Affordable Care Act

Floor Speech

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Mr. CASEY. Mr. President, I rise to talk about the Affordable Care Act, passed some 13 years ago, and in particular to talk about the Medicaid part of that, taking the Medicaid Program and allowing States to sign up for an expansion of Medicaid.

But I thought the best place to start, as any healthcare discussion should start, is to talk about just one family. This happens to be a Pennsylvania family. I will start with two sisters. I will start with the older sister. Her name is Haley. Haley wrote me a letter just about 2\1/2\ years ago now, talking about her little sister. Here is what Haley wrote to me. She talked about where her family lives in Pennsylvania, and then she said--her sister's name is Sienna--she said:

My sister is my best friend. She has Down syndrome so sometimes things are harder for her. It took her a long time to walk and she is still learning to talk. Her therapists help her and sometimes I help her too.

Then she goes on to talk about how she, Haley, introduces her sister Sienna to her classmates. She said that she shares her sister with her friends, and I am quoting directly what Haley says:

Mommy and me read a story at my school to explain Sienna's muscles work different than ours. Our muscles are like rubber bands but hers are more like play-doh. Now my friends understand why things are harder for her and they all love her. They think she is the cutest and so do I.

So said an older sister about her younger sister.

Of course, her mom wrote a much longer letter to me about what that family is facing every day. I won't go through all of it tonight, but when this family received that diagnosis of Down syndrome, Sienna's mom said:

Sienna's diagnosis came as a surprise to us. After enduring four miscarriages, she was our miracle baby. Our miracle baby surprised us on the day of her birth with her diagnosis and a heart condition. We were completely unprepared to raise a child with a disability. After I delivered her, a kind nurse explained to me how lucky we were to have Sienna here in Pennsylvania after the passage of the Affordable Care Act.

Then her mom goes on to describe all the benefits that she received because of the Affordable Care Act and because of her residence in Pennsylvania.

That is what we are talking about here when we talk about healthcare. This isn't a budget question only. This isn't just a policy discussion. This is about real people's lives. And the further away you get from real people's lives, the easier it is to make the calculation, as some have made around here, some Members of Congress whose healthcare is made available to them because of the Federal Government--that is why they have healthcare, because of the Federal Government. Whether they are in the exchange or they have it some other way, most Members of the U.S. Senate and the House have that healthcare because of the Federal Government. So those with healthcare provided by the Federal Government seek relentlessly--too many seek relentlessly to use Federal power to cut people off of healthcare.

This is about real people's lives, not something abstract, not some remote discussion about policy and about budgets and deficits and appropriations. This is about real people's lives, like Haley's little sister.

I know there has been a lot of discussion of late about Social Security and Medicare and how we hope they are off the table, and that is good, those two earned benefit programs being off the table. But there is a third program that is not an earned benefit, but I would argue that Medicaid is--Medicaid tells us who we are as a nation. It is as if we look into a mirror when we consider the Medicaid Program, and it tells us what kind of a nation we are or what kind of a nation we will be if we slash it the way that so many people around here have proposed in budget after budget, year after year, talking about slashing Medicaid arbitrarily and outrageously and obnoxiously. We are going to stop them from doing it once again, but I think it is important to remind people what we are talking about here.

Medicaid is a program basically about three Americans: children from low-income families--and not just in urban communities, but there are certainly a high number of children in our cities who benefit from Medicaid. Thank God we have the Medicaid Program all these decades later. The utilization rate is actually higher among rural children or children who live in rural communities. They have a higher utilization of Medicaid in the Children's Health Insurance Program than urban kids by percentage. That is a fact, and we need to remind people of that.

Medicaid is a program that also helps people with disabilities. You can't march around here every day or year after year and say that you really care about people with disabilities, that you fight for people with disabilities, and then go and cut the Medicaid Program like some have proposed. And the proposals to cut it haven't just been in the tens of billions of dollars. That is just the annual cut they want to propose. It has often been hundreds of billions of dollars over the 10 years within which we talk about budgets around here and appropriations--hundreds of billions of dollars in cuts. That is what some want to do.

