Mr. President, as many Americans know, the current budget is going to expire at the end of September, and if an agreement is not reached, the government will shut down, which is, frankly, not anything that anyone wants. The question that we now have to address is how we keep the government open and serve the needs of the American people. As Americans know, Republicans have a majority in the House and in the Senate, and they also control the White House. They run the government. Republicans have the responsibility, therefore, to keep the government open. My understanding is that there will be a vote tomorrow on a continuing resolution to fund the government until November 20. In the House, a simple majority wins, and I would imagine that, by a very slim vote, Republicans will have the votes they need in order to pass their resolution. In the Senate, however, the rules are different--historically different. In order to pass a continuing resolution, it will take a 60- vote majority to pass. That means that at a time when there are 53 Members of the Republican caucus and 47 Members of the Democratic caucus, it will require bipartisan support. That is what Senate rules are about. In other words, Republicans will need Democratic and/or Independent votes--I am an Independent--in order to keep the government open. Bottom line: Republicans will need to negotiate. That is how the Senate works, and that is how democracy works. Speaking for myself and I believe many millions of Americans, here is some of what it will take to get my vote: No. 1. Republican leadership, don't take away healthcare from 15 million Americans by making the largest cut to Medicaid and the Affordable Care Act in history. No. 2. Republican leadership, don't increase health insurance premiums by 75 percent on average for over 20 million Americans who get their healthcare through the Affordable Care Act. No. 3. Republican leadership, do not undermine modern medicine and the health and well-being of our children by rejecting the scientific evidence regarding vaccines. No. 4. Republican leadership, do not allow our great country to be moved toward authoritarianism by putting Federal troops on city streets without a request from a Governor or a mayor. Do not have ICE agents snatch people off our streets without due process. Do not undermine the Constitution of the United States and the rule of law by allowing an administration to refuse to spend money appropriated by Congress. Let me be more specific. As I think almost every American understands, our current healthcare system is dysfunctional, it is broken, and it is cruel. At a time when we spend almost twice as much per capita on healthcare as any other major country--over $14,000 per person--85 million Americans are uninsured or underinsured--85 million Americans. The Republican continuing resolution in the House does nothing-- nothing--to prevent 15 million Americans from being thrown off the healthcare they currently have, as a result of Trump's so-called Big Beautiful Bill. In other words, instead of lowering the number of uninsured and underinsured, if we do not act, 15 million more Americans will be uninsured. We cannot allow that to happen. This is a life-and-death issue. Studies have shown that up to 50,000--50,000--Americans every year will die unnecessarily if we do not reverse these cuts. So we are talking about here, if we do not act, going from 85 million uninsured and underinsured to 100 million uninsured and underinsured. Those cuts must be rescinded. But it is not just preventing 15 million Americans from losing their health insurance; everybody in this country--every businessperson, every union worker--knows that the cost of healthcare in this country today is astronomically high and unaffordable. I don't care what State you are in--people cannot afford healthcare today. Yet, if we do not act right now, in this continuing resolution, the Affordable Care Act tax credits will expire and premiums will skyrocket by 75 percent on average for more than 20 million Americans. Let me repeat: Healthcare premiums for 20 million working-class and middle-class Americans will go up by 75 percent on average if we do not extend those tax credits in this coming legislation. Let me say that I wish very good luck to my colleagues, whether they are Democrats or Republicans, who want to go home to their constituents and explain why healthcare premiums are going up by 75 percent in order to pay for $1 trillion in tax breaks for the 1 percent. I do wish you the best of luck in trying to explain that one. I do not intend to. Further, let me be clear: Vaccines work--not exactly a controversial statement. It is a statement supported by every major medical organization in the United States and around the world. Vaccines are safe, they are effective, and they have saved millions of lives in our country and tens of millions of lives worldwide. In fact, vaccines are one of the greatest public health achievements in modern history. At a time when the Secretary of Health and Human Services has dismantled the vaccine review process, narrowed access to lifesaving COVID vaccines, fired leading public health experts, and filled scientific advisory boards with conspiracy theorists and ideologues, we must stand with the scientific and medical communities and rescind Secretary Kennedy's dangerous policies. This is not about politics. It doesn't matter whether you are Republican, Democrat, or Independent. We are talking about protecting our children from polio, measles, whooping cough, and other preventable diseases. The American people, slowly but surely, are catching on. No matter what their political view may be--Democrat, Republican, Independent-- they understand that our current economic system is rigged. They understand that the very richest people in this country are becoming much richer, while 60 percent of Americans are living paycheck to paycheck and millions of people are trying to survive on starvation wages. The American people understand that while billionaires are getting huge tax breaks, they are finding it harder and harder to afford healthcare, to pay the rent or their mortgages, to afford childcare, to be able to send their kids to college, to pay for the prescription drugs their doctors prescribe, or to buy decent quality food for their kids. The American people understand--painfully and depressingly--that unless we change the way the economy functions, their kids will likely have a lower standard of living than they do. In the richest country in the history of the world, it is likely that the younger generation will have a lower standard of living than their parents, while almost all new incoming wealth goes to the people on the top. Today, we have more income and wealth inequality than we have ever had in the history of the United States. Today, we have one man, Mr. Musk, who owns more wealth--if you can believe it--than the bottom 52 percent of American households--one man, more wealth than the bottom 52 percent of American households. And, by the way, he is on his way, it appears, to become a trillionaire--even richer and richer. Today, the top 1 percent owns more wealth than the bottom 93 percent--top 1 percent, more wealth than the bottom 93 percent. And the CEOs of major corporations now earn over 350 times what their average employees make. While the billionaire class becomes richer and richer, real inflation accounted for weekly wages that are lower today than they were 52 years ago--huge expansion of worker productivity, and yet the average worker, in many cases, is worse off than he or she was 52 years ago. Enough is enough. At a time of massive income and wealth inequality, it is insane to be giving a trillion dollars in tax breaks to the top 1 percent. If President Trump and the Republican leadership want my vote, they will have to rescind that tax break for their oligarchic friends. Our country today faces not only major economic crises, we are looking at extraordinarily threatening--a threatening moment to our democratic form of government. Frankly, we now have a President of the United States who does not believe in our Constitution and the separation of powers; who does not believe in freedom of speech and the right to dissent; who is moving us, every day, toward an authoritarian form of government with more and more power into his own hands. Too many Americans from my State of Vermont and every other State in this country have put their lives on the line and sometimes died in order to defend democracy and our way of life: the right of people to live without fear, the right of people to express their point of view-- no matter what it may be. You disagree with me, that is great. That is called American democracy--the right of people to vote without intimidation. Today, in an unprecedented way, we have Federal troops in cities in America who have not been requested by a governor or a mayor. Today in America, we have people who are being snatched off the streets--taken right off the streets or out of their workplaces--by masked Federal agents, thrown into vans, and dispatched to detention centers without due process. Does anybody think that that is what America is supposed to be about--somebody walking down the street, getting picked up by masked men, thrown into a van, and taken God knows where? Today, we have a President sending some of these people to South Sudan, Uganda, El Salvador--we don't know where. People have no relationship to the country they are being sent. Imagine being plucked off the