on, we can talk about some bits of segregation but certainly that would be one, the opportunity to have contact with people of another class.and that's at the beginning, the melding of the black middle class in detroit. >> join our life three hour conversation with mister boyd with your calls, emails, tweets and facebook questions sunday at eastern on book tvs in-depth on c-span2. >> we take it back alive now as the u.s. senate returned from a short recess. >> last few days have proven once again that political change in america doesn't start in washington, d.c., and then trickle down. it's from the bottom up. because millions of americans

called and texted and tweeted their opposition to an abomination of a health plan, that plan is not going to be on the senate floor this week. thanks to grassroots america, it is so appropriate at this hour. i also want to make clear that we've got a bottom line for the next two weeks. we've got an incredible amount of heavy lifting that we've got to do to make sure that working families and seniors get a fair shake from the american health care system. i say that because, as we speak, senate republicans are at the white house strategizing with the president. the horse trading has already begun, and the senate republicans have a slush fund

paid for by working families that contains hundreds of billions of dollars that can be used for sweetheart deals that would get them the 51 votes needed to pass this horrendous health bill in the united states senate. now i'll turn to what we need to focus on in the next two weeks at town hall meetings, civic group lunches, discussions with rural health care providers, and that focus has got to be to highlight what this flawed republican bill really means and how it can't be fixed, no matter how much money the republican leadership throws at these problems. this bill is a health care

smash-and-grab designed to benefit the fortunate few, and it's paid for by hundreds of billions of dollars in reductions from medicaid. tax breaks for the wealthy that senate republicans are so anxious to dole out they're willing to make them retroacti retroactive. contrary to what senate republicans say, their tax changes don't create jobs; they do create tax windfalls. exhibit a: under their bill, you have a million-dollar capital gain in february, and if this bill passes, that lucky person would get a $38,000 tax break. many of these gains go directly

into the pockets of america's 400th most affluent families, while disabled kids, those with opioid addictions, and families where a baby boomer has the misfortune of having a stroke and needs nursing home care face the prospect that the crucial health services they need, services that are life and death for them, won't be there because of this flawed health bill. next i want to point out that over the next two weeks we're going to lay out how this legislation would send costs into the stratosphere for millions and millions of americans. start with older people who are about to get hit by what i call a double-age tax. if this bill goes through,

insurance companies will have a green light to charge older americans more than they charge younger people, as if that doesn't raise their costs enough. older americans are also going to be forced to pay a higher share of their income on health costs because the senate republican bill shrinks their tax benefits as they age. older americans need more health care. they can't afford to skimp out on bare-bones insurance. so many of our older people are going to see their premiums nearly quadruple. and it is not just older americans who are going to see their costs jump. right off the top, hundreds of thousands of middle-class families across the country are going to lose tax cuts for health care because the republican bill snatches away

their eligibility. and when it comes to the private insurance market, this bill is centered on a plan to push americans into bargain-basement health coverage. after all the talk about deductibles and out-of-pocket costs being unaffordable, this republican proposal ties middle-class benefits to high-deductible, low-value insurance plans. it's a sleight of hand to make it look like consumers are getting a better deal and lower premiums. but here's the reality, mr. president: of course you can make premiums go down if you force people into insurance that only covers band-aids and a bottle of aspirin. when people get sick or suffer an injury, they're going to read the fine print on their insurance. and with this legislation, if it

were to pass, they would see sky-high deductibles and cut-rate coverage. we would face for working families the prospect they'd get buried under medical debt because their insurance doesn't cover the care they actually need. finally, not even people who get their insurance at work -- mr. president, those folks probably thought they were home free in this debate. not even folks who get their insurance at work are safe from the senate republican health plan. four million americans are going to lose their employer-sponsored insurance coverage just next year, if this bill goes through. tens of millions of americans could once again face some of the worst insurance company abuses: annual and lifetime limits on coverage.

those are limits that the affordable care act banned. but republicans are proposing to bring them back. and let's be real clear, mr. president. you bring them back -- you bring them back, and you don't protect people from sky-rocketing costs, it means that if they develop cancer, they could bust through their coverage limit and, once again, we'd go back to the days in america where those folks were forced into personal bankruptcy. because millions of people without coverage will be unable to pay for the coverage they need, people with employer-based insurance are going to get hit with a hidden tax in the form of higher premiums. so if an american listening to this is considering early retirement, think again. the costs could well be too high. if you are thinking of leaving your job, becoming an

entrepreneur, and starting your own business, you can think again -- especially if you have specific medical needs, your costs could be higher under this plan. and then there's the generation of adults in the workforce today, people who are middle-class, who are doing everything they can to support their families and save whenever possible. they may not be thinking about the expense of long-term care, but the fact is, growing older in america really costs a lot. because of this bill, millions of people will no longer be able to count on medicaid being there to cover their long-term care in a nursing home or at home where they're most comfortable later in life. so, mr. president, i want to close by way of saying that what we have to do now is to make

sure that to beat this destructive republican bill -- this is the only way to do it -- is for americans to keep tweeting, keep sending letters, keep finding rallies to attend, tell your stories about how you're going to do worse with this bill, and then tell your friends' stories and your families' stories. it is a virtual lock that this bill is going to come back around. so -- so i close today by way of saying groots -- grassroots america, by speaking out, the fact that they did that and did all that work that i've described as to why this flawed bill is not going to be voted on in the united states senate this week, but we need everybody over the next two weeks, seniors and working families and people all

across this country, my message is we need you to stay out because that is the only way we will finally stop this bill in its tracks. i yield to our friend from maryland, senator cardin. mr. cardin: mr. president, i want to thank senator wyden for his leadership on this issue and so many issues. his position on the senate finance committee as the ranking democrat. he serves this body very well, and he's done that today and outlined the fall of the health care bill that was presented just a week ago by the republican leadership and what it would do to our health care system. mr. president, i just want to acknowledge that i am very proud to have been in the congress when we passed the affordable care act. millions of americans today have coverage that didn't have coverage prior to the enactment

of the affordable care act. i'm also proud about the quality of that coverage. that coverage has guaranteed benefits so that individuals know that they will be covered for their needs. no preexisting conditions, no caps. and it is affordable, and we made sure that it was affordable for the people of this nation. i've listened to the debate from some of my republican colleagues about how the affordable care act is collapsing under its own weight. nothing could be further from the truth. the problems that we are experiencing with high increases in individual marketplace is caused in part because of the actions of the trump administration to try to undermine the affordable care act. let me just give you an example in my own state of maryland where carefirst, the largest carrier in the individual

marketplace, sought about a 50% increase in individual rates, and they were very direct. at least half of that increase is a result of the uncertainty of the trump administration putting the cost-sharing payments into the budget. that raises the premiums for all of those individuals in the individual marketplace. and the uncertainty as to whether the trump administration is going to enforce the requirements that people buy insurance, which means only the people who have the higher risk are likely to buy the insurance, raising the price for those who want to buy insurance. so when we talk about the fact that there is increased costs beyond what we think is reasonable, recognize that it's the actions of the trump administration that is causing a large part of that premium increase. which brings me to the bill that was unveiled last week by the republican leadership. it moves us in the wrong

direction in trying to fix the problems. it does that because it decimates the medicaid program, which has been the largest expansion of coverage has been in the medicaid program. this bill was significantly cut back, as c.b.o. has scored, a total of 22 million individuals who have insurance today will lose their coverage, but it does more than that. it does that for one reason. not to make health care more affordable. it does that in order to give tax cuts to the very wealthy. so, mr. president, i am glad that we now have a little cooling off period. we are not going to come back to the bill for about another ten days, it looks like. and i just want my colleagues to know, as proud as i am of the affordable care act, i acknowledge that we can make it better, and i hope democrats and republicans will work together to move in the right direction on improving the affordable care act. let me just give you some

examples. we know there's a high cost on the premiums, higher increase than we would like. why don't we join together to make sure that there is predictable cost-sharing provided to the companies that are in the individual marketplace? that would reduce the uncertainty and reduce the premiums in the individual marketplace. why don't we work together, democrats and republicans, to increase the subsidies that we provide to low and middle-class families so that the premiums will be more affordable? we intended to do that under the affordable care act, but after we got the cost scoring, we had to trim that back. so let's work together, democrats and republicans. those two changes, those two changes alone would deal with the concern that in the individual marketplace, we're seeing large premium increases. together, we can solve that problem. and why don't we work for more competition? i have heard my colleagues talk about the fact that some of the

insurance companies are leaving and some aren't, mainly because of the uncertainty of whether they are going to get their rightful payments for cost-sharing, but we can do something about that. why don't we democrats and republicans come together and say that there should be a public option with no public subsidy. so to level the playing field of competition. that way we are guaranteeing to every market in the country that there will be coverage for the people in your community. that encourages more competition. that gives stability in the marketplace. we could do that together. and then democrats and republicans, let's work together to bring down the overall cost of health care in this country. we made proposals that why are we paying more for prescription drugs, twice as much as our canadian friends? because they have an organized market and they negotiate as an organized market. why don't we come together and say let's take the entire market that we have for the government

paying prescription drugs, have one negotiation that would significantly bring down the costs of prescription medicines? and why don't we build on efforts that we have done for collaborative health care for value-based reimbursement that will significantly reduce the costs. we have seen that in mental health in addiction. we can see the same savings in kidney care and in diabetes and heart disease. so, mr. president, there are ways that we can improve the affordable care act. democrats are ready to work with republicans to get that done. what we won't do is make this current system worse. we're not going to cut the medicaid program in order to provide tax cuts for the wealthy, but join us in improving the law to make premiums more affordable in the individual marketplace, to bring more competition into the program and to drive down the overall cost of health care in this country. that's what democrats stand for, and we're ready to work today

with republicans in order to get that done. i would encourage our colleagues to work together, and let's improve the health care system. mr. wyden: would my colleague yield for a question? mr. cardin: i yield to my friend. mr. wyden: i know my friend from maryland is a real expert on this whole matter of private insurance, going back to your days in the state legislature and i was director of the gray panthers. i think what you're saying is that it is critically important that we get more predictability and more certainty in the private insurance market. and what i'm struck by is, of course, this is the private sector. this is not the government. this is the private sector. and the president has been basically pouring gasoline on the fires of uncertainty in the private insurance market because he is always in or out on this question of cost-sharing and the private insurers then say we

can't really predict what our rates are going to be, and maybe we've got to pull out or maybe we have to raise rates. could you just highlight again your thoughts with respect to more predictability and more certainty? it's such an important point. after my good friend from maryland has made that point, i know the senator from delaware is interested in the same subject. mr. cardin: mr. president, senator wyden is exactly right. i have met with the largest insurer in maryland and have gone over their rate requests for this year, and they told me directly that the largest amount of their premium increase request is based upon the uncertainty. they don't know whether the cost-sharing is going to be put in the budget or not, and they have to make their decisions on rates now. not knowing that, they have to cover themselves, and they're asking for a rate increase under the concern that that cost-sharing may not be in the

