00:01Mr. President, I rise today to urge my colleagues, my Republican colleagues,
00:06to reverse course on their proposal that would take affordable health care away from
00:10the many patients across the United States who will suffer, I believe, financial strain,
00:17and the financial strain will be put on the rest of us in our health care system.
00:21Despite the talking points that you hear from our colleagues,
00:25they do propose on Medicaid to really make cuts that will hurt us.
00:31This isn't about waste, fraud, and abuse.
00:34Their plan is to allow enhanced premium tax credits to expire.
00:39That has really nothing to do with lowering costs on average Americans.
00:45And this whole idea, in my mind, is a veiled attempt to repeal the expanded coverage
00:51that we saw for Medicaid under the Affordable Care Act.
00:55Why is that important?
00:57Well, it's critically important because Medicaid has been the cornerstone of,
01:03in the Affordable Care Act, expanding care to working families that could not find
01:08an affordable insurance policy.
01:11Medicaid gave them that coverage.
01:14And now, with the proposal by our Republican colleagues,
01:17they are going to cut Medicaid and thus cut families who need the assistance to cover insurance
01:26to get the coverage they deserve.
01:28The result will be that Medicaid is stripped away,
01:31coverage in the ACA marketplace will become more unaffordable,
01:35and premiums for even employer-based insurance will go up.
01:39But that's what happens when you take dollars out of the system.
01:43In fact, we're already seeing some of these prices start to go up.
01:48Our health care system relies on people being insured so that they can pay for care.
01:53And when you dismantle that, the medical costs for everybody goes up.
01:59It only makes sense.
02:01Uncompensated care gets cost into the system.
02:04That is passed on to the rest of us.
02:06Earlier this month, the Congressional Budget Office confirmed that the House's reconciliation bill,
02:13if enacted, would cost 16 million people to become uninsured.
02:19So that's the Congressional Budget Office.
02:22So again, 16 million people currently insured.
02:25Now all of a sudden, uninsured means cost to the system,
02:29to say nothing of the cost to these individuals.
02:32Just as eye-popping is the projection that this proposal will drive up premiums
02:37and out-of-pocket spending for millions of people struggling to afford private insurance plans
02:42through the ACA marketplace, or those with employer-provided coverage.
02:48A news analysis by the Center for American Progress proves that working-class families
02:53and people with all types of insurance will have to foot the bill for these harmful policies.
02:58For Medicaid, a family of four making $33,000 per year could see additional costs and co-payments
03:08up to $1,600 in annual out-of-pocket spending.
03:13I guarantee you these are people that already have had a tough time finding affordable insurance.
03:19For an ACA market plan, a six-year-old couple making $85,000 a year who want to keep the same plan
03:27and could see their annual premiums increase.
03:32And these are numbers according to the Center for American Progress.
03:36And you could even see the cost of an annual premium be as much as $15,000 a year.
03:45So these are all costs that we don't need to see increase.
03:49But if you are taking people who have affordable insurance and displacing them, according to CBO,
03:5616 million of them, I guarantee you that cost will be absorbed by the rest of us.
04:02For Medicare, which President Trump pledged not to cut, low-income seniors who qualify for both Medicare and Medicaid
04:09will see their out-of-pocket expenses rise.
04:11For example, an older couple on Medicare living on an annual income of $21,000 could face an additional $8,000 in annual health care cost.
04:23Actually, $8,340.
04:26So this just shows that cutting almost $1 trillion in health care from funding
04:32and making millions of people be uninsured does not save the money.
04:37It basically gets into the system and other people are paying the cost.
04:44The Affordable Care Act lowered the individual uninsured rate from 17.8% in 2010 to a historic low of 9.5% in 2024.
04:58So we significantly decreased the number of uninsured.
05:02This drop in uninsured Americans improved people's health, saved money for individuals, saved money for families.
05:11It helped states.
05:12It even helped our state government.
05:16According to the Kaiser Family Foundation, thanks to improved access to general health services,
05:21cancer screenings, and other forms of preventative care,
05:25Medicaid expansion alone lowered health-related mortality rates by 3.6%.
05:32So funding these issues, funding available insurance under the Affordable Care Act drove down the mortality rate and helped substantially save money.
05:46By contributing to a more robust economy, better social society and well-being, lower mortality rates,
05:54it also helped states generate more than $20 billion in increased tax revenue and welfare savings.
06:02So covering people, I like the best example of this is the former Vice President of the United States.
