[Congressional Record Volume 163, Number 126 (Wednesday, July 26, 2017)]
[Senate]
[Pages S4227-S4297]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    AMERICAN HEALTH CARE ACT OF 2017

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of H.R. 1628, which the clerk will 
report.
  The legislative clerk read as follows:

       A bill (H.R. 1628) to provide for reconciliation pursuant 
     to title II of the concurrent resolution on the budget for 
     fiscal year 2017.

  Pending:

       McConnell amendment No. 267, of a perfecting nature.
       Enzi (for Paul) amendment No. 271 (to amendment No. 267), 
     of a perfecting nature.
       Donnelly motion to commit the bill to the Committee on 
     Finance with instructions to report back with instructions.

  The ACTING PRESIDENT pro tempore. Under the previous order, the

[[Page S4228]]

time until 11:30 a.m. will be equally divided between the leaders or 
their designees.
  Who yields time?
  If no one yields time, time will be charged equally to both sides.


                   Recognition of the Minority Leader

  The Democratic leader is recognized.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that my speaking 
time be taken from leader time, not the debate time.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. SCHUMER. Mr. President, as the Senate continues the debate on the 
Republican healthcare bill, it seems the Republican majority is no 
clearer on what the endgame is because there is no good way out of 
this.
  Last night, the Senate Republican TrumpCare bill--after months of 
backroom negotiating and provisions aimed at all kinds of individual 
States and Members--died, with nine Republicans voting against the 
measure and many others who voted for it gritting their teeth 
unhappily.
  Later today, we will vote on a bill to repeal the Affordable Care Act 
without replacing it. I know that you, Mr. President, have championed 
that bill. Based on public comments and public criticism from the other 
side of the aisle, repeal without replace will fail as well. It is 
becoming clearer that in the end, the majority leader might push a much 
scaled-back version of repeal in the hopes of passing something--a so-
called skinny repeal--just to get to conference. My colleagues, make no 
mistake about it, skinny repeal is equal to full repeal. It is a Trojan 
horse, designed to get the House and Senate into conference where a 
hard-right flank of the House Republicans, the Freedom Caucus, will 
demand full repeal or something very close to it. They will demand all 
the things--deep cuts to Medicaid, generous tax breaks for the wealthy, 
elimination of preexisting conditions, slashing the kinds of things 
people need for nursing homes and opioid treatment and disabled kids--
that many of my Republican colleagues in the Senate have very sincerely 
tried to undo.
  There is no such thing as skinny repeal. It is a ruse to get to full 
repeal, with all the concomitant cuts to Medicaid and tax breaks which 
are so unpopular and which so many of my Republican colleagues here on 
the other side have opposed. It is clear House and Senate Republicans 
are miles apart. They are divided on major issues--on Medicaid, tax 
breaks, and preexisting conditions. The differences between House 
Republicans and Senate Republicans are virtually irreconcilable. So 
what is the point of a conference?
  You can imagine a conference that turns into an endless game of hot 
potato; the Republican leader and the Senate passing the potato to the 
House; the Republican leader of the House passing the potato back to 
the Senate because neither wants to be responsible for what is 
inevitable: the demise of TrumpCare. Of course, it is likely a 
conference could probably produce no agreement at all, keeping the 
incredibly toxic and unpopular TrumpCare bill the topic of conversation 
for another 3 months, stalling the legislative agenda for another 3 
months, and in the end getting nothing done.
  My Republican colleagues should consider that. Many of them want to 
work with us on so many issues. Above all, NDAA, which my dear friend 
John McCain, who we pray for every day, wants to get to right away, and 
the Energy bill, which my colleague from Washington and her chair, the 
senior Member from Alaska, could bring to the floor and get moving in a 
bipartisan way. Leader McConnell has made it clear he wants to move 
nominations.
  If we stop playing this game with TrumpCare and send it back to 
committee and do regular order, as John McCain preached so well 
yesterday, we could move on to all these other things in a good, strong 
bipartisan way and start to get things done. My Republican colleagues 
should consider that carefully.
  We Democrats want to start working with our Republican colleagues on 
the issues I mentioned. We also want to work on improving ACA. No one 
has ever said ObamaCare was perfect. I have called five or six of my 
Republican colleagues on the other side and said if we stop this effort 
with TrumpCare--with repeal or repeal and replace with something far 
worse than the present--we can go back to committee and improve the 
present healthcare system and get premiums lower, make healthcare 
better, and stabilize the system so there is more competition. We will 
do that.
  My good friend the Senator from Wyoming, not the Senator sitting here 
but his colleague--I heard he was saying to some Members: Oh, the 
Democrats will never negotiate. Schumer will never negotiate. I saw him 
last night on the floor, and I assured him we will. That is our goal. 
He accepted that in good faith, which I very much respect.
  So the bottom line is simple. I say to my Republican colleagues, when 
you find yourself in a hole, the first rule is stop digging. By 
continuing this process--trying to send something, anything, to 
conference with the House--Republicans are just digging a deeper and 
deeper hole for themselves and for this body. I implore my Republican 
colleagues to stop digging and come work with Democrats. We can work to 
improve our Nation's healthcare system, but Republicans have to turn 
back soon, and they are running out of chances.
  One more thing I would add. I heard my friend the Republican leader 
say we are going to have a full amendment process. He is trying to 
convince the folks on the other side that, oh, we will do a bunch of 
amendments, and then we will have no choice, we will have to send 
something to conference because we couldn't get anything major done. 
That is a lot of bunk. We have had no hearings, we had no amendments, 
we had no bipartisan discussions, and we will not even be able to have 
debate on many amendments on one of the most major bills affecting us, 
that affects tens of millions of people's health, and affects one-sixth 
of the economy. Don't fall for this, oh, we are having a full process. 
I like my friend the Republican leader. We get along well, but 
sometimes he says things that when I hear them, I get a little twinge 
in the stomach. We have a full and open amendment process, he said 
three or four times. Everyone in this Chamber knows that is not the 
case. Don't be deluded into thinking, well, we tried. We haven't tried 
until we go back to regular order.


         Comments of the President on Attorney General Sessions

  Mr. President, on another matter, President Trump continues to find 
new ways to humiliate his own Attorney General, Jeff Sessions, a man 
who stuck his neck out for the President before any other Senator 
would. I heard President Trump say: I was already popular. As I 
remember it, when Jeff Sessions supported him, he was an underdog, and 
everyone said: Wow, Jeff Sessions is doing that out of loyalty and 
friendship with Donald Trump, not because he was jumping on a train 
that was headed down the track. Maybe he saw that, but no one else did, 
and now the President humiliates him.
  I would say to my fellow Americans--Democratic, Republican, liberal, 
conservative--every American should be troubled by the character of 
this person who humiliates and turns his back on a close friend after 
only 6 months. We are already far beyond the dangers of a chilling 
effect at the Department of Justice. The President is taking almost 
every opportunity in public to demonstrate an open hostility toward the 
Attorney General. It seems clear the President's intention is to make 
life unbearable for the Attorney General, hoping to prompt his 
resignation. All Americans should be wondering why the President is 
publicly demeaning and humiliating such a close friend and supporter--a 
member of his own Cabinet. They should wonder if the President is 
trying to pry open the office of Attorney General to appoint someone 
during the August recess who will fire Special Counsel Mueller and shut 
down the Republican investigation. Let me say, if such a situation 
arises, Democrats will use every tool in our toolbox to stymie such a 
recess appointment.
  Second, I can't imagine my friends on the Republican side, 
particularly my friends in the Republican leadership, the majority 
leader and Speaker Ryan--I can't imagine they would be complicit in 
creating a constitutional crisis. They must work with us and not

[[Page S4229]]

open the door to a constitutional crisis during the August recess.


                             Sanctions Bill

  Mr. President, one final point because I know my colleagues are 
waiting: sanctions--finally, a word on them. Yesterday, the House of 
Representatives passed nearly unanimously, 419 to 3, a sanctions bill 
that was a product of bicameral, bipartisan negotiations and includes 
strong sanctions against Russia, Iran, and North Korea. The Senate must 
act quickly on the legislation from the House.
  I understand that earlier today the chairman of the Foreign Relations 
Committee indicated he plans to strip out a section of this package 
that relates to North Korea. This is yet another delay generated by 
Republicans to prevent this bill from landing on the President's desk 
before we leave for the recess. Even as we debate other items here on 
the floor, we shouldn't delay this legislation any longer.
  I will work with the majority leader to schedule another vote on the 
sanctions bill so that we can send the legislation to the President's 
desk before the recess, and I expect the vote will constitute a veto-
proof majority, just like the vote in the House.
  Mr. SCHUMER. Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Cotton). The Senator from Washington.


                           Export-Import Bank

  Ms. CANTWELL. Mr. President, I saw the remarks of the President of 
the United States in Youngstown, OH, and it has brought me to the floor 
this morning because the focus of some of his speech was on the economy 
and job creation. Well, I can tell the President right now that we need 
his urgent attention to making sure that we create jobs right now. It 
is not about something in the future; it is about right now.
  There are over 40 projects worth $30 billion being held up because 
the Export-Import Bank does not have a quorum. It is incredibly 
important to get a functioning bank and to get a board that supports 
having the support of a credit agency to work with the private sector 
to finance the sale of U.S.-made products.
  The President seems to embrace the notion that we should make things 
in America. I think we should make things in America, but I don't think 
that we sell them only in America. I actually want to sell the great 
manufactured products of the United States of America to overseas 
markets, to the 95 percent of consumers who are outside the United 
States. But because this administration has not shown the leadership to 
get a functioning Export-Import Bank, we continue to struggle. Those 
$30 billion in projects are being held up because we don't have a 
functioning quorum.
  GE Aviation in Ohio--I wish he would have visited them because they 
decided to move part of their operations to Canada and Brazil, instead 
of expanding in Ohio, to take advantage of countries that actually have 
a credit agency. GE Aircraft Engines decided to open a turbine prop 
engine facility in Europe for the same reason. We are losing jobs 
simply because we don't have a tool to work with private-sector banking 
to make sure that the sale of U.S.-manufactured products actually gets 
done to countries and organizations in those countries that don't have 
the proper financing. GE supposedly said that they weren't going to 
move their corporate headquarters to Ohio because they did not support 
the reauthorization of the Export-Import Bank.
  Between 2012 and 2016, the Export-Import Bank supported more than 255 
export deals in Ohio from all sizes of companies, such as Haltec, which 
exports auto parts, and Anglo American Hardwoods, which exports wood 
products to the GE Aviation that I mentioned and GE Aircraft Engines. 
These deals were worth more than $2 billion.
  What I am so frustrated about is that this administration has not 
kept its word in support of the Export-Import Bank. We continue today 
with the folly of having our Trade Ambassador show up before the 
Finance Committee and say that the Export-Import Bank is controversial. 
I reminded him that it was actually supported by a majority of 
Democrats and a majority of Republicans in the U.S. Senate. It was also 
supported by a majority of Republicans in the House of Representatives 
and the Democrats in the House of Representatives. So how could it be 
so controversial if we reauthorized it?
  But the White House has continued to have a double-edged strategy, 
pretend that they support the Export-Import Bank, and yet send up the 
name of a nominee to chair the bank who wants to destroy the bank and 
has made that intention clear.
  If we want jobs in Ohio, we need to get the Export-Import Bank 
approving deals from manufacturers that are ready to close sales and 
create more jobs, so let's focus on the task at hand. I hope the 
President will stand up and clearly articulate the need and support for 
an Export-Import Bank and stop sending us the name of someone who just 
wants to destroy it.
  I thank the Presiding Officer.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.


             Requests for Authority for Committees to Meet

  Mr. ENZI. Mr. President, I have 12 requests for committees to meet 
during today's session of the Senate. They do not have the approval of 
the Democratic leader; therefore, they will not be permitted to meet 
past 11:30 this morning, but I ask unanimous consent that a list of 
committees requesting authority to meet be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       Committee on Commerce, Science, and Transportation,
       Committee on Environment and Public Works,
       Committee on Foreign Relations,
       Committee on Homeland Security and Governmental Affairs,
       Committee on Indian Affairs,
       Committee on the Judiciary,
       Committee on Veterans' Affairs,
       Committee on Aging,
       Subcommittee on Public Lands, Forests, and Mining,
       Subcommittee on Africa and Global Healthy Policy,
       Subcommittee on Investigations.

  Mr. ENZI. Mr. President, I listened with a lot of interest to the 
Democratic leader's comments this morning and his proposal that there 
would be cooperation if we went to a system of putting it back through 
committees and doing that, but I have to say that we would have a lot 
more confidence in getting a solution if there were a single positive 
suggestion from the other side for a change. Until that happens, there 
isn't much confidence on our side that the promise of bipartisanship is 
going to happen.
  They keep saying that it isn't perfect, but they don't put forward 
ideas for any of the changes. We have been suggesting changes for 
several years, and we have been told each time that it just needed a 
little more time, that it was a perfect bill.
  Soon we will be trying to do a budget. It would be nice if we had 
some suggestions on budget items that were positive things. I put out 
that offer as well.
  The reason we are having this is that more than 7 years ago, 
President Obama and congressional Democrats imposed a risky, partisan 
healthcare experiment on America that ultimately led to skyrocketing 
healthcare costs and collapsing insurance markets for millions of 
Americans across the country. This riverboat gamble has caused a stark 
and dramatic outcome. Currently, there are projected to be 50 counties 
across the Nation that will not have a single insurer participating in 
the ObamaCare exchange.
  To add further insult, Americans seeking affordable coverage in these 
almost 50 counties will still be fined under the ObamaCare mandate for 
not having health insurance. In other words, many Americans will either 
be forced to pay for insurance they cannot afford or pay a penalty for 
not having health insurance under this so-called Affordable Care Act, 
which they can't even access. Where are these people supposed to go? 
What can we do to help? Again, we are looking for some positive 
suggestions.
  My colleagues on both sides of the aisle know that this healthcare 
experiment has failed and that we must work together to free Americans 
from these mandates and put healthcare decisions back in people's 
control.
  Today, Senate Republicans are taking an important step to rescue the 
millions of hard-working families trapped by ObamaCare's taxes and

[[Page S4230]]

mandates. We are trying to repair the Nation's broken healthcare system 
because we now have a President in the White House who shares our 
commitment to improve America's healthcare system and make better care 
available to all Americans.
  One of our top priorities in Congress has been to provide relief for 
hard-working Americans from ObamaCare, which has pushed insurance 
markets to the brink of collapse. In Wyoming and across the country, 
premiums for hard-working families are soaring while choices for 
patients have dwindled. As I travel across Wyoming, I have a lot of 
people who tell me that their health insurance costs more than their 
mortgage and, if they ever need healthcare, they have a deductible that 
is bigger than that.
  Simply put, ObamaCare stumbled out of the starting gate on the very 
first date the healthcare.gov website launched. You might remember how 
you couldn't get on the website or how you got kicked off after you had 
done a lot to put in information. Yes, ObamaCare stumbled out of the 
starting gate on the very first day that the healthcare.gov website was 
launched, and it has consistently failed to deliver on its core 
promises while hurting far more Americans than it is helping.
  One thing both parties should agree on is that an accessible and 
affordable healthcare system should be available to each and every 
American family, and I truly hope my colleagues on both sides of the 
aisle will work with us to find common ground on healthcare that truly 
delivers better care.
  Millions of Americans have been suffering under President Obama's 
healthcare law, and this past fall our Nation voted for a change. These 
hard-working Americans made it clear that fixing our healthcare must be 
a top priority for Congress and the President. This week, we are 
delivering on that promise of relief from ObamaCare.
  Making America's healthcare system more efficient and effective has 
always been an important and challenging endeavor for the public and 
private sector alike. President Obama and his congressional Democrats 
pushed Washington into the healthcare market, inflicting far greater 
uncertainty, cost, and disruption into the healthcare landscape than 
anyone ever imagined. By taking the important steps necessary to 
untangle Americans from this unworkable, unpopular, and unaffordable 
law, hard-working families can expect to see stability in the 
skyrocketing healthcare costs and egregious penalties imposed on them 
by the ill-named ObamaCare concept of ``affordable care.''
  If you are young and healthy, ObamaCare has made it an easy choice to 
opt out of health coverage. But for those not so fortunate, for those 
who must have coverage, soaring healthcare costs are becoming a 
stunning reality. I have constituents in Wyoming who have written to me 
with worry and concern about their surging health insurance premiums.
  I assume that my 99 other colleagues have received many letters like 
one I received from a family in Gillette, WY. They recently wrote me 
that under ObamaCare they are paying more than $2,400 a month--
essentially taking on more than another mortgage.
  In their letter to me, they write:

       Mike, we are small business owners in Gillette, WY. Between 
     Obama trying to kill the coal, oil and gas industries and his 
     insurance fraud, we are stuck between a rock and a hard 
     place. I just paid a $2400 Blue Cross Blue Shield of Wyoming 
     Health insurance bill. I can't keep doing that. I am a real 
     person with real problems created by my own government. HELP 
     MIKE HELP.

  That last line of this letter is especially moving: ``HELP MIKE 
HELP.'' This is why Republicans in Congress and the President have 
focused on doing just that--helping hard-working Americans like this 
family in Wyoming. They are looking to us to provide real leadership 
and rescue them from the failed ObamaCare law.
  The previous administration seemed to focus only on protecting their 
self-described signature legislative achievement. Our focus must be to 
address ObamaCare's tangled and expensive web of regulations. For 
families like my constituents, the situation is grim and only getting 
worse by the day.
  One of the most disturbing parts of this law is that Americans are 
now essentially double-charged by having to pay more in taxes to fund 
the very healthcare law that is driving up the cost of their insurance 
premiums. Let me explain further. ObamaCare taxes have increased 
insurance premiums and limited options for patients and healthcare 
providers, including taxes on prescription drugs, over-the-counter 
medications, health insurance premiums, and medical devices.
  Unless Congress acts, American households will be forced to pay 
nearly $1 trillion in new taxes and penalties over the next 10 years. 
Individual and employer mandate penalties forced millions of hard-
working families into expensive and terribly inadequate ObamaCare plans 
that they did not want and could not afford. ObamaCare's crushing 
regulations mean smaller paychecks for families and prevent small 
businesses from expanding and hiring new workers.
  For every American, ObamaCare has meant more government, more 
bureaucracy, and more rules and regulations, along with soaring 
healthcare costs and few choices. Working together, we can begin to 
lift these burdens and higher costs this law has imposed on all 
Americans. The bill we are debating this week will begin to provide 
relief from ObamaCare that millions of hard-working Americans have long 
demanded.
  Fortunately, America now has a Congress and a President committed to 
helping stabilize the collapsing insurance markets that have left 
millions of Americans with no options.
  The goal of the Republican healthcare bill will be to improve the 
affordability of health insurance, preserve access to care for 
Americans with preexisting conditions--yes, to preserve access to care 
for Americans with preexisting conditions--and to safeguard and 
strengthen Medicaid for those who truly need it. This will be 
accomplished by giving States more flexibility and ensuring that those 
who rely on this program won't have the rug pulled out from under them. 
Most importantly, we will free the American people from the onerous 
ObamaCare mandates to purchase insurance that they don't want and can't 
afford.
  The American people have endured a lot under ObamaCare--including 
every broken promise. We all remember President Obama's promise to each 
and every American that if they liked their health plan, they could 
keep it. Well, Americans soon learned they couldn't keep their plan or 
their doctor or any extra money in their wallet. The main reason for 
this is because ObamaCare invaded the insurance marketplace and 
drastically reduced Americans' choice of healthcare plans and with it 
the competition necessary to contain the costs of health insurance. It 
was no surprise that the President's promise--if you like your plan, 
you can keep it--became the ultimate example of the unfulfilled and 
unattainable promises of ObamaCare.
  For many Senators, especially from rural States like mine, the real 
impact of ObamaCare on our health insurance market is much more 
disturbing. Wyoming currently only has one health insurer in the 
individual market, both on and off the ObamaCare exchange. Let me say 
that again so there is no mistake. There is only one health insurer 
either on or off the ObamaCare exchange for all of Wyoming. One health 
insurer for all of Wyoming. Many States are experiencing a similar 
crisis, with only one insurer left standing since others have entirely 
abandoned the exchanges.
  For residents of Wyoming and millions of other Americans, the Obama 
administration's public relations campaign--on which it spent millions 
of taxpayer dollars--touted choice that ultimately became false 
advertising. This is the actual ``choice'' for millions of Americans: 
one and none--but the ``none'' will cost you because of the mandate 
penalty. You can't afford it, so you don't get it, and then it costs 
you because of the mandate penalty.
  What about the promise of lower healthcare costs that provided the 
foundation for my colleagues on the other side of the aisle to pass 
this flawed bill? Even President Obama's administration admitted that 
ObamaCare is failing to address costs, with average premiums rising by 
25 percent for silver-level plans on the Federal exchange. That means 
families have to decide whether to purchase unaffordable insurance or 
pay a fine. In most cases, they are literally paying

[[Page S4231]]

more money for less control of their healthcare.
  Last October's dramatic premium increase was clearly on the minds of 
voters when they cast their ballots in the November election. Let me 
say that again. Last October's dramatic premium increase was clearly on 
the minds of voters when they cast their ballots in the November 
election. There is trying to be some blame put on us for those 
increases, but that was before last November's election.
  This is a crucial time for healthcare in America. We do not have the 
luxury of ignoring the crisis in health insurance markets and the 
crushing premiums faced by families across the country. Healthcare 
costs for my constituents in Wyoming continue to be among the highest 
in the Nation, with other States not far behind.
  We must act now to rescue the millions of Americans who are suffering 
under ObamaCare in order to provide relief to those who have been 
harmed by this law. Unwinding this failed law to make meaningful 
changes has not been easy, but Americans are relying on us to 
accomplish this task and keep the promise to rescue them from 
ObamaCare. Our goal is to create a healthcare system where Washington 
gets out of the way and families are again empowered to control their 
own healthcare, with more choices and lower costs.
  So this is where we find ourselves today. Congress and the President 
are fulfilling their promise to provide relief for millions of hard-
working Americans trapped by Obamacare's taxes and mandates. We are not 
tied to any single idea. We hope our Democratic colleagues will 
ultimately join us in this worthy endeavor. The American people are 
expecting us to act. We must not let them down.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Ms. WARREN. Mr. President, since the Republicans have announced that 
their top legislative priority in this Congress would be to rip away 
healthcare from millions of Americans, I have come down to the floor 
many times to beg them to reconsider. I shared stories about families 
in Massachusetts who gained quality healthcare coverage for the first 
time after the passage of the Affordable Care Act. I shared statements 
and letters from hospitals and doctors in Massachusetts talking about 
the incredible difference healthcare coverage makes for the patients 
who walk through their doors. I have also shared many, many stories 
from parents with children who have complex medical needs--all of those 
children depending on Medicaid.
  I know that families, doctors, hospitals, nursing homes, and patients 
lying in their hospital beds haven't just been sharing their stories 
with me; they have been begging every Republican in the Senate to 
listen to them as well. People share their stories because they want to 
make a difference. These are the stories of families we represent. They 
are the reason we are here in the Senate. They are supposed to be our 
guiding light for the choices we make and the way we vote.
  Senate Republicans who voted yesterday to move forward with their 
effort to rip away Americans' healthcare are not listening to the 
people they represent. Their vote was irresponsible. It was reckless. 
It was cruel. It was immoral. But more than that, this was a vote that 
is not who we are as a country.
  Let's be very clear about what is happening on the floor of the 
Senate right now. Fifty Republicans have voted to open debate on a 
series of bills, each of which would have devastating effects for 
healthcare in this country. Now the Republicans don't know which of 
these bills will actually be the ones they will be asked to vote on. 
Only some of the bills have been analyzed by the number crunchers over 
at the Congressional Budget Office, the CBO, to estimate exactly how 
many people would be kicked off insurance and how high premiums would 
go, but every version that the CBO did examine over the last few weeks 
was very ugly, with tens of millions of people losing their coverage 
and costs skyrocketing for millions more.
  The latest plan Senator McConnell has been floating behind the scenes 
would have Republicans ultimately vote on what is called a skinny 
repeal bill. This bill would make a limited set of changes to the 
Affordable Care Act--just the important stuff. What is important to 
Senator McConnell? It seems to be the part of the Affordable Care Act 
that makes the health insurance system actually work, because the 
skinny bill would repeal the parts of the ACA that say everyone needs 
health insurance coverage. This is the individual mandate.
  Republican leadership is telling their Members that if they vote for 
this skinny bill, they can hammer out the rest of the details in 
conference with the House of Representatives. But make no mistake--this 
isn't a more moderate version of the Republicans' ugly plan to repeal 
the Affordable Care Act. This isn't compromise. In fact, this may be 
the worst idea they have had yet because if Senate Republicans vote to 
repeal the individual mandate, they are getting rid of the linchpin of 
the insurance markets in this country. That is because this provision--
the one the Republicans want to junk--is what keeps the price of 
insurance affordable for people with preexisting conditions.
  Don't just take my word for it. Independent experts have looked at 
what would happen if the Republicans repeal the individual mandate. 
Boy, it is not pretty. Just yesterday, the American Academy of 
Actuaries--these are the experts who study how insurance works. They do 
that for a living. These are their numbers. They wrote to Senate 
leadership begging them not to go forward with this reckless plan. They 
wrote that eliminating this part of the health law ``would likely have 
significant implications for health care coverage and costs both to 
consumers and the federal government.'' They said that it would ``lead 
to premium increases.'' It would ``weaken insurer solvency.''
  Let me do the translation on this. The actuaries--those who study 
insurance for a living--are saying that what the Republicans are 
thinking of voting on is a provision to jack up insurance costs through 
the roof and rip away coverage from those who can't afford to pay those 
higher costs.
  We should be very clear about the consequences. If the Republicans go 
through with that vote, they will be responsible for every dollar of 
premium increases that occur over the weeks and months that follow as 
this bill sits in a conference with the House and insurance companies 
jack up prices because they don't know what they might be required to 
cover. Senate Republicans will be responsible for every single person 
who has to drop coverage because they can't afford those price 
increases. The Senate Republicans will be responsible for every single 
person who didn't go to the doctor when they needed to or didn't 
schedule surgery when they needed to because they no longer have health 
insurance. Senate Republicans will be responsible for every family in 
this country who misses a mortgage payment or can't pay their 
electricity bill or is forced into bankruptcy because their medical 
debts have become too big to ever pay off.
  Every time I have come to the floor to talk about this terrible 
Republican bill, I have said that I am ready to work on bipartisan 
proposals that will actually improve healthcare in this country, and I 
say it again. I am still ready to do that, but we cannot move forward 
while Senate Republicans are still trying to take healthcare coverage 
away from millions of Americans and drive up costs for millions more.
  Republicans seem to think they can wear us down, that they can keep 
us here until we get too tired or we give up or we just give in, but, 
boy, that is where they are wrong. They do not have a clue what they 
are up against because we are fighting for families. We are fighting 
for little kids. We are fighting for our neighbors. We are fighting for 
parents and brothers and sisters and loved ones. We are fighting for 
the American people. When you fight for the American people, the wind 
is always at your back, and your heart is always strong.
  So Democrats will be here, fighting for as long as it takes to beat 
back these shameful healthcare bills. We hear the American people. We 
hear you. We are on your side, and we will never give up.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.

[[Page S4232]]

  

  Mr. WARNER. Mr. President, first of all, I thank my friend, the 
Senator from Massachusetts, for her comments today and for her 
relentless willingness to take on this fight and so many other fights 
that are so important to our country.
  I come to join her call to point out some of the challenges in this 
legislation but also to make an appeal to my friends on the other side 
that this does not have to be the way we go. I have been one who has 
acknowledged for many years that there are challenges in the Affordable 
Care Act and that there are areas in which there could be common 
interests in finding solutions, but what we have before us now is a 
series of ``bad, badder, and baddest'' choices. In effect, we have a 
series of options that ask: Do we want to pass legislation that would 
take 16 million Americans off healthcare? Do we want to pass 
legislation that would take 22 million people off healthcare? Do we 
want to pass legislation that would take 32 million Americans off 
health insurance?
  What parts of these choices do my Republican colleagues really 
embrace?
  I think that in the 8 years I have been here, I have never seen a 
series of pieces of legislation that have been so unpopular, even 
before they are passed, than this litany of options from full repeal to 
skinny repeal and all of the variations in between.
  As has been said by the Senator from Massachusetts and I know by the 
Senator from Washington State as well, the American people know this. 
That is why our phones are ringing in our offices and I know in our 
Senate Republican colleagues' offices. People are saying do not pass 
this kind of legislation.
  I think about the fact that in the last couple of weeks, the parents 
of a number of children and young adults who have enormous disabilities 
have come to my office. In Virginia, we run a very skinny Medicaid 
Program. Frankly, it has not been very generous. Some of the 
individuals who have come to my office have waited 5, 6 years--one 
person has waited 10 years--to get a Medicaid waiver. These families, 
these children, in any of the proposals that have been put forward, 
would be the first to lose their coverage.
  Family after family talked about the fact that, right now, both 
parents can work because they have a little bit of relief to take care 
of their disabled young adults in certain cases. In many cases, it is 
because the young adults can at least find someplace to do some 
productive work themselves. Yet, if they were to lose the Medicaid 
waiver, one of the parents would have to stop working, and the child 
would have to stop his form of employment. Net-net, it would be a loss 
not only to that family, but it would be a loss to our economy.
  I mentioned that I used to be the Governor of Virginia. In 2016, 
Virginia received about $4 billion in Federal Medicaid funds--51 
percent of the State's funding for people covered by Medicaid. As I 
mentioned, we are ranked one of the skinniest programs in the country. 
Unfortunately, we rank about 47th, I believe, in terms of our payments. 
Yet, under any of these proposals that decimate Medicaid, Virginia 
would be penalized for running an efficient program.
  Again, one of the ironies of this is that the States that are the 
least penalized in the Republican proposals, in terms of the $700 
billion-plus of Medicaid cuts, are actually the States that have more 
generous programs. They are often States that are represented by 
Democratic Governors. In what way do these proposals help our 
Republican colleagues or, for that matter, their constituents?
  We have heard, as well, that the American Cancer Society, the 
American Medical Association, the American Academy of Pediatrics, the 
American Hospital Association, and AARP--a who's who of groups 
affiliated with healthcare--have come in and pleaded: Please, do not do 
this, this way--any one of these litany of proposals that we will be 
dealing with over the next few days.
  From what I have heard on an individual basis--and I take enormous 
pride in the fact that in my time here--and sometimes it has even 
gotten me crosswise with the ranking member of the HELP Committee--I 
have tried to reach out on virtually every piece of legislation I have 
worked on to find a Republican partner. I actually got put in a timeout 
by a previous leader for doing too much of that.
  What I hear from my Republican colleagues is, they do not want to own 
this. They know, in many ways, that this is walking the plank on what 
is both bad policy, bad politics, bad for their constituents, but the 
notion that somehow they have to provide a win for a President who has 
provided zero leadership before they can take some kind of August 
recess is literally the worst reasoning I have heard in my 8 years in 
the Senate as to why to pass a piece of legislation, particularly a 
piece of legislation that affects one-sixth of our economy. In many 
ways, it is almost one-third of the people who will be affected by some 
of these changes.
  I think many of us were touched yesterday when we saw Senator McCain, 
who is an American hero and who himself is having to grapple with 
enormous healthcare challenges, come back to the floor and, frankly, 
admonish us appropriately but also say that while he was going to vote 
to start debate on this bill, the real way we ought to go about doing 
this is to roll up our sleeves, in a bipartisan fashion, and take this 
legislation back to where it should start, which is in the HELP 
Committee, where the Senator from Washington serves, in the Budget 
Committee, whose chairman is on the floor, and in the Finance 
Committee. Two of those three committees I have the honor of serving 
on.
  I commit to my Republican colleagues that I will work with them. I 
have laid out a series of ideas, some of which they have endorsed in 
terms of there potentially being cheaper options, in terms of 
selections; the idea, as long as we protect consumers, of allowing 
insurance policies to be sold across State lines and other ideas in 
terms of reinsurance that other colleagues have worked on. There are a 
host of ideas we all agree on. Let's start with that premise, in terms 
of coming to a solution, not coming up with legislation that is cooked 
up behind closed doors that even my strongest Republican colleagues 
have acknowledged they cannot vote on when they only get an hour to 
look at it.
  Think about all of the same criticisms--some of them valid--that were 
made against the Democrats when we passed the ACA; although I would 
continue to remind my friends that we had, literally, hundreds of 
amendments which were Republican amendments that were accepted into 
that legislation. It was not a perfect process, but let's learn from 
that and take this advantage right now. Listen to the American public, 
and let's work together to get this right.
  The other item that will come about from any of this Republican 
legislation put forward, even from the skinniest of their proposals, 
would dramatically affect those individuals with preexisting 
conditions. I have three daughters. One of my daughters has juvenile 
diabetes. She has had it for 18 years. Another daughter has asthma and 
a very strange set of allergic reactions that have actually caused her 
to have been hospitalized 38 times in the last 40 months.
  I am an extraordinarily lucky individual. I know that both through 
health insurance and because I had the resources, every time my two 
children got sick, I could make sure they got the medical attention 
they deserved. I cannot imagine talking to any Virginia family or 
Washington family or Wyoming family or Arkansas family who has a child 
with those same afflictions and trying to explain to them that my kids 
who have juvenile diabetes, asthma, and allergic reactions--through no 
fault of their own and that have caused this number of 
hospitalizations--have a right to healthcare and that their kids who 
have preexisting conditions do not have that right.
  Our country is much better than this. We can figure out a way to get 
this right, but we are not going to get it right if we continue to have 
this ploy of one closed-door, cooked-up deal after another that is put 
forward, with no review and no real attempt to find a common solution.
  I do not come to the floor that often, and I do not often talk about 
the medical needs of my family. This is for the sake of not only my 
kids who get the coverage they need and deserve but for

[[Page S4233]]

all the kids who now get the coverage they did not have prior to the 
ACA and who have it now. It is the idea that insurance companies cannot 
discriminate against you because you have preexisting conditions.
  Let's see if we can make sure we maintain that commitment. In the 
greatest country in the world, as Senator McCain so eloquently put it 
yesterday, let's see if we can work through to a way that makes this 
body, once again, the greatest deliberative body in the world. Let's 
see if we can find that common ground that would allow us to put 
forward legislation that at the end of the day, we would all be proud 
of. That is a goal worth working on.
  My hope is, over the coming days, we will find that common group of 
Senators who will say we are going to take that path rather than the 
path we are on right now.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, I hope all Senators in this Chamber took 
the time to listen to the very wise words from the Senator from 
Virginia as to the fact that we are facing real issues in this country 
and that when we work together and go through the regular process of 
having committee hearings and no secret negotiations or backroom deals, 
we can lead this country in the way it should be led.
  I thank the Senator for coming to the floor and reminding us that is 
how we get things done in a way that America accepts it.
  Yet we are not here after having had committee hearings or process or 
anything. We are here because of backroom deals that have brought us to 
this floor at a time when no one can accept the fact that all of the 
proposals are as a result, so far, of how many millions of people will 
lose insurance--22 million, 15 million, 24 million. That is what we are 
debating here, and that is a terrible debate. That is not what we 
should be talking about, but those are the proposals we are being 
offered.
  Again, the Democrats are here. We are not giving up, and we are going 
to fight any effort to pass TrumpCare until the last possible moment 
because that will be the result. We are going to speak out for families 
nationwide--children, parents, patients, people with disabilities, 
seniors, and people who have called and tweeted and marched and filled 
our office halls. So many people are worried and, frankly, scared right 
now. These are families who are being kept in the dark by our 
Republican colleagues and who are being left to wonder what might 
happen to their healthcare, their financial security, and even their 
lives.
  It is appalling the majority of Republicans who are willing to go 
along with this plan and move to begin debate without even knowing what 
bill they will be debating. Yet, last night, the vast majority of the 
Senate did something unusual. It showed just how much agreement there 
actually can be among us, when 57 Republicans and Democrats agreed to 
reject a full TrumpCare replacement bill and sent a message that we 
agreed with Senator McCain in that we should stop letting the 
``bombastic loudmouths'' drive our work and instead return to regular 
order and get back to work on policies that actually help the people we 
are here to represent.
  There are responsible Republicans who disagree with the way the 
Republican leaders have hidden their legislation from Democrats and the 
public throughout this process, who think there should be an open, 
transparent process, with both sides at the table, and who want 
hearings and public debate rather than backroom deals and secret 
negotiations. I do as well, and I know many of my Democratic colleagues 
agree.
  Now that it is clear that there is absolutely no path to full 
TrumpCare in the Senate, what is the reason for continuing this 
damaging, rushed, deeply partisan effort on the floor to jam just any 
bill through the Senate? Together we can do a lot better than the 
lowest common denominator bill that simply sends TrumpCare to 
conference with the House and then gives the Freedom Caucus a blank 
check to gut Medicaid and put insurance companies back in charge of 
people's healthcare, and more. Let's be clear. The only reason to pass 
a cobbled-together, last-minute bill on the floor is to keep the 
extreme conservative dream of repealing ObamaCare alive, no matter what 
that means for patients and families.

