Congressional Record, Volume 161 Issue 122 (Thursday, July 30, 2015)

[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

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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

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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

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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.

____________________