[Congressional Record Volume 163, Number 23 (Thursday, February 9, 2017)]
[Senate]
[Pages S1005-S1012]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                             Overregulation

  There is another issue. I was fortunate enough to spend several years 
as the chairman and ranking member of a committee in Congress called 
the Environment and Public Works Committee. It has a very large 
jurisdiction. It is a committee that deals with--as the title infers--
environment and public works, environmental and some of the 
overregulation that we have had, and created real serious problems.
  Also, we have been successful in passing a lot of the initiatives, 
such as the FAST Act. That was the largest transportation 
reauthorization bill since 1998. So we have done a lot of good things 
there.
  One of the problems we have had--that we dealt with in that committee 
and will continue to under the chairmanship of Senator Barrasso--is 
doing something about the overregulation. This has been a problem, 
serious problem. In 2\1/2\ months between the Presidential election and 
Inauguration Day, the Obama administration produced over 200 
rulemakings; 41 of which are considered economically significant rules, 
rules that would result in $100 million or more in annual costs. Over 
the course of his administration, President Obama added 481 
economically significant regulations to the Federal registry, over 100 
more than the Bush or the Clinton administration.
  Regulations cost our citizens, at the current time, $1.89 trillion a 
year and more than 580 million hours of paperwork in order to comply 
with this staggering amount of rules. People don't realize the cost of 
rules. When they made such an effort, starting way back in 2002, to 
pass legislation that was aimed at trying to get into some type of an 
arrangement on global warming--and all of this to restrict emissions--
they didn't realize at that time, until the bills got on the floor, 
that the cost to such cap and trade--a type of regulation--is between 
$300 and $400 billion a year to the American people.
  Every time I see a large figure coming from Oklahoma--I get the 
latest figures from Oklahoma, in terms of what has happened 
economically in the previous year--those regulations would cost the 
average family who pays Federal income tax in my State of Oklahoma an 
addition of $3,000 a year, and by their own admission, it wouldn't 
accomplish anything.
  I can remember as chairman of that committee, we had Lisa Jackson. 
Lisa Jackson was the Administrator of the EPA, the first one that 
President Obama had appointed. I asked her the question live on TV, in 
an open meeting, I said: If we were to pass, either by regulation or by 
legislation, the cap-and-trade legislation that they are talking about 
passing, and have been talking about, would this reduce CO2 
emissions worldwide? Her answer: No, it wouldn't because this isn't 
where the problem is. If it is not going to accomplish something, even 
if you believe the world is coming to an end because of fossil fuels, 
doing something in the United States is not going to correct it. But 
that is the cost of rules. That is what we are looking at right now.
  We went through 481 significant regulations during the Obama 
administration. At the last minute, after President Obama realized that 
Hillary Clinton was not going to win, he got involved in what we refer 
to as ``midnight regulations.'' He had several of these last-minute 
regulations he was trying to get in after the election took place--and 
he knew who was going to be the next President--before the next 
President took office. One such midnight regulation, finalized January 
13, is the Environmental Protection Agency's rule entitled ``Accidental 
Release Prevention Requirements for Risk Management Programs Under the 
Clean Air Act.'' EPA states that the purpose of the updated rule ``is 
to improve safety in facilities that use and distribute hazardous 
chemicals.'' As you can imagine, environmentalists will not be happy if 
this rule is changed, but I argue this rule does not make facilities or 
surrounding communities safer. In fact, it could put them at greater 
risk.
  There are several concerns with this rule, but the biggest one is the 
national security implications due to the rule's public disclosure 
requirements. Under this rule, facilities are required to share 
information on the types of chemicals stored there and the security 
vulnerabilities with emergency responders, and upon request, to the 
general public. The rule does not provide for the protection of this 
information from further disclosure once it is provided. It is well 
known that terrorists have considered attacks on chemical facilities as 
a way to kill citizens and cause mass destruction in our communities, 
and of course requiring the disclosure of this information to anyone 
whose asks is very reckless and impossible to understand. We can't 
figure out why they would do that. The terrorists would have access to 
the same information, which would make their job a lot easier.

[[Page S1006]]