We have to remind ourselves again that this is a program about children and about people with disabilities. The third group of Americans, of course, is older Americans, our seniors. A lot of middle- class families may not know it, but their mom or their dad or a loved one is in a nursing home solely because of Medicaid. You can't get into the nursing home, unless you can pay out of your own pocket, without the Medicaid Program.

We could actually call the Medicaid Program the senior long-term care program or we could call it the program that provides healthcare to kids or we could call it the program that helps children with disabilities.

Now we are told that the House Republican Study Committee fiscal year 2023 budget plans to cut Medicaid, the Children's Health Insurance Program, and the Affordable Care Act--all three. They want to cut the Affordable Care Act marketplace subsidy spending by nearly half over the next decade.

Again, when it comes to Medicaid, we are talking about a program that provides the funding for almost half of the births in America. So everyone who claims to care about children and babies and still wants to cut Medicaid has some explaining to do when you want to substantially cut a program that provides the funding for half of the births in the United States of America. It also provides almost half of the funding and support for long-term care services--services and supports, I should say--for older adults and people with disabilities. That is what the program is.

This Republican Study Committee goes on to say their budget plan converts Medicaid to a block grant program where Federal funding would be capped and States would receive a fixed amount regardless of their actual costs.

Here is what that means in real life: A State gets a block of money, a block grant, and when the State's costs go up for children or people with disabilities or seniors, and they hit the cap of that, those Americans are on their own. They are on their own because the State is out of money. That is what that means in the real world.

But it gets worse. This plan also, thirdly, wants to cut the Federal so-called FMAP, the Federal medical assistance percentage, the percentage that the Federal Government pays for Medicaid. They want to cut that all the way down to 50 percent instead of the numbers that it has been at for years--so much higher. That is also a bad idea.

So when we get back to this on what it means for families, we also have to consider what not just Sienna's sister said in her letter to me, but what about Sienna's mom, whom I quoted just a little bit a moment ago? Here is what Sienna's mom said:

As I entered this new world--

Because she just had a daughter diagnosed with Down syndrome.

As I entered this new world of early intervention, therapies, and medical needs, I began to realize just how much of a financial toll this would take on us if it weren't for the protections of the [Affordable Care Act] and Medicaid.

She goes on to describe that. She says:

Sienna receives 7 weekly therapies. The costs of those alone are $3,400 per week.

That is $3,400 per week for those seven therapies.

Without the ACA, her therapies and medical care would have quickly exceeded the lifetime cap--

Which was addressed in the ACA-- and Sienna would be uninsurable for the rest of her life and left without access to life saving care.

Uninsurable. I can't tell you the number of times that has been in letters that I receive from parents worried about their child who has a disability in the United States of America, the most powerful country in the history of the world. These families are worried about their child with a disability not having access to services, not having access to those therapies, not having access to what they need to live their lives, and becoming ``uninsurable.'' That is an abomination. We are not the greatest country in the world if we do that. We are nowhere near the greatest country in the world if we do that. That would be a stain on America. Every one of us should be ashamed of that if that were to transpire. If that America transpired, it would diminish all of us. It doesn't matter what else we do around here if that happens.

That is not the America that I think most people believe we are and should be, but some want to go there. I know they have all this talk about, oh, well, the cost of Medicaid is getting so great, and it is ``unsustainable.'' That is Washington gobbledygook for people who do not have the guts, the political guts, to say: You know what, when you passed a tax bill in 2017 that gave away the store and so much else to big corporations for permanent corporate tax relief--and those same people who voted for that bill that gave permanent corporate tax relief to the biggest companies in the world, the biggest companies in the history of the world, are the same people who are saying: But we have to cut back on Medicaid because it is unsustainable. That is just throwing sand in the eyes of the people--that is what it is--blinding them with falsehoods. That is what that is. So we have work to do to prevent this from happening.

Now, Mr. President, I am getting close to my time--and I am over already--but I wanted to make maybe two final points.

