Wyden Statement on Senate Floor on Seema Verma for CMS Administrator and CBO Score of Trumpcare

As Prepared for Delivery

Just an hour ago, the official score came out from the non-partisan experts at CBO – number crunchers who’ve been unfairly attacked over the last few weeks. There is no sugar-coating these numbers.

24 million Americans getting kicked off their insurance plans.

880 billion dollars slashed from Medicaid in the first decade.

A payday worth hundreds of billions of dollars for the wealthiest and special interests.

That’ll be dropped onto Ms. Verma’s plate if she’s confirmed and if the bill passes. And let’s be clear, she’ll even be in charge of the specifics:

If Trumpcare passes, under section 132, she’d be able to give states a green light to shunt their sick patients into high-risk pools, when the historical record shows that high-risk pools are a failure when it comes to offering good coverage that’s affordable.

Section 134 would put her in charge of deciding exactly how skimpy Trumpcare plans will be and how much more Americans will be forced to pay out of pocket for the care they need.

Section 135 would let her pave the way for health insurers to make coverage more expensive for people approaching retirement age. And that’s only the beginning.

Trumpcare is all about huge tax breaks for the wealthy, financed by raiding Medicare, gutting Medicaid, and hurting older, sicker and lower-income Americans. And Ms. Verma would be in charge of implementing it at the Centers for Medicare and Medicaid Services.

So in my view, the Senate cannot debate this nomination without debating the matter of Trumpcare itself, since it would be such a huge part of the job.

Now, I want to take the time today to walk through some specifics with respect to Trumpcare, beginning with a scheme that I consider to be Robin Hood in Reverse.  

If you look at the dollars and cents, it’s clear that this bill is one huge transfer of wealth away from older Americans, from women and children, from the most vulnerable people out there, straight to the pockets of the wealthiest people in the country.

And no part of the Trumpcare bill shows this more clearly than the fact that it steals from the Medicare trust fund to pay for a tax cut that goes only to the most fortunate -- only to those who make a quarter million dollars or more per year.

Everybody in America who brings home a paycheck has a little bit taken out each and every time for Medicare. It’s right on the paystub, and it’s automatic.

Under Trumpcare, the only people who will see their Medicare tax cut are the people who need it least.

And that tax cut is going to take three years off the life of the Medicare program, depleting it in 2025 instead of 2028.

So let’s get one issue straight, this bill breaks a clear Trump promise not to harm Medicare. When the president was asked about cutting Medicare, he said, quote, “You can’t get rid of Medicare. Medicare’s a program that works … I’m going to fix it and make it better but I’m not going to cut it.”

The promise not to cut Medicare lasted about six and a half weeks into the Trump administration before it was broken.

Bottom line, this proposal raids Medicare and brings it three years closer to crisis to pay for a tax cut for the wealthiest in America, and somehow this is called a health care bill.

There’s also the tax break on investment income. Once again, this is a tax break that’ll go only to the most fortunate individuals out there. And with the investment tax break, the overwhelming majority of the benefit, nearly two-thirds of it, will go to the top one-tenth of one percent of earners in America.

Then, as if that didn’t go far enough, there’s the juicy tax cut for health insurance executives’ salaries over 500,000 dollars per year.

Of course it’s not just Medicare getting raided under this proposal.

Some of the people who get hit hardest by Trumpcare are those approaching retirement age. If you’re an older American of modest income, 55 or 60 years old, and you need to get insurance on the private market, Trumpcare would cause your costs to skyrocket.

In parts of my home state – particularly out in rural areas – a 60 year old who brings home 30,000 dollars a year could see their insurance costs go up by 8,000 dollars or more.

A big part of this is because a major part of Trumpcare is built on an age tax. It’s another key part of what Ms. Verma would be in charge of implementing.

This bill would give health insurance companies the A-OK to charge older people five times as much as they charge younger people.

