Body. Thank you, mr. President. I yield the floor. A senator plop . The presiding officer the senator from washington. Ms. Cantwell i come to the floor tonight to raise concern about a proposed Senate Health care bill that might move through the United States senate, as my colleagues are pointing out, without hearing, without attention to the details actually, almost in secret. I guess it would be secret if we didnt know exactly what was in the house bill. It would be even more secret. People have said it will be about 80 of what was in the house bill. I can agree with President Trump. That was a mean bill. If it is just 80 mean, i can guarantee that you its still going to be mean. I say that because i have been at home listening to my constituents. They do not appreciate one bit if youre Harbor View Hospital and you are going to cut 800 million out of their budget because of the cap on medicaid and you are going to leave a hospital without resources, they are mad. If you are talking about Childrens Hospital and Childrens Hospital sees children who are on medicaid and theyre not going to be able to see those children or get coverage, theyre mad. Or just like yesterday or actually saturday i was with veterans in vancouver, washington. People dont understand, but veterans of the United States of america do not get all their Health Care Coverage through the v. A. They get it with medicaid at individual clinics and services. The i have met several of these people in my state, and theyve told me pointblank, without access to medicaid, they would not get the benefits they need as veterans to our country. So i think its mean to break our promise to veterans and not give them access to medicaid. And i think this whole discussion is basically the fact that were doing this, you know trying to box with these guys on a proposal. If their proposal was so great, come to the senate floor and just dont even talk about the bill; talk about the principles. I want to know in the republican proposal what ideas do you have to lower costs, increase the quality of care, or improve access . Thats the milestones by which you should be debating health care. Now, if your goal is just to cut medicaid and cut people off of medicaid and cut their benefits so you can give tax break to the rich, okay, you might you might convince me that, yes, you have a proposal, because i think thats exactly what your proposal is. But if your proposal is about reducing costs, then come out here and debate it. Dont even tell me whats in the bill. Just show up on the senate floor and debate us and say, here is our idea for reducing costs. I will tell you what my idea is, because i wrote it into the Affordable Care act and some states are doing it. It was a good idea. It was called give the individual who doesnt work for a big employer the ability to negotiate with clout and be buntled up and be bundled up with other people. Thats what they did for the working poor in new york. 650,000 people in new york are now on something called the basic plan. Why . Because they didnt work for an employer that could negotiate a big discount for them. But we said on our side of the aisle, why would we let poor people just get thrown on the one handd around in the market and not be able to and get thrown around in the market and not be able to drive a decent price . Youre going to be able to drive a decent price in the marketplace. That plan is giving a family at 40,000 a year of income and four individuals in the family a yearly annual premium about 500 instead of 1,500 on the exchange. Thats so thats an idea. So come out here and discuss that. Come out harder and discuss that. If you want to tell me youve figured out a wait to give better quality of care, id love to hear that. Id love for you to come here and tell me how youre going to deliver better quality of care. There are great things in this bill that are about improving the way organizations deliver care so that they are rewarded for basically delivering better care. The whole idea of aaccountable Care Organizations are so that you put the patient at the center of the Delivery System and you reward them for doing a good job of delivering better outcomes. We have innovated. Weve innovated in this plan. If youre talking about access, come out and tell us what proposal do you have thats about increasing the access to health care . Id love to hear it because in this bill we already do that, too. We said, you know what, its kind of crazy and expensive to think that everybody who ages, particularly on a medicaid budget, should spend time in a nursing home. Why . Its more expensive cost and i dont think ive met one washingtonian that told me they really wanted to go a nursing home. They wanted to stay at home. T so we wrote into the Affordable Care act incentives for states to change the Delivery System like we had done in the state of washington and deliver Affordable Care at home in their communities. So deliver communitybased care. And by gosh, actually some states texas, arizona, indiana, other states took us up on it. They said what a great idea. We want to reduce costs. So if thats such a great working aspect of the Affordable Care act and you think it works, and it increases access to care by giving people communitybased care and reduces our overall medicaid costs, come out here and talk about it. Talk about what you want to do to put that program on steroids so that more people in america can benefit from better access to care and dont think that theyre going to spend their last days in a nursing home. So thats what we should be debating, but we cant even