and we must fight. i will stand with hundreds of thousands in connecticut who will lose their insurance -- more than 220,000. i will stand with the people of connecticut who will lose billions of dollars in investment in health care. i will stand with more than 20,000 people in connecticut and a million around the country who will lose jobs, according to a study recently done by the commonwealth fund. jobs althoughs are inevitably the result -- job losses are inevitably the result at some point in the future because of gutting this program. i will stand with the people who will resist, indeed resist, this secrecy and speed that so disserves the values and betrays the ethos and traditions of this

body. thank you, mr. president. i yield the floor. a senator: plop? the presiding officer: the senator from washington. ms. cantwell: i come to the floor tonight to raise concern about a proposed senate health care bill that might move through the united states senate, as my colleagues are pointing out, without hearing, without attention to the details -- actually, almost in secret. i guess it would be secret if we didn't know exactly what was in the house bill. it would be even more secret. people have said it will be about 80% of what was in the house bill. i can agree with president trump. that was a mean bill. if it is just 80% mean, i can guarantee that you it's still going to be mean. i say that because i have been at home listening to my constituents. they do not appreciate one bit -- if you're harbor view hospital and you are going to cut $800 million out of their budget because of the cap on medicaid and you are going to leave a hospital without resources, they are mad. if you are talking about children's hospital and

children's hospital sees children who are on medicaid and they're not going to be able to see those children or get coverage, they're mad. or just like yesterday -- or actually saturday i was with veterans in vancouver, washington. people don't understand, but veterans of the united states of america do not get all their health care coverage through the v.a. they get it with medicaid at individual clinics and services. the i have met several of these people in my state, and they've told me point-blank, without access to medicaid, they would not get the benefits they need as veterans to our country. so i think it's mean to break our promise to veterans and not give them access to medicaid. and i think this whole discussion is basically the fact that we're doing this, you know -- trying to box with these guys on a proposal. if their proposal was so great, come to the senate floor and just -- don't even talk about the bill; talk about the

principles. i want to know in the republican proposal what ideas do you have to lower costs, increase the quality of care, or improve access? that's the milestones by which you should be debating health care. now, if your goal is just to cut medicaid and cut people off of medicaid and cut their benefits so you can give tax break to the rich, okay, you might -- you might convince me that, yes, you have a proposal, because i think that's exactly what your proposal is. but if your proposal is about reducing costs, then come out here and debate it. don't even tell me what's in the bill. just show up on the senate floor and debate us and say, here is our idea for reducing costs. i will tell you what my idea is, because i wrote it into the affordable care act and some states are doing it. it was a good idea. it was called give the individual who doesn't work for a big employer the ability to

negotiate with clout and be buntled up -- and be bundled up with other people. that's what they did for the working poor in new york. 650,000 people in new york are now on something called the basic plan. why? because they didn't work for an employer that could negotiate a big discount for them. but we said on our side of the aisle, why would we let poor people just get thrown on the one hand'd around in the market and not be able to -- and -- get thrown around in the market and not be able to drive a decent price? you're going to be able to drive a decent price in the marketplace. that plan is giving a family at $40,000 a year of income and four individuals in the family a yearly annual premium about $500 instead of $1,500 on the exchange. that's so that's an idea. so come out here and discuss that. come out harder and discuss that. if you want to tell me you've

figured out a wait to give better quality of care, i'd love to hear that." i'd love for you to come here and tell me how you're going to deliver better quality of care. there are great things in this bill that are about improving the way organizations deliver care so that they are rewarded for basically delivering better care. the whole idea of aaccountable care organizations are so that you put the patient at the center of the delivery system and you reward them for doing a good job of delivering better outcomes. we have innovated. we've innovated in this plan. if you're talking about access, come out and tell us what proposal do you have that's about increasing the access to health care? i'd love to hear it because in this bill we already do that, too. we said, you know what, it's kind of crazy and expensive to think that everybody who ages, particularly on a medicaid budget, should spend time in a nursing home.

why? it's more expensive cost and i don't think i've met one washingtonian that told me they really wanted to go a nursing home. they wanted to stay at home.t so we wrote into the affordable care act incentives for states to change the delivery system like we had done in the state of washington and deliver affordable care at home in their communities. so deliver community-based care. and by gosh, actually some states -- texas, arizona, indiana, other states -- took us up on it. they said what a great idea. we want to reduce costs. so if that's such a great working aspect of the affordable care act and you think it works, and it increases access to care by giving people community-based care and reduces our overall medicaid costs, come out here and talk about it. talk about what you want to do to put that program on steroids so that more people in america can benefit from better access

to care and don't think that they're going to spend their last days in a nursing home. so that's what we should be debating, but we can't even see or hear or have a hearing about what this proposal is. and yet, my colleagues can't even come out here and throw a concept on the table. but i tell you this, the fact that you want to affect over a million veterans who have fought for our country and you're going to cut them off of the medicaid care that they deserve to have access to, that is a broken promise. and it's just as broken a promise as what president trump said. president trump tweeted -- he tweeted this. he said i was the first and only g.o.p. candidate to state that there will be no cuts to social security, medicare, or medicaid. that's what he said. so i'm not surprised he calls it a mean budget, but he should also own up that it also cuts medicaid. now we all have an office budget

here. i sigh me colleague from virginia -- i see my colleague from virginia here. if we took our office budget and said we're going to cut it and cap it and next year it's going to be lower and next year it's going to be lower and next year it's going to be lower and next year -- in perpetuity. that's what their idea is, is to put a cap on medicaid and cut it in perpetuity and basically cut it out of existence. i don't know why they're beating up on medicaid, because medicaid has provided great stability to so many people in our country. they've lifted people out of poverty, provided health care, stabilized communities and raised the economic standard of living in great places in our country. i received a letter from a superintendent from the vancouver school district. he wrote to me about the devastating impacts that capping medicaid would have on his students. he wrote our school based medicaid program serves as a lifeline to children who can't

access critical health care services outside of their school. he goes on to say restructuring it to per capita would undermine our public school's ability to provide for the neediest children access to vital health care insurance. so why would we do this? as i mentioned, i mentioned -- met a veteran, christina. she's 46 years old and she's also a full-time student. she suffered from chronic and disabling physical injuries and needs a high level of care. but the care she gets from medicaid helps her access the medication that meantions her chronic -- manages her chronic care and keeps her going and is working towards that degree. why would we cut somebody like that, a veteran off of medicaid just because someone's idea over here is to cap and reduce medicaid. so these stories are all over the country, and people are wondering why would you take this level of investment in

medicaid out of our entire economic system. why would you impact our school districts, our regional hospitals, our veterans, our medicaid population? why would you affect a community that has a large medicaid base and that is the way they serve them? our hospitals have told them we have stabilized the increase in health care costs because more of the population was covered and had access to medicaid. you rip that back and we will be back to skyrocketing costs with people in the emergency room, no access to care other than that facility with impacts to everybody on private insurance and on medicaid. so it's just not a good idea. so i ask my colleagues, come out here, don't say you won a patient-centered health care deliver system because we're all for that. and we actually put things in the affordable care act that did that and are working.

so if you want to make that claim, come out here and say what is it that you don't like about the patient-centered delivery system that's here and how you want to change it. if you say your proposal increases access to americans, let's hear it. if it's about better quality. but i don't hear any of that. i just hear a dprumbeat by -- a drumbeat by some people who want to be heartless and cut people who have access to health care, people who are less fortunate in our society because you want to cut medicaid. the president promised he wasn't going to do that. i would ask my colleagues to live up to that and let's start talking about the substance that truly will increase access, lower costs, and give better care to our constituents and the people of the united states of america. i thank the president, and i yield the floor. a senator: mr. president. the presiding officer: the senator from virginia. mr. kaine: mr. president, i also rise to talk about the being h of every american. this is critically important to every person and every family in

this country. it's critically important to every local, state, and federal budget in this country. and it's also critical to the economic productivety of our nation. the house barely, in a purely partisan move, passed a bill that would take health insurance away from 23 million american people over the next ten years. dramatically increase premiums to seniors, jeopardized coverage of people with preexisting conditions and imposed huge burdens on states. one of the reasons the house bill was so bad, condemned even by president trump who labeled it mean, was because it flowed from a bad process. the house held no hearings on the final bill. there was not meaningful testimony from patients or health care providers. they did not accept any amendments from democrats. and they rushed the bill through

to vote before the congressional budget office could score the bill. so no wonder, no wonder that the house bill is opposed by the american medical association, the aarp, nurses, hospitals, patient organizations, democratic and republican governors. and yet, the senate is poised to make exactly the same mistake, preparing a secret bill with no testimony, no public scrutiny, no opportunity for meaningful amendments, no opportunity for democrats to participate. we have the opportunity to get this right, and we have the responsibility to get this right. there's so many problems with the house bill. as a member of the help committee, i went on friday to the culpepper free clinic about 75 miles from here to talk about the need for reimprovement in our health care system. not a repeal that would hurt vulnerable people.

and at this clinic which is celebrating its 25th year i saw dedicated staffers and volunteers and i talked to patients. and i talked to them about how this organization has provided passion and care to working people in this region of northern virginia who don't have health insurance. the fact that virginia has refused to expand medicaid is one of the reasons that the need for their care is so significant, fully 70% of the free clinic patients in virginia would be eligible for medicaid if the state would just join the 35 other states that have expanded medicaid. and what i heard at the culpepper free clinic is this, they're already bursting at the seams because we have an expanded medicaid. if there are additional cuts to medicaid it would overwhelm the ability of the 60 free clinics in virginia to provide compassionate care. just a few hours ago, earlier today i went to albamarle county

near charlottesville and had a round table discussion with educators, families and children's advocates to highlight another key problem with the republican approach. by dramatically cutting medicaid, who is the most likely victim? children. the most numerous victims of medicaid cuts are children. in virginia and nationally, nearly 60% of the recipients of medicaid are kids. and yet, the president, through the trumpcare bill, and the president's submitted budget proposes to cut medicaid by $1.3 trillion over the next ten years. $1.3 trillion over the next ten years. and this deeply frightens the parents and educators and kids i talked to today. i heard from parents of kids with cerebral palsy and autism, whose kids are receiving support

through medicaid to buy a wheelchair or get services so that they can learn to adjust with autism. and this will help them grow into adults who have a chance of living independently. these parents had heartbreaking stories, often telling me -- and this is a quote -- i had no idea of the challenges of parenting a disabled child until i had one myself. they view medicaid as absolutely critical to their children's educational and life success. they talked about the current shortfalls in the medicaid funding that lead their kids to be put on waiting list for services. one mom with a child has been on a waiting list for a developmental disability waiver. and i asked her what have they told you about the waiting list? and this was her quote: they have told me my child will die before he is off the waiting list. and that's under the current program before you cut $1.3 out

of it. i heard from school administrators who talked about the importance of medicaid funding for their programs that serve students. special ed teachers worried about the effect on their work if medicaid is slashed. local superintendents and school board members talked about the difficult challenges of funding their school budgets if medicaid funding is cut. they post it as a difficult choice. if the feds cut $1.3 million out of medicaid, do they reduce funding for students with disabilities or do they take local funds away from other important programs to back stop those programs? or do they have to raise their own state and local taxes to make up for the federal cuts? i heard from child service advocates today who would see their programs slashed if medicaid is cut. here's an example: many of them serve court-involved young people. not kids charged with crimes, but kids who are in court because of difficult home lives and challenging situations with

their parents or guardian. and they're in danger of being pushed into the foster care system or into institutions because of problems at home. medicaid pays for support services to help stabilize their family lives. if these services are reduced and more children get institutionalized, how does that help anyone? how does it help these kids? how does it help society? how does it help our budget? it's much more expensive to put a child in a group home or institution than to provide a few hours of medicaid services in their homes once a week. the 60% of virginia medicaid recipients who are children and the parents and teachers and nurses and others who worry about them and help them don't see this as a partisan issue. it's fundamentally an issue of compassion. we will and should be judged by how we treat our children. why slash funds that are used to

help our kids? is it really important to cut medicaid by $1.3 trillion, hurting millions of children so we can get a few adults a $900 billion tax cut? we had a budget hearing recently. i'm on the budget committee. with the o.m.b. director mulvaney. this was just within the last two weeks. and director mulvaney tried to reassure us in his opening statement that the medicaid cuts were really about doing people a favor. about doing people a favor. he testified, and i quote, we're no longer going to measure compassion by the number of programs or the numbers of people on programs like medicaid. we're going to measure compassion by the number of people we get off these programs and back in charge of their own lives. i want to repeat that. prt president's chief budget official. we're going to measure compassion by the number of