06:11As a congressman, Congressman Mike Pence didn't vote for the Affordable Care Act.
06:16But when he became governor of Indiana, everybody in Indiana, the health care providers and others, convinced him,
06:22oh, it's a good idea.
06:24You should get people covered in your state.
06:27And they did.
06:28So this is about a smart way of providing health care.
06:33And we've done it.
06:34And so far, states spent a total of $19.9 billion to expand Medicaid.
06:40So states who were smart about this realized that their economy was better.
06:47Their access to affordable insurance was better.
06:50That it was revenue-stimulating the economy was better.
06:54They knew that the Medicaid expansion literally kept people alive.
07:00We should not reverse that.
07:04We've made great progress in the past 15 years to keep Americans healthier and financially secure.
07:10Allowing 16 million people, including 306,000 people from the state of Washington,
07:16to become uninsured is a bad idea.
07:20Without any alternatives, this will be a shock to our health care system.
07:24It will bring it to the breaking point and threaten the very lives of our constituents.
07:31I would like to take a moment, Mr. President, to read a letter from my constituent,
07:37highlighting the concerns and fears about the impacts of the budget reconciliation bill.
07:44Britton Winterrose from Richland, Washington, is father to a joyful five-year-old girl named Leda.
07:51He said he wrote to me because, quote,
07:55without Medicaid, my daughter's next nap could be her last, end quote.
08:02So now I want to read a letter from the Winterrose family.
08:09Quote, Leda entered the world at the height of the pandemic
08:13and spent the first 45 days of her life in the neonatal intensive care unit.
08:19Doctors finally identified a rare form of congenital central sleep apnea.
08:28If she falls asleep without oxygen, she simply stops breathing and she will die.
08:36The only path out of the hospital was a Medicaid waiver
08:40that paid for the in-home nursing and life support equipment.
08:44Medicaid gave us the opportunity to bring her home, surround her by her siblings,
08:51surround her of normalcy and safety, and the love of her parents.
08:57Since that day, Medicaid has kept up with Leda's needs as she has grown.
09:01A toddler who once needed a walker now sprints across the yard
09:05because the program funded the therapy and a walker that strengthened her legs.
09:10It provided her with a bed that keeps her secure so the equipment stays connected
09:15and we can all sleep at night.
09:19Each stage of development adds new hardware, new supplies, new specialists,
09:26feeding supplies, feeding pumps, G-tubes, sensors, diapers, respite care,
09:31and an AEC device to help my non-verbal autistic daughter communicate.
09:38Private insurance, even the platinum plan that comes with my job, rarely covers these costs.
09:46There is not a private health insurance on the planet that covers the edge cases of human existence
09:51for somebody with the medical complexities of Leda.
09:55Tonight, like every night, my wife and I will hook our daughter to an oxygen concentrator
10:02and a pulse oximeter, then we'll lie down and say no to death.
10:11The only reason we can sleep at all is because Medicaid has provided the durable medical equipment
10:17and supplies needed to support her.
10:19From the days at the neonatal intensive care unit until now, one thing has become obvious.
10:28The last question on anybody's mind when they are trying to keep a child or loved one from dying
10:34should be, how can we afford these things?
10:39I do not speak only for Leda.
10:42The bill before Congress would strike thousands of Washingtonians from the rolls,
10:46and when that happens, clinics and long-term care facilities will collapse.
10:51That blow lands on veterans, on cancer patients, on newborns, in rural communities,
10:57and it surely lands on my family.
11:01No one wakes up and decides, oh, I want to be disabled today.
11:07Everyone's health is a roll of the dice.
11:10Medicaid is how we make sure the roll of the dice is not fatal.
11:13I still lose sleep over what will happen when I'm gone.
11:19As a tired dad, help me rest.
11:24Please defend and strengthen Medicaid so that Leda and every child like her
11:29and those who are rightfully dependent on this system can live and thrive.
11:35That is the end of the letter from my constituent from Richland, Washington.
11:43What an incredible story of how a family is dependent on Medicaid.
11:47Today, I met with organizations and individuals from at Moms Rising,
11:57where families from Washington State and all over their country came to protest the cuts to Medicaid and SNAP.
12:03I heard myself countless examples of how these programs are critical to families,
12:08to their well-being, and how this program, if cut, would be devastating.
12:13There is a common theme, Mr. President, on all these stories.
12:19These families are scared.
