Bernie Sanders

Mr. SANDERS

Mr. SANDERS. I have asked my colleague from Oregon a little bit about some of the cruel and devastating impacts this legislation would have, but we have to be honest and acknowledge that there are some beneficiaries in this legislation as well. Would my friend describe the beneficiaries in the House bill, in particular? While millions were thrown off of Medicaid, while 23 million people lost their health insurance, some people actually did gain from this bill, and we have to acknowledge that; is that true?

Mr. SANDERS. And a massive cut in Medicaid would be devastating to those families who have loved ones in nursing homes?

Mr. SANDERS. Correct me if I am wrong, but my recollection is that in the House bill there were $300 billion in tax breaks going to the top 1 percent at exactly the same time that 23 million Americans were thrown off of their health insurance; is that correct?

Mr. SANDERS. Mr. President, I raise a point of order that the pending amendment violates section 313(b)1(A) of the Congressional Budget Act of 1974. I am glad that the Senator from Nevada is concerned about Medicaid, but I would remind the Senate that yesterday the vast majority of Republicans voted to throw 15 million people off of Medicaid on their way to end health insurance for 22 million Americans. Our job as a nation is to guarantee healthcare to every man, woman, and child and join the rest of the industrialized world, not throw disabled children off of the healthcare they currently have. I urge a ``no'' vote. Mr. President, I raise a point of order that the pending amendment violates section 313(b)1(A) of the Congressional Budget Act of 1974.

Mr. SANDERS. I think it is important to repeat that because this is not something that I think most Americans are aware of. Medicaid now pays, as I understand it, for two out of three nursing home beds in this country; is that correct?

Mr. SANDERS. If I could, let me ask my colleagues from Oregon or Michigan maybe to speculate here. If the House bill were to be successful--and we are going to do everything in our ability to make sure it is not successful--and Medicaid were severely cut back, what do my colleagues think will eventually happen in the near future--not eventually, but in the short term, to programs like Medicare and Social Security? Would it be a reasonable assumption that this is the beginning of the effort on the part of the Koch brothers and Republicans in the Congress to begin dismantling virtually every Federal program that helps working people? Is it not true that the House Budget Committee has already passed legislation that would move toward voucherizing Medicare and privatizing it?

Mr. SANDERS. No hearings?

Mr. SANDERS. There have been no hearings on a bill that impacts one- sixth of the American economy and every single American. Now, let me ask my friend from Oregon this. Obviously, before my Republican colleagues would go forward on radical legislation like this that would throw some 32 million Americans off of the health insurance they have, they have obviously consulted with doctors and hospitals to get their views as to the impact this legislation would have on patients and hospitals all over America. What kind of testimony did the doctors make on this bill or the hospital administrators make?

Mr. SANDERS. One-sixth of the American economy is over $3 trillion every single year. Now, when we are dealing with legislation that impacts virtually every American, over $3 trillion every year, would my friend from Oregon please tell me this--and I know that he is the ranking member of the Finance Committee, and I am on the Health, Education, Labor, and Pensions Committee: How many hearings have been held in the Finance Committee to discuss the economic implications of this legislation? Were there five, ten? How many hearings on this enormously complicated and important issue have there been?

Mr. SANDERS. Right, so if my understanding is correct--and I am quite sure it is--the American Medical Association, which is not one of the great progressive groups in America but the group that represents the physicians in this country, A, they have not been able to make testimony. But, B, what is their view on this legislation? What do the doctors of America feel about this important legislation?

Mr. SANDERS. Now, while the AARP and other senior groups have not been able to testify, would my friend from Oregon tell me what their views are on this particular legislation because of its impact on older workers and seniors in general?

Mr. SANDERS. Madam President, would my colleague please repeat that. I think it is important for older Americans to hear this. We had a candidate running for President of the United States by the name of Donald Trump, and he ran all over this country and said he was going to stand up for working families and he was going to stand up for the working class of this country. Please repeat what this legislation would mean if somebody were a 62- year-old worker in Vermont or in Oregon. What kind of premium increases might he or she see?

Mr. SANDERS. In other words, this bill is not saying to doctors: What will this mean to your patients? What happens if 32 million people are thrown off of medication? How many of them will get sick? How many of them will die? No testimony. How about hospitals? What kind of testimony have we heard from hospital administrators, those in rural America, about the impact of this legislation on rural hospitals in Vermont and rural hospitals in Oregon?

Mr. SANDERS. But we have not heard yet from one doctor making public testimony at a hearing.

Mr. SANDERS. Madam President, will my friend from Oregon yield for a question?

Mr. SANDERS. But it is not only older workers because we have as an aging population more and more people in nursing homes. Would my friend from Oregon describe what happens under this legislation if somebody has a mom or a dad in a nursing home, struggling with Alzheimer's or some other terrible illness?

Mr. SANDERS. Let me ask my friend from Oregon: What kind of testimony have we heard as to the impact of this legislation on older working people, in terms of what it might mean in increased premiums? Have we heard much discussion? Has the AARP, which is strongly opposed to this legislation, been able to come forward at a public hearing and express their point of view?

Mr. SANDERS. I have a meeting that I have to get to. I want to summarize this. My friends from Oregon and Michigan can correct me if I am wrong. We are looking at a bill that came from the House and various proposals being introduced in the Senate, which essentially says that we are going to throw over 20 million Americans off of the health insurance they currently have. What I haven't heard much discussion about is what happens to someone who today has health insurance and is struggling with cancer, maybe getting chemotherapy or radiation therapy right now. What happens to someone who is in treatment for diabetes? What happens to someone with a serious heart condition, who had a stroke and is on Medicaid? What happens to those people when their health insurance is simply cut?

