which twice endorsed President Obama for President
and endorsed Hillary Clinton in this past election, also recently
endorsed Judge Gorsuch's nomination, saying: “From his bench in the
U.S. Tenth Circuit Court of Appeals, he has applied the law fairly and
Clearly, Judge Gorsuch has the right temperament to serve on the
His approach to judging is also spot-on. Judge Gorsuch's opinions
show that he is not only an excellent writer but also that he
understands the proper role of a judge in our constitutional system. He
consistently explains his reasoning by reference to fundamental
constitutional principles. He does not seek to push the law toward the
outcomes he favors but instead tries to apply it in harmony with the
understanding of those who wrote and passed it. In so doing, he shows a
healthy respect for the legislative process and for the democratically
elected branches of government.
As Judge Gorsuch said in a speech shortly after Justice Scalia's
passing, “Judges should be in the business of declaring what the law
is, using traditional tools of interpretation, rather than pronouncing
the law as they might wish it to be in light of their own political
Judge Gorsuch's opinions demonstrate that he understands
fundamentally the importance of this principle and that he seeks
faithfully to apply it in his own judging.
Against this impressive list of qualifications, Democrats and their
liberal allies strain mightily to find plausible grounds to oppose
Judge Gorsuch's nomination. They misread his opinions, misstate his
reasoning, and in
general paint a picture of a man who simply does not exist. We can
expect more of this at his confirmation hearing. In particular, we can
expect to be raised again and again the risible and flatly false claim
that Judge Gorsuch is outside the “judicial mainstream.” These
arguments against Judge Gorsuch are not persuasive--not even close. We
see hints of them in the various letters liberal interest groups have
sent Congress claiming that Judge Gorsuch is a threat to the Republic--
a danger to our very way of life. The over-the-top language these
groups use only serves to highlight the weakness of their case against
One such letter called the judge “an ultra-conservative jurist who
will undermine our basic freedoms and threaten the independence of the
Federal judiciary.” The letter goes on to say that there is “zero
evidence that Judge Gorsuch will be an independent check on this
runaway and dangerous administration.”
As an initial matter, I would ask: If Judge Gorsuch is such an
existential threat to the Republic, where were all these groups 10
years ago when he won confirmation to the Tenth Circuit unanimously?
Did Judge Gorsuch spend the first 40 years of his life hiding what a
monster he is, revealing his true self only once safely ensconced on
the Federal bench?
The outlandishness of these claims against Judge Gorsuch is made
clear by the support he has received from prominent liberals, including
President Obama's own Solicitor General, Neal Katyal. In an op-ed
published in the New York Times, Neal Katyal praised Judge Gorsuch's
fairness and decency and said that he had no doubt that, if confirmed,
Judge Gorsuch would “help to restore confidence in the rule of law.”
Katyal further wrote that Judge Gorsuch's record as a judge reveals a
commitment to judicial independence, a record that should “give the
American people confidence that he will not compromise principle to
favor the President who appointed him.”
It bears mention here that Mr. Katyal is no shrinking violet when it
comes to standing up to the executive branch. He rose to prominence in
the legal community through his work representing Guantanamo detainees.
So when he says Judge Gorsuch will not shy away from holding Federal
officials to account, frankly, his words carry weight.
Then there is the phrase we are likely to hear invoked again and
again at Judge Gorsuch's hearing and beyond: “judicial mainstream.”
Liberals will tie themselves in knots claiming that Judge Gorsuch is
some sort of fringe jurist, that his views place him on the far flank
of the Federal judiciary. Any honest observer will tell you that these
claims are complete bunk. President Obama's Solicitor General and
liberal publications like Slate would not offer praise for Judge
Gorsuch if he were some kind of a nut.
In reality, the claims that Judge Gorsuch is outside the mainstream
boil down to three things: a willful misreading of his decisions, a
disingenuous attempt to redefine what it means to be mainstream, and an
inability to count. On the misreading point, opponents of Judge Gorsuch
claim that his decisions say things that they very clearly do not say
or stand for propositions that even a generous reading cannot
substantiate. They say he favors large corporations over employees,
when really he just believes Federal employment laws mean what they
say. They say he opposes contraception and family planning, when really
he just believes religious liberty statutes should be enforced.
Judge Gorsuch's opponents also cite as examples of his purported
extremism decisions that liberal Democratic appointees joined or that a
majority of his colleagues agreed with. They will take a case in which
more than half--or sometimes all--of the judges who heard the case
agree with Judge Gorsuch and say the decision was outside the
mainstream. I don't know about my colleagues, but I always thought that
being in the mainstream had something to do with being somewhere in the
vicinity of your peers or colleagues on a given issue. But, apparently,
that is not what the left means.