  I truly believe there is a better way to get this done right, and it 
is to stop what Senate Republican leaders are doing right now and start 
over.
  So, once again, I ask my Republican colleagues to drop this partisan 
effort and join us at the table. Let's work together to improve 
families' healthcare, as so many of us truly want to do. My door is 
open, and I am ready to get started.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. MURPHY. Mr. President, no one should normalize what is happening 
on this Senate floor right now. We are all waiting for the white smoke 
to come out of Republican leadership offices so that the millions and 
millions of very scared people in my State will be able to see what is 
about to happen to their lives.
  This isn't a game. People's lives are at stake. People's health is at 
stake. Yet, because this debate is now devoid of policy and substance 
and seemingly just about delivering a political victory to Republicans, 
we wait and we wait and we wait.
  People are scared. All over the Capitol today there are parents of 
children with disabilities, many of whom rely on Medicaid in order to 
keep their children alive. I have spent a lot of time with them over 
the course of the last 6 months because, to them, the measure of a 
civilization is how it treats the most vulnerable, and their kids, with 
these deep disabilities, are among the most vulnerable. For much of the 
last 6 months I have seen anger in their eyes--anger that Congress 
would choose to hurt their kids or to force their family to go 
bankrupt.
  Yesterday, I saw something new in their eyes. I saw fear. I saw deep, 
debilitating fear because they sense that we are on the precipice of 
doing something that they didn't think was possible--a piece of 
legislation passing the Senate and the House that would deliberately 
and intentionally hurt their children.
  There is no way around it. It is not hyperbole. The House bill that 
we are debating right now guts Medicaid to the point where 15 million 
people--the most vulnerable Americans--would lose access to healthcare.
  I know it is very hard for people in this Chamber to understand 
because we all have really good healthcare. But when you have an 
expensive disease or your child has an expensive disease and you lose 
insurance, you can't pay for it. You can sell your house, you can sell 
your car, and you can exhaust your savings. For some families, that 
will cover 6 months' worth of expenses for their sick child. At some 
point, the patient dies if they don't have access to healthcare.
  So people are scared. They are really scared. They are scared not 
just at the consequences of the House bill eventually passing, but they 
are also scared at the casualness with which this debate seems to treat 
their plight.
  There are rumors now that, at the end of this process, we are going 
to vote on what has been described as a stripped-down, gutted version 
of the original Republican healthcare bill. It might have one or two 
provisions in it--maybe the elimination of the individual mandate, 
maybe the elimination of a few taxes. The intent would be to 
essentially punt the more comprehensive debate about what our 
healthcare system is going to look like to a conference committee.
  I want to talk about that for a few moments and what the consequences 
of that are. First, I want to talk about what the consequences are, if 
that end result is achieved, for the Senate. Why do my colleagues 
choose to run for the Senate if they are prepared to surrender the 
biggest policy decision they will likely face to the House of 
Representatives? Why go through all the trouble of running, of raising 
all the money, of getting all the votes to become a Senator if you 
aren't prepared to actually render an opinion and pass a bill on the 
biggest priority issue facing this country right now--the future of the 
American healthcare system?
  Republicans have been unable to come up with a bill that can get 50 
votes. Why? Because they refuse to engage with Democrats. Now the 
solution

[[Page S4234]]

is to punt by passing a stripped-down version of the bill, handing all 
power to the House of Representatives, surrendering to the House of 
Representatives. What is the point of being a U.S. Senator if you 
aren't actually going to make policy, if you are just going to hand 
over the keys of policymaking to the House of Representatives? This is 
the U.S. Senate.
  I disagreed with Senator McCain's vote yesterday, but I heard the 
speech he gave to us that this should be the place in which we make the 
big, tough decisions about the future of the American economy. The 
Senate will put an ``out of business'' sign on the outside of this 
Chamber if we pass a scaled-down version of this bill that admits we 
can't come to a conclusion.
  What is the point of being a Senator if you just hand this debate 
over to the House of Representatives? By the way, that is what will 
happen. If the Senate goes to conference with the House of 
Representatives and there is only one bill in that conference--and that 
is what will happen if a stripped-down version of this bill goes into 
conference and the House has a comprehensive reform bill--the House 
bill will be the only one in the conference committee, and the House 
bill will become law. The House bill will survive. It may have some 
small cosmetic amendments to it, but all of the power will be given to 
the House of Representatives in those negotiations because there is 
only one idea that will be present.
  Let's go back for a moment and remember what was in that House bill 
that so many of my Republican colleagues told me was deeply 
objectionable to them and would never get a vote on the Senate floor. 
Twenty-three million people will lose insurance. Rates will go up by 15 
to 20 percent. People with preexisting conditions in most States likely 
will lose all protections available to them. Insurance plans will not 
have to cover maternity care, mental illness, or addiction any longer. 
Medicaid will be gone as we know it. My small State, with an $8 billion 
Medicaid Program, will have a $3 billion cut. Children will lose their 
ability to stay alive because they lose their healthcare insurance. 
Seniors in nursing homes will be put out on the street. That is not 
hyperbole. That is real. That is what happens when you kick 23 million 
people off of insurance.
  That bill or some version of it would emerge from the conference 
committee because the Senate would have defaulted to it by going to 
conference with nothing. But that is just the long-term consequence. 
The short-term consequence is that this scaled-down bill reportedly 
will include an elimination of the individual mandate. Insurance 
markets will fall apart.
  Everybody here knows, whether you are a Republican or a Democrat, 
that the only way you guarantee that people get priced the same if they 
are sick or not sick is to require people to buy insurance when they 
are not sick. In fact, the Republicans know that because in their bill 
that they wrote behind closed doors, they included an individual 
mandate. They did. It was designed in a different way. They said that 
if you don't buy insurance, you will be penalized by being locked out 
of the insurance market for 6 months. But they had a penalty for people 
who don't buy insurance, just like the Affordable Care Act has a 
penalty. Republicans and Democrats understand that in order for the 
insurance markets to work as they are regulated today, you need to 
encourage people to buy insurance when they are healthy and penalize 
them if they don't. The Republican bill does that, just like the 
Affordable Care Act does that.
  If you pass a bill that removes that mandate, then every insurance 
adjuster, every actuary who works for a major healthcare insurance 
company, will tell you that the markets will crater because individuals 
won't buy insurance until they get sick, knowing that they can't be 
charged any more. Healthy people will not buy insurance. Rates will go 
up. Insurers will flee the markets. The entire thing collapses.
  That is the short-term consequence of telegraphing to the insurance 
companies that you are getting rid of the individual mandate. Even if 
that is not the final result, that telegraph signal, at a point where 
insurers are already rethinking the markets because of the sabotage 
campaign that President Trump has undertaken, would be catastrophic.
  This is not a game. These stakes are big. The casualness with which 
people are approaching this debate is scaring the life out of people in 
my State, out of parents of kids with disabilities and folks who are 
dealing with sickness and illness all across this country.
  It is not too late. We don't have a communicable disease. We aren't 
going to physically harm Republicans if they come talk to us. It is 
time to abandon this Republican-only approach and come work with 
Democrats. Let's jointly own the problems that still exist in the 
healthcare system and jointly own the solution. People are scared of 
what is happening in the Senate today, and there is a different way.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. What is the time situation?
  The PRESIDING OFFICER (Mr. Sullivan). The Senator from Wyoming 
controls 24 minutes. The Senator from Washington controls 1 minute.
  The Senator from Connecticut.
  Mr. BLUMENTHAL. Mr. President, I want to say that the field hearings 
I had have shown me that people not only fear but will be justifiably 
hurt forever by this sabotage of our exchanges and by the repeal of the 
Affordable Care Act. Whether it is called a skinny repeal or any other 
name, it will fundamentally decimate Medicaid, it will put Americans 
who are in nursing homes out on the streets, and it will mean that 
people who need treatment for opioids--the consequences to them and 
many others whom I have seen in Connecticut and around the country will 
be absolutely devastating.
  This shameful and senseless step toward gutting the Affordable Care 
Act has left millions not only in fear but in potential real jeopardy. 
We can do better, and the people of Connecticut and around the country 
know we can do better.
  We owe it to our democracy to go through the regular order, as 
Senator McCain urged us to do, and to make sure that we fulfill our 
promise, our oath that we will uphold the Constitution and do what is 
right for the American people.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. BLUMENTHAL. Mr. President, I yield the floor.
  Mr. ENZI. Mr. President, I yield such time as the Senator from 
Kentucky needs.
  The PRESIDING OFFICER. The Senator from Kentucky.
  Mr. PAUL. Mr. President, as a physician and an eye surgeon, I have 
seen ObamaCare up close, and it is not working for Americans.
  If you look across the country and say ``Is it working?'' you find 
that ObamaCare premiums have doubled for those in the individual 
marketplace in just a few short years. You find that the ObamaCare 
insurance mandates have caused 4.7 million people to lose the insurance 
they chose. If you like your doctor, you can keep him or her--that was 
the promise, and it was a lie. Some 4.7 million people were told that 
they couldn't choose the insurance they want and couldn't choose their 
doctor.
  It is estimated that there are 800,000 fewer jobs because of 
ObamaCare. How does that happen? Well, if you work 32 hours a week and 
your employer has to provide insurance at 30 hours, guess what happens. 
Some people get moved to 28 hours. You add up all those hours, and 
millions of people are working fewer hours.
  Who are the people who got shafted by ObamaCare? Often, working-class 
people. In my State, there are 25,000 people who pay a fine because 
they can't afford ObamaCare. These 25,000 people make less than $25,000 
a year. They are our working class.
  ObamaCare punishes them and says: You have to pay a fine.
  They say: I wish I had insurance, but ObamaCare added all these 
mandates, things that I can't afford.
  Sure, everybody wants to have everything under the Sun covered by 
their insurance, but when you mandate that, you elevate the price of 
insurance. So what has happened? Young, healthy people have lost their 
insurance and don't buy insurance in droves.
  ObamaCare says: You can come back any time after you are sick and buy 
your insurance.

[[Page S4235]]

  That sounds good, but what it leads to is the death spiral of 
ObamaCare. ObamaCare premiums have doubled because the young, healthy 
people are saying it costs too much and the sicker people are the only 
ones left in insurance.
  This is what happens when you let the government get involved in the 
marketplace. If you allow the marketplace to work--what is the one 
universal feature of capitalism? You get the lowest amount of cost and 
the most amount of goods distributed to the most amount of people.
  Right now under ObamaCare, 50 percent of America has one choice. What 
does that mean? A monopoly. Who wants the insurance company to have a 
monopoly? When the insurance companies have monopolies, the prices get 
doubled.
  There are now some parts of our country that have no choice in the 
individual market. If you are a plumber or a welder or a carpenter, you 
have to buy insurance in the individual market. In many places in 
America, you have no choice. In half of America, if you buy insurance 
by yourself, if you are not part of a large group, in half of America, 
there is one choice--a monopoly and monopoly prices.
  In my State alone, 50,000 Kentuckians have to pay a tax. They have to 
pay a fine because they can't afford ObamaCare. They are regular 
working people, and they do work and they do pay taxes. They pay a 
fine. We pay $16 million in fines in just my State. Across America, 
this is happening.
  How did it become an American sort of legislation or plan to force 
people to buy stuff they don't want and then to extract money out of 
their paycheck if they don't do what you tell them?
  Ultimately, Americans should remember that ObamaCare is predicated on 
force and coercion. ObamaCare dictates what kind of insurance you can 
get and makes you pay a fine if you don't get what the politicians tell 
you you must get.
  President Obama basically told you that you were too stupid to make 
your own choices. These people who want to dictate to you are elitists. 
They think they know better than you what kind of insurance you should 
get. If you don't buy the insurance they dictate, they will fine you. 
If you don't pay the fine, they will jail you. How is that consistent 
with the American ideal of freedom?
  This debate is about more than actuarial tables. We get dragged down 
into this debate, and we think it is all this healthcare wonkiness, 
this and that. It is about freedom of choice. It is about whether you 
as an American can make the choice whether you want insurance or don't 
want insurance, whether you want insurance that is really expensive or 
not.
  They put a special tax in there if you have good insurance. First 
they tell you what kind of insurance to buy, and then they tell you 
that your insurance is too good. If you are in a union or you are an 
executive and you have great insurance, ObamaCare tells you they are 
going to tax you because your insurance is too good. These busybodies 
think they know everything about what you want. They are going to 
dictate what kind of insurance you can get, and then when you buy it, 
they are going to tell you that you have too much, so you have to pay a 
tax. That isn't the American way.
  Today we will vote on a bill we have voted on many times. The Senate 
itself voted on this 2 years ago. It is the identical bill. We are 
going to vote on a bill we voted on 2 years ago. I hope everybody who 
voted for it before will vote for it again. It is what we call a clean 
repeal. It is not cluttered with insurance company bailouts. It is not 
cluttered with this and that, new Federal regulations. It is just 
trying to peel back ObamaCare.
  While it is a clean repeal, it is only a partial repeal. Why? It is 
only a partial repeal because we have these arcane Senate rules that 
say we can't repeal the whole thing. Because we are only repealing part 
of it, ObamaCare will remain. Even if we are successful with this bill, 
at least half or more of ObamaCare remains. Bad things remain. All of 
the mandates on what you have to purchase on your insurance will 
remain. That doesn't mean we shouldn't do this.
  The other side does not want to help. The other side has never met a 
regulation they want to repeal and has never met a tax they want to 
lower. So if you want to get rid of the taxes, it has to be done today.
  People say: Well, this doesn't have the replacement.
  Well, sure we should replace ObamaCare. I have been advocating that 
from the beginning. But we have to figure out what that replacement is. 
And the only way we are going to be forced into a bipartisan compromise 
is if we repeal it. If we do not repeal it today, there is no impetus 
from either side to work on replacing it. If you repeal it, even the 
other side will say: Oh, my goodness, we have to do something because 
they repealed these subsidies in this Medicaid expansion. They will 
say: We will work with you now. But everything else is false.

  They will not work on repealing one regulation or one tax. That heavy 
lift is left to Republicans, and my hope is that Republicans would band 
together and say: Sure, this isn't everything I wanted. It is not 
everything I want. It is a partial repeal. It leaves in place a lot of 
ObamaCare that we should get rid of, and we should continue to try to 
get rid of these Federal mandates on insurance.
  This is a beginning, and it is all we are being offered up as a 
beginning, but it is a victory for those of us in America who have 
said: Enough is enough. My government shouldn't be telling me what I 
can buy and what I cannot buy. My government should not tell me which 
doctor I can choose and which doctor I have to leave behind. The 
government should not be involved in my healthcare business. I want to 
be left alone. The right to privacy, the right to be left alone is a 
fundamental right of Americans. That is what this is about.
  It is about freedom of choice. It is not about actuarial tables. It 
is not about the Federal Government designing a perfect healthcare 
system. The Federal Government cannot deliver the mail. They lose a 
billion dollars a quarter delivering your mail. Do you want them in 
charge of your doctor? Do you want them in charge of your insurance? 
This is the one chance we get today. We will have a chance to repeal 
ObamaCare. We will have a chance to fulfill our promise to the American 
voters.
  There is a partisan divide. Democrats are for keeping it; Republicans 
are for repealing it. But Republicans made a promise. We made a promise 
to the American people to repeal it. There may be some Republicans 
today who say: I am not voting to repeal any longer; things have 
changed. The problem is that we are not going to get toward a solution 
if we don't begin to repeal. The other thing about this repeal is that 
there is a 2-year window in which part of the repeal doesn't take place 
for 2 years. Over those 2 years, my guess is that we will have impetus 
from the other side to actually begin to negotiate. Currently, there 
are 27 million people in America without insurance. From all the talk, 
you would think that ObamaCare has covered everyone, and somehow 
Republicans are against that.
  Count me as one Republican who wants to figure out how we insure the 
27 million who don't have insurance. Of the 27 million people who don't 
have insurance under ObamaCare, half of them don't buy insurance 
because it is too expensive. Why is it too expensive? Because ObamaCare 
dictates about 15 different things that every insurance policy has to 
have: Vision, hearing, pregnancy--you name it; it is all on there. 
Everyone wants it. If you put it on every insurance policy, not 
everyone is going to be able to afford it. You force people out of the 
market. So 27 million people don't have insurance, and half say they 
can't get it because it is too expensive.
  Where is the problem in insurance? If you are here today visiting in 
Washington, and you work for Toyota or Ford or General Motors or any 
big American company--any big corporation in our country--if you work 
for them, my guess is that you are not worried about your wife getting 
sick and they fire you from your job or raise your rates. What happens 
when you have group insurance is, if your family member gets sick, you 
don't lose your job. Your insurance rates really don't change, and you 
continue on with your life. You still have the tragedy to deal with of 
someone in

[[Page S4236]]

your family being sick. But if you have group insurance, it seems to 
work in our country.
  What we are talking about is the individual insurance market. We are 
talking about the plumber, the pest control guy, the carpenter, the 
welder, the farmer--people who are in a small business. Either they 
have a few employees or it is just them. That is what we are talking 
about. It is horribly broken. I don't wish it on any American. I wish 
no American had to buy any insurance in the individual market. In fact, 
what I am proposing would so disrupt the individual market that maybe 
everyone would leave. I am trying to give an exit ramp to everyone in 
the individual market to get out of the individual market because the 
individual market is a terrible place to be.
  If you are a farmer in America and you buy insurance for you and your 
wife, and your wife gets breast cancer, you are not only deathly afraid 
for her health, you are deathly afraid your insurance rates will be 
doubled, tripled, or you will be dropped. I don't care if you are a 
Republican, Independent, or a Democrat. People in the individual market 
do worry. We have had people here worried that people are going to lose 
their health insurance. The individual market is a terrible place to 
be.
  So what should we do? Should we give hundreds of billions of dollars 
to the insurance company and say: Please insure these people and make 
sure their rates aren't too high. I don't like that because I am not 
for crony capitalism. These companies make billions of dollars a year 
in profit. I am not for giving them one penny of your money.
  Do you know what I want? I want something that doesn't cost anything, 
that doesn't cost one penny and would completely transform healthcare 
and insurance in this country. I want to legalize--I want to make it 
open to every American that you can go out with an association across 
State lines and buy your insurance as part of a group. What would that 
mean? In my State, the Farm Bureau has 33,000 people. But when you go 
to the Farm Bureau to buy your insurance, you get an individual policy. 
A farmer, his wife, and their family get a policy. It is just them. 
They are not really protected by the group. They don't get the leverage 
of price, and they are not protected. If they get sick, their rates are 
based on them and their family. Why don't we let them join together? 
There are probably a million farmers in the Farm Bureau throughout the 
American Farm Bureau. What if the American Farm Bureau had an 
association and one person negotiated for them? I don't think we can 
overstate the negotiating value of a group.
  In China recently, they negotiated for patented medicines, and they 
reduced the price by 67 percent. Groups can negotiate prices down. This 
is a free market reform. This is collective bargaining for consumers. I 
can't see why either side--I am still hopeful, no matter where this 
goes, that at some point in time, when partisan fervor dies down, we 
can go to the other side and say: What's so wrong with collective 
bargaining? I thought you were for collective bargaining for labor. Why 
not be for collective bargaining for consumers? Let the consumers band 
together. AARP has 33 million people. What if one person negotiated the 
rate for their insurance and their drugs? My guess is that they would 
have the lowest drug prices in the world, and more people would want to 
join AARP. What if the credit unions--there are about 20 million people 
in credit unions, maybe more, across the United States. What if you 
could join your credit union and became part of a national association 
to buy your insurance? The leverage of 20 million people would be maybe 
40, 50 times bigger than America's biggest corporation.

  Right now, if you are General Motors and you are a big corporation, 
you have leverage to bring prices down. What if you were in a 
corporation 20 times bigger than General Motors--an association that 
negotiated your prices? This is freedom, though; this isn't a 
government plan. This is the Federal Government saying that you are 
allowed to do what you want. You are allowed to collectively bargain as 
consumers.
  I think there is every chance that we could fix a lot of the market. 
Would there be anybody left behind? Yes. I mean, we have terrible 
tragedies. I spent my adult career in medicine. I have seen the 
terrible tragedies, the terrible disabilities, the terrible neurologic 
disorders people are born with and have to live their lives with. Those 
exceptions will be treated and are treated.
  Frankly, one of the misunderstandings of this debate is that any 
Republican is up here talking about trying to take away stuff from 
those who are disabled, can't work, and do have to have care. That is 
traditional Medicaid. They will continue to be cared for. Under this, 
we are talking only about able-bodied people. Should able-bodied 
people--people who walk around, hop out of their truck--should they be 
working? Should they be providing for their health insurance? Yes. Can 
there be a transition zone? Yes. We have transition programs between 
unemployment back to employment. We shouldn't have people permanently 
unemployed--people permanently on benefits who don't work or won't 
work. There should be work requirements. I am not afraid to say that 
every able-bodied person on Medicaid ought to work. There should be a 
work requirement. I meet many people on both sides of the aisle who are 
for that.
  I don't say they should work as punishment. I think everyone in 
America should work as a reward. I think work is a reward. I don't care 
whether you are from the lowest job on the totem pole to the top, to 
the chief executive. Work is where you get self-esteem. No one can give 
you self-esteem. Your self-esteem comes from work. I think we are 
wrong. In fact, I think what we have done--in some cases, we now have 
multigenerational dependency on government, and they are so distraught 
and so lacking in self-esteem that it also compounds the drug problem 
that we have.
  Some say that we need more Medicaid money to fight the drug problem. 
I worry that more Medicaid trips to the doctor may actually be part of 
the drug problem--that much of the dependency is coming from OxyContin, 
which the drug company says was not addictive, but everyone got put on 
OxyContin because it supposedly wasn't addictive. A lot of our heroin 
and OxyContin problem came out of going to the doctor.
  If we were to get everyone out of the individual market into group 
insurance, there would be some people left behind. My hope is it would 
be a small number of people, and we would know after a year or two. 
Let's see what it is. We already have a safety net. The other side is 
acting as if there is no safety net. We have had a safety net for 
decade after decade. The safety net is Medicaid. If your child has a 
disability, no one is trying to take that away from him.
  The thing is, we have to try to fix what we have. We need to 
understand that what we are looking at--what we are trying to fix isn't 
just some kind of policy that nobody can understand. Healthcare policy 
is very technical and detailed. This is about freedom.
  Do you think that every American should get to choose whether they 
have insurance and what kind of insurance they have? This is what it is 
about. It is freedom of choice. It isn't about whether we want people 
to be insured. When you hear these hyperbolic statements saying that 
all these people are going to die--Republicans want people to die--
those hyperbolic statements aren't really helpful to the debate.
  I do not question the motives of any of the Democrats as far as 
wanting to provide care. I never questioned President Obama's desire to 
help people get insurance. To me, it is more of a question of what will 
work. What distributes goods better: socialism or capitalism? Look at 
the Soviet Union. We defeated the Soviet Union because capitalism 
defeated socialism. Socialism doesn't work.
  When the government fixes the prices, it doesn't work. Are we going 
to have some government involvement? Yes. But because Government is so 
pitiful at anything they do, we should minimize government's 
involvement in any industry. If we say that government has to be 
involved to take care of the poor, let's do it at the State level, not 
the Federal level.
  People ask me: Are the people in government inherently stupid? I say 
no, but it is a debatable question. The reason is this: Government 
doesn't get the proper incentives, and they are too distant from the 
people, and we have a printing press.

[[Page S4237]]

  What is the fundamental deceit of ObamaCare? This is the fundamental 
problem of all government, but the fundamental deceit of ObamaCare is 
this: They said that everyone is going to get free healthcare. Everyone 
is going to have Medicaid, and you don't have to pay for it, and the 
States don't have to pay for it. We are going to have the Federal 
Government pay for it. But the problem is the Federal Government can't 
pay for most of the things we already have. We already had Medicaid we 
can't pay for--Medicare we were short of money for. We already have 
Social Security that we are short of money for. What do we do? We 
borrow the money. Our deficit this year will be $500 billion. Our 
deficit is projected next year to be $1 trillion. That is the real 
question. It isn't, do you want to help people? It is, how are you 
going to pay for it? If this were done at the State level, what would 
happen? If the State of Kentucky wants to keep the expansion--we have 
expanded Medicare to 450,000 people. The question should be, should we 
double the State income tax in Kentucky? If that went to the State 
legislature, they have to balance competing concerns. If we double the 
State tax to pay for it--we live right next to Tennessee, which has no 
State income tax--would we possibly lose existing businesses or 
existing jobs or would we encourage new businesses not to come to 
Kentucky? That would be a valid debate. We want to help people, but 
what are the ramifications of it?
  In Washington, it is said that there are no ramifications because 
everything goes to the debt. Everything just piles up. We have $20 
trillion in debt. Whose fault is it? Both parties. Under George Bush, 
the debt went from $5 trillion to $10 trillion. Under President Obama, 
it went from $10 trillion to $20 trillion. Both parties are at fault, 
but the entitlements are consuming us.
  How would we possibly move forward with a bill that sets up a new 
insurance entitlement, as some of the Republican plans wanted to do? We 
can't pay for the current entitlements. As we look forward today to the 
solution, what I would say is that there are alternatives. We really 
shouldn't question the motives of those across the aisle, and they 
shouldn't question ours.
  I want more people to have insurance at a lower cost. We should have 
a disagreement on how it works. I think capitalism works better than 
socialism. I think we should minimize government's involvement because 
government is not very good at distributing anything. Just look at the 
mail.
  I also think there are exciting opportunities for saying how we could 
insure the 27 million who are not insured currently. Twenty-seven 
million people under ObamaCare are without insurance. The question 
shouldn't be about debating over the past. It should be over debating 
the future. The future should be about trying to figure out how we 
insure those 27 million. I think there are a lot of opportunities that 
involve more freedom of choice, more freedom to choose your doctor, 
more freedom to choose what insurance works for you. My goodness, that 
is what this debate is about. It is not about healthcare policy. It is 
about freedom of choice, and I hope every Senator today will vote for 
freedom of choice.

  Thank you.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. WYDEN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Is there objection?
  Mr. ENZI. I object.
  The PRESIDING OFFICER. Objection is heard.
  The clerk will continue to call the roll.
  The legislative clerk continued with the call of the roll.
  Mr. ENZI. Madam President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mrs. Ernst). Without objection, it is so 
ordered.
  Mr. ENZI. Madam President, I ask unanimous consent that the actions 
scheduled to take place at 11:30 this morning occur at 3:30 p.m. today 
and that all other provisions of the previous unanimous consent 
agreement remain in place.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The time until 3:30 p.m. is now equally divided.
  The Senator from Oregon.
  Mr. WYDEN. Madam President, on this matter of repealing the 
Affordable Care Act, soon the Senate is going to vote on just whether 
or not to repeal the Affordable Care Act. I think it is important to 
note that this would walk back months and months of Republican promises 
to directly link repealing the Affordable Care Act with a replacement--
a replacement that would improve coverage, lower premiums, and be 
better for the American people. In fact, the President of the United 
States said repeatedly over the last few months that these would be 
inextricably linked, that repeal and replace would go hand-in-hand. 
That is not what is on offer right now. What is on offer are specific 
changes that would actually harm Americans.
  For example, no more middle-class tax credits for healthcare--that is 
something that is critically important to the millions of middle-class 
folks who are walking on an economic tightrope every month, balancing 
their food costs against their fuel costs, their fuel costs against 
their medical costs.
  I was struck this morning when I heard that, under this repeal 
approach, there is not going to be any real pain, that everything is 
just put off. Make no mistake about it. The pain for our families under 
this repeal measure is going to start right away. Nobody says they are 
going to be part of a marketplace if they believe it is not going to 
exist in a few years. Seventeen million fewer Americans are going to 
have healthcare 1 year from now. An analysis from the Congressional 
Budget Office--and this is only a week old--said that half of the 
country will have zero insurance choices in the private marketplace 
under this scheme.
  I would like to repeat that so people understand that, as to this 
idea that there is really no pain here and that nothing starts for a 
long time, the Congressional Budget Office--our nonpartisan, impartial 
umpire--doesn't agree with that. They said just last week that half of 
the country will have zero insurance choices in the private marketplace 
under this scheme. That goes up to 75 percent of Americans with no 
options in later years.
  So my view is that this is just legislative malpractice, first 
because of the pain and harm it is going to cause so many Americans. 
The Congressional Budget Office says that kind of misery is going to 
kick in quickly.
  Second--and I don't think this has been discussed on the floor--this 
walks back months and months of Republican promises. The American 
people were told again and again that repeal and replace were going to 
be directly linked. The President said it multiple times. Then he went 
over the top and told people that they were going to have lower costs 
and better coverage.
  Mr. SANDERS. Madam President, will my friend from Oregon yield for a 
question?
  Mr. WYDEN. I am happy to yield to my friend.
  Mr. SANDERS. Madam President, our friend from Oregon is pointing out 
that this legislation would impact virtually every American because, in 
one way or another, we all interface with the healthcare system.
  I would ask my friend to confirm: This legislation would impact what 
percentage of the U.S. economy?
  Mr. WYDEN. I would say to my colleague, the ranking member of the 
Budget Committee, that we are talking about one-sixth of the American 
economy.
  Mr. SANDERS. One-sixth of the American economy is over $3 trillion 
every single year.
  Now, when we are dealing with legislation that impacts virtually 
every American, over $3 trillion every year, would my friend from 
Oregon please tell me this--and I know that he is the ranking member of 
the Finance Committee, and I am on the Health, Education, Labor, and 
Pensions Committee: How many hearings have been held in the Finance 
Committee to discuss the economic implications of this legislation? 
Were there five, ten? How many hearings on this enormously

[[Page S4238]]

complicated and important issue have there been?
  Mr. WYDEN. My colleague is being logical, and heaven forbid that 
logic should be introduced into this, because we would automatically 
assume that on a matter like this--we are talking about one-sixth of 
the American economy--the Senate Finance Committee would have hearings. 
There have been no hearings.
  Mr. SANDERS. No hearings?
  Mr. WYDEN. None.
  Mr. SANDERS. There have been no hearings on a bill that impacts one-
sixth of the American economy and every single American.
  Now, let me ask my friend from Oregon this. Obviously, before my 
Republican colleagues would go forward on radical legislation like this 
that would throw some 32 million Americans off of the health insurance 
they have, they have obviously consulted with doctors and hospitals to 
get their views as to the impact this legislation would have on 
patients and hospitals all over America.
  What kind of testimony did the doctors make on this bill or the 
hospital administrators make?
  Mr. WYDEN. I can tell my colleagues that Senator Murray and I, the 
two of us--the ranking member on the Budget Committee and I--have 
actually made public the overwhelming opposition from providers on 
this. So, in effect, providers and patients are standing together in 
opposition to this.
  Mr. SANDERS. Right, so if my understanding is correct--and I am quite 
sure it is--the American Medical Association, which is not one of the 
great progressive groups in America but the group that represents the 
physicians in this country, A, they have not been able to make 
testimony. But, B, what is their view on this legislation? What do the 
doctors of America feel about this important legislation?
  Mr. WYDEN. They are opposed, as I have indicated. I think it is 
particularly important to see this provider-patient partnership that 
this time is saying the patients come first and this bill hurts 
patients.
  Mr. SANDERS. But we have not heard yet from one doctor making public 
testimony at a hearing.
  Mr. WYDEN. That is correct.
  Mr. SANDERS. In other words, this bill is not saying to doctors: What 
will this mean to your patients? What happens if 32 million people are 
thrown off of medication? How many of them will get sick? How many of 
them will die?
  No testimony.
  How about hospitals? What kind of testimony have we heard from 
hospital administrators, those in rural America, about the impact of 
this legislation on rural hospitals in Vermont and rural hospitals in 
Oregon?
  Mr. WYDEN. What I can tell my colleagues is that, again, those 
hospitals have not been in front of the Finance Committee.
  One of the things I appreciate about so many colleagues on this side 
of the aisle is that they said: Well, if we are not going to hear from 
these providers, like the hospitals, in the committee, we are going to 
go out to the country and listen to them. I have had townhall meetings 
throughout rural Oregon, as my colleague Senator Merkley has had. The 
rural hospitals, which are the economic engines of so many rural 
communities, are opposed to this legislation.
  Mr. SANDERS. Let me ask my friend from Oregon: What kind of testimony 
have we heard as to the impact of this legislation on older working 
people, in terms of what it might mean in increased premiums? Have we 
heard much discussion? Has the AARP, which is strongly opposed to this 
legislation, been able to come forward at a public hearing and express 
their point of view?
  Mr. WYDEN. The AARP has also not been in front of the Senate Finance 
Committee. I want to say again that Senators have said: If they are not 
going to be in front of the Senate Finance Committee, where we ought to 
actually hear testimony in line with the regular order, we are going to 
go out to the country and listen to AARP members and organizations. 
They are overwhelmingly opposed to this because people between 55 and 
64 would pay five times as much as younger people, and they would get 
fewer tax credits.
  Mr. SANDERS. Madam President, would my colleague please repeat that. 
I think it is important for older Americans to hear this.
  We had a candidate running for President of the United States by the 
name of Donald Trump, and he ran all over this country and said he was 
going to stand up for working families and he was going to stand up for 
the working class of this country.
  Please repeat what this legislation would mean if somebody were a 62-
year-old worker in Vermont or in Oregon. What kind of premium increases 
might he or she see?
  Mr. WYDEN. It is hundreds and hundreds of dollars and, in a number of 
instances, more. The reality is that I think they are going to have a 
lot of trouble getting coverage at all. The reality is, when you pour 
gasoline on the fires of uncertainty--and this is particularly 
important right now as plans are thinking about signing up--that makes 
it more likely you aren't going to have plans at all. The Congressional 
Budget Office has also found that the Paul legislation makes that 
worse.
  Mr. SANDERS. Now, while the AARP and other senior groups have not 
been able to testify, would my friend from Oregon tell me what their 
views are on this particular legislation because of its impact on older 
workers and seniors in general?
  Mr. WYDEN. While the senior groups have not been able to come before 
the Finance Committee to discuss this issue, I can say--and I have been 
working with a number of these organizations since my days with the 
Gray Panthers--that they are overwhelmingly opposed to this. I think, 
in particular, this idea that we heard from the Congressional Budget 
Office last week--that half of the country will have zero insurance 
choices in the private marketplace under this repeal scheme, and that 
it goes up--will just cause even more seniors to be against it.
  Mr. SANDERS. But it is not only older workers because we have as an 
aging population more and more people in nursing homes. Would my friend 
from Oregon describe what happens under this legislation if somebody 
has a mom or a dad in a nursing home, struggling with Alzheimer's or 
some other terrible illness?
  Mr. WYDEN. Under this legislation, you would have a massive rollback 
of the Medicaid Program. So for all of those older people who scrimped 
and saved all of their lives--they didn't take that vacation; they 
tried to make sure they could educate their kids--Medicaid picks up the 
costs of two out of three nursing home beds in America. This 
legislation would produce a massive rollback of the Medicaid Program, 
and I believe so many older people are going to find long-term care 
unaffordable--millions.
  Mr. SANDERS. I think it is important to repeat that because this is 
not something that I think most Americans are aware of. Medicaid now 
pays, as I understand it, for two out of three nursing home beds in 
this country; is that correct?
  Mr. WYDEN. That is correct.
  Mr. SANDERS. And a massive cut in Medicaid would be devastating to 
those families who have loved ones in nursing homes?
  Mr. WYDEN. That is correct. It would be accompanied with further 
misery because it would leave the millions suffering from opioid 
addiction with nowhere to turn for coverage as a result of this massive 
rollback in Medicaid coverage under this amendment.
  Mr. SANDERS. I have asked my colleague from Oregon a little bit about 
some of the cruel and devastating impacts this legislation would have, 
but we have to be honest and acknowledge that there are some 
beneficiaries in this legislation as well.
  Would my friend describe the beneficiaries in the House bill, in 
particular? While millions were thrown off of Medicaid, while 23 
million people lost their health insurance, some people actually did 
gain from this bill, and we have to acknowledge that; is that true?
  Mr. WYDEN. Yes, the fortunate few would benefit under the House bill. 
There is no question about it.
  To give my colleagues an idea of how regressive those efforts are, 
they would actually be retroactive. So this idea that these tax cuts 
for the well-to-do were in some way going to create jobs is just 
absurd. They are made retroactive. So they aren't going to be creating 
jobs going forward.

[[Page S4239]]

  

  Mr. SANDERS. Correct me if I am wrong, but my recollection is that in 
the House bill there were $300 billion in tax breaks going to the top 1 
percent at exactly the same time that 23 million Americans were thrown 
off of their health insurance; is that correct?
  Mr. WYDEN. A few hundred families benefit so greatly that it could 
actually cover Medicaid expansion in several States.
  Ms. STABENOW. Will the distinguished Senator from Oregon allow me a 
question?
  This is a very, very important debate. On the point that my colleague 
just made, isn't it correct that there is nothing in any of these 
versions that lowers the cost of prescription drugs, which is the No. 1 
issue for people in this country, as it relates to healthcare, or for 
businesses? I hear it all the time. There is nothing in here to lower 
the cost of prescription drugs, but there are tax cuts in here for the 
prescription drug companies. Is that correct?
  Mr. WYDEN. That is correct. The special interests get very, very 
substantial tax breaks. Those working-class people lose tax credits, so 
they actually lose, and, in effect, those dollars can be used for the 
tax cuts for the fortunate.
  Ms. STABENOW. There is nothing to go further to use the buying power 
with Medicare to negotiate prescription drugs or to allow, with safe 
FDA approval, for people in Michigan to be able to drive across a 
bridge to Windsor and be able to get the very same prescription drugs 
for 40 percent less. There is nothing in there about that, is that 
correct?
  Mr. WYDEN. There is nothing that would give Medicare bargaining power 
to make sure seniors get a better deal. There is nothing for the kind 
of effort our colleague from Vermont and Senator Klobuchar have 
pursued, which would allow, under circumstances where there were safety 
precautions, for pharmaceuticals to come from other countries. There is 
nothing to go after pharmaceutical middlemen. So, yes, there is nothing 
in these bills to hold down the cost of pharmaceuticals.
  Mr. SANDERS. If I could, let me ask my colleagues from Oregon or 
Michigan maybe to speculate here.
  If the House bill were to be successful--and we are going to do 
everything in our ability to make sure it is not successful--and 
Medicaid were severely cut back, what do my colleagues think will 
eventually happen in the near future--not eventually, but in the short 
term, to programs like Medicare and Social Security? Would it be a 
reasonable assumption that this is the beginning of the effort on the 
part of the Koch brothers and Republicans in the Congress to begin 
dismantling virtually every Federal program that helps working people? 
Is it not true that the House Budget Committee has already passed 
legislation that would move toward voucherizing Medicare and 
privatizing it?
  Mr. WYDEN. My colleague is right. There is a very regressive effort 
going forward in the House, the House Budget Committee, and, clearly, 
this is to try to set up tax cuts for the fortunate few.
  I was struck by the fact that the President has talked about a 15-
percent corporate rate. You lose $100 billion for every point you lower 
the corporate rate. The corporate rate is now 35 percent. If you move 
it to 15, that is $2 trillion that goes out the door.
  Yes, I am very troubled that the House effort plus this legislation 
is really an effort to begin the unraveling of America's social safety 
net, and the funds that provide for those very vulnerable people would 
be used for these additional tax breaks.
  Ms. STABENOW. I wonder if the Senators are aware that in Michigan--
and I share in the deep concerns of the Senator from Vermont about 
those opportunities that people have paid into, by the way. This is not 
free. This is not an entitlement. People pay into Medicare, pay into 
Social Security, which has lifted a generation of seniors out of 
poverty and allowed seniors and people with disabilities to live longer 
because of Medicare, and it has created a better quality of life--
Medicaid, as well.
  There is a great success story in Michigan that I would share on the 
Medicaid front. Of course, three out of five Michigan seniors in 
nursing homes with Alzheimer's or other kinds of challenges get their 
healthcare from Medicaid. In addition to Medicare, Medicaid is there 
for middle-class seniors, for low-income seniors, and so on.
  When our distinguished Senator from Oregon talks about dollars--
saving dollars or costing dollars--an interesting thing has happened by 
setting up Healthy Michigan and expanding Medicaid healthcare to 
minimum-wage working people. We are actually saving money.
  Ninety-seven percent of our children can now see a doctor in 
Michigan. That is great. They have cut in half the number of people who 
walk into the emergency room who can't pay. We all pay if somebody 
walks in and gets the most expensive treatment through the emergency 
room.
  The State of Michigan will save $432 million in taxpayer money next 
year because they are focusing on children going to a doctor, people 
getting preventive care, not using the emergency room. It saves money.
  Instead of doing these tax-cut provisions for the wealthiest and for 
the pharmaceutical companies that take dollars away, actually doing the 
right thing on healthcare in Michigan is a great success story for 
saving taxpayer dollars.
  Mr. WYDEN. I think my colleague is making an important point, as well 
as my friend from Vermont.
  Part of the reason that many Republicans want these tax cuts for the 
fortunate few is arcane to people, pretty complicated. What they really 
want to do is get them now, to put them in the budget baseline in order 
to open up the opportunity when tax reform comes along to have even 
more tax breaks for the fortunate few. So, yes, Medicare and Medicaid 
are going to face real challenges.
  In fact, as my colleagues know, the Affordable Care Act had a modest 
additional tax on people who earn over $250,000 a year, and it was to 
go just to Medicare. You see your paycheck--everyone gets a paycheck--
and the Medicare tax is right on it. The only people under these 
Republican plans who would get the Medicare tax cut would be couples 
who make over $250,000 a year.
  When my colleague from Vermont asks ``What does this mean for 
Medicare?'' it isn't necessarily about some bill far off in the future. 
It is about right now. By the way, taking that money away--the money 
that comes just from the modest additional tax on couples over 
$250,000--reduces Medicare solvency by several years. It actually 
reduces Medicare solvency, which breaks yet another Trump promise not 
to in any way injure Medicare.
  Mr. SANDERS. I have a meeting that I have to get to. I want to 
summarize this. My friends from Oregon and Michigan can correct me if I 
am wrong.
  We are looking at a bill that came from the House and various 
proposals being introduced in the Senate, which essentially says that 
we are going to throw over 20 million Americans off of the health 
insurance they currently have. What I haven't heard much discussion 
about is what happens to someone who today has health insurance and is 
struggling with cancer, maybe getting chemotherapy or radiation therapy 
right now. What happens to someone who is in treatment for diabetes? 
What happens to someone with a serious heart condition, who had a 
stroke and is on Medicaid? What happens to those people when their 
health insurance is simply cut?
  Mr. WYDEN. Two points are raised by my colleague--very good points. 
First, in the immediate, those people will go to the hospital emergency 
room, which means that, once again, we are turning back the clock 
toward approaches that don't provide better care at lower costs.
  I wish to also mention, when we are listening to folks at home--
because they don't get to testify here in the Senate--people appreciate 
the part of the Affordable Care Act that ensures their lifetime limits 
on what they can be charged by insurers. Almost all of these Republican 
bills create an arrangement where a State could waive that protection. 
Not only would people who are facing cancer and serious illnesses and 
probably have to go to the hospital emergency room a fair amount be 
hurt now, but people who have employer-based coverage are going to be 
hurt in the future. So 160 million people don't even know what is 
coming out.

