Mr. REED: Mr. President, I rise in opposition to the budget resolution that the Senate will vote on this week. We are nearly half way through the fiscal year, and the Republicans have offered this budget resolution not to set a path forward for spending for the year but to give them the ability to repeal the Affordable Care Act through the budget process, requiring less support than is needed under regular order.

This budget is nothing more than a sham, being used to take away health insurance from more than 20 million Americans. What is worse is that my Republican colleagues intend to do so without any plan in place to mitigate the impact and protect the people who will be harmed. The uninsured rate is at its lowest point in recent history. Since the implementation of the ACA in my State of Rhode Island, the uninsured rate has fallen from 12 percent to under 4.5 percent. In real terms, that means that over 100,000 people in Rhode Island have gained coverage because of the ACA. That is about 10 percent of my State’s population. Over 30,000 middleincome Rhode Islanders get tax credits averaging $250 a month to help them afford coverage on the State’s health insurance marketplace.

We cannot go back to a system that allows private insurers to deny coverage for preexisting conditions or charge more to those who need insurance the most. In fact, the Republican plan for repealing the ACA means that nearly half a million Rhode Islanders with preexisting conditions, about half the State’s population, will be denied coverage or will be charged more. Again, as Senator MURRAY described so eloquently in the case of a young man who needs years of expensive treatment, if preexisting conditions are once again possible and if that young man is dropped from his parents’ plan at 21, both of those factors will probably deny him the coverage that he enjoys today, and that is not what we want to do. I hope that is not what we want to do. In my State, there are over 106,000 Rhode Islanders with diabetes, over 112,000 with asthma, and nearly 63,000 cancer survivors who will be forced to pay more for coverage. These are huge numbers in my State—roughly 1 million people in population. They have these conditions, and insurance companies said in the past: We won’t cover you, or, by the way, you will be spending 2, 3, 5, 10 times as much for the coverage we extend to someone else.

We have also been able to improve coverage through the ACA for those who are getting their care through their employer. Before the ACA, insurance plans, including employer-sponsored health coverage, could impose annual or lifetime limits on coverage, meaning that coverage could end when it was most needed. You could have a job, and you could have insurance at a job, but if you have a serious condition, when you reach that limit, that is it— no more responsibility by the company. That is exactly the time you need the help because you have already either exhausted some of your own resources or you are in a position where you have been sick for so long that your ability to go back into the workplace is practically nonexistent. The ACA prohibits these limits, along with ensuring free preventive care and coverage of dependents up to age 26, ensuring real coverage for nearly 600,000 workers in Rhode Island with employer coverage.

There is a perception out there that the ACA doesn’t apply to employer coverage and that it has no effect— that if it is repealed, it is fine because I get my health insurance from my employer. That is not the case. The impact will be there, and it could leave many people devastated. Additionally, the ACA strengthened the rate review processes to help control premiums. Prior to the ACA, double-digit increases were always the norm. When I served in the House and in my first years in the Senate, invariably, when trade associations came to visit me, the first or second issue on the list was this: Our insurance coverage just went up 20 percent. We can’t afford it anymore. We are dropping coverage or telling our workers: Do you want a raise, or do you want coverage? You can’t get both. Well, we have to do more to keep premiums under control and bring down costs, but there has been an improvement under the ACA in my State and in many other States. In 2 of the last 3 years, premiums actually went down from the previous year in Rhode Island. During open enrollment for 2017, Rhode Islanders saw decreases of as much as 5 percent in their premiums. In fact, due to the ACA, consumers in Rhode Island have saved nearly $220 million since 2012, according to the State resource. This program has done something that we were feverishly trying to do, which was to somehow bring costs under control and reduce them if we could but certainly eliminate the double-digit growth, when every year every employer group was coming in and saying: We can’t afford this. We want to cover our workers, but we can’t. We are giving them that choice, or we will have to sadly say we can’t give you insurance anymore. Repealing the ACA would end all of these consumer protections and put insurance companies back in charge. One other thing that it has done is that we actually required that a significant amount of the premium be used for health care, not overhead. We actually built into the law that, if you are going to charge a premium, it better go to help people get health care, not just to boost your profits, dividends, or anything else. That is another factor that has helped positively this rate and premium structure.