street, sent to South Sudan, country in the middle of a civil war, virtually no government. That is not acceptable. That is not what our great country is supposed to be about. These undemocratic, unconstitutional policies must be rescinded. The movement toward authoritarianism in this country must be ended. In this very difficult moment in American history, let us stand with the American people and listen to their needs. Let us not throw 15 million working-class people off of the healthcare that they have so that 50,000 people a year die unnecessarily. We cannot allow that to happen. Let us not raise healthcare premiums by 75 percent for 20 million Americans. People can't afford healthcare today. What happens when your premiums go up by 75 percent? Let us not endanger the children of this country by undermining modern medicine and making it more difficult for people to get the vaccines they require. And at a time of massive income and wealth inequality, let us not give a trillion dollars in tax breaks to the top 1 percent. And, lastly, as we observe growing authoritarianism every single day, as we see more and more disrespect for the great Constitution of our country--which has made us an example to the entire world--let us-- Republican, Democrat, Independent--let us stand together and save American democracy. If the Republican leadership does those things, you have got my vote. The PRESIDING OFFICER. The Senator from Rhode Island. Unanimous Consent Request--S. Res. 404

Mr. President, let me begin by stating what the debate we are going to have this evening is about and what it is not about. It is not about whether anyone in this Senate disagrees that Hamas is a terrorist organization which began this war with a brutal terrorist attack on October 7, 2023, that killed 1,200 innocent Israelis and took 250 hostages. Everyone agrees with that. The International Criminal Court was right to indict the leaders of Hamas as war criminals for those atrocities, and I think most of us agree with that. There is also, I believe, no disagreement as to whether or not Israel, like any other country similarly attacked, had a right to defend itself. Clearly, it did. And in a certain sense, this debate is not really about Israel; it is about the United States of America and whether we will abide by U.S. and international law or whether we will continue to contribute billions of dollars to an extremist government in Israel which has caused an unprecedented humanitarian disaster in Gaza. This debate is whether or not the United States of America will have any moral credibility on the international scene, whether or not we will be able, with a straight face, to condemn other countries who commit barbaric acts if we don't stand up tonight. That is what we are debating. The vast majority of the American people and the world community understand that the Netanyahu government in Israel has gone well beyond defending itself from Hamas. Over the last 21 months, it has waged an all-out, illegal, immoral, and horrific war of annihilation against the Palestinian people. This war has already killed some 60,000 Palestinians and wounded more than 143,000, most of whom are women, children, and the elderly. In a population of just over 2 million people--that is all that there are in Gaza--more than 200,000 have been killed or wounded since this war began. That is 10 percent of the population of Gaza. Ten percent of the population of Gaza, in the last 21 months, has either been killed or wounded. To put that into scale so that we, as Americans, can understand the enormity of what is happening there, if that kind of destruction happened here in the United States, if 10 percent of our population were killed or wounded in a war, it would mean that 34 million of us would have been killed or wounded. The toll on Gaza's children is unspeakable, and it is literally hard to imagine. The United Nations reports that more than 18,000 children have been killed since this war began. Just this morning--this morning--the Washington Post published a list of all of these children's names. Mr. President, here is the list. These are the names of children published in the Washington Post today that have been killed by the Israeli military in Gaza. I should mention that more than 12,000 of these children were under the age of 12 and more than 3,000 children in Gaza have had one or more limbs amputated. That is how this war has impacted the children in Gaza. But it is not just the horrific loss of life that is taking place there. New satellite imagery shows that Israel's indiscriminate bombardment has destroyed 70 percent of all structures in Gaza--70 percent of all buildings in Gaza have been destroyed. The U.N. estimates that 92 percent of housing units have been damaged or destroyed. Most of the population is now living in tents or other makeshift structures. And let us not forgot, over the last 21 months, these people--most of whom are poor--have been displaced time and time again--told to go here, told to go there, told to go there, moved around--and often with no possessions other than the clothing on their backs. The healthcare system in Gaza has been destroyed. Most of the territory's hospitals and primary care facilities have been bombed. More than 1,500 healthcare workers have been killed as well as 336 U.N. staff. Gaza's civilian infrastructure has been totally devastated, including almost 90 percent of water and sanitation facilities. Raw sewage now runs all over Gaza. Most of the roads have been destroyed. Gaza's educational system has been obliterated. Hundreds of schools have been bombed, and every single one of Gaza's 12 universities has also been bombed. I should mention there has been no electricity in Gaza for 21 months. All of this is a horror unto itself, but in recent months, the Netanyahu government's extermination of Gaza has made an unspeakable and horrible situation even worse. From March 2 to May 19, Israel did not allow a single shipment of humanitarian aid to come into Gaza--no food, no water, no fuel, and no medical supplies for a distressed population of 2 million people over a period of 11 weeks. Since then, Israel has allowed a trickle of aid to get into Gaza but nowhere near enough to meet the enormous needs of a population besieged for so long. When you cut off all food to a population, what happens is not surprising. People starve to death, and that is exactly what Israeli policy has deliberately done. It is causing mass starvation and famine. Children and other vulnerable people are dying in increasing numbers. In the last 2 weeks, dozens of young children have died from starvation. Starving mothers cannot breastfeed their infants, and no formula is available and certainly no clean water to make it, in any case. Hospitals have run out of nutritional treatments, and doctors and nurses who are already treating the desperate, they themselves are going hungry and are fainting from hunger. The World Food Programme says that the food crisis has reached ``new and astonishing levels of desperation with a third of the population not eating for multiple days in a row.'' Just yesterday, the gold standard U.N.-backed food monitoring group, the IPC, issued a new report saying: The worst case scenario of famine is currently playing out in the Gaza strip. When mass death from starvation begins, it is difficult to reverse. Aid groups say it will soon be too late to stop a wave of preventable deaths in Gaza, all of which is the direct result of the Israeli Government's policies. What I am going to describe now is gruesome, but I think it is important for us to understand what is happening to the children in Gaza. Mark Brauner, an American doctor who spent 2 weeks in Gaza in June, described the situation. This is an American doctor who was in Gaza. A lot of the children have already passed the point of no return, where their physiology has eroded to the point where even refeeding could potentially cause death itself. The gut lining has started to autodigest, and it will no longer have adequate absorptive capacity for water for nutrition. Death is, unfortunately, imminent for probably thousands of children. That is an American physician who was in Gaza in June. What the extremist Netanyahu government is doing now is not an effort to win a war. There is no military purpose in starving thousands and thousands of children. Let us be clear: This is not an effort to win a war. This is an effort to destroy a people. Having already killed or wounded more than 200,000 Palestinians, mostly women and children, the extremist Israeli Government is using mass starvation to engineer the ethnic cleansing of Gaza. They are trying to drive a desperate people out of their homeland to God knows where. This is not my speculation. This is what Israeli Ministers and officials are saying themselves. A few months ago, the Finance Minister vowed that ``Gaza will be entirely destroyed.'' Just last week, another current Israeli Minister said ``all Gaza will be Jewish. The government is pushing for Gaza being wiped out. Thank God we are wiping out this evil.'' Another Likud member of the Knesset and former Minister called for ``erasing all of Gaza from the face of the Earth.'' And in the West Bank--not Gaza--in the West Bank, we see this agenda being carried out clearly and methodically with more than 500,000 Israeli settlers now illegally occupying land integral to any future Palestinian State. Earlier this month, the Knesset even approved a nonbinding motion in favor of formally annexing the West