[[Page S4240]]

  

  Ms. STABENOW. If I might ask one final question, would my colleague 
agree that rather than this approach, in which we don't even know, 
moment to moment, what we are voting on here--unlike what we did in the 
Finance Committee in 2009, where there were 100 hearings in the Finance 
Committee and the HELP Committee before we even voted on anything on 
the Affordable Care Act. Rather than that process, we are looking at a 
situation where everything coming before us will take away healthcare 
for tens of millions of people and raise costs on everyone. Would my 
colleague agree that it would be better to stop this process and go 
back to a bipartisan effort to lower costs and increase healthcare 
coverage? Would my colleague agree, as well, that we know that there 
are people paying too much for copays and premiums, and that needs to 
be addressed?
  In the private marketplace, there is not enough competition among 
insurance companies. In some places, there are none in the individual 
market. We need to work together to lower costs, starting with 
prescription drugs, and to also continue to increase the opportunity 
for people to get healthcare coverage. That is what we ought to be 
doing together and doing it in a thoughtful way and getting input and 
actually solving the real problems.
  Mr. WYDEN. My colleague has described how the Senate works best when 
she says: Look, bipartisanship is not about taking each other's lousy 
ideas. Bipartisanship is about both sides getting together, having 
hearings, listening to all alternatives and ideas, and often coming up 
with something no one has thought of.
  My colleague knows a lot about bipartisanship in healthcare because 
my colleague was part of our effort in 2008 when we put together the 
first bipartisan universal coverage bill in the history of the Senate--
seven Democrats, seven Republicans. By the way, a number of those 
Republicans are still serving in the Senate today. We know that is a 
better path.
  To wrap up this portion of the debate, I wish to say to my colleagues 
that the best way to proceed is with a kind of two-part effort. The 
first is to say that we all agree the Affordable Care Act is not 
perfect. We are going to take steps immediately to stabilize the 
private insurance market.
  We have a number of our colleagues--Senator Shaheen, with her effort 
to make sure people can get some help when they have deductibles and 
copayments; our colleague from Virginia, Senator Kaine, with 
reinsurance; Senator McCaskill with a fine idea to help areas that are 
bare in terms of no coverage. We have to move to stabilize the private 
market quickly because at the end of August, the plans are essentially 
signing contracts for premiums for 2018.
  My colleague is absolutely right. We ought to knock off this partisan 
our-way-or-the-highway approach, move on a bipartisan basis to take 
steps to improve the Affordable Care Act now after we have hearings, 
input, and the opportunity to have people in front of the committees of 
jurisdiction. After that, we then move to the broader array of issues, 
starting with the immediate challenge my colleague has led on, which is 
clamping down on the cost of pharmaceuticals. You take steps to 
stabilize the market immediately, and then you move again in a 
bipartisan way on what our constituents are talking about at every 
community meeting, which is that their Social Security checks, the 
benefits they get, aren't coming close to keeping up with the rise in 
the cost of prescriptions.
  I thank my colleague for her very helpful questions and our colleague 
from Vermont, Senator Sanders.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. THUNE. Madam President, I don't need to tell anyone why we are 
here. We are here because ObamaCare is fundamentally broken. That is 
clear. It is evident. Everybody knows that.
  A combination of soaring premiums and rapidly decreasing insurer 
participation has left the law's centerpiece--the healthcare 
exchanges--literally on the brink of collapse. Insurers are fleeing. 
Nationwide, 141 insurers have registered to offer plans on the 
exchanges in 2018, which represents a 38-percent drop from 2017, and 
that is on top of a nearly 30-percent drop in insurer participation 
from 2016 to 2017.
  If the trend of the past 2 years continues, the final number of 
insurers offering plans on the exchanges in 2018 is likely to be 
roughly half the number that offered plans in 2016--a year ago. At 
least 40 counties around the country are likely to have no ObamaCare 
insurer in 2018 and another 1,300-plus counties are likely to have just 
one choice of insurer.
  President Obama once said that shopping on the exchanges would be 
like buying a TV on Amazon. For a lot of people next year, it is going 
to be like shopping for a TV on Amazon, if Amazon only offered one 
brand of TV. Of course, for some people it is going to be like shopping 
for a TV on Amazon only to discover that Amazon has no TVs at all.
  Another thing ObamaCare was supposed to do was make health insurance 
more affordable. That hasn't worked too well. Premiums on the exchanges 
have soared and soared again. Between 2013 and 2017, the average 
individual market monthly premium in the healthcare.gov States 
increased by 105 percent. How many families in this country can afford 
to have their health insurance premium more than double in just 5 
years--and there is no end in sight.
  Here are some of the premium hikes insurers are proposing for 2018:
  In Maryland, one insurer has proposed an average premium increase of 
52 percent; an Iowa insurer is seeking an average 43.5-percent premium 
increase; a North Carolina insurer is pursuing an average 22.9-percent 
hike; a Virginia insurer is looking for an average rate increase of 38 
percent; a Delaware insurer is looking for an average rate hike of 33.6 
percent; a Maine insurer is seeking an average rate hike of 40 percent; 
and in New Mexico, one insurer is seeking a rate increase of nearly 80 
percent.
  Again, those are rate hikes for just 1 year. That is after years of 
dramatic premium increases on the exchanges. Suffering under ObamaCare 
isn't limited to high premiums and decreasing choices. There are the 
Americans who have lost their healthcare plans, and the Americans who 
have lost access to the doctors they liked, the huge deductibles that 
left some Americans unable to use their insurance, and the ObamaCare 
tax hikes that have hurt small businesses and driven up the cost of 
health insurance.
  ObamaCare has failed. Americans are suffering. Doing nothing is not 
an option. Yesterday we moved forward to debate legislation to provide 
relief to the millions of Americans who have been hurt by ObamaCare. We 
are going to have a full debate and give people a chance to help shape 
the final bill.
  I hope that at the end of the week, we will be able to pass a strong 
bill to start undoing the harm ObamaCare has caused. We owe the 
American people nothing less. We made a commitment to the American 
people; that if they elected us, we would do everything we could to 
give them relief from ObamaCare. It is time to make good on that 
promise.
  Chances to do away with damaging government programs don't come 
around every day. Once you give the government power, it can be pretty 
hard to wrest it away. This week, we have the chance to start repealing 
a really bad government program. We need to take it. If we don't act to 
help the American people, no one will. Democrats have made it clear 
that if they were in power, they would be doubling down on ObamaCare's 
failures.
  The head of the Democratic Party in the U.S. Senate openly stated 
single-payer healthcare is on the table for Democrats. A number of 
colleagues on the Democratic side have proposed that legislation. An 
analysis of one of our Democratic colleague's single-payer plan 
estimated that it would cost $32 trillion over 10 years. Well, that 
would require a tax hike so staggering the Washington Post pointed out 
that even the Senator who proposed it--an avowed Socialist--didn't 
offer anything close to what would be needed to pay for it.
  We are the only hope Americans have of getting out from under 
ObamaCare's burdens. This week, we have a chance to pass legislation to 
finally provide them with relief. I heard my colleagues get up and talk 
about the impact the proposed legislation that is before us

[[Page S4241]]

would have on people across this country and American workers. I have 
to say, I talked to a lot of rank-and-file, hard-working South Dakotans 
and South Dakota families who have been hit so hard by these premium 
increases. I talked to families--a mom and dad with two kids who are 
paying more than $2,000 a month in premiums to get insurance in the 
individual marketplace.
  In my State of South Dakota, premiums since 2013--the last 5 years--
have gone up 124 percent. They have literally doubled. Do you know what 
that means in South Dakota? That is almost a $3,600 increase in just 
the last 5 years. What average family who is trying to raise kids, 
trying to pay the bills, trying to save for retirement, trying to put 
something aside for college education, trying to pay the mortgage and 
the utility bill--how many families can put up with a healthcare bill 
that has gone up in the last 5 years by almost $3,600? That is a 
crisis. That is why we are here.
  Our colleagues on the other side want to turn a deaf ear and blind 
eye to what is happening out there. We can't afford to do that because 
the status quo is unsustainable. There is absolutely no way the 
American people who are suffering under the harms caused by ObamaCare 
can continue to abide the status quo.
  It is up to us to take the steps that are necessary to move us in a 
different direction, a better path that brings stability to the 
marketplace, that gives people more choices, more options, greater 
competition, and brings down premiums and deductibles and the costs 
that are driving family budgets through the roof.
  What we have seen since ObamaCare has been implemented are higher 
costs, higher taxes, and fewer options. It is as simple as that. That 
is what we are up against, and that is why it is time for us to act. I 
hope when we conclude this process at the end of this week--and we have 
an opportunity for everybody to offer their amendments--we will move 
forward with the bill and fulfill our promise to the American people.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Madam President, I appreciate the remarks of my 
friend.
  I would simply note that nothing he has said explains why you would 
want to strip hundreds of millions of dollars out of Medicaid or why 
you want to deny coverage to elderly folks who get Medicaid support for 
their nursing homes, people who are in the throes of addiction getting 
medical support for opioid treatment, children are often born on 
Medicaid--why you want to do all that. Nor does it explain why you 
would want to give big tax breaks to the most well-off people in the 
country.
  Fine, let's fix the markets, if that is the problem, but this isn't 
really about that. This is stripping money out of Medicaid to give it 
to very wealthy people who are doing quite well already, in my view.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. DAINES. Madam President, Karen from Missoula County wrote to me 
about how her daughter can't afford to buy insurance. ObamaCare imposes 
a tax penalty on Americans who don't buy insurance. In fact, in 2014 
and 2015 alone, they collected over $5 billion in fines.
  It turns out, this tax has hurt poor and middle-income Americans the 
worst. That is why I refer to this as ObamaCare's ``poverty'' tax. For 
Karen from Missoula, paying ObamaCare's poverty tax is cheaper for her 
so she pays the IRS a fine because she can't afford healthcare 
insurance.
  Take Debbie from Roundup, MT. She lost her own healthcare insurance. 
She couldn't afford the $1,700 per month premiums so she, too, was 
subject to ObamaCare's poverty tax and was forced to pay the IRS.
  Take Mike from Kalispell, MT. He is concerned for his son who can't 
afford a health insurance plan either. The poverty tax he is forced to 
pay to the IRS is expensive. It is hard to come up with money to pay 
it. There are American families who can't afford health insurance 
because of ObamaCare, and what does ObamaCare do? It fines them. This 
is adding insult to injury.
  These are just a few of the stories I have received from my 
constituents back home in Montana, where ObamaCare is doing more harm 
than good. Yes, it is doing some good, but it is doing more harm than 
good. In fact, 40 percent of the 34,250 Montanans who paid ObamaCare's 
poverty tax made less than $25,000 a year; 80 percent made less than 
$50,000 a year. This is not a tax on the rich. In fact, just 3.4 
percent make more than $100,000. This is a tax on the poor.
  Instead of helping these vulnerable Montanans to make ends meet, 
ObamaCare puts a poverty tax on them for being too poor to afford 
health insurance. In fact, in Montana alone, they paid nearly $7.8 
million to the IRS. This individual mandate--this poverty tax--is 
immoral. It is unfair. It is a tax on freedom. It needs to be repealed 
immediately, and these poverty taxes must be paid back to the poor who 
have paid them.
  Our friends across the aisle will say we want to get rid of taxes on 
the rich, but the rich aren't paying this tax. The poor are paying this 
tax. I think the right thing to do--the handshake agreement we have 
back in Montana as Montanans, where a man or woman's word is worth 
something--the right thing to do is, they should be paid back.
  That is why I will be offering an amendment on the floor when we 
debate. We should pay back this poverty tax to the poor who have paid 
it. The poverty tax is just one of the many problems of ObamaCare, and 
I look forward to continued debate.
  By the way, if you take this to the higher level here nationwide, 
nearly 8 million Americans have paid this poverty tax. As we looked at 
every State's numbers, it all is about the same: Somewhere between 40 
percent and 50 percent of those Americans make less than $25,000 a 
year. In Indiana, it is 176,000 Indianans.
  We have them for every State. Look at West Virginia. West Virginians, 
45,000 have paid the poverty tax; 49 percent make less than $25,000 a 
year.
  Take North Dakota. We share, in Montana, the same fence line with 
North Dakota. They are our neighbor. Over 20,000 North Dakotans paid 
the poverty tax. North Dakotans paid $4.6 million, and 40 percent of 
them make less than $25,000 a year.

  Missouri: 143,000 Missourians paid the poverty tax, and nearly 48 
percent of those Missourians make less than $25,000 a year.
  Wisconsin: 115,000 paid the poverty tax, and 45 percent make less 
than $25,000.
  I have a lot of other States. I would urge my colleagues to take a 
look at their respective States, and I ask: Can you look in the mirror 
and say we should be charging this poverty tax on those who make less 
than $25,000 a year?
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Ms. CANTWELL. Thank you, Madam President.
  I come to the floor--I know my colleague from Indiana, Senator 
Donnelly, is going to be down here to talk a little bit about his 
motion, and I want to support him in that, along with the Senator from 
Pennsylvania, Mr. Casey, because we are here to say we need to stop 
this war on Medicaid.
  Throughout this healthcare process, it has been very clear that there 
are many on the other side of the aisle who just want to cut or gut 
Medicaid. What we are saying is, if you are serious about protecting 
Medicaid and stopping the war on Medicaid, then you should support the 
Donnelly-Cantwell-Casey amendment, which would recommit the bill to the 
Finance Committee with instructions to strike the language about 
Medicaid. It would make sure a state can expand Medicaid Program, and 
it would say: Don't cost-shift to the States.
  With this motion, we are saying to our Republican colleagues: We 
don't want to cut people off of Medicaid. We want the committee to do 
exactly what the Republican Governors are saying, which is, quit 
beating up on Medicaid and focus instead on fixing the individual 
market. The individual market is 7 percent of the overall market for 
health insurance.
  What we have found with the expansion of Medicaid that has been done 
by both Democratic and Republican Governors is great success.

[[Page S4242]]

  I hope my Republican colleagues will heed the warnings of our 
Nation's Republican Governors and Democratic Governors. In June, a 
letter from seven bipartisan Governors was sent to Senate leaders. This 
is a letter by the Governors of Ohio, Montana, Nevada, Louisiana, 
Colorado, Massachusetts, and Pennsylvania. It shows the diversity of 
both our Nation and political parties. It says:

       We believe that, first and foremost, Congress should focus 
     on improving our nation's private health insurance system.

  Then they say:

       Medicaid provisions included in this bill [that has been 
     proposed by the House] are particularly problematic. Instead, 
     we recommend Congress address factors we can all agree need 
     fixing.

  So the message was clear from these Governors, including Republican 
Governors, and I hope my colleagues will listen to them. The Nation's 
Governors know because they have had to provide and be a partner on 
Medicaid for their citizens. They know how it affects their economy, 
and they know what it does when families in their States get access to 
healthcare. It reduces the bankruptcy rate. It helps people stay 
employed. It boosts GDP. All of these things are benefits of Medicaid 
expansion that we have seen in Washington State. It cut the 
uncompensated care cost in half. It also resulted in the creation of 
new jobs.
  A nonpartisan study found that if the current bill we are debating, 
the House bill, is passed, state economies will shrink by $93 billion. 
So pulling the rug out from under Medicaid recipients would hurt jobs 
and hurt economies in Nevada, Alaska, and West Virginia. West Virginia 
would lose more than 10,000 jobs, more than $1 billion in gross State 
product, and more than $1.7 billion in business output. Nevada would 
lose 3,300 healthcare jobs and Alaska would lose 2,600.
  So all of these things are ways for us to say: If you are serious 
now--before you go home for the August recess--about protecting 
Medicaid and stopping this ridiculous war on Medicaid, vote for our 
motion. Stand up and say you understand that we may have challenges in 
the individual market, but it doesn't mean that we should cut people 
off of access to healthcare through Medicaid.
  I thank the Presiding Officer.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Perdue). Who yields time?
  If no one yields time, time will be charged equally to both sides.
  The Senator from Indiana.
  Mr. DONNELLY. Mr. President, I rise today to offer a motion that 
would protect Medicaid, the Medicaid expansion, and the Healthy Indiana 
Plan--known as HIP 2.0--in my home State of Indiana.
  I first want to thank my colleagues for their support of this motion. 
I am proud to have Senators Casey, Cantwell, Blumenthal, Leahy, Brown, 
Harris, Hassan, Franken, Feinstein, Udall, Shaheen, Carper, Coons, 
Whitehouse, Kaine, Van Hollen, Cortez Masto, Baldwin, Menendez, Reed, 
Duckworth, Manchin, Markey, Stabenow, Durbin, Wyden, Murphy, Warren, 
Gillibrand, Cardin, Klobuchar, Heinrich, Hirono, Booker, Peters, 
Warner, and Nelson as supporters of this effort.
  I also want to extend a special thank-you to my friend Senator Bob 
Casey of Pennsylvania. Senator Casey has been a tireless advocate for 
protecting the Medicaid Program and the critical services it provides, 
not just to the people of Pennsylvania but to millions of Americans 
across our beloved country. Senator Casey has done incredible work to 
remind all Americans of the important role Medicaid plays in our 
communities and the millions of children, families, students, and 
seniors who have coverage through Medicaid.
  My motion is simple. It would send this bill back to the Finance 
Committee to get the consideration it never received, and it would 
require the committee to strike provisions that reduce or eliminate 
benefits for those currently eligible for Medicaid, prevent States from 
expanding Medicaid, or shift costs to States to cover that care.
  In my State of Indiana, we have seen the success of a bipartisan 
approach to expanding the Medicaid Program and helping our fellow 
citizen access health insurance. I was proud to work with then-Indiana 
Governor and now-Vice President Mike Pence when he used the Affordable 
Care Act to establish HIP 2.0. More than 400,000 Hoosiers have been 
able to access coverage through HIP 2.0, many for the first time in 
their lives. HIP 2.0 has helped reduce the uninsured rate in Indiana by 
30 percent. Our Vice President called HIP 2.0--that is the Medicaid 
expansion in Indiana--a national model.
  Then-Governor Pence is hardly the only Republican Governor to praise 
the Medicaid expansion as a way to cover more of our citizens. Governor 
Sandoval of Nevada said just yesterday that he ``will continue to do 
all I can to protect the thousands of Nevadans whose lives are 
healthier and happier as a result of the expansion of Medicaid.'' 
Governor Kasich of Ohio has offered similar sentiments as he has fought 
to protect the Medicaid coverage for his State.
  Nationwide, 31 States and Washington, DC, expanded coverage to more 
than 14 million Americans, many of whom have health insurance for the 
first time in their lives. All of that progress is at risk with the 
current bill.
  Many of our States, including Indiana, have been devastated by the 
opioid abuse and heroin use epidemics. This public health crisis hasn't 
been confined to simply one neighborhood or one economic bracket; it 
has been felt in communities across my State and all communities across 
our country.
  Vice President Pence said in his farewell address as Governor: ``With 
HIP 2.0, we have also made great strides expanding treatment for those 
who struggle in the grip of drug addiction.'' I agree with the Vice 
President. HIP 2.0 and the Medicaid expansion have made treatment and 
recovery services more accessible for thousands of Americans struggling 
with addiction as they work to get back on their feet.
  I don't think there is a single Member of this entire body--the U.S. 
Senate--who hasn't heard from the relative of someone who is battling 
addiction or from someone who has lost a loved one due to this 
epidemic. Gutting Medicaid and ending programs like HIP 2.0 as we know 
them would not make life better for Hoosiers or for the other 14 
million Americans who have gained coverage through the Medicaid 
expansion. It would actually do the opposite.
  Too often, this debate has been about statistics and not about the 
people who would be harmed. But healthcare, at the end of the day, is 
inherently personal. It is about the health and the economic well-being 
of our loved ones. It is about not having to go to the ER just to visit 
a doctor. It is about our financial security so our families and our 
friends aren't one illness away from bankruptcy.
  The proposal before us wouldn't just impact Medicaid expansion; it 
would harm millions of working Americans who count on Medicaid for 
basic healthcare. It would affect more families than that, including 
those families who have insurance through their jobs but also use 
Medicaid to access care for chronic or complex conditions.
  In 2015, 63 percent of Medicaid households had at least one full-time 
worker, and another 14 percent had part-time workers. That is almost 80 
percent. For these hard-working Americans, Medicaid provides their 
families with financial security and stability and the healthcare they 
need so they can keep working.
  Last month I stood on this floor and shared the stories of Hoosiers, 
including those who have Medicaid for themselves or to ensure that 
their children have the care they need. I have met with these families 
and heard their struggles, their fears, and their pain. I have listened 
as they pleaded with all of us here to protect their ability to access 
Medicaid. Many of these Hoosiers or their children are struggling with 
very complex medical needs that made it impossible for them to get 
coverage in the past. They would be priced out of the market under this 
current legislation. I cannot support a bill that takes care away from 
these families or from their children.
  My faith teaches me that we are all God's children, and every man, 
woman, and child should have the chance to live up to their God-given 
potential. There is nothing we wouldn't do to take care of our kids. 
These aren't just Indiana values. These are values in every town in 
every corner of our country.

[[Page S4243]]

  My faith also teaches me that we all deserve to live, work, and 
retire with dignity. In Indiana, 62 percent of Hoosier nursing home 
residents use Medicaid to help pay for their care. According to the 
Kaiser Family Foundation, Medicaid supports more than 1.4 million 
Americans in nursing homes across our country. Their care would be 
threatened by this bill, which is part of why seniors' groups have been 
so vocal in their opposition to the proposed Medicaid cuts in this 
bill.
  I have also heard from a number of school superintendents all across 
my State opposing the Medicaid cuts because of the harm it would cause 
to the thousands of students across the Hoosier State. Schools use 
Medicaid funding for certain health-related services they provide, 
including individualized education plans, special transportation for 
children with disabilities, social workers, physical and occupational 
therapists, and medical equipment at the schools.
  Some school districts use Medicaid to help pay for health 
professionals or for full-time registered nurses at schools across the 
country, where they assist students with complex medical needs and 
treat students with everything from illnesses to asthma attacks.
  As school districts and local governments across the country continue 
to make even more difficult budget choices, cutting off this critically 
important source of funding creates just one more huge challenge. In 
addition to trying to make up the lost funding, our communities and 
States could be impacted in other areas as well, including 
infrastructure, other education spending, police and fire, and other 
local priorities.
  The plan from my friends across the aisle undermines coverage for 
millions, but we haven't even had a hearing on their proposal. 
Committees haven't been able to go through regular order to examine the 
merits of Medicaid and the Medicaid expansion and how gutting them 
would harm millions of people--children with really complex medical 
conditions, those struggling with substance abuse disorders, and 
seniors in nursing homes trying to live with dignity and peace.
  My motion sends this bill back to the Finance Committee to ensure 
that we are protecting those Americans who are the most vulnerable 
among our society. It would allow us to move toward strengthening 
healthcare for our country.
  If you believe we should support children and families with complex 
medical conditions, then you should support this motion. If you want to 
protect the 1.4 million seniors using Medicaid for nursing home care, 
then you should vote for this motion. If you want to continue the 
progress we have made fighting the opioid abuse and heroin use 
epidemics, then I ask for your vote in this effort.
  I firmly believe we can improve healthcare and build upon the gains 
we have made if we work together--not as Democrats or as Republicans 
but as Senators and Americans--in a bipartisan manner. This is not a 
political game. The consequences are as serious as it gets, and the 
American people are counting on us.
  I urge my colleagues to support this motion.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. VAN HOLLEN. I thank the Presiding Officer, and I want to start by 
thanking my friend and our colleague, Senator Joe Donnelly, for 
standing up for Hoosiers and, in standing up for Hoosiers, standing up 
for all Americans whose healthcare is threatened if we continue to 
proceed down this very dangerous road in the Senate.
  He talked about the opioid epidemic. Just last week I met with a dad 
by the name of Rick Warner and the brother and sister of a young man by 
the name of Jamie Warner who had recently graduated from the University 
of Maryland. He was a Terp.
  Jamie died of an opioid overdose. He was part of the opioid epidemic 
that is sweeping the country. Rick Warner and his family were here in 
the Senate asking Senators--in fact, pleading with Senators, 
Republicans and Democrats alike--not to pass this healthcare bill.
  He had lost his son Jamie, and he is determined that other moms and 
dads not lose their children to opioid overdose. This bill--make no 
mistake--will make those tragedies much more likely by taking away 
access to care in the way Senator Donnelly just mentioned.
  Yesterday, with the tie-breaking vote of Vice President Pence, the 
Senate began down a very dangerous path, but we can get off that path. 
We can make sure we do not reach the end of that very dangerous 
journey. It was as if yesterday we lit the fuse and the fire is 
traveling down that fuse and at the end of the fuse is the plan to 
totally blow up the Affordable Care Act, which will wreak havoc on our 
healthcare system. That is why we have to put out the fire on that fuse 
right here in the Senate. We have the power to do that. We have the 
power to prevent the chaos and harm that will be created in our 
healthcare system if we continue down this path.
  The reality, we know, is that all the healthcare plans that we have 
seen emerge to date--whether it was House plan 1 or House plan 2, or 
Senate plan 1 or Senate plan 2, or the proposal to repeal entirely the 
Affordable Care Act, which would cause great harm--have the same rotten 
core. All of them have the same nasty DNA, and that is this: They would 
deny access to affordable care for tens of millions of our fellow 
Americans in order to give tax breaks to the very powerful and very 
rich and to big corporations. In fact, the proposal we are voting on 
very soon, which is entirely repealing the Affordable Care Act with no 
replacement, will result, according to the nonpartisan Congressional 
Budget Office--these are the nonpartisan referees who look at these 
proposals and tell the American people what the impact will be--in 32 
million fewer of our fellow Americans having access to affordable care 
than today. They also tell us that we will double the health insurance 
premiums compared to today. And for what? They give a gigantic tax 
break to the wealthiest Americans.
  Warren Buffett, a name most Americans know, said about a month ago: 
For goodness' sake, I don't need a $670,000 a year tax cut in order to 
throw tens of millions of Americans off of affordable care. Don't do 
that. I don't need it.
  Make no mistake. This has never been about healthcare. It has been 
about wealth care. I want people to think about this. If this were 
really about healthcare, why is it that all of the folks involved in 
providing healthcare to the American people are against it--the nurses, 
doctors, and hospitals?
  People hear a lot of facts and figures from Senators and from the 
House. Some people may dismiss those numbers, but why don't we ask the 
people whose daily business it is to take care of the American people? 
What the doctors say is that all of these Republican plans violate 
their Hypocratic oath. What is the Hypocratic oath? It is the oath that 
every doctor in the country takes and the first principle is to first, 
do no harm.
  Doctors, nurses, and hospitals all want to make people better. They 
all want to cure us. They all want to improve our health situation, but 
their No. 1 rule is not to make things worse, and all of these bills 
make things worse. That is what the numbers show us, and that is what 
the doctors, hospitals, and nurses show us. I think it is worse to have 
32 million fewer Americans have access to affordable care.
  What about our colleagues? Don't they think that is worse? I think it 
is worse when you double health insurance premiums and raise the cost 
of healthcare to Americans. That sounds like it is worse to me, not 
better.
  It is not just all the folks who provide healthcare. Why don't we ask 
all of the patient advocacy groups across America about this so-called 
healthcare bill? What do they say?
  The American Cancer Society: Bad bill--don't pass it. It will create 
harm. It will be a setback in our fight against cancer.
  The American Diabetes Association says the same thing: Bad news for 
patients with diabetes.
  The American Heart Association tells us that this will be bad and 
harmful to people with heart disease.
  There is the Alzheimer's association, and we can go down the list. 
Every single patient advocacy group in America that has taken a 
position on this bill says it is a bad bill, it is dangerous to our 
health, and it will do harm.
  So I don't know how our Republican colleagues can bring Senate bill 
1, Senate bill 2, or Senate bill 3 before this

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House and call it a healthcare bill when all the people who provide 
healthcare to our constituents say it is harmful to their health and 
when every patient advocacy group that has weighed in says that it is 
bad for their health. How is that a healthcare bill?
  It is good for one group of Americans--those who will get a windfall 
tax break, but many of them, like Warren Buffett, are saying: Hey, I 
don't want this.
  Now there are some very big corporations that are wanting their tax 
breaks, and, yes, as corporations, they are going to get this windfall 
benefit at the expense of everybody else in America and at the expense 
of our healthcare system.
  So let's not go down this path. The way to avoid going down this path 
is to vote down all of these amendments and make sure that we don't put 
this bill into the House of Representatives, where they have already 
passed a bill that is harmful to Americans' health.
  In fact, I think people will remember that President Trump had this 
big celebration in the Rose Garden of the White House after the House 
passed that bill. They were slapping each other on their backs before 
the cameras.
  Yet, behind closed doors, what did President Trump have to say about 
the House bill? Behind closed doors, he called it a mean bill, and it 
is a mean bill. These Senate bills, when it comes to cuts in Medicaid 
that our colleague Senator Donnelly was talking about, are even meaner 
than the House bill, with deeper long-term cuts. This is not according 
to me. It is according to the nonpartisan Congressional Budget Office.
  Those cuts get translated into stories of people like Rick Warner, 
the dad I talked about at the beginning of my comments who lost his son 
Jamie. Those numbers get translated into harm to people throughout this 
country who have been crying out. We heard some of them in the Gallery 
just yesterday. What did they say? ``Kill the bill. Don't kill us.''
  The reality is, when you deny access to affordable care to millions 
of Americans, you are putting their lives at risk, and when you raise 
premiums and costs, you are putting people's livelihoods at risk. So 
let's not go down this path.
  The motion by Senator Donnelly and others will do what Senator John 
McCain asked us to do yesterday--to go back to regular order, to go 
back to the committee process, to go back to the way this democratic 
institution is supposed to work, which is when we hear from our 
constituents, we hear from the doctors, we hear from the nurses. We do 
not cover our eyes and ears to the facts and the truth.
  That open process is designed to protect the American people. It is 
designed to protect the American people from bills just like this one 
for which this Senate took that dangerous first step down the road on 
proposals that only 11 percent of the American people think is a good 
idea--11 percent. I cannot even find that 11 percent myself. I have 
gone all over the State of Maryland, to those parts of our State that 
voted for Donald Trump for President and to those that did not. I 
cannot find 11 percent in Maryland who are for this bill. That is why 
what we call the regular order around here is supposed to protect the 
public interest--because when you have a committee hearing on a bill 
like this and the doctors and the nurses and the hospitals all come out 
and testify against it, they let people know how bad it is. Instead, we 
have had this process in secret, behind closed doors. In many cases, we 
do not even know what the next amendments after this one that is coming 
up are going to be. We do not know what the Republican leader is 
cooking up behind closed doors.
  Let's do what Senator McCain urged us all to do. Let's get back to 
regular order. Let's get back to a process that is designed to provide 
transparency because with transparency comes accountability. It lets 
the American public know exactly what we are doing and how we are going 
to impact their lives.
  Here is what I do know. Everybody across this country who knows about 
this bill--everyone I have spoken to and from the phone calls we are 
getting and the emails we are getting and at the rallies and the 
townhalls--is catching on. Why would we just steamroll over all of that 
important public sentiment coming from all political views? The 
American Cancer Society is not a Republican or a Democratic 
organization. The American Diabetes Association is not partisan. These 
groups are crying out and saying: Stop.
  So let's get off this path, this very dangerous path. Let's get back 
to regular order. We all know our healthcare system is not perfect. We 
all know the Affordable Care Act is not perfect. Senator Donnelly and I 
and others and many of our Republican colleagues have put forward much 
more narrow plans that focus on improving our healthcare system, not on 
blowing it up entirely. That is the path we should take.
  I hope all of our Senators will agree not to continue to let that 
fire burn on the fuse until it gets to the end and blows up our 
healthcare system. Let's stop now. Let's get together, and let's have a 
committee process. Let's do something that really improves our 
healthcare system and not something that destroys it.
  Thank you, Mr. President.
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, time will be divided equally between both 
sides.
  The majority whip.
  Mr. CORNYN. Mr. President, I am advised we are not in a quorum call. 
Is that correct?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. CORNYN. Mr. President, yesterday we took a giant step toward 
delivering on our promise to the American people to provide relief from 
the failures of the Affordable Care Act, otherwise known as ObamaCare.
  Over the last 7 years, we have discussed what our solution would look 
like, and everybody who has been willing to participate in that 
conversation--sadly, not our Democratic colleagues, who simply refuse 
to do so, but every Member of our conference--has engaged in 
discussions and has had input on how best to accomplish the goal of 
providing people affordable coverage, increased access, market 
stability, and better care.
  We can talk about all of the details, but basically what this boils 
down to is how to provide people with access to quality, affordable 
health care. I know some of our friends across the aisle thought the 
Affordable Care Act was it, but it failed. It started with the promises 
that were made by President Obama when he sold this to the American 
people, saying: If you like your policy, you can keep your policy; if 
you like your doctor, you can keep your doctor. He said that premiums 
would go down $2,500 for a family of four, none of which have proved to 
be true--none of which have proved to be true.
  Now we find that in many parts of the country, insurance companies 
are pulling out, limiting if not denying altogether people's access to 
coverage within the exchanges. We know what has happened to premiums. 
Since 2013, they have gone up 105 percent nationally--a 105-percent 
increase in premiums.
  People find that their deductibles are so high that they effectively 
are self-insured. They have been denied the benefit of their own 
insurance. Nominally, they may have insurance, but the fact is, if you 
go to the hospital, you are going to be responsible personally for what 
is not covered by that deductible.
  Even our colleagues across the aisle admit that ObamaCare has failed 
to provide stable access to insurance markets, but their solution has 
been to pay more money to insurance companies. I would call that an 
insurance company bailout without any reform, without any changes in 
the basic structure of ObamaCare, which has caused this failure.
  What we have tried to do on this side of the aisle--and we have 
repeatedly invited our Democratic colleagues to join us because 
optimally this would be a bipartisan effort, but so far they have 
refused to participate whatsoever and really are focused solely on 
trying to blow up the current process.
  What we have said we want to accomplish are four things. We want to 
stabilize the insurance markets. We want to bring premiums down so they 
are more affordable. We want to protect people with preexisting 
conditions. We want to put Medicaid--the safety net for low-income 
Americans--on a sustainable path.

