[Congressional Record Volume 161, Number 122 (Thursday, July 30, 2015)]
[Senate]
[Pages S6166-S6180]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    PROHIBITING FEDERAL FUNDING OF PLANNED PARENTHOOD FEDERATION OF 
                 AMERICA--MOTION TO PROCEED--Continued

  The PRESIDING OFFICER. The Senator from Utah.


               50th Anniversary of Medicare and Medicaid

  Mr. HATCH. Mr. President, as you may have heard, today marks the 50th 
anniversary of both Medicare and Medicaid. While the last half century 
has seen a pretty robust debate about the merits of these programs, 
today there is no question that they provide significant and vital 
elements to our Nation's safety net.
  This week many are celebrating the lives that have been saved and 
improved by Medicare and Medicaid over the last 50 years. While this is 
appropriate, I hope that we will also take the time to look at how 
these programs will function over the next 50 years.
  Let's start with Medicare. Medicare is, quite simply, a massive 
program designed to provide care to our Nation's seniors. Currently, it 
covers more than 50 million beneficiaries--roughly one-sixth of the 
current U.S. population--and processes more than 1 billion claims a 
year.
  Last week the Medicare board of trustees issued its report for 2015, 
which once again detailed the fiscal challenges facing the Medicare 
Program. For example, in 2014 alone, we spent roughly $613 billion on 
Medicare expenditures. That is roughly 14 percent of the Federal budget 
and 3.5 percent of our gross domestic product for a single health care 
program. In coming years, these numbers are only going to go up as more 
baby boomers retire and become Medicare beneficiaries.

  Over the next 10 years, the trustees project that the number of 
Medicare beneficiaries will expand by 30 percent. We will spend roughly 
$7 trillion on the program as it expands, and by the end of that 10-
year period we will be spending more on Medicare than on our entire 
national defense. Over the next 25 years, spending on the program as a 
percentage of GDP will grow by 60 percent, and by 2040 about $1 out of 
every $5 spent by the Federal Government will go to Medicare.
  As spending on the program expands, so does its unfunded liabilities. 
Using the most realistic projections of the Centers for Medicare & 
Medicaid Services--remember, this is the government agency's most 
realistic projections--Medicare Part A by itself faces long-term 
unfunded liabilities of nearly $8 trillion. The story is even worse 
with Medicare Part B and Part D, which unlike Part A, do not have a 
dedicated revenue stream. Medicare's trustees estimate $24.8 trillion 
in additional taxes will need to be collected over the next 75 years to 
pay for Medicare Part B and Part D services.
  When we look at the entire Medicare Program over the next 75 years, 
once again using CMS's most accurate projections, we are looking at $37 
trillion of spending in excess of dedicated revenues. Those numbers are 
astronomical. They are too large to even comprehend. So rather than 
talk about the numbers in broad terms, let's talk about what they mean 
for seniors and beneficiaries.
  As I mentioned, Medicare Part A, which includes the Hospital 
Insurance, or HI, Program has a dedicated funding stream. It is paid 
for by a 2.9-percent payroll tax split between employers and workers, 
and under ObamaCare that rate went up by an additional 0.9 percent on 
wages over $200,000 for single tax filers and $250,000 for married 
couples.
  Due in large part to the financial downturn, Part A ran a deficit--
meaning that expenditures for the program exceeded income from the 
tax--every year between 2008 and 2014. Last year that deficit reached 
$8.1 billion in just 1 year.
  Because of the economic recovery and the increased tax rates, Part A 
is projected to generate surpluses between 2015 and 2023. However, 
after that, deficits are projected to return, and by 2030 the Part A 
trust fund will officially be bankrupt and the Medicare Program will be 
unable to pay full benefits to seniors. Let me say that again. In 15 
years, Medicare Part A will be bankrupt.
  All of this, of course, assumes that current law remains unchanged 
and Congress is unable to reform the program. I don't think I would be 
going too far out on a limb to suggest that reforms to Medicare are 
absolutely necessary if we are going to preserve the program for future 
generations. Furthermore, I don't think it would be outlandish to 
suggest that Congress should begin working on such reforms immediately 
to avoid future cliffs, standoffs, and the usual accompanying political 
brinkmanship. I am not the only one saying that.
  The Medicare trustees themselves said in last week's report that 
``Medicare still faces a substantial financial shortfall that will need 
to be addressed with further legislation. Such legislation should be 
enacted sooner rather than later to minimize the impact on 
beneficiaries, providers, and taxpayers.''
  These are not the words of fiscal hawks in the Republican Congress. 
The Medicare board of trustees is comprised of six members, four of 
whom are high-ranking officials in the Obama administration, including 
Treasury Secretary Jack Lew, Labor Secretary Thomas Perez, Health & 
Human Services Secretary Sylvia Burwell, and acting Social Security 
Commissioner Carolyn Colvin.
  All of these officials signed on to a report recommending ``further 
legislation'' to reform Medicare and suggesting that it happen ``sooner 
rather than later.''
  Let's keep in mind that we are only talking about Medicare. I haven't 
said anything yet about Medicaid, our other health care entitlement 
program, which also faces enormous fiscal challenges. Currently, 
Medicaid covers more than 70 million patients, and that number is 
growing thanks to expansions mandated under the so-called Affordable 
Care Act. Since the passage of ObamaCare, more than a dozen States have 
chosen to expand their Medicaid Programs and enrollments have surged 
well beyond initial projections. This has a number of people worried 
about added costs and additional strains on State budgets, particularly 
when the Federal share of the expanded program is set to scale back in 
2 years. Already, without the expansion under ObamaCare, Medicaid took 
up nearly one-quarter of all State budgets. That is right: Nearly $1 
out of every $4 spent at the State level goes to Medicaid, and that 
number is going to get much higher.
  In the recent years, combined Federal and State Medicaid spending has 
come in around $450 billion a year. By 2020, that number is projected 
to expand to around $800 billion a year or more, and with all of this 
expansion--that increased fiscal burden and instability--we are not 
seeing improvements in care provided by the program.
  Put simply, Medicaid is probably the worst health insurance in the 
country and the President's health care law did nothing to improve the 
quality of care provided by the program. Fewer and fewer doctors accept 
Medicaid because

[[Page S6167]]

it pays them so little, and the program's reimbursement formulas for 
prescription drugs limit beneficiaries' access to a number of important 
medications.
  Ultimately, we are going to be spending more and more on Medicaid in 
the coming years--and as a result expanding our debts and deficits--
without providing better care for beneficiaries.
  Between Medicare and Medicaid, we will spend more than $12 trillion 
over the next decade with precious few improvements to show for it. 
Former CBO Director Doug Elmendorf referred to these two programs as 
``our fundamental fiscal challenge.'' If you look at the numbers and 
the dramatic expansion projected in the coming years, he was right. 
Keep in mind, we still have Social Security, which faces nearly $11 
billion in unfunded liabilities over the long term as well as the 
exhaustion of one of its trust funds, the disability trust fund, by the 
end of next year and complete exhaustion by 2034.
  Separately, these three major entitlement programs present unique 
challenges that have to be addressed in order to preserve them--and our 
Nation's safety net--for future generations. Combined, they threaten to 
swallow up our government and take our economy down with it.

  Once again, these aren't doomsday scenarios. No one seriously 
disputes the fact that absent real and lasting reforms, our entitlement 
programs present real threats to our fiscal well-being. The disputes 
typically arise when we begin talking about the specifics of reform. 
Some would just as soon use the looming entitlement crisis as a 
political weapon to scare current and near beneficiaries into believing 
the other side wants to take their benefits away. Others support the 
idea of entitlement reform in principle but are too afraid to sign on 
to any specific proposals out of fear it would be used against them in 
the next election cycle.
  This dynamic has resulted in a longstanding stalemate, where the 
possibility of real reform has, for years now, seemed remote. However, 
recently we have seen signs that it may in fact be possible to overcome 
this stalemate.
  Earlier this year, Congress passed the Medicare Access and CHIP 
Reauthorization Act of 2015, a bipartisan bill, which among other 
things repealed and replaced the Medicare sustainable growth rate, or 
SGR, formula. Now, repealing SGR was, in and of itself, a significant 
improvement to the Medicare Program, but there are other Medicare 
reforms in the law as well. These include a limitation on so-called 
Medigap first-dollar coverage and more robust means testing for 
Medicare Parts B and D.
  These aren't fundamental Medicare reforms, and they will not move the 
program from its massive projected deficits into future solvency, but 
keep in mind that for years the idea of bipartisan Medicare reform 
seemed like a pipedream. Yet with passage of the SGR bill, we were able 
to take a meaningful first step toward this all-important goal.
  Of course, the first step is only a first step if it precedes 
additional steps, and that is what we need now. Congress must take 
additional steps to improve these programs and preserve them for our 
children and grandchildren. As the chairman of the committee with 
jurisdiction over these programs, I have been actively engaged in the 
effort to reform our entitlement programs.
  In 2013, when I was still the ranking member, I put forward five 
separate proposals to reform Medicare and Medicaid. All of them were 
serious, commonsense ideas that had received bipartisan support in the 
recent past. I shared these ideas at every opportunity. I put out 
documents, fact sheets, and gave numerous speeches on the floor. I even 
passed them along directly to President Obama, although I didn't ever 
get a response from him. Two of those ideas were, at least partially, 
included in the legislation we passed to repeal SGR. The other three 
ideas, as far as I am concerned, are still on the table.
  I have also teamed up with leaders in the House to call on the 
disability community and other stakeholders to help us come up with 
ideas to address the impending exhaustion of the Social Security 
disability trust fund. I have introduced legislation to improve the 
administration and fiscal integrity of the disability insurance 
program.
  In other words, I stand ready and willing to work with any of my 
colleagues--from either party or from either Chamber--to address the 
coming entitlement crisis before it is too late. I have put my own 
ideas on the table, but I don't think the debate should be limited to 
my ideas. I invite all of my colleagues to come forward so we can work 
together to find solutions to these massive problems.
  I know that when I think about these problems, my thoughts turn to my 
23 grandchildren and 16 great-grandchildren--and everybody else's 
grandchildren and great-grandchildren--who will suffer from any 
promises we fail to keep and will pay the price of any mistakes we fail 
to correct.
  On this landmark anniversary of the Medicare Program, I urge my 
colleagues to also consider future generations of Americans and the 
costs and burdens we will pass on to them if we fail in this endeavor.
  With that, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SULLIVAN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Sasse). Without objection, it is so 
ordered.


                      Nuclear Agreement With Iran

  Mr. SULLIVAN. Mr. President, I rise to talk about the important 
agreement that we are debating here on the Senate floor--the Iran 
nuclear agreement. I want to begin by saying that there seems to be, as 
we debate this and as we hold hearings, a growing sense of frustration 
as we do what is really our sacred duty here in the Senate--to review, 
debate, and, ultimately, to vote on this agreement as to whether it is 
something that is going to keep our country secure or undermine the 
national security of the United States and our allies. This frustration 
stems from a number of sources. Let me just name a few.
  First, I think many Democrats and Republicans feel there has been a 
dismissive attitude from the administration with regard to this 
agreement and a dismissive attitude, actually, towards the American 
people on whether the Congress should weigh in on this agreement, 
should represent their constituents on something that is this important 
to the national security of the United States of America.
  I mention this because if you look at the last several months, every 
step of the way the administration has tried to cut out the role of the 
Congress. Initially, they said it was an Executive agreement and 
Congress would have no role. Well, I don't think our constituents liked 
that, and certainly, the Senate didn't like that. So we started 
debating the Iran Nuclear Agreement Review Act.
  The President said he was going to veto it. Again, that was 
dismissive of this body and the American people. Fortunately, this body 
had a very strong veto-proof majority. We are debating it--but not 
because they wanted us to but because we are representing our 
constituents who know how important this is.
  Then the agreement is taken to the United Nations before we weigh in 
on it at all. Members of the United Nations, citizens from other 
countries, are voting on this agreement before we had the opportunity. 
Again, bipartisan Democrats and Republicans said: Secretary Kerry, 
don't do that. It is an affront to the American people. But they did 
it. So we are debating it, and that is important. But that attitude of 
dismissiveness of this body and the people we represent is frustrating.
  There is a second reason there is frustration in the Senate, and it 
stems from the fact that we are not sure that we are getting the 
straight scoop. We are not sure we are getting all the documents. The 
law requires every document to this agreement come to this body. Yet we 
found out 2 weeks ago that there is a very important agreement, the 
agreement between the IAEA and Iran on implementation of this 
agreement. How did we find out about that? One of my colleagues, 
Senator Cotton, got on a plane, went to IAEA headquarters in Vienna, 
and found that

