Mr. President, I rise today to join my colleagues on the floor to share my concerns that I have been hearing from people in my state about the latest health care repeal bill. Minnesotans and patient groups, such as AARP, oppose this bill because eliminating the Medicaid expansion and the Affordable Care Act's hope for millions of people means that they would lose coverage and it would increase their out-of-pocket costs. People in my state are concerned about this bill's impact on rural hospitals especially, as are the rural hospitals, because it makes deep cuts to Medicaid and the new block grant in the bill for states would end completely by 2027. And I'm very concerned that this bill would reverse the progress we are making in addressing the opioid epidemic. But putting a cap on Medicaid, a program that has been critical for substance treatment for people struggling with this addiction. 

You know, a few months ago, I pointed out that we were on plan F in the Senate. Plans A and B were the two House versions of a repeal plan. C and D were the two Senate versions of the repeal. Plan E was the repeal bill without a replacement plan. And then we were presented with plan F. And that, of course, went down after the Senate Democrats were joined by three Republican senators in voting it down. And I actually thought you couldn't get lower than F, but apparently we can because now we're here. Well, many of the Minnesotans I talked to don't like A, B, C, D, E, F, or the plan that we are discussing that has been proposed. 

I heard form people all over my state at the Minnesota State Fair. I heard from Democrats, Republicans, Independents. I heard from people from our cities and people from our rural areas. Let me tell you, there are a lot of people there. Nearly two million people at the Minnesota State Fair, which is the biggest state fair in the country. So a lot of people stopped by my booth. I heard from the old and the young, from men and women, cancer survivors, and people with disabilities, and many more. None of them wanted us to keep going down a partisan path when it comes to healthcare. And that's why I was so happy to tell them over the recess that new work was being done, bipartisan work with Senator Alexander and Senator Murray. Two senators who have proven they can work across the aisle on the education bill that they did last year. They are the leaders on the Health, Education, Labor, and Pensions Committee, and they have been moving forward together with truly bipartisan hearings and discussions. I've attended a number of them with governors and with experts on this issue to figure out the best ways to strengthen the individual markets to reduce costs.

That's something we've done for our constituents sucessfully with an all-Republcian legislature and a Democratic governor. We worked on it in our state, so I figured we could maybe bring this out on the national level. But if that isn't enough, that work could in fact be imploded--that work that is going on with Senator Alexander and and Senator Murray on a bipartisan basis in favor of another version of a repeal bill that hasn't even gone to a hearing before the HELP Committee or regular order like we would expect. The regular order that Senator McCain spoke up for in his incredible speech that he gave when he came to the Senate. If thst isn't enough, we heard yesterday that we will not even be able to get a full Congressional Budget Office analysis of this bill this month. 

Why would we rush to take a vote before we have that critical information? I have repeatedly heard my colleagues criticize moving forward with bills when we don't know their impact. Our constituents are owed this. This is the entire healthcare system of America. Why would be taking a vote on a bill when we don't even know the full impact? When we do not have a full score of the bill either financially or most honest, the impact it would have on people's healthcare? Our constituents are owed this, and it is their healthcare and it is their money that we are messing around with. When I talked to my constituents, none of them asked me to do what we already know this bill does--cut Medicaid, eliminate the Medicaid expansion, threaten protections for people with preexisting conditions, and kick people off their insurance coverage. 

Instead, they want us to work together on bipartisan solutions to fix what we have when it comes to healthcare to strengthen the exchanges, support small businesses, reform delivery systems, and lower the cost of prescription drugs. And I don't see anything in this bill that would lower the cost of prescription drugs. Nothing. I have heard the same message from senior groups and the Children's Hospital Association, which are strongly opposed to this bill. I have heard the same message from the American Heart Association, and the American Diabetes Association, and the American Cancer Society, and several other patient groups who have said that this "proposal just repackages the problematic provisions" of the bills that were voted down earlier this summer. 

But this bill, the Graham-Cassidy bill, is not the only option. Instead of making these kinds of cuts and moving backward, Senator Alexander and Senator Murray have invited all senators, as I noted, to participate in their process. They have had dozens of senators show up at early morning breakfasts or as Senator Alexander calls them, coffees. Thirty, forty senators showing up. I know because I was there. Why did they show up? Because they know that we must make changes to the Affordable Care Act. And they also know, based on the work we've seen in Minnesota and other places, that these changes can be made across the aisle.

In these hearings and discussions on bipartisan solutions, we talked about the state-based reinsurance program that was passed in Minnesota. We're still waiting for that federal waiver. I'll make a pitch for this at this moment for the Administration. Even passing it alone helped us bring some promised rates down. I know Alaska had the state-based reinsurance program and recently got approval from the Administration. And New Hampshire and other states are pursuing similar plans.

That's why I support Senator Kaine and Senator Carper's legislation, the Individual Insurance Marketplace Improvement Act, to reestablish a federal reinsurance program. This bill would lower premiums by providing support for high-cost patients. And another topic that we have discussed frequently as part of the Health Committee process over the last few weeks, our cost-sharing reduction payments. These are crucial to stabilizing the individual market and reducing uncertainty. That's why I support Senator Shaheen's Marketplace Certainty Act. It's clear that this type of legislation would get support from both sides of the aisle to improve the system.

