we got a majority in 2010. and i found myself being the speaker of the house. mr. president, we were in the middle of the financial crisis. when i got sworn in in january of 2011, north carolina had a $2 billion shortfall on a $20 billion general revenue fund. and i had six months to balance that budget. well, mr. president, we did something that had not been done in north carolina. we took the time to understand every aspect and every dollar being spent in government. we determined how to cut government in a way that was sustainable. we cut 12% from the university system budget. not at the rate of growth, but the actual spending. i had some people say it was going to be disruptive and the university of north carolina would never be the same again. we did it in a way that was

instructed by the operations of the university system. and we did it in a way in concert with the chancellors. you know what happened, mr. president? we actually balanced the budget. we did do those cuts. the last time i checked, the north carolina university system is still considered one of the greatest systems in the united states of america. why do i use that example? because the medicaid proposal in this bill bears no resemblance to that kind of discipline and due diligence. it has no insights into how these provider tax cuts are going to be absorbed without harming people on medicare. and even worse, most of my colleagues do not even understand, on either side of the aisle, the interplay of state-directed payments and the devastating consequences of the funding flows that are going to be before us. mr. president, here's how i figured out the impact in north carolina, i used to be speaker of the house, and i

liked the speaker and have good relations with the speaker and president pro tem. i called them up, and i had my staff ask if they would do an economic impact assessment on what this proposed bill would do to the medicaid program in north carolina. i didn't want just the few of the republican partisan staff that reports to the speaker and the president pro tem on how they're going to absorb this bill. i decided to go to josh stein, the governor. i went to his democrat staff for medicaid. i asked them to prepare an estimate, independent of the estimate i had done with fiscal research. i took it a step further, mr. president. i went to the hospital association. i asked three different independent groups, a partisan democrat group, a partisan republican group of experts, and a nonpartisan group of the hospital association to develop an intact assessment independent, not talking, not sharing, reporting to me.

what i found is the best-case scenario is about a $26 billion cut. we've got a delay, it may be two years, may be one year. all it does is make that $26 billion happen in year one or 12. the impact is the same. when i presented this report that you can find on my website, i had people in the administration say you're all wet. you don't know what you're doing. i said why don't we assemble a series of meetings. we're going to provide you our analytics. you go through it, tear it apart. i told mehmet oz, who i consider one of the most capable people in the trump administration. he's a brilliant man. i encourage my democrat colleagues to talk to him. he knows his stuff. he's very focused on getting owe efficiencies out of cms. we had three different conference calls with cms with oz on the phone and video, and me on the video. i said this, guys, i would love

nothing more than you to prove me wrong. i would love nothing more than you tell me it's not 26 billion or 30 billion but 2.6 billion or 2 billion or 200 million. but after three different attempts for them to discredit our estimates, the day before yesterday they admitted that we were right, that between the state-directed payments and the cuts scheduled in this bill, there's a reduction of state-directed payments, then there's the reduction of the provider tax, they can't find a hole in my estimate. so, what they told me is that, yeah, it's rough, but north carolina has used the system, they're going to have to make it work. all right. what do i tell 663,000 people in two years, three years, when president trump breaks his

promise by pushing them off of medicaid because the funding's not there anymore, guys? the white house advising the president, they're not telling him that the effect of this bill is to break a promise. you know the last time i saw a promise broken around health care with respect to my friends on the other side of the aisle? it's when somebody said if you like your health care, you can keep it, if you like your doctor, you can keep it. we found out that wasn't true. that made me the second republican speaker of the house since the civil war, ladies and gentlemen, because we betrayed the promise to the american people. two years later, three years later, it actually made me a u.s. senator, because in 2010 it had just been proposed, and just anticipation of what was going to happen was enough to have a

sea change election that swept republicans into the majority for the second time in 100 years. now republicans are about to make a mistake on health care and betraying a promise. it is inescapable that this bill in its current form will betray the very promise that donald j. trump made in the oval office or in the cabinet room when i was there with finance, where he said, we can go after waste, fraud, and abuse on any programs. now those amateurs advising him, not dr. oz, i'm talking about white house health care experts, refuse to tell him that those instr instructions, that were to eliminate waste, fraud and abuse, all of a sudden eliminates a government program called the provider tax. we have morphed a legal