people we get off these programs and back in charge of their own lives. what a cruel thought. that reads like something that a villain in a novel by charles dickens would say. but that is the philosophy of this administration and this effort. so what we now tell a kid who loses the wheelchair that is partly paid for by medicaid, you're now back in charge of your own life. would we tell a single mom whose child is receiving services to help with autism but now loses access to these services, hey, guess what? you're back in charge of your own life. would we tell a teenager in a broken home whose medicaid services are the only difference between staying in the community and putting in an institution, guess what? you're now back in charge of your own life. and since medicaid also provides funding for our parents and grandparents, who can no longer

care for themselves and have to be cared in nursing homes, will we go to those seniors who lose places in nursing homes and say guess what? now you're back in charge of your own life. slashing medicaid isn't about putting anybody back in charge of their own life. medicaid enables kids to go to school and succeed. medicaid enables disabled people to function well enough to go to work and pay taxes. medicaid enables seniors to receive compassionate care when they can't care for themselves, and cutting medicaid jeopardizes the ability of people to live with independence and dignity. no folks, let's not kid ourselves. this is not an effort to empower anybody. it's about casting them aside because they are too young or too old or too sick or too poor, and it's about giving a tax break to some people with the very funds we are taking away

from the most vulnerable members of our society. that's why i oppose this mean effort by the majority to secretly craft a bill to repeal the a.c.a. we could improve health care if we work together. let the finance and the health committees discuss any bill, hear from patients and providers, allow amendments and debates before rushing anything to a vote that would so cruelly affect the lives of millions and millions of people. and with that, mr. president, i yield the floor. ms. warren: mr. president. the presiding officer: the senator from massachusetts. ms. warren: i get letters and e-mails every day from families begging me not to let republicans in congress tear up health care in this country. and people aren't writing because they find themselves with lots of extra time on their hands. they are not writing because they are professional activists or political organizers. they are not writing because

they like writing letters and e-mails. they're writing because they're scared. they set aside all the other things they need to do in their days. the sink full of dishes, the load of laundry, the overflowing inbox, and they steal some time to write these letters. they write these letters because they are terrified, terrified down to their bones, that if they don't speak out, their family is going to lose their health care coverage, their children will be shut out from care, their elderly parents will lose the assistance they need to pay for nursing home care, their own insurance costs will be going up, their financial security could be hanging by a thread. a lot of people write letters and send e-mails, a lot of people make calls, too. every week since the republicans started their cruel effort to take away health care from tens of millions of people in this country, my office has been

getting phone calls from worried constituents, but last week, something changed. we went from our regular quota of calls about this terrible republican health care bill to an avalanche of voicemails and phones ringing off the hook. since last week, i have gotten more than a thousand phone calls from people who are pleading with me to do whatever i can to stop republicans who are going forward with their brutal plans. people are literally in tears on the phone. they are scared and they are angry, and they are calling because they know that 13 senate republicans, 13 men are locked away in a secret room behind closed doors, writing a secret plan to trade their health insurance for tax cuts that will go to the wealthiest americans in this country. the bill the republicans are negotiating behind closed doors isn't a health care bill.

it's a tax cut for billionaires bill, and it's paid for by cutting health care for tens of millions of other americans. the republican health care bill has $663 billion in tax cuts in it. $663 billion in tax cuts for the richest people in this country and for wealthy corporations, tax cuts that would blow a giant hole in the american budget. but the republicans didn't let that slow them down. they kept their eye on the prize, for the republicans, the most important thing about this health care bill is tax cuts for the rich. so they decided to cut medicaid by $834 billion in the same bill so they can pay for their tax cuts. you know, this is straight-up

trade. the senate republicans say that americans should cut health insurance for little babies or for seniors in nursing homes or from people getting treatment for opioid addiction, all so that millionaires and billionaires can get their tax cuts. that's not a health care bill. that's a statement of values, and it says that tax cuts for a handful of millionaires and billionaires are more important than health care for millions of hardworking americans and their families. there's only one word for what the senate republicans are doing with this bill -- shameful. it is shameful. the republicans negotiate in secret behind closed doors, they refuse to allow anyone to see the bill, they won't tell anyone what's in it. more mccaskill asked chairman hatch on the finance committee if he would hold a hearing on the bill, and he said no. senator murray asked chairman

alexander on the health committee if he would hold a hearing on the bill, and he said no, no plans to do so. no hearings, no reviews, no public look at what the republicans are up to. what's going on here? i'll tell you what's going on. senate republicans don't dare let the people back home see this bill. they don't dare let voters see this bill. instead, they have decided to try to ram this bill through with no hearings, no public discussion, and get it signed into law. they hope that once that's done, people won't see much point in learning about the details and holding republicans accountable. they hope that if they can do a quick vote, everyone else will just give up. well, i've got news for senate republicans. that's not going to happen. senate republicans may not want to hear from families who are worried about losing their

insurance coverage in the middle of a battle with breast cancer. they may not have time for stories about premature babies who need medicaid so they can get lifesaving care. and maybe they don't want to hear about grandparents with alzheimer's who could get kicked out of nursing homes. senate republicans may not want to hear from these people, but i have a message for these senate republicans. we don't care how long we have to stand up here. we don't care how many times you try to dodge the question about what's in your secret health care bill. democrats are here to keep demanding that you show us this bill, and we're going to keep insisting that you account for its shameful contents. i know, you would prefer to take the phone off the hook so you don't have to hear it ring, and i know you would like to pretend that there aren't families in your state that would be hurt by this bill, but i'm going to take

some time to read you just a handful of the letters i have been receiving about exactly what is at stake in this debate about health care. these families deserve to be heard. a few months ago, i received a letter from jenny in worthington, massachusetts. she wrote to me about how she and her husband got good health care coverage through the affordable care act. and how medicaid was there when they needed it most when jenny was diagnosed with breast cancer. a few days after president trump's inauguration, jenny's son liam wrote a letter to the president. liam asked president trump not to take away his mother's health care. i don't know if president trump ever read that letter, but i'm going to read it right now into the congressional record. dear president trump, my name is liam berry, and i am 10 years old. my mother has been very ill. thanks to the a.c.a., my mother has been able to have the care and medication she needs.

if you repeal the a.c.a., my mother will not be able to get the care she needs. i know there are millions of kids in the same situation as me. please think of them when you read this. sincerely, liam berry. thank you for speaking out, liam. we are fighting for your mom and we are fighting for you. christine from cambridge also wrote to me about her fight against cancer. she wrote i ask that you and fellow senators please fight for the affordable care act. i am a cancer survivor. when i was 28 years old, i got the news no one ever wants to hear -- you have cancer. luckily for me, i had a job that had wonderful insurance, and i was able to get medication, surgeries and treatment to win the fight and not to go broke doing so. however, i know many young people and old people and children who would not be here today if it was not for the

a.c.a. i know people who are still fighting their battles with cancer. they are frightened and losing hope, not because of cancer but because they don't know whether they will be able to continue to get treatments necessary to stay in this fight. i am now 30 years old, and i have my whole life in front of me. because of what president trump is proposing, i am now afraid that if i lose my job or if i wish to change jobs, i might not be able to get the necessary coverage because i no longer qualify. i really didn't think this is what i would be worried about two years ago after having been through eight rounds of chemo, 20 rounds of radiation and surgery to clear me of this disease. please, i ask that you fight for us, fight for those who are in the chemo chair right now at this very moment who are miserable, bald and bloated. fight for the cancer warrior who

is now trying with worry because she doesn't know come a month from now if she will be able to continue to receive the lifesaving treatment she is entitled to. that's why we're here tonight. we are fighting for you, christine. we are in this fight. and thank you for speaking out about your own fight against cancer and for others who are currently battling cancer and worried about the future of their health care. i also heard from sara who lives in shrewsbury, massachusetts, and who wrote to me about her concerns that the republican health care bill would endanger coverage of birth control and access to services at planned parenthood. sara wrote me this past weekend while i was out dancing in the boston pride parade. as i type this, you are at boston pride, which i would have loved to be there to support my friends, but due to my endometriosis pain, here i sit. i am extremely concerned about

the g.o.p. plan to reduce or strip away insurance coverage for birth control. as a 21-year-old woman suffering from endometriosis, a very common disease among young women, i know firsthand that birth control does more than just prevent pregnancy. in fact, for many, it is the only treatment for them. in ten days, i will be undergoing endometriosis surgery, and for the past six months, since i have been diagnosed until the surgery, birth control was the only thing enabling me to stand up straight most days. even while taking oral contraceptives, there were many days i was unable to get out of bed, today being one of them. i am so lucky to have access to an amazing endo specialist at brigham and women's hospital and to have access to the medication and surgery that i need, but every time i groan about having to go to an appointment, i think about how many women are suffering from the same

debilitating pain but without the resources to overcome it. many women rely on planned parenthood, not just for abortions but to provide them with the medicine that will enable them to stand up straight in spite of the pain they deal with every day. endometriosis doesn't discriminate, and it isn't be cured, only treated. until endometriosis becomes a prominent focus of medical research, which i feel it should be, we must protect the right to be treated for it, which means protecting insurance coverage of birth control and protecting planned parenthood. i know that you are a warrior for women's rights, and i know you are the patron saint of planned parenthood. i know these are issues you fight for, and i cannot even begin to thank you enough for all you have done thus far. i hope that by adding my voice and my personal story, i can fuel your fire and somehow be a small part in protecting my fellow females and my fellow endometriosis sufferers. that's one in ten women in the

u.s. thank you for fighting for us. thank you from the bottom of my heart. and sara, thank you for writing, and thank you for fighting. we're going to fight to save your coverage, and next year i expect you -- to see you on the parade route at pride. i also heard from dr. hemmel sumper, who is doctor at m.g.h. hospital. he wrote in with his personal story, and i want to read parts of his letter. i actually grew up in a low-income family myself. my fairnts emigrated to the u.s. my mother is brilliant but had only a seventh grade education because my grandfather couldn't afford to send her to school. my father is college educated but struggled frequently with unemployment. my older brother has multiple disabilities. he's blind and brain damaged from stroke during childhood, epileptic, intellectually disabled and has a transplanted kidney. i am fortunate enough to have

been healthy my entire life. for most of my life, my family was on medicaid, as well as other forms of public assistance. my brother additionally, due to his kidney disease, got medicare as well, but medicaid was always his secondary insurance. he sees multiple different specialists and has done very well over these years. in spite of us having multiple financial struggles we never had to worry about his health care being paid for his transplant from childhood lasted 19 years and then about ten years ago he was transplanted again and has done well with that. my parents still live in the same house i grew up in. right now they're cared for by medicare and medicaid. my brother lives with him, receives s.s.i. archgdz his health needs are met by medicare and medicaid. all those none of these chronic medical conditions can be cured, they're all well taken care of. in the meantime i grew up healthy, was able to attend

georgetown through need-based financial aid and was able to get into medical school at the university of maryland and pay for it using federal student loans which i'm repaying through the public service loan forgiveness program. got into a dual specialty residency of internal medicine and pediatrics at penn state and i'm now working at harvard and m.g.h. my family struggled. goes to show that medicaid is about helping families that struggle, about helping children with complex medical needs, and about how providing for good health care of a family can achieve positive outcomes for the long-term future. today dr. sumput works at harvard and m.g.h. he makes sure his patients on medicaid get excellent care and he told me about one of his patients who came into urgent care in chelsea. this little girl wasn't 2 years old yet and she was freezing and had a fever. here's what the doctor said. this child and her mother were on medicaid through mass health.