[[Page S6168]]

out--again, frustration. We are not receiving all of the documents, as 
required by law, to be able to review.
  Third, in terms of frustration, there is a sense that as we are doing 
our duty here, as we are digging into this agreement, as we are reading 
it, as we are reaching out to experts, as we are trying to understand 
it, as we are questioning administration witnesses at hearings, as we 
are doing our required and sacred due diligence, we are told time and 
again that the plain language of the agreement doesn't appear to mean 
what it means. This is frustrating. This is particularly true with 
regard to sanctions.
  Let me give you a few examples. First we had a closed briefing. 
Almost every Member of the Senate came to that briefing a couple of 
weeks ago. There was a big question. Was there a grandfather provision 
with regard to sanctions; meaning, if you are a company and you rush to 
Iran right now and cut some deals and sanctions are later imposed, does 
the mere fact that you jumped in early mean that you are grandfathered 
away from these sanctions? Well, a lot of people had questions.
  The Secretary of State looked at 100 Members of the Senate and said: 
There is no grandfather clause in this agreement. There is no 
grandfather clause in this agreement.
  This is paragraph 37 of the agreement. I am just going to quote it, 
because it certainly sounds like a grandfather clause to me: ``In such 
event [that sanctions are reimposed], these provisions''--in this 
paragraph--``would not apply with retroactive effect to contracts 
signed between any party and Iran or Iranian individuals and entities 
prior to the date of application . . .'' That is when the agreement 
starts to be implemented.
  That sounds like a grandfather clause. Now, maybe there are elements 
here, maybe there are special circumstances that make it not a 
grandfather clause, but the Secretary of State was in front of all of 
us saying that there is no grandfather clause. It is hard to square 
that with the plain language of this agreement.
  Let me give another example--the much-touted snapback provisions in 
the agreement. Secretary Lew, the Secretary of the Treasury, has talked 
about how we have a strong snapback provision, how it is going to be 
prompt, and how it is powerful. These are terms that he has been using 
in testimony. In many ways I think Members of this body, Democrats and 
Republicans, see that the effectiveness of this entire deal might hinge 
on this so-called snapback provision. The more I read about our 
sanctions and how they work in this agreement, the more questions I 
have, because to this Senator the snapback provision seems to be an 
illusion. It actually seems to be aimed back at the United States. I 
don't think we should be calling it a snapback provision. Maybe it 
should be called the boomerang provision, because it is aimed at us.
  Let me talk a little bit more in detail about this. First, the term 
``snapback'' was not in the agreement. It is a good term--catchy--and 
sounds good. It is actually a term used in trade negotiations when a 
party violates a trade agreement. Trade agreements will have snapback 
provisions where we raise tariffs on goods immediately. That is a 
snapback. But that is not what is going on here. That is not what is 
going to happen here. The practical reality of sanctions, particularly 
economic sanctions, is that there is no snap when you put them in. It 
is a slog.
  Let me give you an example. In my experience, I worked with many 
people at the beginning of our efforts in the Bush Administration, 
during 2006, 2007, and 2008, to start economically isolating Iran. What 
does that mean? Well, what we did is we leveraged the power of the U.S. 
economy in close coordination with the Congress of the United States, 
and we went to countries and companies that were big investors in Iran, 
say, in the oil and gas sector, and we told them that they needed to 
start divesting out of the largest sponsor of terrorism in the world or 
the Congress of the United States might look to sanction their company 
or limit their access to the American market. We were leveraging the 
authority of the Congress and the power of our economy to get 
countries--yes, many of which were our allies--such as Norway, Germany, 
France, and Japan to divest and economically isolate Iran. That took 
months and years to accomplish. It was a slog. There was no snap.
  What do we see today? European companies--it is in the newspapers 
every day--European CEOs, senior administration officials in Germany, 
and government officials are already in Tehran. Already, there are 
companies looking to set up shop, looking to invest billions, as they 
did before. They are there now. This deal is not even done yet. They 
are there. They cannot wait, licking their chops to reinvest in one of 
the--not one of the biggest, the biggest terrorist regime in the world, 
which has done more to kill Americans than probably any country in the 
world in the last 30 years. Of course, this is disappointing, but this 
history is a reminder to all of us that the sanctions regime Secretary 
Kerry talks about--and we certainly did have Iran surrounded in terms 
of sanctions--which was a 110-percent-American-led sanctions regime, 
involving Democrats, Republicans, this Congress, and the Bush 
administration. Yes, a lot of credit goes to the Obama administration 
on this economic isolation of Iran, which is what brought them to the 
table to begin with.

  If we reimpose sanctions, there certainly won't be a ``snap'' when it 
happens. It will be slow. It will be a slog again trying to convince 
reluctant Europeans, Russians, and Chinese to pull out of the market 
once again.
  Finally, I just want to say one other thing, and it goes back again 
to the plain language of the agreement, where again the snapback 
provision, so-called snapback provision, seems aimed back at us, the 
boomerang provision.
  I posed a hypothetical to Secretary Kerry, Secretary Lew in a closed 
session, in a Senate Armed Services session yesterday to try and get 
specifics on what would happen in certain situations. I gave them this 
hypothetical: Let's assume sanctions are lifted in the next 6 to 9 
months. These are called Annex II sanctions. It is a huge list of 
sanctions, the most powerful sanctions our country has placed on Iran. 
All of them--financial, oil, market--are going to be lifted in 6 to 9 
months. Let's assume that happens.
  As we are already seeing, European companies, other countries, 
certainly the Chinese, Russians, Japanese, are going to be rushing into 
this market, investing billions once again. Assume the Iranian economy 
is going to start humming with all of this new investment, the lifting 
of sanctions. A senior Iranian official recently said they are looking 
for $120 billion of new investment by 2020. They are likely going to 
get a lot of it, and they are abiding by the deal--no violations of any 
of the nuclear aspects of this deal. Then, what I think is very likely, 
sometime within the next 3, 4, 5, 6, 7 years, Iran commits a major act 
of terrorism. Let's say they kill more American troops. Let's say they 
blow up a consulate or embassy somewhere. They are the world's largest 
state sponsor of terrorism. It doesn't look as though they want to do 
anything but continue to do that, so that is a very likely scenario. 
When that happens, this body reapplies sanctions. It looks at Annex II, 
some of our most powerful sanctions. We are very upset--bipartisan. We 
reapply sanctions. The President, whoever that is, signs it because 
that President, he or she is very upset, and we reimpose serious Annex 
II sanctions.
  Now, what happens then? I think what is going to happen, very likely 
at that point, is Iran is going to look at this agreement, and they are 
going to cite either paragraph 26 or paragraph 37. Let me read you both 
of those. Again, this is the plain language of the statute.
  Paragraph 37. Iran has stated that if sanctions are reinstated in 
whole or in part, Iran will treat that as grounds to cease performing 
its commitments under the entire agreement.
  Another provision. Iran has stated it will treat the reintroduction 
or reimposition of the sanctions specified in Annex II as grounds to 
cease performing its commitments under the agreement.
  That is in the agreement. So, you see, if we reimpose sanctions as 
part of the snapback, Iran can look at this agreement and say: I'm 
done. I'm walking. I can legally leave this agreement. They can legally 
leave this agreement with a humming economy, on the verge

[[Page S6169]]

of a breakout of a nuclear weapon, still being the largest state 
sponsor of terrorism, and they can say: Hey, I complied with the 
agreement. The United States reimposed sanctions. I told them what I 
was going to do, and they do it.
  Again, bottom line, if we use the so-called snapback provision, it 
certainly appears from the language of this agreement that the deal is 
done. So I have asked Secretary Kerry and Secretary Lew twice now: How 
is that an improper reading of the agreement? Secretary Lew, the 
Secretary of the Treasury, is trying to argue we are reading that 
language wrong. He says Annex II sanctions--the big American sanctions, 
which are what has kept Iran down and what has brought them to the 
table--can be reimposed if they are reimposed for nonnuclear violations 
like terrorism.
  When I read this agreement, that seems to be a bit of a stretch. 
Certainly there is a lot of ambiguity, but it is also clear the 
Iranians clearly won't agree with that reading. They don't agree with 
that reading. This was filed--I ask unanimous consent to have this 
printed in the Record. This is the Iranian letter dated 20 July 2015, 
to the United Nations Security Council. It is their interpretation of 
the agreement.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                              United Nations Security Council,

                                      New York, NY, July 20, 2015.
     Re Letter dated 20 July 2015 from the Permanent 
         Representative of the Islamic Republic of Iran to the 
         United Nations addressed to the President of the Security 
         Council

       I have the honour to enclose herewith a text entitled 
     ``Statement of the Islamic Republic of Iran following the 
     adoption of United Nations Security Council resolution 2231 
     (2015) endorsing the Joint Comprehensive Plan of Action'' 
     (see annex).
       I should be grateful if you would arrange for the 
     circulation of the present letter and its annex as a document 
     of the Security Council.
                                               Gholamali Khoshroo,
                             Ambassador, Permanent Representative.

     Re Annex to the letter dated 20 July 2015 from the Permanent 
         Representative of the Islamic Republic of Iran to the 
         United Nations addressed to the President of the Security 
         Council

  Statement of the Islamic Republic of Iran Following the Adoption of 
 United Nations Security Council Resolution 2231 (2015) Endorsing the 
                   Joint Comprehensive Plan of Action

       1. The Islamic Republic of Iran considers science and 
     technology, including peaceful nuclear technology, as the 
     common heritage of mankind. At the same time, on the basis of 
     solid ideological, strategic and international principles, 
     Iran categorically rejects weapons of mass destruction and 
     particularly nuclear weapons as obsolete and inhuman, and 
     detrimental to international peace and security. Inspired by 
     the sublime Islamic teachings, and based on the views and 
     practice of the late founder of the Islamic Revolution, Imam 
     Khomeini, and the historic Fatwa of the leader of the Islamic 
     Revolution, Ayatollah Khamenei, who has declared all weapons 
     of mass destruction (WMD), particularly nuclear weapons, to 
     be Haram (strictly forbidden) in Islamic jurisprudence, the 
     Islamic Republic of Iran declares that it has always been the 
     policy of the Islamic Republic of Iran to prohibit the 
     acquisition, production, stockpiling or use of nuclear 
     weapons.
       2. The Islamic Republic of Iran underlines the imperative 
     of the total elimination of nuclear weapons, as a requirement 
     of international security and an obligation under the Treaty 
     on the Non-Proliferation of Nuclear Weapons. The Islamic 
     Republic of Iran is determined to engage actively in all 
     international diplomatic and legal efforts to save humanity 
     from the menace of nuclear weapons and their proliferation, 
     including through the establishment of nuclear-weapon-free 
     zones, particularly in the Middle East.
       3. The Islamic Republic of Iran firmly insists that States 
     parties to the Treaty on the Non-Proliferation of Nuclear 
     Weapons shall not be prevented from enjoying their 
     inalienable rights under the Treaty to develop research, 
     production and use of nuclear energy for peaceful purposes 
     without discrimination and in conformity with articles I and 
     II of the Treaty.
       4. The finalization of the Joint Comprehensive Plan of 
     Action (JCPOA) on 14 July 2015 signifies a momentous step by 
     the Islamic Republic of Iran and the E3/EU+3 to resolve, 
     through negotiations and based on mutual respect, an 
     unnecessary crisis, which had been manufactured by baseless 
     allegations about the Iranian peaceful nuclear programme, 
     followed by unjustified politically motivated measures 
     against the people of Iran.
       5. The JCPOA is premised on reciprocal commitments by Iran 
     and the E3/EU+3, ensuring the exclusively peaceful nature of 
     Iran's nuclear programme, on the one hand, and the 
     termination of all provisions of Security Council resolutions 
     1696 (2006), 1737 (2006), 1747 (2007), 1803 (2008), 1835 
     (2008), 1929 (2010) and 2224 (2015) and the comprehensive 
     lifting of all United Nations Security Council sanctions, and 
     all nuclear-related sanctions imposed by the United States 
     and the European Union and its member States, on the other. 
     The Islamic Republic of Iran is committed to implement its 
     voluntary undertakings in good faith contingent upon same 
     good-faith implementation of all undertakings, including 
     those involving the removal of sanctions and restrictive 
     measures, by the E3/EU+3 under the JCPOA.
       6. Removal of nuclear-related sanctions and restrictive 
     measures by the European Union and the United States would 
     mean that transactions and activities referred to under the 
     JCPOA could be carried out with Iran and its entities 
     anywhere in the world without fear of retribution from 
     extraterritorial harassment, and all persons would be able to 
     freely choose to engage in commercial and financial 
     transactions with Iran. It is clearly spelled out in the 
     JCPOA that both the European Union and the United States will 
     refrain from reintroducing or reimposing the sanctions and 
     restrictive measures lifted under the JCPOA. It is understood 
     that reintroduction or reimposition, including through 
     extension, of the sanctions and restrictive measures will 
     constitute significant non-performance which would relieve 
     Iran from its commitments in part or in whole. Removal of 
     sanctions further necessitates taking appropriate domestic 
     legal and administrative measures, including legislative and 
     regulatory measures to effectuate the removal of sanctions. 
     The JCPOA requires an effective end to all discriminatory 
     compliance measures and procedures as well as public 
     statements inconsistent with the intent of the agreement. 
     Iran underlines the agreement by JCPOA participants that 
     immediately after the adoption of the Security Council 
     resolution endorsing the JCPOA, the European Union, its 
     member States and the United States will begin consultation 
     with Iran regarding relevant guidelines and publicly 
     accessible statements on the details of sanctions or 
     restrictive measures to be lifted under the JCPOA.
       7. The Islamic Republic of Iran will pursue its peaceful 
     nuclear programme, including its enrichment and enrichment 
     research and development, consistent with its own plan as 
     agreed in the JCPOA, and will work closely with its 
     counterparts to ensure that the agreement will endure the 
     test of time and achieve all its objectives. This commitment 
     is based on assurances by the E3/EU+3 that they will 
     cooperate in this peaceful programme consistent with their 
     commitments under the JCPOA. It is understood and agreed 
     that, through steps agreed with the International Atomic 
     Energy Agency (IAEA), all past and present issues of concern 
     will be considered and concluded by the IAEA Board of 
     Governors before the end of 2015. The IAEA has consistently 
     concluded heretofore that Iran's declared activities are 
     exclusively peaceful. Application of the Additional Protocol 
     henceforth is intended to pave the way for a broader 
     conclusion that no undeclared activity is evidenced in Iran 
     either. To this end, the Islamic Republic of Iran will 
     cooperate with the IAEA, in accordance with the terms of the 
     Additional Protocol as applied to all signatories. The IAEA 
     should, at the same time, exercise vigilance to ensure full 
     protection of all confidential information. The Islamic 
     Republic of Iran has always fulfilled its international non-
     proliferation obligations scrupulously and will meticulously 
     declare all its relevant activities under the Additional 
     Protocol. In this context, the Islamic Republic of Iran is 
     confident that since no nuclear activity is or will ever be 
     carried out in any military facility, such facilities will 
     not be the subject of inspection.
       8. The Joint Commission established under the JCPOA should 
     be enabled to address and resolve disputes in an impartial, 
     effective, efficient and expeditious manner. Its primary role 
     is to address complaints by Iran and ensure that effects of 
     sanctions lifting stipulated in the JCPOA will be fully 
     realized. The Islamic Republic of Iran may reconsider its 
     commitments under the JCPOA if the effects of the termination 
     of the Security Council, European Union or United States 
     nuclear-related sanctions or restrictive measures are 
     impaired by continued application or the imposition of new 
     sanctions with a nature and scope identical or similar to 
     those that were in place prior to the implementation date, 
     irrespective of whether such new sanctions are introduced on 
     nuclear-related or other grounds, unless the issues are 
     remedied within a reasonably short time.
       9. Reciprocal measures, envisaged in the dispute settlement 
     mechanism of the JCPOA, to redress significant non-
     performance are considered as the last resort if significant 
     non-performance persists and is not remedied within the 
     arrangements provided for in the JCPOA. The Islamic Republic 
     of Iran considers such measures as highly unlikely, as the 
     objective is to ensure compliance rather than provide an 
     excuse for arbitrary reversibility or means for pressure or 
     manipulation. Iran is committed to fully implement its 
     voluntary commitments in good faith. In order to ensure 
     continued compliance by all JCPOA participants, the Islamic 
     Republic of Iran underlines that in case the mechanism is 
     applied against Iran or its entities and sanctions, 
     particularly Security