Then, of course, there is a huge economic impact of ACA repeal. For years I have heard my Republican colleagues very sincerely and adamantly declare that the ACA is a job killer, that it was going to destroy millions of jobs. That was one of the refrains that echoed throughout this Chamber as we were debating the ACA for months and years afterwards. But what has happened? We have had an unprecedented 75 consecutive months of job growth—something we haven’t seen since 1939. Repealing the ACA would wreak havoc on this progress. Premiums for everyone, not just those in the individual market, will skyrocket. Large businesses will see their health care costs go up, which means workers will forgo pay increases as their employers struggle to simply maintain health care coverage or they will drop the coverage entirely.

We have come a long way since the economic downturn in 2008, and we have much more work to do to keep things moving in the right direction, but one of the worst things we can do for the economy is to repeal the ACA. Rhode Island stands to lose over $7 billion in Federal funding over the next 10 years with repeal. Again, that is a staggering number in my State—$7 billion. That would be devastating for the State because they would have to step up as best they could, and frankly, they don’t have the kind of resources to replace that loss. It would have an effect on hospitals and other health care providers. Hospitals in Rhode Island stand to lose nearly $2 billion in funding on top of the added expenses of emergency room care for the newly uninsured. We remember the old model of health care. The old model was that, if you didn’t have insurance, you went to the emergency room. Those emergency rooms were crowded with people. They were much more expensive to treat because they were there without any previous experience with the physicians and without health records, in many cases. They had to do diagnostic tests that were not available and that are now available at the health care facilities because they have insurance. All of that would come undone. It will be a huge impact on the economy. One of the largest employers in the State of Rhode Island is the hospital system. I don’t think we are alone. If you go out into the rural parts of the United States, in many cases, the biggest employer in many counties is the health care system, the hospital system. When they can no longer make their books balance, they are going to have to start closing down operations, laying people off. That is what is going to happen. This is not farfetched. We have seen it before. We have seen struggling hospitals struggling under emergency room uncompensated care. We have seen all these things happen before. Repealing the ACA would lead to a combination of all these factors— skyrocketing premiums and the loss of Federal funding in health care for States, which would have a ripple effect throughout the country. If Rhode Island or any other State has to step in and partially make up for the loss of Medicaid funds or any other aspect of this program, where are they taking it from? Where are they taking it from? Education, infrastructure, public safety. They will suffer.

Ultimately, it is the jobs—the jobs of the people in my State and the jobs of people across the Nation. So there are things we can do to strengthen the bill. Senator Murray was very clear about attempts we have made. She has been one of the great leaders in this effort to make improvements. We have been working on and improving Medicare since 1965, and we still have some work to do, but that was a different program. That was a program that was a bipartisan program, one that was embraced and developed and supported. In fact, one of the ironies today is some of the staunchest supporters and protectors of Medicare are Republicans, as well as Democrats, but that was a program that took several decades to work through, and we are still working through issues with respect to Medicare. We are prepared to do that with the Affordable Care Act in a principled, thoughtful, practical, pragmatic way, not to score political points, but to make it a system that is more affordable, more effective, and that gives more American families a chance. Frankly, you don’t have much of a chance for a good education, a good job, or a secure retirement when your health is in jeopardy and your finances are equally in jeopardy.

