vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? if not, the i didn't say are 54, the nays are 44. the motion is agreed to. mr. moran: mr. president? the presiding officer: the senator from kansas. mr. moran: mr. president, i ask consent that notwithstanding the provisions of rule 22, following leader remarks on monday, march 13, the senate resume executive session for the consideration of executive calendar 18, that the vote on the confirmation occur at 5:30 p.m. the presiding officer: is there objection? without objection. mr. moran: mr. president? the presiding officer: the senator from kansas.

morse more on behalf of the majority leader, there will be no further votes this week in the united states senate. mr. president? the presiding officer: the senator kansas. mr. moran: i notice the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: i ask unanimous consent to vacate the quorum call. the presiding officer: without objection. mr. wyden: mr. president and colleagues, today the senate turns to consider the nomination of seema verma to be the administrator of the centers of medicare and medicaid services.

now i'd be the first to say that in coffee shops across the land, people are not exactly buzzing about the office known as c.m.s., but the fact is this is an agency that controls more than $1 trillion in health care spending every year. and even more important and more relevant right now, if confirmed and if trumpcare somehow gets rammed through the congress over loud and growing opposition, this is going to be the major issue on her plate right at the get-go. and i thought it would be useful, mr. president, to just give one example of the connection involved in this legislation. trumpcare cuts taxes for the

special interests and the fortunate few by $275 billion, stealing a chunk of it from the medicare trust fund that pays for critical services to the nation's older people. if trumpcare passes, under section 132 of the bill, and ms. verma is confirmed, she would be able to give states a green light to push the very frail and sick in the high-risk pools that have historically failed at offering good coverage to vulnerable people at a price that they can afford. under section 134 of trumpcare, ms. verma would be in charge of deciding exactly how skimpy

trumpcare plans would be and how much more vulnerable people would be forced to pay out of their pocket for the care they need. under section 135 of the bill, if confirmed, ms. verma could be paving the way for health insurers to make coverage more expensive for older people approaching retirement age. so given all that, i want members to understand that there is a real link between this nomination and the debate about trumpcare. and this is in effect the first debate, the first discussion we've had about trumpcare since these bills started to get moving without any hearings and getting advanced in the middle

of the night. the odds were against republicans writing a single piece of legislation that would make health care more expensive, kick millions off their coverage, weaken medicare and medicaid, and produce this robin hood in reverse, this huge transfer of wealth from working people to the fortunate. nobody thought you'd do all of that at the same time, but somehow the majority found a way to do it. the republicans are rushing to get it passed before the american people catch on. and so as part of this debate about seema verma, we're going to make sure that people understand that this nomination is intertwined with what happens in the discussion about trumpcare and how these particularly punitive provisions

with respect to medicare and medicaid would affect our people. for seven years my colleagues on the other side pointed to the affordable care act as pretty much something that would bring about the end of western civilization and at a minimum would basically continue a system responsible for every ill in our health care system. that was the argument. the affordable care act, responsible for just about every ill and practically be the end of life as we know it. their slogan was to repeal and replace, and it was a slogan they rode through four elections to very significant success. the only problem was it was really repeal and run and that replacement was nowhere in sight. but now the car continue has been lifted -- the curtain has been lifted.

the lights are shining on trumpcare, and it sure looks to me like there are a lot of people not enjoying the movie. trumpcare really goes back to the days when health care in america mostly worked for the healthy and the wealthy. now we've got a lot of debate ahead, so we're not going to just lay it all out here in one shot. i do want to mention some key points in the role ms. verma, if confirmed, would play. and i want to start by addressing what this means in terms of dollars and cents. you look at the fact that the

medicare tax, which everybody pays every single time they get a paycheck, and that money is used to preserve this program that is the promise of fairness to older people, the medicare tax would be cut for only one group of americans in this bill. i just find this a staggering proposition. the people who need it the leass of over $250,000, people who need it the least would be given relief from the medicare tax. not working families. just the wealthy. and as i indicated, we're talking, all told, about $275 billion worth of tax cuts to the

special interests and the fortunate few, and it's largely paid for by taking away assistance to working people to help, for example, to get on their premiums. so i brought up the a.c.a. medicare payroll tax for a reason, mr. president, because i think when americans look at their next paycheck -- and if you're a cop or a nurse and you get paid once or twice a month, and you live, say, in coos bay, oregon, or in medford -- another oregon community -- you'll see it on your paycheck. if you're a cop or a nurse, no tax relief for you. but if you make over $250,000 on

a tax that is used to help strengthen medicare's finances, at a time when we're having this demographic revolution, the relief goes to people right at the top, and you reduce the life expectancy of the trust fund for three years. so the first thing i'll say with respect to what this means, the provision that i have just outlined, mr. president, breaks a clear promise made by then-candidate trump not to harm medicare. and i just remember these commercials we all saw, scores and scores of them, candidate trump said to america's older people -- many voted for him, i think, to a great extent, because they heard this promise. he said, you know, you work

hard for your medicare. we're not going to touch it. we're not going to mess with it. when the president was asked about cutting medicare, here's what he said. medicare is a program that works. people love medicare. and it's unfair to them. i'm going to fix it and make it better, but i'm not going to cut it. the president of the united states said he's not going to cut it. well, that promise, not to harm medicare, lasted six and a half weeks into the trump administration. so that the wealthy, the wealthy could get a tax reduction, the fortunate few who need it least, and the effect it would be cut by three years the life of the medicare trust fund. i think that ought to be pretty

infuriating and concerning for people who work hard and cops and nurses and people who are 50, 55, 60. you know, today they're counting on medicare to be around when they retire. but because trumpcare made it a focus to give tax relief to the fortunate few, that tax relief cuts three years off the life of the medicare trust fund. now if that wasn't enough, people who are 50, 55, 60, before medicare, they're going to get another gut punch. this one's in the form of higher costs. in parts of my home state, particularly in rural areas like rand county, union county and lake county -- and i'm sure i'm going to hear about this, mr. president. i have town hall meetings in

each one of my counties. a 60-year-old who makes $30,000 a year -- now, those are the people we've long been concerned about, particularly people between 55 and 65, because they're not yet eligible for medicare. a 60-year-old in communities like i just mentioned, who makes $30,000 a year could see their costs go up $8,000 or more. the reason that that's the case is a big part of trumpcare is based on something we call an age tax. mr. president, back in the days when i was the director of the oregon gray panthers, i was really so fortunate at a young age to be the director of the group for close to seven years, we couldn't imagine something like the hit on vulnerable older

people that this age tax levies. republicans want to give the insurance companies a green light to charge older americans five times as much as they charge younger americans. so the reality is older people are going to pay a lot more under trumpcare and that's what we were trying to prevent all those years with the gray panthers, mr. president. we didn't want to see older people pay more for their health care, the way they're going to under trumpcare if they're 50 or 55 or 60. i think the real question is going to be whether they're going to be able to afford insurance at all. a lot of those older people that i've just described -- and i met them at my town hall meetings every single week. they can walking on an economic tightrope.