construct, that admittedly has been abused and should be eliminated, into waste, fraud, and abuse. money laundering. read the code. look how long it's been there. i was speaker of the house. i refused to do it. when i left north carolina, i said, we're not going to use the provider tax. i left it 2.5%. now it's 6%. mistake on the part of leadership. i know my friends think i'm crazy here, but i actually passed a law that made it illegal to expand medicaid. why did i do that? because i was convinced someday we would be here, and i would have rather found a way to get more people on medicaid at the standard fmap than this 90-10 match and watching it disappear and taking away desperately needed health care. so mr. president, over the course of the evening, i may look for an opportunity to speak

again, but i am telling the president that you have been misinformed. you supporting the senate mark will hurt people who are eligible and qualified for medicaid. i love the work requirement. i love the other reforms in this bill. they are necessary, and i appreciate the leadership of the house for putting it in there. in fact, i like the work of the house so much that i wouldn't be having to do this speech if we simply started with the house mark. i talked with my colleagues in north carolina. i know that we can do that. and i believe that we can make sure we do not break the promise of donald j. trump, that he's made to the people on medicaid today, mr. president. but what we're doing, because we've got a view on an artificial deadline on july 4, that means nothing but another date in time, we could take the

time to get this right if we lay down the house mark of the medicaid bill and fix it. i know my friend and colleague from new hampshire, i jumped in front of her, i'm only going to take another minute or two. but mr. president, we owe it to the states to do the work to understand how these proposals affect them. how hard is that? i did it. how hard is it? how hard is it to sit down and ask the medicaid office, ask the legislative staff, ask the independent hospital association what the payment is? if there's no negative impact, what's wrong with daylight? what's wrong with actually understanding what this bill does? mr. president, i know what it does because i spent a career implementing complex systems, then i had the privilege of being speaker of the house, and i implemented them in a government setting.

since i've been here, i focused on bills, watched that implementation from the cradle until fully implemented. mr. president, we owe it to the american people, and i owe it to the people of north carolina, to withhold my affirmative vote until it's demonstrated to me that we've done our homework, we're going to make sure we fulfill the promise. then i can feel good about a bill that i'm willing to vote for. but until that time, i will be withholding my vote. thank you, mr. president. the presiding officer: the senator from north carolina. mr. tillis: i ask unanimous consent that the following appear separately in the record. the presiding officer: without objection. mr. tillis: i ask unanimous consent that the senate proceed to executive session to exercise the following nominations

en bloc, 198 through 249, with the exception of 241, and all nominations on the secretary's desk with the exception of p.n.89. that the nominations be confirmed en bloc, the motions to reconsider be considered made and laid upon the table, with no inconvenienting action or debate, that no further motions be in order to any of the nominations, the president be immediately notified of the senate's action, and the senate then resume legislative session. the presiding officer: without objection. mr. tillis: thank you, mr. president. mr. president, i also ask indulgence for one more minute. i ask unanimous consent that this also, the following appear separately in the record. the presiding officer: without objection. mr. tillis: this is really easy. yesterday was my 38th wedding anniversary. i've convinced susan tillis to stay married to me 38 years. i wish i was going to be with her in a couple of dozen -- and a couple dozen family members at the beach, but i'm doing my work here and i'll stay until it is done. i also want to wish my grandson,

they're celebrating his second birthday at the same beach house. god bless my family. i love you. mrs. shaheen: mr. president. the presiding officer: the senator from new hampshire. mrs. shaheen: thank you, mr. president. i'm sorry to see my colleague, senator tillis, leave before i have a chance to tell him how much i'm going to miss him. we have worked together on a number of things, including the senate nato observer group, and he's been a great partner, an excellent senator, and i'm sorry to hear that he's not going to be staying in this body. but mr. president, i'm really here on the floor to oppose the reconciliation bill we're considering today. it would be the largest transfer of wealth from the poor to the rich in a single bill in our history. this legislation would take away

health care for millions of americans. it would cut food aid for millions more. it would raise household energy and health care bills. and it would add trillions to the debt. all to give the top, not just 1%, but the top 0.1% of people, who make more than $2.5 million a year, an extra $250,000 a year. an at a moment when americans are struggling with the high cost of living, this bill will take money out of the pox of working people -- out of the pockets of working people. the average household making less than -- 30% of americans will lose about $700 a year from this bill. now, here are some of the ways it hurts middle-class americans, the people i'm very proud to represent in new hampshire -- somehow, the senate took the bad

bill, what i thought was a bad bill from the house, and made it much, much worse. this bill is the largest cut to health care in american history. in total, the bill proposes more than a trillion dollars, a trillion dollars in cuts to medicaid and the affordable care a act. 930 billion of that is medicaid alone. because of these cuts, more than 300 rural hospitals could close, more than 500 nursing homes could close. these are core programs and services that benefit seniors, children, veterans, people living with disabilities, and working families. the congressional budget office estimates 17 million americans, including 43,000 granite staters, will lose their health insurance. now, over the past several