payment. now, that was not only envision, we thought it was mandated in the affordable care act. now the president's talking about, well, maybe i'm not going to put it in. we have seen some of those other activities. so if you're an insurance company and you're answerable to your board of directors and you know that this payment is how you're able to get low deductibles and co-pays, but you're not sure you're going to get the federal payment, you know that your consumers, customers are going to want those low cost-sharing, you have to charge a higher premium just to cover yourself, and that's exactly what was done in maryland. exactly what was done in maryland. and if we would have had the president of the united states say that money's going to go in the budget, into the program because that's what congress intended, we would have had significantly lower rates in maryland in the individual marketplace. predictability is critically important. a senator: would the senator yield? mr. cardin: i would be glad to

yield to my senator from delaware. mr. carper: senator cardin and i serve together on a committee called the environment and public works in the senate. one of the issues we deal with is clean air. this conversation about predictability and certainty that businesses seek is not just in health insurance. it's in all kinds of cuts for business across the country. i remember being in a conversation eight, nine years ago with, i think, lamar alexander, senator alexander of tennessee was with us. we met with the c.e.o.'s of a number of utilities across the country. and senator alexander and i were pushing legislation in response to president george bush's proposal called clear skies, which was designed to reduce the emission of mercury and sulfur dioxide and carbon dioxide. and we talked with these

c.e.o.'s from across the country for, i don't know, an hour or more in my office. finally, at the end of the conversation, we had been talking about reductions in x percent and y percent and so forth in the emissions from these harmful pollutants from primarily coal-fired utilities, and at the end of the conversation, as it was about to finish up, this one older fellow representing a utility down in the southern part of our country, and he is sort of a curmudgeon-like person. he said, senator, this is what you need to do with respect to the restraint on emissions, production of emissions. he said here's what you need to do. you need to tell us what the rules are going to be. you need to provide us some certainty and predictability and give us a reasonable amount of time to comply and then get out of the way. i will never forget that conversation. tell us what the rules are going to be, provide us some certainty and predictability, a reasonable amount of time, and get out of

the way. and it's not just utilities that want some certainty and predictability, but so do others. and particularly as iew tilts need predictability, so does insurance. what happened is we assured when we passed the affordable care act -- it's always helpful to remind everybody that the -- we tend to focus just on the exchanges at the marketplaces and the 50 states which provide health insurance for maybe 5%, 6%, 7% of americans who get their health care coverage. most people get their health care coverage from the employer-provided programs. maybe 20%, 25% get their coverage through medicaid. i used to think medicaid was health care for poor women and children. i don't know when senator cardin was the speaker of the house in

the maryland general assembly, but when i was elected state treasurer, i used to think medicaid was health care for poor women and children, not much else. as it turns out, it's a lot more than that today. but 20%, 25% of folks get their coverage there. another 15% or so in -- medicaid, another 15% or so in medicare. and the rest is in the exchanges. every state has the exchange. that's for folks who can't get coverage anywhere else. the idea is to have some opportunity to participate in a purchasing pool. the -- we made a promise when we passed the affordable care act that we would do the kinds of things that senator cardin is talking about to provide certainty and predictability for the health insurance companies when they -- when they insure in these exchanges. the health insurance companies were reluctant to provide coverage to the folks that were going to get coverage through the exchanges. as my friend will recall, some of these people hadn't had health care for months, years, maybe even decades, in some cases maybe never in their

lives. so nobody really knew how much health care they would need, except we knew and the insurance companies knew these people need a lot. they would need a lot. as my friend said, we provided for some ways of reducing that in -- reducing that lack of predict. it's like lucy and charlie brown and the football, when she pulls the football away and always fools him. he kicks and misses every time. we start of did that with the insurance companies. we assured them that we'd helped them provide some stability and then we took away the very mechanism designed to do that. and i think what my friend is saying is we need to come back and provide assurances. there may be three ways to do it. one, with respect to reinsurance. two, the risk -- insurance to

cover the risk costs. the and the third is to do something, if we don't continue with the individual mandate, we need to come up with something that's very much like the individual mandate that is not as harmful as what our republicans are suggesting, the six-month lockout. i just don't think that's huma humane. mr. wyden: will my friend yield? mr. carper: i would be happy to. mr. wyden: my friend, as a governor, really has helped to educate me over the years on this whole question of the states being the laboratories of democracy and trying fresh approaches, and delaware has done that and oregon has done that. i ask my friend, as a former governor, what would it mean you to if you are staring at a 20% or 25% reduction in medicaid? because, as you know, that's what's contemplated with the senate republicans. mr. carper: i was governor from 1992 to 2001, started a recession, started with six, seven really strong years in the

clinton administration. and we were able to balance budgets eight years in a row, cut taxes seven out of eight, got triple-a credit ratings across the board. the person that was my secretary of finance is now our governor, john carney. and ben knows him, i think, pretty well. a wonderful member of congress, a wonderful lieutenant governor before that. but he's looking at a budget of less than $4 billion, he's looking at a $4 million they will fill. -- $4 million hole to fill. what's being proposed by my republican leakers it would not make that $-- what's being proposed by my republican colleagues, it would not make that $4 million hole any smaller. our legislature is struggling enough to try to fill a $4 million hole rather than trying to figure out something bigger. so i share that with everybody.

laboratories of democracy. some people would like to have medicare for all. one of my colleagues -- several of my colleagues are interested in a single-payer system. as a governor, i had the privilege of leading the national governors' association and heading up the national governors' association for best practices. the states can show us and take ideas and show us good ideas for other states or they can take ideas and show us they are they're bad ideas and we ought to enable them to do that. mr. wyden: would my friend like toed a anything else or should we -- to add anything else or should we yield? mr. carper: i would like to say a kind word about our presiding officer. he's heard me say this before. he may recall, having cosponsored legislation in 1993 authored by john chafee that

actually a lot of good ideas in it the idea of establishing exchanges in all 50 states, having a sliding tax scale, had the individual mandate in there to make sure young, healthy people got coverage, too. we didn't end up leaving the health insurance companies a pool of unhealthy people to insure. and there was a prohibition against insurance companies denying coverage. i just want to say that our republican friends who took that idea and mitt romney used that to establish romneycare when he was governor of massachusetts. it worked there. it was not perfect but it worked there. it took a while. we shouldn't give up 0en that idea. and there are ways we can fix it. senator cardin has talked about some of those ways. i'm sure senator wyden as well. we should -- and i would stop with this. i just heard john kasich on one of the interviews -- one of the

shows on tv. he said these words with governor hickenlooper. he said -- the fellow moderating the show said, we've got to stop being just democrats or republicans on this. folks want us to be americans on this and to work together. that's what i think what i'd like to do and i think we can do that in a way that brings credit not just to our party but really to our country and accomplishes the three things the president has talk the about. better coverage for everybody, better quality coverage for less money. there are no way that democrats or republicans by themselves are going to do that. but if we work together, all things are possible. mr. wyden: before senator cardin leaves the floor and we yield to our friend with a washington who also is so knowledgeable about health, i just, on this point of the states being the laboratory of democracy, during the garrett, as my completion will recall -- during the debate, as my completion will recall in the affordable care act, we wrote a

provision 1532 that gives the states the authority to do better to come up with, as senator cardin has said -- excuse me, as the distinguished senator from delaware said, senator carper, it is a chance to do better and to try out those fresh ideas like my colleague has been saying. the problem is, with the senate republican bill, they're talking about giving the states the right to do worse, to waive out of some of these essential protections. so again i think this is a natural for something that could be bipartisan, where democrats and republicans could work together to really encourage states to do better. but let's not go the other way and abuse that provision in the affordable care act so that states do worse. i thank my colleague. the senator from washington. ms. cantwell: mr. president? mr. president, i join my colleagues here from the finance committee, and although i don't want to admit it, it was 10 years ago that we had this

discussion in the finance committee. my colleague from maryland and from delaware and from oregon. and i think what people don't realize -- even the presiding -- the president knows that we spent a lot of time talking about health care. this was not a, let's have a few meetings and let's roll how the a bill. there was a very, very long period. in fact, the president knows that in fact our side got a lot of heat for a lot of dialogue that happened with them. and our colleague from maine, at the time, a lot of heat for the dialogue with her. and there was a period of time, about six or seven months, where every single day i went to at least one thing in the discussion of the health care policy. at least one thing every day for, like, six months. that wasn't even the markup, that wasn't even the meetings. that wasn't -- that was just a time period where the committee

had designated various subgroups that we would talk about policy. i don't know if the two of you remember that period, but my recollection is every single day i was going to something regarding the health care policy and listening to experts and recommendations. and then of course we had these -- i call them more roundtables than hearings. we had a lot of roundtable discussions. then we went through a very, very formal bill process. so there is a little bit of irony that we're the ones out here today still talking about this health care bill. i think because we know what the challenges were and we tried to address them, and we're not afraid to keep addressing them. we're not afraid to be out here today talking about solutions that we want to see as well. so i thank my colleague from delaware, my colleague from oregon, for both being part of that effort because it really was an unbelievable amount of time and energy and discussion

and formulation. and the notion that somehow now we would take something that's one-sixth or one-seventh of the economy and draft something up in a dark process and then throw it out here, i'm not surprised today that there aren't the votes. but the thing to do now is not -- but the thing to do now is not try to just break up some votes in the next few days and then come back in july. the thing is to sit down and have a serious discussion. i notice that a umconfirm my completion are down -- i notice that a couple of my completion are down at the white house and -- i notice that a couple of my colleagues are down at the white house. he's sitting there talking about the individual market. he's talking about the individual market in alaska. and all i'm thinking is the individual market in alaska, we're sitting here proposing -- the other side is proposing to cut 22 million people off of medicaid. what does that have to do with the individual market? nothing. so i don't know if people are ready to focus on this the way

we focused on it, you know, in that time period for more than a year, more than a year, day after day after day, in meetings and hearings. but i would hope what they would do is stop this proposal and sit down and have an open process and have a discussion on these policies because they're so important. now, we've been having all this discussion and a lot of frustration that people have talked about is set -- is the 7% individual market. and there are ways to fix and improve the individual market. i feel like i was fortunate enough to put forward one of the better ideas that has worked successfully, at least interwork being successfully in -- at least its working successfully in the state of new york. 650,000 people are on the basic health plan, as he think they call it in that state, essential care, that you can buy a premium for $500 on an annual basis instead of the $1,500 on the

exchanges for that population that is above the medicaid rate that needed to have a solution in the marketplace. there's 13 different people offering insurance to those 650 people. so that's obviously working. it's working. now, it got implemented late. new york did it in 2016 because they were off to the races. but other states should now consider this. what's so great about this in helping to address the individual market is because where we are on this side, we are willing to allow individuals that don't work for a large company to get the same clout as if they worked for a large company. because when you buy in bulk, you get a discount. americans know that. that's why they shop at costcoment. i-- that's why they shop at cost costco-. that's what they do in new york. 650 people have bundled up and are saying to the marketplace, who wants to bid to us on

selling insurance? the end result is more affordable insurance in the market. that's what they should be discussing down at the white house, not cutting 22 million people off of medicaid. that is not a smart idea. and i'm sure my colleagues here have already gone over this notion that once you cut people off of care, they just end up in the emergency rooms or exacerbated health needs. so longer periods of time to get access to health care, more complicated health care costs, rising premiums. when we've gone around our state, we've heard loud and clear from the provider community, the hospitals, that they saw downward pressure on price of private insurance because we expanded medicaid. and the economic numbers are out there now to show the same thing. so cutting people off of medicaid is not the solution to the individual market. i hope somebody down there at the white house brings that up.