Bank. This slow-moving annexation is backed by violence. Israeli security forces and settler extremists have killed thousands of Palestinians in recent years. Israeli settlers brutally beat a young American to death earlier this month. Just this month, an American citizen was beaten to death, the seventh American killed in the West Bank since 2022. Despite a demand from President Trump's Ambassador to Israel--this is Trump's Ambassador Mike Huckabee--no one has yet been held accountable for these deaths. People around the world--all over the world--are outraged by what is going on in Gaza right now and countries are increasingly demanding that Netanyahu's government stop what they are doing. France and Canada have said that they will recognize a Palestinian State. The United Kingdom has said it will do so as well if Israel does not immediately end this war and surge humanitarian aid. And at the U.N. last month, 149 countries voted for a cease-fire resolution condemning the use of starvation as a weapon of war and demanding an end to Israel's blockade on humanitarian aid. But it is not just the international community. Just yesterday-- yesterday--Gallup, one of the best polling organizations in our country, released a new poll that shows that just 32 percent of Americans support Israel's military action in Gaza while 60 percent oppose it--32 percent support it; 60 percent oppose it. To my Democratic colleagues here in the Senate, I would point out that only 8 percent of Democrats support this war, and I would also point out that just 25 percent of Independents. And to my Republican colleagues, I would point out that more and more Republicans are beginning to speak out against the atrocities of this war and the fact that billions and billions of taxpayer dollars are going to a government in Israel waging an illegal war. Further, a recent Economist/YouGov poll shows that just 15 percent of the American people support increasing military aid to Israel, while 35 percent support decreasing military aid to Israel or stopping it entirely. Just 8 percent of Democrats support increasing military aid to Israel. The American people are haunted by the images coming out of Gaza, and these are some of those images. These are desperate children with pots in their hands, crying, begging for food in order to stay alive. That is what the American people are seeing every night on TV, on the internet, and in the newspapers. These are emaciated children. Their bodies, in some cases, barely more than skeletons. The American people are seeing miles and miles of rubble where cities and towns once stood. They are seeing innocent people being shot down while they wait on line to get food while they are starving. Over 1,000 people have been killed waiting on line to get food because they are starving. Despite these war crimes carried out daily and in plain view, the United States has provided more than $22 billion for Israel's military operations since this war began--$22 billion. One estimate, based on Brown University research, calculates that the United States has paid for 70 percent of the Gaza war. In other words, American taxpayer dollars are being used to starve children, bomb schools, kill civilians, and support the cruelty of Netanyahu and his criminal Ministers. That, Mr. President, is why I have brought these two resolutions of disapproval to block offensive arms sales to Israel. S.J. Res. 34 would prohibit the U.S. taxpayer-financed $675 million sale of thousands of 1,000-pound bombs and many thousands of JDAM guidance kits. S.J. Res. 41 would prohibit the sale of tens of thousands of fully automatic rifles--assault rifles. These arms sales clearly violate the Foreign Assistance Act and the Arms Export Control Act, which prohibit selling arms to countries that violate international law by killing civilians and blocking humanitarian aid, and very few people doubt that is exactly what Israel is doing. If you want to obey the law, vote for these resolutions. The rifles in question will go to arm a police force overseen by far- right extremist Minister Itamar Ben-Gvir, who has long advocated for the forcible expulsion of Palestinians from the region, who was convicted of support for terrorism by an Israeli court and was distributing weapons to violent settlers in the West Bank. Ben-Gvir has formed new police units comprised of extremist settlers and has boasted about how many weapons he has distributed to vigilante settlers in the West Bank, and you want to give him more rifles? That is what one of these resolutions is about. These are rifles the Biden administration held back over fear they would be used by Israeli settlers in the West Bank to terrorize Palestinians and push them from their homes and villages. U.S. taxpayers have spent many, many billions of dollars in support of the racist, extremist Netanyahu government. Enough is enough. Americans want this to end. They do not want to be complicit in an unfolding famine and daily civilian massacres, and we here in Congress tonight have the power to act. No more talks, no more great speeches. But tonight we have the power to act, the power to force Netanyahu and his extremist government to end this slaughter. The time is long overdue for Congress to use the leverage we have-- tens of billions in arms and military aid to demand that Israel end these atrocities. At a time that Israeli soldiers are shooting civilians trying to get food aid on a near-daily basis, when extremist settlers are pushing Palestinians from their homes in the West Bank and when Gaza is witnessing mass starvation as a result of Israeli government policy, the United States should not and must not be providing more weapons to enable these atrocities. Whatever happens tonight, history will condemn those of us who failed to act in the face of these horrors. And I yield the floor to Senator Welch from Vermont. The PRESIDING OFFICER. The Senator from Vermont. Mr. WELCH. Mr. President, the mass starvation in Gaza must end. The forced displacement of 2 million Palestinians in Gaza must end. We all condemn Hamas. We support a Jewish independent democratic state. We want a cease-fire, and we want the hostages home. But a colleague in the other body stated what needs to be said. It is the most truthful and easiest thing to say that October 7 in Israel was horrific and all hostages must be returned but so is the humanitarian crisis and starvation happening in Gaza. And that is happening with U.S. complicity, and it is time for us to stop complying. Let's face it, let's face the facts and not ignore them. The starvation that we are seeing today, it is not unforeseen. It is not the unintended, unfortunate consequence of war. The starvation we are witnessing today is the self-conscious result of a military policy to concentrate the Palestinian population into an ever-smaller slice of land. The starvation that we are witnessing today, it is an advanced and accelerating stage of the military strategy that is being executed by the Netanyahu government to force Palestinians out of northern Gaza and to induce them to leave the territory altogether. And Palestinians, compelled by hunger and thirst, are being forced to make their way to a handful of sites, which our closest allies uniformly condemn as a drip feeding of aid. And, in fact, aid was totally cut off--totally cut off--by Israel for over 2 months. How in the world did they justify doing that? And from the earliest days after October 7, we witnessed this plan of systemic and wanton destruction that included destruction of homes, destruction of mosques, hospitals, and schools. This was done. This is fact. We may not want to face it, but it was done with bombs that were provided by American taxpayers and approved by this Congress. Israel unleashed the most deadly and destructive aerial bombardment campaign since Vietnam. More than 200,000 buildings were destroyed. Thousands of children were killed and injured. Thousands are amputees. And in just the last 3 months, the last 3 months--May, June, and July-- the Netanyahu government campaign has continued, and thousands more homes have been flattened by controlled demolitions. That literally means the military folks go up to a home, wire it, and blow it up. It is a home. Thousands more have been demolished by bulldozers. Israeli forces have bulldozers, and they flatten the home. You know, it is too late, it is too late for the 60,000-plus people that have been killed in Gaza. But it is absolutely not too late for the U.S. Senate to act. We are at an absolute catastrophic inflection point. And I believe that the United States, in fact, does have an obligation under humanitarian law to act. And I do believe that the American people, in your State and in mine, whether they have been supportive of Israel or not, are horrified at what is happening to innocent people in Gaza. We have an obligation to act because if we do act, we can help save thousands of lives of Palestinians, who, as we speak, are starving. You know, some folks take the position that the suffering and starvation will end when Hamas lays down its arms or releases the remaining IDF hostages. Every single one of us wants that day to come. But you know what, we have to ask ourselves a frank question: Is it right, is it just to use as a tool of warfare the starvation of an innocent population? And I believe it isn't. International law says that is not allowed. It is a crime to starve a population to get what you want from your enemy. It is illegal and cruel to starve children to obtain