weeks, past couple of months, i've toured new hampshire, i've heard from countless constituents who are deeply anxious about what this bill means for them and for their families. again and again, they have said pla plainly, without medicaid, without the affordable care act, they would not be here today. i heard from danielle in dalton, northern new hampshire. daniel is the proud mother of three sons, two mof whom had autism. they rely on medicaid for health coverage and home care. danielle receives a stipend to care for therm. both of her sons work part time and they're able to remain active in the community. this bill would put all of that at risk. danielle says her sons could have difficulty qualifying for

medicaid under these new rules. and losing medicaid would be catastrophic for her family because it would likely force her sons out of work, out of her home, and into a group home or institution. and so it's going to cost a lot more if that happens. her boys are now contributing members of society, and this bill threatens not only their livelihood and their independence and their future, it threatens their dignity. i heard from sean in claremont. sean shared with me his story of addiction to alcohol, cocaine and heroin and his long road to recovery. after several near-death experiences, he enrolled in medicaid. he was able to hold a be jo and get his life back on track. he eventually opened his own

sober living home, hope to freedom, where he now helps others suffering from addiction so that they can enroll in medicaid and begin their own journey to sobriety. i heard from karla in exiter. she has three boys, one mo had serious medical problems at birth. she always was able to have health insurance with her job but as her family's medical bills grew, she enrolled in medicaid. he still needs extensive care to this day and losing her coverage would put her family into devastating medical debt. probably the story that i heard that touched me as much as any was from a man in berlin in northern new hampshire. he had had a number of substance

misuse issues, mental health challenges. he said, without medicaid, without this center -- we were at a center where medicaid helped pay to support people who needed help. he said, without this, i would just give up. i would commit suicide because there would be nothing for me. these are just a handful of the countless stories i've heard these past few months. they're about real people. this bill isn't just words on a page. it's a direct attack on not only their health and their economic security but their very dignity, their ability to have fulfilling lives and to contribute back to their communities and to society. we owe them better than this. this bill would also make

catastrophic cuts to food assistance that's provided by the supplemental nutrition assistance program, also known as snap. during this time of high food prices, of increasing food insecurity, it's particularly critical for families to be able to rely on snap to help them keep food on the table. one of the ways this bill cuts the program is by requiring states to pay higher costs. now, as the former governor of new hampshire, i can tell you how much of a burden this is on our state's budget. and there are all kinds of provisions in this bill that are nothing but massive cost shifts to states. and this is one area. the bill puts food assistance at risk for families with teenage children as well as older adults, veterans, and individuals experiencing homelessness. in new hampshire, an estimated 1,000 older adults could lose

snap access. these cuts will mean increased hunger across the country. you know, we talk a lot about kitchen table issues here. passing this bill is an explicit vote to take food off of families' kitchen tables. i heard from rachel. she is a care coordinator at a behavioral health center in claremont, which is in the western part of new hampshire. she told me, and i'm quoting her, snap is not just a program, it's a lifeline. for the parents i work with, it means being able to send their children to school with full stomachs and functioning minds. for caregivers struggling to make ends meet, it provides some peace of mind knowing there will be something on the table each night. and for children, many of whom are navigating mental health challenges, snap supports stability, dignity, and health during formative years.

without snap, the strain on these already vulnerable families would increase exponentially. and she goes on to say finally, snap is not a handout. it's a step forward for families working hard to survive and succeed against overwhelming odds. and on the energy front, for families concerned about energy costs, this bill only offers more pain. in addition to cutting off tremendously successful incentives for electricity that are adding reliable, affordable, and clean energy to the grid at a record pace, this bill cuts off long-standing tax credits for consumers for average, everyday americans to make energy-saving improvements to their homes or to add rooftop solar to take care of their own energy bills. after countless promises to lower people's energy bills,

this legislation would do just the opposite. last year 2.3 million families took advantage of the home energy efficiency tax credit and cut $130 off of their energy bills. that might not sound like a lot to the mar-a-lago crowd. american households are expected to pay an extra $170 billion in energy bills over the next ten years, thanks to misplaced priorities in this bill. and add to that 1.5 million good jobs that are likely to go away, and it makes you wonder if supporters of this bill have actually read it or if they actually care about american energy dominance. and on taxes, this bill spends more than $4 trillion on tax

cuts, including nearly $1 trillion in new tax breaks for the biggest corporations. but for taxpayers earning less than $30,000 a year, they would see an average tax increase -- let me say that again, because i didn't say that quite right, with the right emphasis. for taxpayers earning less than $30,000 a year, they would see an average tax increase in 2029, and these are the same families who are going to be harmed most by extreme cuts to medicaid and snap. families making under $50,000 are likely to be worse off, and some could lose more than $1500 under this bill. if you add to that the effects of trump's tariffs, which raise the cost of living, this makes it even worse for families.