Mr. SANDERS. Madam President, our friend from Oregon is pointing out that this legislation would impact virtually every American because, in one way or another, we all interface with the healthcare system. I would ask my friend to confirm: This legislation would impact what percentage of the U.S. economy?

Mr. SANDERS

Mr. SANDERS. One of the studies my office cited was published on June 22, 2017, by the Center for American Progress. It was coauthored by a Harvard professor of social epidemiology, two medical students who graduated from Harvard's T.H. Chan School of Public Health, and two policy specialists at the Center for American Progress. I won't go through all of the details, but I will say this, quoting from PolitiFact: The Harvard-Center for American Progress study projected that there would be one excess death for every 830 people who lose coverage as a result of the AHCA. The Republican bill. Using Congressional Budget Office projections of the impact of the House version of the bill, the authors estimated an additional 217,000 deaths over the next decade, or 21,700 per year. That is not Bernie Sanders; that is a study done at Harvard. The second piece of evidence Sanders' office cited was an op-ed by yet more health policy specialists who are affiliated with Harvard--David Himmelstein and Steffie Woolhandler, who are professors of public health at Hunter College-City University of New York as well as lecturers at Harvard Medical School. Adapting the findings of the 2012 study to a scenario in which 20 million Americans lost coverage--which turned out to be lower than what the CBO found for the House bill-- They estimated 23 million would lose coverage-- Himmelstein and Woolhandler estimated that there would be 43,956 deaths annually due to the GOP's health policy changes. Quoting again from PolitiFact: So can Sanders' assertion be supported by the peer-reviewed literature alone? Then they cite some studies. In 2002, a panel of more than a dozen medical specialists convened by the federally chartered Institute of Medicine estimated that 18,000 Americans had died in the year 2000 because they were uninsured. In January 2008, Stan Dorn, a senior research associate at the Urban Institute, published a paper that sought to update the IOM study with newer data. Replicating the study's methodology, Dorn concluded that the figure should be increased to 22,000. A 2009 American Journal of Public Health study concluded that a lack of health insurance ``is associated with as many as 44,789 deaths in the United States, more than those caused by kidney disease.'' And on and on it goes. This is not Bernie Sanders talking; this is scientific and medical study after medical study saying what is obvious--that if you have a life-threatening disease and cannot get healthcare, you will die. So I would hope that my Republican colleagues, as they vote tomorrow, understand the consequences of their vote. I know no Republican--nobody here--wants to see anybody die, but when you take 23 million people off of the health insurance they have, many thousands of those people will die. I think most Americans would think that when you are dealing with an issue like healthcare, which impacts, by definition, every single person in our country, and when you are dealing with an issue that impacts about one-sixth of the American economy--over $3 trillion a year--that you just might want to have some serious discussions on that issue. You might want to ask--here is a radical idea--doctors what they think about this legislation. What is it going to mean to their patients? Wow, that is a pretty radical idea when dealing with healthcare for all the American people. You might want to have one hearing, maybe, and say to doctors: Doctors, what do you think about this bill? What about hospitals? How will this bill impact hospitals, especially rural hospitals in Vermont, Virginia, and all across this country? You might want to talk to a hospital administrator. You might want to talk to a patient advocate, maybe somebody from the American Cancer Society or somebody who is active in the diabetes effort. You just might want to talk to the experts on healthcare as to how this legislation might impact the work they do. But, amazingly, in an unprecedented way, this legislation was written behind closed doors. I think it was 12, 13 Republican Senators who wrote this bill. Most Republican Senators don't even know what is in this bill, let alone Democrats and let alone the American people. How do you write legislation that impacts every American, one-sixth of the economy, and not have one public hearing to hear from those most knowledgeable about healthcare in America? But that is exactly what the Republican leadership has done. I know why they did that. It is not a secret. If you had a horrific piece of legislation, trust me, you would want as little public discussion as possible. You would try to hide what this bill does. I understand that. Yet, despite all of that, it turns out that virtually every major healthcare organization in America opposes this bill. I don't know how you can go forward with legislation that has had zero public hearings, that is opposed overwhelmingly by the American people--last poll that I saw from USA TODAY had 12 percent support for this legislation--and go forward with legislation opposed by every major healthcare organization in America. This bill is opposed by the AARP, the largest senior group in America. It is opposed by the American Hospital Association, the American Medical Association, the American Cancer Society, the American Heart Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Psychiatric Association, the Federation of American Hospitals, the Catholic Health Association, the American Lung Association, the Cystic Fibrosis Foundation, the March of Dimes, the National MS society; and the American Nurses Association. In other words, virtually every major healthcare organization does not want to see this bill passed. The American people overwhelmingly do not want to see this bill passed. So how come it might pass? People don't want it. Healthcare organizations don't want it. Who wants it? I will tell how wants it-- people who are going to get tax breaks. They think it is a great idea. Billionaires who got $200 billion in tax breaks from the House bill think it is an extraordinary idea. So what if 23 million people lose their health insurance from the House bill. The top one percent will get $200 billion in tax breaks. Large healthcare corporations like it. The insurance companies and the drug companies are going to get a combined hundreds of billions of dollars. I will tell you who else likes it: those people associated with the Koch brothers who are spending hundreds of millions of dollars on elections. They like it because their ideology, their philosophy is that government should play no role in the concerns of the American people. Mark my words--if this bill, which would cut Medicaid by $800 billion, passes, Medicare will be next. And in the House, they have already passed legislation that would voucherize Medicare. Social Security will not be far behind. That is the ideology of the Koch brothers and the people who fund the Republican Party. Their concern is with large campaign contributors, not the American people. I hope very much that tomorrow when we assemble here--I gather in the afternoon--for a vote, the Republicans will think more about people in their own State, about their children, the elderly, the sick, and not just about their campaign contributors. Thank you very much, Mr. President. I yield the floor.