a battlefield advantage. Yet the Israeli government, under Prime Minister Netanyahu, has said that it is doing that; that is what it is doing. It is so long past time for us to say enough. It is long past time to say, no, the United States will not stand by while hunger is being used as a weapon of war. And we cannot separate the current starvation in Gaza from the Netanyahu government's strategy of forcibly displacing Palestinians from their land. You know, the leaders of Israel have explicitly stated their vision for Gaza. So this is not like a discussion or a debate trying to figure out what is the story. Prime Minister Netanyahu said: I don't care about the tactics and ordered military officials to ``destroy the homes, bomb everything in Gaza.'' He said that. Finance Minister Smotrich, he said, ``Gaza will be totally destroyed, civilians will be sent to . . . the south to a humanitarian zone . . . and from there they will start to leave in great numbers to third countries.'' Heritage Minister Eliyahu, last week, said that the Israeli Government--this was last week he said that--was ``rushing toward Gaza being wiped out'' and ``driving out the population.'' There is no mystery about what the agenda here is under the Netanyahu government. You know, we are here to debate a continuation of American military weapons that are being used to implement the Israeli--Netanyahu-- Government policy. But we are doing it at a time when the horror of starvation has become apparent to everyone. And I applaud President Trump for saying it like it was. There is starvation in Gaza--and then being in conflict with Prime Minister Netanyahu, who still denies it. But America's closest allies are calling for an end to the war. America's closest allies are wanting to cut off the shipment of weapons that sends a green light to Netanyahu's extremist government. And yet we are here today where just 2 weeks ago, President Trump, in fact, indicated that he intends to ship another half billion dollars' worth of 2,000-pound bombs and 1,000-pound bombs to the Netanyahu government. So today we are here to debate, once again, whether we as representatives of the American people and the American taxpayers, people who want peace, who want the hostages home but are horrified at the starvation and the destruction of innocent civilian lives, the wholesale destruction of buildings and communities, whether we should continue to provide those weapons to Israel. These bombs, by the way, are in addition to the 70,000 tons of explosives--70,000 tons--that have already been dropped on Gaza. And that is the equivalent of six Hiroshima nuclear explosions. Those bombs, as Senator Sanders said, have been used to destroy more than 200,000 buildings in Gaza. That is more than three times the number of buildings in Manhattan. The bombs have killed thousands of kids, the equivalent of a classroom full of children every day has been killed in this conflict, a classroom. And let me tell you just about one strike. It was caused with a U.S.-provided JDAM. On June 30, a month ago, a 500-pound bomb struck a crowded beachfront cafe, the Al-Baqa Cafe. People were having coffee. How in the world they had the ability to do that with the destruction all around them, amazing. But CNN reported that 40 people were killed, dozens were injured, including a 4-year-old child and a well-known filmmaker. And a couple that had recently become engaged--just think about that. They got engaged in the midst of this destruction, showing that despite all this violence, they had hope for the future; they had love for one another; they had that capacity amidst this enormous suffering to see a future and want to be part of it--dead. Mona, who was the woman, was an engineering student, spoke fluent English, volunteered with orphans, and she was out for a break with her friend. Mariam Salah, she was a young painter who grew up in a refugee camp. She painted murals and dreamed of a career as a digital artist. She is dead. You know, the Netanyahu government claimed we were targeting terrorists. Who knows? Was there a ``terrorist'' there? There was nobody in combat. So we have to stop. We have to stop. And the question for this country is, Will we stop being complicit in this destruction? I yield the floor. Mr. SANDERS. Let me thank Senator Welch. I yield to Senator Merkley for 10 minutes. The PRESIDING OFFICER. The Senator from Oregon. Mr. MERKLEY. Following the attacks on October 7, 2023, Israel had every right to go after Hamas, but how they do so matters. Indiscriminate bombing with massive casualties, women and children, is horrific, completely unacceptable. Blocking food and medicine with the goal of inducing starvation is horrific and unacceptable. And that is true under any religious or moral code. Let me tell you about a few children the AP reported on a couple weeks ago. Four children who starved to death, ranging from 4 months old to 2 years old--picture that little child in your arm, their legs and arms just a twig, their ribs showing every indentation, and then, finally, their body, as it goes through malnutrition, starts to consume itself, and they died of gastric arrest. Their stomach's ability to absorb nutrition shut down, and they died. The hospital they were at, the Patient's Friends Hospital, had run out of emergency nutrition supplies. There are supplies that are specially designed for malnutrition among children. There are high-calorie biscuits and a high-calorie peanut paste enriched with milk powder that often goes by the name Plumpy'Nut. It is designed to help children. It has a long shelf life. It doesn't have to be refrigerated. To help save them from severe acute malnutrition, couldn't we have enough such assistance that no child would be starving to death in Gaza? Organizations across Gaza have been running out of these supplies. UNICEF warned that their locations are running out. In fact, they said they would run out of this high-nutrition assistance for children 2 weeks from now. Doctors working with malnourished children are saying the wards are quiet. And if you have been around a ward of children, you know that they are not quiet. But why are these children quiet? Because they don't have the energy to cry. Noura has an 11-month-old son. He is deeply malnourished. He is missing his major developmental milestones, and she says: My son is supposed to be drinking formula milk, but there is none . . . [and] I am barely able to breastfeed him; my milk had almost dried up because I'm also not eating well. And, in fact, Noura is in better condition than many other mothers because many mothers across Gaza were unable to breastfeed at all because of their own malnourishment. Samah, another mother, relays that her family was driven from their home by air strikes--certainly true for almost every family in Gaza. And she says: I am pregnant, but I have not eaten anything since yesterday. Dr. Mohammed Fadlalla of Doctors Without Borders says the Gaza ``health system is overwhelmed, and it's collapsing.'' And a Doctors Without Borders report says that doctors and nurses are doing their best with dwindling supplies amidst ``near-daily mass casualty incidents'' and that their clinics report treating ``hundreds of people injured at food distribution sites and ongoing attacks in Gaza,'' while doctors and nurses are working day after day, shift after shift, without eating themselves. The suffering is unimaginable. I have called for international reporters to be allowed in so we could all see exactly what is happening. I have called for Members of Congress to be allowed in to bear witness to what is happening. But the Netanyahu government has said no reporters, no Members of Congress. More than 60,000 Palestinians have been killed, widely reported, but understand this: 18,500 of them were children. According to a reporting by Associated Press, more than 80 children have died from malnutrition- related causes. And for every child who dies of malnutrition, there are thousands more in deep trouble. UNICEF, in a July 25 report, said 320,000 children are at risk of acute malnutrition with thousands already suffering from severe malnutrition, the deadliest form. This headline from the Washington Post, ``60,000 Gazans have been killed. 