they balance their food costs against their fuel costs and their fuel costs against their rent costs. and along comes trumpcare and pushes them off the economic tightrope. where they just won't be able to pay the bills, particularly older people in rural areas. so the reality is, mr. president, it's expensive to get older in america. and we ought to be providing tools to help older people, but what trumpcare does is, instead of giving tools to older people to try to hold down the costs, trumpcare basically empties the toolbox of assistance and basically makes older people pay more. and i want to next turn to the

medicaid nursing home benefit. i've seen working with senior citizens so many older people -- as i say, the people who are on an economic tightrope. they're skimping and saving, and even as they forego anything that wouldn't be essential, they burn through their savings. so when it's time to pay for nursing home care, they have to turn to medicaid. the medicaid program picks up the bill for two out of every three seniors in nursing homes. now today the medicaid nursing home benefit comes with a guarantee, and i want to emphasize, it is a guarantee that our country's older people will be taken care of. all of those folks -- the grand

parents that we started working for in those gray panthers sa -n knows gray panthers days, they had an assurance that they wouldn't be kicked out on the street. trumpcare ends that guarantee. you could have state programs forced into slashing nursing home budgets. you could see nursing homes shut down and the lives of older people uprooted. we could, in my view, have our grandparents that are depending on this kind of benefit get nickeled and dimed for the basics in home care that they've relied on. when it comes to medicaid, trumpcare effectively ends the program as it exists today, shredding the health care safety net in america. and it doesn't only affect older

people in nursing homes. it puts an expiration date, a time stamp on the medicaid coverage that millions of americans got through the affordable care act. for many of those vulnerable persons, it was the first time they had health insurance. so what trumpcare is going to come along and do is put a cap on that medicaid budget and just squeeze them down until vulnerable persons' health care is at risk. as low-income americans lose their coverage through medicaid, it is a good bet that the only trumpcare plans they'll be able to afford are going to be worth less than a trump university degree. i want to move next to the effects of the bill on opioid abuse. clearly, by these huge cuts to

medicaid, trumpcare is going to make america's epidemic of prescription drug abuse-related deaths worse. medicaid is a major source of coverage for substance abuse treatment, particularly after the affordable care act, but this bill takes away coverage from millions who need it. we've had republican state lawmakers speaking out about this issue as well as several members of the majority in the congress. colleagues, just about every major health care organization is telling the congress not to go forward with the trumpcare bill -- physicians, hospitals, aarp -- that's just the beginning. but the majority is just charging forward, rushing to get this done as quickly as possible. now, we're going to have more to

say about these issues, mr. president -- i see my colleagues here -- but to close just by intertwining how this appointment is going to be a key part of the discussion of trumpcare revolves around the questions that we asked ms. verma. for example, i was trying to see if this bill would do anything to help older people hold down the cost of medicine. now, we've heard the new president talk about how he's got all kinds of ideas about controlling the cost of medicine. but here was a bill that could have done something about it. and in fact -- i see my colleague, senator stabenow, senator cantwell -- i said to the nominee, i'd be interested in any idea you have, any idea

you have to hold down the cost of medicine. on this side, we've had plenty of ideas. we'd want to make sure that medicare can bargain to hold down the cost of medicine. we've been interested in policies to allow for the importation of medicine. we said, let's lift the veil of secrecy on pharmaceutical pricing. and i asked ms. verma, how about one idea, just one, that you'd be interested in that would help older people with their medicine costs. she wouldn't give us one example. and i'm going to go through more of those kinds of questions, mr. president, because the reality is -- i see senator stabenow and senator cantwell here -- what weigh got in the committee was -- what we got in the committee was essentially health care happytalk. every time we asked a question, she'd say, i'm for the patients.

i thank my completion for joining us and i yield to -- i thank my colleagues for joining us and i yield to my colleagues. ms. cantwell: would the senator yield to us? mr. wyden: okay. ms. cantwell: i would ask my colleague, because washington and oregon and so many other states spend so much time innovating. the proposal that we're seeing coming out of the house of representatives really isn't innovation. i like it say that if you're looking at this just -- i like to say that if you're looking at this just from the specifics, the budget cap is really just a budget mechanism. it doesn't have anything to do with innovation. it just has to do with basically triggering a cut to the medicaid and shifting that cost to the states. and my concern is that we already do a lot with a lot less and we know how to innovate, and we would prefer to the rest of the country follow that same model. so i would ask the senator from

oregon, do you see any innovation in this model in decapitating and cutting the amount of medicaid and shifting that to the states? mr. wyden: my colleague from washington is ever logical. and when i looked at this, i kind of thought it was an innovation desert because i was looking for some new, fresh ideas. we've seen some of them from senator cantwell's state, and i think the senator from washington makes a very important point with that poster because the reality is, this is a cap. this is a limit on what states are going to get. and as i touched on in my comments, i think what's going to happen -- this cap, there's not going to be enough money for the needs. and i think this is going to slash the help for nursing home care under medicaid, which pays two-thirds of the bill. and i think nursing home care

under this trumpcare, this flawed trumpcare proposal, nursing home care is going to really get nickeled and dimed. so my colleague from washington is right. i think this -- because i tried to read section by section just -- we read it, of course, several times. but we wanted to make sure we were looking for my colleagues' point because in the northwest we value innovation. this thing is an innovation desert. ms. cantwell: well, i would ask the senator from oregon, through the president, that the innovation that was already in the affordable care act really did shift the medicaid population, which so much of that cost, as you just mentioned, is in long-term care, nursing home care. so medicaid equals long-term care for so many americans. the and so in the affordable care act, we started the process to say, let's shift to community-based care because it's about one-third the cost of a nursing home. so if we can keep more people in their homes, that's better

knowvation. in the affordable care act -- so that's better innovation. in the affordable care act, we've incentivized states. we've had 21 states take us up on this, arkansas, kentucky, louisiana, nebraska, iowa -- many statements that are doing thin knowvation and -- that are doing this innovation and basically they are trying to move to community-based care so we can save money. that is a much money as they're trying to save in a bill that basically they're not saving the money. they're shifting the burdens to the states. so instead of giving an innova innovative solution to communities to have community-based care to have long-term care stay in their homes longer -- who doesn't want to stay in their home longer? -- then support them through community-based delivery of home services. our state did this over a