Mr. SANDERS. Mr. President, I do not know--and I don't know if anyone knows--whether the Republican so-called healthcare legislation will pass tomorrow, whether the beginning of the debate will take place or whether it will not. I don't know that, but this I do know. The legislation being proposed--and by the way, we still don't know what that legislation is. In general, what we do know is that the legislation being proposed is the cruelest, most destructive, and irresponsible piece of legislation ever brought to the U.S. Senate in the modern history of our country. I know the media focuses on, do the Republicans have the votes, how is this Senator going to vote, how is that Senator going to vote? All of that is interesting to those of us inside the beltway. The far more important issue--which we don't discuss enough; the media doesn't cover enough--is what this legislation actually would do if it were implemented. Right now, unique among major countries on Earth, we do not guarantee healthcare to all people as a right. The result of that is that we now have today--before this disastrous legislation--28 million Americans who have no health insurance and even more who have high deductibles and high copayments, preventing them from getting to a doctor when they should. We have a bad situation now. It is better today than before the Affordable Care Act was passed, when we had over 50 million people without insurance, but no one suggested what we have today is where we should be. Yet we have 28 million people uninsured. The Republican solution to this problem is to throw another 22 million people off of the health insurance that they currently have. I want the American people to, for one moment, put themselves in the place of someone tonight who may be watching what we are talking about here, who has cancer, who has heart disease, who has diabetes or some other life-threatening illness. Millions of people are in that position. They are struggling for their lives right now. They are under treatment. They are thinking, what happens if this Republican bill is passed? Will I live and continue to get the treatment that I need or will I die? I think there are very few Members of the Senate who have met with their constituents on this issue, who have not seen people break into tears, asking: What is going to happen to me or my children or my parents? We did a teleconference townhall a few weeks ago in Vermont. We had some 16,000 people on the line, and a woman whose kid has a very, very serious illness called. The cost of the prescription drugs are off the chart. She asked: What is going to happen to my child if this bill goes through? Do you know what? I didn't have the guts to tell her what might happen to her child. I don't want to be on the phone telling any person in Vermont or in America that their child might die because of the legislation that might proceed tomorrow. This legislation would cut Medicaid by almost $800 billion over a 10- year period, taking healthcare away from lower income and working-class families, including many children with special needs, kids with Down syndrome, kids who have serious emotional problems, kids whose lives now depend on Medicaid. When you cut Medicaid by $800 billion, many of those children will lose coverage entirely or receive significantly fewer benefits. This legislation, when we cut Medicaid by $800 billion, will have a severe and dramatic impact on nursing homes all over America. A lot of people don't know this, but if your mom has Alzheimer's and is in a nursing home or your dad has a terminal illness and is in a nursing home, guess what: Medicaid pays almost two-thirds of the costs associated with nursing home care in America. What happens to the people in nursing homes when you slash Medicaid? How many of them will get thrown out of the nursing homes? Where do they go? Are families in America, working-class families, going to be forced to make the choice of whether they take care of their parents or whether they send their kids to college? Those are the choices that working-class families may have to make if this horrific legislation gets passed. This legislation would dramatically decrease funding for the opioid and heroin epidemic that is sweeping this country, including my State of Vermont, including Kentucky, West Virginia, New Hampshire, Ohio, and States all over the country that are struggling with the opioid addiction problem. The program that provides the most funding to help deal with addiction treatment and addiction prevention happens to be Medicaid. What happens to our efforts to try to get a handle on this terrible, terrible epidemic sweeping our country when you make massive cuts to Medicaid? I found it amusing that when Donald Trump ran for President--oh, he was a great friend of the working class. He was going to stand up for the working class. Let me mention to workers all over this country who are in their sixties that if this legislation passes, your premiums are going to go up dramatically. That is one of the reasons the AARP strongly opposes this legislation. If you live in Baltimore, for example, where I was this morning, speaking to the NAACP--in Baltimore, if you are 60 years of age and you make $40,000 a year, your average health insurance premiums will go up from about $4,000 a year now to $8,800 per year, more than double. If you are a 62-year-old worker, making $40,000 a year--not a lot of money--how are you going to pay that? Remember, all that Donald Trump said about what a great friend of the working class he was. This legislation would defund Planned Parenthood. I get a kick out of hearing my Republican friends talk about choice, freedom. Oh, my goodness, they love choice and freedom. They want the American people to go to any place they want to go. It is all about what America is about. Two and a half million women have made a choice, and the choice they have made is that they want to get their healthcare from Planned Parenthood. That choice, that freedom would be taken away from them, starting tomorrow, if this legislation is passed. When you think about insurance, you think that insurance is about covering you in your time of need. Before the Affordable Care Act was passed, many millions of the American people could not get the health insurance they needed to address their particular healthcare crisis. If you had a heart disease, if you had breast cancer, if you had diabetes, the insurance companies would say: We are in the business of making money. Why on God's Earth would we want to insure you if you had breast cancer 5 years ago and it is possible it might recur? That is a losing proposition for us. That is what insurance companies want to do. They are not in the business of providing healthcare. They are in the business of making money. They denied, unbelievably--think about how crazy this is; they actually would deny coverage to people who had preexisting conditions. I have problems with the Affordable Care Act. It is far, far from perfect. It did end that obscenity of allowing insurance companies not to cover people who had preexisting conditions--something that is quite unbelievable. Guess what. If this legislation is passed, in all likelihood, many people in this country with preexisting conditions will not be able to get healthcare that they need at a price they can afford. We don't quite know how many of them will die. Nobody can make that prediction. I want to read for you a very interesting article that appeared from an institution called PolitiFact. PolitiFact is an entity that tries to keep a check on what politicians say. They look at you and you make a statement, and they say: Is this true or is this guy not telling the truth? I was on a TV program called ``Meet the Press'' a number of weeks ago. I said: Well, you know, if this Republican legislation is passed, thousands of Americans will die. And my Republican colleagues and the rightwing media said: Bernie Sanders is engaging in hyperbole. He is exaggerating. Who wants to see anybody die? I know nobody here wants to see anybody die. Of course not. No Republican does. No Democrat does. No Independent does. But we have to look at the consequences of what we do. So what PolitiFact did was take a look at the studies to see whether I was telling the truth. Mr. President, I ask unanimous consent that the PolitiFact article be printed in the Record.