Rather, in their failing campaign against Judge Gorsuch, liberals
have redefined “mainstream” to really mean nothing at all. It has
become a code word for liberal, for the sorts of results that liberals
would like to see. But being in the mainstream and being liberal are
not the same thing, despite Democrats' fondest desires. There is such a
thing as diversity of thought, which the left used to venerate, at
least until the confirmation wars and the rise of the conformity cult
on college campuses.
So to my colleagues--and to the American people--I say: Do not be
deceived when liberals say that Judge Gorsuch is outside the
mainstream. He understands that the proper role of a judge in our
constitutional system is to interpret the laws in accordance with the
understanding of those who wrote and ratified those laws. This approach
to judging leaves lawmaking power to the people's elected
representatives and confines the judge's role to implementing the
policy choices selected by those representatives. It is an approach
consistent with our Constitution, our core values, and democracy
It may be at times that this approach yields results that liberals
don't like, but that doesn't place it outside the mainstream. It cannot
be the case that the test of whether a judge is in the mainstream is
whether that judge reaches consistently liberal results. When the
people's elected representatives enact into law a conservative policy,
a judge faithfully applying that law may well reach a conservative
result. The opposite is true when the people's elected representatives
enact into law a liberal policy.
All of this is to say that we cannot judge a nominee solely on the
basis of whether we like the results he or she reaches. As Justice
Scalia famously said:
If you're going to be a good and faithful judge, you have
to resign yourself to the fact that you are not always going
to like the conclusions you reach. If you like them all the
time, you are probably doing something wrong.
That is an interesting statement by one of the great judges, whom
Judge Gorsuch will replace.
Liberals want judges who will always reach liberal results, but that
is not the role of the judge. It is the role of a legislator, and a
judge is certainly not a legislator.
So when you hear liberals say Judge Gorsuch is outside the
mainstream, recognize that they are talking about results--
specifically, liberal results--and recognize that that is not the
proper inquiry for a Supreme Court confirmation hearing.
A Supreme Court confirmation hearing should be about the nominee, the
nominee's experience, and whether the nominee understands his or her
properly constrained role as a judge under our Constitution. On all of
these metrics, Judge Gorsuch is off-the-charts qualified.
When the good judge comes before the Judiciary Committee, listen to
the answers he gives. Ask yourself whether what he says is consistent
with the separation of powers and the system the Framers designed.
Compare his measured demeanor and thoughtful responses to the
histrionics you see from his opponents on the left.
I have full confidence that when the hearing is over and the last
question has been asked, Judge Gorsuch will have shown the Senate that
he is unquestionably qualified and fully prepared to serve our Nation
on the Supreme Court.
With that, Mr. President, I yield the floor.
The PRESIDING OFFICER (Mr. Blunt). The Senator from Delaware.
Mr. CARPER. Mr. President, it is good to be with my colleagues and
the chair of the Senate Finance Committee. I am pleased to say a few
words about the President's nominee, Seema Verma, who, if confirmed,
will lead us at the Centers for Medicare and Medicaid Services. She is
from Indiana, and folks I know in Indiana have said that she knows a
lot about Medicaid, but not nearly so much about Medicare, which is a
cause for some concern.
If confirmed, let me just say we certainly look forward to working
with her and with the team she will have around her in that
responsibility. It is a very tough job, as the Presiding Officer knows.
What I would really like to focus on is that I want to go back in
time, if I could. I want to go back to 1993. I am
not sure what the Presiding Officer was doing in 1993, but I was a
brand-new Governor in 1993. We had a brand-new President and a brand-
new First Lady. She was asked--I presume by her husband, or maybe she
just decided on her own--to try to do what Presidents had talked about
doing for a long time; that is, to try to make sure that everybody in
our country had healthcare coverage. Her name was Clinton, and what she
came up with, in consultation with a lot of folks, was something that
was called HillaryCare--not always as a compliment, but sometimes, in
some cases, derisively. I think our Republican friends, who were
somewhat pointed in their criticism of it, were basically asked: Well,
where is your idea?
In 1993, a guy named John Chafee, whom the Presiding Officer knows--
we served with his son Lincoln in the Senate, and Lincoln went on to be
Governor of Rhode Island--took up the challenge, along with at least 20
other Senators--I think mostly Republican and a couple of Democrats--
and they offered legislation in 1993 that was the Republican
alternative to HillaryCare.
At the end of the day, HillaryCare did not survive, as we know, and
the Chafee proposal from that time essentially went away in that
particular Congress. What he had proposed had five major concepts to
it. One of those was the idea that folks who didn't have healthcare
coverage should be able to get their coverage in their own State--
unless they were very wealthy--and to be able to get coverage in a
large group plan. They called them exchanges or marketplaces, which
would be established in each State. If that sounds familiar, it should.