15-year period of time. we saved $2.7 billion. so that is the kind of innovation that we would like to see. but instead of implementing the innovation that we already started in the affordable care act, they are trying to capitate the medicaid number which is changing the relationship as a partner for the federal government and they're just saying, we are going to cost-shift this burden to you, the states, which i saw one budget and policy analysis center say that that was going to be about a $380 billion shift to states. and i wonder if the senator from oregon, do you think that oregon has the kind of money to take its percentage of that $380 billion -- or my colleague from michigan, do you think the state of michigan has the dollars to take care of that medicaid population? ms. stabenow: well, if i might just lend my voice on this and thank both of my colleagues -- and senator cantwell has been really the leader in so many ways on innovation in the health care system, as we debated and

sat next to each other in the finance committee on the affordable care act. i wanted to just share that in michigan, where we expanded medicaid, because of changes that have been made and work that is being done in the budget going forward to the new year, there's about -- close to $500 million now more in the state of michigan budget than was there before because of medicaid expansion and the ability to manage health care risk. and people have more health care coverage. we actually have 97% of the children in michigan that can see a doctor today, which is incredible. and, at the same time, the state is going to save close to $500 million in the coming year's budget. mr. wyden: if i could justed a, because i think my colleagues are -- mr. wyden: if i could gussied, because i think my completion are making a good point, there

are going to be 10,000 people turning 65 every day for years and years to come. so. a senator: cantwell and the senator stabenow are make the point about some flex u. mr. wyden: i reality is, as i look at the democratic picture, we're going to need more out of a lot of care option options, institutional care, community-based coverage, but i think the point senator cantwell started us on is at a time given the demographics where we're going to need more for a variety of care options, a continuum of care, what my state is basically saying is we're going to get less of everything. there's going to be less money for the older people who have nursing home needs. i'm looking at a new document from the department of human services in oregon, and it indicates that we're going to lose substantial amounts, something like $150 million, for

community-based kinds of services. so i appreciate the point my two colleagues are making. ms. cantwell: if i could, mr. president, ask the senator from oregon one more question and maybe my other colleagues will join in. but when you don't realize the savings and you cost-shift to the states, one of the key populations that we really want to take care of are pregnant women and children. we don't want to have less money, and if you think about medicaid, that's primarily a big part of the population. i know our colleague from pennsylvania has joined us, and he's been a champion of the chip program and everything that we do for women and children. and i don't know if he's seen this in his state, but i don't know if the senator from oregon or the senator from michigan or the senator from pennsylvania wants to comment on this. but the notion that we are not realizing the savings and then figuring out how to best utilize

those for the delivery of the services that so many people are counting on, you're really going to be starting in a very bad place with the people who need these resources most. when it comes to medicaid, women and children are front and center in this debate. so i hate the fact that somebody's going to cost-shift to the states. the states aren't going to have enough money. and then the very people who would end up paying the price are women and children. i don't know if either of my colleagues or the senator from oregon wanted to comment on that. ms. stabenow: thank you. i would say briefly and turn to our colleague from pennsylvania who has been a champion for children, i would say first again as i said a moment ago, because of medicaid, because of health care expansion, 97% of the children in michigan now can see a doctor. that means moms that are pregnant. that means babies, moms and dads are less likely to be going to bed at night saying please,

god, don't let the kids get sick, because you can actually go to a doctor. it reminds me, though, of the other thing happening right now on the floor to the larger question of the nominee for the center for medicare and medicaid, where in the larger context i asked her about whether or not maternity care and prenatal care should be covered as a basic health care requirement for women -- i mean, pretty basic for us -- and she wouldn't answer the question. she essentially said women can buy extra if they want it. the new head, secretary of health and human services said we as women can buy extra coverage for basic health care for us. so it all comes together, medicaid, the nominee on the floor, what the house is doing to take away maternity care. it's really just bad news for moms and babies. mr. wyden: i would only add that

what we learned in our hearings and our discussion is that women, particularly the women served by the medicare -- medicaid program are really dealing with the consequences of opioid addiction as well. and in our part of the world, i'd say to senator stabenow and senator casey, we're in washington and we feel like we've been hit with a wrecking ball with this opioid problem. again, when senator cantwell talks about shifting the cost, she's not talking about something abstract. this is going to take away money for opioid treatment. so i'm very pleased my colleague has made these points and look forward to the presentation. mr. casey: senator cantwell, interto thank you for -- i want to thank you for raising the impact this decision will make with regard to a particular health care bill and then also in particular, the medicaid consequences. i was just looking at what is a two-page report just produced

today. i was just handed. the center on budget and policy priorities, it is state-specific. in this case looking at the data from pennsylvania -- i won't go through all the data on medicaid, but just imagine this. three different groups of americans that benefited tremeny by the medicaid program every day, and that's why what's happening in the house is of such great concern to us. what we've got in pennsylvania, for example, just in the number of americans, number of pennsylvanians that have a disability, 722,000 pennsylvanians with disabilities rely upon medical assistance for their medical care. medical assistance is our state program to partnership with medicaid. 261,000 pennsylvania seniors get their health care through medicaid. so hundreds and hundreds of thousands of people who happen to be over the age of 65 or