[[Page S6170]]

     Council measures, are restored, the Islamic Republic of Iran 
     will treat this as grounds to cease performing its 
     commitments under the JCPOA and to reconsider its cooperation 
     with the IAEA.
       10. The Islamic Republic of Iran underlines the common 
     understanding and clearly stated agreement of all JCPOA 
     participants that affirms that the provisions of Security 
     Council resolution 2231 (2015) endorsing the JCPOA do not 
     constitute provisions of the JCPOA and can in no way impact 
     the performance of the JCPOA.
       11. The Government of the Islamic Republic of Iran is 
     determined to actively contribute to the promotion of peace 
     and stability in the region in the face of the increasing 
     threat of terrorism and violent extremism. Iran will continue 
     its leading role in fighting this menace and stands ready to 
     cooperate fully with its neighbours and the international 
     community in dealing with this common global threat. 
     Moreover, the Islamic Republic of Iran will continue to take 
     necessary measures to strengthen its defence capabilities in 
     order to protect its sovereignty, independence and 
     territorial integrity against any aggression and to counter 
     the menace of terrorism in the region. In this context, 
     Iranian military capabilities, including ballistic missiles, 
     are exclusively for legitimate defence. They have not been 
     designed for WMD capability, and are thus outside the purview 
     or competence of the Security Council resolution and its 
     annexes.
       12. The Islamic Republic of Iran expects to see meaningful 
     realization of the fundamental shift in the Security 
     Council's approach envisaged in the preamble of Security 
     Council resolution 2231 (2015). The Council has an abysmal 
     track record in dealing with Iran, starting with its 
     acquiescing silence in the face of a war of aggression by 
     Saddam Hussain against Iran in 1980, its refusal from 1984 to 
     1988 to condemn, let alone act against, massive, systematic 
     and widespread use of chemical weapons against Iranian 
     soldiers and civilians by Saddam Hussain, and the continued 
     material and intelligence support for Saddam Hussain's 
     chemical warfare by several of its members. Even after Saddam 
     invaded Kuwait, the Security Council not only obdurately 
     refused to rectify its malice against the people of Iran, but 
     went even further and imposed ostensibly WMD-driven sanctions 
     against these victims of chemical warfare and the Council's 
     acquiescing silence. Instead of at least noting the fact that 
     Iran had not even retaliated against Saddam Hussain's use of 
     chemical weapons, the Council rushed to act on politically 
     charged baseless allegations against Iran and unjustifiably 
     imposed a wide range of sanctions against the Iranian people 
     as retribution for their resistance to coercive pressures to 
     abandon their peaceful nuclear programme. It is important to 
     remember that these sanctions, which should not have been 
     imposed in the first place, are the subject of removal under 
     the JCPOA and Security Council resolution 2231 (2015).
       13. Therefore, the Islamic Republic of Iran continues to 
     insist that all sanctions and restrictive measures introduced 
     and applied against the people of Iran, including those 
     applied under the pretext of its nuclear programme, have been 
     baseless, unjust and unlawful. Hence, nothing in the JCPOA 
     shall be construed to imply, directly or indirectly, an 
     admission of or acquiescence by the Islamic Republic of Iran 
     in the legitimacy, validity or enforceability of the 
     sanctions and restrictive measures adopted against Iran by 
     the Security Council, the European Union or its member 
     States, the United States or any other State, nor shall it be 
     construed as a waiver or a limitation on the exercise of any 
     related right the Islamic Republic of Iran is entitled to 
     under relevant national legislation, international 
     instruments or legal principles.
       14. The Islamic Republic of Iran is confident that the 
     good-faith implementation of the JCPOA by all its 
     participants will help restore the confidence of the Iranian 
     people, who have been unduly subjected to illegal pressure 
     and coercion under the pretext of this manufactured crisis, 
     and will open new possibilities for cooperation in dealing 
     with real global challenges and actual threats to regional 
     security. Our region has long been mired in undue tension 
     while extremists and terrorists continue to gain and maintain 
     ground. It is high time to redirect attention and focus on 
     these imminent threats and seek and pursue effective means to 
     defeat this common menace.

  Mr. SULLIVAN. You want to know what the Iranians say about the 
reimposition of so-called snapback sanctions? Here is what they say: It 
is clearly spelled out in the agreement that both the European Union 
and the United States will refrain from reintroducing or reimposing the 
sanctions--now they are talking about Annex II sanctions--and 
restrictive measures lifted under the agreement. It is understood that 
reintroduction or reimposition, including through extension of the 
sanctions and restrictive measures, will constitute significant 
nonperformance which would relieve Iran from its commitments to this 
agreement in whole or in part.
  My colleague Senator Ayotte from New Hampshire yesterday asked 
Secretary Kerry and Secretary Lew about this provision. They did not 
give a clear answer because there is no clear answer. Right now there 
is huge disagreement between the United States and Iran on the language 
in the agreement on whether, to what degree, these so-called snapback 
provisions will work or will undermine our national security interests, 
which is what I believe they will do.
  I have asked the administration to quit using that term. It is not in 
the agreement. The language makes clear that it is going to take years. 
There is no ``snap.'' If we ever use it, that is it for the agreement. 
They have not given the Members of this body a straightforward answer 
on that issue. We need to keep asking these kinds of questions. We need 
to keep doing our due diligence, but we need clarity. The American 
people need clarity, not spin, on critical issues such as this side 
IAEA agreement, which nobody seems to have read, and we certainly have 
not seen; the grandfather clause, which certainly looks like a 
grandfather clause, but now we are told by Secretary Kerry is not a 
grandfather clause; and perhaps, most importantly, this so-called 
snapback provision which I believe is illusory and is aimed at us, not 
at the pariah state that we are all concerned about, and that is Iran.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. COLLINS. Mr. President, I ask unanimous consent that the Senator 
from Delaware, Mr. Coons, and I be permitted to proceed as in morning 
business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Ms. Collins and Mr. Coons pertaining to the 
introduction of S. 1911 are printed in today's Record under 
``Statements on Introduced Bills and Joint Resolutions.'')
  The PRESIDING OFFICER. The Senator from Oregon.


               50th Anniversary of Medicare and Medicaid

  Mr. WYDEN. Mr. President, 50 years ago today, President Lyndon 
Johnson signed into law the Social Security Act amendments that created 
Medicare and Medicaid. Our country slammed the door on the days when 
far too many older people languished in poverty without the financial 
security that comes from affordable, high-quality health care. It was a 
day when sick, older people were warehoused on poor farms and in 
almshouses. Just picture that. On the edge of town we had older people, 
literally without a shred of dignity, in what came to be known as 
almshouses. But Lyndon Johnson and others said that had to be changed, 
and five decades ago it did. Today, more than 100 million Americans 
have access to high-quality health care thanks to Medicare and 
Medicaid.
  We can measure the remarkable success of these programs in so many 
ways, but in my judgment, one of the most important and most appealing 
aspects of Medicare and Medicaid is their ability to grow, their 
ability to change, and their ability to evolve to meet the needs of our 
country. The reality is that Medicare in 2015 is very different from 
Medicare in 1965. Medicare in 1965 was about something like a broken 
ankle. If it was a serious break, you would be in the hospital--Part A. 
If it was not a particularly serious break, you would go to the 
doctor--that was Part B. That was Medicare circa 1965. Today, Medicare 
is about chronic illness, it is about cancer, it is about diabetes, it 
is about stroke, and it is about heart disease. You put Alzheimer's in, 
and that is well more than 90 percent of the Medicare Program. So it is 
a very different Medicare Program today than it was in 1965.

  One of the aspects of Medicare and Medicaid I find so appealing is 
they have shown a certain ability, a sense of creativity, to always 
evolve with the times.
  What I would like to do is take a few minutes to describe how I think 
Medicare and Medicaid are going to change in the next 50 years because 
I think there are some remarkable developments ahead. I see my 
wonderful colleague from the Senate Committee on Finance. She has been 
very involved in a number of these changes that have been so exciting 
in Medicare and Medicaid.
  What I am going to do this afternoon is just take a few minutes to 
talk about four or five trends that I think

[[Page S6171]]

are going to be led by these two programs that have done so much for 
seniors and vulnerable people in our country.
  The first is, I believe Medicare and Medicaid are going to lead a 
revolution in caring for vulnerable people at home. Our health care 
programs are going to give seniors more of what they want, which is to 
secure treatment at home where they are more comfortable. I think 
people are going to be amazed to see that seniors will get more of what 
they want, which is treatment at home--in Michigan, in Oregon, in 
Nebraska--and we now have hard information that it will be less 
expensive for older people to get what they want.
  In the Affordable Care Act, I was able to author a provision with our 
colleague, the distinguished Senator from Massachusetts, Mr. Markey, 
the Independence At Home Program. This program has already shown it can 
save more than $3,000, on average, for every patient who takes part.
  So picture that. This is not an example of reducing the Medicare 
guarantee--these guaranteed secure benefits that older people in every 
part of America rely on. This is about protecting the Medicare 
guarantee and doing it in a way that keeps seniors happier and costs 
less money. That is a pretty good package by anybody's calculation.
  In my home State of Oregon, the Medicaid Program also has a smart 
policy that tracks this focus on caring for the vulnerable at home. In 
effect, what Oregon Medicaid has done is allow health care providers to 
offer services that go beyond what many might consider the textbook 
definition of a medical service. It is all about keeping people 
healthier at home and out of the emergency room. So instead of waiting 
to treat broken ankles or wrists, perhaps in a hospital emergency room, 
after a senior falls again and again and again, what we are now doing 
in Oregon Medicaid is saying the staff of this program will visit the 
senior's home and perhaps replace the broken floorboards or the 
dangerous rugs that are causing the seniors to slip again and again and 
go to the hospital emergency room.
  Think about that. You could help a little bit at home by replacing a 
dangerous rug or you could have somebody slip and fall again and again 
and again and go to the hospital emergency room. Again, replacing that 
dangerous rug wouldn't probably meet the clinical definition of a 
medical service as it was always determined in years past, but now we 
are seeing it as part of having older people in a position to be at 
home, where they are more comfortable, for less money.
  The second significant development where I think Medicare and 
Medicaid are going to lead is on pharmaceuticals. I think the pricing 
of prescription drugs in the future is going to be connected in some 
fashion to the value of treatment. We have seen remarkable changes in 
pharmaceuticals. The reality is that in the last 10 years we have seen 
real cures for illnesses where there was a death sentence perhaps a 
decade ago, but the sticker prices on some of these pharmaceuticals are 
astronomical. For so many working-class families and seniors of modest 
means, they look at these prices and say this just defies common sense, 
and they seem to get more expensive over time. Sometimes there is a 
six-figure pricetag.
  The reality is Medicare and Medicaid weren't set up for these kinds 
of costs. The experts at the Congressional Budget Office are starting 
to ring the alarm bell, particularly about the health of Medicare Part 
D. Addressing this issue is going to take a lot of vigorous debate in 
the Congress, but it can't be ducked any longer.
  Senator Grassley and I have been working for about a year now in 
looking into SOVALDI, one of the hepatitis C drugs, which has had 
enormous ramifications for health programs--Medicare, Medicaid, and 
others--and we are continuing our work.
  Third, in addition to pharmaceuticals and home care, I think Medicare 
is going to lead the revolution for open access to health care data. 
Again, Senator Grassley and I have put a lot of sweat equity into the 
issue of data transparency in Medicare. It paid off in 2014, when the 
Obama administration, to its credit, opened up a massive trove of 
information. The wave of disclosure that began, particularly with 
doctors--and the Wall Street Journal reported this very extensively--
must keep rolling forward.

