I would like to thank my friend and colleague senator hirono for her words and willingness to share how this bill, impacting millions of americans with preexisting conditions. I along with everyone else in this chamber wish her the best and speedy recovery, the people of hawaii and the people of the United States. After weeks of secret Meeting Senate republicans released their healthcare legislation last weekend in many ways it is even worse than expected. It is no wonder Senate Republicans kept this legislative malpractice hidden behind closed doors. For working families and the elderly, for the disabled, those suffering opioid addiction, this legislation is a death sentence. This bill takes a machete to medicaid. It abandons people with preexisting conditions, punishes grandma and grandpa who live in a nursing home including 25,000 seniors, Nursing Homes who are on medicaid. It causes the single greatest rollback of civil rights for people with disability in a generation, by taking away the funding for those with disabilities. It creates an age test for those over the age of 50. It shreds a Critical Healthcare program for the disabled, working families, children, just to bestow billions in tax breaks for the wealthiest. This is an amazing number. The richest 400 billionaires in the United States, a tax break of more than 33 billion which is roughly equivalent to the cuts for ending Medicaid Expansion in four states. There are 700,000 people in just those four states that can be kicked off of their Health Insurance coverage to benefit just 400 billionaires in america who do not have to worry about their healthcare or familys welfare. For those who are going to lose the coverage, people with cancer, people with alzheimers, people who need opioid addiction treatment, people with diabetes, have their coverage slashed, 400 billionaires to get a tax break which they dont need and dont deserve. That is at the heart of the republican healthcare bill. What it is all about. Of the rich, by the rich, for the rich. It is a wealth care bill for the upper 1 in our country. Your healthcare is going to suffer in order to take care of that. With their tax breaks. More than 500 billion tax break to corporations and individuals making 200,000 or more. No wonder donald trump has kept his tax return secret because he knew he was about to get a massive tax break from slashing healthcare for people with cancer, diabetes, Heart Disease, substance disorders. This Selfish Senate republican legislation will increase premiums and outofpocket costs, decreasing quality of Health Insurance coverage for most americans. This will result in Many Americans especially those over the age of 50 paying thousands more in premiums or skimpier health plans. It would put Insurance Companies in charge of our healthcare by allowing them to waive coverage of the essential, emergency care, prescription drugs, or Mental Health treatment. Someone with a preexisting condition like a cancer survivor or a child with asthma may have insurance but might actually be covered for the treatment which is a need. Under this bill the anxiety of suffering, the constant fear, will be exacerbated by financial insecurity. Yet some of the most damaging provisions of this legislation are the brutal cuts to medicaid which already serves 70 million americans. And all seniors in Nursing Homes, and let me say that again, two thirds of all seniors, on medicaid and half of all seniors over the age of 85 has alzheimers and 15 million baby boomers are going to have alzheimers. They are going to need some help. People have a hard time saying 60, 80, 100,000 a year i nursing home vets, whether they doing over the next 15 or 20 years . Slashing that funding and medicaid for seniors in our country who will stay in a nursing home. Going home to their families. They double down and opted for steeper cuts in their bill in the house version, in three years the senate bill will stop the process of kicking millions off of their medicaid coverage by ending Medicaid Expansion in states around the country. It will mean 22 million americans are kicked off of coverage. In 2025, will institute more drastic medicaid cuts that every year become a deeper cut than the year before and it will literally mean death by 1 billion cuts or millions of americans who will lose their healthcare coverage. Medicaid covers one third of americans with opioid use disorder. And a death sentence for thousands, it is a hallucination, the republicans are saying they will find the will to take care of these people with opioid treatments. You cant will your way to dealing with an opioid crisis. It is a disease, millions of americans dont have the treatment they need. Medicaid is the way, republicans are just going to it and the consequences are going to be catastrophic. Here is what republicans are saying, to make up for the cuts to medicaid Senate Republican healthcare legislation creates an opioid fund of 2 billion for 2018. Compare that to the 91 billion in funding for opioid use disorder treatment, provided by the Affordable Care act over the next we 10 years. The opioid fund is pocket change for a crisis that took 2000 lives in massachusetts, 33,000 lives across