Statement of Senator Patrick Leahy On The Repeal Of The Affordable Care Act And The Debate On A Trumpcare Replacement

On Tuesday, the Vice President cast a tie-breaking vote to move to debate on a health care reconciliation bill, the contents of which even now remain a mystery to most of us.

This vote to proceed without a transparent path forward underscores a process that has, from the beginning, been politics and policymaking at their worst.  You would think that after seven years of campaigning to repeal the Affordable Care Act, the Majority would have a plan in place to do just that.  Instead, a dozen or so male, Republican lawmakers met behind closed doors, shielded from public view, to negotiate a grand plan to repeal the Affordable Care Act and make devastating cuts to the Medicaid program.  No hearings.  No debate.  No process.  This is not the path taken when we considered, debated, and approved the Affordable Care Act.  This is not the way the Senate, the greatest deliberative body in the world, should conduct such far-reaching and impactful business.  This is not the Senate that I know and respect.

In spite of multiple drafts and a go-it-alone, hyper-partisan philosophy, the Majority Leader was still unable to garner enough support within his own caucus to pass a sweeping health care bill.  I joined with many Democrats to offer motions to get the Senate back to regular order and have the appropriate committees study the effects of these policies on Medicaid beneficiaries and those with disabilities, on women and children, on seniors and the most vulnerable.  But Republicans voted down those efforts and plowed ahead.  During this debate, the Senate has also considered multiple amendments to rewrite the Affordable Care Act.  Each of these amendments would have caused tens of millions of Americans to lose insurance, and would have made it harder for those with preexisting conditions to obtain coverage.  When those amendments failed, the Republican leadership attempted to fully repeal the Affordable Care Act.  That did not work either. 

The collapse of these ideas should have resulted in a renewed spirit of bipartisanship, where we could work together to stabilize and improve the health insurance markets.  Instead, the Republican majority is so intent on voting on anything, that we are considering voting to repeal two or three policies from the Affordable Care Act solely in order to get something through the Senate and into conference with the House.  This is nothing more than legislative malpractice.  We are presumably considering a bill that will devastate our health insurance markets, and the best reason the Republicans can come up with for supporting final passage is, “because we said we would.” 

The notion that this majority would reduce themselves — and the Senate — to finding the lowest common denominator in order to move ahead with a policy of this magnitude is not only absurd, it is dangerous.  While all the versions of the Republican plans we have seen differ slightly, they all have the same, basic structure.  Let’s call these plans what they are: a massive tax cut for the wealthy on the backs of pregnant women, children, and the disabled who depend upon Medicaid for their health coverage.  It is a tax plan in the guise of a health plan.  We are considering massive entitlement reform bills that the Republican majority is trying to sell as fixes to the Affordable Care Act.  But we know that these bills would fix nothing, and would instead create tremendous new challenges.      

According to the non-partisan Congressional Budget Office (CBO), each of the various Republican proposals would cause at least 22 million people to lose their health insurance.  For instance, the CBO projected that the Senate Republican’s first proposal would result in marketplace enrollees paying on average 74 percent more towards their premiums for a plan in 2020 than under current law.  Another proposal offered by the majority would result in higher deductibles, rising from $3600 under current law to $6000.  Under this one proposal, Americans would be expected to pay more money for less care.  And as if the Medicaid cuts in the House bill were not deep enough – which caused the President to call the bill “mean” – another Senate Republican proposal would double down and even deepen Medicaid cuts beginning in 2025.  The Senate’s proposals have certainly not been less “mean” than the House bill.  If anything, the Senate’s bills are meaner. 

In Vermont, the effects of any of these bills would be disastrous.  Since the passage of the Affordable Care Act, Vermont has made exceptional progress to cut the rate of uninsured Vermonters by half.  The number of uninsured Vermonters is now less than four percent.  Because of the Medicaid program and the Children’s Health Insurance Program, known as Dr. Dynasaur in Vermont, 99 percent of children have health insurance in our state.  Trumpcare, in any version, places Vermont’s progress at risk. 

Vermont has also worked on new and innovative ways of delivering health care, which has brought down costs and increased coordination of care.  One of the most significant ways Vermont has done this is through existing flexibility in Medicaid.  And it is through the Medicaid program that Vermont has offered comprehensive treatment and counseling services for those suffering with opioid addition.  In Vermont, 68 percent of those receiving medication assisted treatment for opioid addiction are Medicaid recipients.  If hundreds of billions of dollars are cut from the Medicaid program, states will be forced to limit coverage, jeopardizing Vermont’s ability to overcome this crisis.  Provisions that cap Medicaid spending do not create “flexibility” in Medicaid.  This policy would instead force states to ration care. 

This spring I met a Vermont mother who has two young daughters.  Both of her daughters suffer from cystic fibrosis.  Luckily, they have the disease mutation that allows them to benefit from new drug therapies, but it is because of Medicaid that they have the resources necessary to afford the $20,000 per month that it costs to provide medication for each of her children.  How can we tell this mother that her daughters might no longer be able to take this medication because of fiscal constraints in Medicaid?  How can we tell future children who should have access to Medicaid that it was more important to give the wealthiest Americans a tax cut?  

I heard from another woman in Norwich who shared this story with me:  “Five years ago, both on the same day, my husband and I were diagnosed with cancer.  The fact that we are both alive today is entirely thanks to President Obama. My treatment alone involved two hospital admissions, four months of chemotherapy, and fourteen surgeries.  I still take drugs every day. There is no way we could have afforded any of this without Obamacare.  Before the ACA, our health insurance costs - both premiums and deductibles - were sky high.  My husband and I used to avoid going to the doctor, reserving that luxury for our three children.  Without Obamacare, it’s entirely possible that we wouldn't have had the check-ups that led to our diagnoses.”   

These Trumpcare proposals are not health care bills.  A true health care bill would not kick millions of Americans off health insurance.  A true health care bill would not allow insurance companies to charge people more for less coverage.  A true health care bill would not move us backwards to a time when health care was unaffordable. 

Instead, we should be working on proposals that improve our existing system.  Where there are deficiencies, let’s fix them.  Where we can find common ground, let’s act.  One of the first things we should do is stabilize the insurance market by making cost-sharing payments permanent.  We should also be working to reduce the cost of prescription drugs, which is why I have introduced a bill along with Senator Grassley that would help reduce drug costs by helping generic alternatives come to market faster.  The American people expect us to work on real solutions.  We should not be voting on a cobbled together plan where the primary goal seems to be to get to 50 votes, rather than actually improving our health insurance system.  Importantly, no member should vote on a proposal unveiled at the eleventh hour, with no debate – a proposal that will impact such a large component of our economy, and tens of millions of Americans.

Was the Affordable Care Act absolutely perfect when it was passed?  No, and we acknowledged the need for continual improvement as the ACA would be implemented.  But unlike other important social programs that have been created over the years — such as Social Security and Medicare — Republicans have not allowed us the opportunity to improve, strengthen and perfect it over time.  Those programs were also not perfect, but instead of playing partisan games, Republicans and Democrats came together to get something done, time and time again.  We did not vote to repeal the Social Security Act.  No, we came together and we discussed what needed to be done to better help the American people, not unravel their safety net.   

I hope that we can end this dangerous exercise and move forward in a responsible way.  Let us act on the best interests of our constituents and not resort to cynical, bumper-sticker politicking.  At its best, the Senate has been able to act as the conscience of the Nation.  I hope now is such a time and that the Senate will rise to the occasion to defeat this harmful bill.

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