see or hear or have a hearing about what this proposal is. And yet, my colleagues cant even come out here and throw a concept on the table. But i tell you this, the fact that you want to affect over a million veterans who have fought for our country and youre going to cut them off of the medicaid care that they deserve to have access to, that is a broken promise. And its just as broken a promise as what President Trump said. President trump tweeted he tweeted this. He said i was the first and only g. O. P. Candidate to state that there will be no cuts to social security, medicare, or medicaid. Thats what he said. So im not surprised he calls it a mean budget, but he should also own up that it also cuts medicaid. Now we all have an Office Budget here. I sigh me colleague from virginia i see my colleague from virginia here. If we took our Office Budget and said were going to cut it and cap it and next year its going to be lower and next year its going to be lower and next year its going to be lower and next year in perpetuity. Thats what their idea is, is to put a cap on medicaid and cut it in perpetuity and basically cut it out of existence. I dont know why theyre beating up on medicaid, because medicaid has provided great stability to so many people in our country. Theyve lifted people out of poverty, provided health care, stabilized communities and raised the economic standard of living in great places in our country. I received a letter from a superintendent from the Vancouver School district. He wrote to me about the devastating impacts that capping medicaid would have on his students. He wrote our school based Medicaid Program serves as a lifeline to children who cant access Critical HealthCare Services outside of their school. He goes on to say restructuring it to per capita would undermine our Public Schools ability to provide for the neediest children access to Vital Health Care insurance. So why would we do this . As i mentioned, i mentioned met a veteran, christina. Shes 46 years old and shes also a fulltime student. She suffered from chronic and disabling physical injuries and needs a high level of care. But the care she gets from medicaid helps her access the medication that meantions her chronic manages her chronic care and keeps her going and is working towards that degree. Why would we cut somebody like that, a veteran off of medicaid just because someones idea over here is to cap and reduce medicaid. So these stories are all over the country, and people are wondering why would you take this level of investment in medicaid out of our entire economic system. Why would you impact our school districts, our regional hospitals, our veterans, our medicaid population . Why would you affect a community that has a large medicaid base and that is the way they serve them . Our hospitals have told them we have stabilized the increase in Health Care Costs because more of the population was covered and had access to medicaid. You rip that back and we will be back to skyrocketing costs with people in the emergency room, no access to care other than that facility with impacts to everybody on private insurance and on medicaid. So its just not a good idea. So i ask my colleagues, come out here, dont say you won a patientcentered Health Care Deliver system because were all for that. And we actually put things in the Affordable Care act that did that and are working. So if you want to make that claim, come out here and say what is it that you dont like about the patientcentered Delivery System thats here and how you want to change it. If you say your proposal increases access to americans, lets hear it. If its about better quality. But i dont hear any of that. I just hear a dprumbeat by a drumbeat by some people who want to be heartless and cut people who have access to health care, people who are less fortunate in our society because you want to cut medicaid. The president promised he wasnt going to do that. I would ask my colleagues to live up to that and lets Start Talking about the substance that truly will increase access, lower costs, and give better care to our constituents and the people of the United States of america. I thank the president , and i yield the floor. A senator mr. President. The presiding officer the senator from virginia. Mr. Kaine mr. President , i also rise to talk about the being h of every american. This is critically important to every person and every family in this country. Its critically important to every local, state, and federal budget in this country. And its also critical to the economic productivety of our nation. The house barely, in a purely partisan move, passed a bill that would take Health Insurance away from 23 million American People over the next ten years. Dramatically increase premiums to seniors, jeopardized coverage of people with preexisting conditions and imposed huge burdens on states. One of the reasons the house bill was so bad, condemned even by President Trump who labeled it mean, was because it flowed from a bad process. The house held no hearings on the final bill. There was not meaningful testimony from patients or Health Care Providers. They did not accept any amendments from democrats. And they rushed the bill through to vote before the Congressional Budget Office could score the bill. So no wonder, no wonder that the house bill is opposed by the american medical association, the aarp, nurses, hospitals, patient organizations, democratic and republican governors. And yet, the senate is poised to make exactly the same mistake, preparing a secret bill with no testimony, no public scrutiny, no