Mr. President, I am truly dismayed by what we've seen in this chamber over the last couple of months with respect to the Senate Trumpcare bill.

We are expecting to take a vote tomorrow on the motion to proceed.  But at this point, our Republican colleagues haven’t shared with us what exactly we're proceeding to.  We don't know if our Republican colleagues will attempt to replace the ACA with their flawed Trumpcare bill or if they will just vote to repeal the ACA and immediately upend health insurance markets across the country.  Not one of these options is acceptable, and I am skeptical that my colleagues will be able to come up with a better solution in the next twenty four hours. 

For an issue of this magnitude, we should be holding hearings, meetings, and discussions in the committees of jurisdiction with experts from around the country, much like we did when we worked to pass the Affordable Care Act (ACA).  In that way we could have worked together, across the aisle, to develop ideas that would improve the system in place, not gut it.

There have long been misconceptions about how the Affordable Care Act came to be.  We held hearings, meetings, and roundtable discussions for over a year with members from both parties and had a robust amendment process in our committees - both the Senate Finance Committee and the Health, Education, Labor, and Pensions (HELP) Committee - on which I served at the time and went through numerous hearings, open discussion, numerous amendments, listening to my colleagues.  In fact, the HELP Committee draft of the ACA included over 160 amendments offered by my Republican colleagues.  It was truly a bipartisan effort at the committee level to try to at least discuss the critical issues that both sides had identified.

This stands in stark contrast to the bill our colleagues have written in secret this year.  Even some Republican Senators were kept in the dark, excluded from the process.  There were no opportunities for experts, doctors, patients, and others to weigh in and offer comments.  As a result, they have written a bill that is bad for patients, bad for health care, bad for states, and bad for the system as a whole.

My colleagues even rejected the chance to hear from states in public hearings about their health care systems in terms of what has worked well and what hasn't.  And there are examples of states that have done some very innovative things, and some examples of states that have had difficulties.  We are always saying that the states can be great incubators for new ideas, yet the process my colleagues across the aisle employed discounts their views in both the cases where it went remarkably well and cases where we can do much better.

We should look to the states to see how we can improve our health care system and let them be partners with us in this process.  That's what we did during consideration of the Affordable Care Act.  In fact, some states had already worked to expand access to care before the ACA, most notably Massachusetts with Romneycare, and we looked carefully at those examples, and tried to incorporate those successful ideas in a national model.

By contrast, governors and senators and state legislators – both Democrats and Republicans – across the country are largely opposed to the Senate Republican Trumpcare bill because they know it would be a bad idea for their states.  State and local officials have crossed party lines and joined together to get the word out about how bad this bill would be for Americans from all states and walks of life.  My Republican colleagues must heed their advice and abandon this harmful approach.

It's no secret why my Republican colleagues have struggled to come up with the votes within their Caucus for their repeal efforts.  Their proposals are bad for my state of Rhode Island and bad for our country as a whole, in fact many states with Republican legislators and Republican governors have done very well in incorporating the ACA and they can understand the impact it will have almost immediately on their health care system.  While we don’t know exactly what we’ll be voting on tomorrow, we have some guesses based on what Republicans have publicly shared over the last couple of weeks.  Each proposal seems to be worse than the next.

First, my colleagues tried to vote on their Trumpcare bill, which would have provided massive tax giveaways to the very wealthiest Americans at the expense of hard working Americans across the country.  This bill would have decimated Medicaid, cutting state budgets and eliminating access to care for seniors, children, and people with disabilities.  50 percent of the funds in my state – and it’s roughly equivalent across the country – go to seniors, typically seniors in nursing homes, who have Medicaid.  If they lost that funding, the states can’t make it up.  I think every state in this country is struggling with their own physical issues – education, transportation, infrastructure  - a host of issues, and when this money is pulled out, they will not be able to replace it.  They will make difficult decisions about cutting back eligibility so that, ironically, middle class seniors will be the first to feel the brunt of these cuts.  That’s exactly one of the areas where we’re trying to prove our system, not only of health care but of government.  Even after doing that, they’ll still come up short, and that’s when they’ll go into the education funding formulas, and there are many states across this country now that are already in crisis.  This would just add to the crisis.  But all of these fixes don’t overcome the damage that would be inflicted on the bill.

The nonpartisan Congressional Budget Office confirmed that last week, releasing an updated score of the bill to reflect some of the changes that they made.  CBO said that under this revised bill – the latest one that’s been evaluated - 22 million Americans would lose coverage, just like the previous version of the bill.  22 million Americans, a significant number of our neighbors, would lose their coverage, many of them working families, many of them who have children with special needs who need this coverage, and they would be thrown out.  I was at a Lowe’s store in Rhode Island and a young man in his mid-thirties came up to me and said “please, Senator, you’ve got to stop this bill. I have a son that has a serious problem.”  I believe he told me it was MS.  He said, “if eventually they remove the lifetime limits, as they’re talking about, on health care insurance, I will be done.  I’ve got employer health care insurance, I’ve got a good job, I’ve got benefits, but if they put those lifetime limits back again, I’ll be bankrupt.  My son will not have the care, or he’ll only get the care through some type of extraordinary method.”  And that’s the reality.  These are our neighbors. 