  Congress has passed several bills to protect just this kind of 
information. I was even the author of one of these bills. Under the 
Chemical Safety Information, Site Security and Fuels Regulatory Relief 
Act of 1999, the distribution of sensitive information from chemical 
facilities is limited to publicly available Federal reading rooms and 
certain Federal, State and local officials and researchers who are then 
barred from further disseminating the information. This makes sense. We 
need local officials to know what they should do in the event there is 
a problem, but our enemies should not be able to get this information. 
It is fine, except you don't want to give it to our enemies, those who 
are in the terrorist community.
  The new rule by the EPA does not provide any of these protections to 
the information now required to be shared upon request, to include 
audit reports, exercise schedules and summaries, emergency response 
details--all of which would provide those intent on criminal acts with 
a blueprint of facility and emergency response vulnerabilities. This is 
exactly what they want to perform their terrorist activities. The 
requirement does not make these facilities safer but actually increases 
the chance of harm to be done to them.
  The sole reason this rule was updated by the Obama administration 
stems from the West, TX, chemical plant explosion of 2013. Yet this 
rule on accidental release prevention would do nothing to prevent 
another West, TX, because that explosion and fire was intentional. It 
was an act of arson. The Obama administration used this tragedy that 
took 15 lives as an excuse to make these facilities and surrounding 
communities less safe, and it doesn't make sense, unless you look at 
what else the rule does.
  This rule is the first step in EPA expanding its authority under the 
Clean Air Act to mandate how chemicals are manufactured and used. We 
just passed a bill, on a bipartisan basis, that takes care of this 
problem. You don't have to worry about that anymore. The EPA is 
requiring paper, petroleum, coal, and chemical manufacturing industries 
to conduct safer technology and alternative analysis, STAA, as part of 
their process hazard analysis. In conducting this STAA, these 
industries must consider what they call inherently safer technologies, 
IST, or inherently safer designs, ISD. This sounds good, but it is 
something that is so ambiguous nobody knows what the real definition 
is.
  While the rule stops short of requiring EPA's approval of these STAAs 
or requiring the implementation of IST and ISDs, it is only a matter of 
time before the environmental groups begin to litigate the issue and 
act as escorts to force EPA to mandate these majors. This is the 
proverbial camel's nose under the tent. Industry will tell you that the 
best time to assess inherently safer technologies and designs is during 
the initial design phase.
  Furthermore, industries are constantly evaluating their processes and 
making changes at the margins based on what works best for the products 
and customers. Allowing the EPA to become a part of that conversation 
adds a third party to the question that does not care about the 
company, the product or the consumers. The inherent safety of a 
technology or design is a relative standard. What might be safer in one 
company or product, does not mean it is going to be safer within a 
process that is completely different and in a different company.
  For example, it may be inherently safe to store or use less of a 
hazardous material, but that would likely increase the number of 
shutdowns and startups due to not having enough materials on hand. 
Research shows that the shutting down and restarting of a chemical 
process poses a greater risk than continuous operation would.
  Additionally, you would increase deliveries and movement of hazardous 
material throughout the surrounding communities, shifting the risk 
elsewhere. How can we say definitely that is safer? As you can see, 
there is no definitive answer to what would be inherently safer. It is 
an ambiguous term. It means it is very difficult to define.
  Allowing the EPA's foot in the door on this would only lead to a 
heavier hand mandate that would hurt industries, consumers, jobs, and 
ultimately the valued public. This rule is promulgated on the premise 
of preventing another West, TX, tragedy, but this rule does nothing to 
protect facilities from intentional actions of a criminal or a 
terrorist and in fact would actually be in a position to aid them in 
their quest to do us harm.
  I only outlined a couple of the many concerns this rule creates. I 
believe we should take a look at what this actually does.
  It is not just this rule. As I said, President Obama went in at the 
last minute and did these midnight rules. This is one of the things we 
can look forward to doing away with, some of the overregulation that 
has cost Americans so much over the last 8 years.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, let me pick up from where I left off 
earlier in my discussion of some of the issues that Representative 
Price, the nominee to lead the Department of Health and Human Services, 
advocated for as a Member of the House, as a leader on the Budget 
Committee. These are issues I continue to be concerned about with 
regard to his nomination.
  With regard to Medicare--I left off with a few comments about 
Medicare. Here are some of the concerns that have been stressed by 
major senior organizations with regard to some of the Medicare 
proposals in Washington.
  In a letter to President Trump, AARP CEO Jo Ann Jenkins said:

       The average senior, with an annual income of under $25,000 
     and already spending one out of every six dollars on health 
     care, counts on Social Security for the majority of their 
     income and on Medicare for access to affordable health 
     coverage.
       Unfortunately, some congressional leaders have discussed 
     plans to use the health care debate to fundamentally change 
     the Medicare program and undermine the contract made with 
     generations of Americans.
       Proposals creating a defined contribution premium-support 
     program; restricting access by raising the age of 
     eligibility; or allowing hospitals and providers to 
     arbitrarily charge customers higher prices than Medicare; all 
     betray the promise made to older Americans who have paid into 
     Medicare their entire working lives.

  She goes on to say:

       Indeed, these proposals do little to actually lower the 
     cost of health care. Rather, they simply shift costs from 
     Medicare onto individuals--many of whom cannot afford to pay 
     more for their care.

  So says the leader of AARP.
  So that is one of the reasons why the proposals that Representative 
Price has supported become front-and-center concerns in his nomination. 
I will move next to a consideration of Representative Price's record on 
the Patient Protection and Affordable Care Act. If you go back to 2009, 
before we passed the Patient Protection and Affordable Care Act, over 
50 million Americans were uninsured in 2009. People with any sort of 
medical condition were routinely denied health insurance or they were 
charged exorbitant rates because of their health history. Women were 
routinely charged more than men for their health insurance. Third, sick 
individuals were routinely dropped from their health care coverage 
because they had reached arbitrary caps on the amount of care an 
insurer would pay for in a given year. Of course, in 2010, the 
Affordable Care Act was passed.
  Now we can say that 20 million Americans have health care coverage, 
and that includes 1 million more Pennsylvanians who have health care 
coverage because of that legislation. And 105 million Americans are 
protected from discrimination due to preexisting conditions. Over 9 
million Americans are receiving tax credits to help them cover health 
insurance premiums, and 11 million seniors have saved over $23 billion 
from closing the Medicare Part D prescription drug plan doughnut hole. 
Pennsylvania hospitals, because of the Affordable Care Act, have saved 
over $680 million due to reductions in uncompensated care.
  I would add to this that all those Americans, by one estimate as many 
as 156 million Americans--there is another estimate that is even higher 
than that; but at least 156 million Americans--with employer-sponsored 
coverage have a long list of protections against being denied coverage 
for a preexisting condition, against annual or lifetime limits, against 
discrimination against women because they happen to be women.
  All of those protections are in place now for more than 156 million 
Americans because of the Affordable Care Act. Yet, despite all of those 
gains that

[[Page S1007]]