as i asked questions, i found out more about this mother. she was working two to three jobs in order to make ends meet. her daughter was in day care during the day and then the grandmother took care of the little girl most evenings. this mother took care of her daughter on the rare days she had off and clearly loved and care for her daughter. this girl's wheezing were probably some of the early signs of what would become asthma. her mother has asthma and it runs in the family. asthma is a completely controllable illness with medication but it requires monitoring by a doctor and access to medication. because the child has medicaid, i feel much more confident in spite of how much the mother is struggling financially that this child has a good shot at growing up healthy. without medicaid this child could live a life in poor health from a treatable condition. these are some of the people, the senate republicans want to

kick to the curb so they can deliver a big tax cut for millionaires and billionaires. a 10-year-old kid with a sick mom, a cancer survivor, a woman with endometriosis, a boy kept healthy by medicaid so he could grow up to become a doctor at one of the best hospitals in this country and help a little girl with asthma. senate republicans are willing to tear away health insurance from these families, to deliver tax cuts for their buddies. but we're not going to let that happen. we can't let that happen. you're fighting back. we're fighting back. and we will keep right on fighting. mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from pennsylvania. mr. casey: thank you, mr. president. i will start tonight with one of the questions that we have and

this will be a procedural question so i want to alert the chair that i'm going to pose this question initially before i make my remarks about the debate we're having on health care. is the chair able to confirm that the committee on finance considered s. 1796, the america's healthy future act which was ultimately incorporated into h.r. 3590, the patient protection and affordable care act in executive session on eight separate calendar days prior to reporting the bill favorably? the presiding officer: the secretary of the senate's office through the senate library confirms that. mr. casey: thank you. mr. president, i rise tonight to provide some context about what is at stake for children in the

united states with regard to the debate we're having on health care and in particular what would happen, some of the adverse impacts on children with disabilities. i'll start with the broad view, but i think it's important to frame our discussion -- sometimes our debate on health care comes down to a discussion of big numbers, how many people will be impacted. for example, the congressional budget office told us that 23 million people would lose their health care coverage over the course of a decade if the house bill were to become law. so 23 million people ripped away -- health care coverage ripped away from 23 million people. or we hear about the impact on the deficit one way or the other. or we hear about broad numbers. but probably the best way to think about the impact of these policies, if the house bill were

to become the law or some version of it because of what a few -- a small number, a few senate republicans are working on it right now. maybe a better way is in terms of a couple of individual, children. i'll give you two examples for now. angelica and rowan, two different children, two different stories. we received a letter in the last couple of -- in the near term -- i'm sorry. angelica is the parent. i should have said amaya, amaya. she's the child her mom wrote us about. but her mom is angelica. and she wrote to us and said i'm writing to you because i'm appalled by all that's happening, and i'm -- i have an amazing story about my daughter amaya. she was basically born with no bones and she received a miracle

drug that regrew her bones. she will have to take this medicine for the rest of her life but the fact that she is doing so amazing has to do with all of the help she received from medicaid. she's the youngest patient in the united states to take the drug. she's the youngest -- the youngest patient to take the drug, but i don't only want to talk about her. but i'm concerned about the future as well. and she then says, i'm looking forward to hearing from you. so says angelica. and then later on she talks about what happened in her case to her child. she says, she decided with a counselor to check with the allegheny county officials about whether or not medicaid

expansion would cover amaya's treatment. and she said they made an inquiry. then she said by the next day, i'm quoting from the letter, by the next day someone from the state had called me and later that week her treatment was approved. thanks to the medicaid expansion, my daughter receives her life-saving treatment. unquote. so i make that reference to one letter about one child, amaya. and then of course so many other letters -- i'll just highlight one that i received months ago now from pam simpson. she's from coatsville, pennsylvania, southeastern pennsylvania just in the -- just outside of the city of philadelphia. and so now you're talking about rowan in southeastern pennsylvania and amaya in southwestern pennsylvania, two

corners of the state, two children facing challenges that most of us can't even imagine. but in this case pam simpson wrote to me about her son rowan and talked about his life before a diagnosis of autism. and before he was getting the help that he's getting now. pam talked about all of the challenges that she and families like her face. she talked about the fact that he was having all kinds of difficulties but then they finally got the word that rowan would be covered by medical assistance. that's the pennsylvania version of medicaid at the state level. she said she applied in january of 2016 and after she got -- after pam got the word that rowan would be enrolled, she said, quote, we were able to

obtain wraparound services which included a behavioral health -- i'm sorry -- behavioral specialist consultant so-called b.s.c., and a therapeutic staff support worker. the wraparound services have been a godsend, unquote, referring to the services provided to her son rowan. then she goes on later in the letter and says without medicaid, i am confident that i could not work full-time to support our family. we would be bankrupt or my son would go without the therapies he sincerely needs. and here's how pam concludes her letter. she says, please think of my dear rowan and his happy face, big blue eyes and his lovely strawberry blond hair. please think of me and my husband working every day to support our family. please think of my 9-month-old daughter luna. and i'll stop there just to explain. we're talking about rowan who is a couple of years older.

the reference here is to his younger daughter -- to his younger sister luna. just continuing with the letter, please think of my 9-month-old daughter luna who smiles and laughs at her brother daily. she will have to care for rowan later in her life when we are gone. overall we are desperately in need of rowan's medical assistance and would be devastated if we lost these benefits, unquote. that's what pam simpson wrote to me months ago. and after referring to her story and rowan's story over the last couple of months, i finally had the chance to meet her and to metro wan and to meet his -- meet rowan and to meet his dad and his sister luna. so i met this family, four people in a family. met them on friday. and it's one thing to read about and to get a sense of what a family is up against every day and it's another thing to meet them. right now that family, the

simpson family, has what they need for rowan. it doesn't mean they don't have challenges. don't mean it won't be difficult in the years ahead. but they have the benefit of medicaid right now. medical assistance as we call it in pennsylvania. so rowan now because he has autism is -- has the benefit of those behavioral specialists and those assistants. in fact, there was a person with him the day i met them to work with rowan every day. so parents can work and have the peace of mind to know that they can go to work and they can raise their family with the benefit of the kind of health care that every child should have. so some might say well, you know what? if the republicans get their way on this bill, maybe the medicaid provisions won't apply to rowan. maybe he'll be protected. or maybe in allegheny county,

amaya, maybe she'll be protected. maybe it won't reach that far. maybe when the congressional budget office -- and i'll read directly from that, page 17 of the report by the congressional budget office analyzing the house bill when it says, quote, medicaid enrollment will be lower throughout the coming decade culminating in 14 million fewer medicaid enrollees by 2026, a reduction of 17% relative to the number under current law, unquote. that's what the congressional budget office says about the impact of the house bill on medicaid. 14 million people lose their medicaid. so some might say well, you know what? let's assume for purposes of this argument that those two children that we just spoke about might be protected from those cuts. we don't know that, of course,

and they can't guarantee that. because w what they're doing whn they go a the these medicaid provisions is take away the guarantees that we been there for 50 years, okay. and over time eliminating the medicaid expansion. that's what we expect to happen. that's certainly what the house bill did. but let's assume for the sake of argument that they could come in here and make an ironclad guarantee that those two children, rowan and amaya, won't be affected. you no he what? that's not good enough. that's not good enough because there are a lot of other children who will be affected, children who might have a disability. 60% of kids with disabilities are enrolled in medicaid. we know that. we know that -- we know that millions of other children who come from low-income families

get the benefit of medicaid. we know that a lot of seniors depend upon medicaid to get into a nursing home. but no family that has a child who benefits from medicaid, who has a disability, no family should have to worry for 15 minutes that what would happen in this chamber because a small group of republican senators are meeting in secret, and they're supposed to produce a bill that we're all supposed to consider in a short time frame. no product of that secret process should in any way give any parent that has a child with a disability any concern at all that that benefit will be taken away. that's not who we are as a country. we're america. we take care of people that need those kinds of services, that kind of benefit. so if a child like rowan, who is receiving the benefits of

medicaid today because of his disability, if a child like that is receiving those services today, we should guarantee that he will receive those benefits for as long as he needs those benefits, even if it goes the length and breadth of his life. we should guarantee that. take it off the table so that family doesn't have to worry. that, i hope, would be the result of this process undertaken by a small group of republican senators. and i've been waiting to hear that, waiting to hear whether or not they will guarantee that to that child, to give that family some peace of mind with all the challenges they have, even with medicaid, even with the great support that they get. it's not easy. it's a very difficult life that many families lead when they

have a child with a disability. but we should do everything we can to make sure that if a child with a disability debaters -- disability, one category of people that benefit, any child with a disability with medicaid should have that protection for as long as they need it. and i'll be waiting to hear that from our colleagues when they finally emerge from this secretive process with a bill. so i hope, i hope that's what they're working on in their meetings, because we know that it affects a lot of children. as i said before, medicaid covers 60% of all children with disabilities ranging from autism, like rowan, to traumatic brain injuries. we know that children on medicaid receive what many consider the gold standard for children's health care, early and periodic screening, diagnosis and treatment

benefits, so-called epsdt. so they get the screenings they need, so they can get preventive health care when they need it. so all of these protections should be not just a goal, should be guaranteed for those children. so i'm hoping that our friends who are working on this right now would consider rowan and amaya and children like that. and we'll come back to it later. we'll have other stories to tell about children and what they're up against. but i'm -- on a night like tonight i'm thinking about those children and worried about some of the headlines we're seeing on some analysis. and i'll wrap up with this, mr. president. the center for american progress report dated may of 2017, quote, cuts to medicaid would harm young children with disabilities.

that's one report. another report for the center on budget and policy priorities, may 18, 2017, medicaid cuts in house a.c.a. reveals bill will limit the availability of home and community-based services. that's another headline and we won't get into the details of those reports now. so we have a lot to work on here to make sure that nothing that happens in this process will rip away health care for children with disabilities. mr. president, with that i would yield the floor. mr. merkley: mr. president, i commend my colleague from pennsylvania who is putting forth our values and that is every child in america should have access to health care. and no one in this chamber should vote in a process or for a bill that eviscerates that coverage. in fact, our values that no one in america, including our adults, including our older americans, including our seniors, and including our children for sure, everyone

should have access to affordable care act. and never have the stress of being worried that if their loved one gets sick, that they might not receive the care they need. never have the stress of concern that their family member might go bankrupt because they need medical care. it's that value that we're here tonight fighting for and it's that value that the republican bill will destroy, whipping away health care from millions of americans. so we come here tonight with a battle cry, and that cry is no hearing, no vote. no hearing, no vote. we are a democratic republic. we are a legislative chamber. have members of this chamber forgotten that we are a we, the people form of government, where the people are in charge.

the people are not in charge if a secret 13 group of senators is hiding in the basement crafting a bill to rip health care away from millions of people. the people are not in charge if they're afraid to show their bill to everyday americans. they're not in charge if they're planning to destroy health care so those with preexisting conditions can't gain access to care. never have we seen a group in the majority so against the fundamental principles of our democratic republic, so against the we, the people vision of our constitution. and that's why we're calling on them to stop, rethink, remember, absorb the values embedded in our beautiful we, the people constitution. they want no public disclosure. fear of how the public will respond. they want no committee hearings.

fear of how the people of america will respond. they want no committee amendments because that will take time in which the people can see what's going on and respond. and they want no substantial floor consideration in order to shove this through so they can go then celebrate the 4th of july with their constituents while having eviscerated the constitution of the united states in the process of attending that gathering, that 4th of july gathering. this has been called the vampire bill, the republican vampire bill. why? because the writers of it, the secret 13 writers, they're afraid for the bill to see the light of day. it's hiding in the darkness. and it's called the vampire bill because its general intent is to suck the life out of the health care system for struggling families, suck the life out of

the health care system for working families and for middle-class families. now this is quite different than the consideration bhe -- when we created the system that we have now back in 2009. in that year, in the help committee, health, education, labor, and pensions committee, 47 hearings, round tables and walkthroughs, a markup that went for more than a month, the longest markup in that committee in the history of the united states of america, a markup that considered over 300 amendments. a markup is in fact a group of senators, bipartisan, sitting around the table with the television cameras rolling while they debated those amendments, voted on those amendments. and in that committee, they accepted or approved by vote more than 100 minority amendments. and then there's the finance committee which held 53 hearings and round tables.

in fact, the minutes of the round table are available, and if you want to print them out and read them, they go for 800 pages. just the round table minutes. and then they had their own finance committee markup where they considered 135 amendments. and then the bill came to the floor december of 2009. 25 days of debate on the floor. well, let's compare that to the plan of the majority leader and the secret 13. well, how many hearings do they want? they want zero in the health committee. how many hearings do they want in the finance committee? they want zero. how many democratic amendments do they want to consider, or republican amendments in the health or finance committee? the answer is zero. and how much floor time do they want to have? they want to have just one day. just one day. introduce it as an amendment to

the house trumpcare bill and pass it on the same day. and how many days do they want for experts to be able to weigh in on a health care system? zero. but here is the most important zero of all. how much time do they want for the american citizens to be able to see this bill and respond to this bill? they want zero time. that is completely against all the premises of our responsibility as legislators. it's against all the fundamental vision of a body that will deliberate and debate and take into account the opinions of a people and the insights of the experts. well, we can turn the clock back not so long ago to the majority leader who said, and i quote, fast-tracking a major legislative overhaul such as health care without the benefit of a full and transparent debate does a disservice to the

american people. that was majority leader mitch mcconnell speaking not so long ago. and what happened to that value? now that was being said when we had 25 days of debate here on the floor, when we had over 100 minority amendments, that is republican amendments accepted, when we had a lengthy debate in the finance committee and health care committee. but the majority leader wanted more time. but here he is today leading the effort to have zero input from the american public. zero input from health care experts. zero committee deliberation. zero bipartisan discussion of the pros and cons. well, we can turn to paul ryan. what did he think back in 2009? and he said congress is moving fast to rush through a health

care overhaul that lacks the key ingredient, the full participation of you, the american people. and he went on to write, congress and the white house have focused their public efforts on platitudes and press conferences, while the substance of details have remained behind closed doors. it's kind of a rewriting in history even if at that moment in time when he said that, when there was a record-setting debate in the health committee, the second longest debate in history in the finance committee. television cameras running the whole time. 100 republican amendments adopted. more than 100 meetings rand walk throughs and round tables and committee meetings and 25 days on the floor. but paul ryan said what it was lacking was full participation of you, the american people.