Let’s be realistic, if you’re a person of modest means a few years away from qualifying for Medicare and your insurance premiums jump by 8,000 dollars, that means you can’t afford insurance. You’re locked out of the system. You’re going to have to hope that you don’t get sick before you get into Medicare.

And the tax credits offered under Trumpcare probably won’t be much consolation. That’s because Trumpcare puts a hard cap on your tax credit as an older person, just 4,000 dollars, and the odds are good that it wouldn't come close to covering the expense of a decent insurance plan.

Then there’s Trumpcare’s radical attack on Medicaid. When it comes to Medicaid, Trumpcare doesn’t just make little changes around the margins, and it doesn’t strengthen or preserve the program for the future -- a program that covers 74 million Americans. Trumpcare hits Medicaid like a wrecking ball. And in my view, any time you discuss this issue, you have to talk about the Medicaid nursing home benefit.

Medicaid picks up the bill for two out of three nursing home patients. These are people who’ve worked a lifetime, raised kids and put them through school, scrimped and saved all they could. But the fact is, growing old in America is expensive. And after a few years of balancing the rent bills against food costs, and food costs against medical bills, eventually a lot of seniors burn through their savings. So when it’s time to pay for nursing home care, they have to turn to Medicaid.

Today, the Medicaid nursing home benefit comes with a guarantee that seniors will be taken care of. Trumpcare breaks the Medicaid nursing home guarantee. And it goes even further than that.

A lot of states have worked hard to give more care choices to seniors, as well as people with disabilities. Maybe instead of living in a nursing home or an institution, they’d rather be in the community -- maybe they’d rather live at home where they’re most comfortable.

Trumpcare could mean that those care choices disappear. State budgets for nursing homes could be slashed. Nobody wants to see nursing homes shut down and boarded up. Nobody wants to see the elderly getting nickeled and dimed for the basics in home care that they rely on.

When it comes to Medicaid, Trumpcare would effectively end the program as it exists today, shredding the health care safety net in America.

It puts an expiration date on the Medicaid coverage that millions of Americans got through the ACA. For many of those people it was the first time they had health insurance. It brought an end to an era when those people could turn only to emergency rooms for care.

And Trumpcare is going to cap Medicaid budgets and squeeze them down until vulnerable people’s health care is in serious danger.

In addition to seniors and the disabled, Trumpcare will hit kids in Medicaid especially hard. Medicaid pays for half of all births, and children make up half of Medicaid’s enrollees. And it’s important to remember that in many cases, these kids already have the odds stacked against them. These are kids from low-income families, foster kids and children with disabilities. It’s already an uphill climb, but today, Medicaid gets them in to see their family practitioners and pediatric specialists. And when a kid needs emergency care, Medicaid is what makes that affordable. Trumpcare would put all of that in danger.

Then there’s the effect of this bill on opioid abuse. By slashing Medicaid, Trumpcare is going to make America’s epidemic of prescription drug abuse-related deaths even worse. Medicaid is a key source of coverage for mental health and substance use disorder treatment, particularly after the ACA, but this bill would take that coverage away from millions of people who need it. Even Republican state lawmakers have spoken out about this issue, as well as a few members of the majority in Congress.

This ought to be a head-scratcher to anybody who remembers the last presidential race, when a parade of candidates rolled through state after state that has been hit especially hard by the opioid crisis. Then-candidate Trump said he would fix it. He was the guy who could end the scourge of drug addiction and get people the help they need.

Instead, Trumpcare would make the opioid crisis worse, and there’s no getting around it.

In effect, Trumpcare would put states in an unimaginable position of having to decide whose Medicaid to slash. Would they tell seniors that the nursing home benefit is no longer a guarantee, and they’ll have to join a waiting list for their local nursing home? Would they tell pregnant women their births are no longer covered? Would they tell mothers and fathers that their kids are cut off, and they’ll have to hope for the best or head to the emergency room?

