As Prepared for Delivery
Trump’s health care agenda rips scores of new holes in the safety net that vulnerable Americans are sure to fall through.
The textbook example is Medicaid. Right now, the administration is attempting to do on its own what it failed to through the Congress: block grant the Medicaid program.
It’s a policy the Finance Committee debated in this very room back in September 2017. It didn’t make it out of the committee. It didn’t get a vote on the floor. It didn’t go anywhere – because it’s a bad policy that hurts people.
That said, the Trump administration doesn’t seem to mind. It’s trying to pull an administrative end-run around the Congress to push the dirty work of Medicaid block grants onto the states. You hear a whole lot of Washington lingo about “flexibility.” They even gave it a name that goes straight to the Orwellian Hall of Infamy: Healthy Adult Opportunity.
Make no mistake: the Trump administration’s proposal to block grant Medicaid, led by CMS Administrator Seema Verma, would be the beginning of the end for the health care safety net. It’s not about flexibility, it’s certainly not about opportunities for healthy adults – it’s about draconian cuts. And it comes in addition to the other cuts the Trump administration has proposed for Medicaid.
So let’s talk about what slashing Medicaid really means for individual Americans. Medicaid pays for two out of three nursing home beds in this country. That’s because in the United States, growing old is expensive. Before I was elected to Congress I was the co-director of the Oregon Gray Panthers, a service organization for seniors. I spent a lot of time visiting with seniors in their homes, and the majority of them were folks who had to stretch every last penny to get by. So this issue goes way back for me.
Even when people do everything right – when they scrimp and save over decades, when they skip vacations, when they live modestly and do every last thing they can to prepare for retirement – people still run out of money in old age. All it takes is one surprise illness or injury for the bills to accumulate. Or a family emergency. Or damage to a home. Savings dry up. It’s a fact of life.
And that’s on top of all those who don’t have savings – the millions and millions of people who go through their lives walking an economic tightrope. Nearly half of all American adults would struggle to come up with $400 in an emergency. That doesn’t mean they have no right to see a doctor or get long-term care in old age.
Protecting those people is what Medicaid and its nursing home guarantee is all about. Without that health care safety net, what are seniors supposed to do when the savings dry up? How are nursing homes supposed to stay open without cutting their services down to frighteningly poor levels? How are low-income seniors who want to stay in their homes going to afford their health care?
So when you hear all the talk about “flexibility,” “innovative solutions” and “holding states accountable,” it’s all a smokescreen for Medicaid cuts. The consequences are dangerous, and they are personal.
The Trump administration has also gone to court have the entire Affordable Care Act thrown out. Protections for pre-existing conditions: gone. Tax credits for health care: gone. Rules banning the worst insurance company abuses: gone. You’re talking about tens of millions of people getting kicked off their health care.
It would be devastating for people like Jasper, who’s pictured on the card in front of me. He’s a young guy with a big heart and a lot of energy. But he was born with serious medical issues. Cystic fibrosis, cardiac and pancreatic problems, hearing loss. He gets a lot of costly treatment, and his family relies on the Affordable Care Act for peace of mind that he will get the care he needs. Donald Trump has no backup plan for Jasper and his family if he successfully repeals the ACA.
That didn’t stop the president from saying during his State of the Union Address that he had made an “ironclad pledge” to “always protect patients with preexisting conditions.” Donald Trump protects preexisting conditions like sea lions protect salmon on our mighty Columbia River. It’s the kind of protection that comes with an uptick in the mortality rate.
Let me turn to prescription drug prices. The president has held a whole lot of curtain raising events for shiny new policies on prescription drugs. Let’s recap a few: He was going to force Big Pharma to list drug prices on television ads – that policy was blocked. He’s talked about requiring rebates to go directly to patients – didn’t follow through. He was going to tie drug prices in the U.S. to drug prices abroad – still nothing. He had a policy to speed approval of generics – no apparent effect.
So for all the Trump talk about drug prices over the last three years, patients are still getting mugged at the pharmacy counter. Drug prices are up again in 2020.
The Finance Committee has worked hard on the prescription drug issue, as has the House. Chairman Grassley has been a good partner on this, and I hope that we can find a way to move all this good work forward.
Bottom line, the president has been making promises about bringing down drug prices for three years, and he hasn’t gotten it done.
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