have been realized in only a few short years, Representative Tom Price 
opposes the law.
  In fact, he wants to repeal it. Rather than working with us to 
improve it, he has proposed a replacement that would strip away many of 
those critical protections. Again, they are not only protections for 
people who are newly insured but protections that are in place now that 
were not there for more than 156 million Americans with employer-
sponsored coverage.
  So I get letters from constituents concerned about his record or 
concerned about the direction that he would take the Department of 
Health and Human Services or the direction that the Trump 
administration would go. Now apparently, after the election, after 
inauguration day, the administration is supporting block-granting of 
Medicaid and supporting changing Medicare as we know it.
  That is why we get letters from individuals across our State. I 
mentioned before that we have 48 rural counties in Pennsylvania. There 
are a lot of people--literally, several million people; 3.5 million by 
one estimate--living in rural counties in Pennsylvania, in rural 
communities.
  I have a letter from Rebecca. That was one of the names I outlined at 
the beginning of my remarks earlier today. Here is what Rebecca said:
  The Affordable Care Act allowed my husband to join me on the dairy 
farm where I worked for 8 years and am co-owner of the herd. Over the 
past 3 years, we have straightened out our finances and have gotten our 
student loan debt under control. Third, we have opened an IRA to plan 
for our retirement.
  We live in a small trailer. We own one car. We shop at discount 
grocery stores and local Mennonite food stands. We have worked hard for 
financial stability. Over the past year we have begun discussions about 
having a child and starting our own business. Threats to the ACA are 
threats to our future, Senator, and to the future of small businesses, 
agriculture, and families.
  She goes on from there to tell her story.
  So that is Rebecca, who has some experience, not just in rural 
Pennsylvania but experience as a dairy farmer, trying to start a 
family, and trying to start even more of a business career. So that is 
another example of what we are hearing from people across Pennsylvania.
  I mentioned at the beginning of my remarks Hannah and Madeline. 
Hannah and Madeline are the daughters of Stacie Ritter. She is from 
Manheim, PA. She is the mom of four children, including Hannah and 
Madeline. They happen to be twins. I met them way back, I guess, in 
2009. At the time Hannah and Madeline were diagnosed with a rare and 
dangerous type of leukemia when they were just 4 years old.
  Stacie and her husband went bankrupt trying to pay their daughters' 
medical bills. She wrote to me at that time--just around 2009--saying 
that, without health care reform ``my girls will be unable to afford 
care, that is if they are eligible, for care that is critically 
necessary to maintain this chronic condition. Punished and rejected 
because they had the misfortune of developing cancer as a child.''
  So said Stacie Ritter about her daughters, pleading with me at the 
time, as the Senator who would vote on the Affordable Care Act. I just 
met with Stacie again. She is very glad that we passed the Affordable 
Care Act so that her daughters could have the health care that they 
need. Fortunately, this story has a happy ending. Hannah and Madeline 
are healthy young women now. They are freshmen at Arcadia University, 
and they are doing well. The Affordable Care Act protects them by 
ensuring they will have access to affordable coverage, whether on their 
parent's plan or on a plan on the individual market.
  So when we talk about that legislation, when we talk about Medicaid, 
when we talk about Medicare--all of those issues--one of my basic 
points is that Representative Price, were he to be Health and Human 
Services Secretary Price, has to have an answer for those 
Pennsylvanians. He can ignore the questions of Members of Congress, and 
sometimes he has done that. We don't have time to get into that today, 
but he has done that in the confirmation process.
  But he has to have an answer for Stacie Ritter. He has to have an 
answer for her daughters Madeline and Hannah. He cannot ignore them and 
their health care needs. He has to have an answer for Rebecca, who is 
worried about what will happen to her, whether she will still be able 
to have a dairy farm, whether she will be able to have a family. He has 
to have an answer for Rebecca in Pennsylvania.
  He also has to have an answer for the two families whom I cited at 
the beginning--for Anthony and Rowan's family, two young boys on the 
autism spectrum who need the services of Medicaid.
  So this is not theory any longer. This is not some idea that is 
floating around Washington. These are real lives that will be destroyed 
by some of these proposals. So if you block-grant Medicaid, you are 
going to destroy a lot of lives. If you change Medicare as we know it, 
and turn it into a voucher program, ripping away the guaranteed benefit 
of Medicare, you are going to hurt a lot of people. If you choose to 
vote for a repeal of the Affordable Care Act and you have no plan to 
replace it--after 7 years of complaining about it, criticizing it, and 
finger-pointing, and you don't have a replacement for it--you are going 
to hurt a lot of lives.
  So this is not some debate that is not connected directly to people's 
lives. This is real life for those families. I have real concerns about 
them if Representative Price's view of the world or his proposals that 
he advocated for vigorously in the House of Representatives were to 
become law. Apparently, now his ideas have been embraced totally by the 
Trump administration.
  Let me finish with this one point about Representative Price. There 
are questions that remain surrounding Representative Price's stock 
deals. He told both the Finance and HELP Committees that the discounted 
shares of Innate Immunotherapeutics that he was able to purchase were 
available to every individual who was an investor.
  But the Wall Street Journal reported not too long ago the following. 
I will just read one line from the story. The headline says:

       Rep. Tom Price Got Privileged, Discounted Offer on 
     Biomedical Stock, Company Says.

  Here is what it says in the third paragraph:

       In fact, the cabinet nominee was one of fewer than 20 U.S. 
     investors who were invited last year to buy discounted shares 
     of the company--an opportunity that, for Mr. Price, arose 
     from an invitation from a company director and a fellow 
     Congressman.

  So says the Wall Street Journal story of earlier this month. So that 
is on the public record, based upon what the Wall Street Journal 
reported.
  I, at the time, joined other Democrats on the Finance Committee to 
try and get this clarified. That request was denied. When we talk about 
the constitutional obligations to advise and consent--the Senate 
advising and consenting with regard to Cabinet nominations--we are not 
talking about a rubberstamp. We are not talking about some kind of 
automatic approval. We are talking about scrutiny, review, and getting 
answers to questions and having a long debate about someone's 
qualifications.
  When you don't get clarified issues that have been raised and 
validated by news organization like the Wall Street Journal, I think we 
have more questions to have answered. It is a constitutional 
requirement--advise and consent--that needs to be honored.
  For these and many reasons, I remain opposed to the nomination of 
Representative Price to be the next Secretary of Health and Human 
Services.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, I rise today to talk for a few minutes 
about the nomination of our congressional colleague, Congressman Tom 
Price, also known as Dr. Tom Price, to serve as our next Secretary for 
the Department of Health and Human Services. When Senator Tester 
arrives on the floor, I will yield to him. I know he has reserved time. 
I will be happy to yield to him when he arrives.
  But until then, I just want to make a couple of comments, if I could.
  From the outset, my colleagues--our colleagues and I; not all, but a 
number of us--have had concerns, in some cases very grave concerns, 
about many of

[[Page S1008]]

