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 The leading web portal for pharmacy resources, news, education and careers January 20, 2019
Pharmacy Choice - Pharmaceutical News - Sen. Murphy: 'Graham-Cassidy is the Meanest Version of TrumpCare Yet' - January 20, 2019

Pharmacy News Article

 9/20/17 - Sen. Murphy: 'Graham-Cassidy is the Meanest Version of TrumpCare Yet'

WASHINGTON, Sept. 19 The office of Sen. Christopher Murphy, D-Conn., issued the following news release:

U.S. Senator Chris Murphy (D-Conn.), a member of the U.S. Senate Health, Education, Labor, and Pensions Committee, laid out the facts of the Graham-Cassidy bill - Senate Republicans' latest attempt to repeal the Affordable Care Act (ACA) and rip health care from millions of Americans. Murphy emphasized that the bill is even crueler than earlier versions of Trumpcare, as it would eliminate protections for those with preexisting conditions, repeal the individual mandate, make cuts to women's health care, and make deep cuts to Medicaid. Murphy also pleaded with Senate Republicans to drop their partisan efforts to repeal the ACA and to instead work with Democrats to craft a bipartisan bill that improves health care for all Americans. Click here to view video of Murphy's remarks.

"Basically every group representing patients who are sick in this country are begging this Congress to not pass this bill. We don't have a CBO score telling us how many people lose coverage, how high rates go, what happens to Medicaid," said Murphy. "For my little state of Connecticut, it will be a $4 billion reduction in health care dollars from the federal government. How do you pass a bill that has no CBO score, that has had no support, that's opposed by every single group that Republicans welcome into their office every year, representing people with serious diseases?

"Everybody said that the repeal bill was dead, that we were going to move on to a bipartisan process in the HELP Committee. I hope and I pray this wasn't all one big ruse to distract the Democratic members of the Senate while Republicans quietly worked on building support for the meanest version of Trumpcare yet. That would be a deceit," continued Murphy. "Let this bipartisan process play out. Let us build some good faith together. That's what the American people want and that's what the American health care system needs."

Highlights of Murphy's remarks are below:

We don't have a CBO score telling us how many people lose coverage, how high rates go, what happens to Medicaid. But it's also another bill that's been written behind closed doors. So Senator Cassidy and Senator Graham may have spent some time thinking about what this legislation does. Virtually no one else has been let into the room. Patients haven't been in that room. Doctors haven't been in that room. Hospitals have not been in that room. And you know why I'm pretty confident of that? Because all of the groups representing those populations oppose this legislation.

We're going to potentially vote next week on a health care bill massively, massively reordering the American health care system that is opposed by the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American Osteopathic Association, the American Psychiatric Association. Those are the physician groups.

By the way, it's kind of hard to know for these groups whether they're for it or against it because there is no CBO analysis of this. But the patient groups have weighed in. Basically every group representing patients who are sick in this country are begging this Congress to not pass this bill. The ALS association, the Cancer Society, the American Diabetes Association, the Heart Association, the Lung Association, the Arthritis Foundation, the Cystic Fibrosis Foundation, the Juvenile Diabetes Research Fund, the Lutheran Services of America, the March of Dimes, the National Health Council, the National Multiple Sclerosis Society, National Association of Rare Diseases. How do you pass a bill that has no CBO score, that has had no support, that's opposed by every single group that Republicans welcome into their office every year, representing people with serious diseases?

There have been some really, really mean health care proposals. Graham-Cassidy is the meanest version of Trumpcare yet. And let me walk you through why I say that. Again, we don't have the numbers here, so we don't have a CBO analysis of how many million people are going to lose access to health care, but let me guarantee you it will be in the millions - likely in the tens of millions. The bill radically, radically trims the amount of money that states will get in order to insure the population that has been insured by the Affordable Care Act. What this bill does is shrink the amount of money that we're spending, then redistribute it out to states, and it will simply not be enough, not nearly enough money in order to cover the 20 million people who have insurance today because of the Affordable Care Act - many of those through Medicaid, others through the health care exchanges.