At this point, the Republicans have offered no plan to replace the ACA, and it is a tough task. I served on the HELP Committee as we were drafting this, and we spent over a year on this law. We spent countless moments reaching out to our colleagues on the Republican side asking: Can we make this better? What improvements can we make? We had numerous folks in the mix. It is tough work. To suggest that we can just repeal this and something will magically appear, I don’t think that is particularly logical, obvious, or will happen. Roughly, 7 years have gone by since the passage of this bill, where the Republicans have had a chance to prepare a detailed plan to replace aspects of the ACA or replace it. I don’t think that plan is out there. It is certainly not being communicated. We have to ensure—and Senator Murray was very effective in making this point—that we can improve ACA, not demolish it, that, if we get into a legislative process, we produce a better outcome for the American people, not an outcome of denial of health care and financial uncertainty and perhaps even financial ruin. So we have to get to work. I think we are prepared to do this but in the context of something pragmatic and productive for the benefit of the American people. Let me switch gears, just for a moment, and talk about Medicare and Medicaid because, when people talk about Medicare and Medicaid, they usually don’t make an association with the ACA. They think that is something else. I can recall being in a public discussion in August of 2009, when we were discussing ACA before it became law, and something came up that was very critical about the program because they didn’t want publicly funded insurance in any way, shape, or form, and I asked: Where do you get your health care? Well, I have a private provider. Again, I asked: Where do you get your health care? I am on Medicare.

Medicare is, as I recall, a singlepayer national system of health care, a funded entitlement by the government, with some copayments by participants. Medicare and Medicaid are effective in a significant way. We made historic improvements to these programs, enhancing benefits. Indeed, we added 9 years of solvency to the Medicare trust fund. One of the great issues that reverberates throughout this Chamber is we have to control entitlements. We have to prepare for the future. We have to make sure these social programs like Medicare, Social Security, Medicaid, and others are solvent. We added years of solvency to the program in the ACA. If it is repealed, subtract 9 years of solvency from the Medicare trust fund. Tell seniors and people in their fifties who are getting ready to enjoy the benefits: Just take 9 years off your expected benefits, or at least a portion of the benefits. The ACA made a number of other improvements. They closed and are closing the doughnut hole for prescriptions, they eliminated cost sharing for cancer screenings, for example, for Medicare recipients. Over 15,000 Rhode Islanders saved $14 million on drugs in 2015. That is an average of $912 per Medicare beneficiary because of what we did with respect to the doughnut hole. In the same year, over 92,000 Rhode Islanders—huge numbers in my State—took advantage of free preventive services, representing over 76 percent of the beneficiaries. Seventy-six percent of the Medicare beneficiaries in my State took advantage of free services. Otherwise, they would have paid out of their pocket, and, frankly, many seniors don’t have the resources to do that. Repealing the ACA means these benefits go away, and it shortens the trust fund by about a decade. Repeal would also mean cutting $270 million in Federal funds to help pay for health coverage for low-income adults, children, seniors, and people with disabilities through Medicaid. The ACA expanded eligibility and streamlined enrollment and made it easier for the most vulnerable to access quality health care coverage. As a result, approximately 70,000 Rhode Islanders were able to access coverage for the first time through Medicaid—their previous source of health care: most times, the emergency room, if they could get there. I want to point out a couple of things about Medicaid. Medicaid has become a program for our senior citizens that happens to also help struggling Americans. Seniors make up a small percentage of the Medicaid population but account for approximately half of Medicaid spending nationwide. Nearly 60 percent of nursing home residents are covered by Medicaid. Think about that. Sixty percent of all nursing home residents need Medicaid.

The next time you hear someone casually suggest drastic cuts and changes to Medicaid, think about that. Those cuts will work their way back to nursing homes throughout your State. Those families of those seniors are not all people who have been poor and on the margins all of their lives; they are our neighbors, and they will feel it. In Rhode Island, over 30,000 seniors access health care coverage through Medicaid. My colleagues across the aisle want to make drastic cuts to Medicaid. Make no mistake, cuts to Medicaid mean cuts to nursing home services for seniors and a return to preMedicaid times when the elderly had few options. In the 1950s and 1960s, before Medicare and Medicaid, your grandmother or grandfather was in your living room in a hospital bed being taken care of by typically your mother. That is the way you grew up back in the 1950s and 1960s in most middle-income neighborhoods. That was at least my experience. If you want to go back, that is what would happen, in some respects, if we repeal this law. If Republicans want to come and work with us, we are ready—more than ready—but we can’t stand by and allow them to do the damage they propose: to take away coverage from 20 million Americans and cut benefits to seniors. That is not the right direction for America and for our country.