18,500 were children. These are their names.'' That was in today's paper. Take a look at it, colleagues. Take a look at the pages of microscopic names, all children. And every name here on this poster, a child who is less than a year old. These are not just numbers. These are individuals, beloved by their family. Children who are dying. Children who are deeply malnourished. Let me read you a couple names to remind us all of the fact that these are individuals, just like you are an individual, just like I am an individual, my friends, my colleagues: Anisa Ali, Diaa Saleh Mousa, Basel Abu Jaser, Malak Abu Saif, Wael Assaf, Sama Darwish. All these children, almost 1,000 of them, under the age of 1. They never got a chance to pursue their dreams. They were cut down by bombing and by malnutrition. The IPC, the world's leading hunger monitor, published a report on Tuesday, and I have that report here. Let me hold it up. This report, it says: The worst-case scenario of famine is [currently] playing out in the Gaza strip. ``The worst case.'' The World Food Programme reports that hunger in Gaza has reached ``astonishing levels of desperation, [and] a third of the population is not eating for multiple days in a row.'' But what do we hear from the head man, the leader in Israel, Netanyahu? He says, on Sunday, this past Sunday: There is no starvation in Gaza. Let me be clear. That is a lie. The world knows it is a lie. We know that it is a lie. Donald Trump knows that it is a lie. President Trump said on Monday: Some of those kids--that's real starvation stuff, I see it, and you can't fake that. The use of food and water and medicine as a weapon of war against civilians--including against children, the ill, the elderly, the women--it is unacceptable. It is unacceptable under international law. It is unacceptable under any religious or moral code. I have much more to share on this topic, many more facts I would like to present, but I want to make sure that my colleague, my colleague from Maryland Senator Chris Van Hollen gets an opportunity to share his thoughts. We have called on addressing starvation, the lack of food, going way back to January of last year, 19 months ago. We called on the Biden administration; we called on the Trump administration. He has been a leader, understanding and reporting so many facts to help the rest of us understand what is going on. I will be voting against any weapon of war provided to Israel until every child and every woman has adequate nutrition in Gaza. Mr. President, I yield to my colleague. The PRESIDING OFFICER. The Senator from Maryland. Mr. VAN HOLLEN. Mr. President, I ask unanimous consent that the following Senators be permitted to speak prior to the scheduled rollcall vote: Senator Van Hollen for up to 10 minutes, Senator Durbin for up to 2 minutes, Senator Risch for up to 5 minutes, and Senator Sanders for up to 5 minutes. The PRESIDING OFFICER. Without objection, it is so ordered. Mr. VAN HOLLEN. Mr. President, I rise to oppose the transfer of over $675 million of U.S. taxpayers' money to finance 1000-pound bombs and 20,000 fully automatic rifles and other offensive weapons to the Netanyahu government. The humanitarian situation in Gaza has gone from horrible to hell on earth. Yesterday, we reached the grisly marker of over 60,000 people killed in Gaza, over half of them women and children. And that number could be much higher. More than 133 people have died of starvation, over 80 of them children, most of them this month. Experts have been warning about the threat of famine in Gaza for months, ever since the Netanyahu government imposed a total blockade on all humanitarian assistance going into Gaza on March 2. This is a man-made, preventable crisis, and the solution is clear. The Netanyahu government must immediately allow the U.N.-led distribution system to resume delivery of aid into Gaza to avert a full-blown famine. I have long said that Israel is completely justified in its war against Hamas, which murdered over 1,200 people and seized over 250 hostages on October 7. And we must not rest until every remaining hostage comes home, and there must be no more October 7s. But the Netanyahu government is not justified in imposing collective punishment against all of the people of Gaza to pay for the sins of Hamas, and yet that is what is going on as it uses food and humanitarian aid as a weapon of war. There are now a half million people facing famine-like conditions in Gaza, but they are not just numbers. Colleagues, this is an awful, awful picture, but we have to look at what is happening in Gaza. This is baby Zainab. She weighed 6.6 pounds when she was born 5 months ago. She was 4.4 pounds when she died a few days ago. Her life could have been saved with a special type of baby formula, but none of that formula can be found in Gaza. It wasn't let in. For months, the Netanyahu government has been blocking thousands of truckloads of lifesaving aid that could save babies like Zainab. And yet the Netanyahu government is denying what every human being can see, and they are denying the humanity of people suffering. Just 3 days ago, Benjamin Netanyahu said: There is no starvation in Gaza. Even Donald Trump, who has given Netanyahu a blank check, called out that lie. He said that ``there is real starvation in Gaza. You can't fake that.'' The World Food Programme says it has enough food to end the crisis, but the Netanyahu government won't let them deliver all of it. And last week, they blocked almost half of the aid convoys that the WFP requested permission to bring in. On July 27, the editorial board of Haaretz, Israel's longest running newspaper wrote simply: Gaza is starving, and Israel is responsible. This chart from the Wall Street Journal tells the story. As you can see, back here in March, the Netanyahu government imposed a total blockade for months on all food and humanitarian aid entering Gaza. After several months, they began to let a little trickle of aid in, but they did not allow the deliveries to resume through the tested distribution system that had been run by the United Nations and supported by trusted organizations like the World Food Programme. Instead, they replaced it with an organization that goes by the name of the Gaza Humanitarian Foundation, but there is nothing humanitarian about it. It is a shadowy private organization backed up by mercenaries and the IDF. The food distribution blocked by Israel had over 400 aid distribution points. The GHF operation has only four, and they are not always open. The operation has become a death trap. When you have 4 sites to feed 2 million people, it is not surprising that thousands of desperately hungry people are surging to get what they can. And as they surge, it is well-documented that many have been shot and killed, sometimes by GHF security contractors, more often by IDF forces. The U.N. Secretary General said: Any operation that channels desperate civilians into militarized zones is inherently unsafe. It is killing people. That should be obvious to all of us. Yet the Trump administration is using $30 million of U.S. taxpayer money to fund that deathtrap, and it is sending more taxpayer dollars to fund bombs to the Netanyahu government to continue the devastation of Gaza. Colleagues, this must end. The Netanyahu government must immediately allow tested U.N. distribution systems to resume operations and quickly surge food to starving people. It is important to note that the Netanyahu government claimed it was replacing the U.N. distribution system because Hamas was systematically diverting food intended for civilians for its own purposes. From the start, that was a pretext and a big lie. The U.N. distribution system had strong safeguards to prevent any significant diversion to Hamas, and they were working. Cindy McCain of WFP said her organization saw no evidence of any effort of Hamas to loot aid trucks. Israeli military officials told the New York Times in a story in just the last couple of weeks that there is no such proof. They said: The U.N. aid delivery system was largely effective in providing food to Gaza's desperate and hungry population. An internal U.S. Government analysis that just came out in the last few weeks found no evidence of systematic theft by Hamas. That was also the testimony of former U.S. Special Envoy for Humanitarian Issues David Satterfield. So why did Israel dismantle a system that was kind of working and replace it with one that is killing civilians as they try to get food? The simple reason is also horrifying. It is that the Israeli Government wants to use food as a weapon of war and for population control. They opened four aid sites--mostly in the south--to displace Palestinians and move more in that direction. The Israeli Government is trying to herd the Palestinian people into concentrated enclaves as a prelude to pushing them out of Gaza entirely. It is not a ``secret'' plan, colleagues; it has been right out there in the open. In fact, in February of this year, President Trump said he wanted to remove Palestinians from Gaza. And the Netanyahu government and the Prime Minister himself embraced the plan--which, by the way, had been previously proposed by members of his rightwing coalition. In fact, recently, his Heritage Minister said, as others have quoted, that the government was ``rushing toward Gaza being wiped out'' and ``driving out the population.'' Colleagues, this is part of a coordinated campaign by the Netanyahu government--a government that has declared the removal of Gaza's population as a strategic goal of the war. That is ethnic cleansing by any other name, supported by American taxpayer dollars. The extremists in the Netanyahu coalition do not just have their eyes set on Gaza. As we speak, Israeli settlers are encroaching farther and farther into the West Bank, killing more and more Palestinians who live there. It is important to note that one of the arms sales we are discussing is the transfer of 20,000 fully automatic rifles to the Israeli national police, headed by one of the most extreme members of the government, Ben-Gvir--somebody who handed out rifles to settlers a little while ago without having any idea where they were going. On top of that, back in February, President Trump suddenly revoked all U.S. sanctions against extremist settlers in the West Bank that had been put in place by the Biden administration. That sent a terrible message. In just the first 6 months of this year, we have seen the highest rate of settler attacks in years. One of those happened on July 11, when violent settlers beat to death a 20-year-old Palestinian-American citizen from Florida while he was visiting his family. His name was Sayf, and he is the seventh American citizen killed in the West Bank since January 2, 2022, and the fifth in just the last 19 months--some