so the bottom 80% of households, those making less than $175,000, will be worse off on average under this bill. now, i talked about how this bill makes families pay more for health care, for energy and food in order to give more money to billionaires, but there are a few other things that people should know. first, because of the trillions of dollars this bill would add to the debt, interest rates are likely to go up. that adds more than a thousand dollars a year for a typical mortgage. this bill makes it harder for students to afford the cost of college and it removes debt protections for students that have been defrauded by their schools. and this bill actually tries to prohibit states from regulating a.i. for the next ten years, making it that much harder to keep our kids safe online and to protect jobs from being lost to the use of this technology.

now, i was first elected to the new hampshire state senate more than 30 years ago. this bill that we're considering today would do more harm to more people than any other law i have seen in my entire time in public office. this bill makes having a family more expensive by raising a the costs of energy, health care, and education. this bill takes food and health care away from seniors and families, and it does all of that, it does all of that to give trillions of dollars more to corporations and to the wealthiest. and it explodes our deficit in the process. that's not what the people of new hampshire are asking for, and it's into the americans deserve -- not what americans deserve. so to my colleagues in the senate, i say this -- at a moment when americans are feeling squeezed by the cost of living, we should be doing something about that.

instead of gutting health care to pay for tax cuts, we should be expanding access to affordable, quality care. instead of turning pointing our backs on -- instead of turning our backs on working parents, we should be making housing more affordable and we should make education more affordable. instead of cutting knew fisheriesing programs, let's make sure that no child in america goes hungry. instead of driving up food and energy prices, let's invest in the programs that help american families succeed. president trump calls this the big, beautiful bill. but it is a big betrayal of the american people. there's nothing beautiful about taking away health care and food from working families to give more money to billionaires. so i intend to vote against this legislation, and i urge all of my colleagues to do the same. i yield the floor.

mr. durbin: mr. president. the presiding officer: the senator from illinois. mr. durbin: mr. president, i don't believe you can serve in the united states senate without being at least an amateur student of history. you're overwhelmed in this chamber where the senate has mess since 1859 -- set since 1859 to reflect on all the things that have occurred in the pasters and you remember your own experience here as well. i certainly do. this is my 29th year of service in the senate. i think back this evening of some of the things which i've witnessed and still stick with me. i can still see that door open and ted kennedy walk through it, someone from his deathbed in massachusetts, to cast a deciding vote on the affordable care act, obamacare. he wouldn't miss it, even if it meant he was going to die in the process. i think of that door over there when president trump in his

first term tried to basically eliminate the affordable care act, and it was saved at the last minute at 2:00 in the morning when john mccain came through those doors, stood in the well right by that table on the republican side and cast his vote, no. he couldn't raise his arm, had been damaged in vietnam, but you knew how decisive his gesture was. he saved health care for millions of americans. there were other moments as well that i can reflect on, but the point i'd like to get to is this -- there was a speech a few minutes ago on the floor of the united states senate which every senator should have heard, particularly every republican senator. the senator from north carolina gave a speech, senator tillis, that explained why he had decided to vote against this republican budget plan, this reconciliation bill. he explained it in a thoughtful

and comprehensive and convincing way, that before he made his decision, he turned to republicans in his state and democrats and a neutral third party to analyze the bill, and he concluded, mr. president, after that study, that careful study, that this measure, the changes in medicaid and medicare and other health programs, would be a disaster for the state of north carolina. he made it clear before tonight that he was going to vote against this bill, and he made it clear this morning that he's preparing to retire from the senate. i felt his statement was compelling. and i'm sorry there weren't other members on the other side -- at least one beyond the presiding officer -- to hear it. it's seldom that you her a speech that you know is so personal and heartfelt and so meaningful as the statement made