An early analysis by an outside group who is trying to help us understand what this means suggests that for my little state of Connecticut, it will be a $4 billion reduction in health care dollars from the federal government to the state of Connecticut. We're a state that doesn't have a $20 billion annual budget. $4 billion means we will either have to kick hundreds of thousands of people off of health care or we will have to dramatically raise people's taxes. So with all of the reductions in insurance are in this bill, you will just have millions of people losing access to health care insurance under this bill.

Specific targeted harm to women is in this bill. Planned Parenthood is one of the country's biggest providers of primary care and preventative health care services to women. I get that many Republicans have a problem with Planned Parenthood because they also provide abortion services, but the majority of their work is, in fact, providing basic preventative health care to women in this country. My wife, when she was a low-income 20-something, could only afford to get her health care through Planned Parenthood. That's where she went for her preventative health care, for her wellness checkups. And there are millions of women just like her.

This bill is particularly cruel and particularly mean to all of the women in this country who, without access to a Planned Parenthood clinic, may not be able to get quality, affordable preventative health care.

This bill is perhaps the meanest, though, to individuals who are sick, or individuals who have been sick, because at least in prior versions of Trumpcare that came before this body, there was at least a meager attempt to try to preserve protections for people with preexisting conditions. It wasn't workable, but at least there was a face-saving gesture by Republicans and by the Trump administration to try to at least claim that there was language to protect people with preexisting conditions.

Senator Cruz sat on this floor a few years ago during his long overnight filibuster. I sat in the chair listening to him explain how everyone knows, including him, that you cannot protect people with preexisting conditions without requiring in some way, shape, or form that healthy people buy coverage. Why is that? Let me walk you through it for a minute. It's not hard to understand but it's really important to understand because people don't like the individual mandate. I can understand that. Nobody likes to be required to do something. But you cannot protect people with preexisting conditions if you don't require healthy people to buy insurance. And the logic goes like this.

If you say to insurance companies that you cannot charge people who are sick more than people who are not sick, if you say to an insurance company that you cannot charge someone with cancer more than someone who is healthy and you don't require that healthy people buy insurance, then what does the rational individual do? The rational individual in that case says why would I buy health insurance while I'm healthy? If I won't be charged anything more for it when I become sick, then there is no rational economic reason for me to be covered when I am healthy.

So what insurance companies tell you, what every insurance expert tells you, is that if you require insurance companies to charge the same between sick people and healthy people, then healthy people won't buy insurance. And if I was actually advising someone, I don't think I would tell them to buy insurance if they didn't have to until they were sick. And the pools get so skewed with sick people and no healthy people, that rates dramatically rise for everyone. Some estimates suggest that the rate increases would be 20% per year, compounding year after year after year.

And so in the last version of this bill, Republicans knew that, and so they included a version of the individual mandate in their bill. Now, it wasn't the same mandate but it was a mandate, nonetheless. The mandate under the Affordable Care Act says that if you don't buy insurance, you will pay a fee on your taxes. What the Republican bill said, the version of Trumpcare that came very close to getting a vote on this floor, it said that if you go without insurance, you'll pay a penalty when you try to get back on. The timing of the penalty was just different. Under the Affordable Care Act, you pay it when you lose insurance. Under the first version of Trumpcare, you would pay the penalty when you try to get back on insurance. It's a mandate, it's a penalty, it's just in a different place.

And Republicans did that because they knew that that was the only way to require states or give states the option to continue to require insurance companies to treat sick people the same as healthy people. Okay. So why am I talking about this?

Because in Graham-Cassidy, the individual mandate is totally gone - gone. Replaced with nothing. Thus, even though it says that states if they wanted to could preserve protections for people with preexisting conditions, states cannot do that because the federal government does not require healthy people to have insurance. And if you think that states are going to reimpose an individual mandate, A, there will be some real question as to whether they can do that, and, B, they won't. They won't because that issue has become, thanks to my Republican friends, so politically toxic around the country. And so you will be left with massive discriminatory treatment of people with preexisting conditions. And nowhere for them to go, because Medicaid is obliterated under this bill.