happen to have a disability of one kind or another are totally reliant on most days on medicaid. and the third group, of course, are children. 33% of all the births in pennsylvania are births that are paid for through medicaid. so when we talk about this bill that's being considered in the house or talk about the confirmation that we're going to be -- confirmation vote for the center on medicare and medicaid services, this is real life. what happens to this legislation, what happens on this nomination is about real life for people who have very little in the way of a bright future. if we allow some here to do what they would like to do apparently to medicaid. it sounds very benign to say you want to cap something or you

want to block grant. they are fairly benign terms. they are devastating in their impact, and we cannot allow it to happen. that's why this debate is so critical. and i'll have more to say but i want to commend and salute the work of senators cantwell, and wyden in fighting these battles. i'll read a letter from a mom about her son rowan. the mom's name is pam. she wrote to us about her son who is on the autism spectrum. in this case she's talking about the benefits of medicaid, medical assistance, we call it in pennsylvania. here's what she said talking about the benefits that he receives. she said that after he was enrolled in the program, she said that they had, rowan had

the benefit of a behavioral specialist consultant. that's one expert helping rowan who was really struggling at one point. and a second professional they had helping them was a therapeutic staff support worker. so real expertise to help a five-year-old child get through life with autism. but here's what his mom said. here's what pam said, talking about how much, since he was enrolled how much he has benefited, how much he has grown and progressed. he benefited immensely, she said, from the create program, the child guidance resource center that's a local program in coatsville. and she said, quote, thankfully it's covered in full by medicaid. unquote. then she goes on to say the following, and i'll conclude with this. quote, without medicaid, i am confident i could not work full time to support our family.

we would be bankrupt, and my son would go without the therapies he sincerely needs. and here's how pam concludes the letter. she asks me as her representative, as her senator to think about her and her family when we're deliberating about a nomination like this and about health care legislation. she says -- and i quote -- plean you're making these decision. then she says please think about my nine-month-old daughter luna who smiles and laughs at rowan daily. she will have to care for rowan later in life after we are gone. overall, we are desperately in need of rowan's medical assistance and would be devastated if we lost these benefits. unquote. so this is real life for people, and sometimes it's far too easy here in washington for

people to debate as if these things are theoretical. that if you just cut a program or cap a program or block grant a program, that you're just kind of moving numbers around and moving policies around. this is of great consequence to these families, and we have to remember that when we're making decisions around here. everyone who works in this building as a, an employee of the federal government, we get health care. we don't have someone else around the country debating whether or not we're going to have health care like those families on medicaid are having to endure. so i want to thank the senator from washington. i know that the senator from michigan, senator stabenow, may have more to add on this. we have a big battle ahead, but this is a battle that is not only worth fighting, but it's absolutely essential that we win the battle to protect and

support medicaid. ms. stabenow: mr. president, i believe as senator wyden's colloquy comes to the end, mr. president, i would make a few comments in addition to my colleagues and very much appreciate all of their work. the presiding officer: the senator from michigan. ms. stabenow: thank you very much. there's so many different things to talk about as it relates to how health care impacts people. and as senator casey said, this is very personal. it's not political. a lot of politics around this, but it is very, very personal. in michigan, when we're talking about health care, medicaid alone, we're talking about 650,000 people who have been able to get coverage now. most of them working in minimum-wage jobs who now are able to get health care that couldn't before, and their children. and that adds to the majority of seniors who are in nursing homes now, folks getting long-term

care, folks getting help for alzheimer's and other challenges who are relying on medicaid health care to be able to cover their costs. and i wanted to share a letter as well from wendy, a pediatric nurse practitioner from oakland county in michigan. we've received so many letters. i'm so grateful for that, and e-mails. she said as a pediatric nurse practitioner, i've seen so many of my patients benefit from the affordable care act. physical exams for the kids are now covered in full with no co-pays. this means the kids are in to see us, which means we catch health care issues and early problems with growth and development that otherwise might be undetected and left untreated until it became a much bigger problem. isn't that what we all want for our children? to catch things early. immunizations are covered, which keeps everyone safer.

screening tests are covered so potential problems are caught while they can still be managed. this better care keeps kids healthier and happier and prevents longer-term costs. she goes on to say, medicaid expansion means even more kids are covered, keeping not only those children healthier, but everybody around them healthier. previously parents have children who did not have health insurance would not seek care until the children were so ill that they had no other option. frequently these children then utilized emergency room care which, by the way, mr. president, is the most expensive way to treat health problems. so they frequently used emergency room care not only a missed opportunity for complete and preventive health care, but at a cost base that was passed on to the community she says. on a much more personal level in 2015, she says our

granddaughter at age three was diagnosed with epilepsy related to a genetic condition which made her brain form abnormally. on top of the epilepsy, she had developmental delays and autism autism, all related to her double cortex syndrome. although our daughter and son-in-law are fully employed employed -- teacher, paramedic r children's special health care under medicaid. this has been a huge blessing for us. and without it, our family would have been financially devastated. we are hopeful that my granddaughter will continue to have good seizure control and will develop to reach her full potential. but without the care that her private insurance and children's special health care provides, she would not have much of a chance of getting anywhere near her potential. i don't know -- i do not want

to even consider how it would affect her and her future if insurance companies can refuse to cover her care due to her preexisting condition. and she concludes, please do not let partisan politics take precedent over doing what's right and what is best for the health of every u.s. citizen. i know we're all getting hundreds of thousands of letters and e-mails and phone calls with very similar stories because health care is personal to each of us. our children, our grandchildren, our moms and dads and grandpas and grandmas. it is not political. so i'm very grateful for colleagues being here today, and i want to speak not only about the importance of expansion under medicaid, but i also want to speak about the

person who would be in charge of that very, very important set of services, and that is the nomination in front of us of seema verma to be administrator of the centers for medicare and medicaid services. this is a critical position especially given ongoing efforts that we are seeing right now to repeal health care, the affordable care act, and replace it with legislation that would literally rip away coverage for millions of people. and pull the thread that unraveling our health care system. the administrator, someone who has the authority to make large changes to the implementation of the existing law, will have far-ranging consequences for all of us, and certainly the people that we represent. and especially for those who