by senator tillis earlier. he made a decision which will be widely reported i'm sure and showed a level of political courage which you seldom see in this chamber. he basically said in a positive way that the president was wrong if believing this wouldn't hurt ordinary people. this republican measure which is before us tonight, tomorrow is going to hurt a lot of people. we estimate that 16 million american families will lose their health insurance as a result of this measure that's on the floor today. i've said it before, but i want to repeat it. if you have ever been the father of a new baby with a serious medical problem and you have no health insurance, you will never forget that moment as long as you live. i know. i've been there. i went to the charity ward of children's hospital here as a

student at georgetown law school with my wife and baby. and we waited in line to see which doctor would walk through the door and see my baby and save her life. you feel that you let everybody down in the world at that point, that you don't have health insurance when you need it so badly. it means so much to you. this bill is designed to take health insurance away from 11 million families in america. 11 million families in america, at a period of time we will not have the peace of mind that they have access to the best care because they would have lost their health insurance. what is it about donald trump taking away coverage of health care? why has this become the trademark of the donald trump republican party? he did it in his first term, tried to and john mccain stopped him and now he's trying to do it again. the question is mr. senator tillis and his republican colleagues can muster enough courage to step up and find four

republican senators who will say no. no, i'm not going there. i don't want it on my conscience or my record that i took health insurance away from so many american people. now, you may argue durbin, you're a democrat, and i am. your arguments have to be tempered because you're so partisan, so political. surely it isn't as bad as you just said it was. let me read something to you. it's from a group called the american cancer society. i'm sure you've heard of them. this is their cancer action network. and it's a letter to the senate from lisa lacoss, president of the american cancer society, cancer action network. and here's what she says about the measure that's pending before us now that we're being asked to vote on. from the american cancer society, cancer action network. quote, history will be made with

this vote. congress has one last chance to stop this unprecedented attack on access to health care for millions of americans, including cancer patients and survivors. congress can say no to terminating health coverage for nearly 11 million people who have no other affordable option available to them if this bill passes. currently one in ten people with a history of cancer have medicaid coverage, including one in three kids who are newly diagnosed with cancer. we know having quality health coverage is one of the most significant factors in whether someone survives a cancer diagnosis. voting for this bill means voting to rip the chance of survival away from real people. she goes on to say, simply put, this bill will mean more americans are living sicker and dying sooner. and then she said, lives are on the line. so if you're skeptical about anything that i say because of

my partisan background, i understand it. but for goodness sakes, from the american cancer society, they have such a definitive statement made that this measure that we're being asked to vote on is going to harm innocent people, men, women, and children. that's a fact. and, mr. president, i might add another short message that we received from the children's hospital association. the children's hospital association. matthew cook is their president and ceo, and here's what he says about this bill that is pending. the new version of the budget reconciliation bill is a crisis for children's health care, hospitals, and providers nationwide. and we ask congress to oppose it as an act of support for american children. this bill goes much too far. the bill -- fewer doctors to see your children. we know the impacts of poor

pediatric health care reverberate for a lifetime. from the children's hospital association. neither of these organizations are partisan organizations. and they have confirmed what senator tillis said earlier on behalf of the state of north carolina, and with those of us on this side of the aisle were saying all along. why would he risk the lives and well-being of so many children, so many american families? what is it about the trillion dollars which we will take out of the health care system in america that is so pressing, so demanding that we're willing to make these big risks? i'll tell you what it is. it is the extension of tax breaks, tax breaks for the wealthiest people. oh, durbin, you democrats always talk about billionaires and millionaires. it can't be true. senator angus king is here. he told me that he did analysis of the actual tax breaks. and if i remember correctly, if you do a cutoff of income of

$400,000 a year and said anyone over that figure is not going to receive any tax break, you would reduce the cost of these -- this tax program by 60% or more. 60% or more. so when we talk about tax breaks for the wealthiest people in america, that's exactly what this is about. i want to give tax breaks if i can to working families who struggle from paycheck to paycheck. but for goodness sakes, $34 #,000 -- $346,000 tax cut for elon musk, the richest man on earth? what are we thinking? i just want to make a quick reference to two states that have an experience coming with this bill which will be dramatic. one is kansas. in kansas 360,000 individuals rely on medicaid coverage. 56% of them are children. but with this bill 89,000 people in kansas are going to lose

their health insurance. in kansas medicaid covers one-third of births, 58% of nursing home residents. what happens when medicaid does not pay for enough money into the nursing home to keep your mother under good care or your father or someone in your family? what do you do next? well, you exhaust the savings that are available to your family. if that isn't enough, what's next? i don't know but when i grew up as a kid, there was a spare bedroom in my grandparents' home for brothers and sisters who had no place else to go. i suppose that's going to happen to some families. already 28 rural hospitals in kansas are at immediate risk of closure. to think that this measure would have no impact on those families and those communities is just plain wrong. in an adjoining state of missouri which i grew up across the mississippi river, grew up in illinois, across the river from st. louis, missouri, 1.2