killed by Israeli settlers and others by Israeli security forces. Just this week, a Palestinian activist who helped make the Oscar- winning documentary ``No Other Land'' was shot and killed by a violent settler who had been sanctioned under the Biden administration--the sanctions the Trump administration withdrew. Meanwhile, on July 23, just a week ago, the Israeli Knesset approved a symbolic resolution that supported annexing the entire West Bank--a place where 2.7 million Palestinians live. Colleagues, for decades, peacemakers on both sides have hoped to make the West Bank and Gaza a foundation of a Palestinian state. We need to make sure that we don't support these efforts that undermine peace and security in the region. Children are starving before our eyes. Colleagues, if ever there was a time to act, it is now. It is overdue, but let's act now and support the resolutions put forward by Senator Sanders. I yield the floor. Mr. SANDERS. I yield to the Senator from Illinois, Senator Durbin. Mr. DURBIN. I thank the Senator from Vermont. Several weeks ago, several Senators joined me in meeting with the Ambassador from Israel. It was an effort to discuss many of the things which we are discussing this evening. We asked him why Israel was not providing humanitarian aid in Gaza. He said: That is not true. We were providing it, but Hamas was stealing it from us and using it to buy weapons and to make them stronger. Then he went on to say--when we asked him about the children starving, the images we had all seen on television, he said: That is not true. That is a United Nations' narrative. Then we asked him basically: If there is such a difference of opinion about what is happening in Gaza, why don't you allow international journalists to come into this area and report to the world what they actually see? He said it was too dangerous for journalists to even witness it. Mr. President, I want to tell you, that was an incredible statement and, I believe, totally wrong. At the outset, Cindy McCain and others told us there is no diversion by Hamas of the humanitarian aid. It just isn't coming into Gaza. They went on to say that these children--of course, we see them on television. You can't avoid it. That is the reality of the situation. Furthermore, when it came down to it, we had to stand up and acknowledge the obvious--that Israel is part of this. Children in Gaza are starving and dying. The question is, What will the United States do about it? I thank the Senator from Vermont for offering these resolutions this evening. It is painful for many of us who devoted our congressional careers to supporting Israel, standing by them through difficult times. It is impossible to explain or defend what is going on today. Gaza is starving and dying because of the policies of Benyamin Netanyahu. It is time for us as a nation to say that our taxpayers are not going to support this effort. I will be joining the Senator this evening in supporting this effort. The PRESIDING OFFICER. The Senator from Idaho. Mr. RISCH. Mr. President, I rise today to oppose the two resolutions that are in front of the body right now. These two resolutions are an attempt to stop munition sales to Israel that have been approved by the administration and are designed to provide Israel with defensive weapons that they need. These are misguided resolutions and, if adopted, would reinstate the failed policies of the Biden administration and would abandon America's closest ally in the Middle East. Let's remember, the conflict between Israel and Hamas and the need for the military assistance for Israel is the fault of Hamas. It is not Israel's fault. It is not America's fault. It is the fault of Hamas. It is the result of Hamas's grotesque action on October 7, the threat Hamas poses to American national security, and, of course, Hamas's treatment of the people of Gaza. They set up their military facilities in hospitals and schools and in mosques, they use the people of Gaza as human shields, and they steal the food the people of Gaza need. It is despicable behavior. These are not good people, and it is in the interest of America and the world to see this terrorist group destroyed. I couldn't agree more with my colleagues who want an end to this war. We all want to see an end to this war and an immediate cease-fire and for the hunger crisis in Gaza to end. The solution to all of this isn't to deprive Israel of the weapons it needs; the solution is in the hands of Hamas. This could end in a moment. Hamas could release the hostages, lay down their arms and surrender, and not one more bullet would be fired. But until this happens, we can't let up on these terrorists who have committed the atrocities against Israel, have caused this chaos in the Middle East, and have endangered American national security again and again. I hope my colleagues will join me in opposing this resolution. Mr. SANDERS. I yield 2 minutes to the Senator from Virginia, Senator Kaine. Mr. KAINE. Mr. President, I will only take 1 minute. A little over a year ago, the Senate voted for $18 billion in defense aid to Israel. On the Democratic side, the vote was 47 to 4. On the Republican side, the vote was 22 to 27. Democrats support defense aid to Israel. This is not a vote to retract a single dollar of that $18 billion in aid; it is a vote to say that defense aid to Israel, which Democrats overwhelmingly supported, should be defensive in nature, not offensive weapons that are likely to lead to unnecessary civilian suffering and destabilization in the region. I support defensive aid to Israel. I will support Senator Sanders' resolutions to not allow the transfer of these offensive weapons. I yield the floor. Mr. SANDERS. Mr. President, let me conclude by saying this: Senator Risch was right. Hamas is a terrorist organization that began this war. They are war criminals. But Hamas is not responsible for the starvation of children today. Hamas is not responsible for the fact that 90 percent of the housing units in Gaza have been destroyed, that their entire healthcare system has been destroyed, that every university in Gaza has been bombed. So today, it is not about Hamas; it is not about Israel; it is about the United States of America and whether we will continue to be complicit in war crimes and in the destruction of women and children in Gaza. I ask for strong support for both of my resolutions. Vote on Motion to Discharge S.J. Res. 41

Mr. President, the so-called reconciliation bill or Mr. Trump's Big Beautiful Bill that the Republican leadership is now attempting to rush through the Senate is a rather extraordinary piece of legislation. In many respects, given the crises facing our country, this legislation does exactly the opposite of what should be done. Whether you are a Democrat, a Republican, or an Independent, you know--no one has any doubt about it--that our current healthcare system is broken. It is dysfunctional. It is a cruel system, and it is wildly expensive. We spend over $14,500 per person on healthcare, double what most countries around the world pay per person. And despite all of that spending, some 85 million Americans today are uninsured or underinsured. And we remain the only major country on Earth not to guarantee healthcare to all people as a human right. And one out of four people who go into a pharmacy to get their prescription drugs can't afford that medicine because of the outrageously high prices. So now, given that reality, how does this reconciliation bill address the horrific healthcare crisis that our country is experiencing? What one might think is that given 85 million people being uninsured or underinsured, this bill would lower that number. It would provide healthcare to more Americans. Given the fact that we are spending twice as much per capita on healthcare as any other nation, one might think that this legislation would lower the cost of healthcare. Given the fact that the insurance companies and the drug companies rip us off every day and make huge profits out of the system, one might think that this legislation would take on the greed of the pharmaceutical industry and the insurance companies. Well, if that is what you think rational legislation should do, understand that this bill does none of that--in fact, does exactly the opposite. This legislation, if enacted, would make the largest cut to healthcare in our Nation's history in order to pay for the largest tax breaks for the rich that we have ever, ever seen--massive cuts to healthcare in order to provide tax breaks for billionaires. The Congressional Budget Office has estimated that this legislation would cut Medicaid and the Affordable Care Act by over $1 trillion. Those cuts, along with ending the enhanced premium credits for the ACA, will lead to 16 million people losing their health insurance. That is not what Bernie Sanders has said; that is what the director of the Congressional Budget Office has told us. That is the nonpartisan group that works with Congress. Mr. President, this bill, further, for the first time, forces millions of Medicaid recipients who make as little as $16,000 a year to pay a $35 copayment every time they visit a doctor. So 16 million people are thrown off of healthcare. Low-income, working-class people are now forced to pay a $35 copayment. What is the impact of all of that? Well, it will not surprise anybody, if people don't have access to healthcare, if they can't get to a doctor when they are sick, people will suffer, and tens of thousands of them will die. The Yale University School of