in 2020 when medicaid cap, if it did go into effect, the analysis is that it would cost-shift $34 million per year to my state. they would be cutting people off of medicaid and then basically the cost would be $324 a million to ore our state. so you can imagine that our state doesn't have that money and isn't interested in picking up that tab. and by 2028, we would be cost-shifting $4.2 billion. so not something that is smart economics for us, and i just, you know, over the weekend visited virginia mason hospital in the northwest again. great success in delivery system reform. they've kind of implemented the toyota model of production. so literally faster turnaround time on lab reports, better expedience of nursing care.

i think it was something like a 72% reduction in insurance liability. i mean, huge successes by changing and improving the delivery system that helps put pressure down on price. this is what we need to be talking about. and there is much innovation that was in the affordable care act, and we need to now ask the question, what further things do we need to do to make sure that that kind of driving down cost is there in the individual market as well? but you are not going to drive down price. there are reports now out by the center o on budget priorities tt shows that the price will actually go up in the individual market if you cut people off of medicaid. basically, it will just increase by several thousand dollars the actual amount of money that the individual market will have to pay in insurance. so that clearly is not the solution. i urge my colleagues on the other side of the aisle -- i

hope they come back and say, it's time to work in a discussion about these ideas, in a broad way, not just another hail mary pass, just get rid of this notion that cutting poor people off of medicaid is somehow going to magically fix the individual market. it's not. and so i just thank my colleagues from the finance committee who went through all of that. and believe me, i'm telling you, these discussions went on for weeks and weeks and weeks. some people here are trying to come up with a score and get an answer, you know, in a week on this entire package. i think we probably debated probably for, i would say probably two or three weeks just on the motion of reforming the getting off of fee-for-service and focusing on a value index and getting the priorities of the delivery system focused on better outcomes at lower costs.

this is something that really should be a big priority in health care. and i remember we had private meetings, we had the head of c.b.o. come down and talk to us. we had hearings. we probably spent three weeks just on one concept of how effective that would be in the health care delivery system. so i just -- i see we're still here. we're still talking. we're still willing to improve this delivery system and make sure people have better access to care. and i thank my colleagues for including me in this discussion today. and i see my -- i just want to again thank my colleague from oregon, the ranking democrat on the finance committee. i know he knows exactly what i'm talking about, when we talk about innovation, there's so much innovation that he put into the affordable care act giving states the discretion. they already have all the discretion they need. they have all the discretion they need to keep innovating. and hopefully we will get our colleagues to follow suit, because this is where -- this is where we're going to deliver

better care at lower cost and help improve the access for everybody in america. so i thank my colleague. mr. wyden: i thank my friend from washington state who was for care coordination, moving away from fee-for-service, using bargaining power, locally driven approaches long before it really became a buzzword in american health care. i thank her very much for this. mr. carper: may i ask the senator from oregon to yield for 30 seconds? mr. wyden: of course. mr. carper: after we heard the news that republicans are basically going to to go back to the drawing board and see what they can come up with maybe during the july 4 recess, i did a radio interview with a station back in delaware. one of the questions that the interviewer asked me, the republicans have a lot of money to play with and won't the

republican leaders offer money to one senator after the other after the other to find out what they need in order to really get them to support this? and i said i hope not. i hope that's not what happens. what we need -- this is a time when we need to hit that pause button and rather than dole out money than try to draw this republican or that republican to come into the fold, if you will, why don't we spend some time, like the rooms that the senator from washington is talking about, spent all that time, a lot of time together democrats and republicans in hearings, private hearings and so forth, that's the kind of thing we need to do over again. if we do that, we might be surprised. we might surprise the rest of the country by how well that would work out. thank you. mr. wyden: i thank my colleague. senator warner. mr. warner: mr. president, let me join my colleagues on the senate finance committee and both express my concern about how we got here, but also acknowledge that an awful lot of

folks in virginia and a lot of decent folks in north carolina and folks across the country breathed a little bit of a sigh of relief today. but all that we -- that sigh of relief was just the fact that we have a bit of a reprieve from a proposal that in my years here, i don't think i've ever seen -- the presiding officer: the senator from virginia will suspend for a minute. in we're going to carry on a colloquy, the senator from oregon has to remain standing. mr. wyden: i thank the president. at this point we're just going to hear from senator warner. mr. warner: mr. president. the presiding officer: the chair recognizes the senator from virginia. mr. warner: thank you, mr. president. again, here joining my colleagues from, democratic colleagues from the senate finance committee and i believe that folks in virginia and for that matter, folks across the

country got a reprieve today when the majority leader indicated that we were not going to vote on the piece of legislation that he brought forward, a piece of legislation that has been acknowledged by the c.b.o., that would take 22 million americans off of health care, will transfer $700 billion to $800 billion depending on the estimate of costs currently joined by federal and state partnership in medicaid, thrust that cost upon the governor of north carolina, the governor of virginia and a host of others. and a proposal that i can't recall in my time here in the senate that has been as universally panned by organizations from the left, right, center and everywhere in between. and as perhaps the president is now acknowledging with the majority leader and a number of other republican senators that using his own quote, that

nobody knew health care was so complicated. well, the fact is the vast majority of members on both sides of the aisle have realized health care is extraordinarily complicated. it's why it took years to fashion the a.c.a. and why there are many of us, again, on this side of the aisle that will continue to say we acknowledge years after implementation of the a.c.a., there are many things that need to be fixed. but the only way they're going to be fixed is if we do it in a bipartisan fashion. instead, the legislation that we were going to vote on tomorrow would have actually made health care much more, much more expensive, less affordable and less accessible for a whole wide breadth of americans. don't take my word for it. don't take these other elected officials for it. let's look at well-respected bipartisan groups.

the american cancer society said that the bill that was, the majority leader put forward would be devastating for cancer patients and survivors. the american medical association said the majority leader's proposal violates the very first dictate of the hippocratic oath which said do no harm. obviously this bill would have done a great deal of harm. the american academy of pediatrics says the bill fails our children. the national center on addiction and substance abuse says the republican proposal will crush efforts to end the opioid epidemic. and the aarp says the proposal would leave millions, including our most vulnerable seniors, at risk of losing the care they need. but it's not just these leading health care organizations who have come out uniformly and virtually universally against

what the majority leader had proposed. i'm also hearing that virginians one day this week i attended an opening of the new pace program in fairfax, virginia. the pace program which i know the ranking member on the finance committee has been a big advocate of. the pace program, a program that works in an extraordinary way at keeping seniors in their home rather than having them migrate to a nursing home. well, folks at the pace program in fairfax were more than disturbed when they heard that the majority leader's proposal cuts medicaid by $772 billion. and that the per capita caps that allowed so many folks to get access to health care, particularly if they have individuals in their family that might have severe disabilities, the majority leader proposal,

those per capita caps would be actually taken off in terms of the amount of health insurance they could receive. the truth is medicaid coverage, 20% of all americans and covers about 40% of all poor adults and seniors. and in my state of virginia, for those folks in pace or a nursing home, literally two-thirds of seniors who receive any kind of care receive care through medicaid. the cuts in this proposed bill would devastate those seniors and their families. and the cuts won't save money because so much of this is just the old-fashioned trickle-down, that trickles down this responsibility to states that would either have to raise their own taxes to take care of those responsibilities or, frankly, put out seniors who receive this critical care. mr. president, i also want to share with you and my colleagues a meeting i had last week with a

series of families who came in who had children or adults who had devastating disabilities. i heard in particular from marlo dean from virginia who was there with her 15-year-old son dante with extensive brain disorders. he just received a medicare waiver. after being on the waiting list for ten years, ms. dean, dante's mother, said, quote, cutting medicated is -- medicaid is not the right thing. it is not the humane thing. other families, angie roanoke who traveled with her 22-year-old son joshua who has autism, said this is not what america ought to be about. rebecca wood who brought her daughter charlie from

charlottesville says she has private insurance, but she's wondering what would happen when that private insurance hit its cap, a cap that had been removed when they put in place the a.c.a. again, rebecca said our country is better than this. boy, oh, boy, is she right. so when our colleagues talk about cutting medicare, when they talk about cutting it at the numbers they're talking about, or putting caps back in place, i'd hope they realized that this was more than about numbers of a government program. this is about providing support to services, to families facing the nightmare of chronic illness or crippling medical illness and bills, quite honestly, that they can't pay on their own. it's about peace of mind for these families. i've said from the outset that

there were mistakes made in the a.c.a., and i stand ready to work with any member of either side of the aisle to make sure that we fix those mistakes. but this debate ought to be about health care reform, not about providing the wealthiest in our country a tax break they don't need or taking hundreds of billions of dollars out of medicare. so, mr. president, i look forward -- i hope our colleagues that will come back from this meeting with the president will come back with a renewed sense of cooperation and collaboration. i know there are other members of the committee that want to speak on this issue. i stand prepared to work with them and the ranking member from the finance committee to do this right. but it ought to be done in a way, whether it's rebecca and her daughter charlie, whether it's ms. dean and her son, get a chance to have their voices heard through a regular order process where at the front end of the process we can hear the concerns, get those concerns

vetted and make sure that legislation that gets brought to the floor is fully vetted and actually improves the quality of care for virginians and americans all across this country. with that, mr. president, i yield the floor. mr. wyden: mr. president. the presiding officer: who seeks recognition the senator from oregon. mr. wyden: mr. president, before he yields the floor, i just want to thank senator warner for his insightful comments. as a governor, he really understands why a medicaid cut of hundreds and hundreds of millions of dollars is going to permanently damage the lives of so many people. he saw it in virginia. i thank him for his comments. let me yield now to senator menendez. mr. menendez: mr. president. the presiding officer: the senator from new jersey. mr. menendez: mr. president. the presiding officer: the senator from new jersey seek recognition? mr. menendez: i do, mr. president. the presiding officer: the senator from new jersey is recognized. mr. menendez: mr. president, i ask unanimous consent that my full statement be included in the record. the presiding officer: without objection. mr. menendez: unfortunately i have a group of nordic

parliamentarians i'm hosting in a minute. let me first say i join my senate finance colleagues in this effort because i still think the legislative process matters, especially when you're dealing with matters of life and death, like health care. in 2009 and 2010, we had a painstakingly open, deliberative process while drafting our health care reform bill. in the senate finance committee alone, we held 53 hearings, round tables, meetings, consulted with patients, advocates, doctors, industry leaders. and only after months of bipartisan negotiations and marathon markups did we bring the health care bill to the floor. and when we did, we spent 25 days debating it in full view of the american people. that's how we passed a law that protected americans with preexisting conditions. that is how we stopped health insurance companies from dropping consumers the moment

they got sick. that's how we passed a law that delivered coverage to nine out of ten americans for the first time in history, because when you have an open deliberative, bipartisan process, you can deliver real progress to millions of americans. but -- but when you have a backroom partisan process, you get an ugly partisan bill, and that's what we have with the senate republican health care bill. it's an ugly bill in terms of what it does to speechle. it's -- people. it's borne of an ugly process and has ugly consequences for the american people. just last night, as we all heard, the c.b.o., congressional budget office, the nonpartisan scoring division for all of us, democrats an republicans alike, said 22 million will lose their health insurance, and this was -- mind you this was a plan that was supposed to be better than the house republican version. well, that bill was mean.