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  Of course, as you might imagine with something as complex as 
healthcare, we have had a number of opinions on how best to achieve 
these goals. Even as approaches and ideas have differed, one thing has 
remained constant: the belief that the status quo is simply 
unacceptable. It is unacceptable.
  Take, for example, one of my constituents in Texas, who wrote me 
recently to say that his monthly insurance premium under the Affordable 
Care Act had nearly tripled, to $690, and his deductible, to my earlier 
point, went from $1,500 to $6,000.
  I don't know many people--unless they happen to be well-to-do--who 
can afford to absorb those sorts of increases in premiums and 
deductibles. Because his coverage went from a PPO, a preferred provider 
organization, to an HMO, a health maintenance organization, some of his 
doctors are no longer in the network, forcing him to switch healthcare 
providers entirely.
  This story is certainly not unique. It is typical. This is the norm 
under the Affordable Care Act. I often hear from Texans who would 
rather drop their coverage and pay the costly fine rather than have to 
pay for insurance that will cost them more and more each month, which 
they can't afford.
  Here is a telling statistic. More than 400,000 Texans who earn less 
than $25,000 a year have decided to pay the penalty rather than to be 
forced to buy the insurance they can't afford, so many of them pay the 
penalty because of the individual mandate in the Affordable Care Act. 
They are left with nothing, other than having to pay the penalty as 
required by the law. That is not a solution. That is why I hope that 
someday we can get out of this rut and off of the talking points on 
each side and say: What can we do to try to provide people access to 
affordable health care? That is the key.
  People are going to make their own decisions based on their own 
economic self-interest. If you are a young person, you might decide: 
What I would like to do is to buy a policy that will cover me in 
emergency circumstances if I have to go to the hospital, but I don't 
want to have to pay for all the bells and whistles that raise the 
price. You can't do that under the Affordable Care Act and take 
advantage of the tax subsidies that everybody else can. It is basically 
a false promise.
  I also heard from another small business owner in Donna, TX, who was 
forced to fire four employees just to comply with the employer mandate 
or otherwise owe the government more than $100,000 in fines that he 
said could bankrupt his business. Those are the kinds of decisions that 
ObamaCare is forcing. Rather than hire enough people--or if you have 
more than 50--you decide you need to fire people in order to avoid 
these penalties that come from the employer mandate. That is not good 
for the economy. That is not good for the job prospects of hard-working 
Texans.
  I shared the story of a constituent in Needville, TX, who, after a 
50-percent increase in his monthly premiums, still lost his doctor 
because the doctor wouldn't accept his ObamaCare plan.
  Then there is the emergency room employee in North Texas, who wrote 
me to say that she has seen a significant increase in the Medicare and 
Medicaid patients in the emergency room because fewer and fewer doctors 
would accept these patients.
  In my State, only about one-third of doctors will accept a new 
Medicaid patient because it pays at such a low rate. We have a better 
idea that will make people up to 350 percent of the Federal poverty 
level eligible for a tax credit they can use to buy private insurance, 
which will increase their access to care and make it more affordable. 
We have coupled that with something called the innovation and stability 
fund, in which we have taken the authority out of Washington and sent 
it back to the States to let Governors and State legislators and 
regulators at the local level design policies that meet the needs of 
the people in the States.
  The basic structural failure of ObamaCare was to assume that you 
could write a one-size-fits-all plan for 320 million-plus people that 
would work. It hasn't. We know that. That is not speculation; this is 
based on experience.
  I know my colleagues across the aisle have heard similar stories from 
their constituents, as well, but apparently they don't seem to care 
very much about that. Otherwise, they would join with us in trying to 
improve the status quo, which they have refused so far to do.
  One thing about the procedure that we are undertaking here is that 
any Senator who wants to offer an amendment to improve the bill or even 
offer a complete substitute to the bill is entitled to do so, and they 
will get a vote on that. Our colleagues on the Democratic side, despite 
hearing from their own constituents that they are hurting as a result 
of the status quo, appear not willing to lift a finger to help them.
  Indeed, the only proposal I have heard from the other side--I have 
heard two. One is an insurance company bailout, which does nothing to 
effect reforms that would ultimately address the structural problems 
with ObamaCare or else they say: We want to have a single-payer system, 
which will bankrupt the country. Those are their solutions.
  On Monday, I noted that in an effort to try to unite their deeply 
divided party after last year's elections, our Democratic colleagues 
unveiled an economic agenda aimed at, they say, lifting up lower and 
middle-class Americans. That is an admirable goal.
  If Democrats are really serious about helping lower and middle-income 
Americans, one glaring and immediate action they could take is to join 
us in alleviating the burdens placed on these very same folks by 
ObamaCare--the types of people I have been talking about back in Texas, 
whom I know exist in their States as well.
  If the Democratic leader refuses to help get rid of one of the 
biggest economic burdens on lower and middle-income Americans, then his 
plan is not worth the paper it is printed on. What they are offering is 
false hope. Unless you are willing to deal concretely with the problem 
here and now, that is just another campaign promise--one they will not 
be able to keep until they address what the failures of the Affordable 
Care Act have imposed on low- and middle-income Americans.
  Simply stated, ObamaCare is a failed experiment. It has failed 
because Washington has tried to do too much at the expense of 
individual choices, individual liberties, and family control over what 
are deeply personal decisions.
  With each day that passes, ObamaCare keeps getting worse. The 
premiums for 2018 will soon be announced by the insurance companies, 
and we are going to see double-digit increases again, over and above 
what ObamaCare has seen so far--105-percent increases since 2013 
alone--on top of that.
  After yesterday's vote, we now have the opportunity to provide relief 
from this failed law. I know Members have a lot of ideas about how to 
fix the mess that ObamaCare has left us, but that was precisely why it 
was so important for us to get on the bill yesterday, so Members on 
both sides of the aisle can offer amendments and share their ideas.
  Do you know how many Democrats voted to get on the bill and begin the 
debate and offer amendments? Zero, zip, nada. Their protestations that 
they somehow want to do things on a bipartisan basis really have fallen 
flat, as demonstrated by their own failure to act.
  If they were really interested in working with us to do something on 
a bipartisan basis, why wouldn't they take advantage of this 
opportunity to do so?
  Last night we began the process of considering amendments, including 
one from my colleague in Texas, Senator Cruz, who has a plan to provide 
people who choose a lower cost premium insurance product the 
opportunity to do so, as long as the State also requires a 
comprehensive plan as well. This is something that is ideal for many 
people who want an insurance safety net but don't necessarily want 
their health insurance to pay for their regular medical expenses or 
doctor visits. They can handle those through a health savings account 
or some other way.
  Later today we will continue to work toward bringing relief to 
millions of Americans suffering from the failure of ObamaCare. 
Yesterday was a big step toward ending ObamaCare and the first step 
toward ending the mandates, the

[[Page S4246]]

penalties on low- and middle-class Texans who are having to choose 
between buying unaffordable insurance or paying a penalty that their 
government is forcing them to pay. We are going to end that.
  We are going to end the job-killing employer mandate, which is 
forcing employers either to lay people off or not hire additional 
people because they don't want to run into the additional costs 
required by the employer mandate.
  Then there is the single mom, whom I met in Tyler, TX, a few years 
back. She said: I want to work full time. I want to work at least 40 
hours a week, but the restaurant where I work figured out that if they 
put me on part time, 29 hours a week, then they wouldn't be required to 
meet the mandates of the Affordable Care Act.
  What this single mother, who wanted to work full time, was forced to 
do because of ObamaCare was to work part time. Do you know what? She 
can't make it on 29 hours a week, so she has to get two jobs. 
Effectively, she had to go from 40 hours a week doing a job she 
enjoyed, which helped her pay the bills, to working two jobs in order 
to make ends meet.
  We can and we should do better, and we invite our colleagues across 
the aisle to join us, if they will.
  People keep talking about a secret process. Well, this is about as 
open and transparent as it gets. Everybody will have an opportunity to 
offer an amendment, to discuss what is in the amendment, and to vote on 
it. To the extent that the Senate's work product differs from what the 
House of Representatives provides us, we can go to a conference and 
work out those differences. That is how the legislative process is 
supposed to work. Sitting on your hands and complaining about something 
while offering no effort to try to help solve the problem simply boils 
down to hollow words. Unfortunately, that is all we have been hearing 
so far.
  We hope our colleagues will change their minds and join us. Insurance 
bailouts with reform are not the answer, a single-payer system is not 
the answer because it will bankrupt the country, but we are more than 
happy to entertain any reasonable proposal from our colleagues across 
the aisle. We will guarantee they get a chance to debate it and to have 
a vote on their amendment. I don't think they could ask for anything 
more.
  The PRESIDING OFFICER (Mr. Cotton). The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, as we all know, we are continuing to 
debate what amounts to repealing the Affordable Care Act without any 
indication of what is going to replace it--what is actually in the 
Republican leader's bill. I think this is worth repeating because we 
are talking about changing one-sixth of the U.S. economy, impacting 
every American family, and yet we still have no idea what the bill 
actually is.
  We do know this. A partisan bill to take away health insurance from 
tens of millions of Americans, written behind closed doors, opposed by 
every healthcare stakeholder group and by an overwhelming majority of 
the American people should not pass the Senate.
  As I have repeatedly said, the only constructive way forward is for 
Democrats and Republicans to come together in a good-faith, bipartisan 
effort to repair and strengthen the current law. Bipartisanship should 
not be our last resort, as Senator McConnell has suggested. It should 
be a starting point. It should be the foundation of what we do in this 
body. This is how the great majority of the American people want us to 
conduct the Senate's business. This is what I hear from my constituents 
in New Hampshire, and this is especially true with healthcare 
legislation which affects families all across this country.
  Make no mistake, every bill proposed by the Republican leadership has 
been designed as a bullet to the heart of the Affordable Care Act. 
Republican proposals will collapse the individual marketplaces, make it 
impossible to provide affordable coverage for people with preexisting 
conditions, and take healthcare coverage away from up to 32 million 
Americans, including the most vulnerable.
  I hope nobody is fooled by this latest partisan measure to roll back 
the Affordable Care Act and take healthcare coverage away from tens of 
millions of Americans. I hope every Senator will, at long last, heed 
Senator McCain's call for bipartisanship--as we have been hearing at 
townhalls and in countless messages from our constituents. The American 
people want us to make commonsense, bipartisan changes to the current 
law. We need to work together to build on the strengths of the 
Affordable Care Act, which has dramatically reduced the number of 
uninsured Americans and has given us valuable tools for fighting the 
opioid epidemic which is ravaging so many communities in America. This 
is the best way forward for both the Senate and our country.
  Republican leaders have spent the last 7 months pushing deeply 
unpopular bills to repeal the Affordable Care Act, including their 
effort to dramatically cut Medicaid--not just the expansion of Medicaid 
under the Affordable Care Act but the Medicaid Program that has done so 
much to protect and provide healthcare for children across this 
country, for pregnant women, for those with disabilities and older 
Americans, so many of whom are in nursing homes who would lose that 
care if we dramatically cut the Medicaid Program as the Republican 
proposals have tried to do.
  At the recent National Governors Association meeting, Democratic and 
Republican Governors alike urged Congress to reject the Republican 
leaders' healthcare bill--in particular, its harsh and unsustainable 
cuts to Medicaid. The Republican Governor, John Kasich, was especially 
forceful in urging Members of Congress to work together to find 
bipartisan solutions. He urged Congress to give first priority to 
stabilizing the healthcare marketplaces.
  We should listen to the Governors, but most importantly we should 
listen to our constituents--to the great majority of our constituents 
who want to preserve what is working in the Affordable Care Act and see 
us change what is not working. Instead of legislation to take 
healthcare away from people, it is time now for an inclusive, 
bipartisan approach to provide quality, affordable healthcare for every 
American.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The assistant Democratic leader.
  Mr. DURBIN. Mr. President, yesterday, on the floor of the Senate, 
there was a speech which will be remembered for a long time. Our friend 
and colleague Senator John McCain came to the floor just days after he 
had been diagnosed with a serious cancer challenge. He made the trip 
from Arizona to Washington to vote on the floor on this healthcare 
debate, then asked for 15 minutes of time afterward to speak to the 
Senate. Of course, he was given that opportunity.
  During the time that we learned about his diagnosis and he was home, 
virtually every one of us sent our personal best wishes to him and his 
family. Our love and respect for John McCain is deeply felt in the U.S. 
Senate, and virtually everyone stayed on the floor to hear his speech. 
Look around the floor now. There aren't many people, right? As good as 
my speech may be, it is not going to touch the quality of what John 
delivered yesterday. I wanted to be here for it and so did my 
colleagues on the Democratic side and on the Republican side.
  John said a lot about who we are and what we are in the U.S. Senate. 
Fewer than 2,000 individuals, in the history of the United States of 
America, have had the honor to stand here and speak on the floor of the 
Senate. This is a rare opportunity. For many of us, it is a dream come 
true and one we couldn't imagine, but what John said yesterday, to 
summarize part of his statement, is that we ought to understand our 
responsibilities, as well, as Senators.
  We ought to be honest about what we now face in America when it comes 
to the political discourse, the political debate. What we face now is a 
divided country, a divided Senate, divided House, and yet a yearning by 
all Americans for us to step up and do something; make America a better 
nation; help America's families, the workers, the businesses; step 
forward and solve a problem. John reminded us yesterday that to do 
that, we needed to move to what he called the regular order.
  It may not mean much to those who are just watching this debate and 
don't follow the Senate closely, but the regular order is to introduce 
a bill into

[[Page S4247]]

the Senate, send it to a committee, have the committee staff review it, 
experts take a look at it, call for a committee hearing so the American 
people can see what is in the bill, debate the back-and-forth at the 
hearing, then have members offer amendments--changes. Some will win, 
some will lose. Then the bill can come to the floor of the Senate for a 
similar process. It is an open, public process. That is what regular 
order is, and that is what John McCain spoke to.
  Let me, at this point, quote what he said verbatim. I like this 
paragraph a lot so I am going to add it here. Here is what John McCain 
said yesterday on the floor of the Senate:

       I hope we can again rely on humility, our need to 
     cooperate, on our dependence on each other to learn how to 
     trust each other again and, by so doing, better serve the 
     people who elected us.

  I like this part:

       Stop listening to the bombastic loudmouths on the radio and 
     television and the internet.

  John McCain said:

       To hell with them. They don't want anything done for the 
     public good. Our incapacity is their livelihood.
       Let's trust each other. Let's return to regular order. We 
     have been spinning our wheels on too many important issues 
     because we keep trying to find a way to win without help from 
     across the aisle. That is an approach that has been employed 
     by both sides; mandating legislation from the top down, 
     without any support from the other side, with all the 
     parliamentary maneuvers it requires. We are getting nothing 
     done, my friends. We are getting nothing done.

  John said it yesterday and it still applies and he is right. I say 
that as a Democrat with respect for him as a Republican, but if we are 
not going to do more than just listen and be warmed by his words and 
applaud his speech, what should we do at this moment?
  What is pending before us on the floor of the U.S. Senate is 
legislation that will change healthcare for every single American--
every one of them. It will change it for us in the Senate, but it will 
change it for the 12.5 million people I represent in Illinois too. 
Every one of them will be changed by this bill. What is in this bill 
that will change it? We honestly can't tell you. The bill has not been 
written. We aren't able to see it. We are being told before the end of 
the week we will actually get a copy of the bill. I am not making that 
up.
  We have tried several amendments on the floor, and they failed--one 
has failed. Several are likely to fail this afternoon, but there is no 
bill before us. We can't explain to the American people what this is 
ultimately going to be, except in the most general terms of what is 
being debated. That is embarrassing. It is embarrassing on the floor of 
the Senate.
  What we should do is take this critical matter that affects every 
American and every American's healthcare and send it to a committee--
the HELP Committee, chaired by Senator Lamar Alexander, Republican of 
Tennessee; Ranking Member Patty Murray, who is a Senator from 
Washington; the Finance Committee, Senator Hatch of Utah, Republican; 
Senator Wyden of Oregon, Democrat. They need to sit down and look at 
these bills carefully.
  Let's not make a mistake at the expense of the people who sent us 
here. Let's stand up for sound, thoughtful judgment. Let's stand up for 
a Senate that works, as John McCain challenged us. Is that what the 
American people wish? I think it is at the heart of all of it. I think 
John McCain really set a standard we ought to live up to. Let's stop 
this waste of time over a debate over a bill that cannot even be 
printed. Let's take this to the regular order. Let's do it the right 
way, to the credit of the Senate and to the credit of our country.
  We took an oath, each and every one of us, to swear to uphold the 
Constitution. That Constitution, that document we revere, spells out 
exactly what we should do at this moment, which is stop what we are 
doing on this floor, stop wasting the time of the American people and 
endangering their healthcare and take this to a debate that is 
befitting a great Constitution and a great nation and a great Senate.
  I yield the floor.
  I do it with the hopes that those who speak after me, of both 
political parties, will first sit down and read what John McCain said 
yesterday and let their applause for his remarks be reflected in what 
they do on the floor of the Senate today.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, I thank my colleague for an excellent 
statement and for appealing to the better angels.
  Mr. President, I am rising to speak about the Donnelly amendment, 
which is very much needed because the President--and now Republicans--
are walking back a clear commitment.
  The President said in the campaign that he would not cut Medicaid, he 
wouldn't touch it, but even before the inauguration, the Trump team 
eagerly signed on to a Republican plan to slash it by more than $700 
billion. They stared into television cameras, looked American voters in 
the eyes, and said that somehow these massive cuts to Medicaid wouldn't 
in any way harm the seniors. Medicaid picks up 2 out of 3 dollars with 
respect to seniors in nursing home beds and special needs kids and 
disabled youngsters.
  When we hear that Medicaid picks up the cost of two out of three 
nursing home beds and compare that to the President's statement that he 
wouldn't cut Medicaid--wouldn't cut it--when we are now faced with a 
plan to cut it by more than $700 billion, one, that is walking back the 
President's solemn pledge in the campaign, and, two, it is going to 
make it harder for older people in this country to be able to afford 
long-term care.
  The majority has brought the TrumpCare debate and the extreme 
Medicaid cuts that I just described directly to the floor of this 
Senate without a single committee hearing to justify this ill-advised 
policy.
  Our colleague from Indiana, Senator Donnelly, has put forward an 
important amendment to stop this ideological crusade to unravel the 
Medicaid safety net. Senator Donnelly's proposal would send this 
partisan attack on Medicaid back to the Senate Finance Committee, where 
it should have been raised and struck down in the first place.
  Mr. President, I am the ranking Democrat on the Senate Finance 
Committee. My focus in public life has always been to try to find 
common ground with people of common sense. And I wrote with 
colleagues--many of whom still serve on the Republican side and on the 
Democratic side--a universal coverage bill that pulled together both 
sides of the political spectrum.
  So unless you provide an opportunity to have a discussion about the 
Medicaid safety net in the Senate Finance Committee, you are not going 
to be able to have policies that get to common ground on this vital 
issue. What you are going to have is what is really on offer now--an 
anti-Medicaid crusade that is a grave threat to the health and well-
being of tens of millions of Americans.
  Over the last few months, I have heard Republican colleagues say that 
Medicaid is a disincentive to work and that there are too many able-
bodied adults enrolled. If you look at the facts, that is not what the 
program is all about. Medicaid is a vital source of coverage for our 
neighbors and friends who live in poverty. It tells those families that 
healthcare is covered while they work to climb the economic ladder in 
the private sector.
  In addition to that, for the older people I have mentioned--these are 
the folks who have done everything right in life. They went to school, 
they found jobs, they worked hard in their careers, they raised 
families, and they scrimped and saved all through their lives. Growing 
old in America is pretty costly. So what happens is that millions of 
seniors who have done everything right spend down their savings, and 
that is when Medicaid steps in to help. It covers two out of three 
seniors living in nursing homes. It is a major source of funding for 
community-based care, and people generally don't know that. Now they 
may have heard about nursing homes, but it also picks up the costs for 
community-based care, where older people are more comfortable, and it 
often costs less than institutional care.
  Seniors who lose those benefits due to TrumpCare Medicaid cuts are 
going to have to find somewhere else to live. A lot of families want to 
be able to help elderly parents and grandparents. It is going to be 
pretty hard because a lot of them are walking on an economic tightrope, 
and if they go looking

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for nursing home care, it is going to cost on average more than 
$90,000.
  So it is seniors, and it is disabled folks who count on Medicaid to 
have a chance to be productive. With the Medicaid benefits under 
threat, people with disabilities are going to find it hard to be able 
to attain the productive role in our society that they so fervently 
want to have. Our communities are so much better off when folks with 
disabilities can contribute, and Medicaid makes that possible. It 
covers services that many private insurers don't. It helps people make 
it out of bed and provides safe transportation to jobs. It helps them 
avoid unnecessary illnesses. It is not a disincentive for people with 
disabilities to work; having the support of Medicaid is what makes it 
possible for disabled folks to work.
  Across the country, there are millions of kids with special needs who 
rely on Medicaid every day for services--behavioral care services, 
mental health services. Mom or dad might have good insurance through 
work, but private plans don't always cover the care those vulnerable 
kids need.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. WYDEN. Mr. President, I ask unanimous consent for 1 additional 
minute.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WYDEN. Mr. President, I have commented on the secret process that 
went on in this discussion, but I will close with this: One version of 
TrumpCare has already been voted down here in the last day. Nobody 
knows where this debate will wind up, but what is important now is that 
Senators support the Donnelly motion. The Donnelly motion is going to 
ensure that the Finance Committee, where Senator Enzi serves so 
admirably, and all of our colleagues, Democrats and Republicans, is 
going to be able to look at this issue in a way that is going to bring 
the Senate together, not divide it, as we would be without the Donnelly 
motion.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. BLUMENTHAL. Mr. President, I appreciate my colleagues across the 
aisle accommodating me for 3 minutes, and I ask that--
  The PRESIDING OFFICER. There is no Democratic time remaining.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, Senator Blumenthal, the Senator from 
Connecticut--I ask for 3 minutes from our time, and we will allot that 
as long as we preserve the full time for the Senator from Wisconsin.
  The PRESIDING OFFICER. The Senator from Connecticut is recognized.
  Mr. BLUMENTHAL. Mr. President, we have seen in the course of this 
debate some very high points and some points that I think in some ways 
we regretted. One of the high points for me was the return of Senator 
McCain, and I want to join all of my colleagues in saying how heartfelt 
our gratitude is for his return and his eloquence here about the need 
for us to work together.
  Yet yesterday we also saw, in my view, a shameful and disgraceful 
mockery of our democracy when Senators proceeded, in effect, to a 
slogan, a shell of a bill, not a really substantive measure. Yet that 
shell itself will undermine the exchanges and insurance coverage for 
millions and millions of Americans by creating uncertainty, and this 
process itself will aggravate that fear.
  I have now held five field hearings in Connecticut, and at each one I 
have heard from countless people with tears in their eyes telling me 
what the Affordable Care Act and Medicaid have meant to them, what 
repeal of it will mean to them, and how devastating and cataclysmic the 
damage will be.
  Thousands of constituents have written, have called, and have also 
contacted others of my colleagues, as I have urged them to do, and I 
want to say how grateful I am to them for their continued activism and 
advocacy. We need to maintain this fight. I have heard from moms and 
dads about what would happen to their children. One said to me: We 
can't thrive as a nation or as individuals if we can't afford to be 
healthy.
  So I ask my colleagues to listen to their constituents, to the people 
in their States, people like Conner and Mackenzie and Amelie and Evan 
and Amanda and Michelle and Jennifer and Gay. I described them on the 
floor in my previous talks. These voices and faces need to be brought 
here because there have been no hearings, no regular order, no 
democratic process, as we have an obligation to do.
  If at some point my colleagues abandon this effort to repeal and 
decimate the Affordable Care Act, I stand ready to come across the 
aisle to work together to drive down the costs of healthcare--
particularly pharmaceutical drugs--and to open the exchanges to more 
competition and create more choices for consumers among insurance 
companies. There are steps we can take together to improve this 
process. As Senator McCain urged us so powerfully, we need to go back 
to regular order, come together, and work across the aisle. There is no 
panacea. There is no instant solution. But we need to work together.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wisconsin.
  Mr. JOHNSON. Mr. President, I come to the floor today to speak to 
three amendments that I have either submitted or plan to submit on the 
matter before the Senate here today, the repeal and hopefully complete 
replacement of ObamaCare.
  There are two issues that concern me the most and that I have fought 
for and debated.
  In this process, how can we bring down gross premium levels that have 
skyrocketed under ObamaCare? According to HHS, on a national average, 
premiums have increased 105 percent. They have more than doubled. And 
of course it is far worse than that in many places.
  Janice Fenniman was a 62-year-old woman when I met her a couple of 
years ago. Prior to ObamaCare, she was paying $276 per month. In 2016, 
just 2 years into the implementation of ObamaCare, she was paying $786 
per month. Last time I talked to her, she would be paying over $900 a 
month, but the problem is, she can't afford it, so she is just taking a 
risk and going uninsured until she reaches the age of 65 and is 
qualified for Medicare.
  The other issue I want to speak about is literally the unsustainable 
nature of Medicaid. The other thing I fought for is reducing the 
disparity between States that have expanded Medicaid and those that 
haven't, like Wisconsin, that have done a great job managing Medicaid. 
My concern is that Medicaid expansion, which is directed toward able-
bodied, working-age, childless adults, is funded by the Federal 
Government 90 to 100 percent, depending on which year you are looking 
at, versus traditional Medicaid targeted toward--40 percent of Medicaid 
spending is targeted toward children, the disabled, and the elderly. 
Medicaid expansion is putting at risk the sustainability of traditional 
Medicaid. So my three amendments deal with those issues, and let me 
first take up the first two amendments dealing with premiums.

  I have a few charts. Unfortunately, in Washington, DC, there is not a 
whole lot of people who understand the problem-solving process. Let me 
describe it briefly.
  It starts with information. It starts with defining the problem, 
doing a root cause analysis, having the courage to recognize and 
acknowledge the truth in reality. Based on that reality, you try to set 
achievable goals. From my standpoint, the achievable goals should be to 
bring down gross premium levels back to a reasonable level where they 
were prior to the implementation of this completely faulty architecture 
of ObamaCare and preserving and sustaining traditional Medicaid.
  This chart, I realize, is a little busy, but let me walk you through 
it. This shows the trend line of ObamaCare, in terms of what we have 
experienced from 2010 to 2017, plus the estimates of the Congressional 
Budget Office as it relates to the Senate bill we voted on yesterday.
  Let's take a look at this. Back in 2010 to 2013, you see the trend 
line here. In 2013, on the national average, an individual is paying 
about $232 per month for healthcare. Now had that trend line just 
continued, had we not passed this faulty architecture of ObamaCare, we 
could reasonably expect that in about 10 years, premiums for an 
individual being about $303 per month.
  What has happened--again, according to HHS--those premiums have gone

[[Page S4249]]

from $232 per month to this year $476 per month on a nationwide 
average. That is a 105-percent increase.
  One of the problems with CBO scoring is it is difficult to interpret. 
What I tried to do for my colleagues is put in chart form exactly what 
CBO is saying. In their scoring of the Senate bill, they said next year 
premiums would be 20 percent above the current baseline. Of course, 
they don't give you the baseline, and they don't really give you the 
premiums so I had to try to cobble those together. This is pretty 
accurate. That would put premiums next year at about $546 versus $232 
about 4 years ago. The following year it would be 10 percent above the 
baseline. So it would start decreasing with the Senate bill, and the 
third year would be 30 percent below baseline. You would see a dramatic 
drop. You would be at $441 per month. Then the trend over the next 7 or 
8 years would be 20 percent below the baseline, $574.
  Take a look at this. Had we never passed ObamaCare, premiums should 
be in the $300-a-month level versus $574. This is the damage done by 
ObamaCare, and this, I am very sad to report, is not what we are 
adequately addressing because we do not have the courage to do the root 
cause analysis and be honest with the American public about what is 
happening.
  Let me read you a dictation from the family I just heard from 
yesterday. Sheri and Vern Kolby, whom we heard about from one of our 
State legislators who contacted one of my regional directors. He sent 
me an email telling me their story.
  I called Sheri last night. She didn't have time. She was just off her 
shift. Her husband is working way more than 40 hours a week--basically, 
that is 60 hours a week. The people whom President Clinton was talking 
about, people busting it, working 60 hours a week, their premiums have 
doubled and their coverage has been cut in half. So my staff reached 
out, and we basically dictated her story, her and her husband Vern's 
story.
  This is not her letter to me but her voice based on what was told to 
me by my staff. This is Sheri Kolby from River Falls, WI.

       My husband and I have preexisting conditions. We need 
     affordable healthcare through ObamaCare or whatever works. 
     Vern is a milkman now, driving a tank to farms to pick up 
     milk, and there are only seven employees at his company which 
     doesn't provide coverage. I am a florist. Now, I am the only 
     full-time employee so they don't have health coverage at my 
     work either. We signed up for ObamaCare in 2014 for the 
     entire 12-month period.
       We went on healthcare.gov, but the site crashed, so we had 
     to call a phone number which was jammed. Finally, I got hold 
     of someone and got through an hour and a half of 
     questionnaires. Then you get information in the mail about 
     what your premium will be and your subsidy, and you make your 
     monthly payment.
       We were getting monthly letters telling us we had to fax in 
     our pay stubs to make sure we were still qualifying for the 
     subsidized premiums. We did that every month, but then next 
     March, when we filed our taxes, that is when my tax preparer 
     said, ``You better sit down. Not only did you pay your 
     premium, but they want your subsidy back.'' That was about 
     $15,000.
       We were earning too much to qualify for the subsidies, even 
     though we held blue-collar jobs. If we stayed on ObamaCare, 
     we would have to pay the entire premium unsubsidized. In 
     2015, we made $59,000 and ended paying almost $30,000 for 
     premiums and deductibles. That was 51 percent of our income.
       In covering our deductibles and our out-of-pocket costs, we 
     used up almost all of our 401(k)s. It just multiplied and 
     multiplied. When a huge amount of money was due the IRS, we 
     decided we had to sell our house.

  Sheri and Vern Kolby had to sell their house so it wouldn't be taken 
away in foreclosure because of Obama's skyrocketing premiums.

       Now we can only get a 3-month plan. That is all that is 
     available. Private catastrophic plans are few and far 
     between.

  And I will add, parenthetically, also way overpriced because of the 
faulty architecture of ObamaCare.

       There aren't a lot of companies that offer plans in Pierce 
     County. We are kind of in a funnel and that funnel keeps 
     narrowing. In May, I went back to healthcare.gov, but 
     coverage would have cost $1,200 per month, about $14,400 per 
     year in premiums for a policy with a $14,000 deductible. If 
     you made $200,000, you could pay that, but we are not even 
     close to that. We usually fluctuate between $50,000 and 
     $60,000. We are blue collar. We pay our bills on time, we 
     respect people, and we want to live a good life, and we 
     have just been dumped on. It has got to stop.
       It may come to a point where we might not have insurance, 
     but we will just end up owing the hospital if something else 
     happens. My husband works 60 to 70 hours a week, and I work 
     30. We drive a `98 Wrangler. We are not running around in a 
     Ferrari. We don't spend money beyond our means. We don't take 
     trips to Tahiti, and we are not trying to swindle the system, 
     but it has been a very stressful experience.
       We have been married 28 years, and we have stayed together 
     through so much, but we are not old enough to even think 
     about retirement for a long time so I don't know what we will 
     do.

  These are the forgotten men and women of this healthcare debate--the 
people who are busting it, who don't get subsidized, who can't afford 
insurance coverage because of the faulty architecture of ObamaCare, and 
we are not courageous or honest enough to really address it.
  We did get from HHS a study that they commissioned and they had the 
results in May.
  I would like to put up my next chart here.
  Basically, what they did is they studied the cause, and I have the 
study right here. Basically this is the question they are asking: What 
portion of the increase in premiums is attributable to the effects of 
guaranteed issue and community rating?
  Now I realize those are very popular elements of ObamaCare. The 
problem is, they cause premiums to skyrocket. That last graph--way 
above what they would have been without that architecture--pricing 
people out of the market, forcing American taxpayers to pay far more in 
subsidies than we otherwise would have to do or would be necessary had 
we never passed ObamaCare.
  Well, here is the result of their study. They studied four States: 
Georgia, Ohio, Tennessee, and I can't remember the last one, but I am 
going to focus on Tennessee.
  What this graph shows--I realize it is kind of hard to see--but in 
Tennessee, between 2013 and 2017, premiums increased $327 per month, 
from $104 per month to $431 a month for a 41-year-old male. That is a 
threefold increase, 314 percent. What caused it, 73 to 76 percent was 
increased risk. Again, increased risk is basically defined as the 
guaranteed issue covering preexisting conditions and community rating--
things that are popular but again that cause premiums to double and in 
Janice Fenniman's case, more than tripled.
  One thing I want to point out about that, when you hear that talking 
point, premiums that double and triple, look at the inverse of that. If 
we could roll back the clock, go back 4 years, premiums would be one-
half to one-third of what they are today. People would be able to 
afford coverage, and the American taxpayer would be supporting those 
whom we want to support with a whole lot less dollars.
  Now, the good news, if we were honest, if we were courageous, and if 
we actually addressed the root cause analysis, which has been done, 
which we have largely ignored, the good news is, you can actually cover 
people with high costs and preexisting conditions without collapsing 
insurance markets. They are called high-risk pools or, in the case of 
Maine, invisible high-risk pools. The people in it don't even realize 
they are in it, but it has worked phenomenally well.
  Maine passed guaranteed issues, and just like they did under 
ObamaCare, guaranteed issues caused premiums to skyrocket. You can see 
the premium rate from their old Anthem HealthChoice plan back in 2011. 
Once they supplanted--they didn't even repeal the guaranteed issue, but 
they just supplanted this with an invisible high-risk pool--their 
premiums were cut in half. This is doable. It is possible, but it is 
only possible if we take a look at best practice, if we are willing to 
have the courage to admit exactly what is causing the problem.
  I have two amendments designed to address the increase in premiums. 
First--and I realize this will probably not even be voted on--would be 
a simple one-sentence amendment that would repeal all of ObamaCare, not 
partial repeal, not just two-thirds repeal but repeal that would 
concentrate on removing all of those market reforms. I would call them 
market distortions that cause premiums to skyrocket, that cause people 
like Sheri and Vern Kolby to lose their house. That is my first 
amendment.

[[Page S4250]]

  The second amendment really relates to exactly what ObamaCare was 
originally designed to do, which was put Members of Congress in the 
exact same position of people like Sheri and Vern Kolby.
  Back in July of 2009, November 18, as this was being debated in the 
HELP and the Finance Committee, Senators Coburn and Grassley introduced 
language to those bills that would make Members of Congress have to 
purchase their health insurance plans on any kind of program or the 
State-based exchanges, whatever was passed under the Democrats' 
healthcare plan.
  On December 24, 2009, the Senate passed the Patient Protection and 
Affordable Care Act, an Orwellian-named bill that did neither, that had 
Senator Coburn's basic language from the HELP Committee that was going 
to require Members of Congress to purchase their coverage through the 
exchanges. What was interesting is, it did not include an employer 
contribution. Those were barred.
  On March 24, after the House had passed their version of the Patient 
Protection and Affordable Care Act and the Healthcare Education 
Reconciliation Act, Senator Grassley again offered an amendment to 
allow an employer contribution to Members of Congress and their staffs' 
healthcare plans. That amendment was defeated with 56 Democratic 
Senators defeating it. Three Democratic Senators voted for it, and 
every Republican Senator voted for it, allowing the Federal 
contribution. So Congress specifically said in the Patient Protection 
and Affordable Care Act, Members of Congress and their staffs must 
purchase their healthcare through the State exchanges, and they cannot 
obtain an employer contribution for those plans.
  Let's fast forward to October 2, 2013. Members of Congress and their 
staff panicked. They went running to the Obama White House and said: 
You have to fix this. We know what we passed. We know what the law 
says, but we have to weasel our way around this--and they did. So the 
Office of Personnel Management issued a rule, first of all, that 
Congress was a small business that could purchase their insurance on a 
shop exchange which required a small business, which is defined in the 
law as less than 100 employees--I just want you to know that Congress 
has about 11,000 employees. There is no way this Congress is a small 
employer, but that was the technique that they were able to work their 
way around this law. So right now Members of Congress and staffs are 
the only Americans who get the special treatment of being able to 
purchase insurance on ObamaCare exchanges and get an employer 
contribution.
  Millions of Americans did lose their insurance because of ObamaCare. 
They had to purchase the overpriced insurance policies out of the 
exchanges, but they have no access to employer contributions. So my 
second amendment would put only Members of Congress--I don't think we 
should penalize our staff--but I want to put Members of Congress in the 
exact same position as Sheri and Vern and thousands and maybe tens of 
thousands, maybe hundreds of thousands, maybe millions of Americans who 
are making too much, busting it, working 60 hours a week. Their 
premiums have doubled, sometimes tripled. Coverage is cut in half, and 
they can't afford it. They are taking a risk. Congress is still 
advantaged because we are making more than $59,000. We are making 
$174,000.
  The reason I am offering this amendment--I know it will not be 
popular--is that the only way Congress will have the courage to act is 
if they are affected every bit as much as the American public. I urge 
all of my colleagues to be honest, to be courageous, and to make sure 
they do not exempt themselves from the pain, from the harm, from the 
damage of ObamaCare, so that they will commit themselves to actually 
fixing this problem.
  Those are my first two amendments that have to do with premiums. I 
urge my colleagues to support them. I think that they are good 
amendments and are worthy of support.
  Mr. President, how much time do I have remaining?
  The PRESIDING OFFICER. There are 30 minutes remaining.
  Mr. JOHNSON. Mr. President, let me move on to my second point.
  Again, I come from a State whose Governor showed real courage in 
recognizing that traditional Medicaid was unsustainable and was in 
trouble. The last thing we really should be doing to an unsustainable 
entitlement program is to throw more promises on top of that and make 
it even more unsustainable. I think it is extremely important that we 
recognize that Medicaid expansion is directed toward able-bodied, 
childless, working-age adults. That is, again, funded at a much higher 
level by the Federal Government, at 90 to 100 percent, versus 
traditional Medicaid, which is really targeted to those we want to 
help--children. Forty percent of traditional Medicaid goes toward 
children, the disabled, and the elderly.
  My next amendment is designed to try and make traditional Medicaid 
more sustainable, not by pulling the rug out from anyone but simply by 
limiting further enrollment and allowing Medicaid expansion to phase 
out based on attrition. Let me show you a couple of facts, because we 
hear an awful lot of demagoguery. We hear an awful lot of 
scaremongering. I hear it in Wisconsin, as people who are on 
traditional Medicaid and who are largely unaffected by this bill other 
than in the out years are scared that their traditional Medicaid is 
going to be taken away from them.
  Here are the facts. Back in 2008, the Federal Government spent about 
$200 billion on traditional Medicaid. With the implementation of 
ObamaCare, we began increasing that pretty dramatically with Medicaid 
expansion. Over the next decade or so, we will spend close to $90 
billion per year, on average, on Medicaid expansion--again, targeted 
toward able-bodied, working-age, childless adults. This was the former 
trend line, and this is the current trend line for traditional 
Medicaid.
  Now, you hear about all of this slashing of Medicaid. Here is the 
current baseline. This is what the Senate bill would have done to 
traditional Medicaid and to Medicaid expansion. Yes, you can see some 
relatively significant cuts to Medicaid expansion, but to traditional 
Medicaid, you see, really, not all that much--about $164 billion over 
10 years.
  My amendment would say, without pulling the rug out from anyone: 
Let's end further enrollment in Medicaid expansion, and as that program 
phases out through attrition, let's devote the money that we save to 
traditional Medicaid--supporting and sustaining the elderly, children, 
and the disabled.
  This is what happens to traditional Medicaid under my amendment. 
First of all, this is what happens under the Senate bill. You do not 
see any year in which Medicaid is actually cut. It is always rising. We 
boost it a little bit further and do not increase the deficit by any 
more, under the Senate bill, by doing that.
  My last point is this, and then I will move on and yield the floor. 
This is what I am talking about in terms of dollars. Under current law, 
traditional Medicaid will spend $4 trillion over the next decade and 
Medicaid expansion almost $1 trillion, for a total of $5 trillion 
spending. Under the Senate bill that was originally proposed, original 
Medicaid would have been cut by about $164 billion, which is still 
close to $4 trillion, and Medicaid expansion, obviously, would have 
been reduced by a fair amount.
  Under what I call my sustainability amendment, traditional Medicaid 
would actually increase in spending slightly and not harm anybody--not 
children, not the disabled, not the elderly. Obviously, with Medicaid 
expansion, just by allowing it to phase out through attrition--not 
pulling the rug out from anyone--in the end, you would be spending the 
same amount on the Senate bill. From my standpoint, I think that we 
preserve and sustain Medicaid.
  Again, I urge my colleagues to support all three of my amendments. I 
hope to get a vote. If not a vote, I hope that they are considered if 
this thing goes to a House-Senate conference.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I thank my colleague from Wisconsin, my 
fellow accountant, for doing a good job of accounting there and 
providing some charts that very explicitly show what he has been 
working on, what he has been encouraging people to do, and

[[Page S4251]]

some solutions. That is what we keep looking for within the criticism 
that we are getting from the other side of the aisle--some solutions.
  Earlier this year, Congress took an important first step in 
fulfilling the promise of repealing ObamaCare by passing a budget 
resolution that paved the way for this debate that we are having right 
now and paved the way for some real healthcare reforms that we are 
currently debating. These reforms are focused on rescuing the millions 
of hardworking families who are trapped by ObamaCare's taxes and 
mandates.
  You heard one example from the Senator from Wisconsin of a family who 
is paying excruciatingly high prices for their healthcare only to find 
out that they have $16,000 in deductibles, which makes it very 
difficult to utilize it at all. Is that insurance, if you have to pay 
$16,000 before the rest kicks in?
  What we are doing here is working to stabilize collapsing insurance 
markets that have left millions of Americans with no options. We 
improve the affordability of health insurance. We preserve access to 
care for Americans who have preexisting conditions while we safeguard 
Medicaid for those who need it the most by giving States more 
flexibility. We ensure that those who rely on this program will not 
have the rug pulled out from under them. Most importantly, we liberate 
the American people from the onerous ObamaCare mandates of purchasing 
insurance they do not want and/or cannot afford.
  Additionally, these bills can reduce the Federal deficit, the amount 
the Federal Government overspends each year, by billions of dollars. 
They can also end up saving taxpayers billions more by improving and 
reforming the way Medicaid operates. These aspects of the bill are 
enormously important. This will be the first time in a generation that 
we will have even attempted to rein in any of these programs and put 
them on a sustainable path--the ones that are threatening to bankrupt 
our country--without pulling the rug out from under people, as you saw 
from the charts by the Senator from Wisconsin.
  By reducing spending, lowering the tax burden on hard-working 
families, and curbing our national debt, which now stands at almost $20 
trillion and is on its way rapidly to $29 trillion, we will be ensuring 
a brighter and stable fiscal future for our children and our 
grandchildren. Actually, with that kind of debt, we are almost ensuring 
a brighter and stable future for ourselves. We are in trouble.
  While my colleagues complain about using the reconciliation process 
to untangle the country from this unworkable, unpopular, and 
unaffordable law, they should remember that they actually employed the 
exact same procedure to secure the passage of ObamaCare, without having 
any input or assistance from Republicans, and rushed it through both 
Houses of Congress in less than a week. Senate Republicans are 
responsibly utilizing this reconciliation process to address the 
healthcare crisis that has been thrust upon America by former President 
Obama and congressional Democrats.
  There is also the common misconception that some of my friends across 
the aisle have promoted--the idea that ObamaCare is a runaway success 
and that repeal will be tearing down a functioning program. This is, 
simply, not true. My Democratic colleagues know it is not true. Former 
President Obama knows that it is not true, and the American people, 
certainly, know it is not true.
  Here is the reality. ObamaCare has put our health insurance markets 
on the brink of collapse in many parts of the country. As I pointed out 
in an earlier speech, that began in October of last year, which was 
before the elections. It has nothing to do with what has transpired 
since the elections. ObamaCare put our health insurance markets on the 
brink of collapse in many parts of the country, and what the 
Republicans are tackling now is what President Obama and congressional 
Democrats simply could not bring themselves to do when they had 
control, which was to fix the problems they had created. This may be 
because ObamaCare has enshrined their idea that bigger government is 
better and that any changes, unless done by Executive action under the 
President, were out of the question.
  In their zeal to protect this flawed program, they may have missed it 
when President Obama himself admitted last year that the law had real 
problems.
  He said:

       There are going to be people who are hurt by premium 
     increases or lack of competition and choice.