Public Health and the University of Pennsylvania estimated in a recent study that if the reconciliation bill is enacted, over 50,000 Americans will die unnecessarily every year. That is what we are talking about--50,000 Americans dying unnecessarily because they are thrown off of healthcare; they can't afford to see a doctor each and every year. What is the reason for that? What is the motivation for that horrific action? It is to give massive tax breaks to the very wealthiest people in this country, people who do not need them. Not only would millions of Americans lose their health insurance and tens of thousands of our constituents needlessly die if this legislation is enacted, rural hospitals all over this country--rural hospitals that are already struggling--would be forced to shut down, lay off workers, or substantially reduce the services they provide. In other words, at a time when rural America is struggling--and I come from one of the most rural States in America, that is what Vermont is--this bill would be a disaster for rural America. Further, when Trump and the Republicans in Congress make massive cuts to Medicaid, they are not just attacking individuals, they are also going after and negatively impacting community health centers, which provide primary healthcare to 32 million lower income and working-class Americans in every State in this country. Community health centers rely on Medicaid for 43 percent of their revenue. And when you cut hundreds of billions of dollars in Medicaid, you are significantly cutting back on the access that millions of Americans will have to the primary healthcare they desperately need. At a time when the healthcare system in America is broken, when primary healthcare is even in worse shape, this will make access to primary healthcare even more difficult. Some 22 percent of our seniors in this, the richest country on Earth, are trying to survive on less than $15,000 a year. This legislation will make it harder for seniors and people with disabilities to receive the care they desperately need in nursing homes. Nursing homes in Vermont--and I expect in every State in this country--are struggling. They are understaffed. Workers there are underpaid. The quality, in many cases, is not as good as it should be. But when Medicaid now provides 60 percent of the revenue nursing homes rely on, slashing Medicaid will make a disastrous situation even worse for some of the most vulnerable people in our country. Let us be clear. Let us not run away from it. Let us not double-talk this issue and come up with all kinds of absurd rationalizations. This legislation coming before the Senate this week is the most significant attack on the healthcare needs of the American people in the modern history of our country. And once again--once again--we are throwing millions of people off the healthcare that they depend upon to stay alive in order to give tax breaks to billionaires who have more wealth today than they will need for a hundred lifetimes. And yet, oddly enough, despite the enormity of what this legislation is about, not a single committee in the Senate has held a single hearing on the impact this legislation will have. In my view, really, this is absolutely irresponsible. I am not quite sure why we continue to even have committees if the Health and Labor Committee, of which I am ranking member, does not hold a hearing on the most important piece of health legislation in the modern history of this country. That is why this morning, I released, as leader of the minority on the committee, a report discussing the impact that this legislation would have on our Nation's healthcare system. I did that by doing something pretty radical, I guess. We actually reached out to healthcare providers all over the country. If you are going to decimate American healthcare, you may want to talk to the doctors and the nurses and the healthcare organizations around America. I think that is kind of a commonsense thing to do. Let me take this opportunity to thank the over 750 healthcare providers from 47 States who responded to my request. I want to thank them sincerely for their thoughtful responses. We basically said: What is this legislation going to do in your State? And we got hundreds and hundreds and hundreds of responses. Mr. President, I ask unanimous consent that this report be printed in the Record. There being no objection, the material was ordered to be printed in the Record, as follows: Health, Education, Labor and Pensions Committee IN THEIR OWN WORDS: WHAT DOCTORS, NURSES, HOSPITALS, AND OTHER PROVIDERS THINK ABOUT REPUBLICAN CUTS TO HEALTH CARE I. Executive Summary The Senate is rushing to pass the largest cuts to federal health care programs in the history of Medicaid and the Affordable Care Act (ACA). The Republican budget bill, which passed the House by only a single vote, would slash federal health care programs by over $1 trillion. These cuts, along with the elimination of tax credits for ACA coverage, will take health care away from 16 million people. In some states, such as Florida, Louisiana, Massachusetts, and Washington, the Republican budget bill will nearly double the number of people without insurance. Remarkably, despite the major changes the Republican budget bill would make to our health care system, the Senate is moving towards passing the bill without a single hearing or vote in Committee. No doctor, nurse, hospital, community health center, or nursing home has been formally consulted to help explain to the American people what these proposed changes would actually mean. This month, Senator Bernie Sanders (I-Vt.), Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions (HELP), asked health care providers across the country what this bill would mean for their patients. Over 750 health care providers from 47 states and the District of Columbia shared their serious concerns. HELP Minority Staff reviewed these submissions from health care providers, as well as health policy research and other publicly available information, to document how the Republican budget bill would turn the crisis in American health care into a national emergency. Health care providers expressed deep concerns that the bill would lead to more patients getting sick and dying; higher health care costs as patients delayed preventative care and visited more emergency rooms; and more hours spent on paperwork. Taken together, higher costs and lower reimbursement would cause providers to cut health services, lay off clinical staff, and close facilities entirely. This would impact everyone--not just those receiving health coverage through Medicaid and ACA. TABLE 1--HEALTH CARE PROVIDERS RAISE SERIOUS CONCERNS ABOUT REPUBLICAN HEALTH CARE CUTS ------------------------------------------------------------------------ Concern Provider Response ------------------------------------------------------------------------ More patients will get sick and die.... ``If Medicaid is cut, my patients will die. I realize I am being dramatic. It is a dramatic situation.'' Dr. Helen Pope, Louisiana. ``[T]hey are humans who are doing their best. Please don't allow them to suffer more.'' ``Patients will fall through the cracks, not because they're unwilling to care for themselves, but because we've made the system too complicated, too conditional, and too punitive. In rural communities like mine, people already struggle with trust, stigma, and access. This bill risks making all three worse.'' Bradley, Medical Student, Kentucky. ``Plainly said, children will die as a result of these cuts. Hospitals will cut back on ICU doctors, doctors will leave because of salary cuts, critical ancillary services will be reduced, more medical students will avoid going into pediatric residencies.'' Dr. Farhan Malik, Florida. ``The proposed cuts to Medicaid will cause untold hardship and deaths among my patients. DON'T DO THIS! You don't want the deaths of tens of thousands of Americans on your hands.'' Dr. Sanjay Chaube, Louisiana. Costs will increase as sick patients ``Outcomes are worse when care delay care and visit emergency rooms. is less accessible. Few doctors, hospitals, clinics mean more visits to the emergency room with worse presentation and ultimately is more expensive.'' Dr. Bonnie Sand, Maine. ``The provisions would ultimately make healthcare more expensive and less accessible while paradoxically making Medicaid unsustainable. When patients lose access to preventive care, they rely on emergency services and dangerous self-treatment, both driving up costs for everyone. Medicaid allows us to treat and prevent disabling conditions like diabetes and hypertension--without it, these become irreversible.'' Dr. Nikhil Kurapati, Ohio. ``If the proposed bill is passed and [my patients'] Medicaid insurance is cut, it doesn't mean their asthma will go away. It will mean that in most cases they will not receive preventative care, and as a result, their asthma will worsen. . . . Worse yet, they would be seen in the emergency room more often and admitted to the hospital. This care is more expensive, and less effective, than preventative care, and some children will die of their asthma.'' Dr. Gregory Omlor, Akron Children's Hospital, Ohio. Providers will need to spend hours more ``Our care managers and front- to handle extra paperwork, including desk staff would likely spend by hiring more staff. an additional 10-15 hours per week assisting patients with insurance-related forms . . . In small clinics, that's the equivalent of losing nearly half a staff member's availability