President Trump's nominees. Having said that, a number of them have 
gotten overwhelming support from both Democrats and Republicans. I 
checked as of sometime yesterday afternoon. There had been seven votes 
on nominees at that time. I think four of them had gotten overwhelming 
bipartisan support; three did not.
  But from the outset, my colleagues and I have had grave concerns 
about many of President Trump's nominees. But we have a responsibility, 
I believe, to thoroughly consider every Cabinet nominee on the merits 
of his or her fitness to serve.
  To evaluate Congressman Price's nomination, I looked--and a number of 
us have looked--at his career in the U.S. House of Representative, 
which I believe spans some six terms, which would be somewhere between 
10 and 12 years. We did that in order to learn more about his guiding 
principles as a legislator.
  All of us have guiding principles. I know the Presiding Officer, who 
has shared with me his guiding principles any number of times, but mine 
include trying to figure out what is the right thing to do--not the 
easy or expedient thing, but what is the right thing to do; to treat 
other people the way we want to be treated; three, to focus on 
excellence in everything we do. If it is not perfect, make it better. 
Four, when you know you are right, you are sure you are right, just 
don't give up. Those are sort of my guiding principles. I sometimes 
violate one or more every week. But I always know that I have them, and 
it is actually helpful to have sort of a compass to get me back on 
track.
  But we wanted to learn more about the guiding principles for 
Congressman Price as we considered his nomination, his core values. 
During Congressman Price's time in the U.S. House of Representatives, 
he spearheaded efforts to dismantle the Affordable Care Act, which I 
regard as landmark health legislation that has provided 22 million 
Americans, including about 35,000 Delawareans with affordable, 
reliable, and comprehensive health insurance coverage.
  Some people say: Well, is it perfect? No, it is not. No, it is not.
  Well, I guess ever since Harry Truman was President, you had one 
President after the other, one administration after the other, 
bemoaning the fact that we had so many Americans who didn't have access 
to health care coverage.
  So the question would be: Well, why don't you do something about it?
  One of the things that we have done about it is to finally pass the 
Affordable Care Act, and I will talk more about that in a little bit.
  Congressman Price has opposed the Affordable Care Act from day one, 
leading his colleagues in the House of Representatives to obstruct and 
sometimes undermine, first, the drafting of the law and, then, its 
implementation.
  Instead of working with colleagues from both parties to offer 
improvements to the new law, he rallied against the need for essential 
benefits, such as contraception or mental health treatment or, frankly, 
access to medical procedures like colonoscopies, mammographies, 
prostate screenings--the kinds of things that, for individuals who are 
at risk of having colon cancer or breast cancer, if they had access to 
those kinds of screenings, could be detected earlier, with a lot of 
money saved, a lot of misery saved or avoided. In some cases, a loss of 
life is avoided as well.
  Congressman Price introduced proposals to repeal the Affordable Care 
Act, doubling down high deductible plans and high-risk pools, which 
have a failed history of inadequate funding, waiting lists, and annual 
or lifetime limits.
  Over the past few months, our Republican colleagues have said loud 
and clear that they will repeal the Affordable Care Act, and Candidate 
Trump certainly said that many times during the campaign. When he was 
elected, he said that one of his major goals was to repeal the 
Affordable Care Act. When he became President, it was the same message. 
But at the same time, we have heard from stakeholders across the health 
care sector about what will happen if the Affordable Care Act is 
repealed without a replacement. Plain and simple, doing nothing would 
unfurl chaos across the health care delivery system. The individual 
market, the marketplaces, the exchanges would collapse. Estimates 
project that more than 32 million Americans would become uninsured over 
the next decade. Health insurance premiums in the individual market 
would skyrocket, increasing by up to 25 percent immediately and 
doubling again by 2026.
  From what I can tell, the cause to which Mr. Price has dedicated 
himself--and that is, repealing the Affordable Care Act with no plan to 
take its place--would devastate people's lives and our economy.
  As we prepare to vote on his nomination, I think it is appropriate to 
remind our colleagues how we got here and the hard work that we did to 
approve a health care reform bill that is helping millions of people 
today.
  I have a couple of charts that I would like for us to take a look at. 
We have on the right of this chart the United States of America, and on 
the left, we have Japan, a place I used to fly in and out of a lot when 
I was a naval flight officer during the Cold War.
  One of the things that we learned a few years ago--6, 7, or 8 years 
ago--when we were debating what to do, if anything, in the last 
administration about extending health care coverage to a lot of 
Americans who didn't have it, we looked at countries around the world 
in the Finance Committee to see who was doing a better job and who was 
not. Among the interesting things that we found out about Japan was 
that they were spending about 8 percent of gross domestic product to 
provide health care coverage to the folks in their country--8 percent. 
In the United States, at the time, we were spending 18 percent of gross 
domestic product, more than twice of what they were spending in Japan.
  Think about it: 8 percent of GDP to provide coverage and 18 percent 
of GDP in the United States.
  You might say: Well, maybe that is because we were covering a lot 
more people in the United States than they cover in Japan. Well, as it 
turns out, just the opposite is true, because not only do they spend in 
Japan like half as much as a percentage of GDP as we do, but they 
actually get better results, lower rates of infant mortality, higher 
rates of longevity among adults, and they cover everybody. They cover 
everybody.
  When the Affordable Care Act was adopted, we had somewhere between 40 
and 50 million Americans who would go to bed at night without any 
health care coverage at all.
  I like to say the Japanese are smart people, and they are good allies 
of ours, good customers of ours. They can't be that smart, and we 
cannot be that dumb.
  So as we were going through the debate on the Affordable Care Act in 
the Finance Committee about 6 or 7 years ago, one of the things we did 
is to say: Well, let's look at some other countries and see if they are 
doing something that maybe we could learn from and maybe we could take 
to heart and sort of reshape our health care delivery system with that 
in mind.
  One of the things they do really well in Japan is they provide good 
access to primary health care. If you happen to live in Japan, you 
don't have to go very far in your neighborhood to find a health care 
provider. It might be maybe someone like an RN, or it might be 
something like an advanced practice nurse and maybe a primary care doc, 
but they have easy access to primary health care.
  What they like to do in Japan is to define problems and to address 
problems when they are small and when they can be treated. They focus a 
whole lot on prevention and wellness. That is a great lesson. If you 
look at the Affordable Care Act, that is a lesson that we learned and 
incorporated into that legislation.
  The heading on this chart is this: The Affordable Care Act is a 
Republican plan. Surprise. Why do I say that? Well, when you go back to 
1993, we had a new President, Bill Clinton, and a new First Lady, 
Hillary Clinton. She basically felt--and I think her husband did, too--
that every President, every administration since maybe Truman, had been 
talking about the need to try to make sure a lot more Americans had 
access to health care--quality health care--but nobody could actually 
figure out how to do it.