the country and if people were dying from opioid addiction at the same rate they were dying in massachusetts, that would be 100 in people a year, two vietnam war a year dying from opioid addiction, they are going to cut the funding for treatment for these families. It will be a death sentence for these individuals if they do not have access to the funding. So the formula of this bill is simple. First, increase the cost of care so working families pay more. Second, decrease the quality of care for seniors and the sick. And finally, hand over hundreds of billions of dollars in tax breaks to the wealthiest people in our country. Billions in tax breaks to people who dont need some, who dont deserve them, paid for by people who cant afford it, healthcare heartlessness. To add insult to injury, it will devastate already strapped state budgets which may be forced to raise taxes or cut other benefits like education or Housing Assistance to make up for the billions of dollars states will lose because of this bill. It is cruel, it is inhumane, it is immoral, it is just plain wrong. To cut the Healthcare Benefits for those who needed to give tax breaks to those who do not need it. That is the republican plan. Republican leadership is trying to catch a political unicorn with this bill, to make moderate republicans happy while satisfying the most conservative elements of the Republican Party but there is no treatment for trumpcare. It is dangerous for healthcare and there is no reviving medicaid if this bill passes. This republican proposal has never been about policy. It isnt about covering more people or decreasing costs of healthcare or making it more patient centered is the republican proposal has always been about cutting healthcare for ordinary americans to give a massive tax break to the wealthy in our country. That is the republican policy agenda, not patient centered care because this will hand the power to Insurance Companies in our country, not patients. If republicans were really concerned about reducing the deficit, then every single dollar in this bill would go to reducing the deficit. The crocodile tears which they said about the deficit. No, ladies and gentlemen, they are shoving this money straight to the biggest number of billionaire beneficiaries than any tax bill in history. They are the party of the wealthy. They are the party trying to make sure that those who are in charge of funding the Republican Party now receive their payback in the form of tax cut at the expense of the healthcare for ordinary people in our country. That is selfish, that is unconscionable and that is why the democrats are going to fight this every step of the way this week in order to protect the health care for every american. I yield the balance of my time. Mister president. Senator from vermont. Todays Congressional Budget Office analysis of the trump mcconnell healthcare bill gives us 22 million reasons why this legislation should not see the heart of day. It tells us in truth that this bill really has nothing to do with healthcare. Rather, it is an enormous transfer of wealth from the sick, the elderly, the children, the disabled and the poor into the pockets of the wealthiest people in this country. According to cbo, the report just came out a few hours ago, this bill would throw 22 million americans off of Health Insurance, cut medicaid by 770 billion, defund planned parenthood and substantially increase premiums for Older Americans. Under this bill, a 64yearold with an income of 60,000 could see his or her premiums increase from 4400 under current law to 16,000, an increase of nearly 800 850 . How are Older Workers in this country going to deal with an 850 increase in their premiums . Meanwhile the trump mcconnell bill would provide a 231 billion tax break to the top 2 , hundreds of billions more in tax breaks to the Big Drug Companies and Insurance Companies that are ripping off the American People every day. At a time when the middle class of this country continues to shrink and families all across america are struggling to make ends meat, put food on the table, pay their rent, save a few bucks for retirement, we cannot take from workingclass families, we cannot take from the sick and elderly and children in order to get even more for the very wealthiest people in this country, people who are at this moment doing phenomenally well. Mister president , this, in fact, is a barbaric and immoral piece of legislation but lets be very clear. This is not just Bernie Sanders who opposes this bill. This is not just every member in the Democratic Caucus that oppose this bill, this is not just the overwhelming majority of the American People oppose this legislation according to a recent wall street journal, 16 of the American People thought that this bill was a good idea. This bill is opposed by virtually every Major Healthcare Organization in this country. The people on the front lines, the people who today, yesterday and tomorrow are dealing with healthcare, dealing with the sick, working in hospitals, Community Health care centers and almost without exception, every Major Healthcare Organization in this country opposes this bill and maybe my republican friends might ask themselves