Mr. SANDERS

Mr. SANDERS. Madam President, I wanted to say a few words about the new Republican healthcare plan that was just announced a few hours ago. While there are some modest changes in it, the truth of the matter is that this plan remains a disaster. It remains an embarrassment. I think the indication that it is an embarrassment is that with legislation that would impact about one-sixth of the American economy of over $3 trillion a year--legislation that, because it is healthcare, impacts virtually everybody--there has not been one public hearing on this legislation. It has all been done behind closed doors. Honestly, no matter what one's view may be on where we as a Nation should go with healthcare, whether you like this bill or you don't like this bill, I just don't know how someone can seriously say that we don't have to hear from physicians about the impact of this legislation on their ability to treat their patients. I just don't know how you do that--or that we don't have to hear from hospitals. I come from a rural State. What will the impact of this legislation and the massive $800 billion cuts on Medicaid do to rural hospitals all over the United States? There is some belief that many rural hospitals in areas where they are desperately needed will be forced to shut down. Is that the truth? That is what I hear, but I can't tell you definitively because there hasn't been a hearing on that issue. So I don't know how we go forward with legislation without having administrators from rural hospitals coming before the committee--I am on the Health, Education, Labor, and Pensions Committee--or the Finance Committee to answer that question. The Presiding Officer comes from a State and I come from a State where we have a major opioid crisis. It is devastating the entire country. What will this bill do to our ability to prevent and treat the opioid crisis, which is decimating this country from one end of America to the other? What happens if you cut $800 billion in Medicaid? How will people get the treatment they need today--which is inadequate? In my State, it is inadequate. I don't think there is a State in the country that today is providing the necessary treatment or prevention capabilities to deal with this opioid and heroin crisis, which is ravaging America. What impact will an $800 billion cut have on that? I understand there is some additional money going into opioid treatment, but how do you do that without the framework of allowing people the access to get healthcare? If you get thrown off of healthcare, what will the additional opioid money mean? I think not a whole lot. In this bill, there are still hundreds of billions of dollars-- several hundred billion dollars--in tax breaks to large health insurance companies, to drug companies, to medical device companies, and to tanning salons. As a nation, are we really interested in giving significant tax breaks to large insurance companies and then throwing children who have disabilities off of the Medicaid they currently receive? Is that what the American people want? I don't think they do. I have to tell my colleagues that this Republican legislation, as the Presiding Officer knows, has been opposed by almost every major national healthcare organization in the country, including the American Medical Association, the American Hospital Association, the AARP, which is the largest senior group in America, the American Psychiatric Association, the American pediatrics association. Virtually all of the major healthcare groups are saying that this legislation would be a disaster for the people they serve. Just last night we had a teleconference townhall in Vermont and we had some 15,000, 16,000 people on the phone. The calls that were coming in were very painful calls. I almost didn't want to be honest in answering the calls. A woman calls up and she says: My son has a very serious medical illness, and we spend a fortune on prescription drugs. What is going to happen if this bill passes? What was I going to tell her, that perhaps her son would die? It is just not something I feel comfortable even talking about. The truth is--and this is not Bernie Sanders talking, this is study after study after study that says that if you do as they did in the House, which is throw 23 million people off of health insurance, including people who are struggling with cancer, people who are struggling with heart disease, people who are struggling with diabetes, what does common sense tell us? If you are struggling with cancer and you lose your health insurance, what do you think is going to happen to you? What study after study has shown is that thousands of people will die. It is not that any Republican here wants to see anyone die, but that is the consequence of what happens when you throw, as the House bill did, 23 million people off of health insurance. We should not be giving tax breaks to insurance companies and then throwing disabled children, or people with terrible illnesses who are fighting for their lives, off of health insurance. The AARP is very strongly opposed to this legislation. The reason is pretty clear. What every person in America should understand, and I am not sure that many do, is that Medicaid now pays for over two-thirds of all nursing home care--two-thirds. What happens to the seniors and persons with disabilities who have their nursing home coverage paid for by Medicaid today? What is going to happen to those people? What happens if your mom is in a nursing home? You don't have a lot of money, and your mom is in a nursing home paid for by Medicaid. What happens if Medicaid is slashed? What is going to happen to your mom? Is she going to be thrown out on the street or end up in the basement of your house? Are you going to have to make the choice about whether you take care of her or put away a few bucks to send your kid to college? If suddenly a daughter or a son is going to have to care for a mom or a dad thrown out of a nursing home, how do they go to work to earn the money their families need? These are legitimate questions, and it would have been nice to have a hearing or two in order to answer those questions. The bottom line is that we have legislation before us that is widely rejected by the American people. The last poll that I saw, which was done by USA Today, suggested that 12 percent of the American people supported this legislation--12 percent. Virtually every major healthcare organization in America opposes this legislation. There is nothing I have seen today--none of the tweaks that have been put into this make this legislation in any way, shape, or form acceptable. It is no great secret that the Affordable Care Act is far from perfect. I don't think you hear anybody here say: Hey, the ACA is great; it doesn't need any changes. It does need changes. Deductibles are far too high in Vermont. Premiums are too high. Copayments are too high. And the cost of prescription drugs in Vermont and all over this country is off the charts. I was in West Virginia, and I talked to a woman for a moment after I spoke, and she said that she is taking care of her older brother. Her brother has seizures. The medicine her brother was using went up by 900 percent over the last few years. Why? Because that is what the drug companies can get away with. Tomorrow it may be 1,000 percent. Does anybody in America think that makes sense? Is anybody happy in America? Are people in Missouri happy, are people in West Virginia and people in Vermont happy that we are paying by far the highest prices in the world for prescription drugs? I don't think so. There are ideas out there about how we can significantly lower the costs of prescription drugs in this country, how we can lower deductibles, how we can lower copayments. Now, as I have said many, many times, I happen to believe that while it is important that we improve the Affordable Care Act, at the end of the day, this country must do what every other major country on Earth does, and that is to understand that healthcare is a right, not a privilege. Right now, we have 28 million people who have zero health insurance. If this bill in the House were to go through, there would be another 23 million on top of the 28--over 50 million people--without any health insurance. Does that make any sense to anybody? Our job is to join the rest of the industrialized world and make sure that every man, woman, and child has healthcare as a right, no matter what your income is. When you get sick, you go to the doctor. When you have to go to the hospital, you don't go bankrupt. That is what a civilized democracy is about. That is what they do in Canada. That is what they do in the UK, France, Germany, Scandinavia, and Holland. Every major country on Earth guarantees healthcare to all people. That is where I want to see our country go, and I will be introducing legislation to make sure that happens. More and more people all over this country want to move us in that direction. But right now, our job is to make sure that millions of people do not lose their health insurance in order to give tax breaks to insurance companies. Our job is to make sure that disabled children continue to get the care they need and older folks aren't thrown out of nursing homes. That is what we have to do. So I urge in the strongest possible way the defeat of this legislation. Then, let's go forward to improve the Affordable Care Act, not destroy it. I yield the floor.