We have had a concern, many of us, over the last number of years about access to Medicaid not being as stable as it should be; and that stability was enhanced by a provision called continuous coverage--that is the term of art, ``continuous coverage''--provisions that were enacted to ensure healthcare coverage during the COVID-19 pandemic.

Across the country, Medicaid enrollment has increased since the beginning of the pandemic. For example, Pennsylvania's number went up to about 3.6 million people currently enrolled in Medicaid to keep their healthcare coverage uninterrupted.

Over the last 3 years, States were prevented from disenrolling people with Medicaid. If not for the legislation passed in February of 2020, at the very beginning of the pandemic just before the CARES Act, people would have had to reapply for Medicaid on an annual basis.

Studies have shown that this annual enrollment process can lead to unnecessary coverage losses due to administrative and procedural issues. This can be yet another barrier to ensuring that people with Medicaid continue to receive the coverage that they need.

Now, here is the problem. Here is the challenge ahead of us. The appropriations bill passed in December set an end for the Medicaid ``continuous coverage requirement'' because we are not in the pandemic anymore, and that was enacted during the pandemic; and that appropriations bill provided guidance to mitigate coverage losses as this requirement ends. So this kind of unwinding of some parts of Medicaid is set to begin April 1. States can start to disenroll people from Medicaid at the start of next month.

So here comes our responsibility. Both parties in the Senate, both parties in the House--I should say, all three parties, Democrat, Republican, Independent--we have an obligation, a legal duty, a moral obligation that is inescapable to make sure that people know what they need to do to maintain that coverage. The Centers for Medicare and Medicaid Services are working with States to provide information, to promote continuous coverage, and, thirdly, to avoid inappropriate terminations as they begin to unwind this continuous coverage requirement.

In Pennsylvania, the State I represent, the State is working diligently to clarify coverage in formats and languages accessible to enrollees to ensure that everyone understands their eligibility and can access the coverage that they are entitled to.

My constituents are fortunate because Pennsylvania expanded Medicaid years ago, yet there are still States that have chosen not to expand Medicaid. We know that the expansion of Medicaid became easier with the passage of the American Rescue Plan. So we have to continue to encourage States to expand to make sure that more and more people get coverage.

Let me end with this, Mr. President. As I outlined before, this is not just something nice to have. This is about life and death. It is about quality of life for families and for children, especially; but it is also about the risk of death if you don't have coverage. That is as true as any statement we could make, that this is about life and death.

Here is what Sienna's mom--you heard from her sister, but here is what Sienna's mom said. And I will end with this. Towards the end of her letter, she said:

I am proud to be Sienna's mom. This journey is full of wonder, joy, and unimaginable love. It changes life's most ordinary moments into the extraordinary. But with constant attacks on our healthcare, it's also agonizing work, hard decisions, and constant advocacy. It gets exhausting fighting for your child, having to prove their value to the world.

This is a mother talking about her child and having to live almost a separate life as an advocate because people in this town, year after year, are proposing cuts that would badly damage the life of her daughter Sienna.

She goes on to say:

Once again, we as parents are forced to suit up for battle and prove that our children are worthy of healthcare.

In America? Is that what we are asking parents to do? Parents who have had a reliance upon this program for years and, in some cases, decades and decades, we are asking them to suit up--again, as she said, ``to suit up for battle,'' to make the case to Washington as to why they shouldn't cut the Medicaid Program in America? That is an insult to all of us.

She shouldn't have to suit up for legislative or policy battles. She should have the opportunity to not worry about that and just to live her life and take care of her children and to live a life that she has been able to live with the help that we provided through Medicaid and other supports.

So we have some work to do here, to stop--not to talk about and hold hands and compromise--to stop them from cutting what they want to cut in Medicaid at all costs. So that is what I am going to be doing. We are going to stop this from happening.

We can compromise on a lot of things around here, but not on that-- not on cuts of hundreds of billions of dollars over 10 years to Medicaid. Not in this America.

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