  He went on to say that these problems are simply called ``growing 
pains.''
  Now, these growing pains have forced millions of Americans across the 
country to grapple with impossibly high health insurance premiums for 
plans they do not want, out-of-reach deductibles to help with common 
prescriptions, and disappearing insurance providers to even be allowed 
to shop for better coverage.
  As I noted earlier, for more and more Americans, there is only a 
single insurer from which they can select health plans, and they may 
soon not have a single ObamaCare insurer, as 50 counties already do not 
have one, and others are threatened. Thousands only have one choice. In 
fact, on the Federal exchanges, one in five consumers will only be able 
to select plans from a single insurer. Many residents across the 
country will have only one choice of health insurer. This includes my 
home State of Wyoming, as well as the entire State of Alaska.
  What does this lack of competition mean? Premiums are surging for 
hard-working families, who now have to choose between unreasonable 
insurance rates or an unreasonable fine. If my colleagues wanted yet 
further evidence that competition lowers prices, they need look no 
further than their constituent mail.
  In Wyoming, some families will be forced to pay more than 30 percent 
of their total income on premiums in order to obtain healthcare 
coverage, which often includes deductibles of over $1,000. One family 
faced premiums of more than $1,600 a month. As an alternative, their 
tax penalty for not carrying coverage was only $1,700 for the year. 
That is a $1,600-a-month premium charge or a $1,700 penalty for not 
covering it for the whole year.
  So guess what they did? They paid the fine because they could not 
afford the insurance premium, let alone the deductible. I think $5.3 
million in fines were collected in Wyoming from the people who could 
not afford the insurance. They took the lesser alternative of paying a 
tax penalty, which gave them nothing.
  For those who are lucky enough to be able to afford insurance, 
particularly in the individual market, under the new health law, 
premiums are expected to increase faster in 2017 than in previous 
years. Some States will see insurance premiums rise by as much as 53 
percent. That is in 1 year. We are talking about a 4-year doubling of 
cost. This will be a 50-percent cost increase in 1 year. That is truly 
a healthcare emergency. Not doing anything and accepting the status quo 
is simply unacceptable to millions of Americans suffering under this 
law.

  Now that we have discussed why we are doing this, it is important to 
also ask how we hope to help these suffering Americans. It is vital 
that we stabilize collapsing insurance markets that have left millions 
of Americans with no options, while reestablishing the affordability of 
health insurance.
  Our bill will also preserve access to care for Americans with 
preexisting conditions, and it will safeguard Medicaid for those who 
need it most by giving States more flexibility, yet ensuring that those 
who rely on this program will not have the rug pulled out from under 
them--contrary to the scare tactics being put forth by ObamaCare's 
defenders.
  Most importantly, Congress is working to free the American people 
from the onerous mandates to purchase insurance they don't want or 
can't afford.
  Congressional Republicans and our President are focused on securing 
the future of Americans' healthcare system and truly understand the 
importance of restoring the trust of hard-working taxpayers.
  What we are doing here under reconciliation, which is a budget 
process, will not solve all the problems. There will be an opportunity 
for bipartisan investigation, support, and changes if the other side is 
willing to do that. There are some things that need to be

[[Page S4252]]

done immediately to protect the American taxpayers and the people who 
want to have healthcare.
  So I ask everyone to focus on securing the future of America's 
healthcare system and to try to understand the importance of restoring 
the trust of hard-working taxpayers.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Toomey). The Senator from Alabama.
  Mr. STRANGE. Mr. President, I ask unanimous consent to speak for up 
to 5 minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. STRANGE. Mr. President, I rise today in defense of those who 
cannot defend themselves. After 8 years of policies that have 
undermined the sanctity of life, we have an opportunity today to extend 
the protections of the Hyde amendment wider than ever before.
  After 8 years of a failed social experiment that subverted the will 
of a majority of Americans and denied rights of conscience and 
religious freedom, we have an opportunity to ensure that taxpayer 
dollars will not contribute to the scourge of abortion under any 
circumstance.
  As we consider options to fix our nation's failing healthcare system, 
partisan lines cut deeper on abortion than on any other issue. However, 
we should all be able to agree that taxpayer funds have no place in 
funding abortions.
  I also hope we can agree that our society cannot be truly prosperous 
until it respects the rights of the most vulnerable among us. If we 
fail to stand for those who cannot stand for themselves, then the words 
of our founding documents, the words inscribed in the halls of this 
building, and the truths we each hold in our hearts mean nothing.
  To that end, I will be offering a motion to waive the point of order 
on Hyde amendment protections as we work to solve our healthcare 
crisis. Today, and every day, I stand for life. I am joined by 
colleagues who understand what is at stake, and I thank Senator Enzi 
for his leadership.
  I yield the floor.
  Mrs. MURRAY. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                       Vote on Amendment No. 271

  The question is on agreeing to the amendment.
  Mr. CORNYN. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  The result was announced--yeas 45, nays 55, as follows:

                      [Rollcall Vote No. 169 Leg.]

                                YEAS--45

     Barrasso
     Blunt
     Boozman
     Burr
     Cassidy
     Cochran
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kennedy
     Lankford
     Lee
     McConnell
     Moran
     Paul
     Perdue
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Strange
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                                NAYS--55

     Alexander
     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Collins
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Heller
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCain
     McCaskill
     Menendez
     Merkley
     Murkowski
     Murphy
     Murray
     Nelson
     Peters
     Portman
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden
  The amendment (No. 271) was rejected.


                        Vote on Motion to Commit

  The PRESIDING OFFICER (Mr. Gardner). The question is on agreeing to 
the Donnelly motion to commit.
  Mr. ENZI. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a second sufficient?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  The result was announced--yeas 48, nays 52, as follows:

                      [Rollcall Vote No. 170 Leg.]

                                YEAS--48

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--52

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heller
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kennedy
     Lankford
     Lee
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Strange
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young
  The motion was rejected.
  The PRESIDING OFFICER. The Senator from Pennsylvania.


                            Motion to Commit

  Mr. CASEY. Mr. President, I have a motion to commit at the desk.
  The PRESIDING OFFICER. The clerk will report the motion.
  The legislative clerk read as follows:

       The Senator from Pennsylvania
       Mr. CASEY moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the American Health Care Act of 2017 that would harm 
     individuals with disabilities as defined in the Americans 
     with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) by 
     reducing their access to affordable health care or limiting 
     coverage or benefits under Medicaid or in the private health 
     insurance market.
  Mr. CASEY. Mr. President, first, I thank my friend from Indiana, 
Senator Donnelly, for his remarks this afternoon and also for his 
efforts to help to protect and preserve Medicaid so that hundreds of 
thousands of people in our States and across the country can continue 
to live in the community.
  I want to point out that today is the 27th anniversary of the signing 
of the Americans with Disabilities Act. This legislation, known as the 
Americans with Disabilities Act, is 27 years old. It is a piece of 
legislation that both recognizes and guarantees the rights of people 
with disabilities. It is, at its heart, a civil rights bill, one that 
promotes and promises liberty and freedom for people with 
disabilities--the liberty and freedom that all Americans are promised, 
that our founding documents guarantee, and that we in the Senate are 
charged with protecting for all citizens.
  We should be celebrating the liberty and freedom of people with 
disabilities, but instead of having a celebration of the Americans with 
Disabilities Act on this anniversary day, the Senate Republican bill--
which, I guess, is basically the House bill that we are on right now--
threatens that freedom and threatens that liberty that was accorded in 
the Americans with Disabilities Act with regard to those with 
disabilities.
  Now, I have heard a lot of speeches on this floor by my Republican 
colleagues about freedom and liberty in the context of healthcare--lots 
of speeches about both of those words. I would argue that, if you 
consider this legislation and the Senate versions of it that came after 
the House bill, all of these Republican healthcare bills were really, 
simply, about decimating Medicaid, limiting community-based care, and 
cutting long-term services and support, which will rob people with 
disabilities of their rights that the Americans with Disabilities Act 
advanced.

[[Page S4253]]

  I think everyone here knows the disabilities story. I will just do a 
quick summary.
  For centuries, people with disabilities have been placed against 
their will in institutions like this one. This is a building in 
Pennsylvania. When it was open and operating, it was known as 
Pennhurst. There were lots of places like this across the country, not 
just in one or two States. These institutions were, in fact, over time, 
warehouses, in which people had few, if any, rights. They were told 
what time to wake up, what time to go to bed, and when to eat. They 
were told they could never leave. That was the basic set of rules they 
lived by when they lived in institutions like that. These were places 
where choice was unknown and where freedom, liberty, and self-
determination were also unknown.
  Over the past 50 years, we have made some improvements--slow 
improvements--with the voices of people with disabilities leading the 
way. Throughout those 50 years, individuals and families have fought 
for their freedom and have worked to create laws that protect their 
freedom.
  For example, the 1973 Rehabilitation Act Amendments and the Americans 
with Disabilities Act affirmed and protected the rights of people with 
disabilities to have access to all of society. The 1999 Olmstead 
Supreme Court decision reaffirmed the right of people with disabilities 
to live where they want to live and to be free of the confines of an 
institution.
  Let's take it from the institution down to the individual--to 
individuals like Jensen, who is pictured right here. People like 
Jensen, who were once forced to live in nursing homes, now live where 
they want to live and pursue their dreams. Yet we know that rights 
alone do not equal freedom and liberty for people with disabilities.
  Medicaid provides the supports that are necessary to live in the 
community and to have that full measure of freedom and that full 
measure of choice. Medicaid protects the hard-won rights of people with 
disabilities to have real choices. Medicaid home-based and community-
based supports mean that people with disabilities can live in their own 
apartments, hold jobs, and contribute to their communities. Medicaid 
makes it possible to use the talents, skills, and knowledge of people 
with disabilities. Medicaid makes their rights a reality.
  Do not take my word for it. Just ask the people who were here today 
in the Gallery, the people who are outside this Chamber and are walking 
the halls of the Senate, walking throughout the buildings, marching, 
demonstrating, and greeting people on the streets, with some of them 
staying overnight at one place to make their voices heard. Ask the 
members of ADAPT. Ask the members of the National Council on 
Independent Living. Ask The Arc's 700 affiliates around the country. 
Ask the folks from Easterseals, the Association of University Centers 
on Disabilities, the Autistic Self Advocacy Network, and on and on and 
on--groups across the country that are telling us with one voice: Do 
not move forward with cuts to Medicaid as have been proposed in each of 
these bills.
  These Americans will tell you that their rights are not real without 
community supports. This bill will drive people back into those 
institutions that I just showed you a picture of.
  In the midst of voting on my amendment--which would basically say: 
Let's go back to the committee of jurisdiction--in this case, the 
Finance Committee--and spend some time to have some hearings, have some 
regular order, which some have called for here, and really consider 
this issue seriously--I know there will be talk that some will reject 
my amendment and will introduce and maybe have a vote on a sense of the 
Senate.
  There is a time and a place for that kind of measure when the Senate 
speaks with one voice on a matter. This is not one of those times. This 
is a time when we have to do more than just have a sense of the Senate. 
We have to be serious about a particular matter of public policy--in 
this case, of making sure that we protect people with disabilities so 
that they have all of the rights and all of the promises fulfilled in 
the Americans with Disabilities Act and other legislation.
  So we are hearing that there might be a sense of the Senate offered 
as a side-by-side to the amendment that I will offer. This is totally 
inadequate in terms of the serious issue that we are here to talk 
about--in this case, protecting people with disabilities. It is a 
totally inadequate response to that. The people with disabilities who 
are in the Gallery, who are in the reception area, or who are back at 
home in congressional districts and States--those folks in each and 
every community around the country--want to ensure that the promise 
that we made to them in the ADA and in other measures will be kept--
that we will keep our promise. If Medicaid community-based services are 
slashed, statements by the Senate will not help very much.
  What will we likely have in front of us in the next couple of hours 
or between today and tomorrow?
  I know it has been described in a lot of ways, if the Republicans 
want to get there. Here is the way I describe it. It is a congressional 
Republican scheme that they are working on to get to repeal--not repeal 
and replace. In this case, it would be repeal and decimate--decimating 
Medicaid, repealing the entire Patient Protection and Affordable Care 
Act.
  Some here will argue that they can support this because this next 
version--this scheme--will not include Medicaid and will likely not 
even include tax cuts for the very wealthy. Cuts to Medicaid have been 
the core part of every House version of healthcare and every Senate 
bill that we have seen so far. They will get to those cuts one way or 
another, and they will also get to the tax cuts for the superrich.
  The bill that we are debating, H.R. 1628, as you know, creates block 
grants in the context of Medicaid. Block-granting, in a sense, may be 
sending to the States a limited amount of money and saying: Good luck 
when you have to balance your budget and pay for Medicaid services. It 
will have per capita caps, which would, again, limit what States can do 
in terms of the dollars they have, or it would just continue to have 
cuts to Medicaid, as every bill has had, the likes of which we have 
never seen--sometimes over $800 billion, sometimes over $700 billion, 
but it is in that neighborhood of hundreds and hundreds of billions of 
dollars of cuts to Medicaid. This next version of the Senate bill will 
do the same.
  When you consider the cuts to Medicaid juxtaposed with the tax breaks 
given to the superrich--really giveaways--there is no other word that I 
can come up with other than ``obscene.'' There are probably other 
words, but that is, I think, a good description of what that is. That 
is one of the reasons that these measures have been so unpopular across 
the board with every income group. Those folks who would get those big 
giveaways--I think most of them would not want them if they knew the 
price of that tax giveaway to someone with a lot of money would be to 
decimate Medicaid.

  So passing this version of the bill--passing a scaled-down scheme--
means that Republicans have not abandoned their Medicaid cuts. They are 
going to get to that as soon as they can. This is simply what we are 
going to see over the next couple of hours--a back door to cutting and 
capping Medicaid--and anyone who believes otherwise is probably 
deceiving themselves.
  What we need are serious policies crafted to ensure long-term 
supports and services that provide and guarantee community-based 
services that promote choice and freedom for people with disabilities. 
This bill doesn't promise freedom or liberty. It doesn't promise the 
choice to live in a community and to be part of a family, like this 
family, where one member of that family has a disability and gets to 
live in a house with other members of the family. That is not possible 
for many Americans without Medicaid.
  For people with disabilities, this bill is anything but a bill that 
would enhance freedom or enhance choice. This bill would, in fact, be 
an anti-freedom bill when it comes to people with disabilities. It is 
not a key to liberty. It is really just a pathway to institutional 
care, where we were years ago and where we have come from, from whence 
we have made progress. It is a return to limited choices, a lack of 
rights, and a place where freedom is not possible.
  In conclusion, let me thank the Members of the Senate who have 
supported

[[Page S4254]]

this motion: Senators Stabenow, Duckworth, Hassan, Van Hollen, Murray, 
Brown, Blumenthal, Carper, Durbin, Kaine, Baldwin, Wyden, Markey, 
Murphy, Harris, Cardin, Warren, Hirono, Reed, Nelson, Klobuchar, 
Warner, Shaheen, Coons, Bennet, King, Menendez, Whitehouse, Leahy, and 
Booker. I want to thank them for joining me in this effort.
  Mr. 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. GRAHAM. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Louisiana.
  Mr. CASSIDY. Mr. President, we are struggling right now to find a 
replacement for the Affordable Care Act. The American people have voted 
in four successive elections for such a replacement, culminating in the 
election of Donald Trump to be President of the United States.
  Now, one can ask oneself, if the Affordable Care Act is so great, why 
would the American people continue to want to have a different program? 
I think the wisdom of the American people is that they do not want the 
government so intrusive in their lives, and secondly, there is a sense 
that somehow the Affordable Care Act is not entirely fair, that perhaps 
there are some who do better under the Affordable Care Act than others. 
Our country is about equity.
  By the way, I am a physician, and for 25 years I have worked in the 
public hospital system of Louisiana trying to get healthcare for those 
who otherwise did not have it. I am all about those who do not have 
insurance or those who are fully insured getting better care. 
Ultimately, to have better care, there has to be adequate financing for 
that care. So we begin to look at the numbers that underlie how the 
Affordable Care Act--ObamaCare, if you will--finances healthcare across 
the Nation. It is very interesting.
  If you look at the numbers from Health and Human Services, three 
States--Massachusetts, California, and New York--get 37 percent of the 
money that ObamaCare spends on Medicaid expansion and health insurance 
access. Three States get 37 percent. And although I don't have an 
accurate depiction of what the demography is, I estimate their 
population to be roughly 18 percent, if that much, of our Nation's 
total population. So they get twice as much, if you will, on a per-
beneficiary basis than the rest of the Nation put together. That is not 
fair. And if we are going to provide access for patients--our fellow 
Americans--to healthcare, ultimately we have to have adequate financial 
resources to do so.
  My colleague Senator Graham will speak in more detail about the 
inequities between the States, but let me just say as a guideline, how 
do we create equity? How do we create fairness so it is not just three 
States that benefit, but wherever you live, if the Federal taxpayers 
are contributing to your access to insurance, you get about the same 
amount whether you are in Louisiana, Colorado, South Carolina, 
Mississippi, or in California, Massachusetts, or New York? That is 
about equity.
  What we attempt to do--and we are going to submit this as part of the 
Graham-Cassidy amendment--is we attempt to establish fairness for all 
Americans in terms of the support they receive from the Federal 
taxpayer. What we will do, beginning in 2020, is begin to equalize the 
payments between those States receiving very little, those States 
receiving a lot more, and those States that are kind of right where 
they should be. We do this by beginning with a formula that 
acknowledges that the poorer the people, the more support they need; 
the older the person, the higher their medical expenses. So between 
poverty and age, it is a good starting point about how to divide those 
dollars. Between 2020 and 2026, we will actually gradually move those 
high-cost States down, those lower cost States up, and keep those just-
about-right States just about right, until at the end, wherever that 
American lives, she or he is getting about the same amount as every 
other patient receiving support across the country.
  When we say this--I am a physician. I know that if you have more 
disease burden in one State, that is a costlier population. If your 
average age is greater in one State, that is another aspect of a 
costlier population. We can go through those sorts of factors. So we do 
put wiggle room at the end, so that if a State is higher cost because 
they have more disease, they would get a little bit more money. But on 
the whole, if you net it out, wherever that American lives, she or he 
would get about the same amount of money.
  Senator Graham will go over this in more detail, but it turns out 
that the average American receiving benefits under the Affordable Care 
Act--if you combine Medicaid expansion and the tax credits people 
receive, the average credit is somewhere in the mid-$6,000 range; call 
it $6,400, $6,500. But if you look at what some States receive, in 
Massachusetts, it is about $18,000 per person. Now, that is a lot of 
money. So if the average is $6,600 and in one State it is $18,000, that 
is not fair.
  Now, I would submit that if we equalize that treatment; if we just 
treat people fairly; if no matter where you live, the amount you get is 
not dependent upon the State in which you live but upon your need, then 
we can actually provide access. We can fulfill President Trump's 
campaign pledges of continuing coverage, caring for those with 
preexisting conditions, lowering premiums--lowering premiums--and 
eliminating mandates.
  By the way, it isn't just Republican-represented States that would 
benefit. We can look at West Virginia. These are some preliminary 
numbers. West Virginia would receive in 2020 about 43 percent more than 
they would based upon current trajectories. Indiana would receive about 
48 percent more. Let's look at Montana. Montana would receive about--my 
gosh--Montana would receive over 100 percent more than they are 
currently scheduled to receive.
  This takes the money that has already been allocated, and instead of 
focusing it on three States--there are a few more; call it seven, but 
those are the States that really bring it home--if, instead of all of 
this Federal largess going to three States, we distribute it fairly, 
all Americans can do better. All Americans can do better.
  Ultimately, we should be about fairness in this Chamber, not about 
partisan politics.
  I thank the Chair for the privilege of addressing this issue, and I 
now defer to my colleague from South Carolina.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. GRAHAM. Mr. President, let me just tell my colleagues where I am 
coming from.
  Under the current system--ObamaCare as we know it--the money to help 
people buy insurance and the money for Medicaid expansion, those two 
pools of money--here is what happens under ObamaCare: California is 
21.39 percent of all the money, and they are 12.15 percent of the 
population. Maryland gets 2.35 percent of the money, and they are 1.86 
percent of the population. Massachusetts gets 6.67 percent of all the 
money, and they are 2.11 percent. New York gets 8.62 percent, and they 
are 6.11 percent. That is a lot of math for a guy who didn't do well in 
math. So 39 percent of all the money goes to four States that represent 
22 percent of the population. I like these people. They are all good 
Americans. I just don't like them that much. The bottom line is, the 
rest of us--46 States--get 60 percent to divide up among ourselves. How 
can that be?
  Senator Cassidy explained that the current system is weighted to the 
benefit of four States at the expense of the rest of us. I would like 
to fix that, and if you don't live in one of those States, you will 
want to fix it too.
  What I want to do is take the money that we are spending under 
ObamaCare and block grant it back to the States so that we can level 
out the disparity in funding but go even further and allow people in 
each State to develop healthcare systems that meet the needs of that 
State.
  If you are for single-payer healthcare, you will hate this idea 
because that will be the end of single-payer healthcare because the 
money and the power will leave Washington and it will go back to people 
where they live. It will be healthcare closest to the patient. So if 
you believe that

[[Page S4255]]

government is better--closer to the voter, closer to the people--if the 
idea of government close to the people is a good idea, I would argue 
that healthcare closer to the patient is a good idea.
  I regret we didn't think of this sooner.
  What Senator Cassidy said is that our goal is to make sure that no 
matter in what State you live, you are going to get X amount of 
dollars, and it is going to be fairly equal no matter where you live. 
If you live in a State with a unique disease problem or an aged State, 
you will get a little bit more because you will need a little bit more.
  The model we have today is really disproportionate. It doesn't work. 
It is driving up healthcare costs all over the country. People are 
dropping coverage because the ObamaCare mandates are too expensive.
  So what we are doing is we are leaving the taxes on the wealthy in 
place. To my conservative friends, I am sorry, but that is what we are 
going to have to do to make this work. We eliminate the medical device 
tax because that hurts innovation. We eliminate the individual employer 
mandate because that stifles the whole idea of having creativity at the 
State level. We leave the taxes on the wealthier Americans in place. We 
are able to take that money, plus money we would give to insurance 
companies to stabilize the national market, and block grant it back to 
the States with a formula that is fairer.
  Let me tell my colleagues what that would look like. Let me drill 
down to what two States do, by the way. California and Massachusetts by 
themselves are 28 percent of all ObamaCare money and 14 percent of the 
population.
  Let's look at Alabama. Beginning in 2020, you are going to get 200 
percent more. How can that be? It is where you start from. The people 
in Alabama are going to get a lot more money because when you look at 
the money coming through the ObamaCare system to the good people of 
Alabama and how we spend per patient, you are way behind. You are going 
to get a lot of money to catch up with what should be the national 
average.
  Our friends in California are going to get a 38-percent reduction, 
but we are going to give you time to adjust for that. There is going to 
be a wind-down period. It is not going to happen overnight. There will 
be a fund that can help you if you can prove you have a unique 
population of people who are sicker and older.
  To my good friend from Colorado, you get 42 percent more. How can 
that be? Under ObamaCare, the money that was going to these four States 
gets a little higher percentage if you block grant. Not only will you 
get 42 percent more money than ObamaCare would give the good people of 
Colorado, you actually get a chance to spend the money unique to the 
needs of Colorado.
  Let's go to Oklahoma, since we have a guy from Oklahoma here whom we 
like a lot. You get 200 percent. Congratulations. Why do you get 200 
percent? You are starting way behind everybody else. The bottom line 
is, we want to catch you up beginning in 2020. We are going to have to 
take away from some other people because they are hoggish.
  New York, California, we want to help you transition, but the rest of 
us are not going to sit on the sidelines anymore and watch you take 
most of the money. We are going to begin to level this out.
  Where is South Carolina? I have a unique interest in that State. How 
did we do? We get 123 percent. That shows you where we start from.
  In about 6 years, we are all going to meet. It is going to take 6 or 
7 years to level this all out, and we are going to get more. Other 
States are going to get a little bit less. The ones that are about 
where they need to be will get about the same.
  The big benefit for all of us is, the people in your backyard get to 
make decisions about healthcare rather than a Washington bureaucrat 
whom you will never meet. The big thing about this to me is, you have a 
voice now as a consumer.
  Right now, if you don't like your healthcare under ObamaCare, whom do 
you complain to? Do you complain to your Congressman? I guess your 
Senator. At the end of the day, most of ObamaCare is administered by 
the Federal Government through a bureaucracy. We don't manage 
healthcare in the Senate.
  Under this construct, the same amount of money is going to go back to 
your backyard, and you will get a better deal if you are starting on 
the tail end of this now. If you don't like what is going on in your 
State, you can actually complain to somebody whom you vote for in the 
statehouse. You can go to your State capital and complain to your 
Governor.
  The likelihood that the person you are complaining to goes to the 
same hospital as you and your family goes up. Wouldn't it be nice to be 
able to complain to somebody who is in the same boat you are who goes 
to the same healthcare network because they live in your neighborhood?
  To me, the most innovative thing we could do in healthcare in America 
is allow people in their own backyard to design healthcare systems that 
meet the unique needs of that State and give consumers a voice that 
really can be heard because, under this model, your statehouse and your 
Governor are going to have a lot of flexibility. They can't spend it on 
roads and bridges. They have to spend it on healthcare.
  If they get really efficient, the savings they will accrue stays in 
that State to even do more for healthcare so you will have a race for 
efficiency rather than just a race to write bigger and bigger checks.
  The big benefit to me is, if you are a healthcare consumer, you will 
finally have somebody you know you can talk to about what works and 
what doesn't.
  We are about to talk about how we end this debate. I hope this idea 
will be looked at by not just Republicans but Democrats. If you are 
from West Virginia--our good friend Joe Manchin--West Virginia gets 43 
percent more dollars under the block grant than they would ObamaCare. 
West Virginia gets to determine how to spend that money more under the 
block grant than they would under ObamaCare. You can't spend it on 
roads and bridges, but you have to spend it on healthcare.
  There are three things we are trying to achieve. We are not going to 
let four States take most of the money, a disproportionate share of the 
money. Over time, we are going to create a system--no matter where you 
live--you are going to get roughly the same amount of money from the 
Federal Government, but the money comes in a bock grant so the people 
in that State can use it without being dictated to by a Washington 
bureaucrat as long as it is on healthcare. The biggest thing we give 
you is a chance to have a voice about your healthcare because the 
people in charge of your healthcare will be in your own backyard, not 
in Washington, somebody who doesn't know you, you will never get to 
meet, and quite frankly doesn't understand your world.
  I hope we can rally around this. These are not 100 percent done 
numbers. Generally speaking, this is pretty accurate. It came from the 
Labor-HHS people. It may change a little bit, but when you start the 
debate with four States getting 40 percent of the money, clearly most 
of us are going to get more. When you see these big numbers like our 
friends in Oklahoma and Montana, the reason you are getting so much 
more now is that the current system leaves you behind in an unfair way.
  My goal is, if you live in Oklahoma, New York, and California, the 
Federal Government is going to provide healthcare resources as equal as 
possible, but those resources will be managed by people in the State, 
not bureaucrats in Washington.
  I hope over the coming day and a half that maybe we can rally around 
an idea that we should have started with to begin with. I don't mind 
being generous when it comes to putting money on the table to make sure 
people can afford healthcare. The tradeoff is as follows. We leave most 
of the ObamaCare taxes in place because we need a funding stream to 
level out the inequities. We are going to have a tax cut bill later. I 
want a flatter tax, a smaller corporate tax, and lower individual 
taxes, but this revenue stream coming from wealthy Americans is going 
to be used in a different fashion. It is going to provide resources to 
States that they can manage, unlike ObamaCare where one-size-fits-all.

[[Page S4256]]

  To me, this is a tradeoff. To the people in West Virginia, I am not 
asking you to take less and have a tax cut for rich people. We are 
going to keep the wealthy taxes in place. I am asking the people of 
West Virginia to take 43 percent more money. It is not a trick. Use it 
wisely.
  Thank you all. I hope over the next day we can inform you about how 
your State benefits. To those States who are going to have to ramp 
down, the only reason you are ramping down is you are taking so much 
more from the rest of us. Quite frankly, that is not fair. We want to 
be fair to you and give you a chance to adjust, but the rest of us 
should stand up and say it is not fair that an American in California 
or New York or Massachusetts--all fine States--gets 40 percent of the 
money. That is not right.
  It is not right to have a one-size-fits-all healthcare system because 
you will not get the best product. The best product will come from 
innovation. Your strongest voice will come from having a say to people 
who live in your same community, talking to a politician who sends 
their kids to the same hospital you do. That is what this is all about.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mr. Lee). Time will be equally charged to both 
sides.
  The Senator from Oklahoma.
  Mr. INHOFE. Mr. President, I ask unanimous consent that I be 
recognized in morning business for as much time as I shall consume.
  The PRESIDING OFFICER. Is there objection?
  Mr. INHOFE. Mr. President, there seems to be some confusion. I will 
take whatever time you designate is left. I wanted to talk longer.
  The things the Senator from South Carolina was talking about are 
pretty amazing. I look at my State of Oklahoma. Did you know our 
premiums in the State of Oklahoma under ObamaCare have tripled? They 
have gone up 201 percent.
  When you look and you see the options that are out there, what really 
disturbs me--I understand one big difference between Democrats and 
Republicans is Democrats are disciplined, Republicans aren't, so they 
are all voting against any kind of a change. I guess they all love 
ObamaCare.
  I can assure you, though, if you look at the charts the Senator from 
South Carolina was showing, you would wonder why in the world they 
would all be gathering around when they would dramatically benefit by 
taking one of the alternatives to ObamaCare.
  I didn't come down to talk about that, but I have to say, from a 
State where our premiums have gone up--tripled--you stop and you ask: 
What is this going to look like when we get the new bill done?
  We don't know exactly what it is going to look like. It is going to 
have the individual mandates done away with. It is going to have the 
taxes reduced. It is going to have block grants going to the States.
  Look at my State of Oklahoma. That will increase the amount of money 
that will be coming in, with less taxes, by 200 percent. I dare say, 
there are a lot of Democrats who would find that in the same situation.
  One last note about that, as I go back and I work around the State, I 
find there are a lot of people who are saying: I don't like this 
alternative.
  I would only say, not just in Oklahoma but anywhere in the Nation, if 
you oppose what is going to be the alternative, what you are saying is, 
you would rather have ObamaCare.


                  Commending Attorney General Sessions

  Mr. President, actually, I came to the floor for a different reason. 
It is probably the most awkward situation I have been in before. Since 
they cut me down to 8\1/2\ minutes, I will have to come back to the 
floor and embellish a little bit more. I am in an awkward situation. 
First of all, I believe that we have a President in President Trump who 
is doing a great job.
  I look around and I see what is happening to us. We are now a leader 
in the free world again. All kinds of things have happened that are 
very good. Yet I have to say the Attorney General, Jeff Sessions, if I 
could single out three people in the U.S. Senate whom I respect more, 
he would be among those.
  I am fortunate enough to have known him since the middle eighties, 
back during the Reagan administration. I knew him very well when he was 
elected the first time in 1996. Here is a guy who is an outstanding 
guy, who does things, gets things done. Look at his accomplishments as 
Attorney General. In that short period of time, what he has done is, he 
has been working to crack down on immigration. He has performed some 
real miracles there, and he has worked on protecting law enforcement. 
In fact, a law enforcement group came out and singled him out as the 
most prominent and most popular Attorney General we have had.
  Look what he has done in his time, what he has introduced. Child 
abuse--he did the Child Abuse Act. He did it himself. Nobody else 
helped him. His quote was: ``There is no higher duty than protecting 
our Nation's children.'' The Prison Rape Elimination Act, the first 
Federal law dealing with sexual assault on prisoners. A lot of those 
are young prisoners. We all know the stories. He is the guy who passed 
that, and nobody else was in on that deal--just him. Forensic sciences, 
he has been able to be a champion there.
  I would have to say that the major thing he did during the time in 
his early years was that he was the one who was standing up against 
segregation. He was the one who single-handedly put himself in a 
situation where he was taking on the bad guys, and he was desegregating 
the schools in Alabama. He was key to the prosecution of the Klansmen 
for abducting and killing a Black teenager. We all remember that. Who 
was that? Who did that? That was Jeff Sessions. So he gets things done. 
He was the one who was responsible for bankrupting the Klan in his 
State of Alabama. Here is a guy who has the sensitivity. I have never 
known a person I could respect more. That is what bothers me.

  I think we have a President who is doing a good job, and the only 
area where I disagree with him--he has this fight going with Jeff 
Sessions.
  Let me just say this: There is no one I hold in higher regard. He is 
about the most knowledgeable person, compassionate person, and 
honorable person we could have in that job.
  When there is more time on the schedule, I will come back and 
elaborate a little bit more on my hero Jeff Sessions and how he ought 
to remain in that office and do a great job for the United States.
  With that, I will comply with the request and yield my time.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that Senator Enzi or 
his designee be recognized to offer the Heller amendment No. 288 and 
that the time until 6:10 p.m. be equally divided in the usual form on 
the Casey motion to commit and the Heller amendment. I further ask that 
at 6:10 p.m., the Senate vote in relation to the Casey motion, followed 
by a vote in relation to the Heller amendment, with 2 minutes of debate 
equally divided in the usual form between the votes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Delaware.
  Mr. ENZI addressed the Chair.
  Mr. CARPER. I am happy to yield.
  The PRESIDING OFFICER. The Senator from Wyoming.


                 Amendment No. 288 to Amendment No. 267

  Mr. ENZI. Mr. President, I call up the Heller amendment No. 288.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Wyoming [Mr. Enzi], for Mr. Heller, 
     proposes an amendment numbered 288 to amendment No. 267.

  Mr. ENZI. Mr. President, I ask unanimous consent that the reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To express the sense of the Senate that Medicaid expansion is 
            a priority and that Obamacare must be improved)

       At the appropriate place, insert the following:

     SEC. ___. SENSE OF THE SENATE.

       It is the Sense of the Senate that--
       (1) the committee of jurisdiction of the Senate--
       (A) should review the issue of Medicaid expansion and 
     coverage for low-income Americans, and the incentives such 
     expansion provides States for certain services;

[[Page S4257]]

       (B) should consider legislation that provides incentives 
     for States to prioritize Medicaid services for individuals 
     who have the greatest medical need, including individuals 
     with disabilities;
       (C) should not consider legislation that reduces or 
     eliminates benefits or coverage for individuals who are 
     currently eligible for Medicaid;
       (D) should not consider legislation that prevents or 
     discourages a State from expanding its Medicaid program to 
     include groups or individuals or types of services that are 
     operational under current law; and
       (E) should not consider legislation that shifts costs to 
     States to cover such care;
       (2) Obamacare should be repealed because it increases 
     health care costs, limits patient choice of health plans and 
     doctors, forces Americans to buy insurance that they do not 
     want, cannot afford, or may not be able to access, and 
     increases taxes on middle class families, which is evidenced 
     by the facts that--
       (A) premiums for health plans offered on the Federal 
     Exchange have doubled on average over the last 4 years, and 
     those increases are projected to continue;
       (B) 70 percent of counties have only a few options for 
     Obamacare insurance in 2017, and at least 40 counties are 
     expected to have zero insurers planning on their Exchange for 
     2018;
       (C) 2,300,000 Americans on the Exchange are projected to 
     have only one insurer to choose from for plan year 2018; and
       (D) the Joint Committee on Taxation has identified 
     significant and widespread tax increases on individuals 
     earning less than $200,000; and
       (3) Obamacare should be replaced with patient-centered 
     legislation that--
       (A) provides access to quality, affordable private health 
     care coverage for Americans and their families by increasing 
     competition, State flexibility, and individual choice; and
       (B) strengthens Medicaid and empowers States through 
     increased flexibility to best meet the needs of each State's 
     population.