for patient support.'' Trent Bourland, Regional VP of Rural Health, SSM Health Oklahoma. ``These changes would dramatically increase the administrative burden on our care team. We would likely need to hire at least 1-2 full- time administrative staff just to track patient eligibility, navigate complex documentation requirements, and assist families with enrollment or appeals. This would divert already limited funding away from clinical care and impose new costs on our department.'' Ashley, Social Worker, South Carolina. Facing higher costs and lower ``These harmful proposals will reimbursement, providers will be impact access to all patients forced to cut health services, layoff who are served by our nation's staff, and even close facilities hospitals and health systems. entirely. These cuts will strain emergency departments as they become the family doctor to millions of newly uninsured people. Finally, the providers will force hospitals to reconsider services or potentially close, particularly in rural areas.'' Rick Pollack, President and CEO, American Hospital Association. ``Louisiana's rural hospitals and healthcare providers are already operating on razor- thin margins, struggling to keep their doors open while serving some of our most medically vulnerable communities. In Louisiana, 38% of hospitals operate on negative margins and 27% are currently vulnerable to closure. Medicaid cuts would worsen these losses, putting more hospitals at risk of shutting down entirely.'' Louisiana Rural Health Association. ``If our patients lose Medicaid coverage, they will still need our care and our hospital will provide it. But this will mean more uncompensated care and even worse bottom lines. The city will need to pull funding from elsewhere to help the hospital keep running as is, or we will be forced to cut staffing or services in order to stay open.'' Dr. Katrina Marie Green, Tennessee. ``These cuts will cause rural hospitals in Texas to close entirely. As a neurologist, I am terrified that the closest hospital for many rural folks may then be hours away. During an ischemic stroke, there is only 3 hours of precious time . . . the increased travel time may cause unnecessary cases of paralysis and death.'' Dr. Audrey Nath, Texas. ``The proposed cuts would require our organization to cut back on the number of clinical staff that serve our residents. It would also cause [us] to stop our plan to improve the physical plant improvements for our skilled nursing center that are designed to bring greater dignity, safety, and clinical effectiveness to our residents.'' President & CEO of a provider organization, Kentucky. ``Our margin last year was - 31%, burning through cash to see patients, the majority of whom are on Medicare or Medicaid. If they lose Medicaid, we'll still take care of them because that's what we do, but the bills won't get paid.'' Tom Reinhardt, CEO, Cascade Medical Center, Cascade, Idaho. ``With significant cuts to Medicaid (and any cuts to HRSA or other grant funding for FQHCs), we may not be able to keep the doors open. We would potentially have to stop caring for many of our patients.'' Dr. Mia Henderson, Missouri. ------------------------------------------------------------------------ The responses included in the report represent a mere fraction of the responses reviewed by HELP Minority Staff raising concerns about the Republican health care cuts. Taken together, doctors, nurses, hospitals, and providers are clear about the immense harm the Republican health care cuts pose to their patients. The consequences also extend well beyond Medicaid and the Affordable Care Act. As one California doctor described it, ``If Medicaid collapses, the entire health care system collapses.'' The American people should not be forced to lose their health insurance--or pay higher premiums, higher copays, and higher costs at the pharmacy counter--so that Republicans can pay for tax breaks for the wealthy. Consider, for example, that the one trillion-dollar cuts to health care in the bill are nearly equivalent to the $1.1 trillion in tax breaks that households above $500,000 will receive from the legislation. Or that the bill provides tax breaks to more than 800,000 millionaire households, while ripping health insurance away from 16 million people--a ratio of over 19 to 1. When all the spending and tax cuts are put together, the Penn Wharton Budget Model finds that the 40 percent of Americans making $51,000 or less would see their taxes go up in 2026 by hundreds of dollars, while those making at least $4.3 million would see a tax cut of $390,000. As one doctor from Maine notes: ``We have an existential choice to make. The very wealthy want to steal from the less wealthy and poor Americans. We cannot allow that to happen. This legislation must not pass. Appendix HELP Minority Staff used KFF data to estimate the increase in the uninsured rate from 2023 to 2034 as a result of the One Big Beautiful Bill Act. A 100 percent increase means the number of uninsured doubled. REPUBLICAN BILL WILL LEAD TO A MASSIVE INCREASE IN AMERICANS LOSING HEALTH INSURANCE ---------------------------------------------------------------------------------------------------------------- 2023 Uninsured 2034 Uninsured Percent State Rate Rate Increase ---------------------------------------------------------------------------------------------------------------- Alabama......................................................... 8.2% 11.6% 46% Alaska.......................................................... 10.0% 13.3% 35% Arizona......................................................... 9.6% 13.4% 50% Arkansas........................................................ 8.9% 13.1% 48% California...................................................... 6.2% 10.2% 74% Colorado........................................................ 6.5% 8.6% 50% Connecticut..................................................... 5.4% 9.6% 77% Delaware........................................................ 6.6% 10.0% 60% District of Columbia............................................ 2.6% 7.3% 229% Florida......................................................... 10.4% 18.8% 98% Georgia......................................................... 11.1% 16.7% 61% Hawaii.......................................................... 2.7% 4.9% 99% Idaho........................................................... 8.8% 10.2% 28% Illinois........................................................ 6.0% 10.4% 74% Indiana......................................................... 6.6% 10.0% 55% Iowa............................................................ 4.9% 7.6% 61% Kansas.......................................................... 8.1% 10.5% 32% Kentucky........................................................ 5.5% 9.7% 81% Louisiana....................................................... 6.7% 12.4% 91% Maine........................................................... 5.9% 8.8% 49% Maryland........................................................ 6.2% 8.7% 50% Massachusetts................................................... 2.5% 5.6% 135% Michigan........................................................ 4.3% 7.6% 78% Minnesota....................................................... 3.9% 6.8% 84% Mississippi..................................................... 10.1% 15.7% 54% Misouri......................................................... 7.3% 10.6% 47% Montana......................................................... 8.3% 11.7% 48% Nebraska........................................................ 6.2% 8.4% 44% Nevada.......................................................... 10.5% 11.9% 27% New Hampshire................................................... 4.4% 6.4% 47% New Jersey...................................................... 7.0% 10.9% 63% New Mexico...................................................... 8.7% 13.0% 51% New York........................................................ 4.7% 8.8% 100% North Carolina.................................................. 8.9% 13.0% 54% North Dakota.................................................... 4.0% 6.0% 73% Ohio............................................................ 5.9% 9.5% 63% Oklahoma........................................................ 11.0% 14.8% 38% Oregon.......................................................... 5.3% 9.5% 97% Pennsylvania.................................................... 5.2% 8.2% 59% Rhode Island.................................................... 4.3% 8.2% 98% South Carolina.................................................. 8.7% 13.1% 58% South Dakota.................................................... 8.3% 10.0% 26% Tennessee....................................................... 9.0% 12.5% 45% Texas........................................................... 16.0% 20.0% 39% Utah............................................................ 7.6% 11.3% 69% Vermont......................................................... 3.3% 6.0% 85% Virginia........................................................ 6.2% 9.0% 56% Washington...................................................... 6.2% 11.0% 102% West Virginia................................................... 5.8% 10.0% 68% Wisconsin....................................................... 4.8% 6.3% 34% Wyoming......................................................... 10.2% 12.2% 20% ----------------------------------------------------------------------------------------------------------------