this bill is down right nasty because it takes health care away from those who most need it only to give tax cuts to the warren buffets and donald trumps of the world who, fortunately for them, don't need it. it's amazing me that for years i heard my republican colleagues rail against the affordable care act, or as they call it obamacare, pledged to repeal it and replace it with somebody r something better. they had seven years to decide what that would be and then only on a plan that was put out late last week, we see the consequences of something that was rushed together by 13 men, no women, and nobody creating the diversity of america as it relates to their health care. that's just fundamentally wrong. i'm not surprised that many of my republican colleagues revolted against it, at least at this point. the question is whether they will continue to demand of the

their -- of their party and of all of us the type of health care that wean want to see for -- that we want to see for each american. because they will have to pay higher deductibles all for less comprehensive coverage. pay more for less. and it rolls back key consumer safeguards. there's a difference between a guarantee -- when we hear the word entitlement, we're really talking about a guarantee -- a guarantee against lifetime limits. you have a serious disease, you come up to that cap in your insurance, you still have a disease, you still have cancer, still fighting it and trying to save your life but you don't have anymore money. we eliminated. there is no guarantee of continuing that safety under the republican bill. there is no guarantee that you

send states and give them waivers and that they will truly have a guarantee against preexisting conditions not be a prohibition against getting health care. finally, if you're middle class and middle age, this bill gives you nothing, nothing. if you're an older american, it costs you enormously. let me make my final point about medicaid. i'm tired about medicaid being only about the poor, as if the poor don't deserve health insurance. they certainly do. medicaid is about a lot more than the poor. in my home state much new jersey 60% of medicaid recipients are either seniors or those disabled. they didn't choose to be disabled in their life. they were born with or developed a disability. they deserve the full potential of their god-given potential as anybody else does. medicaid provides them the ability to be a successful part

of our society. medicaid provides for pregnant mothers who may not get insurance elsewhere, medicaid takes care of special education students in our schools and, yes, medicaid takes care of the poor. medicaid expansion helps those go to work in some of the toughest jobs in my state and in our country have the dignity of having health care and being able to stay healthy so they can work. we want them to work. yet, we take away the very health care that is the essence of being healthy so they can work. that's not the america i know. that's not the health care that was promised. we can do better and we can do better together. what we need to do is get over the mantra of, just let's repeal the affordable care act, instead of improve it. if we want to improve it, improve the health care of americans, you will find a lot of democrats that will do that. the presiding officer: the senator from oregon. mr. wyden: mr. president, i believe we are very close to

consuming the hour that the finance democrats have had. so i would ask unanimous consent at this time that senator casey be recognized for his remarks and at the conclusion of his remarks i be recognized for some final comments. the presiding officer: is there objection? without objection, it is so ordered. mr. casey: mr. president. the presiding officer: the senator from pennsylvania. mr. casey: mr. president, i seek recognition to continue this discussion with regard to health care. i ask consent to speak as if in morning -- as part of morning business. the presiding officer: without objection. mr. casey: thank you, mr. president. i rise to talk about an issue that some of us have talked about, but i think it's an issue that's just barely breaking through now. there's been a lot of discussion in the debate so far about various aspects of the bill. we know that the bill in its current form is about 142 pages, i guess. in more than 60 of those pages

deal with one topic, medicaid. this is basically a medicaid bill and tax cut bill. the two are not just referred to on a regular basis in the text, but i would argue they are actually in conflict with one another. i was on the floor last night in showing a -- and showing a chart that basically indicated that the top 400 households in the country would get a tax cut of $33 billion. just imagine that. 400 families gets dz 33 billion you the -- $33 billion out of the bill -- the house bill, but it hasn't changed substantially at all when it comes to tax cuts -- and then on top of that the medicaid cuts in just four states add up to the same number. so we have $33 billion in cuts on medicaid for four states and $33 billion in tax cuts for 400 families. if you're within the sound of my voice and you're one of those

400 families, sorry, but i don't think you deserve a tax cut. here's another way of looking at it. this is the same basic information, but now instead of looking at four states, as we did last night, those -- those four states were alaska, arkansas, nevada, and west virginia where the total medicaid cut was for those four states $33 billion. here's one state, the state i represent, pennsylvania. the cut over time is $35 billion. now, the senate bill might move that one way or the other a little bit, but it's basically that's what it is. but you still have this number that we just referred to, $33 billion in tax cuts for the 400 highest income households in the country. nothing about that is fair. in fact, i think that's obscene. there are other words we could use that we shouldn't use on

this floor, but that's obscene. in the same bill you're ripping away medicaid over time and, as you know from the bill, when we -- from the c.b.o. report, as we saw last night, the house bill had the medicaid cut of 14 million people losing their medicaid coverage over the course of a decade. the senate bill, that number goes up by one million to 15. so 15 million of the 22 million who lose their health care coverage are from medicaid. as my colleague from new jersey just outlined, the folks who are low-income folks, folks with disabilities and folks who need to get into a nursing home. that's basically the medicaid population, children and adults, low-income children and adults and children with disabilities and, of course, seniors. those the basic inequity here.

i don't think anyone around the country if they really were looking at that comparison would say that is fair. how can that be fair in a health care bill. that a small group of americans gets that tax cut. by the way, it doesn't end there. it's not just the top 400 americans, it's a lot of other people as well. so if you're in any way wealthy, this bill is a bonanza for you. this is a once in after lifetime injection of revenue that you're rarely, if ever, going to see. why should a single family get millions and millions of dollars potentially under this scenario, tens of millions for one family. why should they get that kind of a break while others are losing their health care by way of the medicaid cuts or otherwise? so if -- if we're going to have a real process here that leads to a bipartisan conclusion, we've got to get serious about

the issue of health care. this is not a serious attempt to change our health care system for the better. a third greater -- a third grader could give away health care from a lot of people. that is an exercise that anyone can do. that's simple. but to fix problems in our health care system, to make sure that if you're living in a rural area and there's only one insurer, that we work to create some competition. to fix that requires some work. to fix had that requires bipartisan support. it's -- it's not this exercise that we've been going through so far. so i hope that folks on the other side can defend and go home and say, i voted for this bill -- or the updated version of the bill in a couple of days and weeks -- and i'm here to tell you that i not only voted for the bill, but i'm asserting that it's fair to give $33 billion to 400 households

and tear $35 billion -- 35 billion out of the medicaid program just for pennsylvania, just one state, and it gets worse when you add the other states. mr. president, i know our time is short and others are waiting to speak, but we've got a listening way to go to make sure that we're focused on some of the real challenges that we have in our health care system, not ripping away coverage from vulnerable americans in order to enrich people who need no help. they need no injection of a tax cut. in fact, they don't even want the tax cut. i was at a town hall the other day and a doctor stood up and he said if the -- if the house version of the bill went through, this one doctor in pennsylvania would gets dz 20,000 -- $20,000 in a tax cut. he said i don't need that, i don't want it. he wants to make sure that people in medicaid still get

their coverage. mr. president, i yield -- i yield the floor. the presiding officer: the senator from oregon. mr. wyden: mr. president, i was struck when senator menendez talked about the senate republican health bill being more for less. i think millions of americans might say it's classic bait and switch. after the horrible house bill was passed, senate republicans and the trump administration promised something new. it would have more heart, it would be less mean, but essentially what they have done is doubled down on exactly what the american people rejected in the house bill -- the secrecy. the fact that the breaks went to the fortunate few and the pain went to millions of americans who needed nursing home care,

had youngsters with a special -- with special needs or who were disabled. and the fact is that the process that the senate republicans have used on this health reconciliation bill hadn't gone well. that's why they can't go forward with consideration of their health care bill this week and it looks like -- i heard remarks from one of our senior colleagues early this afternoon -- the same darn thing is going to be used for tax reform. once again, a bill processed behind closed doors without any input from the other party looks like the route that's going to be taken on tax reform.

i think that's unfortunate. i've made it very clear -- very clear -- to the trump administration that the history of successful tax reform is bringing both sides in early and finding a way to secure principles that each side feel strongly about that the other can live with. there has been no such consultation -- zero -- with respect to this administration and democrats on the finance committee. i'm struck, mr. president, because i've written over the last decade what are the only two bipartisan federal comprehensive tax reform bills. first, with our former colleague, the distinguished senator from new hampshire, senator gregg, and most recently

with the new head of the office of national intelligence, senator coats. and we've had no consultation on the substance of tax reform. that that is a prescription for trouble. it is in effect walking away from the history that the only way to get a sustainable bipartisan tax reform plan is to get both sides together, not do what is being discussed now openly in the media that the republican leadership and the trump administration are just going to write a tax bill, write a tax bill and then just pop it on the american people in the fall. and i anticipate it will be more of the same in terms of stacking the deck dramatically in favor of the fortunate few. so i say this because we heard

again what appears to be the plan of senate republicans to kind of double down on the flawed strategy of health care, which is just do it in secret and then expect to see if maybe they can get a couple of democrats to go along, and then they can say that's a bipartisan bill. that's not a bipartisan bill. a bipartisan bill is the kind of work that was done in 1986, where my predecessor, senator packwood, bill bradley of new jersey -- another tall democrate committee, a big group got together and worked out a bill that made sense and broadened the tax base, gave everybody in america a chance to get ahead. so i'm going to close this afternoon, mr. president, by way of saying that my hope is over the next two weeks that the

american people in terms of defeating a flawed health care bill and showing that there needs to be a different path for tax reform, that they keep making those calls, they keep tweeting, they keep texting, they keep going to rallies, they keep going to meetings where health care providers get together and say look, this health bill that republicans are talking about doesn't work for us. it doesn't work for us, and it doesn't work for our parents and our grandparents and youngsters and the disabled folks and those who need opioid services. so i close this afternoon -- and i thank my colleagues again from the finance committee. we had something like eight colleagues participating in this over the last hour.