They also said that folks who were going to get their coverage who
didn't have coverage for healthcare in these 50 States would get some
help in buying down the cost of their healthcare, and they would get
that by the adoption of a sliding-scale tax credit which would buy down
the cost of premiums for low-income people. The lower their income, the
bigger the tax credit was; the higher the income, the lower the tax
credit. And finally, it phased down.
There were concerns raised by insurance companies that it would be
hard to insure folks who were going to be getting healthcare coverage
on these exchanges in each of these States because a lot of these
people hadn't had healthcare in a long time. There was an expectation
that they would have a high demand for healthcare, they would need a
lot of healthcare, and they would be a hard group to insure because
their need for healthcare was very large. The insurance companies were
fearful that the group of people in each of the States they would be
asked to insure on the exchanges would not be insurable--not in the way
in which the insurance companies could break even or make money.
This idea came along. Just to insure that we have a good mix of
healthy and maybe not-so-healthy people in the exchanges to insure in
each of the States, Senator Chafee and these folks came up with the
idea that people would be mandated to get coverage in the States--
everybody. You can't make people get coverage, but under the Chafee
plan, for folks who didn't, they would have to pay a fine, and the
fine, over time, would go up and become stiffer. So finally, people
might say: Well, I am paying all this money for no healthcare coverage.
Maybe I ought to get coverage and stop having to pay this fine. At
least I would have something for my money.
The two other things in the original legislation from Senator Chafee
and company were something called an employer mandate, the idea that
employers were mandated to provide coverage. At least employers with a
minimum number of employees would have to provide coverage--to provide
a large group plan within their business or within their employment.
That was the employer mandate in the Chafee proposal.
The other thing that was in Chafee, as I recall, was something like a
provision that said to insurance companies: You can't just stop
providing coverage for people because they have a preexisting
condition; you have to insure people.
So those are the five major precipes: No. 1, creating exchanges in
every State or marketplaces for people to get their coverage; No. 2,
sliding-scale tax credits to help drive down the costs for low-income
people for their coverage in their States; No. 3, individual mandates,
or trying to make sure the mix of people insured was actually
insurable, without the insurance companies losing an arm and a leg; No.
4, employer mandates that employers of a certain size have to provide
coverage for their employees; and, finally, the idea of knocking people
off coverage because of preexisting conditions was a no-no.
As we know, HillaryCare was not adopted, and neither was the Chafee
plan. But it turned out the Chafee plan had legs, as they say in show
business. It means it actually lasted beyond just being a bill
introduced in the Senate in 1993.
It surfaced in Massachusetts about 10 years later, thanks to Governor
Mitt Romney, who was thinking about running for President. Some of the
people advising him said: You know, Governor, you could probably help
your chances of running for President if Massachusetts could be the
first State to have universal healthcare coverage for its residents.
That sounded pretty enticing.
He said: How do we do this?
They looked up the Chafee bill. They apparently knew about it,
thought about it, and said: Let's take the Chafee proposal and do that
That is what they did. Guess what. They found that they did a pretty
good job in terms of covering more people on the coverage side. It
worked pretty well. Where it didn't work very well was on the
affordability side. As we might imagine, there were the young
invincibles--like some of these pages we have down here and their older
brothers and sisters who maybe say: I don't need healthcare coverage. I
am young and invincible. I will never get sick and go to the hospital.
They had a sliding scale. They had an individual mandate, but they
had a fine people had to pay over time. Eventually, as more years went
by, the young and healthy people said: I might as well get coverage. It
helped provide for a better mix of folks in the exchange to provide
insurance for. So they did a better job on the cost and, after a while,
When we went to work in the beginning of the Obama administration in
2009 on the Affordable Care Act, some people think Democrats just sat
down in our caucus and just rolled out a plan and said: This is what we
are going to do to provide healthcare coverage to people. That is not
what we did. We spent a lot of time trying to figure out what we should
do. We had, I want to say, dozens of hearings in the open, in public,
on the Finance Committee. I am sure they had other hearings in the
Health, Education, Labor, and Pensions Committee, which shares
jurisdiction with Finance on this subject. We had dozens of hearings.
We actually had the head of the Congressional Budget Office come and
We had a pretty good idea of what it would cost. We had a pretty good
idea of what impact it would have on the Medicare trust fund. It turned
out that the adoption of the Affordable Care Act extended the life of
the Medicare trust fund by, I think, 12 years. It actually brought down
the Federal budget deficit over the next 10 years by quite a sizeable
amount, and over the 10 years after that by even more. The idea was to
provide coverage for a lot of people who wouldn't have it--actually,
using the Chafee plan.