  Mr. ENZI. I thank the Senator for yielding.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. I was happy to yield. Good to see you.
  Mr. President, I want to say a few words about ObamaCare. If you ask 
most people in this country ``What is ObamaCare?'' my guess is, they 
probably wouldn't know. Those who do might think it has something to do 
with the exchanges that would allow people to have coverage who don't 
have coverage on their own. They are not in a large group plan and they 
are not insured by their employer. They are not covered by Medicaid. 
They are not covered by Medicare. Maybe they are not a veteran. And 5 
or 6 or 7 percent of the people today get their coverage from something 
called the exchanges.
  We have large purchasing pools in each State that are insured by 
private health insurance. That was not invented by Barack Obama. People 
call it ObamaCare, but its roots go back well before he was a U.S. 
Senator, much less before he was President of the United States. The 
idea of these large purchasing pools in each State--called exchanges--
goes back to, as far as I can tell, 1993, when the new First Lady, 
Hillary Clinton, was offering to begin work to find a way to do what I 
think every President since Harry Truman has tried to do, and that is 
three things: provide better coverage for people in this country, do so 
at less cost, and cover everybody. I believe that has been the goal of 
every President since Harry Truman.
  When Lyndon Johnson was President, some notable progress was made 
with the introduction of Medicare and Medicaid. But there were still a 
lot of people who, in 1993--in fact, in 2003 and 2008 and 2009--who 
didn't have healthcare coverage in this country, tens of millions of 
people.
  In 1993, when Hillary Clinton worked on what was called--in some 
cases derisively--HillaryCare, she and others said to Republicans: 
Well, where is your idea? What is your idea? At least we have an idea. 
The Republicans apparently turned to the Heritage Foundation and said: 
Help us come up with an alternative. And Heritage did. The alternative 
they came up with was a market-based approach to providing coverage for 
people. The idea was that in every State across the country, something 
called an exchange or marketplace would be created, which is really a 
large purchasing pool for people who don't have coverage.
  So the idea of the exchanges originally suggested by Hillary were 
introduced in the U.S. Senate by a Republican Senator from Rhode Island 
named John Chafee, who was a very good man, a marine veteran, a former 
Governor, and a greatly admired U.S. Senator. He offered legislation to 
do five things. As far as I can tell, all ideas were suggested by the 
Heritage Foundation.
  No. 1, create purchasing pools in every State. People who didn't have 
coverage could buy their coverage as a member of a much larger 
purchasing pool, and by doing that, bring down the cost of coverage.
  The second thing in the Chafee legislation in 1993 was to allow folks 
who bought their coverage through the exchanges to be eligible for a 
slight tax credit--the lower their income, the bigger the tax credit. 
When their income reached a certain level, the tax credit would go 
away.
  The third component of the Chafee proposal--again, going back to 
Heritage--was the idea of individual mandates. You can't make people 
get coverage, but in the case of the Chafee legislation, provide for a 
monetary fine for people who failed to get coverage. Over time, the 
amount of that fine would go up. The idea was to make sure that 
younger, healthier people would get healthcare coverage, and they would 
sign up for coverage in the exchanges. That way, the insurance 
companies would have a healthy mix of people to insure. Otherwise, 
people would wait until they were really sick--they need to go see a 
doctor, go to the hospital, or have an operation--to get their 
coverage, and then the health insurance companies would be left with a 
tough mix of people to insure. Financially, that would be very 
challenging for health insurance companies. They said: We need 
something to ensure that young, healthy people get their coverage 
through the exchanges.
  The fourth piece of the 1993 legislation offered by Senator Chafee 
said that employers of a certain size, with a certain number of 
employees, have to cover their employees. You don't have to cover them 
100 percent for their insurance and their family's insurance, but they 
have to be covered with insurance and have access to health insurance 
through their employer.
  The fifth and last piece of ObamaCare, which is really the Heritage 
Foundation's idea, was a prohibition against health insurance companies 
saying to people who have a preexisting condition--they had to cover 
people with preexisting conditions in these exchanges.
  That is what people think of and call ObamaCare.
  Barack Obama is a bright guy. I knew him before he was a U.S. 
Senator. I knew him when he was a State senator. He didn't invent it. 
It was not made up in his head. The source of those ideas was 
originally the Heritage Foundation. I actually think they are good 
ideas. I thought they were good ideas then, and I think they are good 
ideas now.
  Somewhere between 1993 and 2009, when we debated on this floor the 
Affordable Care Act--including exchanges, tax credits, the individual 
mandate, the employer mandate, a prohibition against insurance 
companies not covering people with preexisting conditions--somewhere 
between 1993 and the debate here in 2009 on the Affordable Care Act, a 
Governor of Massachusetts said: Why don't we try to be the first State 
to provide healthcare coverage for everybody? And they took that Chafee 
legislation--the Heritage Foundation idea--dusted it off, and turned it 
into RomneyCare. It actually worked pretty well. They sure covered a 
whole lot of people in that State who hadn't been covered before. They 
covered a lot of people who were not eligible for Medicaid, not 
eligible for Medicare, maybe not a veteran. They were not receiving 
coverage from a large group plan, so they now had an option to get 
coverage in the exchanges.
  For those who chose not to in Massachusetts, they had to pay a fine. 
As it turns out, it was not a very big fine, and it went up over time 
but not quickly and not very high. So did some people who were young 
and healthy get coverage in the exchanges in Massachusetts? Yes. If you 
asked some of the people who were involved with Governor Romney at that 
time, they would say that if they had to do it over again, the fine 
would have started a little bigger and gone up a little faster in order 
to make sure healthier, insurable people got into the exchanges for 
their coverage.
  Well, in 2009, we were here on this floor and debating what some 
people

[[Page S4258]]

still call ObamaCare, but it is something else. It is really 
RomneyCare. It is really ChafeeCare. It is really HeritageCare. But it 
ain't ObamaCare. It is a market-based idea to get coverage for people. 
I think it happens to be a good idea.
  Right now, this administration has done their dead level best to 
destabilize the exchanges. They made it a question of whether the 
individual mandates will be enforced. If young, healthy people decline 
to sign up for coverage, will there be a fine they would have to pay? 
Will it go up over time? This administration has thrown big doubt on 
that. As a result, a lot of young people haven't signed up. They are 
not sure they really need to.
  We had something in place for a couple of years called CRAs, cost-
sharing arrangements. Think, if you will, about people who are buying 
their healthcare coverage on the exchanges. Their income is under 250 
percent of poverty. For several years now, they have been able to get 
help paying down their copays and their deductibles when they get their 
coverage on the exchanges.
  What this administration has sought to do is throw doubt on whether 
those cost-sharing arrangements will continue. What has happened as a 
result is the health insurance companies, which lost their shirts in 
2014, raised premiums, deductibles, and copays. They lost money again 
in 2015, but less. They raised premiums, deductibles, and copays, and 
lost money in 2016, but less. Some of them even actually made some 
money. They were not in a death spiral. According to Standard and 
Poor's, they were actually coming to a stronger financial position.
  Enter into that this administration throwing doubt on whether the 
exchange are going to be around, the individual mandate is going to be 
enforced, these cost-sharing reductions are going to continue to be 
offered. That is why a lot of the health insurance companies in this 
country decided they are going to get out in different States. They are 
not going to offer coverage in a number of States, a number of 
counties. That is why. Businesses need certainty and they need 
predictability, and that includes health insurance costs. Frankly, they 
didn't have that certainty and predictability.
  If we are smart about it, we will hit the ``pause'' button and maybe, 
before we do anything else, provide the certainty and the stability in 
the exchanges that are needed. And for the health insurance companies, 
make sure they will offer coverage without having to fear that they 
will be back in 2014 and lose their shirts again. That is not why they 
are in business.
  There are three things that need to be done in order to stabilize the 
exchanges.
  The first thing that needs to be done is the individual mandate, 
which we have by law. It says: If you don't have healthcare coverage, 
get your coverage on the exchange. If you choose not to, you have to 
pay a fine. Over time, that fine goes up.
  We need to preserve something that works like the individual 
mandate--maybe, ideally, the individual mandate as it is, and if we 
can't get the votes for that, then something that works at least as 
well as the individual mandate in making sure people--healthy people 
too--get their coverage on the exchanges if they are eligible.
  The second thing we ought to do is reinsurance. Senator Kaine, 
myself, and others, including some recovering Governors who serve here 
in the Senate, have cosponsored legislation that we have described as 
reinsurance. I am told it has been around forever in the insurance 
business, and it is one of the reasons the Medicare Part D drug program 
is successful and works.
  The way it works, quite simply, is this: Say an individual who has 
serious medical problems gets their coverage in the exchanges. They 
first start in 2018. In 2018, 2019, and 2020, for a person who has 
significant health challenges and is expensive to insure, the first 
$50,000 of their cost to the insurer in a year would be borne by the 
insurer. Between $50,000 and $500,000 for one individual for one year, 
the Federal Government would pay 80 percent of that. It is reinsurance.
  For anything over that in those 3 years, 2018 through 2020, the first 
3 years, anything between $50 and $500,000, the Federal Government 
would pay 80 percent.
  Starting in 2021 and beyond, the reinsurance program would continue, 
but it would be a little bit different. In 2021 and beyond, the first 
$100,000 of costs incurred by an individual covered by a policy in the 
exchange--the first $100,000 would be on the insurance company. They 
would have the liability. Anything between $100,000 and $500,000 in one 
year for that individual, 80 percent of that cost would be borne by the 
Federal Government. Anything above $500,000 from 2021 and beyond would 
be borne, again, by the insurance company. It is called reinsurance.
  The last piece of the three is to make it clear that these cost-
sharing reductions are reduced and make sure that the copays and the 
deductibles will continue to be subsidized by the Federal Government. 
It will reduce the out-of-pocket costs for people whose income is below 
250 percent of poverty.
  If we do those three things, the insurance companies tell us we will 
stabilize the exchanges. They will have a healthy group of people to 
insure. More insurance companies will come in to provide coverage in 
States and in counties. More insurance companies providing policies and 
coverage leads to competition. The competition leads to better quality 
coverage, and the competition leads to lower prices--lower prices for 
individuals who are getting their coverage in the exchanges and lower 
prices, we are told, for Uncle Sam. The Federal Government, the costs 
to the Treasury, will be reduced, as well, if we do these three things.
  Again, we are told by the health insurance companies that have been 
reluctant to stay in the exchanges, if we do those three things, we 
would reduce the cost of premiums in the exchanges by 25 to 35 percent. 
That helps individuals get their coverage, and it helps the government, 
too, in reducing our exposure. I think that makes a lot of sense.
  Unfortunately, what our colleagues here on the floor are talking 
about doing--and the rumors we hear about some kind of skinny repeal--
certainly, it doesn't stabilize the exchanges. It does more to 
destabilize the exchanges. That isn't where we need to go.
  We need to hit the pause button and say: Let's stabilize the 
exchanges, and then let's revert to regular order. People have ideas on 
health insurance. Let's introduce bills. Let's have hearings with 
witnesses who come in and say what is good or what is bad. The 
witnesses could include Governors, health insurance folks, providers, 
normal people.
  Let's have a debate. Let Members offer amendments in committee, have 
votes, report the bills out, and eventually bring them here and go 
through the same thing. We call that regular order. John McCain, in his 
return speech yesterday--thank God he is back--called again and again 
for return to regular order. We need to do that, and if we do, we will 
end up not with a Democratic victory or a Republican victory or a Trump 
victory, we might win a victory for democracy and actually doing what 
is right and what needs to be done. That, most of all, is what we need 
to do.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Ms. HASSAN. Mr. President, I rise today in support of Senator Casey's 
motion to strike provisions from TrumpCare that would harm individuals 
with disabilities by reducing their access to affordable healthcare or 
limiting coverage or benefits under Medicaid or in the private health 
insurance market.
  Today, as Senator Casey noted, we celebrate the 27th anniversary of 
the Americans with Disabilities Act, recognizing the enormous 
contributions that Americans who experience disabilities have made in 
communities in New Hampshire and across our Nation.
  Unfortunately, Senate Republicans are proposing massive cuts to 
traditional Medicaid, which threaten the support that individuals who 
experience disabilities need to thrive in their homes, their schools, 
and their communities.
  A few weeks ago, I visited an organization called Granite State 
Independent Living in Concord, NH. It is a nonprofit that helps 
individuals with disabilities of all ages to try to have an independent 
life for themselves. What struck me the most was the consistent theme 
that I heard over and over from

[[Page S4259]]

different people who experience different disabilities. They said that 
because of services like personal care attendants, transportation help, 
and other medical supports, they were able to work and live more 
independent lives.
  Many shared their biggest fears about what would happen if they 
didn't receive the support--a real possibility if plans to decimate 
Medicaid go into effect. Their biggest fear is that independence would 
go away. There were fears of becoming a burden for their families or 
having family members have to give up their jobs or having to be put in 
a nursing home because that would be the only way they could survive.
  Person after person talked about how much they wanted to contribute 
to American life--to their communities, to their States, and to our 
economy. I kept thinking that all of these people were expressing such 
an American value with their desires to roll up their sleeves, do 
everything they could to make a difference, to be self-sufficient, to 
be independent.
  The ability for Americans who experience disabilities to reach their 
full potential is truly put at risk with some of these TrumpCare 
proposals, and just a little while ago on the floor, I heard a 
discussion that perhaps there might be a proposal put forward on the 
floor--maybe this evening--that would record a sense of the Senate that 
the Senate wants to make sure that whatever action it takes will not 
hurt people with disabilities. It will support people with 
disabilities.
  There is no doubt that a kind word can go a long way on a difficult 
day, but as someone who has raised a child who has experienced severe 
disabilities, as someone who has spent a lot of time talking to people 
with disabilities and their families, I can tell you that sympathy and 
empathy only go so far.
  The people I know who experience disabilities want to do everything 
they can to support themselves, to be independent, to be able to reach 
their full potential. There is a difference between charity and 
justice, and while none of us would ever reject the kindness that so 
many people demonstrate to people with disabilities, what we really 
should be working toward is making sure people with disabilities have 
the same access to healthcare, to education, to the workforce that will 
allow them to have what every American wants, which is an independent 
life where they are free to chart their own course, support themselves, 
move forward.
  We celebrate the 27th anniversary of the Americans with Disabilities 
Act today--one of our great moments in this country, as we have 
reminded ourselves of our Founders' vision. Our Founders said that 
every single person counts, and while they didn't honor that principle 
perfectly at our founding, while they did not count everyone at first, 
they have had the confidence that every generation of Americans would 
move forward, bringing in more and more people from the margins into 
the heart and soul of our democracy, our communities, our economy, and, 
in doing that, we would unleash the talent and energy of more and more 
Americans. It is that talent and energy that has been the secret of our 
country's success. It is our vision that continues to drive us forward.
  On this day of all days, when we celebrate the progress we have made 
to honor the freedom, strength, and productivity of Americans who 
experience disabilities, the last thing we should do is pull the rug 
out from under those very people by decimating the Medicaid Program 
that provides them the kind of support that actually allows them to be 
free, to work hard, to be with their families, to make a difference, to 
be treated like every other American, to have the rights of every other 
American, and to feel like every other American.
  We can't afford to go back to the days when we marginalized or didn't 
assist some of our most vulnerable people--people who want to 
participate and contribute to their communities and to the country they 
love. So I urge my colleagues to vote in favor of Senator Casey's 
motion and make clear that individuals with disabilities deserve the 
right to receive the support they need at home, at school, and in their 
communities, so they can be free and thrive.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, I have listened very carefully to the 
majority leader and his requests that we come forward and bring 
amendments to the floor--all of our ideas about how we can improve our 
healthcare system so that this would be an opportunity through budget 
reconciliation for us to deal with those issues.
  I asked my staff to prepare amendments in order to protect the 
Medicaid system from cuts. I asked my staff to prepare amendments to 
protect the essential health benefits that are in the Affordable Care 
Act because it is important that we preserve those benefits, whether it 
is mental health and addiction services or one that is particularly 
important to Maryland; that is, pediatric dental. In Maryland, we all 
recall the loss of a 12-year-old not too many years ago because he 
couldn't get dental care--Deamonte Driver.
  I asked my staff to take a look at preparing amendments to protect 
minority health and health disparities because the Affordable Care Act 
made tremendous advancements in trying to close that gap on the 
disparities in minority health and health disparities. I asked my staff 
to take a look at the tax provisions because we want to make sure that 
we are not giving tax cuts to wealthy people at the expense of cutting 
the Medicaid system. I asked them to look at this in a lot of different 
ways.
  Listening to the majority leader, I also have introduced legislation 
that I will talk about that could build on the Affordable Care Act, and 
I was wondering what bill I should amend? What is the bill that we are 
considering? It is not the bill that Senator McConnell brought forward 
because that bill was defeated. It is not the repeal--and we are 
starting with a blank slate--because that was defeated. I don't believe 
it is the House bill because that has been discredited, called a mean 
bill by the President, as well as by Members of this body, who said it 
has no chance of passing. So my dilemma is that I don't know what I 
should be amending.
  I expect we will get to see another bill somewhere along the process 
with virtually no notice and no opportunity to read and no opportunity 
to amend, but the majority leader says I am going to have that 
opportunity. Yet we don't know what the bill is that I am supposed to 
be addressing my amendments to.
  We know that all the bills we have seen today--every single one from 
the Republicans--have been scored by the Congressional Budget Office as 
to tens of millions of Americans losing their insurance coverage--tens 
of millions. I understand it is about 33 million if we just repeal the 
Affordable Care Act, 22 million if we use the type of replacement that 
the majority leader was suggesting. All of those move in the wrong 
direction.
  We also know that in every one of these proposals to date, insurance 
premiums are going to go up, not down.
  That is one thing I have heard from my constituents. They would like 
to see us bring down the growth rate of health insurance costs and 
healthcare, not increase it. So, yes, I would like to be able to offer 
amendments, but I don't know what to offer amendments to.
  I also am concerned when I see that every one of the bills that have 
been suggested by the Republicans would reverse the protections that we 
put in law against the wrong practices--the discriminatory practices--
of insurance companies. I have talked to many of my constituents who 
tell me that if we reimpose caps, either yearly or lifetime--they have 
the circumstance where their child was born with a disability and that 
cap would have been expended within a matter of months--they would be 
left without insurance coverage. They tell me about how preexisting 
conditions could be jeopardized. All of us have some form of 
preexisting condition, and, on a lot of these plans that are being 
suggested where you could choose the type of coverage you want, 
insurance companies are not going to offer the benefits you need. 
People who have challenges are going to be most discriminated against. 
So I don't quite understand how I can offer amendments and we could 
have a vote on the floor when we don't know what we are trying to 
amend.

[[Page S4260]]

  I must state that there is a common theme here, and we know it. We 
know that there is now talk that the majority leader might bring up, 
sometime during this process, what has been called in the press a 
``skinny'' bill. I call it a slow death of the Affordable Care Act, 
and, in fact, I am afraid it might be a fast death of the Affordable 
Care Act because, if the reports are accurate, one of the provisions 
that the majority leader is looking to bring in as the final bill that 
we would vote on would eliminate the requirement that companies have to 
provide insurance coverage to their employees and individuals must have 
coverage.
  Now that seems innocent enough, except for the tens of millions who 
are going to lose their insurance coverage--people who are working for 
companies that decide to terminate their policies, healthy people who 
decide not to buy insurance policies. I believe you are going to find 
that there still will be tens of millions of people losing their 
insurance coverage, and that is unacceptable. But it goes beyond that. 
That proposal will also increase premium costs by a very large percent. 
Why?
  Think about this for a moment. If you don't have to buy insurance and 
you are young and healthy, are you going to buy insurance or not? Many 
will say no until they need the insurance, and then they will buy the 
insurance. Actuaries tell us that without the requirement to have 
insurance, the insurance pools will contain a very high percentage of 
adverse risks--people at higher risk--and when that happens, the 
purpose of insurance to spread the risk is no longer done. It means 
premiums will go up dramatically. That doesn't help the people who are 
going to need it.
  What you also find when you eliminate this requirement is that people 
get what we call job locked. They may have a company that provides 
health benefits, but now they may have to leave that company. But if 
they want to leave that company and start a job or go to another job 
that doesn't have insurance, they are locked into where they work. All 
of that adds to anxiety, adds to lack of coverage, adds to people who 
don't have health insurance, adds to people not getting adequate 
healthcare, adds to bankruptcies, adds to the problems that we 
addressed with the Affordable Care Act.
  But there is another explanation here. Maybe this is just a shell 
bill that is going to go back--hopefully, as the Republicans believe, 
but I hope it does not happen--to the House, and then we will put in 
the Medicaid cuts and the tax relief and all the other things that are 
not in the bill. This is just a shell to get us back to one of the 
bills that couldn't get the votes here on the floor, where tens of 
millions of people will lose their insurance coverage, premiums will go 
up, and insurance company arbitrary and discriminatory practices will 
return.
  Every one of these proposals--every single one--moves us in the wrong 
direction in healthcare. We recognize that we can improve our 
healthcare system. I am for improving our healthcare system. I think we 
can work together--Democrats and Republicans--to improve our healthcare 
system.
  So here is my request: Vote for the Casey motion. Why? For two 
reasons. One, I would hope that on this anniversary of the ADA, or the 
Americans with Disabilities Act, we would want to do no harm to those 
with disabilities in our healthcare system and they would have adequate 
coverage. I was in a celebration over the weekend in Baltimore City 
with the disabilities community. We celebrated one of the great 
victories in America, the Americans with Disabilities Act--a bipartisan 
bill, with Democrats and Republicans coming together in a proud moment, 
in the best traditions of the Senate, to say that people with 
disabilities will be treated fairly in America. On this day we should 
adopt the Casey motion on the issue of protecting people with 
disabilities.
  But there is a second issue here.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. CARDIN. Mr. President, I ask unanimous consent to speak for 2 
additional minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CARDIN. I will try to conclude my remarks. On this day that we 
are celebrating the anniversary of the Americans with Disabilities Act, 
let's do right by that. There is a second part to the Casey motion that 
sends it back to committee so we can use the regular process, as 
Senator McCain talked about yesterday. Let's have the committee 
hearings, as Senator Alexander talked about. Let's have the committee 
markups and work together. I introduced legislation that would bring 
down the cost of healthcare and lower the rate of increase of 
individual premiums. I do that by suggesting more competition in the 
individual marketplace, by having a public option, by providing 
stronger subsidies to lower income families, by making sure that cost-
sharing is in fact paid for so we don't have that uncertainty, with the 
reinsurance that Senator Carper was talking about to deal with the 
overall cost of healthcare, by dealing with prescription drug costs, 
and by dealing with coordinated care so that we can deal with the whole 
patient rather than their individual disease.
  All of those issues would improve the Affordable Care Act, but before 
we get there, we have to get off of this train. We have to stop this 
disastrous course. I am going to do everything in my power to make sure 
that, as to the bill we have, whenever it comes forward, we stop it 
right here, and then work together, Democrats and Republicans, to 
improve our healthcare system, not to take away insurance coverage and 
increase costs for so many Americans.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Ms. DUCKWORTH. Mr. President, I rise in support of Senator Casey's 
motion protecting people with disabilities.
  The PRESIDING OFFICER. I am sorry. There is no Democratic time 
remaining.
  The Senator from Nevada.
  Mr. HELLER. Mr. President, I rise today to talk about my amendment, 
Heller amendment No. 288.
  My amendment reinforces the important role Medicaid has played in my 
home State and in the States of many of my colleagues here today.
  Let me explain the impact Medicaid has had on the State of Nevada. As 
many of you know, the State of Nevada was the first to expand Medicaid. 
Before Nevada made that decision, the State's uninsured rate was at 23 
percent, and it was one of the highest in the country. So think about 
that for a minute. One in four Nevadans did not have healthcare 
coverage. Under expanded Medicaid today, Nevadans' uninsured rate is 
between 11 percent and 12 percent. I have also seen the number of 
uninsured people living in Nevada's rural communities cut in half, and 
I have seen major gains with the number of children in our State with 
healthcare coverage.
  In fact, Nevada has seen one of the most significant decreases in 
uninsured children in the country. In 2013, our State had the highest 
rate of uninsured children in the country. We were ranked 50th in the 
nation. Now I can proudly say that Nevada is the most improved State 
when it comes to addressing our rates of uninsured children. Our State 
has made significant progress since the State's decision to expand 
Medicaid, and that has made a big impression on me.
  Over the past few months, I have had the privilege of meeting with 
Nevadans here in Washington, DC, as well as back home, to discuss 
healthcare. The resounding message I continue to hear is that, because 
of Medicaid expansion, more than 200,000 Nevadans have health insurance 
today who otherwise wouldn't. The other resounding message I hear is 
that drastic cuts to the Medicaid Program threaten the critical 
services that Nevadans rely on.
  Let me read you a letter I received from a woman in Las Vegas. She 
said:

       My oldest child has Down Syndrome and has depended on 
     Medicaid since the day she was born, and was denied 
     healthcare because of preexisting conditions that she was 
     born with. My husband and I are hardworking Americans. We 
     started our own business 5 years ago and have seen that 
     business grow more and more each year. We do not rely on the 
     government for assistance, other than Medicaid coverage. 
     Without it, we would be unable to afford the numerous 
     appointments with specialists and surgeries that keep our 
     daughter happy, healthy, and progressing in life.


[[Page S4261]]


  This is one example of the real stories behind the numbers, and I 
want to do everything I can to make sure they are protected and their 
coverage is not threatened. I want to make sure their daughter has 
healthcare coverage today and tomorrow.
  Medicaid also plays a crucial role in Nevada when it comes to 
covering the elderly and people with disabilities. More than 30,000 of 
Nevada's seniors receive healthcare through Medicaid, including nursing 
home care and services that help them live at home. In fact, more than 
half of Nevada's nursing home residents are covered by Medicaid. Nearly 
50,000 people with disabilities in Nevada now have access to care that 
helps them live independently, thanks to Medicaid.
  Karen from Henderson recently contacted me and said that her adult 
son has MS and depends on Medicaid to help cover the cost of his 
medication, which costs $300 per month. Without Medicaid, he can't 
afford it.
  One Nevadan traveled all the way from Las Vegas to talk with me about 
her two sons with cystic fibrosis. She is worried about any legislation 
that would jeopardize access to care for people with serious, chronic 
illnesses, such as the ones her sons are struggling with.
  In total, over 631,000 people in Nevada are covered by the Medicaid 
Program. That is low-income children, pregnant women, seniors, and 
people with disabilities. It is why I have said since the beginning of 
the healthcare debate, that I will only support a solution that 
protects Nevada's most vulnerable. The House bill didn't go far enough 
to do that, and neither did the Senate's bill, and that is why I voted 
against it last night.
  Nevada faces unique challenges when it comes to healthcare. I have 
spent the past few months trying to find ways to protect Nevadans who 
depend on Medicaid and provide coverage for those with preexisting 
conditions, all the while bringing down costs and improving quality and 
access to care. I have also been having discussions with Nevadans in 
Washington and back home to hear from them how potential changes could 
impact their care.
  Whether it is a mom in Reno who has a son with a heart condition and 
is terrified about the future of his treatments or the nurses from Las 
Vegas who came all the way to DC because they are worried that their 
patients could lose coverage, I have been listening and I do 
understand.
  Make no mistake, ObamaCare needs fixing. It has led to higher costs 
and fewer choices in my State. For the past 7 years, I have said that 
we need more competition to drive down costs and increase competition 
for Nevadans. My discussions with Nevadans in Washington and back home 
have also allowed me the opportunity to hear from them how potential 
changes could impact their care. I believe we can achieve these goals 
while recognizing the role that Medicaid plays in our States and 
ensuring that those who have coverage today are protected.
  My role as a Senator is doing the very best I can for my State, and 
that means standing up for Nevadans who depend on Medicaid. We are 
having this debate because I do believe there are commonsense solutions 
that can improve our healthcare system, and I voted to give us the 
opportunity to have that discussion and to fight for them. But, as I 
have said all along, healthcare reform cannot be balanced on the backs 
of Nevada's low-income families and sickest individuals. That is 
something I cannot and I will not stand for.
  We can work to find a way to lower costs, increase choices, and 
improve the quality of care for Nevadans everywhere, but we can do it 
in a way that also protects our most vulnerable. That is why for the 
past few months I have been working with my colleagues in the Senate 
who also understand the unique challenges expansion States face, and we 
have been fighting for solutions that will protect those who currently 
rely on the Medicaid Program. It hasn't been easy, but that is the way 
it is supposed to be, and that is OK.
  I am here to roll up my sleeves, get to work, and fight for policies 
that will be in the best interests of all Nevadans. So I encourage my 
colleagues to support this amendment, Heller No. 288, today to 
reiterate the value of Medicaid in our States. We have much work ahead 
of us to do to improve the healthcare system for Nevadans and Americans 
across this country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Ms. DUCKWORTH. Mr. President, I speak in support of Senator Casey's 
motion protecting people with disabilities.
  It is appalling that the Republican Party is working to strip 
healthcare from the disability community on the very anniversary of the 
day when we passed monumental legislation that improved the lives of 
Americans with disabilities.
  It was 27 years ago that the Americans with Disabilities Act--one of 
the most important pieces of legislation of our time--was signed into 
law, and it is a shame that as we celebrate our great achievement for 
equality, we are moving backward rather than building on the progress 
our community has worked so hard on to make it so Americans with 
disabilities can live healthy, productive, independent lives. We cannot 
afford to move backward, and I will not sit quietly by and let that 
happen and neither will my constituents.
  I have heard from thousands of Illinoisans who are struggling to 
understand why lawmakers are considering ripping away the care that is 
keeping them alive and allowing them to be independent and productive 
members of our community. I want to share just one of their stories 
with you.
  It is about a woman by the name of Jessica Baker, from Mascoutah, IL. 
Nearly 10 years ago, when she was a healthy and young 19-year-old, her 
entire life changed. Jessica was driving on the highway on a foggy 
morning. Because of the lack of visibility on the road, a truckdriver 
ahead of her ran through two cars. Jessica, just feet behind the truck, 
never saw the brake light go off. She struck that semi-truck and became 
part of a 20-car pileup. This young, healthy woman's life completely 
changed in an instant.
  Jessica is now 29 years old and is a quadriplegic. She depends on 
Medicaid for her healthcare needs. She is living an independent life 
and has done well under the ACA. Now she fears she will lose her care 
that the law has helped her to receive. Jessica was a healthy, vital 
person whose life changed in an instant.
  I understand how that feels. I went from being a soldier--one of the 
most physically fit people among my peers--to becoming wheelchair 
bound. So many of our brave men and women take that risk every single 
day, and we must be completely honest with ourselves as any American's 
life can change in the blink of an eye. The healthy can become sick, 
and the able-bodied can become disabled in a single moment. Any one of 
us can end up at the mercy of our healthcare system.
  After her accident, Jessica had to fight for her life and relearn how 
to live as a thriving young person. Now Senate Republicans and 
President Trump are threatening her life by eliminating her access to 
care. As proud as I am to be a part of the Senate Chamber, which passed 
the monumental ADA, I am also appalled by what the Republicans in this 
body are doing today.
  Yesterday's vote to proceed on a debate on a bill that would rob tens 
of millions of their health insurance is utterly shameful. It would 
jeopardize a program that 1 in 10 veterans, 2 out of 3 nursing home 
residents, and children with autism, Down syndrome, and special needs 
depend on. That is simply unacceptable. Senate Republicans have done 
everything they can to hide their legislation from the American people, 
crafting it in secret, behind closed doors. However, one thing remains 
clear; that the fight to protect healthcare is not over.
  This is the time for the American people to keep speaking up, to make 
their voices heard, and Senate Republicans must listen. They must 
listen to their constituents and to the most vulnerable among us, like 
the members of the disability community who have been here day after 
day, literally, fighting for their lives. Day after day, I see people 
who come into my office who say: Save me. Save my child. Save our 
lives.
  That is why I am working every single day to not only push back 
against these Republican efforts to strip away care from those who need 
it the most

[[Page S4262]]

but also to bring people together on commonsense improvements to our 
current healthcare system. We cannot be a nation that says: If you are 
sick or ill, we are going to leave you behind. That is simply not who 
we are. We are the greatest democracy on the face of the Earth, and we 
do not leave our most vulnerable behind.
  Thank you.
  The PRESIDING OFFICER (Mr. Tillis). The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I know the Chair said I may speak for a few 
minutes before the vote. I spoke earlier so I will not reiterate every 
argument.
  Really, what we are doing with this particular amendment is sending 
this legislation to the Finance Committee so as to focus it as the 
motion itself says: When this bill would be recommitted to the Finance 
Committee, the Finance Committee could examine it from the perspective, 
in this case, of people with disabilities and to focus on changes that 
could be made in order to prevent harm to individuals with disabilities 
as defined in the Americans with Disabilities Act of 1990.
  The reason we mention that particularly is that is the seminal piece 
of legislation to protect people with disabilities who would be harmed 
by this legislation because you cannot just have rights that are 
guaranteed without the support for those rights. Medicaid provides that 
support so folks, if they want to live at home or if they want to live 
in a community-based setting, can do that, but they can only do that 
with the help of Medicaid. It is a pretty simple amendment to make sure 
there is some adequate review of the impact on Americans with 
disabilities.
  We have, in Pennsylvania, for example, over 720,000 people who have a 
disability and depend upon Medicaid. I want to make sure every one of 
those Pennsylvanians has all of the protections we say we are 
guaranteeing with disability legislation--with laws like the Americans 
with Disabilities Act and with the protections Medicaid provides.
  This is critically important. At a time when we are talking about 
freedom and liberty in the context of healthcare, I would hope we would 
take steps to guarantee that freedom and liberty apply to those with 
disabilities so that as the Americans with Disabilities Act has 
enshrined in our law, they may be able to choose the kind of places 
they want to live and choose the settings within which they want to 
live their lives, to be able to have the freedom to choose that by way 
of the support they can get from Medicaid. I hope that is something 
that is reasonable enough so as to get support from both sides of the 
aisle.
  I know my friend from Nevada is offering a sense of the Senate in the 
next vote. I just do not think that a sense of the Senate, in any way, 
is commensurate with the gravity of this problem. There is a time and a 
place for a sense of the Senate--when we are expressing a sentiment 
that is bipartisan--but we need more than sentimentality here. We need 
more than good wishes. We need to make sure we get this policy right as 
it relates to people with disabilities.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. All time has expired.


                        Vote on Motion to Commit

  The question occurs on agreeing to the Casey motion to commit.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Wisconsin (Mr. Johnson).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 48, nays 51, as follows:

                      [Rollcall Vote No. 171 Leg.]

                                YEAS--48

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--51

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heller
     Hoeven
     Inhofe
     Isakson
     Kennedy
     Lankford
     Lee
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Strange
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                             NOT VOTING--1

       
     Johnson
       
  The motion was rejected.


                           Amendment No. 288

  The PRESIDING OFFICER. There is now 2 minutes equally divided before 
the vote on the Heller amendment.
  The Senator from Nevada.
  Mr. HELLER. Mr. President, I have an amendment at the desk that would 
express the importance of Medicaid in our individual States. I would 
like to read from it two provisions that I think are important to this 
whole body; that is, the Senate prioritizes ``Medicaid services for 
individuals who have the greatest medical need, including individuals 
with disabilities;'' also, that we ``should not consider legislation 
that reduces or eliminates benefits or coverage for individuals who are 
currently eligible for Medicaid.''
  That is the amendment. I want everyone to express for their own 
States how important the Medicaid Program is for their States, and I 
would urge a ``yes'' vote from my colleagues.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, I raise a point of order that the pending 
amendment violates section 313(b)1(A) of the Congressional Budget Act 
of 1974.
  I am glad that the Senator from Nevada is concerned about Medicaid, 
but I would remind the Senate that yesterday the vast majority of 
Republicans voted to throw 15 million people off of Medicaid on their 
way to end health insurance for 22 million Americans.
  Our job as a nation is to guarantee healthcare to every man, woman, 
and child and join the rest of the industrialized world, not throw 
disabled children off of the healthcare they currently have.
  I urge a ``no'' vote.
  Mr. President, I raise a point of order that the pending amendment 
violates section 313(b)1(A) of the Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. HELLER. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974 and the waiver provisions of 
applicable budget resolutions, I move to waive all applicable sections 
of that act and applicable budget resolutions for purposes of amendment 
No. 288 and, if adopted, for the provisions of the adopted amendment 
included in any subsequent amendment to H.R. 1628 and any amendment 
between Houses or conference report thereon, and I ask for the yeas and 
nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  The yeas and nays resulted--yeas 10, nays 90, as follows:

                      [Rollcall Vote No. 172 Leg.]

                                YEAS--10

     Capito
     Cassidy
     Collins
     Enzi
     Gardner
     Heller
     McCain
     Murkowski
     Portman
     Sullivan

                                NAYS--90

     Alexander
     Baldwin
     Barrasso
     Bennet
     Blumenthal
     Blunt
     Booker
     Boozman
     Brown
     Burr
     Cantwell
     Cardin
     Carper
     Casey
     Cochran
     Coons
     Corker
     Cornyn
     Cortez Masto
     Cotton
     Crapo
     Cruz
     Daines
     Donnelly
     Duckworth
     Durbin
     Ernst
     Feinstein
     Fischer
     Flake

[[Page S4263]]


     Franken
     Gillibrand
     Graham
     Grassley
     Harris
     Hassan
     Hatch
     Heinrich
     Heitkamp
     Hirono
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kaine
     Kennedy
     King
     Klobuchar
     Lankford
     Leahy
     Lee
     Manchin
     Markey
     McCaskill
     McConnell
     Menendez
     Merkley
     Moran
     Murphy
     Murray
     Nelson
     Paul
     Perdue
     Peters
     Reed
     Risch
     Roberts
     Rounds
     Rubio
     Sanders
     Sasse
     Schatz
     Schumer
     Scott
     Shaheen
     Shelby
     Stabenow
     Strange
     Tester
     Thune
     Tillis
     Toomey
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wicker
     Wyden
     Young
  The PRESIDING OFFICER (Mrs. Ernst). On this vote, the yeas are 10, 
the nays are 90.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The point of order is sustained and the amendment falls.
  The PRESIDING OFFICER. The majority leader.