Medicaid dollars get lumped into all the rest of the money, get sent down to states, and then Medicaid dollars are capped going forward, intentionally capped at a number that is well below what the general rate of increase in the Medicaid program is. There's an intentionality in the underfunding of Medicaid here. The old bill would have taken, I think, 15 million people off of the rolls of Medicaid - I think I'm getting that number right - and we'll never know what this number is before the vote happens. Likely around the same number because this bill treats Medicaid in roughly the same way, in terms of capping the amount of money that states get. The formula by which states get this money is so wildly complicated that no one could understand it between now and next week. I would challenge any Republican other than Bill Cassidy and Lindsey Graham to come down here and give us an explanation as to how this formula works. It is the most bizarre Rube Goldberg scheme that you could ever imagine. But in it is an dramatic reduction over time in Medicare, in Medicaid payments to the state.

So think about this little boy Deacon. Deacon is 10 years old, and he lives in Ohio. And I'm just looking here at a picture of him clutching a Pokemon character. I know which character this is. It's Pikachu. I know that because I have a 9-year-old that is the same age as Deacon. But there for the grace of God, my 9-year-old is not going through what Deacon the 10-year-old is going through.

I will read you a little bit about Deacon. He loves playing baseball, playing video games, volunteering at animal shelters. He loves being a patient champion for children's hospitals, spending time with his friends and family, being a big brother, raising money and awareness for heart disease and defects. My 9-year-old doesn't enjoy raising awareness for heart disease and defects. The reason that Deacon enjoys doing that is because he has a condition called Hypoplastic left heart syndrome. It's combined with asthma and acid reflux. It essentially means that Deacon has half a heart. We have whole hearts. Deacon has half a heart

Right now, everything is controlled for Deacon by medications. He's had six heart surgeries to get to the point of stability. His heart will fail. Not may fail. His heart will fail. He will go into heart failure, requiring a heart transplant. That is Deacon's future. A heart cannot last on the two-chamber system that Deacon's surgeons put into place. Affordable quality insurance means everything to Deacon. Strep throat could be a death sentence for him. Any little virus that gets into him and goes into his bloodstream, that's it. Game over for 10-year-old Deacon. His parent writes:

"My child is alive because he has Medicaid. That allowed for him to have the doctors, the surgeons, and the care he has always needed. Deacon had six heart surgeries before 3 years of age. He has continued medications since, as well as regular doctor checkups - he needs them. Because of his diagnosis, he even has a specialist for simple things, like dental care. If he had not had medical coverage, there is no way I could have afforded his care. By his first surgery at ten days, he was over the million-dollar mark. I would have lost our house easily, quickly. I'm a single mom. Medicaid helps keep my son alive and healthy. It's given me my best friend to love and watch grow up. Medicaid helps a boy live a normal live where we would have never thought that it would be possible. Medicaid lets a boy with half a heart be on a baseball team with his friends. A best friend."

This isn't hyperbole. This isn't a game. It's not about scoring political points just because you made a promise that you were going to repeal the Affordable Care Act in the first year that you had control of this body. This is about this little boy who lives in a state that had the wisdom on a bipartisan basis to expand Medicaid. Ohio would be one of the biggest losers under this bill. A massive withdrawal of billions of dollars away from Ohio's health care system, simply to fulfill a political promise that Republicans made. We're not making this up. We're not trying to tug your heartstrings just for our own political purposes. Kids are going to die if they don't have access to health care. Twenty million people lose insurance, as may be the case under this legislation. Thousands of people won't be able to survive. That's a million dollars of care. I can guarantee you that this single parent's home is not worth a million dollars. At some point, you just stop being able to provide the care necessary to keep people alive. And Republicans are treating this like it is a game, talking about taking a vote next week when no one in this country has looked at this legislation.

No member of this body would have looked at an analysis by the Congressional Budget Office to know what its impact is. This bill will be rammed through in the dead of night, guarantee you, without any input from people like Deacon and his family. This is the meanest version of Trumpcare yet, in part because of what's in it, in part because of the butchered process. But in part because Deacon's family won't get to come down here and talk to you about it because you're going to rush it through next week if reports are to be believed.