opportunity for meaningful amendments, no opportunity for democrats to participate. We have the opportunity to get this right, and we have the responsibility to get this right. Theres so many problems with the house bill. As a member of the help committee, i went on friday to the culpepper free clinic about 75 miles from here to talk about the need for reimprovement in our Health Care System. Not a repeal that would hurt Vulnerable People. And at this clinic which is celebrating its 25th year i saw dedicated staffers and volunteers and i talked to patients. And i talked to them about how this organization has provided passion and care to working people in this region of Northern Virginia who dont have Health Insurance. The fact that virginia has refused to expand medicaid is one of the reasons that the need for their care is so significant, fully 70 of the free clinic patients in virginia would be eligible for medicaid if the state would just join the 35 other states that have expanded medicaid. And what i heard at the culpepper free clinic is this, theyre already bursting at the seams because we have an expanded medicaid. If there are additional cuts to medicaid it would overwhelm the ability of the 60 free clinics in virginia to provide Compassionate Care. Just a few hours ago, earlier today i went to albamarle county near charlottesville and had a round table discussion with educators, families and childrens advocates to highlight another key problem with the republican approach. By dramatically cutting medicaid, who is the most likely victim . Children. The most numerous victims of medicaid cuts are children. In virginia and nationally, nearly 60 of the recipients of medicaid are kids. And yet, the president , through the Trumpcare Bill, and the president s submitted budget proposes to cut medicaid by 1. 3 trillion over the next ten years. 1. 3 trillion over the next ten years. And this deeply frightens the parents and educators and kids i talked to today. I heard from parents of kids with Cerebral Palsy and autism, whose kids are receiving support through medicaid to buy a wheelchair or get services so that they can learn to adjust with autism. And this will help them grow into adults who have a chance of living independently. These parents had heartbreaking stories, often telling me and this is a quote i had no idea of the challenges of parenting a disabled child until i had one myself. They view medicaid as absolutely critical to their childrens educational and life success. They talked about the current shortfalls in the medicaid funding that lead their kids to be put on waiting list for services. One mom with a child has been on a waiting list for a Developmental Disability waiver. And i asked her what have they told you about the waiting list . And this was her quote they have told me my child will die before he is off the waiting list. And thats under the Current Program before you cut 1. 3 out of it. I heard from School Administrators who talked about the importance of medicaid funding for their programs that serve students. Special ed teachers worried about the effect on their work if medicaid is slashed. Local superintendents and School Board Members talked about the difficult challenges of funding their School Budgets if medicaid funding is cut. They post it as a difficult choice. If the feds cut 1. 3 million out of medicaid, do they reduce funding for students with disabilities or do they take local funds away from other important programs to back stop those programs . Or do they have to raise their own state and local taxes to make up for the federal cuts . I heard from Child Service advocates today who would see their programs slashed if medicaid is cut. Heres an example many of them serve courtinvolved young people. Not kids charged with crimes, but kids who are in court because of difficult home lives and challenging situations with their parents or guardian. And theyre in danger of being pushed into the foster care system or into institutions because of problems at home. Medicaid pays for support services to help stabilize their family lives. If these services are reduced and more children get institutionalized, how does that help anyone . How does it help these kids . How does it help society . How does it help our budget . Its much more expensive to put a child in a group home or institution than to provide a few hours of Medicaid Services in their homes once a week. The 60 of virginia medicaid recipients who are children and the parents and teachers and nurses and others who worry about them and help them dont see this as a partisan issue. Its fundamentally an issue of compassion. We will and should be judged by how we treat our children. Why slash funds that are used to help our kids . Is it really important to cut medicaid by 1. 3 trillion, hurting millions of children so we can get a few adults a 900 billion tax cut . We had a Budget Hearing recently. Im on the Budget Committee. With the o. M. B. Director mulvaney. This was just within the last two weeks. And director mulvaney tried to reassure us in his Opening Statement that the medicaid cuts were really about doing people a favor. About doing people a favor. He testified, and i quote, were no longer going to measure compassion by the number of programs or the numbers of people on programs like medicaid. Were going to measure compassion by the number of people we get off these programs and back in charge of their own lives. I want to repeat that. Prt president s chief budget official. Were going to measure compassion by the number of people we get off these programs and back in