Similarly, CBO said that out of pocket costs would increase across the board, and care would be prohibitively expensive for the sickest and poorest among us.  And that is one of the great ironies here.  The sick would be paying more and more and more.  CBO was not misled  by these so-called “fixes” that have come into the bill.

In fact, we know that the reality would be even worse than CBO predicted, because it did not take into account a provision added too late to be scored, which would bifurcate insurance markets, separating the sick from the healthy, leading to a death spiral in the market that would all but certainly collapse the market.  That would qualify as a plan.  The healthiest, youngest people would buy it because it’s cheap and they have some sort of sense of protection.  It would drive the sickest and oldest people into other plans, increasing their costs and, in fact, creating a bifurcated system where either young, healthy people don’t have insurance or they have this insurance which is not insurance when you need it.  And then you have more and more people with chronic conditions and illnesses and the accumulated health conditions that come with age flocking toward what is left and bringing that system down.  It would be a death spiral.

And if that wasn’t bad enough, some of my colleagues on the other side of the aisle decided that the back up plan would be to vote on a bill to repeal the ACA in its entirety on a two-year delay.  They claim that this will give them an opportunity to work out a replacement plan. 

This not sound policy.  Firstly, they have had more than seven years to come up with a replacement without any success.  At this moment, there’s this ad hoc where we put in or we take out.  Seven years of supposed study and analysis has produced apparently nothing.  And they have spent all of this year behind closed doors trying to come up with a replacement with the same failed result, the same CBO scores.  The real end game is not to simply repeal and replace, it seems to be just to repeal.  My other concern is that if even if this repeal is delayed for two years, markets will not wait two years to react.  Insurance companies will not wait two years to react.  They have to provide for decades in terms of actuarial values, in terms of their shareholders.  Hospitals will not wait two years – they’ll start seeing this as coming to an end and will start scaling back their programs, their outreach, and all of the things they do.  The effects will be imminent.   

This effort would leave 17 million more Americans uninsured next year and 32 million more Americans uninsured over the next decade.  That’s the repeal and wait approach.  Once again, CBO said that this repeal bill would lead to skyrocketing health care costs, with premiums doubling over the next decade.  Markets will not wait.  Markets will move very quickly once they know that this is gone.  Since in the last seven years, we couldn’t get a replacement, the idea that we’re going to get it in two more years is something they won’t believe.  It will be immediate and devastating in many respects.  Again, another death spiral for the marketplace.  

But here we are, on the precipice of voting over whether or not to upend our entire health care system so that, in some respects, this President can claim a victory over former President Obama.  Not because it’s sound health care policy, just because of that very complicated relationship.  It's not the right thing to do.  It is long past time for us to leave the campaign rhetoric behind and come together in a bipartisan fashion to work on ways to improve our health care system.  That is what we attempted to do with the ACA.  We sat in meeting after meeting, hearing after hearing, having the longest markup in the history of the health committee, accepting and voting on Republican amendments and Democratic amendments.  That’s how you get things done.

Health care makes up one-sixth of our economy.  When you walk into the ER or a doctor’s office, it doesn’t matter if you’re a Democrat or a Republican.   But it does matter whether or not you have insurance.  If you don’t have insurance, you’re in an awfully difficult position.  Everybody will use the health care system at some point in their lives.  It’s not an optional thing or something designed for a special group of people.  We all will use the health care system, and if you can’t access it because you have no money or no insurance, maybe you’ll find a way through the emergency room or some other way, but it won’t be the best health care and it won’t be the most efficient or economical for our country.  

In fact, one of the ironies of our health care system before the ACA is that you could have large portions of our population with no health insurance not getting treatment for illnesses that could have been readily fixed while they were in their forties and fifties, and then suddenly at 65, with Medicare, they could have any kind of treatment they want. I had an optimologist in my office on day and I made this point and they sad “well, you’re right. I see right now people coming into Medicare at 65 or 66 years old who because they had adult-onset diabetes, which could have been treated by a modest drug regime when they were in their forties and fifties who are not so sick that they have to have extensive optimological surgery.  That’s not affective for the country.  With the Affordable Care Act, we were putting or whole nation, from children all the way up in age on a path to good health care so by the time they get to Medicare, those issues would not be so pertinent.  Let’s work to improve this system for all of our constituents, not just for the well-off, and certainly not to merely score political points. 

To my colleagues on the other side of the aisle, we urge you to drop your efforts, cancel the vote tomorrow, and begin a true bipartisan effort of working with us to improve our health care system.  One of the tests of life is whether you allow your colleagues and friends to do what you did.  Or do you insist they do something else?  We’re just asking to do the same thing we did with the Affordable Care Act over many months of hearings and debate.  And then at the end, there was a vote.  We’re going to see this for the first time tomorrow.  We still don’t know what’s going to be in it.  There will be a vote, but it won’t be an informed vote.  It won’t be the result of careful deliberation or bipartisan efforts or the input of all the equity holders such as doctors, patients, public health officials, governors coming together and saying “we can do this better.”  That, to me, is a shame.

With that, Mr. President, I would yield the floor.