need health care have begun receiving it and now may very well see it ripped away. in the finance committee when i asked mrs. verma about medicaid, i found that her positions would hurt families in michigan -- would hurt seniors in nursing homes, would hurt children. looking at her long record as a consultant on medicaid, we know that mrs. verma's proposals limit health care coverage and make it harder to afford health care coverage, putting insurance companies ahead of patients an families once -- and families once again. i'm also very concerned about her position on maternity coverage. during the hearing i asked mrs. verma whether women should have access to basic care as the law allows, and i'm proud to offer that in the finance

committee or whether insurance companies should get to choose whether to provide basic health care coverage for women. i reminded her that before the affordable care act only 12% of health care plans available to somebody going out to buy private insurance offered maternity care. the majority did not -- the vast majority. and that the plans that did often charged extra or required waiting periods. her response indicated that coverage of prenatal and maternity care should be optional -- optional. we, as women, cannot say our health care is optional. the next c.m.s. administrator should be able to commit to enforcing the law requiring maternity care to be covered and commit to protecting the law going forward for women. being a woman should not be a

preexisting condition. getting basic health care should not mean we should have to buy riders or extra coverage because somehow being a woman and the coverage we need is somehow not viewed as basic by the insurance company. we've had that fight. women won that the fight with the affordable care act. we should not go backwards. i followed up with mrs. verma, along with many colleagues, but have not received a response. over 100 million americans count on medicare and medicaid. they need a qualified administrator who puts their needs first, and i cannot vote for a nominee who does not guarantee that she will fight for the resources and the health care that the people of michigan count on and need. finally, i wish to take a moment, mr. president, to talk about the health care bill that has now come out of committees in the house and will be voted

on in the house and then coming to us in the senate. frankly, let me start by saying this is a mess. it's a mess on process and it is a mess on substance. as a member of the finance committee, i can tell you firsthand this was not rammed through the senate finance committee when we passed the affordable care act. we had months and months and months of hearings of which i attended every one, i think, and after that, the floor debate and the discussion and the discussion in the house and we knew what it would cost when we brought it up, and it saved a lot of money by doing a better job of managing health care costs and creating innovation for our providers. but the truth of the matter is that when you look closely at

what is being debated in the house for families in michigan and across the country, it's really a triple whammy, higher costs, less health care coverage, and more taxes. overall it means more money out of your pocket as an american citizen unless you are very wealthy and it means less health care. this is not a good deal. it cuts taxes for the very wealthy, for insurance companies -- gives an opportunity for insurance company executives to get pay increases and cuts taxes for pharmaceutical companies. someone making more than $3.7 million a year would save almost $200,000. let me say that again. someone making more than

$3.7 million a year would put $200,000 more in their pocket as a result of this health care bill -- trumpcare. to put that in perspective, 96% of michigan taxpayers would not qualify for this. 96% of everybody in michigan who gets up every day, getting up and going to work, some take a shower before work and some take a shower after work, working hard every single day and they would pay more while the small percent of those at the very top would gets -dz 200,000 -- $200,000 back in their pocket. as indicated, it provides a tax break for insurance companies c.e.o.'s to get a raise of up to $1 million, but increases taxes

and health care costs for the majority of americans. middle-class americans, those working to get into the middle class would see tax increases and lose health care coverage at the same time. such aeal. for seniors, this would allow insurance companies to hike rates on older americans by changing the rating system, and aarp, a nonpartisan organization has indicated that premiums would increase up to $8,400 for somebody who is 64 years of age earning $15,000 a year. so they earn $15,000 a year and their premiums could go up by more than half of what they are making. now, to put that in perspective, again, a comparison of who wins

and loses under this plan -- if you're 64 earning $15,000 a year, you pay more, $8,400 more. if you're 65 years of age and earning over $3.5 million a year, you put $200,000 more back in your pocket. is this a ripoff for the majority of americans and should not see the light of day. so on top of that, trumpcare creates medicaid vouchers. we've been talking with colleagues about the change in medicaid, and what does that mean? well, instead of being a health care plan that covers nursing home care, whether that is someone who needs very little care or someone who has

alzheimer's or other extensive needs, your mom and dad or grandpa and grandma would get a voucher, and if it didn't cover the care in the nursing home, as it does now, then your family would have to figure out a way to make up the difference and we could have very possibly the situation we had before the passage of the affordable care act where a lot of folks were going bankrupt trying to figure out, you know, use the equity in your home, except for what happened in the financial rice crisis -- crisis, you may not have much in your home anymore and trying to figure out how to help grandpa and grandma in the nursing home. so turning medicaid into a voucher system would cut nursing home care and health care for families. and let me also say that when

there's a health care emergency, like we had in flint,michigan, with one00,000 -- 100,000 people being poisoned with lead, over 9,000 children under the age of six with extensive lead poison. when we had the past administration help in to -- help in -- step in to help, it would not be possible in this situation when there was a health care emergency for children or or for a community. in michigan today, 150,000 seniors depend on it can through medicaid for long-term care. three out of five seniors in nursing homes in my state. three out of every five seniors count on medicaid for their

long-term care. this radically changed and dismantles that health care system. we have nearly 1.2 million children in michigan, 380,000 people with disabilities that use this system. so we have a situation where we would see a radically different health care system for seniors, additional costs for seniors, which is why the aarp is calling this the senior tax. we would see children losing their health care, we would see insurance companies being put back in charge for decisions -- decisions about whether or not women can get basic care, what, if any, kind of preexisting

condition coverage happens. what i have seen is something that doesn't work is going to put more costs back on to families. mental health care, the ability to make sure that if you have a health care challenge, cancer, or some other kind of challenge, that your doctor's going to be able to treat you and give you all the care you need, not just a hrupl sum that the insurance -- lump sum that the insurance company has decided they will spend, accountability as far as how much of your health care dollar that you spend goes into your medical care. a whole range of things have been put in place so you have more confidence that at least you're getting what you're paying for, and those things go away and insurance companies are put back in charge, they are given a big tax cut, the insurance company executives are

given an opportunity for big increases in their pay while everybody else is paying more. so let me go back to where i started, mr. president. trumpcare the bill being voted on in the house, is really a triple whammy for the people of michigan. higher costs, less coverage, and more taxes. it makes no sense and i will strongly oppose it when it comes to the senate and i'm hopeful that we can put this aside, stop all of the politics around repeal and have a thoughtful discussion about how we can work together to bring down costs and to be able to address concerns to make health care better, not take it away.