And what a great trick Republicans will have pulled on this country. Everybody said that the repeal bill was dead, that we were going to move on to a bipartisan process in the HELP Committee, that the Senate was going to move on to another issue of tax reform. What a great head fake that would be if it was all a lie, if it was all a ruse just to be able to give cover for Republicans to quietly muster support for another devastating assault on America's health care while Democrats were looking hopefully at a bipartisan process playing out in the HELP Committee. It was never intended to result in an outcome. I hope that's not the case. I really do.

I have put enormous faith and trust in Senator Alexander. Admittedly I gave him a very hard time over the course of the first six months of this year because I could not understand what the point was of being on the health committee if we weren't going to debate one-fifth of the American economy, the health care system. Why be a member of the health committee if the biggest reform to the health care system during my tenure in the Senate wasn't going to be debated in the committee? I thought that was an abomination. And I have been very pleased that in the last two weeks, Senator Alexander has convened a bipartisan process that I have invested in. I've showed up to all these hearings. I've talked to him over and over again on the floor of the Senate and in these committee meetings. I've offered constructive suggestions about how we can come up with a bipartisan fix to the parts of the Affordable Care Act that aren't working as well while maintaining the parts that are working as well. And as I sit here today, I hope and I pray this wasn't all one big ruse to distract me and the Democratic members of the Senate while Republicans quietly worked on building support for the meanest version of Trumpcare yet. That would be a deceit.

I hope it's not going to be the case. This isn't a game. People are going to be really terribly badly hurt if this bill becomes law. I don't even know what the effects will be because we don't have the analysis. We don't have a score. I can guess but I've never been part of anything like this in my 20 years of public service. I have never seen a group of public officials so hell-bent on achieving a political goal as to throw out decades of precedent on how this body has normally worked on major pieces of legislation, shown such casual disregard for good, old-fashioned nonpartisan analysis as is happening if this bill comes before the floor without a CBO score.

We can do something together. We can continue the work of the HELP Committee to pass a truly bipartisan product that admittedly would just be a start that could involve real compromise on both sides. Republicans could compromise by saying we know we need to have some stability in these health care exchanges, and thus, we're going to make sure that President Trump can't take away payments from insurers, or threaten to take them away on a month-to-month basis. And Democrats can recognize that Republicans want flexibility in these exchanges, want the ability for states to do a little bit more innovation, whether it be with benefit design or reinsurance pools. We can both give and we can get a product that would build trust between both sides that might allow us to do something even bigger later on.

I have no idea whether Deacon's family is Republican or Democrat. I have no idea whether his single mother, who is so deeply fearful today of what Republicans are about to do for her and her child, her best friend, her ten-year-old son, voted for Donald Trump or voted for Hillary Clinton. Because when it hits you, when that heart defect or that schizophrenia or that heroin addiction or that lung cancer strikes you, it doesn't discriminate whether you're a Democrat or Republican. It hits you hard no matter who you voted for. And that's why when we go back home, I know what Republicans want because I hear it in Connecticut. They want us to work together. They are sick and tired of health care being a political football that just gets tossed from one party to the other. We used it to bludgeon Republicans and Republicans used it to bludgeon us and we used it to bludgeon you. It happens back and forth and back and forth

We're on the verge of passing a bill, getting a bill out of the health committee that might begin to end that use of health care as a simple political cudgel. And that's what our constituents want. We're not going to have time to get any public polling on this because no one's going to be able to understand it by next week, but I'll guarantee you it will poll at the same rate that previous versions of Trumpcare have polled - in the teens, in the 20's, Trump voters being the only folks who support it, and that is because people have gotten hip to what's in here. They don't actually think that it's a good idea to take health care away from tens of millions of Americans. But they also don't like the fact that this has been done behind closed doors, this has been done with Republicans only. They want this debate to occur in the open. Whether they are Republican or Democrat, they want both sides to be a part of it. And we are closer to that reality than ever before, pulling the rug out from under the bipartisan process. It's not the meanest, the cruelest part, but it's pretty high on the list.

Think about Deacon. Think about the tens of thousands of little boys like Deacon that live in your state. Don't do this to people of America. Don't do this to the United States Senate. Don't break this place beyond recognition by ramming this through without any process or without any CBO score next week. Let this bipartisan process play out. Let us build some good faith together. That's what the American people want and that's what the American health care system needs.

I yield the floor.

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