well, if it was lacking in 2009 , what do we say about this? when the majority deliberately wants to exclude the american people or the american people are standing at the door and they're standing at the windows and leaning in and saying what's in this bill? we want to have a say because it's so important to our families, and the republican is slamming the door. and they're shuttering the windows and saying we will not share one word with you because we know you won't like what we're doing. that is not the way democracy is supposed to work. aaron from portland wrote, because she has been diagnosed with diabetes and is terrified if the republican plan goes into effect and she won't be able to afford coverage because of her preexisting condition. and jeannet from portland wrote -- she's in her 60's and

desperately waiting to turn 65 and qualify for medicare. she's on the oregon health plan and terrified she'll lose that plan before she qualifies for medicare. and the list goes on and on and on. this weekend i was out conducting town hall meetings in four different counties of my 36 counties. i go to every county every year. and these four counties are counties that voted, i'm sorry to say, overwhelmingly against me when i ran for the u.s. senate and overwhelmingly against me when i ran for reelection. they are red counties. they are republican counties. and folks came out to my town halls this weekend, and they said one message to our republican leadership in the senate. we, the american people, demand the chance to participate in this debate. it so profoundly affects our quality of life. so i carry their messages from klamath county and lake county.

i carry their messages from grant county to the republican majority. listen to the american people. listen to rural america. listen to the families that will be devastated by the plan you're concocting with the secret 13. it is not right. it is not moral. in fact, we need to work together to improve health care, not to devastate it. thank you, mr. president. ms. klobuchar: mr. president? the presiding officer: the senator from minnesota. ms. klobuchar: mr. president, i rise today to join my colleagues to speak out and ask for a normal process here, to ask for hearings, to ask for a debate, to ask for amendments because the house health care repeal bill is a major step backwards throwing over 20

million people off of health insurance, strongly opposed by aarp. we don't know what is being concocted here in the senate, but clearly something is going on, and we would like to have a say. and, most importantly, the people of my state would like to have a say. look at laura from north st. paul who wrote to me about her concerns about that bad house. laura has recently retired but won'ting eligible for medicare until next year, and she has a daughter with several chronic health conditions. laura is worried that if the proposal goes through this chamber, she will end up paying far more for her health insurance and her daughter might lose her coverage altogether. like so many others, laura asked that we work across the aisle to make improvements to the bill that her family needs and that foam families across the -- and that so many families across the

country need. or take mike in grand marier, up in the tip of our state, not too far from canada. there in canada, mike knows the kind of they can they have across the border. he knows what the prices are for the prescription drugs. but here in america, that house health care bill, it doesn't do mig to bring down the cost of -- it doesn't do anything to bring down the cost of prescription drugs. mike has been self-employed his whole life and is now approaching retirement. he told me he is very worried that just as he is about to retire, he will not be able to afford health insurance because of premiums that under that bill minnesota's -- older minnesotans like him would skyrocket. or take a woman from andover, minnesota. she wrote to me 10 say she is so worried, quote, about the g.o. g.o.p.'s slamdunk approach to check off a box their to-do

list, end quote with the health care proposal. she asked me to put a face on the type of person that's a checklist on that to-do list and that would be her 28-year-old son. she says that medicaid coverage has been a lifesaver for her son because it helps him afford the treatment he needs to strive for an independent, productive life. the truth of the matter is, i've heard from so many people like these three, from all corners of my state -- the old to the young to the middle-i am aned. i have heard from -- to the middle-aged. i have heard from so many people from the rural parts of my state about the bill. they are especially worried go the $834 billion in cuts to medicaid. medicaid covers more than 1.2 million minnesotans including more than one-fifth of our rural population. you any that. 20% of our rural population. this funding is vital for our rural hospitals and the health

care providers' ability in those parts of our state to stay open and serve their patients. many, many people who work in rural hospitals, who are serve the by rural hospitals, have come up to me to talk about their concerns. and these hospitals are not like big urban hospitals. they're not. one of my rural hospitals -- i see the senator from hawaii here. i thank him for organizing this along with senator murray. our rural hospitals, they actually treat a lot of accidents. people out snowmobiling or on a.t.v.'s. in fact, one of them has a chart every summer showing all the places, the fishhooks -- they've had to remove fishhooks from people's hands. they have more than 100 of them by the end of the summer. you wouldn't see this in an urban area. it just shows, different parts of the country, different parts of our state have different

issues that they're dealing with. these hospitals are particularly concerned about these cuts. these drastic cuts would cause many of our hurl hospitals to close -- of our rural hospitals to close, forcing families to drive 60, 70, 80 miles or more when they need the health care the most. the other issue that this bill brings up to me when you look at rural areas is the opioid epidemic. that is hitting communities across the country. in my state, deaths from prescription drugs now claim more lives than homicides or car crashes. while there is more work to do to combat this epidemic, i want to recognize that we have made meaningful progress so far in a bipartisan way. we passed a framework bill, the cara bill. we passed the cures act last december as well as money to fund treatment. unfortunately, just as we're starting to move forward on this issue, the health care repeal bill passed by the house would

put us at the risk of moving backwards. there is money in that for opioid treatment, but guess what? medicaid and children's health insurance cover three out of every 10 people with an opioid addiction. but according to the nonpartisan congressional budget office, mental health and substance abuse benefits could be hut under the house bill increasing out-of-pocket costs. it is clear this legislation pass -- it is clear that this legislation has massive life-changing implications for families across this country, yet we haven't even seen a draft in the senate. what we do know is that just last week the president of the united states, who's known for not really mincing words, known for using very directly language, called the house bill mean. he called it mean. he didn't need a poll or a focus group. didn't need to know every detail of the bill. but when you hear that over 20 million people can lose their health insurance, that's a

pretty good word to describe it -- mean. so what we don't want to have here out of the senate is that we bring forward the son of mean, or mean ii. we don't know what we have because we haven't seen it, because the legislation is being drafted behind closed doors. most of us agree that we must make changes to the affordable care act. i certainly think so. i would love to pass my bills or include them in amendments to the affordable care act to bring down the cost of prescription drugs. my bill to allow 41 million seniors to harness their negotiating power to bring drug prices down. right now they're banned to do that. that's wrong. i would love to see more competition come in the market in the form of less expensive drugs from other countries like canada. a bill i have with senator mccain. or make it easier to get general makers on the market -- generics on the market.

or pay for delay. i think the american people would be surprise fundamental they found out that the big pharmaceutical companies are paying their generic competitors to keep their products off the market. we can make improvements to the exchanges, just as we've done some of that work in the state of minnesota, we can do that nationally. we can make improvements to change the small business rates. there are things we can do. but we can't do it if we're not in the door because the door is closed. and when the door is closed, it is not just closed for the democrats in the senate. the door is closed to the american people. when it all comes down -- what it all comes down to is we need-to-work in a bipartisan way to make health care better and less expensive for the people in our country. last week we all came together -- i was at that congressional baseball game. it was such an amazing moment, 25,000 people in the stands, all four leaders out there looking

like they actually liked each other. there they were, and there our teams were, two teams -- a republican team and a democratic team. in the end, it was a hard-fought game. one team won -- the democratic team. but they handed their award to the republican team. they said, put it in representative scalise's office. we want to take that spirit and go even further. instead of two teams, one team for america. and the way we make changes to an issue that has been long fought on both sides -- both sides. i know republicans weren't happy with everything that happened during the debate on the affordable care act. they have made that clear. but now we have a moment in time where we can come together, make some sensible changes, and make things better for the people of this country. let's do it. thank you, mr. president. i yield the floor. mr. franken: mr. president?

the presiding officer: the senator from minnesota. mr. franken: thank you, mr. president. i rise today to talk about the republican effort happening in total secrecy behind closed doors under the direction of leader mcconnell to repeal the affordable care act and gut medicaid in order to give huge tax breaks to the wealthiest georgians, the wealthiest americans. just about five monthsing a ago i came -- just about five months ago came before this body. i i should a simple request to republicans. i asked you to show me your plan to repeal and replace the affordable care act, mr. president. i asked you to show me the plan that was going to be, quote, terrific, end quote.

the bill that president trump promised during his campaign, the one republicans had seven years to come up with -- i asked you to explain how you would meet the standards set by one of president trump's top advisors, kelley anne conway, who said, quote, we don't want anyone who currently has insurance to have no insurance -- to not have insurance, end quote. i asked you all to show me the plan that retains coverage for the nearly 20 million people who have gained it, continues to contain health care costs and ensures that nobody gets denied or has to pay more because of

their gender or because of preexisting conditions. i never got that plan from you. instead, what we received was the american health care act, or the ahca, a heartless, terrible bill that passed the house in early may, a bill that president trump heralded in the rose garden after its passage as, quote, great, end quote. the ahca -- sorry, the ahca is a far cry from what president trump and his allies promised. if the ahca becomes law, 23

million more people would be uninsured. the bill ends protections for people with preexisting conditions and drives up health care costs dramatically for older, sicker folks. worse still, the ahca would end the medicaid expansion and slash medicaid by $834 billion over ten years, and for what? to offer massive tax breaks to the wealthy americans, for the wealthiest georgians in the presiding officer's state. the average tax savings for the

400 richest savings under this plan: $7 million apiece each year. $7 million. -- $7 million each for every year. you know, because they need it. no wonder people are outraged. just 8% of americans think the senate should pass this bill into law unchanged -- 8%. that has to be a new low. americans do not want trumpcare. three in four americans want president trump and his administration to do what he can to make the a.c.a. work rather than undermining it. even president trump reportedly now considers the house bill, quote, mean.

it went from great to mean. in the rose garden, it was great. now just a few weeks later, that same great bill is mean. instead of listening to the american people, republicans are pursuing a strategy that former acting administrator of c.m.s. andy slavett has described as sabotage, secrecy and speed. up first, sabotage. a few years republicans choked off the risk corridor program which was designed to help stabilize premiums in the first years of the new exchanges. the trump administration has gone even further. it has stopped enforcing the individual mandate, undermined outreach efforts to help people

sign up for health insurance, and cut the amount of time people have to sign up for health insurance coverage in half. but perhaps most troubling of all, republicans have refused to commit to funding cost-sharing reduction payments. these payments help low-income families cover their out-of-pocket costs. since insurers aren't sure if they can count on the administration to continue to provide these payments, some are pulling out of the individual market or dramatically increasing their premiums to account for this instability, its uncertainty. there is much more that we can do to shore up the individual market, but my colleague,

senator stabenow, had it right when she say to secretary price, of the presiding officer's state, regarding the administration's sabotage efforts that, quote, it's like pulling the rug from under somebody and going oh my gosh, they fell down. end quote. from debbie stabenow of michigan. the next tenet of the republican approach is secrecy. a group of 13 men have been meeting in secret to draft the senate version of the ahca. what little we do know is that senator cornyn estimates that there will be about 80% overlap between the senate and house bills. prior to now our understanding was that the senate

republicans, that you would completely rewrite the bill. senator burr even saying that the house bill was, quote, dead on arrival. end quote. it sounds like that plan has been jettisoned. but we can't be sure because the senate has had precisely zero hearings. zero days of public floor debate. and we have yet to see or hear about the revised draft of the ahca, despite the forthcoming vote. i urge my republican colleagues to recall that during the long debate over the affordable care act, the senate held nearly 100 bipartisan hearings, round tables and walkthroughs, and had 25 consecutive days of

public floor debate. let me repeat that, mr. president. nearly 100 bipartisan hearings, round tables and walk-throughs. and the senate alone, 25 consecutive days of public floor debate on a bill that affects one-sixth of our economy. in the senate health committee, democrats considered nearly 300 amendments during a 13-day markup, one of the longest in congressional history, and ultimately accepted more than 160 republican amendments in the process. in 2009, then-house budget

committee ranking member paul ryan argued that, quote, before congress changes health care as the american people know it, we must know the likely consequences of the house democratic legislation, including the number of people who would lose access to their current insurance. end quote. the irony is palpable. feel the palpable irony. you feel it, mr. president? does everybody feel it? that brings me to the final component of the republican approach, and that is speed. leader mcconnell would prefer to have a vote on the senate plan before the july 4th

recess or shortly thereafter. that timing only leaves us a few days to go. there just won't be enough time to truly understand how this bill would affect the health care system which, again, is one-sixth of our economy, mr. president. it affects all the millions of americans who rely on it. republicans plan to schedule the vote in such a way as to keep the american people in the dark about this bill as long as possible. the american people deserve a chance to weigh in on a bill that would affect their lives and those of their friends and families in my state of

minnesota and the presiding officer's state of georgia. my office has received over 15,000 letters from very worried minnesotans these past few months, and i've gone to visit rural health care facilities that would be among the hardest hit by the ahca. my constituents, the people of minnesota, are, frankly, scared about what will happen to them or their families if they lose their health insurance. i am too. as i did in january, i would like to encourage my republican colleagues to join me on a trip to minnesota to meet leeanna.