          Amendment No. 340, as Modified, to Amendment No. 267

  Mr. McConnell. Madam President, I call up amendment No. 340, as 
modified.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Kentucky [Mr. McConnell], for Mr. Daines, 
     proposes an amendment numbered 340, as modified, to amendment 
     No. 267.

  Mr. McCONNELL. I ask unanimous consent that the reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment, as modified, is as follows:

 (Purpose: To provide for comprehensive health insurance coverage for 
  all United States residents, improved health care delivery, and for 
                            other purposes)

       Strike all after the first word and, insert the following:

     SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Expanded & 
     Improved Medicare For All Act''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.

                   TITLE I--ELIGIBILITY AND BENEFITS

Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.

                           TITLE II--FINANCES

                   Subtitle A--Budgeting and Payments

Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and 
              medically necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.

                          Subtitle B--Funding

Sec. 211. Overview: funding the Medicare For All Program.
Sec. 212. Appropriations for existing programs.

                       TITLE III--ADMINISTRATION

Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced 
              clerical workers.
Sec. 304. Confidential electronic patient record system.
Sec. 305. National Board of Universal Quality and Access.

                    TITLE IV--ADDITIONAL PROVISIONS

Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.

                        TITLE V--EFFECTIVE DATE

Sec. 501. Effective date.

     SEC. 2. DEFINITIONS AND TERMS.

       In this Act:
       (1) Medicare for all program; program.--The terms 
     ``Medicare For All Program'' and ``Program'' mean the program 
     of benefits provided under this Act and, unless the context 
     otherwise requires, the Secretary with respect to functions 
     relating to carrying out such program.
       (2) National board of universal quality and access.--The 
     term ``National Board of Universal Quality and Access'' means 
     such Board established under section 305.
       (3) Regional office.--The term ``regional office'' means a 
     regional office established under section 303.
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (5) Director.--The term ``Director'' means, in relation to 
     the Program, the Director appointed under section 301.

                   TITLE I--ELIGIBILITY AND BENEFITS

     SEC. 101. ELIGIBILITY AND REGISTRATION.

       (a) In General.--All individuals residing in the United 
     States (including any territory of the United States) are 
     covered under the Medicare For All Program entitling them to 
     a universal, best quality standard of care. Each such 
     individual shall receive a card with a unique number in the 
     mail. An individual's Social Security number shall not be 
     used for purposes of registration under this section.
       (b) Registration.--Individuals and families shall receive a 
     Medicare For All Program Card in the mail, after filling out 
     a Medicare For All Program application form at a health care 
     provider. Such application form shall be no more than 2 pages 
     long.
       (c) Presumption.--Individuals who present themselves for 
     covered services from a participating provider shall be 
     presumed to be eligible for benefits under this Act, but 
     shall complete an application for benefits in order to 
     receive a Medicare For All Program Card and have payment made 
     for such benefits.
       (d) Residency Criteria.--The Secretary shall promulgate a 
     rule that provides criteria for determining residency for 
     eligibility purposes under the Medicare For All Program.
       (e) Coverage for Visitors.--The Secretary shall promulgate 
     a rule regarding visitors from other countries who seek 
     premeditated non-emergency surgical procedures. Such a rule 
     should facilitate the establishment of country-to-country 
     reimbursement arrangements or self pay arrangements between 
     the visitor and the provider of care.

     SEC. 102. BENEFITS AND PORTABILITY.

       (a) In General.--The health care benefits under this Act 
     cover all medically necessary services, including at least 
     the following:
       (1) Primary care and prevention.
       (2) Approved dietary and nutritional therapies.
       (3) Inpatient care.
       (4) Outpatient care.
       (5) Emergency care.
       (6) Prescription drugs.
       (7) Durable medical equipment.
       (8) Long-term care.
       (9) Palliative care.
       (10) Mental health services.
       (11) The full scope of dental services, services, including 
     periodontics, oral surgery, and endodontics, but not 
     including cosmetic dentistry.
       (12) Substance abuse treatment services.
       (13) Chiropractic services, not including electrical 
     stimulation.
       (14) Basic vision care and vision correction (other than 
     laser vision correction for cosmetic purposes).
       (15) Hearing services, including coverage of hearing aids.
       (16) Podiatric care.
       (b) Portability.--Such benefits are available through any 
     licensed health care clinician anywhere in the United States 
     that is legally qualified to provide the benefits.
       (c) No Cost-Sharing.--No deductibles, copayments, 
     coinsurance, or other cost-sharing shall be imposed with 
     respect to covered benefits.

     SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.

       (a) Requirement To Be Public or Non-Profit.--
       (1) In general.--No institution may be a participating 
     provider unless it is a public or not-for-profit institution. 
     Private physicians, private clinics, and private health care 
     providers shall continue to operate as private entities, but 
     are prohibited from being investor owned.
       (2) Conversion of investor-owned providers.--For-profit 
     providers of care opting to participate shall be required to 
     convert to not-for-profit status.
       (3) Private delivery of care requirement.--For-profit 
     providers of care that convert to non-profit status shall 
     remain privately owned and operated entities.
       (4) Compensation for conversion.--The owners of such for-
     profit providers shall be compensated for reasonable 
     financial losses incurred as a result of the conversion from 
     for-profit to non-profit status.
       (5) Funding.--There are authorized to be appropriated from 
     the Treasury such sums as are necessary to compensate 
     investor-owned providers as provided for under paragraph (3).
       (6) Requirements.--The payments to owners of converting 
     for-profit providers shall occur during a 15-year period, 
     through the sale of U.S. Treasury Bonds. Payment for 
     conversions under paragraph (3) shall not be made for loss of 
     business profits.
       (7) Mechanism for conversion process.--The Secretary shall 
     promulgate a rule to provide a mechanism to further the 
     timely, efficient, and feasible conversion of for-profit 
     providers of care.
       (b) Quality Standards.--
       (1) In general.--Health care delivery facilities must meet 
     State quality and licensing guidelines as a condition of 
     participation under such program, including guidelines 
     regarding safe staffing and quality of care.
       (2) Licensure requirements.--Participating clinicians must 
     be licensed in their State of practice and meet the quality 
     standards for their area of care. No clinician whose license 
     is under suspension or who is

[[Page S4264]]

     under disciplinary action in any State may be a participating 
     provider.
       (c) Participation of Health Maintenance Organizations.--
       (1) In general.--Non-profit health maintenance 
     organizations that deliver care in their own facilities and 
     employ clinicians on a salaried basis may participate in the 
     program and receive global budgets or capitation payments as 
     specified in section 202.
       (2) Exclusion of certain health maintenance 
     organizations.--Other health maintenance organizations which 
     principally contract to pay for services delivered by non-
     employees shall be classified as insurance plans. Such 
     organizations shall not be participating providers, and are 
     subject to the regulations promulgated by reason of section 
     104(a) (relating to prohibition against duplicating 
     coverage).
       (d) Freedom of Choice.--Patients shall have free choice of 
     participating physicians and other clinicians, hospitals, and 
     inpatient care facilities.

     SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.

       (a) In General.--It is unlawful for a private health 
     insurer to sell health insurance coverage that duplicates the 
     benefits provided under this Act.
       (b) Construction.--Nothing in this Act shall be construed 
     as prohibiting the sale of health insurance coverage for any 
     additional benefits not covered by this Act, such as for 
     cosmetic surgery or other services and items that are not 
     medically necessary.

                           TITLE II--FINANCES

                   Subtitle A--Budgeting and Payments

     SEC. 201. BUDGETING PROCESS.

       (a) Establishment of Operating Budget and Capital 
     Expenditures Budget.--
       (1) In general.--To carry out this Act there are 
     established on an annual basis consistent with this title--
       (A) an operating budget, including amounts for optimal 
     physician, nurse, and other health care professional 
     staffing;
       (B) a capital expenditures budget;
       (C) reimbursement levels for providers consistent with 
     subtitle B; and
       (D) a health professional education budget, including 
     amounts for the continued funding of resident physician 
     training programs.
       (2) Regional allocation.--After Congress appropriates 
     amounts for the annual budget for the Medicare For All 
     Program, the Director shall provide the regional offices with 
     an annual funding allotment to cover the costs of each 
     region's expenditures. Such allotment shall cover global 
     budgets, reimbursements to clinicians, health professional 
     education, and capital expenditures. Regional offices may 
     receive additional funds from the national program at the 
     discretion of the Director.
       (b) Operating Budget.--The operating budget shall be used 
     for--
       (1) payment for services rendered by physicians and other 
     clinicians;
       (2) global budgets for institutional providers;
       (3) capitation payments for capitated groups; and
       (4) administration of the Program.
       (c) Capital Expenditures Budget.--The capital expenditures 
     budget shall be used for funds needed for--
       (1) the construction or renovation of health facilities; 
     and
       (2) for major equipment purchases.
       (d) Prohibition Against Co-Mingling Operations and Capital 
     Improvement Funds.--It is prohibited to use funds under this 
     Act that are earmarked--
       (1) for operations for capital expenditures; or
       (2) for capital expenditures for operations.

     SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.

       (a) Establishing Global Budgets; Monthly Lump Sum.--
       (1) In general.--The Medicare For All Program, through its 
     regional offices, shall pay each institutional provider of 
     care, including hospitals, nursing homes, community or 
     migrant health centers, home care agencies, or other 
     institutional providers or pre-paid group practices, a 
     monthly lump sum to cover all operating expenses under a 
     global budget.
       (2) Establishment of global budgets.--The global budget of 
     a provider shall be set through negotiations between 
     providers, State directors, and regional directors, but are 
     subject to the approval of the Director. The budget shall be 
     negotiated annually, based on past expenditures, projected 
     changes in levels of services, wages and input, costs, a 
     provider's maximum capacity to provide care, and proposed new 
     and innovative programs.
       (b) Three Payment Options for Physicians and Certain Other 
     Health Professionals.--
       (1) In general.--The Program shall pay physicians, 
     dentists, doctors of osteopathy, pharmacists, psychologists, 
     chiropractors, doctors of optometry, nurse practitioners, 
     nurse midwives, physicians' assistants, and other advanced 
     practice clinicians as licensed and regulated by the States 
     by the following payment methods:
       (A) Fee for service payment under paragraph (2).
       (B) Salaried positions in institutions receiving global 
     budgets under paragraph (3).
       (C) Salaried positions within group practices or non-profit 
     health maintenance organizations receiving capitation 
     payments under paragraph (4).
       (2) Fee for service.--
       (A) In general.--The Program shall negotiate a simplified 
     fee schedule that is fair and optimal with representatives of 
     physicians and other clinicians, after close consultation 
     with the National Board of Universal Quality and Access and 
     regional and State directors. Initially, the current 
     prevailing fees or reimbursement would be the basis for the 
     fee negotiation for all professional services covered under 
     this Act.
       (B) Considerations.--In establishing such schedule, the 
     Director shall take into consideration the following:
       (i) The need for a uniform national standard.
       (ii) The goal of ensuring that physicians, clinicians, 
     pharmacists, and other medical professionals be compensated 
     at a rate which reflects their expertise and the value of 
     their services, regardless of geographic region and past fee 
     schedules.
       (C) State physician practice review boards.--The State 
     director for each State, in consultation with representatives 
     of the physician community of that State, shall establish and 
     appoint a physician practice review board to assure quality, 
     cost effectiveness, and fair reimbursements for physician 
     delivered services.
       (D) Final guidelines.--The Director shall be responsible 
     for promulgating final guidelines to all providers.
       (E) Billing.--Under this Act physicians shall submit bills 
     to the regional director on a simple form, or via computer. 
     Interest shall be paid to providers who are not reimbursed 
     within 30 days of submission.
       (F) No balance billing.--Licensed health care clinicians 
     who accept any payment from the Medicare For All Program may 
     not bill any patient for any covered service.
       (G) Uniform computer electronic billing system.--The 
     Director shall create a uniform computerized electronic 
     billing system, including those areas of the United States 
     where electronic billing is not yet established.
       (3) Salaries within institutions receiving global 
     budgets.--
       (A) In general.--In the case of an institution, such as a 
     hospital, health center, group practice, community and 
     migrant health center, or a home care agency that elects to 
     be paid a monthly global budget for the delivery of health 
     care as well as for education and prevention programs, 
     physicians and other clinicians employed by such institutions 
     shall be reimbursed through a salary included as part of such 
     a budget.
       (B) Salary ranges.--Salary ranges for health care providers 
     shall be determined in the same way as fee schedules under 
     paragraph (2).
       (4) Salaries within capitated groups.--
       (A) In general.--Health maintenance organizations, group 
     practices, and other institutions may elect to be paid 
     capitation payments to cover all outpatient, physician, and 
     medical home care provided to individuals enrolled to receive 
     benefits through the organization or entity.
       (B) Scope.--Such capitation may include the costs of 
     services of licensed physicians and other licensed, 
     independent practitioners provided to inpatients. Other costs 
     of inpatient and institutional care shall be excluded from 
     capitation payments, and shall be covered under institutions' 
     global budgets.
       (C) Prohibition of selective enrollment.--Patients shall be 
     permitted to enroll or disenroll from such organizations or 
     entities without discrimination and with appropriate notice.
       (D) Health maintenance organizations.--Under this Act--
       (i) health maintenance organizations shall be required to 
     reimburse physicians based on a salary; and
       (ii) financial incentives between such organizations and 
     physicians based on utilization are prohibited.

     SEC. 203. PAYMENT FOR LONG-TERM CARE.

       (a) Allotment for Regions.--The Program shall provide for 
     each region a single budgetary allotment to cover a full 
     array of long-term care services under this Act.
       (b) Regional Budgets.--Each region shall provide a global 
     budget to local long-term care providers for the full range 
     of needed services, including in-home, nursing home, and 
     community based care.
       (c) Basis for Budgets.--Budgets for long-term care services 
     under this section shall be based on past expenditures, 
     financial and clinical performance, utilization, and 
     projected changes in service, wages, and other related 
     factors.
       (d) Favoring Non-Institutional Care.--All efforts shall be 
     made under this Act to provide long-term care in a home- or 
     community-based setting, as opposed to institutional care.

     SEC. 204. MENTAL HEALTH SERVICES.

       (a) In General.--The Program shall provide coverage for all 
     medically necessary mental health care on the same basis as 
     the coverage for other conditions. Licensed mental health 
     clinicians shall be paid in the same manner as specified for 
     other health professionals, as provided for in section 
     202(b).
       (b) Favoring Community-Based Care.--The Medicare For All 
     Program shall cover supportive residences, occupational 
     therapy, and ongoing mental health and counseling services 
     outside the hospital for patients with serious mental 
     illness. In all cases the highest quality and most effective 
     care shall be delivered, and, for some individuals, this may 
     mean institutional care.

[[Page S4265]]

  


     SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, MEDICAL 
                   SUPPLIES, AND MEDICALLY NECESSARY ASSISTIVE 
                   EQUIPMENT.

       (a) Negotiated Prices.--The prices to be paid each year 
     under this Act for covered pharmaceuticals, medical supplies, 
     and medically necessary assistive equipment shall be 
     negotiated annually by the Program.
       (b) Prescription Drug Formulary.--
       (1) In general.--The Program shall establish a prescription 
     drug formulary system, which shall encourage best-practices 
     in prescribing and discourage the use of ineffective, 
     dangerous, or excessively costly medications when better 
     alternatives are available.
       (2) Promotion of use of generics.--The formulary shall 
     promote the use of generic medications but allow the use of 
     brand-name and off-formulary medications.
       (3) Formulary updates and petition rights.--The formulary 
     shall be updated frequently and clinicians and patients may 
     petition their region or the Director to add new 
     pharmaceuticals or to remove ineffective or dangerous 
     medications from the formulary.

     SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSEMENT LEVELS.

       Reimbursement levels under this subtitle shall be set after 
     close consultation with regional and State Directors and 
     after the annual meeting of National Board of Universal 
     Quality and Access.

                          Subtitle B--Funding

     SEC. 211. OVERVIEW: FUNDING THE MEDICARE FOR ALL PROGRAM.

       (a) In General.--The Medicare For All Program is to be 
     funded as provided in subsection (c)(1).
       (b) Medicare For All Trust Fund.--There shall be 
     established a Medicare For All Trust Fund in which funds 
     provided under this section are deposited and from which 
     expenditures under this Act are made.
       (c) Funding.--
       (1) In general.--There are appropriated to the Medicare For 
     All Trust Fund amounts sufficient to carry out this Act from 
     the following sources:
       (A) Existing sources of Federal Government revenues for 
     health care.
       (B) Increasing personal income taxes on the top 5 percent 
     income earners.
       (C) Instituting a modest and progressive excise tax on 
     payroll and self-employment income.
       (D) Instituting a modest tax on unearned income.
       (E) Instituting a small tax on stock and bond transactions.
       (2) System savings as a source of financing.--Funding 
     otherwise required for the Program is reduced as a result 
     of--
       (A) vastly reducing paperwork;
       (B) requiring a rational bulk procurement of medications 
     under section 205(a); and
       (C) improved access to preventive health care.
       (3) Additional annual appropriations to medicare for all 
     program.--Additional sums are authorized to be appropriated 
     annually as needed to maintain maximum quality, efficiency, 
     and access under the Program.

     SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.

       Notwithstanding any other provision of law, there are 
     hereby transferred and appropriated to carry out this Act, 
     amounts from the Treasury equivalent to the amounts the 
     Secretary estimates would have been appropriated and expended 
     for Federal public health care programs, including funds that 
     would have been appropriated under the Medicare program under 
     title XVIII of the Social Security Act, under the Medicaid 
     program under title XIX of such Act, and under the Children's 
     Health Insurance Program under title XXI of such Act.

                       TITLE III--ADMINISTRATION

     SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DIRECTOR.

       (a) In General.--Except as otherwise specifically provided, 
     this Act shall be administered by the Secretary through a 
     Director appointed by the Secretary.
       (b) Long-Term Care.--The Director shall appoint a director 
     for long-term care who shall be responsible for 
     administration of this Act and ensuring the availability and 
     accessibility of high quality long-term care services.
       (c) Mental Health.--The Director shall appoint a director 
     for mental health who shall be responsible for administration 
     of this Act and ensuring the availability and accessibility 
     of high quality mental health services.

     SEC. 302. OFFICE OF QUALITY CONTROL.

       The Director shall appoint a director for an Office of 
     Quality Control. Such director shall, after consultation with 
     State and regional directors, provide annual recommendations 
     to Congress, the President, the Secretary, and other Program 
     officials on how to ensure the highest quality health care 
     service delivery. The director of the Office of Quality 
     Control shall conduct an annual review on the adequacy of 
     medically necessary services, and shall make recommendations 
     of any proposed changes to the Congress, the President, the 
     Secretary, and other Medicare For All Program officials.

     SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF 
                   DISPLACED CLERICAL WORKERS.

       (a) Establishment of Medicare For All Program Regional 
     Offices.--The Secretary shall establish and maintain Medicare 
     For All regional offices for the purpose of distributing 
     funds to providers of care. Whenever possible, the Secretary 
     should incorporate pre-existing Medicare infrastructure for 
     this purpose.
       (b) Appointment of Regional and State Directors.--In each 
     such regional office there shall be--
       (1) one regional director appointed by the Director; and
       (2) for each State in the region, a deputy director (in 
     this Act referred to as a ``State Director'') appointed by 
     the governor of that State.
       (c) Regional Office Duties.--Regional offices of the 
     Program shall be responsible for--
       (1) coordinating funding to health care providers and 
     physicians; and
       (2) coordinating billing and reimbursements with physicians 
     and health care providers through a State-based reimbursement 
     system.
       (d) State Director's Duties.--Each State Director shall be 
     responsible for the following duties:
       (1) Providing an annual State health care needs assessment 
     report to the National Board of Universal Quality and Access, 
     and the regional board, after a thorough examination of 
     health needs, in consultation with public health officials, 
     clinicians, patients, and patient advocates.
       (2) Health planning, including oversight of the placement 
     of new hospitals, clinics, and other health care delivery 
     facilities.
       (3) Health planning, including oversight of the purchase 
     and placement of new health equipment to ensure timely access 
     to care and to avoid duplication.
       (4) Submitting global budgets to the regional director.
       (5) Recommending changes in provider reimbursement or 
     payment for delivery of health services in the State.
       (6) Establishing a quality assurance mechanism in the State 
     in order to minimize both under utilization and over 
     utilization and to assure that all providers meet high 
     quality standards.
       (7) Reviewing program disbursements on a quarterly basis 
     and recommending needed adjustments in fee schedules needed 
     to achieve budgetary targets and assure adequate access to 
     needed care.
       (e) First Priority in Retraining and Job Placement; 2 Years 
     of Salary Parity Benefits.--The Program shall provide that 
     clerical, administrative, and billing personnel in insurance 
     companies, doctors offices, hospitals, nursing facilities, 
     and other facilities whose jobs are eliminated due to reduced 
     administration--
       (1) should have first priority in retraining and job 
     placement in the new system; and
       (2) shall be eligible to receive two years of Medicare For 
     All employment transition benefits with each year's benefit 
     equal to salary earned during the last 12 months of 
     employment, but shall not exceed $100,000 per year.
       (f) Establishment of Medicare For All Employment Transition 
     Fund.--The Secretary shall establish a trust fund from which 
     expenditures shall be made to recipients of the benefits 
     allocated in subsection (e).
       (g) Annual Appropriations to Medicare For All Employment 
     Transition Fund.--Sums are authorized to be appropriated 
     annually as needed to fund the Medicare For All Employment 
     Transition Benefits.
       (h) Retention of Right to Unemployment Benefits.--Nothing 
     in this section shall be interpreted as a waiver of Medicare 
     For All Employment Transition benefit recipients' right to 
     receive Federal and State unemployment benefits.

     SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD SYSTEM.

       (a) In General.--The Secretary shall create a standardized, 
     confidential electronic patient record system in accordance 
     with laws and regulations to maintain accurate patient 
     records and to simplify the billing process, thereby reducing 
     medical errors and bureaucracy.
       (b) Patient Option.--Notwithstanding that all billing shall 
     be preformed electronically, patients shall have the option 
     of keeping any portion of their medical records separate from 
     their electronic medical record.

     SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS.

       (a) Establishment.--
       (1) In general.--There is established a National Board of 
     Universal Quality and Access (in this section referred to as 
     the ``Board'') consisting of 15 members appointed by the 
     President, by and with the advice and consent of the Senate.
       (2) Qualifications.--The appointed members of the Board 
     shall include at least one of each of the following:
       (A) Health care professionals.
       (B) Representatives of institutional providers of health 
     care.
       (C) Representatives of health care advocacy groups.
       (D) Representatives of labor unions.
       (E) Citizen patient advocates.
       (3) Terms.--Each member shall be appointed for a term of 6 
     years, except that the President shall stagger the terms of 
     members initially appointed so that the term of no more than 
     3 members expires in any year.
       (4) Prohibition on conflicts of interest.--No member of the 
     Board shall have a financial conflict of interest with the 
     duties before the Board.

[[Page S4266]]

       (b) Duties.--
       (1) In general.--The Board shall meet at least twice per 
     year and shall advise the Secretary and the Director on a 
     regular basis to ensure quality, access, and affordability.
       (2) Specific issues.--The Board shall specifically address 
     the following issues:
       (A) Access to care.
       (B) Quality improvement.
       (C) Efficiency of administration.
       (D) Adequacy of budget and funding.
       (E) Appropriateness of reimbursement levels of physicians 
     and other providers.
       (F) Capital expenditure needs.
       (G) Long-term care.
       (H) Mental health and substance abuse services.
       (I) Staffing levels and working conditions in health care 
     delivery facilities.
       (3) Establishment of universal, best quality standard of 
     care.--The Board shall specifically establish a universal, 
     best quality of standard of care with respect to--
       (A) appropriate staffing levels;
       (B) appropriate medical technology;
       (C) design and scope of work in the health workplace;
       (D) best practices; and
       (E) salary level and working conditions of physicians, 
     clinicians, nurses, other medical professionals, and 
     appropriate support staff.
       (4) Twice-a-year report.--The Board shall report its 
     recommendations twice each year to the Secretary, the 
     Director, Congress, and the President.
       (c) Compensation, etc.--The following provisions of section 
     1805 of the Social Security Act shall apply to the Board in 
     the same manner as they apply to the Medicare Payment 
     Assessment Commission (except that any reference to the 
     Commission or the Comptroller General shall be treated as 
     references to the Board and the Secretary, respectively):
       (1) Subsection (c)(4) (relating to compensation of Board 
     members).
       (2) Subsection (c)(5) (relating to chairman and vice 
     chairman).
       (3) Subsection (c)(6) (relating to meetings).
       (4) Subsection (d) (relating to director and staff; experts 
     and consultants).
       (5) Subsection (e) (relating to powers).

                    TITLE IV--ADDITIONAL PROVISIONS

     SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.

       (a) VA Health Programs.--This Act provides for health 
     programs of the Department of Veterans' Affairs to initially 
     remain independent for the 10-year period that begins on the 
     date of the establishment of the Medicare For All Program. 
     After such 10-year period, the Congress shall reevaluate 
     whether such programs shall remain independent or be 
     integrated into the Medicare For All Program.
       (b) Indian Health Service Programs.--This Act provides for 
     health programs of the Indian Health Service to initially 
     remain independent for the 5-year period that begins on the 
     date of the establishment of the Medicare For All Program, 
     after which such programs shall be integrated into the 
     Medicare For All Program.

     SEC. 402. PUBLIC HEALTH AND PREVENTION.

       It is the intent of this Act that the Program at all times 
     stress the importance of good public health through the 
     prevention of diseases.

     SEC. 403. REDUCTION IN HEALTH DISPARITIES.

       It is the intent of this Act to reduce health disparities 
     by race, ethnicity, income and geographic region, and to 
     provide high quality, cost-effective, culturally appropriate 
     care to all individuals regardless of race, ethnicity, sexual 
     orientation, or language.

                        TITLE V--EFFECTIVE DATE

     SEC. 501. EFFECTIVE DATE.

       Except as otherwise specifically provided, this Act shall 
     take effect on the first day of the first year that begins 
     more than 1 year after the date of the enactment of this Act, 
     and shall apply to items and services furnished on or after 
     such date.

  The PRESIDING OFFICER. The Democratic leader.
  Mr. SCHUMER. Madam President, I rise this evening to announce the 
Democrats will offer no further amendments to the pending legislation 
until the Republican leader shows us what the final legislation will 
be.
  Clearly, the Senate bill--repeal and replace--has failed. Senator 
Paul's bill--repeal without replace--has also failed. We know the 
Republicans are not going to take a final vote on the underlying House 
bill, which is still the pending legislation.
  Now the Republican leadership team has been telling the press about a 
yet-to-be-disclosed final bill. If the reports are true, the 
Republicans will offer a skinny repeal plan.
  We just heard from the nonpartisan Congressional Budget Office that 
under such a plan as reported in the press, 16 million Americans would 
lose their health insurance and millions more would pay a 20-percent--
20-percent--increase in their premiums--at least 20 percent.
  I thank Senator Murray and Senator Wyden for working with CBO so that 
we could figure out what exactly is going on, if this skinny bill is 
the bill that is brought to the floor.
  My Republican friends come to the floor every day to assail the 
problem of high premiums. If the reporting is accurate and skinny 
repeal is their plan, it makes premiums far higher than they are today. 
We don't know if skinny repeal is going to be their final bill, but if 
it is, the CBO says that it would cause costs to go up and millions to 
lose insurance.
  In the meantime, Democrats are not going to continue to try and amend 
the House plan that is already dead. Certainly, we are not going to do 
that while there is some secret legislation--skinny repeal it is 
reported--waiting to emerge from the leader's office.
  The Republican leader has said that this is a robust amendment 
process. No, it isn't--far from it. We don't even know what bill to 
direct our amendments to. Certainly, a process that bypassed the 
committees and public hearings was never an open and transparent 
process. There was never a robust amendment process to this bill, but 
now it has gotten even worse. Since the beginning of this debate, we 
have just been taking votes on amendments to a piece of dead 
legislation.
  What kind of process is this? Anyone who listened, as we all did, so 
intently to Senator McCain's wonderful speech yesterday and applauded 
the sentiment that he mentioned--getting back to regular order and 
proper procedure--anyone who listened to that speech would blush at 
this sham of an amendment process thus far. We don't even have a final 
bill to amend. The idea that this is a robust amendment process, I 
would say to my dear friend the leader, defies credulity. No one 
believes it. I bet not a single person on either side of the aisle 
believes it. So Democrats are not going to participate in this one-
sided and broken process.

  Once the majority leader shows his hand, reveals what his bill will 
actually be, Democrats will use the opportunity to try to amend the 
bill. But we have to see it first, and we ought to see it soon in broad 
daylight, not at the eleventh hour.
  Until we see the real bill, Democrats will offer no further 
amendments.
  Thank you, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. REED. Madam President, let me join the Democratic leader in 
expressing my dismay in what has been going on on the Senate floor with 
respect to healthcare.
  For over 7 years, my colleagues on the other side of the aisle have 
been talking about how they intended to repeal the Affordable Care Act 
in order to replace it with something better and improve our healthcare 
system. President Trump has said time and again that he would provide 
better healthcare at a lower cost. He said that everyone would be 
covered. Yet we have seen no solutions from the other side that would 
accomplish these goals. We have been trying to work with Republicans, 
not just this year but for the last several years to improve our 
healthcare system. In fact, we worked with them to craft the Affordable 
Care Act in the first place, holding public hearings and meetings with 
both Democrats and Republicans around the table. The Affordable Care 
Act included well over 150 Republican amendments. Yet they refused to 
work with us on our final passage of the law and refused to work with 
us on the current law and healthcare ever since.
  However, today we have seen a couple of glimpses of bipartisanship. 
First, the Senate voted last night, both Democrats and Republicans, to 
reject the TrumpCare bill that would have provided tax breaks to 
special interests while decimating Medicaid. I am glad the Senate has 
spoken on that issue and said that we do not support this effort. This 
afternoon, Democrats and Republicans voted to reject a bill that would 
have repealed the Affordable Care Act with no replacement. A majority 
of Senators voted to say that effort was unacceptable.
  Now that we have taken those votes, Senators have had their say on 
what they think is the best path forward, and to me, these votes show 
that most Senators want to work in a bipartisan fashion to improve our 
healthcare system. I have heard many of my colleagues on the other side 
of the aisle say just that, as Senator McCain said so eloquently 
yesterday.
  I think, if my colleagues are willing to sit down and negotiate in 
good faith

[[Page S4267]]

on legislation to improve our healthcare system and bring down costs, 
we could come up with a bill that would get the support of the majority 
of this body. My colleague Senator Shaheen, for example, introduced 
legislation to help stabilize the individual market, something I think 
most of us would agree is an important step forward in improving the 
Affordable Care Act. However, we are now hurdling toward a vote with 
absolutely no plan to improve the healthcare system. My Republican 
colleagues are scrambling to get enough votes just to pass anything at 
all.
  Right now we are debating the bill, but what does that mean when we 
have not yet seen the bill we are eventually going to vote on? This is 
not a meaningful exercise with opportunities to amend and improve 
legislation. We are simply killing time so that the Republican 
leadership can unveil a new bill, if they are able to come up with one, 
that they can convince enough of their Members to support. Hours or 
minutes before final passage this could be sprung upon us, and we would 
then be forced to take a vote. That is not the way the legislative 
process should work.
  What kind of message does this send to our constituents? This is an 
example of legislating at its worst.
  This is why many Americans don't trust Washington to have their 
backs. We don't know what Republicans intend to pass at the end of this 
debate, but we do know that they intend to pass something that is 
harmful. The CBO score, which the Democratic leader suggested, based 
upon the reports of what is pending, suggests significant losses in 
coverage across the country and significant increases in the cost of 
healthcare insurance for Americans. Based on what we have seen so far, 
each proposal would send the healthcare market into a death spiral, 
impacting all of our constituents--not just the Medicaid recipients, 
not just those who are in the exchanges--and even private employers who 
provide insurance coverage for their workers would see increases.

  As I mentioned earlier, the bill we voted on this afternoon would 
repeal the Affordable Care Act with no replacement. In that case, the 
nonpartisan Congressional Budget Office said this would cause 32 
million Americans to lose health insurance over the next decade, 
including 17 million next year alone, and health insurance markets 
would collapse.
  As I indicated, fortunately, that failed, with both Democrats and 
Republicans voting against it, but it looks like Senate Republican 
leadership is still trying to cobble together yet another version, 
taking some of the worst elements of the repeal act. What is worse, 
there will be no opportunity to review the bill, no chance for CBO to 
analyze the bill and provide feedback, no opportunities for 
stakeholders, patients, and States to weigh in.
  It is telling that the only path forward they have for their repeal 
effort is to pass a bill no one has literally read. The only chance 
they have to get support for their effort is to hide, essentially, the 
impact of the bill because on the merits it appears devastating to our 
constituents.
  Nevertheless, as much as they try to hide this bill, the American 
people will find out. They will find out when they get the bill for 
their health insurance. They will find out when they go to their doctor 
and discover the treatment they had last year that was covered under 
the Affordable Care Act is no longer covered. They will find out when 
the only insurance company in their State decides to leave. They will 
find out when their employer says: We are no longer providing 
healthcare to our employees. They will find out when they start a 
family and discover that maternity care is no longer covered and, if 
the child needs medical care early in life, the insurance company can 
say: No, thank you; we don't have to cover the child. There is a 
preexisting condition.
  Just last night I got a call from a woman in Charlestown, RI--Amy. 
She urged me to continue fighting to preserve the Affordable Care Act. 
She is a hairdresser and her husband is a commercial fisherman. Because 
they are both self-employed, they are not able to get coverage through 
work. They have been able to access care through our State's health 
insurance marketplace, HealthSource RI. As Amy said, she and her 
husband are hard-working, middle-income taxpayers, but they never have 
been able to afford coverage without the help of the Affordable Care 
Act. They would not have been able to do that. Amy recently got sick 
and had to be hospitalized. She has coverage because of ObamaCare. She 
was able to get the treatment she needed. Without coverage, she would 
have been left to pay a bill of $78,000. Amy told me that she and her 
husband would have had to sell their house to afford that, and, 
probably even with that, they would have been left impoverished.
  Is that really what my colleagues want for their constituents?
  My constituents know what is at stake. I have heard from thousands 
and thousands of them throughout the year, urging me to keep fighting 
for healthcare, asking me to put an end to this repeal effort. However, 
Democrats cannot do this alone. We need more Republicans like some of 
my colleagues, Senator Collins and Senator Murkowski, to come forward 
and say: Enough is enough. Even if you have problems with the current 
system, let's try to work together to solve the problems. We might not 
always agree, but we will try our best to come to a consensus. There is 
no harm in trying to come up with a bipartisan solution. It is not too 
late to reverse course and return to regular order, to start again, to 
start right, and to do it, as my colleague on the Armed Services 
Committee, Chairman McCain, said, the good old fashioned way, with 
Senator Alexander and Senator Murray on the HELP Committee and my 
colleagues on the Finance Committee working their way through, 
carefully and deliberately, listening, amending, moving forward 
legislation so that we can come to this body not with a few minutes' 
notice but fully prepared to vote on something that is critical to 
every family in the country.
  With that, Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. FRANKEN. Thank you, Madam President.
  Madam President, I rise this evening to speak in opposition to the 
Republican plan to dismantle our healthcare system. Their effort to 
repeal the Affordable Care Act and gut Medicaid would put the health, 
as well as the financial security of millions of Americans, at risk.
  Let me tell you how this would affect Minnesotans such as Annie and 
her 5-year-old son Carter. Carter has autism spectrum disorder and 
relies on Medicaid to help cover necessary therapy services. When 
Carter was 2, he did not talk, make eye contact, or interact with 
anyone. But now, because of the treatment he receives under Medicaid, 
Carter speaks full sentences and is entering kindergarten. Annie 
explains how none of that would be possible without Medicaid. If 
Republicans succeed in imposing drastic cuts to Medicaid, which is what 
they want to do, and States are forced to cut back services, Annie and 
her family would not be able to afford the therapy that Carter needs to 
thrive.
  Think about that. Think about what that does to one life. Think about 
the other millions that would be affected in such a negative, tragic 
way.
  There is also Mari and Chrysann, both from Moorhead, MN. Moorhead is 
in northwestern Minnesota, right across the river from Fargo. Mari took 
care of her aging mother in her home as long as she could, but when 
Chrysann's health began to decline, Mari helped her mom move to a 
nursing home where she could access the higher level of care she 
needed.
  Mari and her husband work full time and still have children at home. 
I visited the nursing home where Mari spoke, and she got emotional when 
she told me that if it were not for Medicaid, her family would not have 
any other way to pay for her mother's care. She does not know how she 
would care for her mom or what would happen to her.
  Chrysann, Mari's mom, is worried too. She spoke at this roundtable at 
the nursing home. She is worried about how the Republican plan will 
affect her own future and those of others who are in similar situations 
in nursing homes. Sixty-four percent of Americans in nursing homes have 
their care paid for by Medicaid. Chrysann told me this

[[Page S4268]]

plan is not about taking care of people but simply about ``survival of 
the fittest.''
  Is that really the healthcare system we support in the United States 
of America--the survival of the fittest?
  How about Chuck? Chuck is the CEO of Perham Health. It is a rural 
hospital that is doing really innovative work in Northwest Minnesota. 
It is kind of central, north. It is in rural Minnesota, not unlike the 
rural areas in the Presiding Officer's State.
  Chuck told me: ``Cutting Medicaid as drastically as they are 
proposing will force us to cut staff in areas that are actually saving 
the system money today.''
  These cuts would affect nurses who run the hospital's medical homes, 
community paramedics, and other staff who are helping to keep people 
out of the Emergency Department, reduce readmissions, and keep people 
healthy overall. This is part of the innovation they are doing there. 
This is part of the innovation that Minnesota leads the Nation in.
  Perham Health is one of the largest employers in town so taking away 
jobs does not just impact the patients and the hospital, it affects the 
community and rural economy. Cutting jobs and getting rid of successful 
reforms just does not make sense, and this would be repeated over and 
over and over again in rural America.
  Again, the question is, Why are Republicans pursuing such a reckless 
and irresponsible strategy?
  All of the bills they have proposed thus far will increase patient 
costs, including premiums and out-of-pocket costs, will increase the 
number of uninsured Americans, and will rip apart our healthcare safety 
net. These are not the changes Americans want. In fact, this is the 
opposite of what Americans want and are asking for.
  Now, over the last day, we have heard a lot more about another path 
Republicans may pursue--a scaled-back plan that eliminates a handful of 
the ACA provisions, including the employer mandate and individual 
mandate. While these two changes may be politically expedient, they 
would, according to the Congressional Budget Office, drive up premiums 
and cause millions of Americans to become uninsured.
  What is more, as the New York Times points out, this plan does 
nothing to address the criticisms Leader McConnell, President Trump, 
and their allies continue to lodge against the Affordable Care Act. For 
example, this approach does nothing to improve competition and choice 
in the individual market and, in fact, injects far more uncertainty 
into individual health insurance markets, which are already rattled by 
the administration's deliberate efforts to sabotage them.
  Should this plan pass the Senate, it will surely get much worse when 
the differences between the plan and the House bill are reconciled in 
the conference committee. According to news reports, a number of my 
Republican colleagues are arguing that passing this scaled-back version 
of repeal is really just a means to get to conference, where Members 
can further negotiate the House and Senate repeal and replace bills. In 
fact, some are even suggesting that the provisions in the House-passed 
bill would be a guidepost for negotiations.
  I think all of us remember how awful, far-reaching, and--according to 
President Trump--mean the House-passed bill is. What is more, we can 
see the worst provisions of the Better Care Reconciliation Act 
resurface in the conference committee, which is the Senate repeal and 
replace bill that was defeated on a bipartisan basis.
  Overall, pursuing this path is dangerous, given the tremendous number 
of unknowns. Not only would this half-baked--that is being generous--
quarter-baked, scaled-back version of the ACA repeal destabilize health 
insurance markets, but it would also serve as a vehicle for Republicans 
to take up the most controversial measures included in the defeated 
BCRA and the House-passed bill.
  Why on Earth would we support that?
  Frankly, it is also delusional to believe that a small group of House 
and Senate leaders can craft a workable solution in a matter of days or 
weeks. They have had 7 years to come up with an alternative. They do 
not have one so how can we expect them to, all of a sudden, come up 
with a viable plan that affects one-sixth of our economy?
  Look, this whole process has been and continues to be irresponsible. 
In fact, this is one of the most irresponsible policymaking processes I 
have seen in my time in the U.S. Senate. What we should do is just what 
Senator McCain called for in his speech yesterday, which is to pursue 
regular order, work together--Republicans and Democrats--and seek out 
compromise. If we reject this wrongheaded effort, then I and many of my 
colleagues are ready and committed to work in a bipartisan way on 
reforms that will expand coverage, lower costs, and improve care.
  Let's have bipartisan hearings on the individual market, on drug 
prices, and more. Let's call in nonpartisan expert witnesses. Let's 
have meaningful committee and floor debates. Let's fix what needs 
fixing in the Affordable Care Act. Annie, Carter, Mari, Chrysann, 
Chuck, and millions of other Americans need us to do just that.
  To my colleagues on the other side of the aisle, please, stand up to 
the bullying, stand up to the lies, and work with us to improve 
people's lives, not make them worse. Paul Wellstone said that politics 
is not about winning, that it is not about power, that it is not about 
money. Politics is about working to improve people's lives, and that is 
what we should be doing. You owe it to your constituents. You owe it to 
yourselves.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.


