09.26.17

Statement On Health Care, The Affordable Care Act, And The Flawed Graham-Cassidy-Heller-Johnson Proposal

The Senate finds itself today in a familiar situation:  Deeply partisan efforts to repeal and replace the landmark Affordable Care Act have hit a wall.  By their own admission, the Senate Majority has, with their backs against a wall and a looming deadline to advance legislation by a simple majority vote, put forward one last-gasp effort to roll back access to health care for millions of Americans -- not because it is sound policy, but in an effort to meet a campaign promise, regardless of its harm to millions of Americans.  It is as irresponsible as it is dangerous.  These efforts put lives at risk.  This zombie project should be abandoned, and we should get back to the constructive and promising bipartisan work toward strengthening troubled insurance markets. 

Instead of working on a responsible budget, or disaster relief for Puerto Rico, Florida and Texas, or on any of the many pressing issues facing our country, we began this week in a situation virtually identical to where we were in July.  In fact, it reflects the state of the Senate for much of this year, where policymaking has been replaced by partisanship and politics. 

When we considered a health care reconciliation bill in July, 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, seemingly unaware or willingly blind to the real-life impacts of what they were trying to do.  During July’s debate, the Senate 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.

Instead of learning from that painful process, the Republican leadership emerged from the August recess with a new plan.  Released just last week – and revised several times since – the proposal of Senators Graham, Cassidy, Heller, and Johnson was intended to revive the health care reconciliation bill the Senate already defeated.  Unfortunately, their bill contains all of the problems of previous versions, and includes new, troubling provisions that would fundamentally change health care in this country for the worse. 

This Graham-Cassidy-Heller-Johnson bill – just the latest version of Trumpcare – would make dangerous changes to our health care system resulting in millions of Americans losing health insurance coverage, including Vermonters.  In fact, based on previous estimates, a provision in this bill would cause 15 million Americans to lose insurance and premiums to increase by an average of 20 percent on Day One.

This hasty proposal would allow insurance companies to charge seniors, those with disabilities, those with preexisting conditions, and women more for coverage.  These are all discriminatory policies that the Affordable Care Act changed.

Like previous versions of Trumpcare, this bill would end Medicaid as we know it, by capping spending in the program and forcing states to cut eligibility, benefits, or both.  What’s worse, this new version of the bill would fully repeal the tax credits and subsidies created under the ACA, and instead give states inadequately funded block grants with no requirement that the funding goes to those in need.   

States like Vermont have done the right thing.  Because of Vermont’s Medicaid expansion, thousands of Vermonters now have access to lifesaving health insurance and care.  That’s never been more critical than now as we continue to grapple with the opioid crisis.

But this latest Republican proposal would hurt states like Vermont, simply for doing the right thing and expanding coverage.  In the latest version of the Graham-Cassidy-Heller-Johnson proposal, there seems to be no consistency to how block grant funds are divvied between states, leaving some to conclude the formula is merely a ham-fisted attempt to appease some reluctant Republican Senators to support this measure.  And by 2027, all states lose under this proposal as the block grant funding created under this proposal runs out.  You cannot consider legislation of this magnitude, with such far-reaching truly life-and-death consequences, with no debate and no meaningful consideration. This is not the way the Senate, the greatest deliberative body in the world, should conduct such expansive and impactful policies.  This is not the Senate that I know and respect.

Yesterday, the Senate Finance Committee held the only hearing in the Senate on Trumpcare.  We heard how devastating this bill would be for millions of Americans who depend on subsidies to purchase health insurance.  We heard how reduced funding would force states to choose what services to cover for children, pregnant women, and those with disabilities who depend on Medicaid.  Benefits like maternity coverage or home care will be at risk as states choose to relax the insurance requirements under the ACA.  Remarkably, experts disagreed with the authors as to what this amendment would mean for those with preexisting conditions. 

One thing the hearing made abundantly clear is that this sweeping policy needs further examination.  The Congressional Budget Office says it needs at least a couple of weeks to fully examine this proposal.  How many will lose insurance?  How much will premiums increase?  How many will lose access to health care?  These are fundamental questions to which we do not and will not have answers before the majority’s arbitrary timeline is up.  The preliminary estimate released late Monday by the CBO says that “millions” of Americans would be uninsured as a result of the Graham-Cassidy-Heller-Johnson proposal.  What’s more, I have not heard from a single health-related group that supports this measure. 