million individuals rely on medicaid coverage. 50% are children. with this bill, 250,000 people in missouri are projected to lose their health insurance. medicaid covers 40% of births in missouri, 65% of nursing homes. already ten rural hospitals in missouri are at immediate risk of closure. mr. president, you know as well as i do what happens in small town america, rural america when they close the hospital. it is devastating, not just because you don't have access to quality health. because you just lost a major economic engine for that community. try to attract a new business to that town after the hospital closes and watch what you run into. it is that devastating. that is the reality of this approach. why are we doing it? what is the national emergency that calls on us to make this change? tax breaks for the wealthiest people in america. that is what's motivating the republicans now.

i want to close and just say thank you to senator tillis. he's shown extraordinary courage. the question is whether others will join him. whether four republican senators will step up and say enough. i heard enough, i've seen enough, i believe this is wrong. there are ways we can help people who need it rather than the wealthiest people, that won't damage so many families, 11 million, 16 million, whatever the number turns out to be who lose health insurance. i hope that we come to our senses and do it soon. i hope that what senator tillis said on the floor will inspire members of his own caucus to listen carefully, to know that he speaks the truth, and has taken great political risk to say it. i yield the floor. a senator: mr. president. the presiding officer: the senator from wisconsin. ms. baldwin: thank you, i am proud to join my midwestern colleagues today to draw

attention to what is happening in our states if this bill were to come to pass. and so i rise today on behalf of the 17 million americans who are poised to have their health care terminated because of the republicans' disastrous budget bill. while i'm laser focused on the nearly 260,000 wisconsinites whose health care will be placed in jeopardy by this measure, i realize that so many americans who reside in states that are represented by republicans don't have a voice in this fight right now on this senate floor. you know, i have traveled my state extensively listening to people talk about how this bill would impact them and their families. and i've shared those stories. i've uplifted those stories. sometimes right here on the senate floor and sometimes in other ways. but i know that my republican

colleagues are getting the same influx of phone calls and letters that i'm getting from parents of children with disabilities, from the elderly and folks who are working hard but just can't keep up. these are constituents who are downright scared that they will have a rug pulled out from under them. and i know my republicans are hearing from their rural hospitals and their pedi pediatricians who are clear about what this bill will mean for their ability to keep their doors open and to care for their patients. according to reports, my colleague from kentucky even admitted as much behind closed doors last week saying that, i know a lot of us are hearing from people back home about medicaid. but rather than committing to join us in this fight, he said they'll get over it. and urge his colleagues to forge ahead with this bill. well, if my republican

colleagues won't fight for these americans, i think it's well passed time that some of us do. and that is why i'm proud to be standing with my midwestern democratic colleagues to do and say something about it. i'm here to stand up for the over half million midwestern americans in iowa, kansas, missouri, nebraska, the dakotas whose health care is on the chopping block in republicans jam through this terrible budget bill. in just those six states alone, over 340,000 americans will lose their affordable care act coverage. and over 225,000 americans will be kicked off medicaid if the republicans get their bill and their way. in iowa over a hundred thousand americans care could be on the chopping block including over 58,000 americans whose facility rely on medicaid. when we talk about hundreds of

thousands of people losing health care coverage, it could sometimes get lost that this actually means people, not numbers. the numbers we're talking about are people. they have faces. they have stories. they have families. and they matter. take patrick kearns, a registered nurse at the v.a. center and a father with two adult children with disabilities. he told "the des moines register," my children are not scamming the system. the idea that they're somehow gaming the system at the detriment to the rest of society, especially when people like elon musk are using words like parasite to describe my children, anger doesn't quite encompass how i feel. he continued, i just find it shocking that he would go after truly the most vulnerable people as if they are somehow conducting fraud.