  The next step is turning open data into valuable tools and getting 
them into patients' hands. Health care data, packaged the right way, 
ought to help seniors and others choose doctors and nursing homes. It 
ought to help figure out which hospitals and specialists excel in 
certain areas, and it ought to help show exactly what you get for your 
dollar with various treatments or doctors.
  Fourth, I believe Medicare is going to lead the debate on improving 
end-of-life care. All the roads with respect to end-of-life care, in my 
view, point toward patients having more choices and a better quality of 
life. In my view, we ought to make sure patients are in the driver's 
seat. In this regard, I was very pleased the Obama administration 
announced just a few days ago a real breakthrough in terms of end-of-
life care. I think we have all had the debate. We certainly had that 
debate in the Affordable Care Act, where we heard about seniors not 
being given the opportunity to choose life, to choose cures, and they 
were going to, in effect, be receiving what amounted to death 
sentences.
  In the Affordable Care Act, I was able to get included a provision 
that made it clear that is not what this debate would be all about. For 
the first time it would be possible for an individual who is receiving 
hospice care to also have the option for curative care. In other words, 
they would not have to sacrifice one for the other. That is very 
important to patients because even when patients are contemplating the 
prospect of hospice care, they want to know--because it is almost in 
our gene pool as Americans, as Nebraskans, and Oregonians--whether 
there may be a cure. Maybe our ingenuity will come up with a cure, and 
they want to have that hope. Now they are going to have it.
  The result of the change is called concurrent care--the Care Choices 
model. For the first time patients and families will be in the driver's 
seat and they will not have to give up the prospect of curative care in 
order to get hospice. For the first time we are giving those who want 
treatment in hospice some real flexibility.
  Next, I think Medicare is going to go further to protect Americans 
with catastrophic coverage. The reality is that millions of Americans 
who are younger than 65 are protected against the huge expense of an 
accident or serious illness. This is an area where I think Medicare, 
having led in so many areas with the kind of creative genius I have 
described--going to show the way on home care, pharmaceuticals, end-of-
life care, and more access to data--that most advocates for seniors say 
Medicare has a little catching up to do. Seniors ought to have the 
safety of an out-of-pocket maximum in Medicare.
  I know this is an area I very much look forward to talking to my 
colleague from Michigan about. She has been a wonderful advocate for 
seniors throughout all her career in public service. I think colleagues 
on the Committee on Finance of both political parties are going to say, 
if there is catastrophic protection in the private sector, it is high 
time we have it for seniors on Medicare. I think this is an area we 
will also be talking about.
  I want to wrap up with one last point; that is, about Medicaid. I 
also believe more States are going to come around and expand their 
Medicaid Programs. It took nearly two decades for all 50 States to 
adopt Medicaid initially, so there is already a history of this 
unfolding over time.
  When we look at the numbers, we see the proposition and the benefit 
of expanding Medicaid is not exactly some kind of theoretical notion. A 
new study shows there is a gulf opening in terms of access to health 
care between States that have expanded Medicaid and States that have 
not.
  In our country, everybody should have access to medical care, 
regardless of their ZIP Code, but it is not only a question of what is 
best for the health of our people, it can often be pretty important to 
a State's economy. A recent study found that Kentucky and their cost of 
covering new Medicaid patients will be far outstripped by the other 
economic benefits of expanding the program. In my view, more States are

[[Page S6172]]

likely to do the right thing by their citizens and their economies, and 
the gulf between those States that cover individuals on Medicaid and 
those that do not will narrow.
  Mr. President, I am going to close on a little bit of a personal 
note. My background is working with older people. Years ago I was 
director of the Oregon Gray Panthers. It was an extraordinary honor to 
be able to do this. Those were the days when if a town had a lunch 
program for older people, it was considered a big deal. Senator 
Stabenow was starting her career in the Michigan Legislature, and she 
remembers those days. It was a big deal when a town just had a lunch 
program where older people could congregate. That was considered a 
pretty serious array of senior services because you could get a few 
things there where older people got lunch.
  So as we have heard, now we are looking at the opportunities for 
extraordinary innovation.
  Elizabeth Holmes was here today and had a chance to visit with 
several Members. She has taken the whole notion of personalized 
medicine--and personalized medicine where in effect an individual could 
order their own test, and it costs only a few dollars. The State of 
Arizona has already embraced it. She is talking to government officials 
about something that would empower patients and would make sense from a 
health quality standpoint and from the standpoint of cost.
  She is a young, very gifted woman. I believe she is a graduate of 
Stanford, my alma mater. I talked yesterday to her about this. I could 
just see the enthusiasm for the future of health care and what she has 
already been able to accomplish and what she is going to be able to do 
in the days ahead with this new focus on personalized medicine and 
tests that empower patients to make their own decisions about health 
care. As to the sums of money that are involved for the tests, I am not 
sure they are even going to be able to be processed by government 
computers because they are too small. We are going to save too much 
money. So there are going to be very exciting developments ahead for 
Medicare and Medicaid.
  The last 50 years have been an extraordinary run for these programs. 
It is a personal thrill for me to have been involved in the early years 
of these programs. Now they are essential to the well-being of more 
than 100 million Americans.
  We take this special day to kind of savor how much progress has been 
made from the days when America had poorhouses and almshouses for 
seniors to today, where Medicare is leading the way on home care and 
disclosing data and looking at new approaches with respect to health 
tests, such as what Elizabeth Holmes has been here to visit on. We can 
see that with Medicare and Medicaid, their particular genius is that 
they are always keeping up with the times and looking to new approaches 
that better meet the needs of older people and do it in an affordable 
fashion.
  I will close by way of saying that I don't think there is a single 
area I have talked about--I know my colleague and the Chair are members 
of a different political parties--or I don't think there is a single 
issue that I have brought up here in the last 15 or 20 minutes that 
Democrats and Republicans can't find common ground on. In fact, 
Chairman Hatch in the Finance Committee, to his credit, has said that 
by the end of the year he wants Democrats and Republicans on our 
committee to produce a bill dealing with chronic illness--which, as I 
suggested, is what Medicare is all about and is responsible for 90 
percent of the spending. So on that hopeful note, after an incredible 
50-year run, I think the next 50 years are going to be even better. In 
the four or five areas that I have been talking about for a few 
minutes, I don't think there is a one of them where Democrats and 
Republicans can't find common ground.
  I know my colleague from Michigan is waiting to speak. I will note as 
I wrap up that she has really been a leader in this field, particularly 
in getting Democrats and Republicans together. By the way, as she 
begins her speech, I would note that many Americans are going to 
receive better mental health care services in the years ahead largely 
due to the work--the bipartisan work--of my colleague on these issues.
  So I am happy to wrap up my comments and look forward to hearing from 
my colleague from Michigan.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, before my friend from Oregon leaves, I 
wish to make a couple of comments about our leader on the Finance 
Committee. Sitting and listening to him about his optimism and 
hopefulness really helps me have optimism so we can actually come 
together and get things done.
  I can't think of anybody who, first of all, is more creative or 
willing to look at all kinds of ideas in order to be able to strengthen 
health care--Medicare, Medicaid--for quality and cost containment 
issues. Back during health care reform, I was proud to join Senator 
Wyden on what I believe was an extremely thoughtful approach around 
health care. Again, I very much appreciate all that he does.
  I have to say that I know he has reminded me many times about coming 
to the Senate and elected office from the early years with Gray 
Panthers and organizing for seniors. I come to public-service elected 
office after a big fight to save the county nursing home in Ingham 
County, Michigan. So we both came to public service fighting for health 
care for older Americans. It is my honor to continue to serve with him 
and also with the Senator from Pennsylvania, who has joined us on the 
floor as well.
  I do in fact come to recognize the 50th anniversary of the signing of 
Medicare and Medicaid into law. I view these as great American success 
stories and the best about us in terms of our values. I think it is 
important, though, when we look at this, to sort of say: This is 
Thursday; we are going to do a ``Throwback Thursday'' moment here, and 
look at the context in which these programs were created.
  There was the early 1960s. It was a time of great social upheaval. It 
was a time, frankly, of segregation and Jim Crow laws and a time also 
when there was no safety net for older Americans or Americans with 
disabilities when it came to the possibility of going to the doctor or 
getting the medical care that people needed. If someone was living in 
poverty, they simply could not afford to see a doctor to be able to get 
medical care for them or for their family.
  But within the civil rights movement, our Nation became more attuned 
to the injustices of society for people of color as well as those in 
society who were struggling with illnesses--just basic health care 
needs--or with poverty.
  In 1963, in his ``I Have a Dream'' speech, Martin Luther King 
challenged Americans to live out the true meaning of the creed of our 
Nation, the Declaration of Independence: that all men and women are 
created equal, and that all of us are entitled to life and liberty and 
the pursuit of happiness. I think that includes access to health care 
for ourselves and our families. Our country responded to that challenge 
through the passage of the Civil Rights Act and through the passage 50 
years ago of legislation that created Medicare and Medicaid. This was a 
momentous event in our Nation's history. It demonstrated our 
willingness to take action to ensure that our Nation's laws were in 
line with our core values as a country. It is so important that we be 
working together to do that again. That is what we should be doing 
every day.
  Let's remember that before the creation of Medicare, only half of our 
seniors had health insurance or could even find health insurance. That 
meant half of them were struggling probably to get the medical care 
they needed or they were going into an emergency room--which, by the 
way, is the most expensive way--to be treated rather than going to the 
doctor and getting preventative care and so on. We saw about half of 
our seniors and people with disabilities in that situation.
  President Lyndon B. Johnson was the strong principled leader we 
needed in that moment, and 50 years ago he signed the Medicare bill 
into law. When he did, he said:

       No longer will older Americans be denied the healing 
     miracle of modern medicine. No longer will illness crush and 
     destroy the savings that they have so carefully put away over 
     a lifetime so that they might enjoy dignity in their later 
     years.