leeanna's three-year-old son henry has been diagnosed with acute lymphoblastic leukemia. in his treatment, mr. president, will last until at least april of 2018. mr. president, he needs around-the-clock care to manage his nausea, vomiting, pain and sleepless nights. henry's immune system is so compromised that he's not supposed to go to day care, so leeanna left her job to care for him.

henry and leeanna are supported by lee anna's spouse, but they can't pay for his treatment on one salary. leeanna says, and i quote, it is because of the a.c.a. that henry gets proper health care. henry can get therapy and the things he needs to maintain his health and work towards beating cancer. henry is still with us because of the a.c.a. end quote. he's three. let me say that again. henry is still with us,

mr. president, because of the a.c.a. i will do everything i can to fight the republican effort to repeal the affordable care act, strip away consumer protections and gut medicaid. to all of my constituents who care about this, i need you to keep fighting. now is the time to make your voices heard. thank you, mr. president, for your attention, and i yield the floor. a senator: mr. president. the presiding officer: the senator from rhode island. mr. whitehouse: mr. president, i'm pleased to follow the senator from minnesota because i had the chance because of him to be on the help committee during

all of those hearings, all of those dozens and dozens of republican amendments that took place during the vibrant, robust, bipartisan process in the help committee. senator franken was still in litigation over his election, and so his seat on the help committee was vacant, and harry reid asked if i would take that seat. so my senior senator, jack reed, and i, both of rhode island, were there in the room day after day, week after week while this exhaustive public bipartisan process went forward. i can even remember senator isakson of georgia working with him and supporting his amendment that would allow a doctor to be paid for having a conversation with a very ill patient about

what their desires were if their condition didn't get better. what type of end-of-life care did they want. did they want every possible intervention or did they want a dignified time at home with their family? what were their desires? that's a conversation that is important for doctors to have with those patients. in the environment at the time, that became the death panel phony story. so i was there. i saw it happen, thanks to senator franken's delay in getting here. jack reed and i were in the room. and why does this matter? this matters because like the story of leeanna and henry, there are people on the other side of what is for apparently for our republican colleagues, a purely political piece of parliamentary chicanery. i've got a woman named pamela,

lives in jamestown, rhode island. she works with people in nonprofit organizations that advocate for people who have very rare diseases. so she has seen in her work the before and after of the affordable care act. before the affordable care act, she wrote me, i saw many patients and families distraught by medical bankruptcy. then it came even closer home to pamela as she was diagnosed with stage 4 breast cancer. if there were an annual or lifetime limit on health benefits, she would be in deep trouble. if the protection for people with preexisting conditions were undone, that would imperil her ability to get insurance in the future. she wrote to me as a patient myself, with a chronic, costly

medical condition, i'm very worried that these protections will be taken away, making my life-sustaining care unaffordable. pamela deserves to be heard, but nobody can speak up for her with a bill that nobody can see. from cumberland, marilyn wrote to me. marilyn is a family physician. she knows the health care system. she also has severe asthma. she's had asthma since she was a little child. and she manages her severe asthma with medication. her husband is retired and she purchases health insurance through health source rhode island, our obamacare health insurance marketplace which, by the way, is working very well. there is no need to undo what's going on in rhode island. it gives her peace of mind, and she wrote to me to say that she was terrified by the possibility

that the preexisting condition clause will be allowed back in. she wrote to me, i'm not a specialist, but a family medicine physician, doing the best i can to pay my student loans and daily expenses. i could not afford the lifesaving treatment i require to function. i do not know how i would survive financially if the current legislation the house has approved is allowed to become law. gina wrote to me from lincoln, rhode island. gina's daughter sophia is six. sophia has cerebral palsy. we think we have problems here? i'll tell you, whatever the political problems we have over the affordable care act, have a 6-year-old with cerebral palsy and then come hell me about how -- and then come tell me about how big a problem not liking obamacare is. sophia needs round-the-clock

care and gets it because of medicaid. from her home nursing care to her wheelchairs, we could not live without medicaid. before sophia came along, gina and her husband never imagined that they would need medicaid. it never crossed their mind. but now the welfare of their little daughter is entirely dependent on medicaid. depending on what we do here, gina wrote, will there even be a medicaid then? this administration is stripping benefits from the most vulnerable in our society. how will they survive? the last story i'll share is tony and his family who live in north kingstown, rhode island. tony has a son, his name is michael. michael right after he was born was diagnosed with something called mitochondrial disorder. it is a severely catastrophically debilitating

illness. it left michael severely disabled. michael is 10 years old now, but developmentally, he's more like a three-month old. he can't walk, he can't talk, he can't feed himself, but he is happy and he is sweet, and he is a source of joy for his parents and his four siblings. through medicaid, michael can receive up to 30 hours per week of care from a certified nursing assistant. it is this program -- it is medicaid supporting the certify nursing assistant, those 30 hours a week, that lets michael live at home with his parents and those four siblings. otherwise he'd have to be institutionalized. somebody explain to me why a political victory shoved through this body after secret proceedings is worth explaining

to michael's parents that he's at risk of losing that coverage. when president trump said that the house bill was mean, he was not kidding around. it is mean, mean, mean, dirty, rotten mean. and if you think the one on the senate side is going to be any better, there's one little phrase i'd like to bring to your attention. "we're not stupid." "we're not stupid" is what a republican staffer said when he was asked, why aren't you guys having a public process, why are you trying to jam this through in secret? his answer: "we're not stupid." well, what can you logically deduce from that? what kind of bill would be stupid to show the american public? if this was a bill that was going to be greeted with great

applause and joy and relief and satisfaction by the american public, would you hide it? no. if it were terrible, if it would threaten people all across this country, then you wouldn't want them to see it. that would be stupid. so that's what they're up to. they know perfectly well that this bill is not good for america. that is why showing it to the american people would be, by their own words, stupid. let me switch to my geek point before i go, because this is something i talk about a lot, and it bothers the heck out of me. this is a graph that shows health care in most of the countries that compete with us, the oecd nations. this shows life expectancies in

years. where you fall in this is where the average life expectancy is in most of the countries. life expectancy is a pretty good measure of how good the health care system is. here is the cost of health care per capita, averaged across the population. and as you'll notice, most everybody is right up in here -- japan, switzerland, netherlands, united kingdom, mos most of our competitors, france, germany, they're all up in higher. where are we? we're out here. the most other expensive country in the world is switzerland which doesn't break $6,000 per person. we are over $8,000. the average in here where japan comes in above where the united kingdom comes in is $4,000 per person. we're above $8,000. we are 100% more expensive than the average and more than 50% more expensive than the least efficient other country in the world. so there is progress to be made

at bringing costs down. if we would pay attention to this real problem instead of the imaginary problem of americans having too much health care. and over here, look at the life expectancy in years. look where we come in. we watch the czech republic -- we match the czech republic. so there is progress to be made on cost and on outcomes in this country, and believe it or not, we're actually starting to make a little progress. let me take you through this graph and then i will he leave you be. this -- and then i'll leave you be. this top line was drawn by the congressional budget office. back here in 2010, what they do is they project forward into the future where they think health care costs are going to go. these are all federal health care costs, the whole federal health care cost, all them piled up -- medicare, medicaid,

veterans veterans, all of it. so here is what they projected it would be, this top line, in 2010. then they got to 2016, i guess, and they did another projection because they realized that as of 2014, things were coming in below their expectations. after the affordable care act, things started to change. so they did another projection in 2016, and they projected this line right here. now, those of us who serve on the budget committee know that we think in 10-year increments. so-- so here's a 10-year incremt from 2017 to 2027. if you look at just at the difference between what c.b.o. predicted in 2010 before the affordable care act, and what they projected in 2016 after the affordable care act, $3.3

trillion in savings. $3.3 trillion in savings. think of what a difference that makes for our country if you can save $3.3 trillion in our health care costs. health care cost is what's driving most of our debt and our deficit. $3.3 trillion in savings. i tell you what, i want to see this bill because i want to know what cbo thinks about what happened 20 that $3.3 trillion in savings. because if the cost is going to be losing $3.3 trillion in savings, the american people ought to know about that. so i call on my republican colleagues to have a process. i don't know if the presiding officer has seen the bill yet. it's so closely held, i don't know if all the republicans have even seen it. but for gosh sake, when you've got these stories from rhode island and from all the other states around the country, when

you've got real fellow americans counting on the health care that the affordable care act made possible, the idea that you'd throw that out to score political points and to give superrich people a tax break is disgraceful. it is a disgrace. and i yield the floor. a senator: mr. president? the presiding officer: the senator from hawaii. mr. schatz: thank you, mr. president. i'd like to give a status report on this bill. right now we think it's within a 13 men who are working on it in men. they will show it to republican lobbyists and then they will send it over to the c.b.o. for a score and eventually the american public and the senate will be able to see the bill, and we will have a process called vote a marks which is mostly -- vote-a-rama, which is

mostly nonsense and there will be lots of opportunities to offer amendments. the leader will offer an amendment in the nature of a substitute. so what does that mean? that means that all of the amendments that were adopted along the way get taken out with one 51-vote margin and all of that -- all of that vote-a-rama was for show because mitch mcconnell will put his bill on the floor that was negotiated in secret with those 13 people. if there was any question that our democracy is being rolled over by senate republicans, i want you to think about these 13 men. they are drafting a bill without any input from women, from democrats, from experts, and by working in secret, they are cutting out about 250 million people who are from the 40 states who aren't represented among those 13 men. and you can bet that those 40 states have unique health care

needs and unique health care laws, and without the right language, the bill could throw health care in each of those states or any of those states into total chaos. they've also cut out senators on the health, education, labor, and pensions committee and the finance committee, even though these committees are actually constructed for the purpose of working on legislation like this. they know how to get things done like this. there are members of the help committee and the finance committee that are among the experts on this issue, and yet they don't get a chance to seen even see the bill -- to even see the bill. these senators have jurisdiction over this legislation, but they're being left out. and this is just not the way it's supposed to work. we need transparency, we need bipartisanship, but now the republicans will try to tell you that, you know, hearings are bypassed all the time. that's not true. that's not true.

in fact, this body will hold a hearing on almost anything. in 2017 alone, the senate has had hearings on hottub safety, self-driving cars, a treaty for out-you are space, multimodal ships and the maritime administration, and dozens of other issues. look, those are actually not to be trivialized. it is important for the senate to have hearings. it is important for subcommittees to do their work. but nobody can tell me that hot tub safety, self-driving cars, a treaty for outerspace, multimodal shipping, the maritime administration, are more important than one-sixth of the american commitment of it is a joke. we're talk about one-sixth of the american economy. about millions of jobs, and people with life-threatening diseases and life-changing medical bills and so we know how important hearings are to do legislation when the senate took up a.c.a., there were almost 100

hearings. think about that. 100 hearings versus zero. there were round tables, walk-throughs held by the two committees. we considered hundreds of amendments and accepted more than 150 amendments from republicans. but for this bill, no markup, no transparency, no bipartisanship -- just 13 men meeting in secret outside of the regular process. and the only thing that has changed is now the market is under siege but the market is under siege because of the republican administration. they are purposefully creating uncertainty, and that's not a rhetorical fluor identifiability they're saying they're doing that. president trump actually said he wanted to create uncertainty in the health care market in order to create leverage with democrats. think about how unusual that is. think about how offensive that is. it is perfectly appropriate for one party to try to generate

leverage in a negotiation against the other. that's part of politics. either in an election context or in the public policy context. but the way that this president and tom price are trying to generate leverage is by raising health care premiums in order to force democrats to buckle. that's unheard of. it really is unheard of. and it hurts everybody across the country to create this uncertainty. it's bad enough that the republicans are trying to take health care away from 23 million people, from nursing home patients and their families, from women who are pregnant or fighting breast cancer, from sons and daughters and moms and dads who struggle with opioids, but toed a insult to injury -- but to add insult to injury, they are going to jam it down your throat. you don't get to read what it's about before it passes, or hear from doctors or nurses or experts about how it will affect you. so why are they working on this bill in secret? and the answer is very simple. the bill stinks.