i would just say the american people, the reason that we have been able to hold off this horrendous senate republican health bill is because grassroots america showed again the political change doesn't start at the top and trickle down. it comes from the bottom up. it was all of that citizen involvement that has caused the republican leadership to put this bill off. but it is a lock, an absolute lock that it is going to come up again in a couple of weeks. so i want to say as i wrap up my remarks this afternoon, mr. president, that i hope over the next two weeks that the american people are allowed, that they come out to their elected officials events, tell them what they're for, what they're against. and with that, mr. president, on behalf of the senate finance democrats, i yield the floor.

the presiding officer: who seeks recognition? mrs. murray: mr. president. the presiding officer: the senator from washington. mrs. murray: thank you, mr. president. mr. president, before i go any further, i want to make something absolutely clear. this health care fight is anything but over. trumpcare is not dead, not even close, and we cannot let up. now it's no surprise that senate republicans needed another week to try to jam their trumpcare bill through given everything it would mean for families' health, their financial security, and their lives. so while we don't know what kinds of back room deals senate republican leaders will cut or which republicans will decide they care more about towing the party line than protecting the patients and families in their states, but here is what we do know: the majority leader is not going to give up. he wants to get to yes, and so does president trump. so the back room deals and arm twisting are going to go into overdrive starting now. that's why my message to every

patient and family, every mom and dad, adult caregiver, doctor, nurse, teacher, anyone who believes trumpcare would be devastating for their community is do not let up the pressure. we saw what happened in the house, and we need to keep fighting. and democrats are going to keep fighting along with all of you. now, mr. president, you have to ask, given how mean this bill is and how clearly patients and families are rejecting it, why aren't my republican colleagues pushing ahead? it's not like this is some kind of foregone conclusion. at any moment republicans can drop this effort and work with democrats on health care policies that actually help patients and families and not hurt them. but it is clear right now republican leaders are not interested. in fact, they've done just about everything possible to prevent not just democrats, but

anyone, including most of their own party, from being involved in this process. mr. president, as democrats have made clear, this is unprecedented. i was here when the affordable care act was debated and passed. we organized dozens of bipartisan meetings. we held hearings. we took amendments from both sides, and we certainly did not leave the fate of women's health care up to a few men. but the republican trumpcare plan, no hearings, no scrutiny, no public input, no expert testimony. and why is that? because the bill isn't actually about health care. far from it. their bill is about giving a massive gift to the wealthy and already well-connected on the backs of children and working families and the sick and the elderly. and it is an enormous broken promise.

yesterday's c.b.o. report made that alarmingly clear. republican leaders promised to lower health care costs. this plan will actually raise them, especially for seniors. they promised not to pull the rug out from patients. this plan would take coverage from 24 million people and gut medicaid, with even deeper cuts, by the way, than the house version. they said that under their bill, no one -- no one would be worse off. well, tell that to a woman who would have to pay as much as $1,000 extra for maternity care or will have to see her local planned parenthood center closed. they said their bill would protect patients with preexisting conditions. read the fine print. the fine print said this plan is a back door way to put those patients' fate in the hands of insurance companies. and this is truly shameful.

republican leaders promised they were committed to tackling our growing opioid epidemic. but with this plan, all of our efforts, all the work left to be done by states would be at risk. that would be incredibly harmful. now over the past year i met so many families in my home state of washington who lost a loved one to the opioid crisis, in bellingham, in spokane, in yakima, in the tricities. community after community, i know the same stories are being told in west virginia and in ohio and kentucky and pennsylvania and states across our country. i've heard directly from people on the path to recovery who have told me how getting treatment and medicaid coverage changed their life for the better. what will they do under trumpcare? you know, mr. president, i'd be ashamed too if i had to defend this cruel bill over the upcoming recess. i would be ashamed if i had to

explain this bill to constituents of mine like jennifer england. jennifer is a woman from kent, washington. she's a mom, a softball coach, and a cancer survivor. because of coverage she had under the medicaid expansion, she decided to play it safe and go to the doctor to get a lump checked out, something she told me she wouldn't have done before. well, jennifer was diagnosed with invasive ducto carcinoma. it was about to spread to her lungs and could have been deadly. jennifer went through rounds of chemo, and trip after trip to the doctor, and on march 8 her daughter's 18th birthday, she was finally able to tell her daughter she's in the clear. now jennifer is terrified of what this bill would mean for her finances, for her family, for her life if her medicaid coverage goes away.

mr. president, i would be ashamed if i had to defend this bill to kelly hill from seattle. i met kelly during a tour of seattle's international health services community clinic and kelly shared with me that she has been living with h.i.v. for 17 years and has a son with a severe developmental disability. fortunately, kelly told me she was able to g.e.d. medicaid when she -- was able to get medicaid when she needed it most, in graduate school when she was first diagnosed and when she was pregnant with her son. today her son avram is 15 years old and he cannot be left unattended. he's going to need expensive care and support for the rest of his life. medicaid plays a crucial role to keeping avram active at home in their community and it allows kelly the opportunity to have a full-time job so she can support her family. kelly knows just how important access to health care is and the

harm and uncertainty that trumpcare will cause. so, mr. president, i want to be very clear. if republicans jam through trumpcare this month, they will own the consequences. they will have to defend this bill to people like jennifer and kelly in their own states, and they will be responsible for increasing families' health care costs, undermining protections for people with preexisting conditions, defunding planned parenthood and allowing insurance companies to charge women more. they'll be responsible for taking away care, for seniors, pregnant women and people with disabilities. now, again, republican leaders can still choose to drop trumpcare once and for all. i'm not going to take any chances, though, and neither should anyone listening who joins democrats in opposing trumpcare. i fully expect the back room deals to continue and to get even worse now that republican

leaders were forced to delay this week's vote. i just hope that republicans who are rightly concerned about the impact trumpcare will take a close look at the facts on the table. recognize it is time to change course and stand strong for their constituents. mr. president, that's what this debate should be about. making sure the people that we represent can count on the security of health care when they get sick, that they won't have to consider foregoing treatment for a sick child because they don't have the money, that they will be treated fairly and equally in our health care system. that's what i've been thinking about these last several weeks. it's why democrats have been holding the floor all these nights, participating in rallies and staying out on the capitol steps. it is why my friend, the senior senator from hawaii, took to the floor yesterday and bravely talked about what this fight now means to her personally.

as she said, everyone is only diagnosis away from a serious illness. and no one should have to worry about what they will do if and when that moment comes. mr. president, in this country, health care should be a right, not a privilege reserved for the few. that's what democrats are going to keep fighting for, and we will not let up. thank you, mr. president. i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

ms. warren: mr. president. the presiding officer: the senator from massachusetts.

ms. warren: mr. president, are we in a quorum call? the presiding officer: we are. ms. warren: i ask that the quorum call be lifted. the presiding officer: without objection. ms. warren: mr. president, i'm relieved that the majority leader has delayed a vote on the republican's cruel bill to rip up health care for 22 million people, people in massachusetts and across the country spoke out against this terrible bill and today they proved they can make their voices heard. but let's be clear, the republicans so-called health care bill has come back to life already more times than the scariest zombie in a horror movie. despite how deeply unpopular this bill is and how hurtful it would be to families across the country, senator mcconnell says he intends to vote as soon as the senate returns in a little more than a week. that means senate republicans still stand on the brink of passing legislation that will end health insurance coverage

for 22 million people in america. make no mistake -- if this plan passes, the rich will get richer and other people will die. i know that is a strong statement and i know some people don't want to hear it and i know some people will hear it, but they don't want to believe it, but facts matter. here's the fact that republicans simply want to ignore: people without health care coverage are more likely to die than people with health care coverage. for many americans health insurance is a matter of life and death. decades -- decades of rigorous academic reserve back this up. the data show that people with no health insurance die earlier than those with coverage. for example, a 2009 study published in the american journal of public health found that uninsured people died at

significantly faster rates than those with insurance. the authors claimed that lack of health insurance was associated with nearly 45,000 american lives lost in just one year -- 45,000 american lives lost in one year. that's more people in this country dying from lack of health insurance than from breast cancer. and the impact isn't limited to adults. john's hopkins researchers found that sick kids without insurance who end up in the hospital are 60% more likely to die than the children down the hall who had health insurance. in 2012, a study in the new england journal of medicine compared states that expanded medicaid, which provided coverage to millions of low-income americans, to those that didn't.

they found that for every 100,000 people in states that did not expand medicaid, nearly 20 more people died every year than in the states that expanded medicaid. that's right. more people died in states that refused to expand medicaid. now, we know a lot about this in massachusetts, which has been one of the best test cases for understanding how insurance affects death rates. we've been working for years -- long before the affordable care act -- to expand health coverage. today, with the help of the affordable care act, more than 97% of people in massachusetts have health insurance. that is the highest coverage rate in the entire country. researchers from harvard and the urban institute studied our health reforms to figure out the impact of expanding coverage. their results, a 2014 study

published in the internal medicine, found that their health reform was presented with a 4.5% drop in deaths. this data suggests that nationwide the a.c.a.'s coverage expansion are already preventing 24,000 deaths a year and it's a fact and only in only 31 out of 50 states. i could keep going, but the consensus is clear, a new study hot off the press put it bluntly, the case for coverage is strong. the reasons are actually pretty straightforward. people who don't have access to high-quality, affordable care, people who work as hard as they can but just don't have the money can't go to a doctor when they need to, can't get preventive care like breast

cancer screenings and vaccinations, can't fill the prescriptions they need to stay healthy. when someone doesn't have coverage, they typically wait to go to the doctor until things get really bad. when the cough turns into a rattle or when the lump gets too scary to ignore or the backache makes it impossible even to walk. this is the reason why everyone who actually works in health care, doctors, nurses, hospitals, patient groups, researchers, experts, everyone is coming out against the republican bill. the american medical association, the nation's largest association of doctors, says that the republican bill violates the most basic principle of medicine. first, do no harm. the national council for behavioral health is 290 member

organizations provide mental health care and addiction treatment for 10 million americans said the bill would, quote, cost hundreds of thousands of lives. national nurses united, representing 150,000 registered nurses across the country said the bill would, quote, prove to be deadly for our nation's seniors. the president of a leading coalition of safety net hospitals said about the republican bill, quote, let's not mince words. people will die. if the republican bill passes, people will die. that's what the health care professionals are telling us. the republican plan to kick 22 million people off their health insurance, they want to slash tax credits that help people afford their premiums.

they want to open the door to insurance companies offering plans with higher costs and less coverage. and why? nothing in this bill, not one thing improves health care for anyone. not one thing. nope. the only reason for this bill is to finance $569 billion in tax cuts for a handful of millionaires and billionaires. there has been a lot of concern about the discussion of health care getting overheated, but the facts don't lie. the academic studies don't mince words. if the republican health bill passes, tens of thousands of people in this country will die every year. republicans can ignore these facts. they can turn away from the studies. they can pretend they don't know what's going on.