So why does the Majority insist on pushing forward?  It seems they are so intent on voting on anything, that they would have us consider an unexamined, hastily cobbled together bill solely to repeal the ACA – for the express purposes of fulfilling a crassly partisan campaign promise.  This would be nothing more than legislative malpractice.  Their desire to undo any of the success of the Obama administration, at any cost, would have them push forward a proposal that would devastate our health insurance markets, cause millions to lose insurance, and fundamentally change the Medicaid program, and the best reason the Republicans can come up with for supporting this new attempt is, “because we said we would.” 

In Vermont, the effects of Trumpcare 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 below 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. 

Let’s talk about what that means to Vermonters. This week I heard from Deborah in Waterbury, Vermont, who wrote to me urging me to vote to protect Medicaid funding:

“For a while Medicaid paid for medical care my son and I needed. Later Medicaid funding, and the cancer care it paid for, literally saved my life. It turns out many Americans find out that they or someone they love needs medical care or disability services that only Medicaid covers. Medicaid not only helps individuals and families who need medical care or disability services in the community; it also pays for approximately 64 percent of the people in nursing homes—financial help that is necessary because so many people spend down their life savings in the first few years of care. I am glad that over the years some of my tax dollars have paid for needed services for others. I believe we must and can improve the quality, affordability and effectiveness of health care in this country; but we won’t do it by denying so many Americans basic health and disability services.”

And consider this deeply personal story from Allyson in Brattleboro:

“About a year ago, I got a migraine. It never went away. Instead, it got worse and worse, and turned into what is called a hemiplegic migraine. These migraines look and feel like strokes, but are ‘just’ migraines. I started having seizures soon after that; they would later be diagnosed as psychogenic nonepileptic seizures. I have also had rheumatoid arthritis for five years.

“The saving grace in all of this has been Medicaid, made available to me through the Obamacare Medicaid Expansion. I have not had to worry about affording the care I've needed (probably close to $100,000, plus $80,000 in prescriptions), which has taken one huge worry off my plate. I could go to the seizure monitoring unit at DHMC for a week without stopping to wonder how I was going to pay for it. I could fill my --- prescription ($4,000 a month) without worry, and continue to walk around and look after my kids. I could try several medications for migraine to try to get better. And I could get good, solid therapy for mental health treatment.

“Without these things, and the Medicaid that pays for them, I would be far sicker than I am now. I would not be able to care for my children, or work even a little bit. I would likely die young. Instead, I am making it through, spending time with my children, and healing.

“Please continue fighting for my healthcare, for my life.”

Vermonters came to Washington Monday, in their efforts to attend the sole hearing on the hapless Graham-Cassidy-Heller-Johnson proposal.  They waited in line for hours, and they were not granted access to the hearing, held in a smaller room despite the known public interest in this hearing.

Waiting in line for a hearing he was not allowed to attend, Drew from Readesboro said:

“[T]his is my second time down here.  I’m here to finally kill this bill as it will result in the deaths of millions of Americans and significant loses to Vermont’s funding.”

Todd from Bennington said:

“The reason I oppose the bill is being I’m a walking pre-existing condition.  Diabetes, high blood pressure.  It’s getting under control, but it wouldn’t without healthcare.”

Mari from Lincoln said:

“I’m here because I have to.  Like Marcelle [Leahy], I’ve been a nurse for almost 30 years and if it weren’t for the Affordable Care Act many of the patients that I’m caring for now in the inpatient cardiology unit at the University of Vermont Medical Center would either not be alive or would be in a much more devastating situation.  Many of the young adults that I care for in the cardiology unit have opiate addiction and are there with serious infections because of that.  And if it weren’t for the part of the Affordable Care Act that allowed young adults up to 26 to still be covered by their parents insurance, many of these young adults would not be alive.  So I’ve been fighting for health reform in Vermont for decades now…This is THE most immoral bill I’ve seen in my 58 years of life…I’m appalled and I’m angry, and I’m very motivated.  I wish we didn’t have to be here but I’m so proud to be here.”

These are real stories.  Real lives.  This matters.

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. 

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.  Earlier this month, the Senate was doing just that.  The Health, Education, Labor, and Pensions Committee held bipartisan hearings aimed at stabilizing our insurance market.  This week, the Finance Committee reached an agreement on a five year extension of the Children’s Health Insurance Program.  This is important progress that should not be cast aside. 

We should also be working to shore up funding for our health centers, which will see a 70 percent cut at the end of the month if we fail to act.  One of the issues I hear most about is 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 pushing a plan that hasn’t been vetted where the primary goal seems to be to get to 50 votes, rather than actually improving our health insurance system. 

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 with 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.   

We must end this dangerous exercise of considering sweeping policy solely for the purposes of fulfilling a nearly decade-long partisan campaign promise.  We should move forward in a responsible way.  We should act in 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 and abandon these harmful efforts.

Press Contact

David Carle: 202-224-3693