to get beyond the politics of this, get beyond republicans and democrats, ask people who know about healthcare in america and ask yourself how does it happens that virtually every Major Healthcare Organization in this country opposes this legislation. This is the aarp that opposes this legislation, largest senior group in america who knows what high premiums for health care will do to their membership. This is the American Hospital association. They know a little bit about hospitals and what will happen to rural hospitals if this legislation is passed. This is the American Medical Association, the American Medical Association is a conservative organization. It is not a progressive radical group, these are our doctors. They oppose this legislation because they know what happens if there are massive cuts to medicaid for 22 Million People thrown off of Health Insurance. It is the American Academy of family physicians, the American Academy of pediatrics who know what this will mean for the children of our country, the American Psychiatric association, the federation of American Hospitals, the American Lung association, the Cystic Fibrosis foundation, the American Nurses association. Every one of these organizations opposes the republican legislation. Not Bernie Sanders but every Major Healthcare Organization says do not go forward with this disastrous bill. This is what the aarp said recently the senate but was crafted in secrecy behind closed doors without a single hearing or open debate and it shows. The senate bill will hit millions of americans with higher costs and result in less coverage for them. Aarp is adamantly opposed, it would allow Insurance Companies to charge Older Americans 5 times more for coverage than everyone else while reducing tax credits that make insurance more affordable. I ask all of my republican friends to think for a moment about the implications of this bill and what it means to your constituents when they lose the currently have. Put yourself in their place. Today you have Health Insurance but tomorrow, next year, what does that mean . Think about it. What does it mean if you are in individual today, sadly their too many of them, suffering with cancer, fighting for your life, maybe under radiation treatment, under chemotherapy, you are scared to death, you have cancer, you are struggling, now you read in the papers that this republican bill may take away your Health Insurance from you. How do you think you feel . I suspect scared to death. The same with people with Heart Disease, asthma, diabetes or any other lifethreatening illness. What happens to those people, millions of those people when they cannot afford to go to the doctor, when they are sick, cannot afford to buy the medicine they desperately need. And mister president , i know this is a sensitive issue, the horrible and unspeakable truth is if this legislation were to pass, i will do everything to see that it doesnt, if it were to pass, many thousands of our fellow americans every single year will die and many more will suffer and become much sicker than they should. That is not Bernie Sanders talking. That is exactly what a number of studies have shown. Study after study including one from the american journal of Public Health to the new england journal of medicine to the Harvard School of Public Health, this is not Bernie Sanders engaging in a rhetorical debate. This is what scientists and doctors are telling us. This afternoon a few hours ago, the annals of internal medicine, a prestigious medical journal published an article from researchers at the City University of New York School of urban Public Health and harvard medical school, quote, the relationship of Health Insurance and mortality is lack of insurance, deadly, that was the title of the article appearing today. According to a summary of this article, quote, insurance decreases the odds of dying among adults by at least 3 and is much is 29 and, quote, being uninsured substantially raises the risk of dying. The coauthor of this article commented according to the cbo you Senate Republicans plan would strip coverage from 22 million americans. The best estimate based on Scientific Study is 29,000 americans would die each year as a result. I know that no republican wants to see anybody die, none of us do but that is the reality we are given because you cannot ignore it. If somebody has cancer, if somebody has Heart Disease and you take away their Health Insurance i dont need studies from Harvard University to tell you what is the case. This is the United States of america and we can do better than that and i ask unanimous consent the article that appeared today in the annals of internal medicine be submitted to the record. Without objection. This issue is not just about healthcare. This is a profound moral debate defining who we are as a people today and who we want to be as a people in the future. Mister president , a great nation is not simply one judged by how many millionaires and billionaires we have and by how many tax breaks we can give to billionaires. It is judged by how we treat the weakest and the most vulnerable among us. Those who dont contribute hundreds of thousands of dollars, a great nation is j