I think it is really ironic, sometimes almost humorous, when my
Republican friends--and they are my friends--attack the Affordable Care
Act. The piece that they attack is, I like to say, their stuff. They
are the Chafee-Romney ideas.
I studied economics at Ohio State and studied some more in business
school after the Vietnam war. I like market approaches to problems. So
I find real virtue and interest in what Chafee came up with and what
Romney put to work. Romney provided kind of a laboratory in
Massachusetts to see how that idea would work--maybe not on a national
scale but at least on a statewide scale, with a lot of people involved.
I am troubled by where we find ourselves today. During Presidential
campaigns, I know people say things in campaigns that maybe they don't
or maybe they exaggerate or something like that. But I think the
campaign might have been over and Donald Trump had been elected
President. He promised, I believe shortly thereafter, that his plan to
repeal and replace the Affordable Care Act would lower the cost of
health insurance, while providing better coverage for everyone. That is
what he said. His plan to repeal and replace the Affordable Care Act
would lower the cost of health insurance, while providing better
coverage for everyone.
I realize that the ink is barely dry on what the two House
committees--the Ways and Means Committee and the Energy and Commerce
Committee--have been working on. As best we can tell at this point in
time, the bill they reported out of the committees--and I presume they
are going to vote in the full House pretty soon, if they haven't
already--but the House Republican bill to repeal the Affordable Care
Act does just the opposite of what Donald Trump called for. It does not
lower the cost of health insurance, as best we can tell, and it doesn't
provide better coverage for everyone. The House Republican bill to
repeal the ACA does nothing to slow down the growth of healthcare
One of the great virtues of the Affordable Care Act is the focus on
value. How do we get better results, better healthcare outcomes, for
less money? If we go back to where we were 8 years ago and compare how
much we were spending in this country for healthcare as a percentage of
gross domestic product, we were spending 18 percent. One of our major
competitors in the world--a major ally but a major competitor--is
Japan. In 2009, while we were spending 18 percent of GDP, Japan was
spending 8 percent--less than half as much, 8 percent of GDP. They got
better results, and they covered everybody.
So as we were approaching the debate and eventually the markup on
voting on the Affordable Care Act, we had this in the back of our mind.
We looked around the world to see what seemed to be working to get
better results for less money, and we looked at Massachusetts to see
how that was working and what we could learn from what they called
RomneyCare up there.
But the House Republican bill to repeal the ACA does, as best we can
tell at this point in time, very little--maybe nothing--to slow the
growth of healthcare costs, and that is a shame. Apparently, fewer
people will be insured. I think Standard & Poor's estimates as many as
10 million people could lose coverage under the House Republican plan.
Insurance markets will destabilize faster. I mentioned earlier that a
great concern insurance companies had is that they would end up in each
or in a number of States with a pool of people to insure in the
exchanges that were uninsurable--the elderly, maybe the sick, people
who hadn't gotten healthcare for a long time. It is hard to insure that
group and stay in business if you are a health insurance company. There
was a concern about destabilization and instability within the markets
for health insurance.
The individual mandate is replaced by something called the continuous
coverage requirement. I would like to think it is going to work. I am
not sure it would. But under this, I understand that people who go
without a health insurance plan for more than 2 months will be charged
a 30-percent surcharge when they are able to get back on and reenroll.
People with expensive healthcare conditions will be willing to pay a
penalty. But how about healthier people who often chose to stay out of
the health insurance markets?
Also, as best we understand, in the House Republican plan, health
insurance plans will become less robust, and many Americans will only
be able to afford rather skimpy insurance plans. Preliminary estimates
of the House GOP plan shows that insurance costs for the average person
would increase by roughly $1,500. By 2020, the average person would pay
I had the privilege of representing Delaware as Governor. One of the
things I was responsible for in the treasurer's office was
administering fringe benefits for State employees and teachers and a
lot of folks. So this is something I have thought about over the
years--about healthcare coverage for people.
We have only three counties--unlike Missouri, where the Presiding
Officer is from, which has probably hundreds of counties--maybe not
that many. But we only have three. In our southernmost county, Sussex
County, we have a lot of chickens, a lot of corn, and a lot of
soybeans. We have five-star beaches. A number of people like to come to
Delaware to retire. We have no sales tax. We have very low property
taxes in Sussex County. And for people who are not making a ton of
money, we have pretty low personal income tax.
Take the example of a 60-year-old Delawarean in Sussex County who
makes $30,000 a year. Under the Affordable Care Act, they get a tax
credit. I mentioned earlier a sliding-scale tax credit. If you are
lower income, it is a bigger tax credit. If you are a higher income, it
finally fades out when your income goes up to a certain level. But for
somebody making $30,000 a year in Sussex County, under the current
law--the Affordable Care Act--the tax credit in 2020 will be about
$10,000 to help buy down the cost of their coverage.