thank you, mr. president. the presiding officer: the senator from rhode island. mr. reed: thank you, mr. president. mr. president, i rise today in opposition to the nomination of seema verma to be the administrator of centers for medicaid and medicare services. as a $1 trillion agency with oversight over medicaid, medicare, and the children's health insurance program, and in addition state health insurance marketplaces, c.m.s. is providing affordable health insurance to 100 million americans, including half a million rhode islanders.

given the responsibility this post ensures to ensuring access to health care coverage for our most vulnerable citizens, couple with fighting back against proposals by this administration, i cannot support ms. verma's nomination to be c.m.s. comms is responsible for the key aspect of the affordable care act. the health insurance marketplaces to provide an avenue for all consumers to shop for the health insurance options that fit their needs and connect consumers with tax credits and subsidies that make the coverage affordable. president trump and his new health and human services secretary tom price are adamant about repealing the a.c.a. and rolling back these benefits. in her confirmation hearing, miss verma was asked multiple times to commit to protecting the a.c.a. for the millions of americans who are able to access coverage for the first time because of the law. but she would not do so.

this to me is unacceptable. cms also -- c.m.s. also works with the department of health and human services to ensure the plans offered on the exchange are not only affordable but also provide real coverage for when it is most needed. i am concerned with miss verma's beliefs about what health insurance coverage should look like. during her confirmation hearing, she spoke at length about providing consumers more choices about their health care, yet she opposes many of the protections the a.c.a. provides for consumers. for example, she implied that she thought maternity care should be optional. it seems to me that for many families, they would be left with a choice of either pay for maternity care entirely out of pocket all the while paying premiums and copays to the insurance company or to go without care at all. i don't think that these are the kinds of choices we should be imposing on families. now, turning my attention to

medicaid for a minute, i am deeply concerned about the republican proposal to fundamentally change medicaid and shift costs to the states and to consumers. these proposals aren't new. year after year republicans often under the leadership of then congressman now h.h.s. secretary tom price have proposed block granting medicaid, cutting the program by hundreds of billions of dollars, while mrs. verma is not yet confirmed she did stress support in her confirmation hearing for the very concept, block granting or capping medicaid spending. just this week we saw a new version of this proposal which simply delays cuts to medicaid until 2020. in my opinion, this is just a vail attempt and then turn around and decimate medicaid in a few years. in my home state of rhode island, nearly 300,000 rhode

islanders access health care through medicaid. that's about a third of our population roughly. now, that is a significant number for a small state like rhode island. let's break down the number to see who would be impacted by these across the board cuts to medicaid. one out of four children in rhode island gets care through medicaid and half of the births in the state are financed through medicaid. one of two rhode islanders with disabilities are covered by medicaid and 60% of nursing home respect dentszs in the -- residents in the state get their care through medicaid. think about what would happen if this funding is cut and that is the trajectory of the republican proposals. states would have to decide among these populations who will get health care. children or the elderly in nursing homes? the disabled or other medicaid recipients? and if states try to make up the

difference, that will result in cuts elsewhere, such as education and infrastructure. indeed, given the demands for health care, given the tensions between seniors and nursing homes and children needing care, the states will try their best to pull from other areas. what's the next biggest area of state expenditure? education. now you'll have pressure on state education budgets. higher education particularly will be pressured. all of this will be the ripple effect from these proposed cuts to medicaid. and make no mistake, when miss verma and my colleagues talk about converting medicaid to a block grant program or capping funding, it's not about flexibility for states. it's about reducing the federal commitment to providing funding to the states. lastly, i'm concerned about mrs. verma's ability to safeguard medicare for our seniors. over 200,000 rhode islanders

access care through medicare, a benefit they've worked for and earned over their entire careers. i believe that medicare is essential for the quality of life for rhode island seniors and for seniors across the country and indeed for the children and family of these seniors. in fact, i supported the a.c.a. because it made key improvements to medicare that strengthened its long-term sovereignty and increased benefits, such as clothing, the prescription drug donut hole and eliminating cost-sharing for preventive services, such as cancer screenings. over 15,000 rhode islanders saved $14 million on prescription drugs in 2015, an average of $912 per beneficiary. and in the same year, over 92,000 rhode islanders took advantage of free preventive services representing over 76% of the beneficiaries. repealing the a.c.a. means repealing these benefits for

seniors and shortening the life of the medicare trust fund by over a decade. unfortunately, miss verma has little to no experience working with medicare and in her hearing and written response to the questions, she appeared to have very little or to no familiarity with major aspects of medicare. in her confirmation hearing and accompanying documents she simply has not proven herself to be an effective advocate for protecting these earned benefits for our seniors. we need an administrator for c.m.s. who will work to safeguard health care coverage for children, seniors and people with disabilities who will seek to strengthen medicaid, medicare, "chip," and our entire health care system. for the reasons i have outlined along with other reasons that some of my colleagues have raised, mrs. verma is not up to this task. as such, i will oppose the nomination and i encourage my

colleagues to do the same. and with that, mr. chairman, i would yield the floor. mr. president, i would request the ability to yield the remainder of my postcloture debate time to senator wyden. the presiding officer: the senator has that right. mr. reed: thank you, mr. president. mr. president, i also would note the absence of a quorum. the presiding officer: the clerk shall call the roll. quorum call:

quorum call:

mr. wyden: mr. president. the presiding officer: the senator from oregon. mr. wyden: i ask unanimous consent to vacate the quorum call, mr. president. the presiding officer: without objection. mr. wyden: mr. president, here we are with our colleagues on their way home, and i thought it would be helpful to take a minute and give an assessment about where the trumpcare debate is at this point because we have seen the two major committees in the house act, and $300 billion was slashed from safety net health programs while insurance company executives making over $500,000 annually were given a juicy tax break as a bonus.