these folks are barely sure sure vieshing -- barely surviving. in kansas where nearly 90,000 americans' health coverage is at risk including 18,000 kansans on medicaid. kathy and jacob shared the story of their adopted sister maria who suffered a traumatic brain injury at just four weeks old. i'm sorry, seven weeks old. because of medicaid, the family could afford at-home nursing services. before their sister passed away in 2024. jacob told the kansas reflector, this is not right or left. this is truly a human right. yes, we want to get rid of fraud. people using the support that's not fraud. that's called people helping people live the best life in the most respectful and dignified

way possible. in missouri, 250,000 americans' care is on the chopping block including over 100,000 with medicaid. in the suburb of st. louis, sandra told the kaiser family foundation health news that she worries about her 24-year-old daughter sarah and the 24-hour care she needs, including in-home nursing. sandra said i truly don't know what i would do if we lost the medicaid home care. i have no plan whatsoever. it is not sustainable for anyone to do infinite 24-hour care without dire physical help, especially as we parents get into our elder years. in nebraska, 74,000 people could

lose coverage, including 26,000 americans on medicaid. dr. ann anderson barry, who works at the children's hospital in omaha, nebraska, told nebraska public media these cuts would greatly harm those in nebraska's rural communities. according to dr. anderson barry, this is not just a health care issue, it's a workforce issue, an education issue, an economic issue. communities without access to safe childbirth cannot attract or retain young families. they struggle to grow and they suffer generational consequences, nebraska simply deserves better. our rural families deserve better. cutting medicaid may save money on a spread sheet, but it will cost lives in rural communities and put the expensive burden of care back on our communities.

in south dakota, 31,000 americans' insurance is at risk under this bill, including 12,000 americans on medicaid. retired family physician tom dean from wessington strings, shared -- springs, shared what this would mean to nursing care. he told the south dakota searchlight. i'm really frightened about the impact it will have on nursing homes. medicaid is a major payer for prenatal, delivery and postpartum care. that is a major concern, especially in rural areas. i know my republican colleagues are hearing these stories from their constituents, and we need to make sure that they can't ignore them. these stories, and the people behind them, make all the difference in this fight to protect medicaid. i'm proud to give them a voice

in the senate. as my republican colleagues continue their crusade to rip away health care from 17 million americans. the american people don't like this bill, and that includes americans who live in red, blue, and purple states. we're going to keep ringing the alarm bells on behalf of americans in every corner, every pafrt this nation -- part of this nation, and protect the critical coverage working families need and deserve. lives depend upon it. i yield. a senator: mr. president. the presiding officer: the senator from minnesota. ms. klobucher: mr. president, i rise today along my colleagues from illinois and from wisconsin and you just heard from senator baldwin, about the effect of this budget bill on the midwest. i guess i'd start by asking the

same questions that our colleague, senator tillis, who just announced he wasn't going to seek reelection after the president threatened him with a primary, and after he took a vote and had the audacity to ask the questions that had to be asked about this bill. you heard him today. he talked about how he had talked to the hospital association in his state, how he had had talked to the governor's office, had he had gotten the actual data on the efbts of -- effects of medicaid in north carolina, and then he asked the question, how hard is it to see the impact of these proposals? and he asked, what's wrong with putting a little daylight on what's going on here? so that's what i'm going to do in my view fins here -- few minutes here, put a little midwestern daylight on what's

going on here. that is that under this bill 17 million people would be kicked off their health care because of the medicaid and the affordable care act changes, that was 16 million people until we got the updated numbers from the congressional budget office. that's a nonpartisan group. it also drives $4 trillion debt, used to be $3.4 trillion, now it's up to $4 trillion. what will that mean? that will mean big time in the midwest where i have so many of my own constituents wanting to buy their first house, it's going to mean major increased interest rates, it's going to mean difficulty in buying all kinds of things for which you would take out loans for small businesses, all for giving a bunch of tax cuts for millionaires and billionaires. $400,000 for multimillionaires.

our colleagues are going to raise costs and take health care and food away from millions of americans. so my colleagues have talked about senator baldwin and senator durbin talked about the effect that this bill has in the midwest when it comes to health care, the closing of the rural hospitals. the midwest has a huge number of these rural hospitals, about half of them are forecast to close. they talked about the medicaid cuts. i'm going to talk about a different piece of this. and this is the impact to cuts to food assistance. there's no avoiding the facts. here they are. about a month ago the house passed a budget bill, as you know, that cut nutrition assistance by nearly $300 billion. it put the country on tract to eliminate snap for four million americans and reduce benefits for millions more. i was hopeful that we would go

in another direction. and while there were some changes made by the republicans on the agriculture committee that i appreciated, it still amounts to over $185 billion in cuts from the snap program. and let me remind you that the vast majority of people on snap are older american, people with kids, veterans, people with disabilities. we were just out on the senate steps with a number of those people and the groups that they represent and faith leaders talking about this very subject. why them? why give tax cuts to the wealthy on their backs? we know that the impact of the big beautiful betrayal will be even more stark in the midwest. in the midwest, here are some examples, americans use snap