The final point I’d like to make on Trumpcare and Ms. Verma’s role implementing the bill has to do with effect it’d have on American workers and entrepreneurs.

In my view, Trumpcare would create a huge disincentive to work. Today if you’re on Medicaid, you’re able to pick up a few extra hours at work or go out and accept a higher-paying job without the fear that you’ll lose access to care. That’s because under the Affordable Care Act, low-income Americans get the most help when it comes to paying insurance premiums. A lot of people out there get health insurance for less than a hundred bucks a month.

Let’s contrast that with the Trumpcare approach. Under the Trump plan, people who walk an economic tightrope, bringing home barely more than minimum wage, don’t get the most help. They could see their insurance costs go up by thousands and thousands of dollars every year, which would effectively mean they’d be locked out of the health care system.

So for millions of people, staying on Medicaid would suddenly look a lot more attractive. Making a little more money and losing your Medicaid coverage could mean losing your access to high-quality health care altogether.

So bottom line, Trumpcare could, in effect, keep people trapped in poverty.

Entrepreneurs and people who want to go back to school to pursue a degree could face a similar dilemma.

Somebody who wants to quit their job and pursue their dream of starting their own business ought to be able to do it without the fear that they won’t be able to afford health insurance. The same goes for people who want to go back to school full-time to pursue a degree or certification. Trumpcare could make insurance unaffordable for those individuals.

Trumpcare would be the biggest issue on Ms. Verma’s plate if she’s confirmed as CMS administrator.

And the fact is, this bill is taking fire from all sides – moderate Republicans and members on the far right are against to this bill. Governors from both parties are against this bill. Democrats in Congress are united against this bill. AARP, the American Hospital Association, the American Medical Association, and the American Nurses Association are all against this bill. And in my view, it shouldn’t come as any surprise.

Trumpcare is all about huge tax breaks for the wealthy, financed by raiding Medicare, gutting Medicaid, and hurting older, sicker and lower-income Americans.

When you ask why anybody should support this bill, all you hear is a lot of health care happy talk to get around broken promises.

In an interview this weekend, HHS Secretary Tom Price said, quote, "I firmly believe that nobody will be worse off financially in the process that we're going through, understanding that they'll have choices that they can select the kind of coverage that they want for themselves and for their family."

But that statement ignores the simple math that shows that Trumpcare will force millions of people – particularly older, less affluent people – to pay thousands of dollars more for their health insurance.

In another interview, OMB Director Mick Mulvaney was pressed on why Trumpcare breaks the president’s promise of “insurance for everybody.”

His response was that Trumpcare is about access and that the bill, quote “helps people get health care instead of just coverage."

But here’s the bottom line, access doesn’t mean much if people can’t afford care. That’s the future that Trumpcare would bring on for millions of Americans.

I also asked Ms. Verma some basic questions during her confirmation hearing to try to give her an opportunity to lay out her priorities for the Finance Committee, particularly because it seems she has little experience when it comes to Medicare.

For example, since the president has made big promises about bringing down drug costs, I asked for one example – only one – what Medicare can do to bring down the cost of prescription medicine. I asked how Medicare can do more for rural health care providers to help them succeed when it comes to implementing new payment rules. I asked about how CMS’s actions undermining the Affordable Care Act square with the president’s goal of more coverage for everybody at lower costs.

Ms. Verma didn’t have answers to any of these questions. All I heard in response was more happy-talk. And Ms. Verma’s responses to written questions after the hearing were even less forthcoming.

So here’s where this nomination stands. Ms. Verma gave the Finance Committee and the public extremely little to go by when she was asked how she’d approach her job as CMS administrator.

But it is a fact that she’d be one of the top officials when it comes to implementing Trumpcare, a bill that would raid Medicare, slash Medicaid and kick millions off their health plans to pay for a tax cut for the wealthy.

I will be unable to support this nomination, and I urge my colleagues to oppose it as well.

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