but the people who lose their health care, the babies, the women, the seniors in nursing homes, the people with disabilities, the workers who get hurt on the job, the people who get hit by heart attacks and strokes and diabetes, they will suffer all the same. yes, if the republicans go forward with their bill, people will die. those are the facts. we have less than two weeks to make sure the republicans hear from everyone in this country who wants them to abandon this terrible bill once and for all. thank you, mr. president. i yield. a senator: mr. president. the presiding officer: the senator from rhode island. mr. whitehouse: i ask unanimous consent to speak for up to 15 minutes as if in morning business. the presiding officer: without objection. mr. whitehouse: thank you, mr. president. i am back for my weekly time to

wake up speech, which given the theme of the week here in washington is going to focus on the health consequences of what is going on in climate change, and it's timely to do so because just recently the national weather service issued an excessive heat warning for the southwestern united states. in california, san diego county set a record at, hang on, 124 degrees. 124 degrees. as a result of this heat, the weather service warned of -- and i'll quote them here -- a major increase in the potential for heat-related illness and even death. out in phoenix, arizona, they

got up to around 120 degrees. it got so hot that flights had to be grounded at the phoenix airport because of the hot air was too thin for the jet engines to get enough bite on the air for the planes to fly safely. the emergency rooms saw patients coming in with burns caused by walking bare foot on hot pavement or touching their cars that had gotten so hot in the sun that they were burned, and there were several heat-related deaths reported in the las vegas area and in california. this heat wave problem is not going away. heat waves like the one we are seeing in the southwest are becoming much more frequent, said robert e.copp, director of the coastal climate risk and resilience initiative at rutgers university. he went on to say, looking forward, we expect the amount of

extreme heat on the planet to continue increasing even more. with obvious health effects. it has gotten deadly serious in many places. in the 2003 european heat wave, there were more than 30,000 deaths across the continent, and the three-day 1995 chicago heat wave killed more than 700 people. so we need to pay attention as mr. copp concluded, this calls for a major rethink of the systems that we rely upon. this is not normal any longer. this week also saw the publication in the providence business news of an article by newton domley called "climate change's dire health

consequences." newton domley is a physician in rhode island, he is a leader of our medical profession in rhode island and just recently was the president nationwide of the american college of physicians. in "the providence business news," he writes the medical community is witness to the health effects of climbing now and not in some distant future. there are five categories of health effects that will not -- that will affect not thousands but millions of people around america and around the world. first as we just talked about we saw in arizona and southern california, he goes to say an increase in global temperature and frequency of heat waves will expose people to a risk of heat exhaustion, dehydration, headaches, weakness, nausea and vomiting, and/or heat stroke, high fever, stroke, confusion and coma. the most vulnerable will include the elderly with multiple heart,

lung and kidney conditions, multiple medications, and a poor ability to regulate their body temperature. but dr. domlen goes on to say that children will also be at risk due to their inability to thermoregulate, as will laborers who work outdoors and the homeless. he goes on to report that history tells us there have been 7,400 annual deaths between 1999 and 2010 in the united states, 15,000 deaths in france in 2009, 70,000 deaths in europe in 2003, and 15,000 deaths in russia in 2010 from heat waves. respiratory effects are another health consequence that dr. dr. donnelly elucidates here. respiratory effects from particulate matter and ozone results in exacerbation of asthma and other chronic lung

conditions. he continues that 55% of the u.s. population tests positive for allergens and 34 million people have asthma. the increased length of the pollen season and growth of allergen-producing weeds, grasses, mold, and fungus will lead to more exacerbation of asthma and chronic lung conditions at an annual cost of $56 billion per year with visits to the emergency room and hospital admissions. i was at a conference recently and saw a presentation by dr. dr. carrie netto who is the director of the sean parker center for allergy and asthma research at stanford university and professor of medicine and pediatrics. i'm going to borrow a few of her slides that relate to the asthma and allergen concerns. let me just start with this

graph which shows asthma prevalence nationwide and asthma prevalence in rhode island. in rhode island, we run a little bit higher for the experience of asthma than nationwide, and this is an issue that is important to us. it comes home to roost. dr. nado used this slide. this was exposure to extreme heat and precipitation events associated with increased historic of hospitalization for asthma. this was a study that was done in maryland, u.s.a., and as the temperature went up and there was extreme heat or precipitation, asthma hospitalization went up as well. she showed a graph from another study in new york that related

the e.d. visits, emergency department visits related to ozone, related to smog, which is a well-known asthma trigger, and the estimated increase in ozone-related emergency department visits for children in new york from the 1990's to the 2020's resulting from climate change related increaseses in ozone concentrations. so as the ozone concentrations went up, up went the ozone-related emergency room department visits. the dark blue shows places where the emergency department visits went up 10%. the lighter blue 7.8% to 9%. the even slighter blue 6.6% to 7.7%. and in these counties, up to 6.5%. globally, we see that pollen counts go up in conjunction with

increasing carbon dioxide. back in 1900, there were about 280 parts per million of pollen production. 370 parts per million we hit in 2000. i take it back. at 280 parts per million of carbon dioxide, there was five grams per plant of pollen production. at 370 parts per million of carbon dioxide, pollen production increased to over 10 grams per plant. we are headed for -- we're over 400 now, and we're headed for 720 parts per million, and at that point, we have more than quadrupled the pollen output. and we're seeing this happen not only in terms of the amount of pollen output that can trigger asthma, but also the length of the pollen season. so the months in which people who have asthma are vulnerable

are extending themselves. nearly 27 extra days. here at 24 extra days. 17 extra days. 19 extra days. 14 extra days. 13 extra days. we went through the middle of the country here and saw over and over the ragweed pollen season is getting long, worse for asthma sufferers. another thing that we have associated with climate change and with the die drought spells has been wildfires, and wildfires, for obvious reasons, put a lot of stuff, ash and things up into the air, and in this monitoring map of california, when the wildfires were going on, you could see these spikes in asthma activity. so here is before the fire, here is during the fire activity, and here it falls back down afterwards. the risks for asthma climbed dramatically during that period.

so wildfires present yet another climate-related risk for people who have asthma, and here's the wildfires in california shown to increase asthma as determined by the emergency department visits. and the emergency department visits climbed based on various risk factors. so when you're seeing folks have to go to the emergency department for asthma, that's gotten pretty serious. so there's a lot of concern for dr. donnelly's assertion that this is a concern we should pay attention to. he goes listen to list another concern, exposure to infectious disease from mosquitoes and ticks. he says it has and will continue to escalate there is a documented increase in chicken gunia, west nile virus and zika. he goes on to say, we'll likely

see a resurgence of malaria in certain areas of north america. other illnesses come from other consequences of climate change. he goes on to report, an increase in heavy downpours and flooding in america and the world will lead to an increase in waterborne diseases such as e-coally and other bacteria, salmonella, typhoid and cholera, parasites and viruses like hepatitis a and norwalk, with an impact on millions of people around the world. he goes ton cite also ex-strene extreme weather events which create stress, anxiety, depression. hurricane katrina led to 32% of people affected by the hurricane suffering from post-traumatic stress. seekers he concludes, we know that there will need to be a global effort to reduce

anthropogenic greenhouse gas emissions and that countries need to take a leading role in developing, implementing, and monitoring those measures. we need to reenter the paris agreement and move forward at the local and state levels for the benefit of our patients. he is a respected doctor in rhode island. he is a clinical assessing professor of medicine at graham university and he was just recently the president of the american college of physicians. now, i know my colleagues don't want to listen to any of this stuff about climate change because the fossil fuel industry controls them so much that they cannot even say the words in many cases "climate change" on the floor of the senate. but for crying out loud, you've got the former president of the american college of physicians talking about the health effects, you've got a prominent researcher at stanford university talking about the health effects, you have are a. got the nationalwork service warning about dangerous and

health effects from climate-related heat effects in the southwest. when are we going to get around to having a serious discussion about this? so it is great that we've had a little pause on this wretched health care bill. i couldn't be happier to be rid of it for a while. i'm hoping we can be rid of it for good. but it's probably going to come back. we're going to have to hammer a few more steaks into the heart -- a few more stakes into the heart of this zombie before we can get rid of it. then we can get on to working on health care. we've got to take the wretched special interests politics out of it so we can get to serious business. with that, i yield the floor. mr. coons: mr. president? the presiding officer: the senator from delaware. mr. coons: i have can a many to the floor today to -- i have come to the floor tonight 10h. to join my colleagues in

opposing the senate health care reform bill, which i'll call the trumpcare bill. i'm also here to thank the thousands of delawareans who have called and e-mailed my office to express their opposition to this bill, that is near the about -- that is neither about hell or care. it is because of the efforts of thousands of americans across the country who have made their voices heard that the senate doesn't today have enough votes to pass this trumpcare bill. and i urge everyone watching and listening to remember that this fight is not over. the senate will be back next month and republicans will be doing everything they can to make tweaks or shaves or changes or amendments to the bill to get it passed this body. and we need the engagement, the persistence, even the resistance of delawareans and americans to make sure that the senate trumpcare bill never becomes law. this is as urgent now as ever

because of how hurtful this bill is. as many nonpartisan organizations have pointed out, this bill is slings mass -- is essentially a massive tax break for the wealthy paid for on the backs of many of america's most vulnerable citizens. many of my colleagues have discussioned the impact this bill would have over time on millions of americans. this senate bill would make hundreds of billions of dollars in cuts to medicaid. it would slash tax credits that help americans buy health insurance and it would force 22 million americans off their health insurance and drive up costs for many millions more. that's not bad enough, the senate trumpcare bill does all of this slashing and cutting in large part to give another tax break farrow wealthiest citizens. if this bill becomes law, the very richest americans would get an extra $700 billion in tax breaks over the next decade. if it only affected the millions of americans who depend on medicaid or who purchase insurance on the individual

market it would be unconscionable, but it's even worse. let me explain. many of our constituents don't realize that even americans who get their health insurance through their employer, the 150 million americans who get their health insurance through their employer, have benefited from the affordable care act. in fact, i think in some ways the consumer protections put in place by the a.c.a. is the most important accomplishment of that bill. a core requirement of the a.c.a. was that all health insurance plans cover what are known as essential health benefits. these are basic services like emergency care, prescription drugs, pediatric services, maternity and newborn care, hospitalization, health care for the mentally ill, and substance abuse for the addicted. to put it more succinctly, these are all the reasons many people want health insurance in the first place. thanks to the a.c.a., almost every insurance plan in the country today has to carry these

core services. that includes the more than 150 million americans and the half a million delawareans who get their health insurance through their job. the senate trumpcare bill would allow states through waivers over time to gut these essential health benefit requirements, gradually making many americans' health insurance less and less valuable and less and less protective of their health and their families. that provision of the senate trumpcare bill would also allow states to waive the ban on insurers imposing annual and lifetime limits on essential health benefit coverage. that means that even if you get insurance, good insurance, through your employer, if you have an unexpected development -- let's say the birth of a child prematurely who develops serious medical challenges or a terrible diagnosis that requires expensive and he repeated surgery -- you either have to come up with that money on your own or you're forced into bankruptcy once you hit the

lifetime cap. let me demonstrate with an all-too-real example. about one in ten newborns have to spend time in the neo-nato care unit. according to the american medical association, in the nicu, it is not unusual for costs to top $1 million for an extended stay, unquote. that means even a baby born to parents with great insurance coverage through their employer hit their lifetime insurance cap before they even leave the hospital for the first time. and as americans are scrambling to find ways to pay for their astronomical out-of-pocket costs under the so-called senate trumpcare bill, wealthier americans and corporations will be given big tax breaks. moreover, while senate republicans may claim their bill still does cover preexisting conditions, insurance under this bill would be rendered meaningless if it doesn't cover what you need to treat your preexisting condition through these essential health benefits.