Mr. SANDERS

Mr. SANDERS. Mr. President, my staff recently had the pleasure of visiting with Jen Kimmich of The Alchemist Brewery in Stowe, VT. The Alchemist owners Jen and John Kimmich are model employers who have shown considerable dedication toward creating positive working conditions for their employees. Their workers receive excellent benefits and working conditions, including livable wages, paid sick days, vacation time, health insurance, wellness opportunities, paid family leave, and generous retirement benefits. The Alchemist not only produces an internationally award-winning product, but it has also fostered a workplace culture where people are put before profits. Further, I would like to thank Jen for her statewide leadership championing workers' rights. She serves on the State Workforce Development Board helping to create opportunities for good jobs in Vermont. Through her volunteer work with Main Street Alliance, Jen has advocated for paid sick leave and paid family leave legislation. I also commend the company for developing The Alchemist Foundation. The Foundation provides college scholarships and career pathway opportunities for area youth. I am grateful for all that they do for their employees, their community, and the entire State of Vermont. Companies across the Nation should follow in The Alchemist's footsteps by supporting workers' rights and creating a positive workplace.

Mr. SANDERS

Mr. SANDERS. Mr. President, let me be as clear as I can be. The so- called healthcare bill that passed in the House of Representatives several months ago, strongly supported by President Trump, is the most anti-working-class legislation that I have ever seen. The Senate bill, also supported by Mr. Trump, in some respects is even worse. At a time when working families in Vermont and all across this country are working longer hours for low wages--many people in my own State are working two or three jobs just to bring in enough income to maintain a family--this legislation will cause devastating harm to millions of our families from one end of America to the other. The American people are united. This weekend I was in West Virginia and Kentucky--so-called conservative States--but I tell you that what is true there, what is true in Vermont, and what is true all over this country is that the American people are standing up and saying loudly and clearly that we will not allow 22 million Americans to be thrown off of the health insurance they currently have in order to give over $500 billion in tax breaks to the wealthiest 2 percent, to the drug companies, to the insurance companies, and to other profitable corporations. We will not support a bill that takes from the most vulnerable people in our country--the children, the elderly, the disabled, the sick, and the poor--in order to make the very, very rich even richer. This is unconscionable, un-American, and the American people will not accept it. Plainly stated, this so-called healthcare bill is really nothing more than a massive transfer of wealth from the working families of this country to the very rich. While this bill contains massive cuts to Medicaid; while seniors will pay far, far more in premiums; while Planned Parenthood will be defunded, the 400 highest income taxpayers, most of whom are billionaires, will get about $33 billion in tax cuts. There is no State in this country--none, not the most conservative-- that thinks that you throw 22 million people off of health insurance, including disabled children, in order to give $33 billion in tax breaks to the wealthiest 400 Americans. At a time when so many people in America are struggling, the very wealthy are already doing phenomenally well. They do not need more tax breaks. Not only is this bill a disaster, but the secretive, backroom process by which it has been written is unprecedented and literally beyond belief. That is not just me speaking; I think a number of my Republican colleagues who disagree with me on everything make that point as well. This bill impacts one-sixth of our economy--over $3 trillion--and by definition, dealing with healthcare, it impacts virtually every American. Yet the discussions and negotiations on this legislation have never been made public. In fact, I suspect they are going on right now--not here on the floor but behind closed doors. Unbelievably, with legislation that would completely revamp our healthcare system, there have been no doctors, no nurses, no hospital administrators, no representatives of senior citizens, no experts on the opioid crisis--which is sweeping our country--who have testified in public about the impact this legislation will have in our country. How can one possibly dream of drafting a bill of such enormous magnitude without hearing one public comment from the most knowledgeable people in America with regard to healthcare? How can you possibly go forward without one public hearing where Senators have the opportunity--Democrats, progressives, Independents-- to ask questions? But that is precisely the process this legislation has gone through. I fully understand there are a lot of people who will say: Well, big surprise, Bernie Sanders, a strong progressive, opposes this Republican bill. What else is new? But I want you all to understand that it is not just Bernie Sanders or Democrats here who oppose this legislation; this legislation is opposed by virtually every major healthcare organization in the United States. I am not quite sure how we can go forward with major legislation impacting one-sixth of the economy, opposed by every major healthcare organization in the country, and not have one hearing. I am not quite sure how that can be done, but that is precisely what the Republican leadership here is doing. It is not just Bernie Sanders who opposes this legislation. It is the AARP, which is the largest senior group in America. It is the American Medical Association. Hey, those are our doctors. When you get sick, you go to a doctor. Many of them are members of the American Medical