they're ashamed of it. the bill itself is an embarrassment. the process is an embarrassment. they've said so themselves. no matter how you look at it, this bill is disaster for people and their families. it will be a disaster for anyone who relies on medicaid, which will be cut by at least $800 billion. medicaid is a safety net for people who need care but can't afford it. look at nursing home care. medicaid covers three out of every four long-staying nursing home residents. medicaid covers three out of four long-stay nursing home residents. my wife's grandmother was just in a nursing home and just passed away and had great care. and wouldn't have been able to get the care that she needed were it not for medicaid. and this is not an uncommon story. these are millions of americans across the country, by the way, of all income levels. people think of medicaid as

people who are financially not in a position to get care at any given moment. that's true. it does take care of the poor, but it also takes care of nursing home care for people who worked all their lives and just don't have enough. it's $9,000 a month in the state of hawaii for nursing home care. it's more than that for hospice care. we all know, nobody escapes end-off-life care. rich or poor, left or right, red, blue, purple, nobody escapes this part of your life. and everybody needs help. there might be a few people who save up enough cash money to be able to shell out $10,000 a month for that kind of care, but for the rest of us, medicaid is that lifeline. there are actually some republicans who don't want to cut medicaid. they have seen how the program improves people's lives.

arkansas, kentucky, for example, they expanded medicaid. these states have seen big jumps in the number of people who now have their own doctor or who have gotten a checkup in the past year, people who are now more likely to say they are in excellent health. but under trumpcare, we will go back to the bad old days. this bill is also a disaster for older people who will be hit with what the aarp is calling an age tax. and this will get a little wonky, not as wonky as my colleague who spoke about five minutes ago, but a little wonky. right now, companies are not allowed to charge three times as much for an older person as a younger person. three times is the cap. but trumpcare will increase that rate to five times. and so what happens is every year as you get older, your insurance costs will go up and up and up and up. that's why they call it an age tax. in other words, many seniors will see premiums increase -- premium increases that could cost them thousands of dollars more each year at a time when

people are already struggling to find the money to pay for health care. this is also a disaster for patients who don't want to lose their health care provider. right now, an estimated one in five women go to planned parenthood clinics. and i understand that we have different views about reproductive choice. i understand that. but we also understand when we're talking on the level about planned parenthood and we're talking about the federal funding for planned parenthood, everybody who pays any bit of attention to this understands what planned parenthood does for women across the country. again, conservative women, progressive women, planned parenthood doesn't care. and planned parenthood is not using federal funding for abortion. we all know that by now. it's cancer screening, it's quality health care and birth control. people talk about giving more choices for health care and

saving taxpayers money, but the c.b.o. estimates that defunding planned parenthood will take away options for nearly 400,000 women across the country, and it will cost taxpayers more than $130 million. it's also a disaster for those who are struggling with opioid addiction. this bill will take away treatment for mental health and addiction, leaving hundreds of thousands of people fighting opioid addiction without adequate health insurance. we saw the statistics that opioid addiction, i believe, is killing more people annually than hiv-aids killed at its apex. i believe it has either surpassed or is comparable in terms of cause of death to car accidents. this is one of the leading killers in the country, and medicaid is the program that funds opioid addiction for most of the people who get help. this bill is also a disaster for patients with preexisting conditions because it means we're going to go back to the

dark days when insurance companies could charge you more for having a preexisting condition. i've heard from people back home in hawaii who were terrified of what this could mean for their health. one woman wrote that she is in the middle of a fight for her life against breast cancer. and she is scared that under trumpcare, she will lose her insurance. she will have to stop her treatments, and she could lose her life. a husband wrote to me that his wife has stage four breast cancer. she has had every possible treatment and surgery imaginable to extend her life, but without the guarantee of affordable coverage for all, her fight will quickly come to an end. she is 29. even people without serious medical conditions will be affected by this preexisting conditions nonsense, and we know that because before the affordable care act became law, insurance companies were able to discriminate based on what they determined to be a preexisting condition. one woman in hawaii told me that in the days before the affordable care act, she was

rejected by insurance companies because she had back pain at one point in her life. the pain never came back, and she never needed treatment again, and she was young and healthy, but the insurance company wouldn't give her insurance. we cannot accept the end of nationwide protections for people with preexisting conditions. we cannot accept high premiums or so-called high-risk pools that have historically failed in giving people the coverage that they need and they deserve. look, we don't have to do it this way. we don't have the majority, and this is being done under a process called reconciliation, which means that you don't need a filibuster-proof majority. you just need 51 votes. so if you're proud of your bill, you have got senator hatch, he's the chairman of the finance committee, one of the most respected republicans in the

country, actually. you have got senator alexander, likewise the chairman of the health, education, labor and pensions committee. both of them have a long history of being able to do deals. orrin hatch with teddy kennedy and my predecessor, dan inouye. lamar alexander with just about everybody, chuck schumer, patty murray. i mean, these are conservative members of the senate. no doubt about their republican credentials, but they are also people who are capable of crafting legislation in the right way. and i have no doubt that they like their gavel. i have no doubt that they like chairing hearings. and i have no doubt that they have the personal, intellectual, emotional, political stamina to go through a process that may take more than a couple of days. and i'll tell you, this is the world's greatest deliberative body, it is, and this is a bunch of impressive people who i serve

with in the united states senate, but you know what? without a hearing, you get a garbage product. you get a bill that just stinks, that staffers say that they are keeping secret because, quote, we are not stupid. they are so embarrassed at this product that they are keeping it secret, because they know the moment this thing gets posted, everybody from everybody's home state, and not just democratic states and not just purple states but every home state is going to say my community health center is going to get shut down. wait a second, my opioid treatment program is going to get shut down. my hospital may no longer exist. they know this bill stinks, and there is a simple solution. all we need is three republicans to say let the senate be the senate. the house did whatever the house is going to do. there was a weird white house rose garden signing ceremony without a bill even being

enacted. it was the most bizarre thing i have ever seen where everybody was congratulating each other for inflicting pain on the american people. but the senate has to be the senate here, and what that means is that we have to be that cooling saucer, right? we have to actually slow down and have a deliberative process, and all we need is three members of the united states senate on the republican side to say a very simple thing. and they can be as critical of obamacare as they want. they can be as partisan against us as they want, but all they have to say is this -- i'm not voting for a bill that doesn't get a hearing. i'm not voting for a bill that doesn't get a hearing. let this thing see the light of day. i yield the floor. mr. murphy: mr. president. the presiding officer: the senator from connecticut. mr. murphy: thank you, mr. president. i thank my friend from hawaii for convening us here tonight. so this isn't theoretical. this isn't about numbers.

this is about real people. we know them. they exist throughout our states. i have told this story a few times on the floor of the senate before. when i think about the progress that's been made over the course of the last six years, i think about betty burger. betty is a woman who lives in mayor dan -- in meridan, connecticut. betty did everything we asked them to do. they were morally upstanding citizens, contributed to their community, they had full employment, they were raising good kids, and her husband switched jobs. he switched jobs and he had a one-week, maybe a two-week period of time in between those two jobs, and as luck or lack of it would have it, during that brief intermission between employment, their son was diagnosed with cancer.

cancer then became a preexisting condition which meant that her husband's new employer would not cover the son as part of a family plan. the cancer progressed and progressed and progressed. his family, the burgers, had no means to keep up with their payments. their story unfortunately is not foreign to folks who have heard from constituents who have gone bankrupt because of health care costs. the burgers lost everything. the burgers first went through their savings. then they went into their son's college account. then they sold their car. then they sold their house. they lost everything they had trying to make sure that they had health care for their son simply because he got diagnosed with cancer during the one tiny interim between their family's

insurance coverage. that preexisting condition doomed that family. there but by the grace of good would that be us. that could happen to any one of us, and yet today medical bankruptcy is frankly a thing of the past. why? well, it's not because health care costs any less. it's because we have said that we are not going to allow insurance companies to deny coverage to someone because they have a cancer diagnosis. in fact, we're not going to allow insurance companies to charge you more just because you are sick. and guess what? people have been able to keep their college savings account, they have been able to keep their car, they have been able to keep their house even if they get sick. that's what this bill has meant. 20 million more people are insured. yes, but the number of personal bankruptcies in this country have plummeted by 50%, almost entirely because there aren't burgers any longer.

there aren't people who had to live through what the burger family had to live through. that's what this is about. this is about real people who are going to go through miserable, terrible experiences because of the bill that the senate -- senate republicans are just days away from putting onto the floor. i know my colleagues have covered this exhaustively, but i just want to show you visually what c.b.o. says the house bill does. i know it's in vogue for the president or republicans to say that obamacare is in a death spiral, but that's not what c.b.o. says. c.b.o. says that if you keep the american -- the affordable care act and you actually implement it rather than undermine it, rather than sabotage it as the president of the united states is today, well, then the number of people that don't have health insurance, it remains fairly

stable from 2017 to 2026. it's about 28 million people. but if you enact the american health care act, a bill that passed through the house, that number goes almost immediately from about 26 million up to 40 million. right about 15 million people lose insurance right off the bat, within a heartbeat of passing this bill. about 14 million people lose insurance, and then over time it grows to 51 million people. that is not the american -- the affordable care act in a death spiral, right. that's market stability. this is a death spiral. the death spiral starts upon passage of the act that is being secretly negotiated today. and i get it that 25 million is kind of a hard number to get your head wrapped around. what does 23 million people really mean? these numbers are so huge. here is what 23 million people is. it's the entire population of alaska, delaware, hawaii, idaho, kansas, maine, montana,

nebraska, nevada, new hampshire, new mexico, north dakota, rhode island, south dakota and let's just throw in west virginia. that's what 23 million people is. that is a humanitarian catastrophe, right? and remember, 23 million people is what you get to at the end of ten years, but 14 million people lose it right off the bat. there's no way for our health care coverage to provide covered to 14 million people who had insurance one day and don't have tt next. by the way, they tend to be the sickest people because that's who's going to lose health care first. so why are we doing this? why would you choose to inflict this kind of pain on people? why would you ask to run for congress in order to put this kind of hurt on the american public? and here's the answer. i wish this weren't the answer. like i wish there was a different answer but here's the answer. 23 million people lose health

insurance. the cost of that is about $800 billion of money out of the health care system. and it's not coincidence that that then gets transferred into 650 or so odd billion dollars in tax breaks for the pharmaceutical companies, the insurance companies, and for really, really rich people. that's not just by accident that it worked out that the amount of money that you took from poor people and from middle class people and from sick people isn't the exact money that you're transferring to the pharmaceutical industry, the insurance industry, and rich people. here's another way of looking at it. here's where the tax cuts go. the lowest quintile, the middle quintile, even the fourth quintile don't get a lot of money out of this tax break. it's the top quintile, the top 20% of income earners that get an average tax cult of $2,700 and here's the big benefit, the top 1% of incomers got $37,000

tax cut out of this bill. top 1% of income earners get a $37,000 tax cut from this bill. let me say that again. 23 million people lose health care so that the top 1% of income earners get a $37,000 tax cut who runs for congress to do that? what constituency is asking for the united states congress to pass a bill that takes health insurance from all sorts of working americans, people that are playing by the rules, people like the burgers in order to pass a tax cut for the super wealthy? i don't know what's happening behind these closed doors. i don't know exactly what they're talking about, but i'm going to guarantee that it's not fundamentally different than what the house bill did which is what i'm describing here. it's still massive numbers of

people losing health care, rich people getting a tax cut, and lots of folks getting hurt. why? just because republicans made a political promise to do this. and i know i have other colleagues who want to talk so let me just turn for a moment to this process because the process doesn't matter. the majority is breaking the senate. they are breaking the senate. and don't think this won't be how this works if you're in the minority. the fact of the matter i is that we acknowledge that there's a lot that is still very wrong with the american health care system. our constituents command us to try to make those things better. and we would love nothing more than to sit down with the republicans and try to figure out how we can come together on a path forward to make this health care system better. and i know you don't believe us, but you didn't even try. i'm not sure that we believed you at the beginning of 2009

when you said we want to help people get insurance because we had watched republicans have control of the presidency and the house and the senate for a long time without a lot of progress being made. but dks tried -- but democrats tried. democrats spent a whole year sitting down with republicans trying to figure out if there was common ground, holding committee processes, exhaustive hearings. we had 30 daze of senate debate -- days of senate debate here on the senate floor. i get it in the end republicans didn't support that package and i get it republicans can lay blame at the feet of democrats i understand how that argument works. the fact is when democrats were in the majority, they tried. they opened up the committee process. they let everybody in the public see the debate we were having. why? because it's a big deal. we're talking about one-sixth to one-fifth of the american economy. if you're talking about reordering that big a segment of

the u.s. economy, if you're talking about millions of people benefiting or losing, that shouldn't happen behind closed doors. my constituents, even though they're represented by democrats, have no less rights than the citizens of iowa or the citizens of texas who are represented by republicans. why are my constituents not allowed to see the details of what's about to happen to their lives? why are only a select group of americans able to have a voice inside that room? why are the people of connecticut going to get like three minutes to look at this bill once it hits the senate floor? my constituents are americans just like the constituents in republican states are americans. they deserve to know what's about to happen to them. you're breaking the senate.