[[Page S1009]]

  So Hillary Clinton began working in 1993 on health care, and people 
eventually called it HillaryCare--HillaryCare. If my life depended on 
it, I could not explain the elements of HillaryCare, but I could 
explain the elements of the Republican alternative that was offered to 
it. It was introduced by a fellow named John Chafee, a Republican 
Senator from the State of Rhode Island, and it had a number of elements 
to it. So I just want to mention these five elements that were found in 
the Republican alternative in 1993 to HillaryCare.
  Senator Chafee's bill is the column right here. The next column over 
is called RomneyCare--right here. Farthest from me--my left, your 
right--is the Affordable Care Act.
  We will look at five different components. As to individual mandate, 
which of these proposals had the individual mandate and which did not? 
As to employer mandate, which of these proposals included the employer 
mandate and which did not?
  There is the ban on preexisting conditions--the idea that insurance 
companies could not say: Oh, because you had breast cancer, because you 
had this or that--patient or health care--if someone needs health care 
but they have preexisting conditions, insurance companies can't say you 
can't get coverage because there was a ban included on that.
  As to subsidies for purchasing health insurance, which of these had 
it and which did not?
  And we are going to look at the idea of--we will call them 
exchanges--purchasing in bulk.
  When we were debating the Affordable Care Act, people would say: Why 
do you want to do this?
  I would say: Well, look at the Federal Government. In the Federal 
Government, you have the legislative branch, the executive branch, and 
the judicial branch. If folks work as full-time employees, they can get 
access to health care. We get our coverage usually through private 
insurers. The Federal Government provides about 70 percent of the 
premium costs; the individuals provide about 30 percent of the premium 
cost. It is a large purchasing pool because we have over a million 
people in the Federal Government purchasing pool. We don't get free or 
cheap insurance, but it helps drive down the cost because you are 
buying health care coverage for a lot of people.
  Somebody had a bright idea in 1993--John Chafee, I think, and the 
folks working with him, 20 Republican Senators and 3 Democrats, who 
said maybe we ought to give folks who don't have health care coverage 
the opportunity to buy their coverage in large group plans, much like 
we have in the Federal Government.
  I will just hit the pause button right there and stop my remarks for 
now and yield the floor to the Senator from Montana.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Mr. President, I want to thank the Senator from Delaware, 
and I also want to thank the Senator from Georgia, who has about the 
same length speech as I have here--short and sweet.
  Mr. President, I rise today on behalf of thousands of Montanans who 
have reached out to me in opposition to the nomination of Congressman 
Tom Price to lead the Department of Health and Human Services.
  Health care in this country is a very complex thing. It has many 
moving parts. It impacts patients, doctors, nurses, hospitals, 
families, and rural communities in Montana and across this country.
  Recently, I traveled across Montana, speaking with folks from most of 
the 60 hospitals that we have in Montana. There is no doubt our health 
care system has some problems. Costs are rising, and families are being 
priced out of health care. There is no doubt about it--not all but 
some. But these problems to be solved require thoughtful, responsible 
solutions. These problems require folks to put politics aside and work 
together for the health of our country and for rural America and for 
our next generation.
  Over the years and throughout this confirmation process, Congressman 
Price has shown that he is not equipped for this vital and formidable 
job. Health care in this country is too important to turn over to a man 
who wants to reverse the progress, cut up the safety net, and rip away 
the health care that our seniors have earned.
  Everyone in this body knows that we have work to do to fix the 
Affordable Care Act, but each and every Senator also knows that the ACA 
has expanded coverage for millions of Americans, improved rural 
America's ability to recruit and retain health care workers, and moved 
us closer to closing the Medicare doughnut hole. We cannot make any of 
these improvements if we do what Congressman Price has promised and 
repeal the ACA, especially without a single plan to replace it. I would 
tell you, if one exists, I would love to hear it, and I would love to 
hear it today.
  So I want to work to fix the problems with the ACA, not send us back 
to a time when folks couldn't afford to get sick or couldn't change 
jobs due to preexisting conditions.
  Don't take my word for it. Joseph from Missoula wrote to me and said:

       I am a practicing cardiologist in Missoula. I am adamantly 
     opposed to the nominee, Congressman Price. His approach takes 
     us back to the 1980s, ignores the reality of life for a large 
     portion of our population, and is inconsistent with our 
     obligation to care for the least of our brothers.