Association. They say this bill is a disaster. It is not just doctors. It is nurses. It is hospital administrators. It is the American Cancer Society, the American Heart Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Psychiatric Association, the Federation of American Hospitals, the Catholic Health Association, the American Lung Association, the Cystic Fibrosis Foundation, the March of Dimes, the National MS Society, and the American Nurses Association, among many other organizations that oppose this bill being written behind closed doors. Several months ago, as I think everybody knows, with the strong support of President Trump, the House passed their disastrous healthcare bill. Now, we know what is in the House bill. The Senate bill probably is being worked on as we speak, so we don't know what is in that exactly, but let me tell my colleagues what the House bill does. At a time when 28 million Americans today--before the Republican bill--have no health insurance and millions more are underinsured, with high deductibles and copayments, this bill from the House will throw another 23 million Americans off of the health insurance they currently have. Think about it. Gee, if we have 28 million Americans off of health insurance, what most Americans would say is: OK, how do we lower that number? In fact, the Affordable Care Act added another 20 million people to the ranks of the insured. This bill throws 23 million on top of the 28 million we currently have uninsured, almost doubling the uninsured in America to over 50 million people. Think about it. People have a hard time even beginning to believe that legislation that is being seriously debated would almost double the number of uninsured in America. Everybody understands--there is no debate about this--that the Affordable Care Act is far, far from perfect. This is a point I have been making from the day the Affordable Care Act was passed. Premiums in my State of Vermont and around this country are too high, deductibles are too high, copayments are too high, and too many Americans remain uninsured or underinsured. But in each and every one of these legitimate concerns, the Republican legislation that has been brought forward and passed in the House would only make a bad situation much worse. The Republicans say: Oh, the Affordable Care Act is a bad piece of legislation. It has problems. The Affordable Care Act does have problems. Their legislation exacerbates every single one of the problems that it has. So our job today, and I think what the average American understands-- OK, we have problems. What are the problems? We have listened. Deductibles are too high. Copayments are too high. Premiums are too high. Prescription drug prices are way too high. OK. Let's discuss it. What is your idea? How do we deal with these problems? That is what the American people want. The American people want us to address the problems that are in the Affordable Care Act, not destroy it. It seems to me clearly that our job right now--and the American people are rising up. They are not going to accept this Republican legislation. Together we are going to defeat it. I wish to speak for a moment about what it means if this legislation were to pass. What are the implications of throwing 22 million people-- that is the Senate bill--off of health insurance, and 23 million people in the House bill? Let me tell my colleagues. I want every American to think about this. Just think about it. Think about somebody today who has cancer and is maybe in chemotherapy or maybe in radiation, somebody who has heart disease, somebody who has diabetes or some other life- threatening disease. There are God knows how many people in this country right now who are sick. What happens if they lose their health insurance? A simple question. You have cancer, you are getting treatment today, and the Republican bill takes away your health insurance. What happens to you when you cannot afford to go to the doctor when you feel a lump in your breast or when you have problems with your heart? What happens to you if you have a heart attack or a stroke and need significant care, but you have no health insurance and you don't have the money to pay for the outrageously high cost of care? Here is the horrible and unspeakable truth that has to be brought out into the open; that is, if this legislation were to pass, many thousands of our fellow Americans would die, and many more would suffer and become much sicker than they should. Now, I am not suggesting that there is anybody in this body who wants to see anybody die unnecessarily. Nobody does. But people have to take responsibility for their actions, and if you throw 23 million people off of health insurance, many of whom might have life-threatening illnesses, thousands of people will die. Several weeks ago I was on a television program, and I said just that, and then right after that, I was criticized by Republicans and rightwing critics: Why did you say that? What a terrible thing. Why are you frightening the American people? ``Some people will die''--that is not true. Well, PolitiFact is a nonpartisan organization that checks out what public officials say, and they took a look at well over 10 different studies on the issue of mortality rates and lack of insurance coverage. That is what they studied. They looked at more than 10 different studies looking at mortality rates and lack of healthcare coverage. What PolitiFact concluded is that the point that I made--that many thousands will die--is well supported. It is not Bernie Sanders. I am not coming up with some idea off the top of my head. This is what many, many medical and scientific studies have told us. Obviously nobody can predict exactly how many people will die if 23 million people lose their health coverage, but what experts at the Harvard School of Public Health estimate is that if 23 million people are thrown off of health insurance, as the House bill does, up to 28,000 people could die each and every year--28,000 people. That is nine times more than