so, mr. president, let's briefly recap this senate trumpcare bill. millions of americans lose health insurance. those who manage to keep it end up paying more but getting less coverage. and the wealthiest americans get another big tax break. that is a painful, even cynical political calculation. mr. president, since came to the senate seven years ago, i've said more times than i can count, i want to work with republicans to fix the parts of the affordable care act that need fixing. let's simplify the reporting requirements that burden small businesses and increase the tax credits that help small business employers offer insurance to their employees. let's find ways together to increase competition and expand the tax credits to bring down premiums and deductibles on the individual market. let's explore new mechanisms that control health care costs by incentivizing reforms and producing healthier outcomes rather than more tests and services.

sadly, this senate trumpcare bill does none of these things. it is my hope that after today's developments, that after the next few weeks, that after hearing from their constituents and returning in the next month, that my colleagues will recognize that if we work together, we can address the broken parts of the a.c.a. and sustain the best of what it's done to expand insurance in health care for millions of americans. let me close with a story that i shared earlier today on the steps of the capitol. this is carrie orr from my hometown wilmington, delaware. she is a massage therapist, a self-employed yoga instructor and considers the affordable care act, and i quote, nothing short of miraculous. carrie signed up for health insurance in 2014 thanks to a subsidy that made it available to her through the a.c.a. she'd had some nagging abdominal

and lower back pain for years but didn't think much of it, considering she had no family history of disease and had never even had stitches before. but that next year in january of 2015, a routine procedure covered by her new insurance, which she told me she wouldn't have even gone for if it hadn't been covered by this new health insurance, revealed that carrie in fact had stage 3 colon cancer. she had surgery a week later. she had six months of chemotherapy, and she ultimately faced no out-of-pocket expenses and was fully in remission. carrie's cancer has now been in remission since that september of 2015 and as she wrote to me earlier this year, quote, the a.c.a. came along at the last possible moment that it could have saved my life. i'm certain without it i would have continued to just live with the discomfort and try to self-treat until my cancer was so advanced it could not have been treated.

i am opposing the senate trumpcare bill for carrie and for the thousands of delawareans and millions of americans just like her. i've heard stories from delawareans about things that need to be fixed in the affordable care act, and i hope i get a chance to work across the aisle to do that. but i have also heard from hundreds of delawareans whose lives have been improved or, in cases just like carrie's, saved by the affordable care act and i will not yield on defending the best parts of the a.c.a. that have saved the lives of americans across the country. in the days and the weeks to come, i hope all americans will stay active, stay engaged, and stay on the course so that we can push aside this cruel, cynical bill and find an opportunity to work together on a bill with real heart. that fight is not yet over, and i will not yet yield. thank you, and with that, mr. president, i yield the floor.

mr. mcconnell: mr. president? the presiding officer: the majority leader. mr. mcconnell: moi to proceed to scif session to proceed to consider the nomination of nomination 154, neomi rao, to be administrator of the office of information and regulatory affairs. the presiding officer: question is on the motion to proceed.

all in favor say aye. mr. mcconnell: yea. the presiding officer: opposed, nay. the ayes appear to have it. the ayes do have t mott session agreed to. the the clerk will report. the clerk: executive office of the president, neomi rao of district of columbia, to be administrator of the office of information and regulatory affairs. mr. mcconnell: i send a cloture motion to the desk. the presiding officer: the clerk will report the motion. the clerk: cloture motion: we, the undersigned senators, in accordance with the provisions of rule 22 of the standing rules of the senate, do hereby move to bring to a close debate on the nomination of neomi rao to be administrator of the office of information and regulatory affairs, signed by 17 senators as follows -- mr. mcconnell: i ask unanimous consent that the reading of the names be waived. the presiding officer: without objection. mr. mcconnell: i ask unanimous consent the mandatory quorum call with respect to the cloture motion be waived. the presiding officer: without objection. in being mci ask unanimous consent that the senate be in a -- mr. mcconnell: i ask unanimous consent that the senate be in a period of morning business with senators permitted to speak up to ten minutes each. officer without objection. mr. mcconnell: ask l. i ask unanimous consent that a

correction to aan poison pillment made on march 22, 2017, be printed in the record. for the information of the senate, this correction is clerical and does not change membership of the service academy board made by the appointment. the presiding officer: without objection. mr. mcconnell: i ask unanimous consent that when the senate completes its business today, it adjourn until 12:00 noon wednesday, june 28. further that is correct follow -- further that following the prayer or pledges, the morning business be deemed expired, the journal of proceedings be approved to date, the morning business be closed. finally, following leader remarks, the senate proceed to executive session and resume consideration of the rao nomination. the presiding officer: without objection. mr. mcconnell: if there is no further business to come before the senate, i ask that it stand adjourned under the previous order, following the remarks of our democratic colleagues. the presiding officer: without objection. .

quorum call:

mr. markey: mr. president? the presiding officer: the senator from massachusetts. mr. markey: mr. president, i ask for a vitiation of the quorum call. the presiding officer: the in a is the not in a quorum call. the senator is recognized. mr. markey: i thank the president very much. mr. president, we now have reached a point where the senate majority, the republicans, and president trump have been unable to put together the package which allows them to take medicaid and try to successfully turn it into a shadow of what it once was in our country, to turn it into a debt-soaked relic of what it is today by taking out $770 billion that otherwise would have gone to the families of those in our country who need

the health care services, who need help in providing for those who need it the most within our country. but the same thing was true in the house of representatives when they were moving through their bill. over there, people said, ah! trump doesn't have the votes. the republicans don't have the votes. they're not going to be able to be successful. however, this trumpcare hail mary that they through in the house -- that they threw in the house, notwithstanding the remarkable defense put up by the american people, the millions of phone calls, of protests, and rallies -- well, they still were able to find the votes to ultimately pass this incredible

attack upon the health care of tens of millions of americans. and so what they did in the house is what they're doing in the senate. the g.o.p. retreats, they wait for the defense to disperse, but then they plow through to get this bill over the finish line, hoping that a two-week high yea it is will be -- hiatus will be sufficient for the energy level of defense against these cuts to so wane that they can come back and finish off the job on their second try in the same way they did in the house of representatives. so right now it's only half-time. it's half-time. they're coming back. the ball is in their court.

they will attempt again to destroy the health care system of our country, as we know it today. we have not defeated this bill yet, so now is the time for those who oppose this bill to redouble their energy, to play even tougher defense against this republican attempt to undermine medicaid, to undermine access to care for everyone in our country. their bill is now down. so let's keep it down for the count. let's make sure this bill cannot get up. and come back and haunt us in the middle of july. the senate proposal right now

has $188 billion, which is now going to be within the hands of the trump administration, in the hands of the republican leadership as a slush fund to be used in order to get the votes, which they need in order to pass their bill. and that $188 billion is right now being divided up in a way that will help them to get the votes. and what is the ultimate goal of the g.o.p.? the ultimate goal is to take a machete to medicaid, because they harbor an ancient animosity towards medicaid. and i'll throw in medicare and

the obamacare -- all of it. and they see this as the best opportunity they have had in two generations to be able to lead these programs as -- leave these programs as relics of debt debt-soaked as they are today. so when they say they're going to cap the funding, they're talking about decapitating the funding. to cut it in half, send it back to the states, and then say to the states, you figure it out, you try to help those people who are poorest in your states, which you were never able to figure out how to help in the first place, which is why we put the federal programs on the books nord to then those -- in

order to help those who are in need in all of those states. so what's their real goal? it's pretty simple. slash these programs and then turn it into one big huge tax break for the richest people in america. because that's what this program will do. one little example of that $750 billion: let's just take $33 billion of it. that $33 billion gets divvied up by the 400 wealthiest families in america. 400 billionaires walk up and they say, can i please have my $7 million that i get as part of taking away coverage for cancer, coverage for alzheimer's, coverage for opioid addiction treatment? can i now get my payoff for the success in your wealth-income

transfer program? because that's what you have. you don't have a health care policeman. you have a -- you don't have a health care program. you have a wealthcare program. the wealth of the wealthiest. please, make them even more wealthier. that's what their entire plan is about. and, by the way, that $33 billion would be enough to take care of the health care of 700,000 people in our country. but the republican priority is to give all that money back to the wealthiest people in our country. that's immoral, that's inhumane, it's just plain wrong, and the american public have to rise up and fight against this greatest injustice legislatively that has been perpetrated or attempted to be perpetrated on the american people in more than a generation. this bill is the bill of my entire career in the united

states congress -- which is now 41 years -- this is the worst bill. it's the greatest attack upon the well-being of our nation. this program is of the rich, for the rich, by the rich. and where are they going it take the money from? from the poor, from the sick, from the elderly, from the disabled. it is selfishness on stilts to think that there's plan to take health care away from the poorest, sickest, the most disabled people in our country in order to give a tax break to the wealthiest is the most indecent action that may have ever been perpetrated here on the floor of the united states congress. billions in tax breaks for those who don't need them or deserve them, paid for by people who

cannot afford it. it is health care heartlessness. that is what it is. if you kick these people -- if you kicked these people in the heart, you would break your toe. there is no heart. there is no sense of decency towards those families who are going to see their loved ones' diseases get even worse or to see them ultimately die because of the lack of coverage. now, the republicans say -- at least they purport as their plan, to decrease the deficit by passing this bill. but what do they do with the money that they save? ah, a tax break for the wealthy. well, i thought that you were shedding tears about your concern of subsequent generations having such huge deficits. but we know that those are

crocodile tears about future generations, because you want to pay off this generation of billionaires, this generation of millionaires who need no additional wealth for their families today. so there is no real concern about the deficit. this is once again just an attack on the programs which the republicans have always opposed. and if they can combine it as a tax break at the same time, all the better. so from my perspective, people are just going to wind up paying more for health care. they're going to be getting less. they're going to be paying for a cadillac but only getting a tricycle as the people go forward. for too many families, they won't be able to afford anything at all, and there will be no subsidy to help them get the health care for their families. and the anxiety of suffering from an illness will only be