As I understand it, under the GOP health plan, for their comparable
tax credit for the same person in Sussex County--which, quite frankly,
has a lot of people 60, 65, 70 years old who make this amount of money
down there; a lot are retired or semi-retired--the tax credit in 2020
would be $4,000. That is about $6,200 less. If you happen to be this
person, you may want to think twice about which of these two paths you
want to take.
We have another chart here that might be helpful. This is something
we got from AARP. When we are passing legislation or drafting
legislation or debating legislation, we are always interested in what
key stakeholders feel. AARP is a big stakeholder. They represent a lot
of people 50 and older. We are interested in hearing from folks who
represent seniors. AARP represents the views of a lot--not all. We are
interested in the views of those like doctors, the American Medical
Association, nurses, providers. We are interested in hearing from
hospitals. As it turns out--again, while the ink is barely dry on what
is coming out of the House of Representatives--AARP tells us they are
not very excited. Well, maybe they are excited about it, but not in a
They say the change in structure will dramatically increase premiums
for older consumers. That is what we have seen from the previous chart.
In their example, AARP tells us about a 64-year-old person who is
earning about $15,000. Their premiums go up $8,400. They are making
$15,000 a year. I don't know how they pay for much of anything else
with that kind of increase in their premium costs. That is a concern
for me and certainly a concern for the folks at AARP and the people
they represent, the millions of people they represent.
TrumpCare. The House has come up with different names. Some call it
ObamaCare light, ObamaCare 2.0 or .5. Some people call it TrumpCare.
The House is working on it. The concern we are hearing from a lot of
folks is that it forces women to pay more for basic care.
Let's go back to the care for women. My wife and I have been married
31 years. I don't know everything about healthcare needs for women, but
I do know this. A lot of women I have known--including my own family,
my sister, my mom, and my wife's family--their primary healthcare
provider is their OB/GYN. I didn't know that for a long time--not for
everybody, but for a lot of people that is who their primary care
provider is. For millions of women, surprisingly, their primary
healthcare provider happens to be an OB/GYN or healthcare provider who
works at Planned Parenthood.
For some people, Planned Parenthood is synonymous with abortions, but
I think a very small percentage of what they do relates to abortions.
What they do, for the most part, is try to make sure women get the
healthcare they need, a lot of times in the OB-GYN realm but also in
terms of contraception.
Somebody told me the other day that the cost of contraception for a
woman in a year could be as much as $1,000. It is not cheap. The cost
of a single delivery of a child from an unplanned pregnancy that is
paid for by Medicaid is over $10,000, if I am not mistaken.
A lot of times, as we know, especially if a young person brings a
the world, maybe doesn't finish high school or whatever, the outcome
can be not that good for that child. I heard Mary Wright Edelman of the
Children's Defense Fund say these words. If a 16-year-old girl becomes
pregnant, does not graduate from high school, does not marry the father
of her child, there is an 80-percent likelihood they will live in
poverty. The same 16-year-old girl who does not have a baby, finishes
high school, graduates, waits until at least 21 to have a child,
marries the father of the child, there is an 8-percent likelihood they
will live in poverty. Think about that.
That suggests to me that we should--particularly for young people and
those not so young who are sexually active--we want to make sure that
when they are ready to bring a child into the world they can do that, a
healthy child, a child with a lot of promise in their life.
For those who aren't prepared to bring that child, raise that child,
prepare that child for success, contraception is needed. One of the
things the Affordable Care Act does is provide access for that
contraception. I am fearful the plan in the House of Representatives,
however well-intentioned, will take away that opportunity for a lot of
women and frankly for their children.
We have other people who have arrived on the floor. I want to be
mindful of their time.
I don't know if we have another chart to look at before I yield.
We have all heard of double whammy. This has been described as
TrumpCare, ObamaCare light, whatever you want to call it. It has a
triple whammy. One of those is higher costs, a second is less coverage,
And for some people, particularly low- and middle-income folks, more
taxes. For certain people whose income is over one-quarter million
dollars, they get a tax break. It adds up to quite a bit for somebody
who makes a lot of money, but this is not the kind of triple whammy we
ought to be supporting.
When the bill gets over here, if it gets out of the House, we will
have a chance to slow down and hopefully do hearings in the light of
day and bring in the folks from CBO, ask them to score this, let us
know what is the real impact of what is being proposed in the House.