[[Page S6173]]


  The Medicare Program really is a great American success story that 
connects all of us together--each generation--and each generation has 
done its part to strengthen that, including our own. That is why it is 
so important that we not go backwards at this time. This is where, 
unfortunately, we see a real difference here in the Senate and the 
House and in the political discourse more broadly, because we have 
seen, unfortunately, a Republican budget--House and Senate--that has 
passed this year with almost $500 billion in Medicare cuts, efforts to 
turn the system away from a universal program into something that--
whether we call it vouchers or whether we have other names for it--
would take away the confidence and ability for older people and people 
with disabilities to know they have health care, which is what Medicare 
is all about.
  What we need to be doing instead of those things--and we even have 
Presidential candidates saying we should phase out Medicare. We should 
not be doing that. We should be working to ensure the programs' health 
and longevity so people are confident that, as they work and pay into 
the system--because, by the way, people are paying into this system--it 
will be there when they retire in terms of a health care system for 
them.
  I also very much appreciate our ranking member in the Finance 
Committee talking about the new things we need to do. I will just 
mention one. When we look at Medicare, $1 out of $5 today is spent on 
Alzheimer's, as our ranking member knows. So many of us are working 
together. There are bipartisan efforts going on to tackle this 
question. Senator Collins from Maine and I have what is called the HOPE 
for Alzheimer's Act. Senator Collins is also working very hard and has 
in fact increased research, which is so important. But we need to know 
that we are doing everything we can to support Alzheimer's patients and 
their families and to find cures.
  The exciting part is that we are seeing more and more opportunities 
through research. I have had so many conversations with researchers in 
Michigan and across the country. We are so close in so many areas to be 
able to break through if we don't go backwards on research funding, as 
unfortunately happens if we are not coming together and appropriately 
funding the budget.
  So there are a lot of things we need to do: save dollars, increase 
quality, and make sure we are tackling the challenges right now of 
health care for older Americans. I am constantly reminded that in my 
State there are nearly half a million people right now who get their 
health care through Medicare and some 40 million nationwide.
  I will talk for a minute now about the other path on that 
legislation, which is Medicaid. Now, that program came in response to a 
crisis in health care for low-income Americans and those with 
disabilities as well, and it has been nothing less than a lifeline for 
people, saving lives now for 50 years. During this last great recession 
that we had, there were so many families struggling to pay for basic 
health care needs that Medicaid literally was the saving grace that 
helped them and their families get back on their feet.
  Medicaid is especially vital to women. Nearly half of all births in 
our country are funded through Medicaid. It gives young women access to 
preventative services such as cancer screenings.
  I would also again thank our ranking member and our chairman for 
including legislation on Medicaid and a series of bipartisan bills that 
just passed the Senate Finance Committee. The Quality Care for Moms and 
Babies Act is about making sure we have quality standards across the 
country for low-income moms who are pregnant, going through prenatal 
care, delivery, and for babies. Senator Grassley from Iowa is my 
partner in that effort.
  It is also critical to note that on Medicaid, actually 80 percent of 
the dollars goes to long-term care for low-income seniors. As I said in 
the beginning, when I got involved in this whole process of public 
service and elected office, it was because of a nursing home that took 
Medicaid and helped low-income seniors be able to have a nursing home. 
In fact, 80 percent of Medicaid goes for seniors in nursing homes and 
long-term care.
  Unfortunately, as with Medicare, what we have seen in the budgets is 
this: Rather than working together to strengthen Medicaid, we have seen 
countless attacks over and over to cut funding, to block grant the 
program. Over $1 trillion in the next 10 years to cut Medicaid was 
actually passed by the Republican majority in the House and the Senate.
  That is not the direction we need to go in as we are celebrating the 
50th anniversary of Medicare and Medicaid. We still have Governors who 
refuse to use funding that is available to them to cover their seniors 
in nursing homes under Medicaid or moms and babies, families--low-
income working families.
  We put into the Affordable Care Act the ability for people who are 
working in low-paying jobs to be able to have access to health care 
through Medicaid. Yet we still have 3.7 million Americans who can't get 
health care. It is not because the money is not there but because of 
politics. I think that is pretty outrageous.
  Of the 3.7 million, 2 million are women. That is 2 million women who 
can't get health care services, whether it is screenings or mammograms, 
they can't get coverage for labor, delivery, and prenatal care. It is 
available. It is right there. It is not happening because of politics.
  I am determined--as I know our ranking member is and my Democratic 
colleagues are as well--to make sure we are standing up for Medicare 
and Medicaid every single day. Medicaid is a program that allows 72 
million Americans--including nearly 13 million working Americans, low-
income working Americans who have gotten coverage because of the 
Affordable Care Act--to be able to go to bed at night with the 
knowledge that if their children get sick, they will be able to take 
them to the doctor or for any of us, if our parents or grandparents 
need a nursing home, they will be able to have one.
  Medicaid and the Children's Health Insurance Program together provide 
33 million children with the ability to see a doctor, to get the 
operation they need, to be able to have their juvenile diabetes taken 
care of or other health care issues.
  Today is not just an anniversary of programs. I think it is an 
opportunity to recommit ourselves to the ideals that created these 
programs, the values that are behind these programs, and to say that 
health care is pretty important to families.
  Now, 50 years ago we decided for our seniors we were going to make 
sure they could live in dignity in retirement and know they were going 
to be able to get the health care they needed. People are living longer 
and healthier lives. People are living today because of Medicare, 
Social Security, and Medicaid, all together. That is a great thing. We 
should be celebrating the fact that President Johnson, working with the 
Congress, got that done.
  I believe this is the kind of approach we need to continue to 
strengthen for future generations. There is a huge divide right now 
about what to do on these programs, unfortunately, but I can say that 
we as Democrats are recommitting ourselves to a strong Medicare Program 
and a strong Medicaid Program for the future for American families.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I rise as well--as the senior Senator from 
Michigan just told us--to highlight and celebrate this anniversary, 50 
years for both Medicare and Medicaid.
  I am going to focus my remarks on Medicaid and to say, first, that 
contrary to what we often hear about an important program such as this, 
Medicaid is working. Medicaid is helping tens of millions of Americans. 
We can all come up with ways to make changes, and we probably will over 
the next couple of years, but Medicaid is maybe one of the most 
underrated health care programs in recent American history, for sure, 
and it is not simply millions who are benefiting from Medicaid but tens 
of millions. There are 68 million Americans who are Medicaid 
beneficiaries nationally and 36 million of them are children.
  When folks talk about families and children and the priority we place 
on helping our families, I hope that means

[[Page S6174]]

strengthening Medicaid, not slashing it, not destroying it, and not 
taking some of the steps that have been proposed in Washington over the 
last couple years.
  It is interesting, about 45 percent of all births in the country are 
paid for by Medicaid. So 45 percent of the babies born in America are 
on this Earth because they have the Medicaid Program to pay for the 
cost of the birth, which is not inexpensive. On the other end of the 
age spectrum, about 60 percent of nursing home placements in the 
country come through Medicaid. This isn't a program for someone else 
far away. This is a program that affects most of America. A lot of 
lower middle income families and others have the opportunity to place a 
loved one in a nursing home because of Medicaid, as well as what I said 
about the births.
  Another way to think about Medicaid is the impact on children across 
the country--not only children in urban areas or children in 
communities where most families are low-income. When you examine both 
health care for children as it relates to Medicaid and to children who 
receive health care through the Children's Health Insurance Program--
which in Pennsylvania we call CHIP--in rural areas that number is very 
high. There was a study done last fall that 47 percent of rural 
children get their health care from either Medicaid or from the CHIP 
program--actually, a higher percentage of the children in rural areas 
than in urban areas.
  This is serious business when we talk about highlighting the benefits 
of Medicaid--not just celebrating an anniversary but celebrating 
working and having a sense of purpose and solidarity about preserving 
Medicaid for our families and strengthening it where we can.
  One of the reasons Medicaid has been so successful over time is 
because of some of the strategies that were embedded in the program 
many years ago, especially as it relates to children. We know Medicaid 
serves children. It serves individuals with disabilities. In fact, that 
is a big number as well. Now, 8.8 million nonelderly individuals with 
disabilities are Medicaid beneficiaries nationally. It serves 
individuals with disabilities. But when you focus just on children as a 
segment of Medicaid, here is what we find in one of the strategies put 
in place years ago: The so-called EPSDT--Early Periodic Screening, 
Diagnosis, and Treatment Program--that benefit is of substantial 
significance for the future of our children and therefore the future of 
our country. Early periodic screening, diagnosis, and treatment is 
responsible for making sure vulnerable children receive quality and 
comprehensive care. Private insurance companies should emulate in their 
care what is provided in the so-called EPSDT.

  Twenty-five million low-income children have access to this important 
program through Medicaid. What is it? I think it is evident from the 
name, but it is good to highlight what it means. First of all, the 
``early'' part of it is the early access in identifying problems early. 
The second word is ``periodic,'' which means checking children's health 
at periodic age-appropriate intervals. ``Screening'' is self-evident, 
but maybe you don't remember what is behind the screening. It is 
providing physical, mental, developmental, dental, hearing, vision, and 
other screening tests to detect potential problems. The ``screening'' 
part of early periodic screening, diagnosis, and treatment is vital. 
``Diagnostic'' is performing a diagnostic test to follow up when a risk 
is identified. ``Treatment'' is control, correct or reduce health 
problems when they are found.
  This isn't just vital to the life of that child and his or her family 
and his or her ability to grow and learn in school and then succeed and 
get a job and contribute to our country, it is also important to the 
rest of us. We are going to be a much stronger country if children are 
the beneficiaries of preventative health care. We all know that. The 
data has been telling us that for decades. We are just starting to get 
about the business of finally, at long last, doing more preventative 
work in our health care system, just like Medicaid has been doing on 
behalf of children for many years. I think we are learning some lessons 
from Medicaid that can be applied to the rest of our health care 
system.
  I know we are short on time because we have a number of people who 
want to make presentations today. I will reduce my remarks in this 
fashion. I will tell one story from my home State. Here is one example 
of a particular family, the Sinclair family. In this case, Owen 
Sinclair was born with a genetic defect with wide-ranging effects. His 
aorta wraps around his trachea and esophagus. He has trouble 
swallowing, jaundice, and has other organs that are malformed because 
of his condition. He needed extensive treatment at a specialized unit 
of the local children's hospital in Pennsylvania. After birth, he had 
to stay in the hospital on and off for most of the first 6 months of 
his life, but his parents' insurance only covered him for 30 days after 
birth. The tests and treatments and the surgeries and medications were 
far beyond the income of his parents. In the first 30 days, their 
copays alone were more than $15,000--30 days, $15,000. Medicaid 
literally saved this child's life. Owen Sinclair needs continuing 
testing, treatment, and nutrition support. The Sinclairs worry about 
their little boy, but at least they don't have to worry about going 
bankrupt because they love him and want him to get the medical care he 
needs.
  That is the real world of the substantial and immeasurable benefits 
that Medicaid provides in the life of a child, the life of a family, 
and obviously in the life of our Nation's future.
  We have to do more today than just celebrate 50 years. That is nice. 
We should all take time to celebrate, but we have to be committed and 
recommitted to the future of Medicaid, to strengthen it, to support 
it--not to undermine it and not to destroy the benefits we all know are 
vital to our children, vital to their future development, and vital to 
help them learn. If kids learn more when they are young, they are going 
to earn more later. We are all better off for that.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Barrasso). The Senator from Virginia.
  Mr. KAINE. Mr. President, I also rise to celebrate this important 
anniversary. Fifty years ago today, President Lyndon Baines Johnson 
signed into law Medicaid and Medicare with my favorite President 
sitting next to him, President Harry S. Truman.
  Mr. President, I came up and asked you a question, and I am proud to 
tell the whole Chamber, as everybody is listening, there is only, I 
think, one Member of the current U.S. Senate who was at the 
inauguration of LBJ, and it is the Presiding Officer, the Senator from 
Wyoming, who was at that inauguration in January of 1964.
  Clearly, the signature of Medicare and Medicaid was one of President 
Johnson's and one of our Nation's proudest legislative achievements. 
Medicare is the landmark program which makes sure seniors have access 
to health care, and Medicaid is equally critical. It helps low-income 
seniors, children, and people with disabilities get their necessary 
health care.
  Today I wish to talk about Medicaid. Others have spoken about 
Medicare earlier. Senator Casey did a good job speaking about Medicaid, 
and I want to do the same because I have seen the success of Medicaid 
as a mayor and as a Governor, and now as a Senator, it is absolutely 
critical.
  In 2014, as Senator Casey mentioned, Medicaid provided health 
coverage to nearly 70 million Americans, including 1 million 
Virginians. In Virginia, about 600,000 children, 2 out of every 7 kids, 
are covered through Medicaid or its companion program CHIP. Medicaid is 
important. The Presiding Officer is a physician, so he knows that 
Medicaid is not just coverage to get health care when you need it, it 
is also about financial security because health care bills are often 
what push families into bankruptcy or into financially stressful 
situations, so the Medicaid coverage that covers 70 million Americans 
gives them financial stability.
  Medicaid is about peace of mind. If you are completely healthy, but 
you are going to sleep at night wondering what will happen if your wife 
is in an auto accident or if your child becomes ill, that is a source 
of anxiety that is helped a little bit by having the coverage that 
Medicaid provides.
  It is also for people with disabilities. This is important to note. 
It is about independence. A lot of citizens with disabilities, because 
they are able to be on Medicaid, are able to work part