But beyond these immediate fixes, it is long past time that we come together to pass legislation to address the skyrocketing costs of prescription drugs. I have a bill that would harness the negotiating power of 41 million seniors on Medicare to bring drug prices down. Right now, Medicare is actually banned by law from using their market power to negotiate for better prices. I bet on 41 million seniors for getting better prices, but we're not giving them that chance. Senator McCain and I have to allow Americans to bring some safe, less expensive drugs from Canada. Senator Lee and I have a bill that would allow temporary importation of safe drugs that have been on the market in another country for at least ten years when there isn't a healthy competition for that drug in this country. This would let patients access safe, less expensive drugs. Senator Grassley and I have a bill to stop something called pay-for-delay where big pharmaceutical companies actually pay off generic companies. They pay them off to keep less expensive drugs off the market. That bill would save taxpayers $2.9 billion and a similar amound for individual consumers.

Are those bills in this lates proposal that we see from our Republican colleagues? No, they are not. Instead what does this bill do? Well, it devastates the Medicaid program, repeals big parts of the Affordable Care Act that help people afford insurance, and instead puts in place an inadequate block grant that completely goes away in ten years. This bill does the opposite of what the people came up to me and talked to me about in my state over the August break. So before we rush through a vote on it, before we even know the impact on it, before it is even gone through the committee process like it's supposed to do, before we are even given an opportunity from Senator Lamar Alexander and Senator Murray--the two leaders that matter. Give them an opportunity to come up with their plan. No, the proposal would be to rush a vote on this, and that is just wrong.

So what is this in real terms? Well, it's a woman from Pine Island, Minnesota. Her husband struggled with mentall illness for years, but she told me she felt so fortunate that he was able to get mental health treatment through their insurance coverage. She is worried that if these type of repeal efforts succeed, people like her husband will go back to being desperate for help. This debate is about peope with preexisting condtions who would see their costs skyrocket under this bill.

Terry from my state has ovarian cancer. Unfortunately, it's not the first time she's had it. She said that when she was diagnosed back in 2010, she ended up declaring bankruptcy due to the cost of her treatment. Terry said bankruptcy was "just a reality for a lot of people with cancer." Luckily, under the Affordable Care Act, Terry can afford insurance and is currently responding well to treatment, which by the way I see Senator Durbin here, is based on NIH funded research. Treatment based on that research, treatment that unfortunately we cut back on in the bill, and Senator Durbin will continue to fight to get that treatment through the Department of Defense included. But the bill we're facing now, the Graham-Cassidy bill, would allow insurers to charge sick people or those with preexisting conditions much more than healthy people. And Terry is worried that it would make it difficult, if not impossible, for people like her to afford health insurance.

And this debate is about all the parents who I've spoken to over the last few months who have children with disabilities. These parents would literally come up to at parades over the summer and bring their kids over in the middle of the parade route and introduce those children to me. Kids in wheelchairs, kids with down syndrome and say, this is a preexisting condition. This is what a preexisting condition looks like. This is why they opposed repeal. In Minnesota, one out of four children get their health coverage from Medicaid. And 39 percent of our children with disabilities or special healthcare rely on Medicaid or Children's Health Insurance.

We should be spending our time this week reauthorizing the Children's Health Insurance Program before states like mine run out of money at the end of the month before debatig another repeal bill for which we don't even have our Congressional Budget office score on the impact. That score sounds technical, but it's about what the bill would mean to people like those kids that came up to me in the parades with their parents, to people like Terry with ovarian cancer. And this debate is also about our seniors in our rural communities. Our hospitals are essential to rural communities. They don't just provide health services. They employ thousands of doctors, nurses, pharmacists, and other health care workers of these rural hospitals often operate at margins of less than one percent. That's one reason Senator Grassley and I introduced the Rural Emergency Acute Care Hospital Act a few months ago to help rural hospitals stay open.

But cutting Medicaid by billions of dollars and repealing the Medicaid expansion would move us in the opposite direction. In my state, Medicaid covers one out of five people living in rural areas. I know my Senate colleague, Senator Collins, Capito, and Murkowski have previously expressed real concerns about the impact of Medicaid cuts in their states, which also have big rural populations. Cutting Medicaid and eliminating the Medicaid expansion doesn't just threaten healthcare coverage for these populations. It threatens the entire local communities where these hospitals are located. And these rural hopsitals are on the front lines of one important fight. 

That is the fight against this opioid epidemic. We just found out in our state that last year over 600 people died from opioid and other drug overdoses. Over 600 people. That is something like two per day. That is more than we see people die from car crashes in our state. It is more than we see from homocide. Deaths from prescription drugs now claim more lives than either of those two issues. And this epidemic affects our seniors, too. One in three Medicare Part D beneficiaries received a prescription opioid last year. While there is much more work to do to combat the epidemic, I want to recognize the progress we've made with the CARA Act, with the CURES Act, with all the work that has been done. But making cuts to Medicaid will move us in the other direction.

We have all heard the voices, not just of those on the front lines of the opioid crisis, but from doctors and hospitals, patients, seniors, and nursing homes, and schools saying that this bill is not the way forward. So instead, let's do what we all heard people wanted us to do in August. That was to work across the aisle on actual solutions to help people afford healthcare. 

Thank you, Mr. President. I yield the floor.