now, to just kind of put this into perspective, this tax break that the insurance company c.e.o.'s seem to have, after the two companies in the -- after the action in the other -- this would be enough to cover the trumpcare-created shortfall in oregon's community-based services for the elderly and the disabled two or three times over. so what we are talking about is how hundreds of billions of dollars in tax breaks are going to the fortunate few and special

interests while some of the money is coming from stealing a chunk of those dollars from the medicare trust fund and this is very much intertwined with the nominee's work because she would be overseeing medicare payments to rural hospitals in places like louisiana and oregon. so what i'm going to turn to now, mr. president, is what trumpcare, based on these two committees, means for rural areas. and, of course, it repeals medicaid expansion, it caps the medicaid program. in my own view, and i know the

senator from louisiana knows a lot about health care, that in rural communities, in most of our towns are under 10,000 in population. i'm from southeast portland and i love southeast portland. the only regret is that i didn't get to play for the portland trailblazers, but most of our communities have a population under 10,000. as the senator from louisiana knows, we're talking about critical access facilities, we're talking about sole community hospitals, we're talking about the facilities that deal with, you know, acute care and i just -- during the last major break over the president's holiday start what is going to be a year-long

effort for me, mr. president, and i called it the rural health care listening tour. and it is really eye popping to have those rural health care providers that in my state have worked so hard to find ways to get beyond turf and battles, you know, to work together, the hospitals and the doctors and the community health centers, and the like. and they have built an extraordinary effort that helps to wring more value out of scrace dollars. their programs are -- skis dollars. their scrace programs. they are a huge source of

economic growth and jobs for our rural communities. and so i spent that president's day recess, the next major recess as well, getting out and listening to them. and the verdict from oregon's health care providers who have worked very hard at being innovative, trying to make better use of what's called nontraditional services -- they said these kinds of cuts are not an option if you want to meet the needs of so many who have signed up, of course, as a result of the medicaid expansi expansion. trumpcare ends medicare expansion, rolling back federal matching funds in 2020. the rural hospitals in my state are frequently the only health care provider available for hundreds of miles. the medicaid expansion helped these hospitals keep their doors

open. now, mr. president, i don't think it's hard to calculate why the hospitals are speaking out against the flawed approach of trumpcare. they've got a lot of facilities in rural areas that are already on tight margins. if these communities lose the ability to cover needy people -- some of the essential hospitals, and i just described three types of them, mr. president. some of these essential hospitals are going to have to close and the reality is going to be that patients aren't going to have any doctor anywhere nearby. now, understand if the majority insists on ramrodding trumpcare

through -- and at this point we have -- staff just told me there aren't any budget estimates. as of now, the congressional budget office is tasked with providing accurate assetments -- assetments of the budget implications. there are not any budget implications. mr. chairman, here's the latest and it comes from media that i think is not considered by many trump supporters a purveyor of fake news. this comes from fox news, and they said, unknown in the new health care plan, unknown in trumpcare, the cost. how many lose or gain insurance? so i'm very pleased that my colleague from new hampshire has come to join me because, you

know, some of this really, i would say to my friend from new hampshire, leaves you incredulous because this comes from fox news. fox news, hardly a source for many trump supporters of what they would consider fake news. fox news is asking the question because they are saying it is unknown -- unknown in the new health care plan, senator shaheen, according to fox news. unknown in the cost, unknown how many lose or gain insurance. i would say to my colleagues, because my friend from louisiana has joined the finance committee, and i remember welcoming him and senator

mccaskill, our new members, and my colleague from louisiana is a physician and they knowledgeable about these issues. i don't know how you have a real health care debate in america. i've been working on this since i was director of the gray panthers at home during the days i had a full head of hair and rugged good looks, but when we would start a debate, nobody would consider starting it without having an idea of costs or how many lose or gain insurance. how much more basic, senator shaheen, does it get than that? are these tkpwafpa questions -- gotcha questions? are these alternative facts? are these people who are hostile to conservatives? i think not. fox news. unknown in the new health care plan. so i have been outlining what

this means in terms of the transfer of wealth from working families in new hampshire and oregon to the most fortunate in our country, people who make $250,000 or more, they are actually going to be the only people in america who get their medicare tax cut. and so after you have this enormous transfer of wealth, what i call senator shaheen, the reverse robin hood, taking from the working people, giving to the fortunate few. we have after two committees have now acted in the other body, two committees have acted. fox news says that the big questions are outstanding. and my colleague from new hampshire i myat noes a lot about -- i know knows a lot about rural health care and i was outlining to my colleagues what this means to critical access hospitals, sole community

hospitals, accuse care facilities. these are the centerpieces of many rural communities, the essence of rural life. you can't have rural life without rural health care president and here we are on thursday afternoon with many of our colleagues out there tackling jet exhaust fumes heading home and the big questions, according to fox news, are outstanding. so i'm very pleased that my colleague is here and as usual she is very prompt and i appreciate it. i look forward to her remarks. mrs. shaheen: mr. president? the presiding officer: the senator from new hampshire. mrs. shaheen: before my colleague from oregon leaves, i want to ask you, i'm reminded that in 2009 and 2010 as we were working on the affordable care act, that the help committee held 14 bipartisan round tables, 13 bipartisan hearings, 20 bipartisan walk throughs on

health reform. the help committee then considered nearly 300 amendments and accepted more than 160 republican amendments, and the finance committee where my colleague is the ranking member held 17 round tables, summits and hearings on the topic. the finance committee also held 13-member meetings and walk-throughs, 38 meetings and negotiations for a total of 53 meetings on health reform, and during its process, the finance committee adopted 11 republican amendments. so don't you find it particularly ironic that we're seeing this trumpcare legislation being pushed through on the house side and what we're hearing, the rumors about what's going to happen in the senate is take it's not going to have any hearings and it's going to be brought to the floor and we're going to be expected to vote on without really having a chance for the public to know what's in

it? mr. wyden: my colleague is making a very important point. and i think we all know that senate budget process is a lot of complicated lingo and people in coffee shops in new hampshire and oregon don't follow all the fine points of reconciliation. but as my colleague has just said, what they're using is a process. it's known as reconciliation that is the most partisan process you can come up with. there is no more partisan kind of process. and we were talking about the tally as of this afternoon. two committees in the house have acted. my colleague colleague from newe -- my colleague from new hampshire just mentioned i think it was 11 republican amendments in just one of the committees was accepted. as of this afternoon at 4:00 after hours and hours of debate, i'm of the impression that not a