  Joseph knows Montana cannot afford to go back to the old system. But 
Congressman Price has indicated that is exactly what he wants to do.
  In his confirmation hearing, when Congressman Price was pressed about 
President Trump's replacement plan, he played it off with a joke to a 
laughing audience.
  The health care of the American people is no laughing matter. We need 
a serious plan to address rising premiums and deductibles, but 
Congressman Price and President Trump have come up empty. In fact, 
Congressman Price's plan to repeal the ACA without a replacement is a 
serious threat to the health of our country.
  But the Congressman's attack on our health care system does not end 
with dismantling the ACA. He wants to take a chainsaw to the safety net 
that helps our hardworking, low-income families stay afloat.
  Last year in Montana, under the leadership of Gov. Steve Bullock, the 
Montana Legislature worked across party lines to expand Medicaid to 
thousands of Montanans, giving folks coverage for the first time in 
their lives. A man in Butte, MT, looked me in the eye, and he told me 
that because of Medicaid expansion--listen to this--for the first time 
in his life, he was able to go see a doctor, get his diabetes under 
control, and ultimately find full-time employment. Because of Medicaid 
expansion, this man was finally able to provide for his family.
  Congressman Price's proposals will rip that coverage away from that 
man and make it more difficult for others to use Medicaid as well. His 
plan to block-grant Medicaid will do exactly that, and I have heard 
from health care providers from across our great State that this will 
cripple rural America.
  In Montana, with the expansion of the Affordable Care Act and 
Medicaid, it has created hundreds of jobs in the health care industry, 
and we can't afford to let those jobs go away. Rural America cannot 
afford Congressman Price's reckless plan--or lack of plan--to replace 
the ACA.
  But Montana's working poor aren't the only ones threatened by 
Congressman Price. Our senior citizens often fall into the crosshairs 
of Congressman Price's irresponsible battle with the Affordable Care 
Act.
  President Trump campaigned on protecting Medicare for seniors, and I 
am with him on that one.
  If Congressman Price had his way, Medicare, as we know it, would 
cease to exist. He has supported budgets that would turn Medicare into 
a voucher system and cut the program by nearly $500 billion. 
Congressman Price's plan moves more of the burden of health costs onto 
our seniors.
  Under Congressman Price's plan, a senior in Glasgow, MT, who is 
struggling with dementia would receive a fixed amount of money and 
would be expected to go out, shop for insurance, and buy a private 
insurance plan. A couple retired in Whitefish would be forced to spend 
less time enjoying their final years together in order to comparison 
shop and wrangle with insurance companies--not really how most of us 
would envision retirement. A farmer from Fort Benton, who has

[[Page S1010]]

given his blood, sweat, and tears to feed our country would be hanging 
up his dirty baseball cap for the last time and will have to worry 
about finding extra money in his savings to cover higher premiums and 
out-of-pocket costs.
  Does that sound like a fair way to treat our seniors? I think not.
  America's seniors have earned their Medicare over a lifetime of hard 
work, and because most of them live on fixed incomes, they can't afford 
to see it privatized. We cannot allow this administration to gamble 
with our seniors' future and their health care.
  Ann from Stevensville agrees. She wrote to me and said:

       Please do not support anybody wanting to privatize 
     Medicare. No to Tom Price.

  But that is not all. Congressman Price's track record of fighting 
against affordable health care for all Americans is disturbing. 
Throughout his confirmation process, a disturbing pattern has emerged.
  Congressman Price has spent his 12 years in Congress pushing 
legislation that would make health care less accessible for the poorest 
among us and enrich himself by corporate special interests. In 2016, 
Congressman Price used an exclusive sale of discounted stock of a 
foreign biotech company to line his own pockets. Now he is nominated to 
lead the agency that would directly impact this company.
  Congressman Price underreported his holdings in this company by as 
much as $200,000. Now, I know $200,000 may not seem like a lot to some 
folks, but I am going to tell you, to this Montana farmer and to 
farmers across this country, we would remember if we had $200,000 or so 
invested in a company.
  He introduced legislation to lower the tax bills of three 
pharmaceutical companies that he personally held investments in. CNN 
reported that during his time in the House, Congressman Price invested 
in a company and then 1 week later, introduced legislation to delay 
regulations that would have hurt that company's bottom-line profits.
  Patients, nurses, doctors, and hospital administrators got a raw deal 
while Congressman Price and his corporate special interests got richer 
and richer.
  As an elected official, as a potential Secretary, you are held to a 
high ethical standard. Congressman Price failed to reach that standard.
  President Trump pledged to drain the swamp. Congressman Price's 
record shows that he swam with the alligators for a while.
  It is clear to me that Congressman Price's priorities put him at odds 
with the fundamental job of HHS Secretary.
  Congressman Price's record is not one of expanding access to 
affordable care, increasing coverage to rural America, and protecting 
the Medicare that our seniors have earned. The legislation that he has 
carried in the House enriched himself and the companies he has invested 
in.
  I think Elaine from Lolo, MT, said it best when she wrote to me and 
said this:

       I believe we should be expanding health care coverage for 
     Americans, not making it more difficult to access and afford.
       Price wants to scale back Medicare and Medicaid, is out of 
     touch with the realities of the challenges and needs for 
     reproductive freedom and safety, and has financial conflicts 
     of interest that would potentially skew his judgment.
       A better choice should be demanded for the person who will 
     lead Health and Human Services to ensure our country has the 
     best possible healthcare and service support for the needs 
     for all humans, not just those in line with Rep. Price's 
     interests.
       I urge you to vote no on Price's appointment. I will be 
     watching the vote closely. Thank you.

  Well, I couldn't have said it better myself, and I would encourage my 
colleagues to vote no for Elaine, for Montana seniors, for Montana 
families. Well, they are all going to be watching closely.
  I would encourage a ``no'' vote on Congressman Price.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Cassidy). The Senator from Georgia.
  Mr. ISAKSON. Mr. President, I ask unanimous consent that these 
answers to four questions that have been raised in the last few days in 
the media be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 Four Examples of the Liberal Character Assassination of Dr. Tom Price