Does it really save money? Does it do what President-Elect Trump said
he wanted to do, which is make sure everybody gets coverage and be less
expensive. Does it really do that? And we need to find out what the
impact is on taxpayers. Is this the holy grail of better results for
less money or is this something altogether different?
The Presiding Officer, from Missouri, is somebody who is pretty good
at working across the aisle. I would like to think I am too. We have
worked together on a number of issues. When you are working on
something that is this big and this complex and has this kind of impact
on our country, we are always better off if we can somehow fashion a
bipartisan compromise and something that would have bipartisan support.
We tried to do that in the Affordable Care Act. I know my Republican
friends feel we didn't, but I was there. I know we tried. In fact, the
evidence that we tried was literally the foundation for what we do for
the Affordable Care Act, a Republican proposal from Senator Chafee and
20 other Republicans, including Orrin Hatch and including Chuck
Grassley from Iowa. I think that was a pretty good effort.
If this bill makes its way over here, we need to have at least a
strong effort, maybe a better effort, maybe a more successful effort in
If we are not going to repeal the Affordable Care Act, actually find
a way to repair it and make it better, there are things we can do. I
know I can think of some--I know the Presiding Officer can as well--
that would move us closer to better coverage at a more affordable
The last thing I would say is this. I have a Bible study group that
meets here on Thursdays with Barry Black, who opens our session with a
prayer every day that we are in session. We also have his Bible study
group that meets for about a half an hour, 45 minutes in the Capitol--
Democrats and Republicans. We pray together, share things together. I
describe it as the seven or eight of us who need the most help.
He is always reminding us of our obligation to the least of these.
There is a passage of Scripture in Matthew 25 that a lot of us have
heard of, and I am sure you have heard this in Missouri too. It says:
When I was hungry, did you feed me? When I was naked, did you clothe
me? When I was thirsty, did you get me to drink? When I was sick and
imprisoned, did you visit me? When I was a stranger in your land, did
you take me in?
It doesn't say anything about when I didn't have any healthcare
coverage and my only access to healthcare was an emergency room to a
hospital. It doesn't say that in Matthew 25. I think the implications
are clear. They are the least of these as well. They need our help, and
I think we have a moral obligation, as people of faith, to help them.
We also have a fiscal imperative because while the Federal deficit is
down from $1.4 trillion 6, 7, 8 years ago, down to about one-third of
that, it is still high. We need to make more progress on that. We have
a fiscal imperative to meet that moral imperative.
With that, I think I will call it quits. I know my colleagues will be
disappointed, but they are standing here, from all over the country,
waiting to say their piece. I am going to yield to them and wish them
all a good weekend, and I look forward to seeing you on Monday.
I yield the floor.
Before I do, I yield the remainder of my postcloture debate time to
Senator Ron Wyden of Oregon.
The PRESIDING OFFICER. The Senator has that right.
The Senator from Arkansas.
Mr. BOOZMAN. Mr. President, when President Trump began his campaign
for the White House, he made national security and, in particular,
homeland security a cornerstone of his platform. His calls to secure
the border to keep terrorists off U.S. soil and to protect our
communities struck a chord with a large majority of Americans who for
years felt that Washington ignored their very real concerns about our
porous borders and broken immigration system.
As expected, the President moved quickly to deliver on his promises
to fix this broken system. This week, the Trump administration rolled
out a revised version of this Executive order aimed at restoring
confidence in the procedures we have used to vet refugees fleeing from
nations that are known to harbor radical and violent extremists.
The revised version appears to have benefited from the engagement of
the President's Cabinet, especially the key input of Homeland Security
Secretary Kelly. This valuable input underscores how important it is
for the President to have his team in place to govern effectively.
Senate Democrats have slowed the confirmation process at every turn.
I encourage them to abandon the political games so we can quickly fill
the remaining vacancies that require Senate confirmation.
It is vital that every affected agency is engaged in these types of
decisions. That isn't possible if the Senate is failing to do its duty
to confirm the President's nominees. Congress has many problems to
tackle, but protecting our Nation is at the top of that list. That
requires we work together to govern.
It also requires we take a step back from the heated rhetoric and
have honest conversations. Taking the fundamental steps to protect our
homeland does not diminish the fact that we are a welcoming nation that
strives to help the vulnerable.
It is no secret that ISIS and other volatile extremists want to
exploit our Nation's generosity and welcoming spirit to sneak
terrorists onto American soil. This plan has worked well in Europe.
ISIS believes it can work here as well. We can, and must, take
reasonable measures to prevent that.
It is reasonable, responsible, in fact, to put a pause on accepting
refugees from these nations in order to fix the flaws in the process
and instill confidence in the system. The revised order removes Iraq
from the list of countries. That is a move in the right direction. It
shows that the Iraqis have taken the right steps in agreeing to
increase their cooperation with us, and effecting positive outcomes in
our relations with these nations is what this pause is all about.