single, significant democratic amendment has been adopted. so your point of highlighting the difference in the process where we had all of the hearings and all of the opportunities that you have to have to get a good partisan bill. and as my colleague knows, i've tried -- i don't take a back seat to anybody in terms of bipartisan approaches in health care. i've worked with republicans, chairman hatch in chronic care, senator bennet and i worked on a bill with eight democrats and eight republicans. so i really appreciate your making this point. and as of this afternoon, as far as i can tell, no democratic amendment has been adopted. you highlighted 11 republican amendments getting adopted in just one committee. and as we indicated, fox news

not exactly hostile to something of the ideas being advanced to the majority is certainly calling them out on this. mrs. shaheen: well, i appreciate the eloquent comments from my colleague from oregon and all of his efforts to make sure that we don't take away health care for so many people who desperately need it. that's really why i came to the floor today. because i spent the week that we were back home, not last week but the week before talking to constituents in new hampshire and listening to what their concerns were. and what i heard was that people were deeply, deeply concerned and very upset by the efforts here to repeal the affordable care act when they didn't know what the replacement meant for them. in dozens of conversations and round table discussions at a

town hall forum, granite staters shared stories of how the affordable care act has been a lifeline for them, including -- i heard from people who say their lives have been saved by the law. and in fact we can see what's at risk here in the state of new hampshire where we have almost 600,000 granite staters who have preexisting conditions. we have 118,000 people who could lose coverage. we have 50,000 granite staters with marketplace plans who are in the exchange. 42,000 who are enrolled in medicaid, and 31,000 who have tax credits that lower the cost of health care for them. and if that is taken away, so many of those people have no option for getting health care. and what we know now after we have finally seen the plan that

republican leaders are talking about, we know that those fears were well founded, that they were worried that they were going to lose their health care. because what we've seen is legislation to repeal the affordable care act that would have catastrophic consequences, not only for people in new hampshire but for people across this country. and it's especially distressing that trumpcare as it's been introduced by the republicans would roll back expansion of the medicaid program which has in new hampshire and across this country been an indispensable tool in our efforts to combat the opioid epidemic. in addition, we're seeing that as my colleague from oregon pointed out, the trumpcare would terminate health care subsidies for the middle class and for other working americans, and it would replace those subsidies with totally inadequate tax

credits, as low as $200,000 which doesn't begin to pay for health coverage for an individual, much less a family. and this means that as many as 20 million americans could lose their health coverage. and even as the bill makes devastating cuts to the middle class, it gives the wealthiest americans a new tax break worth several hundred thousand dollars a year per taxpayer. so i think this proposed legislation is totally out of touch with the lives of millions of working americans, people whose health and financial situation would be turned upside down by the bill. last week in his response to president trump's address to congress, former governor steve beshear of kentucky said something that really resonated with me. he reminded us that people who have access to health care thanks to obamacare are not aliens from some other planet as

he described. they are our friends and neighbors. we sit on the bleachers with them on friday night. we worship in the pews with them on sunday morning. they're farmers, restaurant workers, part time teachers, nurses aides, construction workers, entrepreneurs, and often minimum wage workers. before the affordable care act, they woke up every morning and they went to work hoping and praying they wouldn't get sick or members of their family wouldn't get sick because they knew they were just one bad dying know sis away from -- diagnosis away from bankruptcy. now, to understand why people in new hampshire are so upset and fearful about efforts to repeal the affordable care act, we have to look again at this chart because some 120,000 granite staters could lose their health insurance. that's nearly one in every ten people in the state of new

hampshire. and in particular, repeal of the affordable care act would very literally have life or death consequences for thousands of people who are fighting opioid addiction, who have been able to access life-saving treatment thanks to the expansion of medicaid and to the affordable care act. sadly, one of the statistics that we're not happy about in new hampshire is that we have the second highest rate of per capita drug overdose deaths in the country. we trail only west virginia. the chief medical examiner in new hampshire projects that there were 470 drug-related deaths in 2016, including a sharp increase in overdose deaths among those who are 19 years old or younger. and for a small state like new hampshire, this is a tragedy of staggering proportions affecting not just those who overdose but

their families and entire communities. now, i'm happy to say that in the last couple of years we've made real progress in combating this epidemic because we've had the affordable care act and its expansion of medicaid, which has given thousands of granite staters access to life-saving treatment. over the past year i've had a chance to visit treatment centers all across new hampshire. i've met with individuals who are struggling with substance abuse disorders and providers who are trying to make sure they get the treatment they need. last month at a center in the nonnadknock region of new hampshire, i had an amazing private meeting with more than 30 people in recovery from substance abuse disorders. they're putting their lives back together. they're hoping to reclaim their jobs, to get back with their families and they're able to do that largely because of treatment that's made possible

by the affordable care act. one patient shared her story with me. as with so many others in treatment, her story is one of making mistakes, of falling into dependency, of struggling with all her might to escape from addiction. she's in recovery for the second time, and she said that this time for her it's a life or death situation. she has no family support. she worries that she'll be homeless when she leaves the treatment program. but she is grateful for the affordable care act because it's given her one more shot at getting sober and the chance for a positive future. at a forum in manchester, new hampshire's largest city, a courageous woman named ashley herto said access to health care as an enrollee in medicaid expansion was critical to her addiction recovery. she'd been arrested following

the overdose death of her husband. and ashley said an understanding police officer and a drug court were key to her recovery. and she added this, and i quote, i am living proof that by giving individuals suffering with substance use disorders, access to health insurance, we as a society are giving people like me the chance to be who we really are again. without that access to treatment, where would ashley be? and several weeks ago i received a letter from nancy feeney who lives in concord, the capital of new hampshire. she told me that the affordable care act saved her son's life and this is what she wrote. my son benjamin went to keene state college the same hopes and dreams many have when building their american dream. while there he tried heroin. addiction overcame him but it didn't stop him from graduating.

after graduation he suffered a long road of near-death existence. after a couple of episodes where he had received -- where he had to be revived because he had taken fentanyl, he chose recovery. and it was due to obamacare that we were able to get him insured so he could get the proper help he needed and into a saboxone program that assisted him with staying clean. in april she wrote, and you can read between the lines how relieved she was, it will be a year for ben and his recovery. without obamacare this would not have been possible. i can't find the words to define my gratitude to president obama. i believe my son would not be alive today were it not for this plan that provided the means he needed to get the help he needed at the time he needed it. ben still has a long road ahead of him, but i wilee