       Even the great Perry Mason would be stumped by this one. 
     Democrats, with the help of an eager media, have attempted a 
     character assassination of Rep. Tom Price, M.D., President 
     Trump's nominee for Secretary of Health and Human Services. 
     Despite an impeccable record in both public service and 
     medicine, they insisted Dr. Price's good name, built 
     throughout decades of serving others, did not belong to him 
     anymore.
        And they almost got away with it. Here's how it happened.
       Exhibit A: New York Magazine forecasts Price character 
     assassination.
       Buried in a December 27 story in New York Magazine, then-
     incoming-Senate Minority Leader Chuck Schumer (D-NY) 
     broadcasts that he has unanimous Democratic opposition to a 
     single Trump nominee: Dr. Tom Price. He plans to inflict as 
     much pain as possible on the HHS pick, and Democratic 
     staffers indicate they'll delay the process as long as 
     possible.
       ``Senate Democrats appear to be unanimous in their 
     opposition to Tom Price, Trump's choice for Health and Human 
     Services secretary, and they hope to raise such a ruckus 
     about Medicare during Price's hearings that at least three 
     Republicans decide to vote against Price, too, thus handing 
     Democrats their first scalp of the Trump era.
       ``According to various Senate aides, Schumer doesn't 
     believe his party has a chance of torpedoing any other Trump 
     nominees, but he hopes to make their confirmations as 
     bruising--and, with smart floor management, as prolonged--as 
     possible. (Schumer himself decided to comment.) `The goal 
     will be to show the public how controversial these 
     nominations are,' explains a Senate Democratic aide.''
       Evidence A: http://nymag.com/daily/intelligencer/2016/12/
who-will-do-what-harry-reid-did-now-that-harry-reid-is-
gone.html
       Exhibit B: Democrats, with help from media, begin Zimmer 
     Biomet smear.
       In mid-January 2017, CNN began nonstop coverage of what 
     they believed was a bombshell story that would rock the HHS 
     nomination process. Dr. Price, they claimed, introduced 
     legislation to benefit a medical device manufacturer, Zimmer 
     Biomet, whose stock he owned.
       ``Rep. Tom Price last year purchased shares in a medical 
     device manufacturer days before introducing legislation that 
     would have directly benefited the company, raising new ethics 
     concerns for President-elect Donald Trump's nominee for 
     Health and Human Services secretary.''
       The written piece breathlessly continues that theirs is the 
     ``latest example of Price trading stock in a healthcare firm 
     at the same time as pursuing legislation that could impact a 
     company's share price.''
       Predictably, Schumer and his henchmen began gleefully 
     alleging on television that Dr. Price potentially broke 
     federal law--a law that calls for up to 15 years of 
     imprisonment if broken.
       Except none of what CNN said happened actually happened.
       1) Dr. Price's Morgan Stanley broker purchased the Zimmer 
     Biomet stock without his knowledge as a part of a routine 
     rebalancing of his portfolio on March 17, 2016. They notified 
     Dr. Price on April 4, 2016. He disclosed it in his filings on 
     April 15, 2016.
       2) The 26 stocks, totaling less than $2,700, were so small, 
     in fact, that even Zimmer Biomet, like Dr. Price, was not 
     even aware that he was a stockholder.
       3) The legislation CNN and others keep referencing concerns 
     Dr. Price's well-documented efforts, including a 2015 letter 
     and subsequent bill, requesting the delay of a rule issued by 
     CMS.
       4) While CNN claims this would have benefitted Zimmer 
     Biomet, the company actually supports the CMS rule and 
     publicly opposed Dr. Price's legislation,
       So, CNN (and Congressional Democrats musing about alleged 
     crimes punishable by imprisonment) runs--and reruns and 
     reruns--a story about Dr. Price potentially breaking the law 
     or behaving unethically and doesn't even get the story 
     correct about Zimmer Biomet's position on the very 
     legislation they claim he introduced for them? Way to go, 
     guys.
       Evidence B: http://www.freebeacon.com/issues/dem-
accusations-regarding-tom-prices-stock-trades-
 unsubstantiated.
       Exhibit C: Democrats, with help from media, go low with 
     Innate Immuno play.
       In a salacious twist, media and Democrats turn their 
     attention to Australian medical company Innate Immuno. At the 
     recommendation of another Member of Congress, Dr. Price 
     decided to purchase Innate Immuno stock through a ``friends 
     and family'' referral program. Any eligible buyer referred to 
     the company by a current stockholder received a 12 percent 
     discount to fund a research project the innovator was 
     launching.
       This fact didn't stop Democrats from claiming he received 
     ``insider information'' as a Member of Congress, a rather 
     strange accusation about a company based in Australia.
       Then, they pointed to what they insisted--and insisted and 
     insisted--was his active support for the 21st Century Cures 
     Act, legislation they said would help Innate Immuno gain 
     access to American markets.
       That would be pretty suspicious, except for the fact that 
     Innate Immuno went on the record with the Wall Street Journal 
     back in

[[Page S1011]]

     December to express that they didn't care about the bill one 
     way or the other because they were governed by Australia and 
     New Zealand law.
       And then, of course, there's the little detail that Dr. 
     Price was not a co-sponsor of the 21st Century Cures Act. He 
     never whipped for the bill. He never even voted for it. In 
     fact, he was one of only a handful of Republicans to vote 
     against it when it was introduced in the U.S. House of 
     Representatives. As House Committee on the Budget chairman, 
     Dr. Price had concerns that the law would bust spending 
     limits set by the budget. Thus, he could not vote for the 
     bill. So, a lawmaker doesn't co-sponsor the bill, doesn't 
     whip for the bill and doesn't even vote for the bill, and yet 
     he's being accused of crafting it, pitching it to his 
     colleagues and promoting it to the public? Seems a bit odd, 
     doesn't it?
       Months later, the conference committee on the bill (of 
     which Dr. Price wasn't a member, since he voted against the 
     legislation) repaired the funding mechanisms for it, moving 
     it from mandatory spending to discretionary spending. Then, 
     Dr. Price felt comfortable voting to approve of the 
     conference report, which, again, is not the same as 
     ``actively supporting the legislation.'' And to top it all 
     off, it was because of Dr. Price's opposition to it that the 
     American taxpayers weren't on the hook for 21st Century Cures 
     as mandatory spending.
       So, another swing-and-a-miss from the media and the Left. 
     He didn't ``actively engage'' in supporting legislation that 
     they insist he spearheaded, and funnily enough, neither did 
     the company!
       EVIDENCE C1: http://clerk.house.gov/evs/2015/roll433.xml
       EVIDENCE C2: http://budget.house.gov/
news/docmentsingle.aspx?Document
     ID=393978
       EVIDENCE C3: http://www.georgiapol.com/2016/12/23/tom-
price-stock-investments-needed-perspective/
 EXHIBIT D: Puerto Rico Lies, Lies, Lies
       Another story emerged that Dr. Price introduced legislation 
     to benefit himself, via stocks he held in a pharmaceutical 
     company that did business in Puerto Rico. Again, the facts 
     don't match their claims.
       In 2004, Congress enacted the Section 199 deduction for 
     qualified U.S. manufacturing activities. Realizing a 
     technical omission, in 2006 Congress extended the 199 
     deduction for Puerto Rico on a temporary basis. As a result, 
     Puerto Rico was returned to a level playing field and would 
     no longer be competitively disadvantaged against the 
     mainland. The 199 deduction was temporarily extended in both 
     2011 and 2014.
       The Section 199 deduction was not extended as a part of the 
     PATH Act in 2015. Dr. Price's bill would simply make 
     permanent the 199 deduction, no longer requiring periodic 
     reauthorizations, just as it is for the mainland. This would 
     not give Puerto Rico or any U.S. company (and thus, a 
     shareholder of such a company) a tax advantage. It merely 
     creates a tax neutrality so a company can make a decision to 
     invest in a jurisdiction for economic purposes, rather than 
     tax. Dr. Price was never lobbied by PhRMA on this 
     legislation. However, it is a priority of American companies, 
     such as Georgia-based Coca-Cola, who would prefer to maintain 
     their operations in Puerto Rico. The Puerto Ricans they 
     employ, who already face perilous economic circumstances, 
     would be inherently disadvantaged if these extenders did not 
     occur.
       Whoops.
       Evidence D: https://www.pwc.com/us/en/tax-services/
publications/insights/assets/pwc-new-section-199-regs-could-
affect-wide-range-of-taxpayers.pdf