exacerbated by their families understanding that they can't even afford the care for their loved one because of the financial insecurity in their own families. so this is going to be a historic two weeks where we must raise our voices like they have never been raised before, that we stand on the ramparts and let those republicans know that they are in for the fight of their lives. and ca ssandra-like we must warn of the dangers of complacency or the misunderstanding of what is happening now as the republicans removed the health care bill from the senate floor for consideration. they are not defeated. they are just at half time. now trying to construct a plan

that will bring it back as soon as we return with the votes now secured from their perspective in order to pass this bill and send it over to the house of representatives and then down to president trump for his signature. this next twos weeks are the most important two weeks for the health care of our nation in two generations. this battle is the battle to ensure that they are not successful. so from my perspective, this is a fight that each and every american has to be a part of, because it's your families who are going to be harmed. if we just take opioid addiction coverage in massachusetts, 2,000 people died from opioid

overdoses last year. we're only 2% of america's population. if that number multiplied across the whole country, that would be 100,000 people overdosing and dying. that would be two vietnam wars of deaths in one year, from one disease, which if it got to treatment for families, if the prevention was put in place, we could begin to reverse. but if there is no treatment, if there's no prevention, if there's no access, then people who otherwise would have been able, with treatment, to live normal lives will now die. if you have alzheimer's and you're in a nursing home, a very high probability since two-thirds of all people in nursing homes, two thirds of all grandmas and grandpas in

nursing homes are on medicaid. you slash medicaid, the care that that loved one is now receiving in a nursing home is going to be slashed. grandma and grandpa in that nursing home is going to see the services that they otherwise would have been provided not available to them. that is what this republican plan is going to do. it says to a kid, a family member with opioid addiction problems, it says to grandma and grandpa in a nursing home, it says to a woman who has cancer, it says to a man who has diabetes, i'm sorry, we no longer can afford in america to help you get the health care which you need. we are better than that. we're a better country than that. and we're definitely a better country than saying we're going to take away that health care from all of those people and

then give it as a tax break to billionaires. we are better than that. that is just wrong. so this is the battle, the most important battle. martin luther king said in 1967, that the most important civil right was the access to health care, because health is the first wealth. without health, you have nothing. so that is what we are fighting for right now. we are fighting for that fundamental civil right for everyone. this slashes coverage for those who are disabled in our country. we have made progress over the last generation in reconfiguring how we view the disabled in our country. we have given them access to the health which they need so they can be fuller citizens in our society. this bill slashes the funding to help 20 million disabled in our

country with fuller, more functioning lives to give a tax break to a billionaire. it is wrong. it must be stopped. we must put up the defense against this bill ever becoming law. and for the next two weeks, while they sit and plot to try to find a way of camouflaging what they are doing, the american people must rise up and say no, america is better than that. we will not allow this to happen. god help us in 2017 in the united states of america. mr. president, i yield back the balance of my time.

a senator: mr. president. the presiding officer: the senator from hawaii. mr. schatz: thank you, mr. president. this is the beginning, not the end. today we claimed an important victory because of thousands of people across the country, there are not enough senators supporting this republican health care plan, and so there won't be a vote this week because of all the people who spoke up, the realities of this bill, tens of millions of people without insurance, a decimated medicaid program, the closure of health clinics and hospitals, that reality is delayed. but that's the key word here. this bill is delayed. this bill is not dead. and so everyone who spoke up about this bill should take a victory lap, pat yourself on the back tonight. it's an extraordinary moment in terms of what grassroots democracy can accomplish. you did what you had to with

what you could, and you succeeded, but only for tonight. because tomorrow morning we've got to get ready, because the minute that the senate comes back from the july 4 recess, they have three weeks to ram through a bill. they are not done. i heard the vice president say today, quote, we are going to keep working until we get it done. and they're not giving up, and so we can't rest either. most importantly, we can't let them forget that we're watching. we're waiting, and we will still be here when they try to come back and jam this bill through. i really hope that the republicans take another course. setting aside the policy disagreements that we're having, there is really a better way. there is a way for the senate to be a senate, and that is to

empower two of the best republican senators that we've seen in generations -- lamar alexander and orrin hatch. two people who nobody doubts their conservative credentials, but they're the chairmen of two of the biggest committees in the united states senate, the health, education, labor, and pensions committee and the finance committee, and they have done bipartisan work. orrin hatch for decades, lamb march alexander for decades, both of them relatively recently on tax extenders, on repealing no child left behind. these are not easy issues but these two chairman, because they understand the committee hearing process, baw -- because they earned those gavels, because they earned those gavels. i can only imagine the frustration. i'm a progressive and i support the affordable care act. but if i were sitting there as a republican member of the help

committee or the finance committee, and these bills were going through and taking the country in a direction that i objected to, and if i were the ranking member or maybe a couple off from being the ranking member, i'd be thinking to myself i can't wait until i get that gavel back, so i can have my own hearings and i can listen to expert testimony and i can craft a bill. that's what i want to do. that's the point of being a legislator, is to actually work together on a bipartisan basis. everybody knows that the chairman or the chairwoman, you know, has the lion's share of the authority. but it's still a collaborative process. it's politics. you try to accommodate people on both sides of the aisle. and within, you know, both sides of the aisle, you've got quite an ideological spectrum both on the d side and the r side, but that's the fun of it. that's the way the senate is supposed to work. you know, you have a hearing,

and the thing that we should remember about a hearing is that generally speaking, if you have four testifiers, the rule -- i don't know if it's a rule or kind of an operating assumption is the majority party picks three of the four testifiers, three republican witnesses and one democratic witnesses if you have a hearing in finance about the affordable care act or what ought to happen with the american health care act or whatever it may be. it's not like you can't control the message. it's not like you can't in the end do whatever bill you want to do, but all i'm saying is that isn't that the fun of being in the senate? rather than sitting here as a -- forget the democrats for the moment. i mean the democrats were totally in the park, the public were totally in the dark. even republican members, this has got to irritate you that 13 people were sort of kept in the loop, some more than others,

some less than others. but it was like these consecutive conversations; right? what will it take to get you to yes. okay, we'll consider that. we'll let you know what we're able to do. why not just have a public hearing? i mean that is literally what we do for everything, for the defense authorization, for appropriations bills; right? we have every single subcommittee of the 12 subcommittees, we have several hearings, whether it's telecommunications or railroads or education or even other health care issues, we have public hearings. and we do so on a bipartisan basis. and as tough as we are in the lexicon -- on the election context with each other and on the floor with each other, the committee hearing process is rarely as partisan. the committee hearing process allows you to kind of get to the work of legislating. and so all i'm suggesting is that i understand what leader mcconnell is going to try to do. he's going to try to, you

know, peel off votes. and senator markey is exactly right. he's going to try to peel off votes. but there is another way to go here, and that is to legislate. and let me just make the political argument for this. for on behalf of republicans, the problem with being the majority party and trashing the health care system by not properly funding the exchanges right now by creating all this uncertainty is that prices go up and nobody is going to buy -- everybody understands this. barack obama is not president. he was river rafting when all this was happening, and he deserves it. i'm happy for him. but he's not president. and so the idea that you're going to sort of say well, we're going to cut medicaid, we're going to cut opioid l funding. we're going to turn this into a big tax cut for people who are already doing well financially, because that last bill was called obamacare -- it had the

word obama in it -- republicans and democrats across the country, they may not be politically sophisticated like we pretend to be, but they're smart. and they're thinking to themselves like, you know, i'm a republican, i'm a conservative, but i don't care about barack obama anymore. he's gone. he's not the president. so if you sit there and tell me that we need to slash funding for mental health services or slash funding for my community health center in a rural neighborhood, i don't care -- your argument cannot be because of obamacare. you can't be because of obamacare. now you have a majority in the house, a majority in the senate, you have the presidency. so now the republicans own the health care s so here we are trigg trying to figure out a way where we can both own the health care system. and we're acting like this is impossible to discover.

we're acting like, gosh, what way would we work where we could each sort of shoulder some of the political and policy responsibility, the personal responsibility for the american health care system? and there is a very simple answer to that. which is to do this through the regular order. if you do this through the regular order -- and that means is -- and it's interesting me the difference between now and, say, six monthsing a, is people actually know what reconciliation is. they know that there is a threshold for regular legislation of 60 votes to overcome to a filibuster. but it is a really important point the moment the republicans decided to do this via reconciliation, that was tactical and that was kind of technical, but what that meant is they said, we got 25. we only need 51. we don't need to talk to you. and i understand the kind of rationale. you got 52 votes. you can give up two and have

vice president pence break the triumphant -- have vice president pence break the tie. but her we are. the way to take this off the table as a political liability for the republicans is to get a bill that could get 60 votes because once it becomes a bipartisan enterprise, once it becomes a bipartisan enterprise, it cannot be a cudgel. we cannot beat each other up over it. listen, what the affordable care act passed originally, one of the challenges that we had as a political matter is we had not a single solitaire republican vote. i will take everybody at their word that they just couldn't vote pour it because it was -- for it because it was against their political ideology and their principles. but it also had the side benefit of the moment a bill doesn't have the patina of bipartisan, the moment only one party participates in a process, boy, do you own it. and so the question i have is, do you really want to own the

american health care system, whatever happens, good or bad -- you know, you become like the utility company. nobody likes their utility company. the best thing that can happen is if the lights stay on and the rate of increase slightly slows. you are never going to have cheaper rates. when you slip your light switch on, you don't go, boy, i am so pleased with my utility company. the best possible thing that can happen is you come up with a brilliant bill without any democratic support and then everybody shrugs their shoulders and moves on. more likely, you're going to own all the problems you're creating. and you are creating a myriad of problems. and i just want to say that there are a lot of democrats who are on the level about wanting to legislate here. and we will do it the moment that repeal is taken off the table. the moment there is a commitment to public hearings, the moment there is a commitment to doing things through the regular order. now, those were not my prepared

remarks, but that really matters to me. i really believe in the senate. for all of our flaws, we're still the place that is to solve the problems. we're still the world's greatest deliberative body because we must be, because these are federal programs problems and we are the federal legislature, so we've got to fix this ourselves. there is only two paths -- one is the partisan path, which is brought peril for people across the country and great political peril, and then there is the path of statesmanship and stat stateswomanship, the path of us, woulding together and being a senate again. but we've to decide that's what we want to do. so i'm hoping that we go home, we participate in our parades, we hang out with our families, cook some burgers, some hotdoings. you know what, i want to

legislate again. i'd like to start legislating again and i'd like to start doing so in the regular order. so i'm hoping that that's what happens over the next week. if it doesn't, then we'll be ready to fight again and i know that there are literally millions of americans who are not going to let up until this bill is dead. i'd yield the floor. the presiding officer: the senate stands adjourned until senate stands adjourned until the new york times writes that this deal president trump an embarrassing setback on a key part of his agenda. the wall street journal reports gop leaders were short of the vote needed for