Four of the countries on this list don't even have a U.S. Embassy. So
you can understand how difficult it is to get a complete picture of the
refugees seeking asylum from those countries when we don't even have a
means by which to communicate.
Once the President's Executive order goes into effect, every country
will be evaluated within 20 days. If a country comes up short of where
it needs to be, it will have 50 days to fix the failures and
communications with us.
The reasonable measures we are taking to reduce this threat in no way
run counter to the ideals our Nation is built upon. We can be proud of
the resources the United States has provided to support those fleeing
persecution in war-torn Syria. I have visited the refugee camps we
support in Jordan and Turkey. Our commitment to their well-being is
strong. The rhetoric doesn't match the realities when it comes to this
The administration's efforts to secure our borders has been met with
similar hyperbole. Again, there is nothing unreasonable about ensuring
that we know who is coming into our Nation. We are a nation of
immigrants and must remain welcoming to those who want to achieve the
American dream. We should be proud of our record to naturalize those
who immigrate here legally. We naturalize more new citizens per year
than the rest of the world combined. Enforcing the law, ensuring the
safety and security of our Nation, will not change our commitment to
being a welcoming society to those who seek a better life.
But you can't create policies to secure our homeland while wearing
rose-colored glasses. There are terrorists seeking to exploit our good
graces so they can attack us here at home. This is not a scare tactic;
this is reality, and we have to root our policies in reality.
As chairman of the Appropriations Homeland Security Subcommittee, I
strongly support President Trump's efforts to get Washington to uphold
our most important responsibility: protecting the American people. I
stand ready to work with him, Secretary Kelly, and my colleagues to
accomplish this goal.
I yield the floor.
The PRESIDING OFFICER. The Senator from Michigan.
Mr. PETERS. Mr. President, I rise today to express my opposition to
the confirmation of Seema Verma as Administrator of the Centers for
Medicare and Medicaid Services, known as CMS.
As CMS Administrator, Ms. Verma would oversee healthcare coverage for
more than 55 million seniors and disabled individuals in the Medicare
Program. In addition, she would be the primary authority for the
Medicaid Program, the Children's Health Insurance Program, and our
Nation's health insurance marketplace. Together, these programs cover
over 70 million Americans.
I have serious concerns that if confirmed, Ms. Verma will pursue
shortsighted changes to our healthcare system that could jeopardize
care for working families, while providing huge benefits to corporate
Ms. Verma has openly stated her desire to put insurance companies
back in charge of our healthcare by allowing insurers to deny women
maternity care coverage as an essential health benefit. She has also
expressed support for proposals that would weaken essential health
benefits that ensure coverage for mental healthcare, preventive
screenings, and comprehensive pediatric care for children. These
comprehensive services form the backbone of the healthcare system that
invests in preventive care, improving outcomes, lowering costs, and
puts consumers in charge of their own healthcare. Ms. Verma is
proposing to take us back to the days when insurance companies were in
control and when they would tell you what was best, not you or your
She has also expressed support for dangerous and radical proposals
that would change Medicare as we know it. I believe that when it comes
to Medicare, our future CMS Administrator should be doing everything he
or she can to strengthen an incredibly successful program. Ms. Verma,
instead, supports policies that reduce the quality of care and increase
costs on older Americans.
Our Nation's seniors have worked hard their entire lives. We owe them
a secure and dignified retirement. When Congress was first debating the
Affordable Care Act in 2009, I heard from seniors who had split their
pills in half or would forgo their prescriptions altogether just to put
food on their table. This is simply unacceptable in this great country
It is important to remember that the Affordable Care Act extended the
solvency of Medicare by more than a decade, while simultaneously
bringing down prescription drug costs for seniors. Because of
improvements to Medicare in the Affordable Care Act, the average senior
in Michigan saved over $1,000 on prescription drug costs in 2015.
While this shows the success the ACA has had in helping older
Americans, there is still much more work to do. We must keep moving
forward to strengthen and improve Medicare. I am concerned Ms. Verma
will move us backward.
During her confirmation hearing, she failed to express her opposition
to proposals that would increase Medicare's eligibility age. This means
that Michigan's construction workers, nurses, and autoworkers would
need to spend more years on their feet before they see the coverage
they have earned.
Ms. Verma provided no clear direction on what she will do to
strengthen the Medicare Program, and I am concerned that she sees older
Americans as just one more line on a budget. These Americans have
worked hard their entire lives, and the very last thing we should be
doing is making cuts at their expense. Instead, we should focus on
proven advances in technology that improve Medicare and cut costs
without jeopardizing care for seniors and disabled individuals.