[[Page S6175]]

time because Medicaid provides them with coverage that enables them to 
live independent lives. That is what Medicaid is about.
  Now, today at 50, we think Medicaid is a given, but let me remind 
everybody that Medicaid was controversial when it was passed 50 years 
ago. In the House and Senate there were a lot of ``no'' votes, and 
Medicaid was an opt-in program, not a mandate. States could decide 
whether to opt-in or not. A lot of States chose not to be a part of 
Medicaid. They were the slowpoke States.
  I think every family knows what I mean. Every family probably has a 
slowpoke. Frankly, I have a sister-in-law who is a slowpoke. If we are 
trying to go to church, a restaurant, or anywhere, we can always know 
that whatever time we say we will go, we will have this one family 
member who will likely be the slowpoke and hold everybody back.
  Well, States were like that in 1965. A lot of States wouldn't sign on 
to Medicaid. By 1972, 7 years later, 49 States had embraced Medicaid, 
but the 50th State, Arizona, didn't embrace Medicaid until 1982. It 
took them 17 years to embrace Medicaid. Arizona was the original 
Medicaid slowpoke. So Medicaid is now 50 years old. It was 
controversial at first, increasingly accepted, and later embraced. It 
kind of sounds familiar to me.
  The biggest change in the health care system since the signing of 
Medicaid and Medicare was the Affordable Care Act. The Affordable Care 
Act has so many benefits, such as protecting people with preexisting 
conditions, rebating premiums back to folks if they have to overpay 
their health insurers, making sure women don't have to pay different 
premiums than men, and there are so many other benefits. But the 
biggest benefit of the Affordable Care Act is that in the United States 
right now there are 16 million people with health insurance coverage 
who didn't have it before and are now able to walk around, go to work, 
and be with their families because of the expansion of Medicaid. 
Sixteen million is a very big number. I will put that in perspective. 
There are 16 million people who didn't have health insurance before and 
now have health insurance coverage because of the ACA. Sixteen million 
is the combined population of Alaska, Delaware, the District of 
Columbia, Hawaii, Idaho, Maine, Montana, Nebraska, New Hampshire, New 
Mexico, North Dakota, Rhode Island, South Dakota, Vermont, West 
Virginia, and Wyoming. The combined population of 15 States, plus the 
District of Columbia, has health care coverage because of the 
Affordable Care Act. But there is more to do.
  One piece of the ACA is the ability of States to expand Medicaid to 
cover those who make up to $16,000 a year. It is optional, just as 
Medicaid was in 1965. Thirty-one States have embraced the Medicaid 
expansion, but as of today, we have 19 slowpokes, and I am sad to say 
that Virginia is one of the slowpokes. Despite the best efforts of our 
current Governor, working so hard to try to get the State to accept 
Medicaid expansion, so far the legislature has blocked him from doing 
so.
  This is just like 1965, 50 years ago. There are States that get it 
and embrace the program, and then there are the slowpoke States.
  I am here today not just to say happy birthday to Medicaid and 
Medicare, but to urge Virginia and the other slowpokes to get with the 
program. Here is what it would mean in Virginia: If Virginia accepts 
the Medicaid expansion, it will open up the possibility of health care 
coverage to another 400,000 people. It would provide health care, 
financial security, independence for those with disabilities, and peace 
of mind even when you are well. If all 19 slowpoke States get on board, 
an additional 4 million Americans would get health insurance, which 
would take the ACA coverage number up to 20. Those are all the States I 
mentioned earlier, plus the State of Nevada--16 States and the District 
of Columbia.
  Now, you shouldn't be consigned to second-class health status in this 
country because you live in one of the 19 slowpoke States, especially 
since your taxpayers are paying taxes to provide you coverage.
  Senator Brown and I have authored a letter, which has been signed by 
many in this body, to the 19 slowpoke States. We asked them to join the 
program during Medicaid's 50th year. The program has an amazing legacy 
and a bright future. Don't be a slowpoke.
  Remember how I said that Arizona was the original slowpoke? It was 
the last State--17 years later--to embrace Medicaid in 1982. Well, they 
may have been the original slowpoke, but when it came to the ACA, they 
learned something. Arizona--with a Republican Governor, two Republican 
Senators, a Republican State legislature, an overwhelmingly Republican 
congressional delegation, and votes for Republican candidates in 
Presidential elections--is not a slowpoke. Arizona has embraced the 
ACA. They are now a jackrabbit. Good for them. I hope Virginia joins 
them soon. I hope that all remaining 19 States join them soon, and I 
hope that 4 million more Americans can have health insurance coverage 
with the health, financial security, and peace of mind that that will 
provide.
  I thank the Presiding Officer.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.


                     Drinking Water Protection Act

  Mr. PORTMAN. Mr. President, I rise to talk about the Drinking Water 
Protection Act. This is commonsense, bipartisan legislation. Nobody 
opposes it on the merits, and it is urgent we get it done for my home 
State of Ohio and States all around the country.
  What could be more important than having access to clean drinking 
water? There are a lot of pollutants in the water that contribute to 
not having clean drinking water. Of particular concern to us right now 
in Ohio are the toxins in the harmful algal blooms. This is blue-green 
algae that appears in both fresh water and saltwater. In the case of 
drinking water, unfortunately, it is finding its way into more and more 
fresh water bodies that provide drinking water.
  This is something that is a big concern, not just for drinking water, 
but it can also cause illness or death in humans, pets, wildlife, and 
it is doing so, unfortunately, in my State of Ohio and around the 
country. If not confronted, these toxins will continue to contaminate 
our lakes and other fresh water bodies. Unfortunately, in Ohio we are 
all too familiar with this.
  About a year ago, last summer, Toledo had to actually shut down the 
use of their water supply. They had to tell people there was a ban on 
drinking water. It was a big deal. Up to 500,000 people were affected. 
I was actually back home in Ohio because this happened over a weekend, 
and I filled up my pickup truck with bottled water and made a beeline 
for Toledo because people were desperate. I was able to pass out 
bottled water and also work with the local officials to try to get the 
testing done by EPA and to be sure that we could clean up the water 
supply.
  It took a while, and you can imagine the impact on Toledo and the 
impact on so many other people now all over the northern part of Ohio 
who depend on Lake Erie for their water supply because they are 
wondering--again, this year we have a heavy toxic algal bloom forming. 
What is going to happen to their water supply?
  Unfortunately, it not just Cleveland, Toledo, and cities along the 
lake. Celina, OH, which is further south but gets its water from Grand 
Lakes St. Marys, which is another fresh water lake. It is actually a 
reservoir and the water supply for Celina, among other things. Celina 
has spent over $400,000 annually just to combat the algae in Grand 
Lakes St. Marys.
  Columbus was forced to spend over $700,000 to mitigate an algae 
outbreak at the Hoover Reservoir in 2013. Buckeye Lake in Ohio has also 
been affected by this. Again, it is not just Ohio; it is happening, 
unfortunately, around the country.
  These harmful algal blooms continue to put public safety and health 
at risk. We have to keep our fresh water resources safe so our drinking 
water isn't threatened, and natural habitats and echo systems are 
protected.
  By the way, this isn't just about drinking water either. Our 
waterways are important economic engines as well. Lake Erie, as an 
example, brought in $1.8 billion in business activity last year just 
through the fishing industry, and $226 million in taxes in 2013 alone. 
Tourism around the lake now supports one in four private sector jobs.

[[Page S6176]]

  I was at Lake Erie last weekend, and I had the chance to go out on 
Lake Erie. I was out there with Captain Dave Spangler. This is Dave 
Spangler. Dave was the charter boat Captain of the Year in 2014, and 
the reason he became the charter boat Captain of the Year is not only 
because he is a great fishermen and knows how to find the fish, but he 
is a good steward of Lake Erie. He gets out there, along with other 
charter boat captains, and they actually monitor the quality of the 
water, including taking samples.
  This is one of the samples that he took. This is what I saw when I 
was on Lake Erie. If you look at it, you can see that it is a jar. I 
was told I couldn't bring it on the floor today because I brought it 
back to DC with me from Ohio, but I wanted to have a photograph of it.
  This is what it looks like. This is the blue-green algae that are in 
that water. This is the stuff that is cutting off the oxygen supply for 
the fish, creating toxins so you can't swim in it, and it is also 
contaminating the drinking water if you get too much of it, as we did 
last year. We are fearful that it might happen again this year because 
it is another bad year. The weather patterns were all wrong. There was 
a lot of rain early on; therefore, a lot of runoff, and now a lot of 
heat and stillness on the lake which creates the algal bloom. This is a 
real problem for us right now, and it is a real concern to the people I 
represent in Ohio but also to places all over the country that are 
dealing with this issue.
  After we were out on Lake Erie, we hosted a townhall meeting where 
people came in from the area. This included not only fishing boat 
captains, but also small business owners, marina owners. It included 
people who are living along the lake, residents who are very concerned 
about the future of the lake. We had a bunch of experts there. We 
talked about the algal blooms and how to deal with it. It all came back 
to the fact that we have to take action at the local, State, and 
Federal levels.
  We have passed legislation on this. We passed it last year. It has 
been helpful at the Federal level. We have come up with a new bill that 
will help to deal with this issue by forcing the Federal departments 
and agencies to work better together to come up with a report on how to 
better monitor what is happening, how to ensure that we have a 
strategic plan that actually identifies the human health risks from 
contaminated algal toxins and recommends feasible treatment options, 
including procedures on how to prevent algal toxins from reaching these 
local supplies in the first place, and of course to mitigate adverse 
public effects of algal toxins.
  This is an appropriate role for the EPA. It is an appropriate role 
for NOAA, by the way, to do the monitoring because they have satellites 
that can help us to monitor what is happening on Lake Erie and other 
fresh water supplies for drinking water around the country.
  This is a critical piece of legislation. It was introduced in the 
House by Congressman Bob Latta. It was supported on a bipartisan basis 
in the U.S. House. They have already passed it in the House of 
Representatives. They passed it in February. It passed by an 
overwhelming vote of 375 to 37.
  It then came over here to the Senate where Sherrod Brown, my 
colleague from Ohio, and I had drafted legislation on this. I commend 
Senator Brown, who was just down here on the floor. We were just 
talking about this legislation. We put it into the process here to 
begin getting it cleared by Democrats and Republicans back in March. So 
for 4 and \1/2\ months, we have been trying to clear this legislation.
  This week, I learned that the legislation is cleared, that nobody has 
substantive concerns with it, and we can finally move forward with it, 
and none too soon. We need this help, and we need it now. The people 
who live along the lake and get their drinking water from these 
reservoirs and other lakes I talked about are worried, and for some 
very good reasons. By the way, they are closing down beaches in my area 
because of this. There are pets and people who are seeing negative 
health effects from it.
  We need to get the EPA more engaged and involved. We have a 
bipartisan way to do that. Again, it passed the House by an 
overwhelming 375 to 37 vote.
  I am hopeful we can get this legislation passed tonight by a voice 
vote. We need to do everything we can to bring the Federal resources 
together, along with State and local governments and local conservation 
groups to combat this threat.
  This is something, again, that is a no-brainer, as they say. It is 
one that everybody supports. It is one that is an urgent matter for us 
in Ohio. It is a matter that is of great concern to us right now. We 
need to get it moving, and it is one where we have bipartisan and 
bicameral support.
  If we act tonight to clear this legislation and get it done, it will 
go to the President's desk for signature. And, of course, the President 
will sign it. Why? Because it is good, commonsense, bipartisan 
legislation that engages the EPA in an appropriate role to ensure that 
we can deal with these harmful algal blooms before they cause more 
damage and before we have another huge drinking crisis, just as we had 
last summer, in Toledo, OH.
  So tonight I am going to ask my colleagues to pass this legislation. 
I am going to ask that there be a voice vote on it. I hope that this 
will go smoothly and that we can get this done.
  Again, for 4\1/2\ months we have had this out there. Everybody has 
had a chance to look at it. There are no substantive concerns with it.


                  Unanimous Consent Request--H.R. 212

  So at this time I ask unanimous consent that the Senate now proceed 
to this legislation, which is H.R. 212, which is at the desk; that the 
bill be read a third time; and that the Senate vote on passage of the 
bill with no intervening action or debate.
  The PRESIDING OFFICER. Is there objection?
  The Senator from New Mexico.
  Mr. UDALL. Mr. President, with great respect for my colleague from 
Oregon, I object. But I object because there is an additional 
bipartisan proposal that is out there and another unanimous consent 
request where this bill is paired with another bill.