12:21They will not be able to afford or get the care that their family really relies on.
12:28They are also concerned that there is nowhere to turn, even if the coverage is taken away.
12:32Does this mean these patients will no longer need care or their illnesses will just magically go away?
12:39We all know that doesn't happen.
12:43This means that uninsured patients will wait to see a doctor until they're so sick they have to go to the ER, which costs more.
12:51This will lead to increased costs across the board.
12:54Specifically, it's estimated that 5.4 million Americans will incur medical debt because they will become uninsured,
13:01and the total medical debt that Americans owe will increase by $50 billion.
13:06I think this is numbers from the Center for American Progress.
13:10Hospital providers will have to shoulder an additional $36 billion in uncompensated care costs,
13:15and a portion of the costs will be recouped by increased premiums on employment-based insurance coverage.
13:23As a result, people with employment-based insurance will also see an additional anywhere from $180 billion to $485 billion in annual cost increases.
13:36That's what happens when you increase the cost of uncompensated care,
13:40and the system has to make up for it somewhere.
13:42You increase everyone's costs.
13:44This is particularly damaging in the area of certified community behavioral health.
13:54I'm sure the President knows that behavioral health is a very tough challenge,
14:00particularly with the fentanyl epidemic in our country.
14:03I met with representatives of Peninsula Behavioral Health in Port Angeles, Washington, and Sound Health in King County,
14:11who told me that clinics are already operating on narrow margins and have already sustained a 1% budget cut this year at the state level.
14:19If Congress passes the budget reconciliation bill and enact policies like the suggestion on the state-directed caps,
14:29state-directed payment caps, they will have to reduce their budget by 20%,
14:35meaning they'll have to cut staff and lay off people.
14:40As a result, patients who rely on them for substance abuse treatment will be left out in the cold.
14:47We literally will see an increase in overdose deaths, law enforcement run-ins, and incarceration rates.
14:57Where do you think these people go when they don't have behavioral health treatment for fentanyl?
15:03All this costs taxpayers more.
15:06Actually, a lot more.
15:07A lot more than just covering Medicaid.
15:10It would be better if we just kept the Medicaid program
15:14and funded patients so they could get the care when they needed it.
15:18My Republican colleagues know that this bill will cause harm.
15:22Hospitals and physicians and various leaders across the industry are at their doorsteps
15:27telling them not to hallow out our health care system.
15:31But I beg my colleagues to drill down and listen
15:36to the fact that the revenue that rural hospitals particularly live on
15:45are huge Medicaid-Medicare budgets.
15:49That means there is no margin to have a 20% decrease in funds.
15:57Spending money to fix a problem caused by not spending money
16:02doesn't seem the smart thing to do.
16:06The logic doesn't make sense.
16:07In fact, it sounds to me like waste and fraud
16:13to say to people that you're going to somehow make this a better system
16:17when in reality, you are going to cut care and increase costs on all of us.
16:24Passing this bill and enacting these policies
16:26will only hurt working-class and middle-class Americans.
16:32Americans are still reeling from the effects of inflation
16:36to say nothing about the tariffs.
16:39This is not the time to be taking away health care coverage
16:42or increasing premiums on anyone.
16:45We have already seen enough inflation.
16:48For most families, any extra money from a tax cut
16:51will be swallowed up by these higher health care costs.
16:54And every time a new report or analysis is done on this bill,
16:58the outlook gets more challenging for people at home.
17:05If we really had this serious of a waste, fraud, and abuse problem in Medicaid,
17:11why haven't we had hearings on it?
17:13Why haven't we had legislation trying to fix it?
17:16Why haven't we had, you know, communication that this is a real issue?
17:21Because it's not a real issue.
17:24What is a real issue is Congress has been trying to fix the uninsured problem
17:31by passing the Affordable Care Act.
17:34It has worked successfully,
17:36and now our colleagues on the other side of the aisle want to try to repeal it.
17:42I hope that my colleagues will realize
17:47the only thing that you can know for sure
17:50about this proposal that cuts Medicaid,
17:54the only thing we know for sure
17:56is that thousands of Americans will become sicker
18:02and will become poorer
18:03because without the access to care,
18:06that is exactly what's going to happen.
18:09I urge my colleagues to really understand
18:13the harmful effects of this legislation,
18:18understand the harmful health effects
18:21on the citizens of our country,
18:22and I ask them to reject these Medicaid cuts.
18:27I thank the president, and I yield the floor.