benefits. nearly 155,000 people in nebraska, let's face it that is not the biggest population state, but 155,000 nebraskans use snap. about 190,000 people in kansas, 260,000 people in iowa, 660,000 people in missouri, 700,000 people in the state of wisconsin. senator baldwin just talked about the impact of health care there. but 700,000 people in my -- are my neighbors in wisconsin. nearly 1.5 million people in michigan use snap. and in minnesota, 450,000. so guess those people will be affected greatly about in faux shift to the state. while we tried to fight

part-this shift weeks were not able to get that changed in the last few days. this means certain states, i'm just going to give you some examples hundreds of millions of dollars are supposed to shift over to states in the midwest when 41 of the 50 states in our country have balanced budget amendments. so what are they supposed to do? cut infrastructure? cut law enforcement? when the majority of these cuts, and this is why this is such funny math, are shifts to the states, and it's why governors, especially in the midwest, governor kelly in the state of kansas has been speaking out big time on this why they are so concerned about this shift. in addition, and this is not something everyone thinks about when they think about snap, but we think about it big time in the midwest, farmers and goesers. over -- grossers. over a third of america's

farmlands is in the midwest, that is 122,000 farm operations which is more than one-third of farms nationwide. so why would farmers care about this? well, they would lose revenue because americans won't be able to buy their products. and that loss, that's the snap program, it buys food from america, just like international programs were buying food from usda or trump tariffs that dry up markets all over the world because of retaliatory tariffs, that's hitting our farmers, input costs, inflation, you name it. and now this on top of it. in addition, this is going to be a big hit to our grocery stores. in many counties in the midwest, their independent grocery store is the loan grocer.

in 76 counties nationwide, they don't even have a single grocery store, and half-those are in the midwest -- half of those are in the midwest. i recently visited an ploy- -- employee-own grocery store, they operate on tight margins, and they don't just serve that county, but they serve surrounding counties, or they may be the only one in town. businesses like that, the cuts to snap, it's pretty significant because that's sometimes the margin in which they're able to stay alive as a business. this would make it harder and harder and more expensive for those grocery stores. it could put them out of business, that's for sure, that's what the grocery stores believe, but it also hurts the individual people in their areas because in the rural areas you

have an overwhelming number of seniors, you've got an overwhelming number of veterans, and you have just an overwhelming number of people who are using these kinds of grocery stores. so snap supports hundreds of thousands of jobs and billions of dollars in wages at these independent grocers, farms, other industries, including more than 1700 jobs in nebraska, more than 1900 jobs in kansas, more than 2600 jobs in iowa, mosh than 7 -- more than 7,000 jobs in missouri, more than 6,000 jobs in -- more than 4,000 jobs in minnesota. we know that from farmers and truck hers to local grocers, for every dollar invested in snap, about 1.50 of economic activity is generated nationwide.

for many midwesterners, this bill would make the difference between having a grocery store in their region or not. i mentioned the shift of millions of dollars that will blow holes through the state budget. they won't able to afford it and our republican colleagues know this. because 44 states have this balanced budget rule, and they'll be forced to choose between paying the cost for food and paying for critical services. that is why 23 democratic governors, all of them, just laid out in a letter to congress. these cuts don't just increase state costs, they make it nearly impossible for states to effectively prepare for these long-term budget impacts. those are governors from kentucky with governor beshear to arizona with governor hobbs,

across the entire nation we heard from these governors, not to mention the governors such as governor pritzker in illinois, and governor kelly in kansas, and governor whit mermer in -- whitmer in michigan. based on 2023 figures, the house and senate verse of this bill -- version of this bill would shift and it varies because the bills are different. but this is it how much money we're talking to. between 16 million and 49 million on to the state of nebraska. queen 6 -- between 61 million and 101 million of costs on to kansas. imagine the budget, suddenly, oh, you've got to do an extra $60 million, troo bad you -- too bad. up to 160 million costs to iowa, between 225 million and 376

million on to the state budget in missouri. up to 68 million in costs to wisconsin where governor evers was a signature of this letter. between 456 and 761 millions in costs on to michigan and between 43 million and 128 million on to costs in minnesota. those numbers are on top of an increased administrative cost shift to states. it used to be 50-50. now it's 75-25. hello, states, you with strapped budgets, we're now making you pay 75% of administrative costs. which would make it even harder for states to invest in the staff training and upgraded financial systems that would make the program more sound and reduce payment errors. it's not just the state oning et cetera that will be -- not just the state budgets that will be affected. it is also