the tragic loss of life we suffered on 9/11, and that would take place each and every year. In the wealthiest country in the history of the world, we must not allow that to happen. This bill would impact the children, many of whom are covered by the CHIP program, covered by Medicaid. You tell me what happens to a kid who has a disability right now and whose family receives Medicaid. Some of those children may have Down syndrome. Some of those children may have cerebral palsy, muscular dystrophy, maybe autism. They may have mental health needs, such as depression or anxiety, or complications from premature birth. Today, Medicaid and CHIP cover 5 million--or 44 percent--of those kids, providing them with coverage so that they can live with dignity and security. But it is not just the children who will be impacted, it is also the elderly. What every person in America should understand--and many do not--is that Medicaid now pays for over two-thirds of all nursing home care. So I ask my Republican friends: What happens when you slash Medicaid? Who will pay for somebody's mom or dad in a nursing home dealing with Alzheimer's disease? How many seniors in this nursing home will get thrown out on the street or be forced to live in their children's basement? Well, we don't know the answer to that. We haven't had any hearings. We haven't heard any people testify to that. But I think we will see a whole lot of families disrupted, having to make the choice about whether to take care of their parents or provide for their kid to go to college. It is not just nursing home care. What happens if you are just an older worker. Maybe you are 60 years of age. Well, the likelihood is that if you are a 60-, 62-year-old worker, the cost of your premiums is going to soar. Again, this is not Bernie Sanders' view; it is what the AARP says. This is a quote from the AARP from June 22: This new Senate bill was crafted in secrecy behind closed doors without a single hearing or open debate--and it shows. The Senate bill would hit millions of Americans with higher costs and result in less coverage for them. AARP is adamantly opposed to the Age Tax, which will allow insurance companies to charge older Americans five times more for coverage than everyone else while reducing tax credits that help make insurance more affordable. That is the AARP. What about the opioid epidemic, which is hitting my State of Vermont hard and hitting States all over this country? Each and every day, more than 90 people in America die from an opioid overdose. Can you believe that? Ninety people die every single day. Nearly 4,000 people begin abusing prescription painkillers, and about 600 start using heroin. We have a major, major crisis in opioid addiction and heroin overdoses. It turns out that if you cut Medicaid by $800 billion, which is what the Republicans are talking about, our ability to address the opioid crisis will be severely curtailed. At a time when we should be expanding prevention efforts, expanding treatment efforts, the Republican bill will make it much harder for us to deal with the opioid crisis. This legislation is not what the American people want. I understand that the Republican leader today suggested that Members of the Senate may have to stay here for a few more weeks in August, and I can understand that. If I were the Republican leader, I would not want my Senators to go home to hear what the American people have to say about this legislation. The truth is, poll after poll shows overwhelming opposition to this disastrous legislation. According to the latest USA TODAY/Suffolk University Poll, just 12 percent of the American people support the Republican bill. As a matter of fact, according to a recent report, this is the most unpopular piece of legislation in the last three decades. It is more unpopular than the $700 billion bailout of Wall Street. That is pretty unpopular. The American people are catching on as to what is in this bill, and they do not want to see it. Let me conclude by saying what is as obvious as can be. It is what the American people want. Are there problems with the Affordable Care Act? Absolutely. Premiums are too high, deductibles too high, copayments too high, prescription drug prices are off the charts. Let's deal with it. What is the problem? Let's deal with it. Put it on the table, and let us address those problems. The American people want to improve the Affordable Care Act, not destroy it. Let me now, speaking for myself only, say this. I hope very much there can be bipartisan efforts to improve the Affordable Care Act, but I happen to believe we have to go further than that. I intend to help lead that effort. In my view, there is something profoundly wrong when the United States of America is the only major country on Earth--the only one-- that doesn't guarantee healthcare to all people as a right, while at the same time we spend far more per capita on healthcare. We spend far more per capita on prescription drugs, and our healthcare outcomes are not particularly good compared to many other countries. I think the time is long overdue as to why we do not ask ourselves: How is it Canada can guarantee healthcare to all people, the UK can do it, Germany can do it, France can do, Scandinavia can do it? Every major country on Earth recognizes that healthcare must be a right, not a privilege. I happen to agree with that. That is why I will--as soon as this debate is over and as soon as, hopefully, we defeat this disastrous Republican legislation--introduce a Medicare-for-all, single-payer bill, which will in fact guarantee healthcare to all of our people in a cost-effective way. Let me conclude by saying that the current Republican bill in front of us is a moral outrage. There are very few people in America who think you should throw 22 million of our people off of health insurance in order to give huge tax breaks to billionaires. This is a moral outrage, and it must be defeated. I will do everything in my power to see that it is defeated. I yield the floor.