            Unanimous Consent Request--H.R. 212 and S. 1523

  I ask unanimous consent that the EPW Committee be discharged from 
further consideration of H.R. 212, a bill to provide for the assessment 
and management of the risk of algal toxins in drinking water, and S. 
1523, a bill to reauthorize the National Estuary Program; further, that 
the Senate proceed to their immediate consideration en bloc; that the 
Senate proceed to vote on passage of the bills and the motions to 
reconsider be considered made and laid upon the table with no 
intervening action or debate.
  The PRESIDING OFFICER. Objection is heard to the request of the 
Senator from Ohio.
  Is there objection to the request of the Senator from New Mexico?
  Mr. PORTMAN. Mr. President, reserving the right to object, I don't 
know what the Senator from New Mexico is talking about, to be honest. 
He is my friend and colleague. I will say that I am from Ohio, not 
Oregon.
  We just talked about the importance of this bill to Ohio. It is also 
important to Oregon and to the Senator's State of New Mexico and to 
other States around this country. There is no paired bill with this. I 
am talking about a bill that has been around here for 4\1/2\ months. It 
has been cleared. There are no substantive concerns. My understanding 
is that the Senator from New Mexico is talking about a bill that is 
still in committee. It has not even come out of committee. It is not a 
House bill. In other words, it hasn't been passed in the House. It is 
not going to go to the President's desk for his signature.
  I would be shocked if my colleagues on the other side of the aisle 
say they are going to block this commonsense, bipartisan bill that 
Senator Sherrod Brown and I have worked steadfastly on with both sides 
of the Capitol to get this done tonight on an urgent basis because we 
have to get it done. Ours has been out here for 4\1/2\ months; we 
didn't hear about yours until 45 minutes ago--45 minutes versus 4\1/2\ 
months.
  If the Senator from New Mexico wants to block this for other reasons, 
he ought to say so. But if he is blocking it because there is a 
pairing--there is no pairing. Maybe he is trying to pair it with 
something in committee.
  But let's get this done. This is not a difficult issue. This is one 
where we

[[Page S6177]]

have total agreement. There is no substantive concern. I would urge my 
colleague to allow us to get this done tonight, and then I am happy--
happy--to work on this other bill, whatever it is--of course, we don't 
know because I just heard about it 45 minutes ago. In fact, I just 
directed the staff, because I just heard about it when I came here, to 
go ahead and run the hotline on the other bill. So we have already done 
that, and we will see what comes back. I know what is going to come 
back, which is people are going to say, probably on both sides of the 
aisle, we haven't had a chance to look at this. It hasn't been out for 
4\1/2\ months; it has been out here for a couple of minutes. It was 
just a couple of minutes ago that we heard about it.
  So I can't believe we are going to block this tonight in order to say 
we have to move something that is in committee, has not been passed by 
the House, will not go to the President for his signature, and has not 
been through any process, as this has been.
  I urge my colleague and my friend to withdraw his objection.
  The PRESIDING OFFICER. Is there objection from the Senator from Ohio?
  Mr. PORTMAN. Yes.
  The PRESIDING OFFICER. Objection is heard.
  The Senator from New Mexico.
  Mr. UDALL. Mr. President, just to clarify, the bill that it is being 
paired with is S. 1523. It is a bipartisan bill in the same committee. 
The proposal to pair them has come from the committee chairman, 
Chairman Inhofe. So that is the reason for the pairing. They are both 
sitting in the EPW Committee. The chairman believes this is the way to 
proceed.
  That is the state of play as it is right now. I would say that with 
all due respect to my colleague from Ohio.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. PORTMAN. Mr. President, I find it very strange that Senator 
Inhofe has somehow objected since he has signed off on this. It has 
been totally cleared. This has been cleared to have a voice vote and to 
have it done tonight. There is no objection from Senator Inhofe. He has 
cleared it. So I would check the Senator's sources on that.
  I would just say I am really disappointed that this legislation that 
makes so much sense, that is needed right now in my home State of Ohio, 
is being blocked, and I don't know why it is being blocked. I assume 
there are some reasons that aren't being discussed tonight. This is 
very disappointing to me.
  We are going to try this again on Monday. We are going to try it 
again on Tuesday. We are going to try it again on Wednesday. I would 
urge my colleagues on that side of the aisle to please allow us to get 
this done. Allow us to provide some relief right now.
  If my colleague was up there with me in Lake Erie talking with these 
people--talking to the folks who had to go through this water crisis 
last summer; who are worried about what is going to happen this summer; 
who are being told they can't use the beaches; the fishing captains are 
worried about their businesses; the small businesses; the marinas; the 
folks who are not allowing their pets to walk along the lakes and drink 
the water--I think he would feel differently about it.
  Let's get this done. This is not an example of something that should 
require some sort of partisan exercise. Let's do this in a nonpartisan 
way. Senator Sherrod Brown and I have been working on this for 4\1/2\ 
months. I am disappointed we can't move it tonight--very disappointed--
but I am very hopeful we can move it on Monday or Tuesday. We are going 
to keep trying, and I urge my colleagues to support it.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. UDALL. Mr. President, I ask unanimous consent to be recognized 
for as much time as I may consume.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                      Nuclear Agreement With Iran

  Mr. UDALL. Mr. President, today we are considering a diplomatic 
agreement about the future of a nuclear-armed Iran. Most of us in this 
body have strong opinions about that agreement. Some believe it will 
weaken our position. I believe the opposite, and I have come to the 
floor to express my support.
  Republican and Democratic Presidents have all at times used the tools 
of diplomacy. Those efforts made us stronger and in some cases brought 
us back from the brink of nuclear disaster. President Reagan negotiated 
disarmament with the Soviet Union. President Nixon reengaged with 
China. President Kennedy used diplomacy--not war--to resolve the Cuban 
Missile Crisis. These were heroic initiatives. In each case, they were 
attacked for weakness, and in each case they made us safer.
  I begin my remarks with the power of diplomacy because I want to echo 
points Senator Durbin made so well last week. I urge my colleagues to 
review his remarks, to better understand the history and importance of 
diplomacy in our country. None of the historical deals we reference was 
perfect. All were fiercely attacked. But they made the world a safer 
place. They moved us forward. And this agreement will also move us 
forward.
  When it comes to our relationship with Iran, there is much we need to 
do, but there is one thing we must do: Stop Iran from building a 
nuclear weapon, period. That is our priority. That is our goal. And 
that is what we all agree on.
  The sanctions did what they were intended to do--they brought Iran to 
the table and enabled our diplomats to effectively stop Iran's nuclear 
weapons program. The results are clear: multiple centrifuges--ready to 
be disconnected; uranium levels--insufficient for a nuclear weapon or a 
quick breakout; and no access to plutonium.
  This is a historic moment. This agreement has profound impact if we 
approve it and, make no mistake, if we fail to approve it, because 
let's be clear on one reality: This is a multilateral agreement. It was 
confirmed by the U.N. Security Council just last week. The sanctions 
regime cannot be sustained by U.S. action alone.
  This is a time for careful review, and I hope we can take a step back 
and take a clear view. In this debate, we need to consider three basic 
points of the agreement: No. 1, what it does; No. 2, what it does not 
do; and No. 3, what it will require of us in the future. I wish to 
start by talking about what this agreement does.
  To build a nuclear weapon, we need either weapons-grade uranium or 
plutonium, and we need infrastructure. Those are the pathways, and this 
agreement will block them all.
  Before the negotiations began, Iran was well on its way to enough 
uranium, enriched to nearly 20 percent, for breakout to weapons grade--
possibly within 2 to 3 months. With this agreement, the breakout time 
would increase to 1 year, giving the United States and the 
international community more than enough time to respond. Under this 
deal, Iran's uranium stockpile is cut by 98 percent. I will repeat. 
This is a surprising development. Under this deal, Iran's uranium 
stockpile is cut by 98 percent. Enrichment is limited to 3.67 percent 
for 15 years. Centrifuges are reduced by two-thirds. Enrichment 
capability at the Fordow facility will also be limited and closely 
watched. The International Atomic Energy Agency will be able to verify 
that Iran is abiding by its uranium limits by monitoring every stage of 
the nuclear supply chain. Plutonium will be blocked. The reactor core 
at Arak is a heavy water reactor and can produce plutonium. The core 
will be removed. Its openings will be filled with concrete in a way 
that the IAEA can verify--those international inspectors can verify--so 
it will not be used for plutonium application.
  Critics rightly ask: How will we be sure? Iran has cheated before, 
and they may cheat again. That is why the P5+1 will be closely involved 
in the redesign and rebuilding of this reactor. If it has plutonium, we 
will know it. A modernized reactor will not use heavy water and will be 
limited to 3.67 percent enriched uranium. A violation at Arak would be 
nearly impossible to hide.
  It doesn't stop there. Iran will have to abide by and ratify the 
additional protocol of the nonproliferation treaty before the deal is 
finalized. Contrary to detractors, this is not an 8-year or 10-year or 
15-year deal but a deal that lasts.
  We all agree on one thing: Verification is key. I don't think any of 
us have any illusions here. Iran has had a long and troubling history 
of deception.

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  I am pleased the administration included Secretary of Energy Moniz in 
these discussions. The Department of Energy is one of the world's 
foremost experts on nuclear energy and nuclear weapons. Any agreement 
on nuclear weapons must be guided by science--not politics, not 
speculation, science. Our scientists at New Mexico's two National Labs, 
Los Alamos and Sandia, and scientists at Lawrence Livermore and Oak 
Ridge National Laboratories--all have played a key role in these 
negotiations.
  The physics of nuclear weapons is complex. You can't make a bomb out 
of thin air. I have met with our scientists. I have listened to the 
experts at the Department of Energy. Iran may be able to break the 
rules of the deal, but it can't break the rules of physics. Nuclear 
materials give off telltale signatures. The radioactive decay of 
uranium and plutonium is detectable even in the event of delayed 
access. Uranium in nature has a half-life of 4.5 billion years. 
Enriched uranium 235, which can be used in a weapon, has a half-life of 
700 million years. In effect, you can delay, but you still can't hide.
  Verification will be strong, and that means continuous monitoring, it 
means tamper-proof electronic seals, and it means dedicated facilities 
to inspect the Iranian nuclear program. It will include up to 150 
inspectors with long-term visas. We will have the best inspectors in 
the world in Iran. They will have unprecedented access 24/7 to all 
declared sites. I would add that they are all trained by nuclear 
experts at our National Laboratories. I may not trust Iran, but I do 
trust the science and our National Laboratories.
  This is a serious debate and one of the greatest challenges of our 
time. This agreement will meet that challenge ongoing and for years to 
come. But let's not kid ourselves. There are other challenges. There 
are continued dangers posed by the Iranian regime. We all know this. 
That is why sanctions against Iran's support for terrorist groups will 
remain and we will stand by our allies in the region. The President has 
made this very clear.
  This agreement will take the nuclear threat off the table. That is 
what it will do, but here is what it will not do: It will not diminish 
our resolve to combat other threats or to defend our allies in the 
region. That resolve will be and must be stronger than ever.
  To my colleagues who argue that we should walk away from the 
agreement which has already been approved by the world's leading 
powers, I would ask, walk away to where, to what end, to what 
alternative? Has an alternative been proposed?
  I would make two proposals:
  First, I urge my colleagues to support this agreement. We have a 
choice between this deal or no deal. I do not believe we will get 
another chance.
  Second, I ask that we be open to ways that Congress can reinforce the 
agreement--and that should be part of this process, too--with 
investment in people and technology to support nonproliferation 
enforcement with strong oversight of the implementation plan--not to 
embarrass or score political points but to ensure Iran is abiding by 
its part of the deal--and with increased support for our allies in the 
region and with a clear provision for a quick snapback of existing 
sanctions should that be necessary.
  We have a strategic opportunity, just as Presidents Kennedy, Nixon, 
and Reagan did with adversaries in the past. We need to act now from a 
position of strength and not wait until another day when the danger may 
be greater and our options may be more limited.
  I began my remarks with a reference to history. I would conclude with 
one other, closer in time and devastating in consequence, and that is 
Iraq. Instead of exhausting our diplomatic options, we opted for war. 
Instead of measured resistance, we opted for regime change. The result 
was and is tragic.
  Diplomacy takes time. It is often imperfect. But there are times when 
it is our best option and our best course, and this is one of those 
times.
  Mr. President, I yield the floor to my colleague from Michigan.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, at a time when we have so many urgent 
issues on our national agenda--our economy, jobs, all the issues we 
need to address, such as making sure every American has a fair shot to 
get ahead after college, has retirement security, and all of the other 
issues we know Americans care about--unfortunately, we are revisiting a 
very old debate that doesn't seem to want to go away, and that is 
whether we will provide funding for preventive health care for women, 
specifically for family planning clinics that provide essential primary 
health care services for women and men for things such as wellness 
visits, mammograms, and breast cancer screenings.
  In 2013, Planned Parenthood performed 500,000 breast exams, including 
15,000 for women in Michigan. Planned Parenthood provides screenings 
for cancer, heart disease, and HIV. In 2013, 400,000 Pap tests and 4.5 
million STI tests and treatments were conducted. Women go to Planned 
Parenthood for cervical cancer screenings, for life-and-death cancer 
screenings, for vaccines, and for blood pressure checks.
  In States where Republican Governors have refused to use the funding 
that is available to expand Medicaid health care under the Affordable 
Care Act, Planned Parenthood provides services critical to low-income 
Americans.
  In 2013, more than half the people seeking health services at Planned 
Parenthood clinics were covered by Medicaid. Nearly 80 percent of these 
men and women have incomes at or below the poverty level. We are 
talking about all across the country, many places where there is no 
other access to health care, no other place to get a mammogram or a 
breast cancer screening, where these services that are literally life-
and-death are being provided.
  So when we talk about Planned Parenthood, we are talking about the 
full spectrum of women's health care, including contraception and 
family planning services that serve both women and men. One out of five 
women has been to a Planned Parenthood clinic at some point in her 
life. In 2013, 2.7 million women, men, young people, relied on Planned 
Parenthood for preventive care, and about 70,000 of those were in my 
State of Michigan.
  In my State, 40 percent of the Planned Parenthood health clinics are 
located in areas we call medically underserved. There isn't access to 
other kinds of clinics or health care. There may not be a hospital 
nearby or there may not be many doctors nearby. We are talking about 
basic health care.
  Unfortunately, we see politics played with women's preventive health 
care and family planning over and over again in attacks on Planned 
Parenthood. As I see it, this is really an attack on every woman who 
needs preventive health care services.
  This is what this is about. Instead of focusing on jobs and closing 
loopholes that are causing our manufacturing jobs to go overseas; 
instead of making sure we are focussed on equal pay for equal work or a 
standard of living that will allow everyone to be successful and 
economically independent and care for their families; instead of 
focusing on robustly moving forward as a country in a global economy; 
instead of focusing on that or continuing to focus on making sure 
people have access to college without getting out of college with so 
much debt that they can't buy a house because they can't qualify 
because they already have so much debt, it is as if they have a 
mortgage--instead of focusing on all of that, one more time we are 
seeing an attack on Planned Parenthood and women's preventive health 
care.
  Fortunately, the vast majority of the American people recognize the 
value of having health clinics like Planned Parenthood that are 
dedicated to serving women's health care needs in every community 
across the country. That is why a poll shows that 64 percent of voters 
oppose the move by congressional Republicans to defund Planned 
Parenthood and therefore preventive health care services such as 
mammograms, cancer screenings, blood pressure checks, and access to 
birth control. Unfortunately, what is the majority view of the public 
is not what we see debated in the House and in the Senate.
  We have come a long way in actually strengthening our health care 
system, making sure that women and men, older people and younger 
people, can get preventive health care services, annual wellness visits 
without having to pay a copay. We have seen a lot of strengthening of 
access to health care