and it won't get put back together that easily. these are tough questions. they're partisan questions, but it doesn't mean that there's not an obligation to try to find common ground. and if you can't find common ground, don't bury the proceedings behind closed doors where nobody can see it. people hate this bill. they hate this bill. and they hate it in part because they don't trust the process. when they see this balance, tax breaks for pharma, insurance, and rich people and them losing coverage, they want to know why they lose and why super rich people win but they can't get answers because it's all happening behind closed doors. it's not too late. i'll just end with this. senator schatz said it right. it's not too late. you can -- my republican

colleagues can reject this. say let's start over. let's sit down and see if there are some democrats who want to work on stabilizing these exchanges, seeing if there's some middle ground, being able to build a partisan consensus when it comes to the future of the health care system. it's not too late. i think you're going to hear that consistently from my colleagues this evening. i yield the floor. a senator: would the senator from connecticut yield for a question? mr. murphy: i did. i yielded the floor. the presiding officer: without objection. mr. booker: your charts were stunningly laying plain the benefits and -- who benefits from the republican bill we saw

in the house, the c.b.o. as you pointed out plainly demonstrate that 23 million americans will lose health care but i heard you talk about this with other issues, about how we as americans are far more connected than we realize. that while family might suffer from lack of health insurance like the folks you talked about at the beginning of your remarks, the reality is when that child doesn't get the health care that they deserve, when they don't chief in life to the great potential that they might have, others suffer as well. and we see this here on the foreign relations committee as you travel to european countries and have far vastly more people insured, vastly more investments in childhood education and childhood health care. i'm wondering if you can extrapolate for me for a moment that this isn't just about individual families who are vulnerable. this is really all americans who suffer when you have other

americans not getting the benefit of health care in this country. mr. murphy: i think we all got a gut bench. this young man who came back from north korea after having been abused and tortured there passed and if you read the statement from his family it was hard to read. you can't help read that without sort of feeling your heart drop into your stomach. why? because this is a young man with such promise ahead of him who had that future robbed from him. i didn't know him. you didn't know him. the people in my state who are similarly affected didn't know him yet they felt something. i think the reason the bill is so wildly unpopular is because people are going to die. i mean, the fact of the matter is if people don't get coverage for addiction, if folks don't get to see a doctor who are mentally ill, they aren't going to survive.

and people -- you know, even those that have enough money to be able to pay for the premium increases in this bill, they know there's something -- there's something a little evil in wanting to do this to people. as you remark, even if you're not amongst the 23 million people who lose insurance, the c.b.o. also says that your rates are going up, right? because when those people don't get health care insurance, they show up somewhere else in the system. they show up at the emergency rooms. they get much more expensive care. that cost gets passed on to the rest of us. and so even if you're lucky enough to not be amongst the 23 million, you are going to be personally financially affected by this. the c.b.o. says everybody rates go up by 15% to 20%. but even if it's not the money that you care about, we are all connected and nobody should want this to happen to people. we're all weaker if we pass a

piece of legislation here that ends up hurting people in such a real meaningful and dweses at a timing way. -- devastating way. mr. booker: if you can, the senator from connecticut, just ask one more question. that interrelatedness, it's a part of a larger system. and these systems we all benefit from. you mentioned momentarily ago hospitals and how -- whether it's my family that gets injured and is rushed to a family or a wealthy family or a poor family, those hospitals are a critical part of the health care system. i was mayor of a city and i imagine my experience is similar to yours in connecticut. our hospitals before the affordable care act were having a really difficult time because so many of those costs at the most expensive point, when a disease had become so much more acute were being pushed into hospital emergency rooms, and my state was having a very difficult time with the costs of

that so-called charity care. they literally had tough choices. they weren't just going to close their door when someone goes into a diabetic shock or someone has an asthma attack or some of these diseases that are not treated at an earlier stain. i'm wonder -- stage. i'm wondering if you can help explain in terms of connecticut's perspective why this has an impact for all of us in terms of the systemic health care steams that sustain our communities. mr. murphy: the law says there's only one health care provider that by law has to treat every single person who comes in the door, that can't turn away individuals based upon their ability to pay. and that's the emergency room. but what we al also know is the emergency room is where you get the most expensive care. by the time you get there, you're often in crisis and the care you receive in the emergency room is expensive. and then all of the care that you need afterwards is extensive as well.

i always remember a woman from connecticut who lost her medicare -- excuse me -- her medicaid coverage and in losing her medicaid coverage, she didn't end up being able to see a doctor for an infection she had in her foot. it was hurting for a long time, that infection. she didn't have medicaid any longer so she decided to let it hurt. she popped some til tylenol and hoped it would go away. one day it was so painful that she pent so the emergency room but it was too late. her foot became so badly infected that she had to have that foot -- that leg below her knee amputated. she had no insurance so we all picked up the cost of that but she had her life altered in a way that is hard for us to fathom. and there's not a single winner in that scenario because obviously she -- her entire life is changed because of that. but it's not like we saved any

money in treating her so shabbily because we ended up having to cover all of those costs. that's just one story. but if you think about what the house bill does, it repeats that story millions of times over. it's morally bankrupt but it's also fiscally imprudent and foolish. mr. booker: one more thing, senator murphy and if you'd indulge me because i just visited your state and as i was talking to a lot of your members being from new jersey, there might be a small rivalry between our two northeastern states. some of your folks came up to me and got in my face in a polite and joking way about how our constitution was formed. they talked about the connecticut compromise. and as you well know, this was a compromise that allowed our republic to form. and in understanding that -- that we'd have two bodies, the house and the senate, and every state would have two members representing it. and in many ways the founders of our country coming out of this viewed this body very different liz than the other body.

now, the other body you served in. i'm hoping maybe you could shine some light. i've been here three and a half years. you've had experience as a house member and as a senator. you said some people at home might dismiss this as hyperbolic partisanship. i think you're right. i've seen this body change. what frustrates me, i was here a brief period of time when democrats were in the majority and i heard my republicans on the -- colleagues on the republican side talking about regular order, how important regular order is, how when we're in charge we're going to have regular order. the leader spoke publicly about this thing called regular order. now, the house operates on majority rule, and there is a different -- our founders saw that as a very different body than this, which is in many ways talked about a different rhythm, a different way of doing things. in fact, how one senator over here can have a lot of power within the system. sometimes to the frustration of folks to slow things down. now, you made this claim about this being broken.

and i think this is a perfect example of it. this idea that this would be the body that on such a big issue would -- would have a chance to be deliberative and to focus on this. could you just -- because i really think that you're right. we have seen this body in a very short period of time that i have been here begin to undermine not just things that happen under the obama administration but undermine traditions that go back decades if not more than a century. i just wonder if you could just give some light on why you really are substantively factually saying that this is probably one of the low moments of the united states senate in the way that this process is being done. mr. murphy: there is right outside the senate chamber a picture of the authors of the connecticut compromise, two of the connecticut delegates to the constitution convention. a shout out to connecticut. but no, you are right. the idea of the house is that it

is supposed to respond perhaps more quickly to the temporary passions of the public, which is ironic given that the passion of the public today is in deep opposition to this piece of legislation. unfortunately, the house is responding to the passions of one very small portion of the public, which is the sort of extreme republican base which may be the only remaining segment of this country which supports the american health care act. this place is supposed to be able to step back and look at the long term, look at the long view. that's why we have six-year terms so that we don't do something that may feel good in the moment politically but has devastating impacts over the course of time. that's exactly what this debate is about. it's about a massive reordering of one-fifth of our economy that has just enormous consequences

over time when these people who lose insurance start to feel the effects of that as they believe through their savings over five or ten years and go bankrupt at the back end of that time period. and so this is a place where both parties should be able to sit down and talk about what this really means for folks. and i thought senator schatz put it well. when you don't engage in regular order, not only do you do things that are very partisan and political, but you also do things that don't make sense. one of the things that regular order brings is the ability to talk to experts. we all sit on committees, and those committees bring experts to the table to tell us what the impact of legislation is. there has been no committee process on this bill. we haven't had a single committee meeting. we have one hearing in the health committee upon which i sit. as senator schatz said, the result is a product that is garbage, that just logistically does not work because neither the house nor the senate engage

in the kind of deliberation that would get you to the facts. so, yes, this place is supposed to work differently, but also you're supposed to use the committee process to make sure that you're not passing something that just makes sense politically, that makes sense from a policy standpoint as well. mr. booker: thank you, senator murphy, for giving me those few moments. i wonder if the chair would be willing to recognize me to give some remarks for a few moments myself. the presiding officer: the senator is recognized. mr. booker: thank you very much, mr. president. so i just want to pick up from that conversation that we were having which is senator murphy so really laid it plain on his charts about larger issues with this bill, but i want to get back to the point he was just talking about that i have observed here in the united states senate for about three and a half years, is the functioning of this body. i love history. it's something that i'm one of these guys that doesn't read any nonfiction anymore. i love reading about this country, about its past leaders,

about great moments in history. what's interesting about this body, being someone who has the privilege to stand on this floor quite literally given to me by the state that i love, new jersey, and i walk on this floor and i feel a sense of history every time i'm here. three and a half years, and it hasn't lost its wow factor for me. i get to stand on this floor. and i have to say i love my state, and in my campaigning, i don't think the issue that i am new jersey's first black senator really came up that much. new jerseyans just want to know would i come down here and fight for them, but i was aware of the history about being the fourth african american elected in the history -- popularly elected in the history of this body. and i came down here as a student of many of the great moments in time on this floor, and many of the records that were set. i think some of those records are really germane to this moment right now. the longest filibuster on this

floor where one senator could actually grind the white house of the senate down to a crawl because of senate rules and senate traditions. in this case, something i wasn't even alive for, but something that to me is frustrateing but it's a moment of history that shows what regular order is. it slows down this body. a filibuster takes 60 votes to overcome. and so here was this moment, it was actually almost exactly 60 years ago that it was the 1957 civil rights act, and it was strom thurmond that gave this long filibuster trying to block something that, yes, indeed was going to have societal impact on this country. the 1957 civil rights act. now, this is one illustration of how when monumental pieces of

legislation are coming to this floor, the history of this body, the traditions of this body to slow things down, to have a process, to have rules, especially for things that are so monumental. in this case of the 1957 civil rights act, something we look back in the past and say wow, it took them a long time to get there. but it demonstrates what this body's rules have been about for a long time. let me go with another record that i mentioned earlier tonight, but it's -- it shows again that when monumental pieces of legislation are coming, this is a body that looks closely, takes its time, is deliberative and has a time-honored process. and that is the other records set by the longest consecutive session in senate history was a

debate about truly one of the more important things in our society, which is issues of war and peace. the longest consecutive session in senate history of debate, of deliberation, open and public for not just the nation to see but for the world to see was a debate during the first world war about whether to arm merchant ships. it brought about tremendous consternation, tremendous debate as we were doing the leadup into the first world war. now, what's interesting is if you think about the forming of our country, in that debate, again, constitutional convention , public, open,

transparent. issues were debated. and one of the fundamental reasons for organizing our government was seen as the protection of the american people. the ideals of a common defense. the public welfare. these were the things literally put into the preamble of our constitution about what this government is about. that these are the most important ideals. in fact, we herald some of these ideals. they have become part of our civic gospel. everyone knows when they hear the words liberty and justice for all. part of our civic gospel. well, part of that gospel as well in the core center of our country is that this is a nation about life, liberty, and the pursuit of happiness. that word life, this government,

this republic affirming the ideals of life is only understandable that we are debating epic pieces of legislation that will go to affect the lives of tens of millions of americans. i was in a children's hospital today. families in peril, families in crisis talking about the lives of their children. i've seen it happen. unfortunately, to neighbors and people in my community when the lives of their children are at stake or threatened or inflicted with disease. it puts so many things in perspective. and so here we have legislation speeding its way to the senate floor that go to the fundamental ideals of this nation. will we be a country that has a

system of health care that affirms life? now, it is no coincidence that when we're talking about records in the senate, it is no coincidence to me that the longest time that there was a consecutive session in senate history for debate, no coincidence to me that one was about war and peace, the rush that some people saw then towards war in world war i. but what's fascinating is that folks should know that the second longest consecutive session in senate history was about health care. and it was in 2010. it was over the affordable care act.