Mr. SANDERS

Mr. SANDERS. Mr. President, today's Congressional Budget Office analysis of the Trump-McConnell healthcare bill gives us 22 million reasons why this legislation should not see the light of day. What CBO tells us in truth is that this bill really has nothing to do with healthcare; rather, it is an enormous transfer of wealth from the sick, the elderly, the children, the disabled, and the poor into the pockets of the wealthiest people in this country. According to CBO--and that report came out just a few hours ago--this bill would throw 22 million Americans off of health insurance, cut Medicaid by over $770 billion, defund Planned Parenthood, and substantially increase premiums for older Americans. Under this bill, a 64-year-old with an income of $56,000 could see his or her premiums increase from $4,400 under current law to $16,000--an increase of nearly 850 percent. How are older workers in this country going to deal with an 850-percent increase in their premiums? Meanwhile, the Trump- McConnell bill would provide a $231 billion tax break to the top 2 percent and hundreds of billions more in tax breaks to the big drug companies and insurance companies that are ripping off the American people every day. At a time when the middle class of this country continues to shrink and when families all across America are struggling to make ends meet, to put food on the table, to pay their rent, to save a few bucks for retirement, we cannot take from working-class families and we cannot take from the sick and the elderly and the children in order to give even more to the very wealthiest people in this country--people who are at this moment doing phenomenally well. Mr. President, this, in fact, is a barbaric and immoral piece of legislation. But let's be very clear. It is not just Bernie Sanders who opposes this bill. It is not just every Member in the Democratic caucus who opposes this bill. It is not just that the overwhelming majority of the American people oppose this legislation. According to a recent NBC/ Wall Street Journal poll, only 16 percent of the American people thought this bill was a good idea. This bill is opposed by virtually every major healthcare organization in this country--the people on the frontlines, the people who today, yesterday, and tomorrow are dealing with healthcare issues, dealing with the sick, working in hospitals, working in community health centers. Almost without exception, every major healthcare organization in this country opposes this bill. Maybe my Republican friends might want to get beyond the politics, get beyond Republicans and Democrats, and ask the people who really know about healthcare in America and ask yourself, how does it happen that virtually every major healthcare organization in this country opposes this legislation? The AARP opposes this legislation--the largest senior group in America, which knows what high premiums for healthcare will do to their membership. The American Hospital Association knows a little bit about hospitals and what will happen to rural hospitals if this legislation is passed. The American Medical Association is a conservative organization. This is the doctors organization all over this country. This is not any progressive radical group; these are our doctors, the doctors we go to. They oppose this legislation because they know what will happen if there are massive cuts to Medicaid, if 22 million people are thrown off of health insurance. The American Academy of Family Physicians knows what this legislation will mean to the children of our country. The American Psychiatric Association, the Federation of American Hospitals, the Catholic Health Association, the American Lung Association, the Cystic Fibrosis Foundation, the March of Dimes, the National MS Society, the American Nurses Association--every one of these organizations opposes the Republican legislation; not Bernie Sanders but every major healthcare organization says do not go forward with this disastrous bill. This is what the AARP, the largest senior group in America, said recently: This new Senate bill was crafted in secrecy behind closed doors without a single hearing or open debate--and it shows. The Senate bill would hit millions of Americans with higher costs and result in less coverage for them. AARP is adamantly opposed to the Age Tax, which would allow insurance companies to charge older Americans five times more for coverage than every one else while reducing tax credits that help make insurance more affordable. I ask all of my Republican friends to think for a moment about the implications of this bill and what it will mean to your constituents when they lose the healthcare they currently have. Put yourself in their place. Today you have health insurance, but tomorrow, next year, you might not. What does that mean? Think about it. What does it mean if you are an individual today--and, sadly, there are too many of them. If you are a person today suffering with cancer and you are fighting for your life--maybe you are on radiation treatment. Maybe you are on chemotherapy. You are scared to death. You don't have a lot of money. You have cancer. You are struggling. And now you are reading in the papers that this Republican bill may take your health insurance away from you? How do you think they feel? I suspect scared to death. It is the same with people who have heart disease, who have asthma, who have diabetes or any other life-threatening illness. What happens to those millions of people when they cannot afford to go to the doctor when they are sick, cannot afford to buy the medicine they desperately need? Mr. President, I know this is a sensitive issue, but I am going to raise it, and that is that the horrible and unspeakable truth is that if this legislation were to pass, and I am going to do everything I can to see that it doesn't, but if it were to pass, many thousands of our fellow Americans every single year will die, and many more will suffer and become much sicker than they should. That is not, again, Bernie Sanders talking; that is exactly what a number of studies have shown. Study after study, including one from the American Journal of Public Health to the New England Journal of Medicine, to the Harvard School of Public Health have told us. Again, this is not Bernie Sanders engaging in a rhetorical debate; this is what scientists and doctors who have studied the issue are telling us. In fact, just this afternoon, a few hours ago, the Annals of Internal Medicine, a prestigious medical journal, published an article from researchers at the City University of New York School of Urban Public Health at Hunter College and Harvard Medical School entitled: ``The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?'' That is the title of the article appearing today. According to a summary of this article, ``Insurance decreases the odds of dying among adults by at least 3 percent and as much as 29 percent and `being uninsured substantially raises the risk of dying.' '' The coauthor of this article, Dr. David Himmelstein, commented: According to the CBO, the Senate Republicans' plan would strip coverage from 22 million Americans. The best estimate based on scientific studies is that about 29,000 Americans would die each year as a result. I know no Republican wants to see anybody die--none of us do--but that is the reality we are dealing with, and you cannot ignore it. If somebody has cancer, if somebody has heart disease and you take away their health insurance, I don't need studies from Harvard University to tell me and to tell you what you know to be the case. This is the United States of America, and we can do better than that. Mr. President, I ask unanimous consent that the article that appeared today in the ``Annals of Internal Medicine'' be printed in the Record.