[[Page S6179]]

for women through the Affordable Care Act.
  Finally, actually being a woman isn't viewed as a preexisting 
condition anymore. In too many cases, that had been the situation. 
Women in childbearing years had to pay higher rates, or someone who 
survived breast cancer or cervical cancer or some other kind of 
challenge in their life. Under the Affordable Care Act, we are finally 
able to say: No, you don't carry that with you as a preexisting 
condition for the rest of your life. That is a good thing. A lot of 
women are sleeping better at night as a result of that.
  When it comes to basic preventive health care, access to birth 
control, access to screenings, and so on, it seems that somehow we have 
to speak out over and over again to defend these basic health care 
services. One more time we are headed for a big debate, a big fight on 
the budget. We are hearing people say they won't allow the United 
States of America to have a budget for next year unless we defund 
Planned Parenthood and health care access for millions of women in this 
country. It doesn't speak well for what the priorities are of Congress.
  I challenge colleagues across the aisle to join with Democrats, to 
join with the majority of the American people, who support the ability 
of women to get a full range of health care services through clinics--
where they don't have any other kind of access--through Planned 
Parenthood and other community clinics that allow them to get the basic 
health services they need. Women should not be treated as second-class 
citizens. We have come too far, as we look at the Affordable Care Act 
and health care access, and it will be incredibly disappointing, 
disheartening, and maddening, frankly, if we end up in a fight one more 
time. I have seen it before, and I have had to participate in holding 
back efforts to say we are not going to fund anything unless we defund 
women's preventive health care. It is wrong, and this Senator can state 
as one woman--as well as all of the Democratic women and men who are 
here--that we don't intend to allow that to happen.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Sullivan). The Senator from Hawaii.
  Ms. HIRONO. Mr. President, I rise today to speak against the bill to 
defund Planned Parenthood. I see this bill and others like it as 
nothing less than an assault on women's health. What else can you call 
it when defunding Planned Parenthood will result in 2.7 women in this 
country--that is more than twice the population of the State of 
Hawaii--not getting the cervical cancer screenings, mammograms, 
treatment for sexually transmitted diseases, and other health care they 
need.
  For over 100 years Planned Parenthood has been a leader in improving 
the health and well-being of women throughout the United States.
  For many women, especially low-income women, survivors of domestic 
and sexual assault, young women, and others, Planned Parenthood health 
centers are their primary health care provider that they go to for 
lifesaving cancer screenings, birth control, disease testing, and other 
essential health care services.
  One out of five women in this country will pass through a Planned 
Parenthood health center for health services at some point in her life. 
These numbers matter. One out of five women in this country will go to 
a Planned Parenthood center, and here we are debating whether or not to 
close these centers. I find it astounding that some--especially on the 
other side of the aisle--think this is a good idea. Six out of ten 
women who access family planning services rely on Planned Parenthood as 
their primary point of care.
  In the State of Hawaii, my State, over 7,000 women annually have 
relied on Planned Parenthood for their basic health services--services 
that help individuals maintain their health so they can live full, 
productive lives.
  This latest attack--basically fearmongering by the fringes of some on 
the other side--against Planned Parenthood is unwarranted and 
unnecessary. This Senator considers it mean-spirited, on top of 
that. Defunding one of the largest health providers to women shows how 
far some of my Republican colleagues will go to restrict women's access 
to basic health care. As previously noted, this latest attack on 
women's access to care will impact nearly 2.7 million women across the 
country who benefit from Planned Parenthood's services. Some 2.7 
million women--that, again, is nearly double the entire population of 
the State of Hawaii. Lots of women are going to be impacted by this 
drive to defund Planned Parenthood.

  These 2.7 million Americans do not deserve to have their access to 
health care terminated just so politicians can score political talking 
points. If these women can't go to Planned Parenthood, where will they 
go? Women who rely on Planned Parenthood for essential health care 
services will be forced to find medical care elsewhere or, tragically, 
go without.
  Defunding Planned Parenthood means there will be 400,000 fewer 
cervical screenings. There will be 500,000 fewer breast exams. There 
will be 4.5 million fewer tests and treatments for sexually transmitted 
disease like HIV.
  In Indiana, when the State defunded Planned Parenthood, several 
clinics closed. The clinic in Scott County was the only testing 
facility for STDs. Scott County today is in the middle of an HIV 
outbreak, and the State had to open a popup clinic to offer such 
services. Defunding led to residents in Scott County being unable to 
get services due to partisan statesmanship. We do not want these 
results replicated throughout the United States.
  On behalf of the thousands of women in Hawaii and millions across the 
country who rely on Planned Parenthood for health care services, I 
oppose this politically motivated attack that will set women's health 
care back. I will stand vigilant against those attempts to defund 
Planned Parenthood and will continue to defend the good work this 
organization does for women across this country every single day.
  Planned Parenthood has long been on the ideological hit list of those 
who want to block abortion. That is the reality. That is being honest. 
So, today, we are talking about defunding Planned Parenthood as a way 
to get to that goal of stopping abortions, and tomorrow we will be 
talking about some other way to limit a woman's right to choose. This 
bill is dangerous to women's health. I urge my colleagues to join me in 
voting against this bill and any like it that come our way.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. MURPHY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MURPHY. Mr. President, later this week we are going to have our 
first Republican Presidential debate, the official one that is on TV, 
and a lot of people are going to be watching. There has been a lot of 
speculation as to who is going to be in the debate, who is not going to 
be in the debate, who will do well, who will not, who will rise in the 
polls, and who will fall in the polls.
  Frankly, we don't need to wait for that debate because the Republican 
Presidential primary campaign is playing out right now on the floor of 
the Senate, I think, to the detriment of the institution. How else 
would you explain a threat from Members of this body and frankly from 
Members of the House--many of whom are not running for President--to 
shut down the government over the issue of funding for Planned 
Parenthood. We have been through this before. We have been through 
government shutdowns prompted by ideological politics before, and a lot 
of people got hurt--a lot of people got hurt.
  The life of a woman in Bridgeport, CT, was torn apart because her 
Head Start Program was shut down because of the Federal Government 
shutdown. She was just beginning a new job, and she had to make a new 
choice between continuing in this new place of employment that was 
going to lift her out of poverty, essentially sending her kids out on 
the street while they didn't have care, or leaving the job and taking 
care of her kids while Head Start was shut down. Those are the 
consequences of a government shutdown.
  So if you are going to shut down the government, your reason for 
doing it better be pretty good. The reason a

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couple of years ago was a miserable one--taking health care away from 
millions of Americans who are getting it because of the Affordable Care 
Act.
  But this one is just as insidious. I don't know where women in my 
State would be without Planned Parenthood. My wife is one of tens of 
thousands--probably hundreds of thousands--of Connecticut women who got 
their preventative care from Planned Parenthood. She did that when she 
was young, didn't have a lot of income, and needed to find a primary 
care provider who could get her access to basic health care services. 
There are 2.7 million patients all across the country who receive their 
health care, their preventative health care, from Planned 
Parenthood. More than 90 percent of what Planned Parenthood does all 
across the country is engage in preventive health care.

  In 2013, 400,000 Pap tests, 500,000 breast exams, 4.5 million STI 
tests and treatments, including HIV tests. In Connecticut, there are 17 
Planned Parenthood centers and they serve--here is the number--64,000 
patients in the State of Connecticut.
  So we are going to shut down the government in order to take health 
care away from 64,000 women in Connecticut, all in order for a handful 
of people to make an ideological point that may get some additional 
votes within a Republican Presidential primary, despite the fact that 
since the 1980s the law in this country has been clear: You can't use 
Federal dollars for abortions.
  I oppose that law because I believe abortions are part of a panoply 
of medical services that should be available to people in this country 
at their choice. Frankly, I think the government should stay out of the 
business of deciding what medically necessary health care choices women 
can make. I don't think we should be involved in that. So I don't 
actually support the underlying law that prevents those dollars from 
being used, but it is the law of the land, it has been the law of the 
land, and it will be the law of the land.
  We are saying we are going to shut down access to 64,000 women in 
Connecticut because the place they are getting health care also 
performs a health care service that is objectionable to people who are 
running for President, but let us take that logic to its natural 
extrapolation. Let's take it to its logical end point. If you believe 
no one should be eligible to get health care services from any 
institution that has anything to do with abortions or the full array of 
reproductive health care services, then you can't actually stop at 
Planned Parenthood. You have to stop funding any hospital that has 
anything to do with offering a full array of health care services. You 
have to stop funding for health care centers that do the same.
  Why wouldn't you stop sending Medicaid dollars to States such as 
Connecticut that have codified Roe v. Wade? What is the logical end to 
this policy if all of a sudden an organization that spends 90-plus 
percent of its resources simply engaging in the good stuff of 
preventive health care now all of a sudden can't serve anybody because 
they engage in a service that is a politically hot topic in Congress, 
despite the fact that there is a law on the books that says they can't 
use any of their Federal dollars for that particular service.
  Take this to its logical end, and we cut off Federal funding for not 
64,000 patients in Connecticut but virtually every patient in 
Connecticut if any association with the provision of abortions all of a 
sudden denies you Federal funding. I don't concede the fact that the 
Hyde amendment is the law of the land, but I acknowledge that it is and 
it will be.
  This is just Presidential Republican primary politics finding its way 
onto the Senate floor. What this could lead to is not the defunding of 
Planned Parenthood, because they will not get the votes nor the 
Presidential signature to defund one of the most important primary and 
preventive health care providers in our States--I will not do that. I 
will not deny health care to 64,000 Connecticut women. So all they do 
by creating this line in the sand, once again, is shut down the Federal 
Government, sucking thousands of jobs out of our economy, leading to 
tens of thousands of stories of individual misery, such as the woman 
from Bridgeport who all of a sudden awoke to find her kid couldn't go 
to his Head Start Program and so she had to think about quitting her 
new job in order to take care of her child.
  I get it that threats about shutdowns make good headlines. They play 
to a slice of a Presidential primary electorate, but they are big 
headaches for real people. We are not playing with politics when we 
talk about shutting down the government over defunding Planned 
Parenthood or over repealing the Affordable Care Act. We are playing 
with people's lives.
  So I hope this is just the issue of the week in the Republican 
Presidential primary. I hope when we come back in September we are not 
seriously talking about another government shutdown. I hope we 
seriously are not talking about an attack on women's health care all 
across this country. I hope we are not entertaining the idea that tens 
of thousands of women in my State are all of a sudden going to lose 
access to services or tens of thousands of women and men are going to 
lose access to programs such as Head Start, job training, and all the 
other things that get affected when the government shuts down.
  I am sick of shutdowns. I have only been in the Congress for less 
than a decade, and I have been through more of them, real and 
threatened, than I care to remember. I am certainly not going to stand 
for a shutdown threatened on the basis of denying health care to women 
in the State of Connecticut or anywhere else across this country.
  I hope we can spend some time after this vote next week--that even my 
Republican friends in the Republican Presidential primary will admit is 
a showboat--and get down to the real business of passing a budget that 
respects the values and priorities of this country, that keeps our 
government operational, and separates, to the best we can, the business 
we do on the Senate floor from the business of sorting out who is going 
to be the next Republican nominee for President.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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