a bill that the full senate spent 25 consecutive days considering. 160 hours, not including, though, those 160 hours in session does not include hundreds more hours in committee hearings, in meetings. all that took place in the development of a bill that came to this floor and set a record about being the second longest debate. it is perfectly justifiable that that bill should have taken so much time, so much focus, that the world's greatest deliberative body would deliberate, would do its job. and for that piece of legislation, don't believe the

lie. it wasn't rushed through here. it didn't get the express train through the united states senate. it set a record for discussion, deliberation, debate, and a process that included comments and input and thoughts and testimony from americans across the country. not just red states, not just blue states, but all americans. and it was justifiable. it was absolutely justifiable. i wasn't here. i was at home in newark. i was mayor of a city. and this debate went on and on and on and captured the attention of the nation. something i have never seen before and i haven't seen since. the president of the united states then barack obama -- this

to me was stunning. it caught my attention -- on national tv cameras. sure it was c-span. not what i turn to first when i am home relaxing on my couch, but the president of the united states invited congress in. republicans. some of the smartest minds. i've served here three and a half years now. some of the smartest minds i have met here in this country are here in the senate on the republican side. he invited the congress in to discuss and debate with him on live tv health care. i don't know if reagan did that. i don't know if bill clinton did that. i can't remember that they did. so here was something that was done fully in the light, vetted, debated, deliberated, discussed in open air. and the hearing numbers are

incredible. i have been here three and a half years, and i have never seen anything like it. in the senate's so-called help committee, health, education, labor, pensions, they held 13 bipartisan roundtables. 13 bipartisan hearings. 20 bipartisan walk throughs and they considered 300 amendments. this is the thing i didn't know till i got to the senate because of all the rhetoric on 24-hour cable news. this wasn't a pure democratic bill. they actually accepted over 160 amendments from republicans. the stories i've heard from people on both sides of the aisle is that they were bending over backwards trying to pick up one republican vote. and so they -- it incurred and

took on amendments and actually shaped the bill. republican ideas on to this health care bill. 160 amendments. but stop. that's only in the help committee. in the senate finance committee, they held 17 bipartisan round roundtables. they held summits and hearings. 13-member meetings and walkthroughs. 38 meetings and negotiations, bipartisan. they held a markup. i've been to lots of markups. i've never seen them last or scarcely can think of times they lasted more than a day but they held in the finance committee a seven-day markup on the bill. that seven-day markup, talk about records, that seven-day markup was the longest markup on a bill in 20 years.

that was the process. a bill effecting that fundamental american ideal that this nation, not a monarchy, the oldest constitutional democracy on the planet earth that aofficialed ideals -- that affirmed ideals that put into the ether of earth for the first time this constitution talking about life, liberty, and the pursuit of happiness, that this health care bill involved such debate and discussion, and the nation participated. policy experts, market experts, medical professionals, health nonprofits, insurers, hospitals, americans all got to put forward their input, their ideas.

sure, not all of them were accepted but into the mix went everything. and so this should be shocking to the conscienceness of all people, of good conshens that aren't reflexively partisan but look at the history of this country, history that is proud, history that should be shameful about how things got done in matters of war and peace, in matters of foreign policy and domestic, in matters that made it possible for me to stand on the senate floor like integrate and civil rights. there was a process. and somehow in the last three and a half years in the name of what? a vicious brand of partisanship?

that somehow undercuts not just the voice of democrats, not just the voice of policy expert, not just the voice of hospital expert, not just the voice of medical professionals, doesn't just undercut their involvement in the process but it is an insult to the history and the traditions of this body. this was not the constitutional intent that something as important as health care should be done in a back room where a small handful of senators are trying to hammer out amongst themselves a piece of legislation that's going to affect tens of millions of americans and change our economy and change our communities. there is honor in this place that isn't on tv. there are good folks on both sides of the aisle. i've gotten to know them.

i consider folks my friends. i know their hearts. this does not sit well the way this is being handled. i know it. and this is one of those moments of history that somebody needs to raise their hand and say you know what? i may even like that bill that came out of that back room. i may like that bill that was hammered out by 12 republicans but this process is wrong. it is an insult to our history. i wouldn't want this done to me. this is the moment. it's a test. history will look back and see what this body did at this moment in history. i fear we're going to fail the test. but what's even more painful than that, for me is not just

the sadness or the anguish i feel about a body contorting its extra divisions -- traditions, breaking its way. what even hurts me more than that subpoena what -- more than that is what they're going to be pushing through. you saw it in the house. instead of this body coming together and literally there is agreement on this. all of us believe the affordable care act needs to be improved. i've had it in conversations formal and informal that we could build upon the affordable care act. we could correct for its deficiencies and we could build upon its extraordinary successes. i see those extraordinary successes in my state.

i have republicans and democrats who are now fearful about the consequences should a bill like the house republican health care bill be made law. folks who fear for their families, fear for their children, who don't want to go back to a nation that we had before it, with the number one reason for bankruptcy was not to be able to afford your medical bills, where people with preexisting conditions were denied insurance, when mental health care wasn't on parity with physical health care. i can go through all the things i've seen make a huge difference in new jersey, in communities rural and urban for americans.

and i want to highlight some of those right now, some of those questions that people are asking at home about what happens if a bill like the house bill becomes law. if they take that bill here in the senate and push it through, have is back to the house, these bills, a subverted process, go to that process called reconciliation, there's questions that are being asked. here's one. what happens to a mother who's pregnant with, say, her second child who suddenly loses medicaid coverage. understand, a very large percentage of the children born in the united states of america are born covered by medicaid, which we already see in this house bill as being gutted. the biggest rollback in the

safety net in our country in my lifetime and more. what happens to that mother who's pregnant with her second child, loses her medicaid coverage and her parental care -- prenatal care, she loses her prenatal care along with it? what happens to that american citizen? what happens to that baby? well, we know that according to the united states department of health and human services, babies born to mothers who receive no prenatal care are five times more likely to die than those whose mothers did not receive -- did receive prenatal care. five times. and tragically women without prenatal care are three to four times more likely to suffer maternal mortality. that means dying in childbirth, than women with prenatal care. and these rates significantly increase for women of color.

what happens to the tens of thousands of mothers who may lose access to maternity services? and what happens to the already dismal infant mortality rate and maternal mortality rates in our country if this plan goes through? that is a legitimate question. the data is clear. you restrict access to prenatal care, you endanger children, americans. you endanger mothers. but let's keep asking those questions. what happens to the health care worker who works 60 hours a week taking care of others but loses their own health care coverage and then is unable to afford getting screened themselves, preventive screenings for cancer. let's say ovarian cancer. what happens to them?

we don't have to imagine what happens when millions of americans forego preventive screenings. we have factual data on what happens should access to those preventive screenings like what happened with the house health care bill, what happened? the american cancer society tells us clearly that inadequate health coverage is a preventive to early care and optimum treatment. they find patients with stage 2colo dtion rectal -- stage 2 colorecta cancer that have it detected had higher survival rates. in fact, they point out that people with stage 2 colorectal cancer with adequate insurance have better survival rates than people with stage 2 -- stage 1

colorectal cancer that have no health coverage. in other words, the american cancer society shows that access leads to survival and denial leads to higher rates of death. a recent cancer study found and i quote right now the number of americans whose cancers were diagnosed at the earliest stage when it's most likely to be cured increased after obamacare went into effect and more citizens had access to health coverage. you take away the expanded coverage that was found through obamacare. you did he crease pre-- you decrease preventive screenings. you decrease early detection as indicated by the american cancer society death rates go up. another question in general. what happens to cancer rates in

america when these gains are reversed? what happens when these gains are reversed? what happens to the father of two who's diagnosed with a rare cancer who can't afford the additional estimated $82,000 his cancer treatment goes up if this bill, like the republican house bill, passes. that's what's estimated. $82,000 would his cancer treatments go up. what happens when he can't afford that care, when he's forced to choose between his family's home, for example, and treating his cancer? well, this is what we know. these are the facts, that from 2010 to 2016 personal bankruptcy filings have dropped close to 50% in the united states of america. one of the collateral benefits of obamacare, 50% drop in personal bankruptcy filings with experts agreeing that the

affordable care act played an important role in this significant decrease. a group of economists has estimated that the house republican bill would cost the average enrollee more than $1,500 more per year than the current system. this is despite the fact that surveys have found that the majority of americans had less than $1,000 in savings. with only one study finding -- excuse me -- with one study finding that 63% of americans don't have the savings to cover a $500 emergency. remember what senator murphy showed. that's a bill that gives massive tax cuts to the wealthiest of americans shifting the cost burden so that the average enrollee now under this bill is going to see a $1,500 more per year payments, when the average

american doesn't have the savings to cover a $500 emergency. let me -- that's another question that folks are asking. what happens to a family whose child with a disability loses their access to home and support services, to physical and speech therapy? that they receive through medicaid if the republican plan goes forward? i was in a hospital today with such parents, telling me about children who the only way they got the coverage was because of the expanded medicaid. and now what happens under the republican plan? we know that medicaid is a critical lifeline for people and families with disabilities, providing access to things like rehabilitative therapies, that help children meet developmental goals. one of the incredible women, young girls i met today because of developmental therapy, she went from not being able to walk to now continue to do the things

that her normal teenaged peers and her twin sister is able to do. we know that today, 15% of kids are growing up with a developmental disability, and in new jersey, one in 41 children live with autism. but this plan we saw pass in the house threatens to make it more difficult for children with disabilities to receive the care they need, to go to school and to live healthy lives. losing coverage can mean the difference between a child with a disability achieving a developmental milestone or falling further behind, and unfortunately in the republican bill that passed the house that's exactly what will happen if it should become law. if that bill passes, what happens to older americans who don't get qualified for medicare but still need access to critical health services? well, we know that because insurance companies would likely be allowed to change older

americans to much higher premiums, premiums under the republican plan. remember, it used to be capped. the costs for older americans used to be capped. it's now being estimated that americans between the ages of 55 to 64 would pay some of the highest increases. it seems to me that wave would be $5,200 more per year. standard and poor's -- standard & poor's actually estimated that premiums for a 64-year-old could increase by 30% under the republican bill that passed the house. the congressional budget office noted in their report on the house republican health care plan that, and i quote, although the agencies expect that the legislation would increase the number of uninsured broadly, the increase would be disproportionately large among older people with lower income,

particularly between people between 50 and 64 years of age with incomes of less than 200% of the federal poverty level. think about that for a second. executives in insurance companies, the richest would get tax breaks into the hundreds of thousands of dollars but the poorest folks, elderly in our community, according to the c.b.o., would see their costs go up considerably. the new jersey hospital association noted that, and i quote for them, under current law, a 64-year-old making $26,500 a year will pay an average of $1,700 in annual premiums. under the ahca, the republican plan in the house, that same individual making just above minimum wage, they will pay under their plan $13,600 --

between $13,600 and $16,100 in premiums. that's the increase for older americans, working americans. that's the increase. we know that if more older americans lose their health coverage and in turn enter medicare in worse health, our entire medicare system is made weaker and less solvent. and if this bill passes, what happens to older americans who have already spent their life savings in nursing homes? well, we know right now elder americans that are in nursing homes that medicaid actually covers the costs of two out of three of those individuals. in the piece that just ran this past weekend in "the new york

times," and i quote, roughly one in three people now turning 65 will require nursing home care at some point during his or her life, one in three. over three-quarters of long stay nursing home residents will eventually be covered by medicaid. many american voters think medicaid is only for low-income adults and their children for people who aren't, quote-unquote, like them, but medicaid is not somebody else's insurance. it is insurance for all of our mothers and fathers and eventually for ourselves. i continue the quote. mr. trump and the republicans would lower spending on the frailest and most vulnerable people in our health care system. they would like most americans to believe that these cuts will not affect them. only their, quote-unquote, undeserving neighbors. but that hides the truth that

draconian cuts to medicaid affect all of our families. they are a direct attack on our elderly, our disabled and our dignity. i want to wrap up with just this concluding thought. we know right now that we are at a turning point in our country, that the process that has made this deliberative body known throughout the land, throughout humanity, that this deliberative body is about to alter its traditions and have a bill that affects tens of millions of americans done and crafted in the back room without public input will be rushed to this floor. that's what the process is right now. it was martin luther king in a speech to the medical community for human rights in 1966 that

said of all the formats of -- forms of inequality, injustice in health care is the most shocking and inhumane. this bill will perpetuate injustice in our nation. it will further the gulf between the haves and the have-nots, but it will not just target those most vulnerable, the elderly, the poor. it targets all of us. it targets our character as a country, our highest ideals, the very core of many of our faiths. to the least of these, the least of these, we cannot allow this legislation that will so hurt our country to be crafted in darkness behind closed doors, that subverts a tradition, a mighty tradition of the world's most deliberative body to be rushed through when it will

cause so much damage to so many americans, and indeed the very soul of our country. mr. president, i yield the