                                Summary

       Dr. Price's detractors on the Left have no actual defense 
     of their opposition to him. They can't deny his 
     qualifications or expertise, so they've resorted to an 
     attempted character assassination. The media, eager for 
     flames to fan, ran these baseless attacks time and time 
     again, despite easily accessible information (i.e. a Google 
     search) that would disprove these outrageous claims.
       Both the Left and their media support must be held to 
     account for conjuring up lies and spreading them for the past 
     two months.

  Mr. ISAKSON. Mr. President, I would also like the Record to reflect 
that I have never been to Montana. I have been to Delaware, but I 
respect anything either one of these Senators would say about any 
physician in Delaware or any physician in Montana. They have never been 
to Georgia. I have been to Georgia for 72 years. I have lived there for 
72 years, and for 30 of those years, I served with Tom Price in the 
State legislature, in the same neighborhood organizations. He has been 
my friend. He has been my doctor. He is a great individual, and my 
knowledge of him is firsthand. I am not going to read to you something 
that somebody told me Tom Price was or is or did or was accused of. I 
am going to tell you about the man I know who has been nominated for 
Secretary of the Department of Health and Human Services.
  I have known Tom, as I said, for 30 years. He is a great family man. 
He and his wife Betty are great members of our community. He is a great 
churchman. He is active in his church in his community. He started out 
working in neighborhood organizations, graduated to the State 
legislature, and became the first elected Republican majority leader in 
the history of the Georgia State Senate. He went from the Georgia State 
Senate to the Congress to replace me. He raised the intellectual 
component level of that seat tremendously when I got out and when he 
came in. He has done a tremendous job here in the seven terms in this 
Congress, representing the people of my State.
  Now, I don't know much about medicine, except that shots hurt, and I 
don't want to go to the doctor unless I absolutely have to. Tom knows 
everything about medicine because he has delivered it for 30 years. He 
knows about the affordability of health care. He knows about the needs 
of senior citizens. He knows about the innovations that are necessary 
to help all of us stay healthy for the rest of our lives.
  Tom Price is a committed public servant who has worked diligently and 
hard for the State of Georgia and people of Georgia.
  There have been a few things said about Tom that I want to address, 
not because I want to waste my time talking about things that are just 
allegations that are put together in some fashion or form to make him 
look bad. I want to just make the record straight.
  First of all, it has been said that Tom is for taking funds away from 
Medicare. That is ironic to me because last December, Tom and I were 
called on by AARP, the representative of the senior citizens of 
America, to go on the road and talk about how we were going to save 
Medicare and save Social Security--not cut and rob it. So we 
represented the organization AARP at their request. We wanted to save 
Social Security and save Medicare. We have never spent a minute of our 
time talking about taking it away from anybody. If there is anybody who 
is going to be able to make sure Medicare works for the senior citizens 
of the 21st century, it is Dr. Tom Price, of Georgia, and he is going 
to do it as Secretary of Health and Human Services in the United States 
of America.
  Secondly, there have been a lot of things impugning Tom and his 
investments--the investments he has made.
  I introduced Tom to the Senate Finance Committee. I introduced Tom to 
the Senate Health, Education, Labor, and Pensions Committee. I went 
through his application. I have seen everything on it. Everything that 
he is being accused of doing, he disclosed in his report. They are just 
using a technique that trial lawyers use called desperate impact, where 
you take two facts, put them over here, and put them together to make 
them a negative, rather than a positive. It is all in how you explain 
it and how you describe it. It is not how the act took place.
  As the chairman of the Ethics Committee and the one that administers 
the STOCK Act for this body, I know what we have to submit and make 
public; I know what we don't. Every single thing he has been accused of 
doing is from information taken out of his own disclosures, which 
anybody who owns a computer can get today to make him look like he is 
bad and a bad guy.
  In fact, I told the Senate Finance Committee when I went to introduce 
him there--after listening to Chuck Schumer on the Sunday shows for 2 
weeks talking about Tom Price--that I felt like I was going to have to 
be a character witness for a convicted felon at a sentencing hearing. 
That is not right for us to do that to people.
  Tom Price is a great man. He has done a great public service. He has 
done a great job, and he will do a great job as Secretary of Health and 
Human Services.
  I am proud to have introduced him. I am proud to know him as a 
friend, and I am proud that he is going to be my Secretary of Health 
and Human Services. America and all of her citizens will be better off 
because the doctor will be in the house.
  I urge a vote for Tom Price and yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, I come to the floor to, one, thank my 
friend and colleague, the Senator from

[[Page S1012]]

Georgia, for making his comments about Tom Price, President Trump's 
nominee to be Secretary of Health and Human Services.
  I have known Tom for over 20 years. We are both orthopedic surgeons. 
I know his professional ability. I know his passion for patients and 
health care. I am delighted and confident that he will be confirmed to 
be the Secretary of Health and Human Services. I think he is the right 
person for the important task that lies ahead.