I worked with my colleagues in Congress to introduce bipartisan
proposals that will do just that. For example, Medicare spends one out
of every three dollars on diabetes treatment. The total economic cost
of diabetes is estimated to be $245 billion every year. I have
introduced bipartisan legislation that allows Medicare to enroll
individuals at risk for developing diabetes into medical nutrition
therapy services proven to decrease the likelihood they will develop
diabetes in the first place. I have also introduced bipartisan
legislation that expands Medicare's use of telemedicine, increasing
access for patients in rural and underserved communities and bringing
down future health costs by ensuring patients get the preventive care
they need to stay healthy.
I will keep working to improve and modernize our healthcare system
without sacrificing care for the most vulnerable. Unfortunately, I do
not believe Ms. Verma shares this commitment. I am voting against Ms.
Verma's nomination because our seniors and working families deserve a
CMS Administrator who is fighting to improve their healthcare, not one
who merely sees them as a budgetary obligation.
I will oppose her confirmation, and I strongly urge my colleagues to
do the same.
Mr. President, I yield 35 minutes of my postcloture debate time to
The PRESIDING OFFICER. The Senator has that right.
Mr. PETERS. I yield the floor.
Ms. CANTWELL. Mr. President, I rise to discuss the nomination of
Seema Verma for Administrator of the Centers for Medicare and Medicaid
We have before us a nominee that would run an agency responsible for
the healthcare of more than 100 million Americans, with an annual
budget of about $1 trillion. This is the agency that administers
Medicare, Medicaid, the Children's Health Insurance Program, and health
insurance exchanges. In short, CMS is the single most consequential
agency in health care.
Yes, I am deeply concerned about this administration's ideas on
Medicare and on the individual insurance market, over both of which CMS
has profound influence, but I am most concerned about their plans for
Based on Ms. Verma's history, her actions, her statements, and her
testimony before the Senate Finance Committee, it is clear to me that
Mrs. Verma is not only complicit but is leading the charge to wage a
war on Medicaid.
Why do I say that? Let us look at Ms. Verma's record, actions, and
testimony on Medicaid. In Indiana, Ms. Verma made millions of dollars
fees by kicking poor working people off of Medicaid for failure to pay
monthly contributions similar to premiums. This plan forced people
making $10,000 a year, $5,000 a year, or even homeless people with
virtually no income to pay a monthly contribution or be penalized. As a
result of Ms. Verma's work, about 2,500 Hoosiers have been cut from
care. Evaluations of this plan by independent experts show it is
confusing to beneficiaries and has not demonstrated better results than
traditional Medicaid expansion. Meanwhile, enrollment is far lower than
During my meeting with her and in her testimony before the Senate
Finance Committee, Ms. Verma stated that Medicaid should not be an
option for able-bodied people. Ms. Verma seems to think the private
sector can serve this population on its own. Based on what we know
about the historical affordability challenges in the individual health
insurance market, I find this notion hard to believe.
My State is innovating in Medicaid through “rebalancing” from
nursing homes to home and community care, integrating behavioral health
and primary care, and adopting of innovative new waivers through
collaboration with the Federal Government. In fact, Washington State
realized more than $2.5 billion in savings over 15 years through
rebalancing efforts; yet Ms. Verma will not commit to a single delivery
system reform idea.
Ms. Verma claims Medicaid is a top-down Federal power grab. On the
contrary, Medicaid is an optional State program, with all States
participating. Every State participates because they know Medicaid is a
good strategy for covering a low-income and vulnerable population and
supporting their healthcare delivery system. Medicaid is highly
flexible right now, and States have wide latitude over eligibility,
benefits, provider reimbursements, and overall administration of their
Ms. Verma claims Medicaid produces poor outcomes, but she cannot
offer a single credible clinical outcome or quality measure that the
program is not achieving. Meanwhile, data show that patient
satisfaction in Medicaid is high and the program achieves improved
public health and clinical outcomes for its patients.
Most concerning, Ms. Verma has repeatedly endorsed the administration
and Republicans' plan to permanently cap Medicaid, which would hurt
patients, States, health providers, and local economies.
I am voting no on Seema Verma's nomination for CMS Administrator
because I cannot endorse a full-scale assault on the Medicaid Program.
Mr. RUBIO. Mr. President, Seema Verma has a proven track record of
helping States create patient-centered healthcare systems that improve
quality and access and give individuals and families more control over
their healthcare. Due to a family commitment, I was unable to
participate in the cloture vote. However, I strongly support Ms.
Verma's nomination and look forward to working with her on the many
important healthcare issues facing Florida and our country.
The PRESIDING OFFICER. The Senator from Alaska.