                             Climate Change

  Mr. WHITEHOUSE. Madam President, something else happened this 
afternoon in Washington that I wish to relate today on the floor, which 
is that the American Enterprise Institute hosted the launch of Senator 
Schatz's and my American Opportunity Carbon Fee Act. I am delighted the 
American Enterprise Institute did that. Their conservative credentials 
are rock solid, but they do not fear debate, and they were 
extraordinarily helpful and open-minded in allowing us to make the 
announcement and in hosting a discussion on the bill that followed.
  Virtually every person on the Republican side who has thought the 
climate change problem through to a solution has come to the same 
place--a revenue-neutral, border-adjustable price on carbon. That means 
that all of the revenues are returned to the American people.
  Former Treasury Secretaries Baker, Shultz, and Paulson--all 
Republicans--former EPA Administrators Ruckelshaus, Thomas, Reilly, and 
Whitman--all Republicans--and leading economists and former 
Presidential economic advisers Arthur Laffer, Gregory Mankiw, and 
Douglas Holtz-Eakin--all Republicans--along with many others, support a 
revenue-neutral, border-adjustable carbon fee. Well, that is what we 
do.
  You all know the phrase ``offering an olive branch.'' Former 
Republican Congressman Bob Inglis described our proposal as an olive 
limb, not a branch, when pairing a carbon tax with corporate tax 
reduction. He said it provides what he called ``an opportunity for 
conservatives to show how free enterprise can solve climate change.''
  When I first came to the Senate in 2007, this place was humming with 
bipartisan action on climate change for years--but, in 2010, a dead 
stop. The Republican Party disappeared from the field after the fossil 
fuel industry secured from five Justices on the Supreme Court the 
infamous Citizens United decision. The fossil fuel industry, as if it 
saw the decision coming, immediately launched a veritable Soviet May 
Day parade of political artillery and rocketry. No special interest had 
that kind of political muscle before Citizens United. The combination 
of this industry political weaponry, plus the proliferation of dark 
money, plus the shady science simulacrum of climate denial has been 
formidable.
  Despite this, there is room for optimism. There are Republicans who 
are willing to work with us. They just need some prospect of safe 
passage through the political kill zone that the fossil fuel industry 
has created.
  Over 1,000 American companies have voiced their support for the Paris 
climate agreement, including corporate powerhouses like Walmart, 
Goldman Sachs, PepsiCo, and Google. If American companies were to 
mobilize in

[[Page S4269]]

Congress just like they did for the Paris Agreement, that would be a 
game-changer.
  But notwithstanding all of that corporate support, the big business 
trade associations and lobbying groups have lined up against action on 
climate change. The so-called U.S. Chamber of Commerce--probably more 
accurately described as the U.S. chamber of carbon--is one of climate 
action's most implacable enemies, despite the good climate policies of 
so many of its member companies. How is it representing its members? It 
is incredible.
  The American Petroleum Institute represents Shell, BP, Total, and 
Exxon--companies that claim to support the Paris Agreement and the 
Climate Leadership Council's carbon fee proposal--but API opposes 
anything getting done.
  We all know here that corporate America commands extraordinary 
attention in our political system. If American corporations aligned 
their political engagement on climate change with their actual position 
on climate change, which should not be asking too much of them, we 
could get going.
  So, in a spirit of hopefulness, Senator Schatz and I reintroduced at 
the American Enterprise Institute our American Opportunity Carbon Fee 
Act, a framework that I hope both Republicans and Democrats can 
embrace. The bill would establish an economy-wide carbon fee on carbon 
dioxide and other greenhouse gas emissions. The fee would be assessed 
where it is easiest to administer, minimizing the compliance burden. 
Other greenhouse gases would be tied to their carbon dioxide 
equivalency with a bumper for fluorocarbons to account for their high 
greenhouse gas potency. Sequestering, utilizing, or encapsulating 
carbon dioxide emissions would earn you a credit. The market would 
begin to work in this space.
  Our bill sets the 2018 fee per ton of carbon emitted at $49--the 
central range of the social cost of carbon last estimated by the Office 
of Management and Budget. That fee would increase each year at a real 2 
percent until emissions fall 80 percent below 2005 levels, and then it 
would follow inflation.
  Border adjustments for energy-intensive goods traded with countries 
that have weaker or no carbon pricing will make sure that we protect 
our industries at home. We took care to design the border adjustments 
in harmony with World Trade Organization rules.
  This carbon fee would produce meaningful reductions in carbon 
emissions. The nonpartisan Resources for the Future projects a 36-
percent drop by 2025, compared to the benchmark year of 2005, exceeding 
the U.S.-Paris Agreement commitment significantly.
  In addition to the environmental value, of course, a carbon fee also 
generates revenue--in this case, nearly $2.1 trillion in revenue over 
10 years. Our plan would return every dime of that to the American 
people. Here is how.
  First, the bill lowers the top corporate income tax rate from 35 
percent to 29 percent--a longstanding goal of Republicans. This would 
cut American corporate taxes by almost $600 billion over the first 
decade.
  Second, it provides workers with a $550 refundable tax credit--$1,100 
for a couple--against payroll taxes. The tax credits, which would grow 
with inflation, would return almost $900 billion to the pocketbooks of 
American households over the first 10 years.
  Third, it would provide a matching benefit to Social Security 
beneficiaries, veterans program beneficiaries, and certain other 
retirees. These benefits would total nearly $500 billion over 10 years.
  Finally, the bill would establish a block grant program, delivering 
the remaining funds to our States--over $100 billion to help workers in 
coal country, for instance, or provide coastal protection for seaside 
States facing terrible threats of sea level rise, at the discretion of 
the State, to meet local needs and concerns.
  I understand the suffering in coal country. Coal country will 
continue to decline as natural gas drives coal out of the energy 
market. There is now no mechanism to remedy that inevitability.
  Remember Huey Long's old slogan, ``Every Man a King''? With a carbon 
fee, we could make every miner a king--a solid pension, retirement at 
any time, full health benefits for life, a cash bonus based on years 
worked, a voucher for a new vehicle, a college plan for their kids. 
These things become doable with carbon fee revenues.
  It is not the miners' fault that the coal industry has collapsed. 
They worked hard. They did dangerous work. It is a rigorous occupation 
to be a coal miner, and they are entitled to respect. Give them their 
dignity. Make them kings. With a small fraction of the revenue from a 
carbon fee, we could assure every single coal miner a lifetime of 
comfort, security, and financial stability.
  Senator Schatz and I extend an open hand, an olive branch. Give 
Senator Schatz and me a Republican to negotiate with. That shouldn't be 
too much to ask. Then let's talk about the economics. Let's talk about 
where the revenue should go. And because I know it is a part of the 
Baker-Schultz-Paulson proposal, let's talk about where we can get fact-
based, scientifically rigorous analytics of which regulations might 
become unnecessary or duplicative of a carbon fee's emission 
reductions.
  Let's restart the bipartisan conversation we had going until 2010.
  Let me close with an appeal to our patriotic sense. America holds 
herself out as an exemplary nation, a ``City on a Hill.'' The tactics 
of climate denial and political menace the fossil fuel industry has 
deployed around here have degraded our city.
  There is a remorseless functioning of the laws of physics, of 
chemistry, and of biology. Deny them all you want, but time will tell. 
And even now, everyone, from our Secretary of Defense to every single 
Senator's home State, State university, understands that climate change 
is real and urgent, is teaching the science of climate change in those 
universities, and is warning of the dire consequences.
  When the Presiding Officer left the Environment and Public Works 
Committee the other day, I was talking about the Leopold Center at Iowa 
State University and the powerful language in which they describe the 
present effects on agriculture of climate change and the danger of 
disruption to the fundamental systems of the planet. That is the home 
State universities telling us what the facts are.
  So one day there will be a reckoning, and the longer our American 
democracy lies incapacitated at the hands of the fossil fuel industry, 
the worse the outcome will be, and the worse the outcome, the greater 
the harm to the country we love that holds its example up to the world.
  We are all extremely fond of John McCain. John McCain returned to the 
Senate yesterday and called our country ``the strong, inspiring, 
inspirational beacon of liberty and defender of dignity of all human 
beings.'' Some beacon, if we continue to get this wrong because of what 
one industry did to our politics, using political menace, dark money, 
and fake science.
  America deserves better than what we are doing in this Chamber on 
this issue.
  I thank the Presiding Officer.
  I yield the floor.
  Mr. TESTER. Madam President, I intend to offer the following motion 
to H.R. 1628 and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators King, Heinrich, Baldwin, 
Bennet, Brown, Cantwell, Carper, Coons, Donnelly, Feinstein, Franken, 
Harris, Heitkamp, Klobuchar, Leahy, Manchin, McCaskill, Shaheen, 
Stabenow, Udall, Van Hollen, and Warren.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Tester moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would force the closure of 
     rural hospitals or otherwise reduce access to affordable 
     health care in rural areas.

  Ms. KLOBUCHAR. Madam President, I ask unanimous consent that the text 
of my motion to commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Klobuchar moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the

[[Page S4270]]

     Senate with instructions to report the same back to the 
     Senate in 3 days, not counting any day on which the Senate is 
     not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) provide a tax credit equal to 25 percent of the 
     premiums for health insurance paid during the taxable year 
     for individuals who--
       (A) do not qualify for the credit under section 36B of the 
     Internal Revenue Code of 1986;
       (B) are not enrolled in or eligible for Medicaid coverage; 
     and
       (C) in the case of individuals residing in a State that has 
     not expanded Medicaid as provided under the Patient 
     Protection and Affordable Care Act, would not be eligible for 
     Medicaid coverage even if the State did so expand Medicaid.

  Mr. KING. Madam President, I intend to move, with the support of 
Senator Blumenthal, that H.R. 1628 be committed to the Committee on 
Health, Education, Labor, and Pensions with instructions to report the 
same back to the Senate in 3 days with changes that will direct the 
Secretary of Health and Human Services to establish 10 pilot projects 
in 10 States that have experienced high rates of opioid substance use 
disorder and neonatal abstinence syndrome to further research the 
efficacy of early intervention and case management model of care for 
mothers and babies. Success to be evaluated by determining the rate of 
child protective services intervention, foster care for minor children 
and successful long term recovery. At least five projects are required 
to be granted for projects focused primarily on rural populations.
  I ask unanimous consent that the text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. King moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) direct the Secretary of Health and Human Services to 
     establish 10 pilot projects in 10 States that have 
     experienced high rates of opioid substance use disorder and 
     neonatal abstinence syndrome (including 5 such projects 
     focused primarily on rural populations) to further research 
     the efficacy of early intervention and case management model 
     of care for mothers and babies, and provide that the success 
     of such projects shall be evaluated by determining the rate 
     of foster care for minor children and successful long term 
     recovery.

  Ms. DUCKWORTH. Madam President, I ask unanimous consent that the text 
of my motions to commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would eliminate any provision that would result in a 
     reduction in funding for the Ryan White HIV/AIDS Program of 
     the Health Resources and Services Administration.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would eliminate any provision that would result in a 
     decrease in health care for patients who receive employer-
     sponsored health insurance coverage.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) strike provisions in the bill that would result in a 
     decrease in care for any veteran who depends on orthotics, 
     prosthetics, and complex rehabilitation technology.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) strike provisions in the bill that would result in a 
     decrease in care for any individual who depends on orthotics, 
     prosthetics, and complex rehabilitation technology.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would eliminate any provision that would result in 
     increased epinephrine prices for patients.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would eliminate any provision that would result in 
     increased insulin prices for patients.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would eliminate any provision that would result in an 
     increase in the price of naloxone, a medication designed to 
     rapidly reverse opioid overdose.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no veteran or former service member of the 
     United States Armed forces will lose access to mental health 
     care services currently funded in any part through Medicaid.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) revise the bill in a manner that prevents any veteran 
     or former member of the Armed Forces from losing access to 
     nursing home care funded through Medicaid.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) revise the bill in a manner that prevents any veteran 
     or former member of the Armed Forces from losing access to 
     spinal cord injury services, prosthetics or sensory aid 
     services, or other specialty services due to changes in 
     Medicaid or other programs.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) maintain all lactation standards that were established 
     under the Patient Protection and Affordable Care Act (Public 
     Law 111-148).

  Mr. DONNELLY. Madam President, I intend to offer the following motion 
to H.R. 1628 and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Casey, Cantwell, 
Blumenthal, Leahy, Brown, Harris, Hassan, Franken, Feinstein, Udall, 
Shaheen, Carper, Coons, Whitehouse, Kaine, Van Hollen, Cortez Masto, 
Baldwin, Menendez, Reed, Duckworth, Manchin, Markey, Stabenow, Durbin, 
Wyden, Murphy, Warren, Gillibrand, Cardin, Klobuchar, Heinrich, Hirono, 
Booker, Peters, and Nelson.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Donnelly moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) strike provisions that will--
       (A) reduce or eliminate benefits or coverage for 
     individuals who are currently eligible for Medicaid;

[[Page S4271]]

       (B) prevent or discourage a State from expanding its 
     Medicaid program to include groups of individuals or types of 
     services that are optional under current law; or
       (C) shift costs to States to cover this care.

  Mr. WARNER. Madam President, I intend to offer the following motion 
to H.R. 1628 and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Stabenow, Baldwin, Kaine, 
Coons, King, Carper, Nelson, and Peters.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Warner moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) eliminates the harm that would be caused by the 
     termination of the Medicaid expansion; and
       (3) ensures that every State that expands Medicaid coverage 
     can receive the full enhanced Federal medical assistance 
     percentage available as if they expanded in 2014, regardless 
     of when they expand Medicaid.

  Mr. WARNER. Madam President, I intend to offer the following motions 
to H.R. 1628 and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Warner moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) eliminates the harm that would be caused by the 
     Medicaid per capita caps; and
       (3) ensure that any changes to Medicaid made in the bill do 
     not adversely impact the ability of school districts to 
     comply with the Individuals with Disabilities Education Act, 
     the Rehabilitation Act of 1973, or the Americans with 
     Disabilities Act.

                   Motion to Commit With Instructions

       Mr. Warner moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that nothing in the bill impacts the ability of 
     local educational agencies with an urban-centric district 
     locale code of 32, 33, 41, 42, or 43 to meet the health care 
     needs of their students and staff.

                   Motion to Commit With Instructions

       Mr. Warner moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that individuals with employer-sponsored health 
     insurance coverage will not lose comprehensive coverage on 
     account of the amendments to the waiver program under section 
     1332 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052).

                   Motion to Commit With Instructions

        Mr. Warner moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) strike subsection (c)(1) of section 102 (relating to 
     affordability of employer-sponsored coverage); and
       (3) offsets any increased spending that results from such 
     changes.

  Mr. NELSON. Madam President, I intend to offer the following motion 
to commit on older Americans to H.R. 1628 and I ask that it be printed 
in the Record. The motion is supported by Senators Casey, Leahy, Brown, 
Harris, Feinstein, Hirono, Blumenthal, Whitehouse, Baldwin, Franken, 
Carper, Van Hollen, Menendez, Coons, Udall, Reed, Manchin, Warren, 
Stabenow, Durbin, Cardin, King, Klobuchar, and Warner.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Nelson moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that harm older Americans by 
     increasing their premiums, cutting Federal Medicaid funding 
     that supports those in nursing homes, or weakening Medicare.

  Mr. UDALL. Madam President, I intend to offer the following motions 
to H.R. 1628 and I ask unanimous consent that they be printed in the 
Record.
  I ask that the Record  reflect the support of Senator Heinrich.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days, not counting any day on 
     which the Senate is not in session, with changes to ensure 
     that the bill does not limit the ability of State Medicaid 
     programs to continue to make medical assistance available to 
     low-income adults under the eligibility options under clause 
     (i)(VIII) or clause (ii)(XX) of section 1902(a)(10)(A) of the 
     Social Security Act, and does not reduce Federal payments to 
     States for providing such assistance.

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no provision of the bill reduces access to 
     substance abuse and mental health services.

  Mr. UDALL. Madam President, I intend to offer the following motions 
to H.R. 1628 and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days, not counting any day on 
     which the Senate is not in session, with changes to exempt 
     any State with an unemployment rate of 4 percent or higher 
     from any provision that would reduce or limit Federal 
     payments to the State for spending on the State Medicaid 
     program, including any provision that would impose a per 
     capita cap on such payments.

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, after having held a hearing to 
     assess the impact of the bill on Medicaid, as the 
     Congressional Budget Office has not prepared a statement of 
     the costs which would be incurred in carrying out the bill 
     and the effect on revenue of the bill.

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that States that have a 4 percent or higher 
     unemployment rate cannot implement work requirements to 
     determine Medicaid eligibility.

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days, not counting any day on 
     which the Senate is not in session, with changes to ensure 
     that qualified health plans offered through the Consumer 
     Operated and Oriented Plan (CO-OP) program are treated in the 
     same manner as other qualified health plans under the State 
     waiver program under section 1332 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18052).

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no provision adversely impacts Medicaid 
     coverage or services for children age 18 or younger.

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) would ensure that no provision eliminates or reduces 
     funding for public health programs.

[[Page S4272]]

  


                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no provision of the bill eliminates or 
     reduces access to pediatric dental coverage.

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that medically underserved areas with limited 
     providers are not subject to any reductions in Federal 
     Medicaid funding.

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no State may use funds described in section 
     1332(a)(3) of the Patient Protection and Affordable Care Act 
     for purposes unrelated to the public health.

  Mr. CASEY. Madam President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Stabenow, Duckworth, 
Hassan, Van Hollen, Murray, Brown, Blumenthal, Carper, Durbin, Kaine, 
Baldwin, Wyden, Markey, Murphy, Harris, Cardin, Warren, Hirono, Reed, 
and Nelson.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Casey moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the American Health Care Act of 2017 that would harm 
     individuals with disabilities as defined in the Americans 
     with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) by 
     reducing their access to affordable health care or limiting 
     coverage or benefits under Medicaid or in the private health 
     insurance market.

  Ms. Duckworth. Madam President, I ask unanimous consent that the text 
of this motion to commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) strike any provision in the bill that results in a 
     decrease in maternal care for new mothers, including pre-
     natal care, delivery, and post-natal care.

  Ms. WARREN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Markey, Carper, Durbin, 
Stabenow, Hirano, Van Hollen, and Brown.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no provision of the bill would increase 
     costs for community health centers, including by increasing 
     the number of uninsured individuals or by reducing Federal 
     funding of the Medicaid program that helps provide coverage 
     for many patients receiving care at community health centers.

  Mr. KING. Madam President, I intend to move, with the support of 
Senator Blumenthal, that H.R. 1628 be committed to the Committee on 
Finance with instructions to report the same back to the Senate in 3 
days with changes that will require tax rebates to individuals who, 
through no fault of their own, received lump-sum Social Security 
disability insurance settlements which resulted in loss of advance 
premium tax credits for that year and not include as income retirement 
and savings drawdowns used to pay medical bills.
  I ask unanimous consent that this statement be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. King moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days, not counting any day on 
     which the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) require--
       (A) tax rebates to individuals who, through no fault of 
     their own, received lump sum social security disability 
     insurance settlements which were calculated in the year they 
     were received and disqualified the individuals from receiving 
     advanced premium tax credits in that year; and
       (B) that income drawn from retirement and savings accounts 
     utilized to pay medical bills not be counted as income for 
     purposes of the premium tax credit.

  Mr. WHITEHOUSE. Madam President, I intend to file the following 
motion to H.R. 1628 and I ask unanimous consent that it be printed in 
the Record. The motion is supported by Senators Brown, Franken, Van 
Hollen, Cardin, and Feinstein.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Whitehouse moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) establish a public health insurance option.

  Ms. WARREN. Madam President, I intend to offer the following motions 
to H.R. 1628, and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that will lead to an increased 
     likelihood of bankruptcies for American families, including 
     provisions that would allow insurers to impose annual or 
     lifetime limits on insurance benefits or that would eliminate 
     insurance coverage.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that reduce funding for special 
     education programs, including provisions that break President 
     Trump's promise not to cut Medicaid.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that harm individuals with 
     Alzheimer's disease by increasing their premiums or cutting 
     Federal Medicaid funding that supports those in nursing 
     homes.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that harm babies born prematurely 
     by cutting Federal Medicaid funding that supports 
     medications, special equipment, and therapies to help these 
     babies thrive and protect their family from bankruptcy.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and

[[Page S4273]]

       (2) eliminate provisions that reduce coverage for 
     prescription drug benefits, lead to increased out-of-pocket 
     prescription drug costs, or allow States to apply for waivers 
     to drop prescription drug coverage from the list of essential 
     health benefits.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that make it harder for a person 
     with breast cancer to access health care.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that make it harder for a person 
     with cervical cancer to access health care.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that make it harder for a victim 
     of human trafficking to access health care.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that make it harder for a pregnant 
     woman to access health care.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that make it harder for a victim 
     of sexual violence to access health care.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for children with a rare disease.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for foster children.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with a disability.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people living in a nursing home.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving home and 
     community based services.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving long term 
     services and supports.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people seeking treatment for 
     opioid addiction.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with any substance use 
     disorder.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people seeking mental health care.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with brain cancer.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving chemotherapy or 
     radiation treatment.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people living in a rural area.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for veterans.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people over the age of 50.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with ALS.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days,

[[Page S4274]]

     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with multiple sclerosis.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with diabetes.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving Social Security 
     benefits, including SSI and SSDI.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with heart disease.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with prostate cancer.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for children with a rare disease.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for foster children.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with a disability.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people living in a nursing home.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving home and 
     community based services.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving long term 
     services and supports.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people seeking treatment for 
     opioid addiction.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with any substance use 
     disorder.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people seeking mental health care.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with brain cancer.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving chemotherapy or 
     radiation treatment.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people living in a rural area.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for veterans.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people over the age of 50.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with ALS.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with multiple sclerosis.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the

[[Page S4275]]

     Senate in 3 days, not counting any day on which the Senate is 
     not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with diabetes.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people receiving Social Security 
     benefits, including SSI and SSDI.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with heart disease.

                   Motion to Commit With Instructions

       Ms. Warren moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health 
     insurance unaffordable for people with prostate cancer.

  Mr. HEINRICH. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Heinrich moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that would ensure 
     that the bill would not result in a decrease in the number of 
     children enrolled in Medicaid, or the Children's Health 
     Insurance Program.

  Mr. HEINRICH. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Heinrich moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that would ensure 
     that the bill would not result in an increase in the rate of 
     uninsured individuals in rural areas, a decrease in Medicaid 
     enrollment or a reduction in the scope of Medicaid benefits 
     offered in rural areas, reduced wages or a shortage of 
     employment opportunities in the health care profession for 
     prospective employees and previously insured individuals 
     living in rural areas, or a decrease in revenue or Federal 
     funds available to rural health care providers, including 
     hospitals, clinics, and community health centers.

  Mr. CARDIN. Madam President, I intend to offer a motion to commit the 
reconciliation bill to the Finance Committee with instructions to 
report the bill back to the Senate within 3 days, not counting any day 
on which the Senate is not in session, with changes eliminating 
provisions that would weaken access to essential health benefits, 
reduce access to affordable preventive services, and undermine the 
prohibition of annual and lifetime limits and caps on out-of-pocket 
expenditures for health insurance plans.
  I am offering this motion because the reconciliation bill affects 
tens of millions of Americans who gained health coverage under the 
Patient Protection and Affordable Care Act, ACA. The reconciliation 
bill allows insurers to eliminate coverage of essential health 
benefits. Insurance companies could exclude essential benefits like 
maternity care, substance use disorder treatment, mental healthcare, 
prescription drugs, and hospitalization--the very services people buy 
insurance to obtain. Before the ACA, one-third of individual market 
health plans did not cover substance use disorder services, nearly one-
fifth of those plans did not cover mental health, and only nine States 
required all insurers on the individual market to cover maternity care.
  Allowing States to waive essential health benefits would also allow 
insurance companies to reinstate annual and lifetime caps. This means 
that a premature baby could exceed its lifetime limit within its first 
few months of life or that a cancer patient could hit an annual cap 
just a couple of months into treatment.
  Before the ACA, too many people and families were hurt physically and 
financially because they could not afford access to healthcare. They 
didn't get the tests they needed. Perhaps they did not catch a 
preventable disease early enough--so the treatment costs skyrocketed. 
We saw too many families go through bankruptcy because they could not 
afford the healthcare that they needed. We saw too many people 
literally cutting their prescription pills in half, hoping to stretch 
out their medicine because they could not afford more, even though they 
knew they were compromising their health. We cannot go back to this 
cruel, dreadful situation.
  The following Senators support my motion to commit: Senators Carper, 
Brown, Blumenthal, Warren, Nelson, Van Hollen, Duckworth, and Stabenow. 
I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Cardin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions in the bill that would weaken 
     access to essential health benefits, reduce access to 
     affordable preventive services, and undermine the prohibition 
     of annual and lifetime limits and caps on out-of-pocket 
     expenditures for health insurance plans.

  Mr. CARDIN. Madam President, I intend to offer a motion to commit the 
reconciliation bill to the Senate Health, Education, Labor & Pensions, 
HELP, Committee with instructions to report the bill back to the Senate 
within 3 days, not counting any day on which the Senate is not in 
session, with changes that would eliminate provisions in the bill that 
would increase health disparities among certain populations, including 
disparities on the basis of race and ethnicity, socioeconomic status, 
gender, religion, disability status, geographic location, and sexual 
identity and orientation.
  I am offering this motion because communities of color and 
disenfranchised communities have faced significant barriers to 
accessing affordable health coverage, and these barriers have 
contributed to health disparities, which are evident in higher rates of 
diabetes, heart disease, hepatitis B, HIV/AIDS and infant mortality, 
among other conditions. The Patient Protection and Affordable Care 
Act's vital coverage reforms, which include Medicaid expansion, cost 
sharing reductions, eliminating annual and lifetime limits, and 
creating coverage options for individuals with preexisting conditions, 
has led to sharp declines in the uninsured rates for minorities and 
low-income populations. With the implementation of the major ACA 
coverage provisions in 2014, the uninsured rate dropped dramatically 
and continued to fall in 2015. In 2015, the nonelderly uninsured rate 
was 10.5 percent, the lowest rate in decades, with the most dramatic 
changes seen among low-income Latino Americans, African Americans, and 
Asian Americans.
  Minorities now make up more than 35 percent of the American 
population, and that number is expected to rise in the future. Every 
community across this great Nation deserves optimal health. A person's 
ethnic or racial background should never determine the length or 
quality of his or her life. We must work to bridge health equity across 
communities, ensure that all Americans have access to affordable, high-
quality healthcare, and continue our efforts to eliminate health 
disparities.
  The following Senators support my motion to commit: Senators Booker, 
Hirono, Brown, Carper, Stabenow, Markey, Blumenthal, Van Hollen, and 
Nelson. I ask unanimous consent that the full text of my motion to 
commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page S4276]]

  


                   Motion to Commit With Instructions

       Mr. Cardin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminates provisions of the bill that would increase 
     health disparities among certain populations, including 
     disparities on the basis of race and ethnicity, socioeconomic 
     status, gender, religion, disability status, geographic 
     location, and sexual identity and orientation.

  Ms. BALDWIN. Madam President, I intend to offer the following motion 
to commit H.R. 1628 with instructions, on behalf of myself and Senator 
Hirono, to the Committee on Health, Education, Labor, and Pensions to 
eliminate provisions that threaten to make healthcare unaffordable for 
those with preexisting conditions. I ask unanimous consent that it be 
printed in the Record.
  The motion is supported by Senators Blumenthal, Durbin, Stabenow, 
Feinstein, Leahy, Brown, Harris, Franken, Carper, Coons, Udall, 
Shaheen, Van Hollen, Menendez, Reed, Manchin, Cardin, Murphy, 
Duckworth, Warren, Wyden, Whitehouse, Heinrich, Warner, Klobuchar, 
Nelson, Bennet, Markey, Booker, and King.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Baldwin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make health care 
     unaffordable for those with pre-existing conditions.

  Mrs. McCASKILL. Madam President, I intend to offer the following 
motion to H.R. 1628, and I ask unanimous consent that it be printed in 
the Record. The motion is supported by Senator Donnelly.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mrs. McCaskill moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with--
       (1) changes that are within the jurisdiction of such 
     committee and are comparable to the amendment described in 
     paragraph (2); or
       (2) the following amendment: At the appropriate place, 
     insert the following:

     SEC. __. ACCESS TO COVERAGE FOR INDIVIDUALS IN AREAS WITHOUT 
                   ANY AVAILABLE EXCHANGE PLANS.

       Part 2 of subtitle D of title I of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18031 et seq.) is amended 
     by adding at the end the following:

     ``SEC. 1314. ACCESS TO COVERAGE FOR INDIVIDUALS IN AREAS 
                   WITHOUT ANY AVAILABLE EXCHANGE PLANS.

       ``(a) In General.--
       ``(1) Coverage through dc shop exchange.--Not later than 3 
     months after the date of enactment of this section, the 
     Secretary, in consultation with the Secretary of the Treasury 
     and the Director of the Office of Personnel Management, shall 
     establish a mechanism to ensure that, for any plan year 
     beginning on or after the date described in subsection (c), 
     any individual described in paragraph (2) may enroll in 
     health insurance coverage in the small group market through 
     the Exchange operating in the District of Columbia, including 
     the health insurance coverage that is available to Members of 
     Congress and congressional staff (as defined in section 
     1312(d)(3)(D)).
       ``(2) Individual described.--An individual described in 
     this paragraph is any individual who--
       ``(A) is eligible to purchase health insurance coverage 
     through the Exchange operating in the State of residence of 
     the individual; and
       ``(B) resides in a rating area or county in which the 
     Secretary certifies that no qualified health plan is offered 
     through an Exchange established under this title.
       ``(b) Premium Assistance Tax Credits and Cost-sharing.--Any 
     individual described in subsection (a)(2) who enrolls in 
     health insurance coverage through the Exchange operating in 
     the District of Columbia pursuant to subsection (a)(1) shall 
     be eligible for any premium tax credit under section 36B of 
     the Internal Revenue Code of 1986, or reduced cost-sharing 
     under section 1402, that the individual would otherwise be 
     eligible for if enrolling in health insurance coverage in the 
     individual market through the Exchange operating in the State 
     of the individual.
       ``(c) Date Described.--The date described in this 
     subsection is the date on which the Secretary establishes the 
     mechanism under subsection (a)(1).''.

  Mr. NELSON. Madam President, I intend to offer the following motion 
to commit about children with a Zika-related condition to H.R. 1628, 
and I ask unanimous consent that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

        Mr. Nelson moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) ensure that no children who are born with or develop a 
     Zika-related condition will lose their existing health 
     insurance coverage whether obtained through an Exchange or 
     Medicaid.

  Mr. CARDIN. Madam President, I intend to offer a motion to commit the 
reconciliation bill to the Finance Committee with instructions to 
report the bill back to the Senate within 3 days, not counting any day 
on which the Senate is not in session, with changes that would 
eliminate provisions that hand out tax breaks to large corporations and 
the most affluent Americans while the bill makes cuts to Medicaid, 
which serves millions of our most needy Americans, including the 
elderly poor and poor children.
  I am offering this motion because the Finance Committee should review 
the implications of depriving millions of Americans, including 
children, veterans, individuals with disabilities, and older people, of 
their health insurance while at the same time providing large tax 
breaks to the richest Americans and biggest corporations. H.R. 1628 
offsets those tax breaks by voraciously cutting the Medicaid Program. 
Republicans are using the Medicaid Program as a pay-for for these large 
tax breaks. As a result, the Republican bill harms far more people than 
it will help. Former President John F. Kennedy said, ``To govern is to 
choose.'' The Republicans have made a cruel choice, and I object to it.
  The following Senators support my motion to commit: Senators Harris, 
Van Hollen, Casey, Udall, Coons, Markey, Booker, and Leahy. I ask 
unanimous consent that the full text of my motion to commit be printed 
in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Cardin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that hand out tax breaks to large 
     corporations and high-income taxpayers in connection with a 
     bill that makes cuts to Medicaid.

  Mr. KING. Madam President, I intend to move, with the support of Mr. 
Blumenthal and Mrs. Shaheen, that H.R. 1628 be committed to the 
Committee on Health, Education, Labor, and Pensions with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that preserve, 
maintain, sustain, and expand the Prevention and Public Health Fund 
established under section 4002 of the Patient Protection and Affordable 
Care Act, 42 USC 300u-11.
  I request unanimous consent that this motion to commit be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. King moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) preserve, maintain, sustain, and expand the Prevention 
     and Public Health Fund established under section 4002 of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 300u-
     11).

  Mr. KING. Madam President, I intend to move, with the support of Mr. 
Blumenthal and Mrs. Shaheen, that H.R. 1628 be committed to the 
Committee on Health, Education, Labor, and Pensions with instructions 
to report the same back to the Senate in 3

[[Page S4277]]

days, not counting any day on which the Senate is not in session, with 
changes that will support the preservation, maintenance, sustenance. 
and expansion of the National Health Service Corps and public health 
nursing programs by preserving such programs and their funding.
  I request unanimous consent that this motion to commit be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. King moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) support the preservation, maintenance, sustenance, and 
     expansion of the National Health Service Corps programs and 
     public health nursing programs by preserving such programs 
     and their funding.

  Mr. KING. Madam President, I intend to move, with the support of Mr. 
Blumenthal and Mrs. Shaheen, that H.R. 1628 be committed to the 
Committee on Health, Education, Labor and Pensions with instructions to 
report the same back to the Senate in 3 days, not counting any day on 
which the Senate is not in session, with changes that will protect, 
preserve, maintain, sustain, and expand all programs related to 
addressing, identifying the causes of, and reducing infant mortality.
  I request unanimous consent that this motion to commit be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. King moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) will protect, preserve, maintain, sustain, and expand 
     all programs related to addressing, identifying causes of, 
     and reducing infant mortality.

  Mr. KING. Madam President, I intend to move, with the support of Mr. 
Blumenthal, Mr. Casey, Mrs. Shaheen, and Mr. Coons, that H.R. 1628 be 
committed to the Committee on Finance with instructions to report the 
same back to the Senate in 3 days, not counting any day on which the 
Senate is not in session, with changes that will support the promotion 
of maternal and child health, including the reduction of infant, child, 
and maternal mortality, through the use of home-visiting services by 
extending funding for maternal, infant, and early childhood home-
visiting programs under section 511 of the Social Security Act, 42 USC 
711, through the 10-year budget window.
  I request unanimous consent that this motion to commit be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. King moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) supports the promotion of maternal and child health, 
     including the reduction of infant, child, and maternal 
     mortality, through the use of home visiting services by 
     extending funding for maternal, infant, and early childhood 
     home visiting programs under section 511 of the Social 
     Security Act (42 U.S.C. 711) through the 10-year budget 
     window.

  Mr. MERKLEY. Madam President, I intend to offer the following motions 
to H.R. 1628, and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with diabetes.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people wih diabetes.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     pregnant women.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     parents of children ages 3-10.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     parents of infants.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for Korean 
     War veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     Vietnam War veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     veterans of the wars in Afghanistan.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     veterans of the War in Iraq.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for World 
     War II veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for Social 
     Security recipients.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     Medicare beneficiaries.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     individuals with pre-existing conditions.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are

[[Page S4278]]

     within the jurisdiction of such Committee to strike 
     provisions in the Better Care Reconciliation Act of 2017 that 
     could have the effect of increasing health insurance premiums 
     for people with cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for 
     children with cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with brain cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with leukemia.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with cervical cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with colorectal cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with lymphoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with lung cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with melanoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with ovarian cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with pancreatic cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with prostate cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with breast cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with asthma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     autism.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with Alzheimer's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with cerebral palsy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with cystic fibrosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with crohn's disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with ulcerative colitis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with lupus.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with rheumatoid arthritis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with AIDs.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with HIV.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with multiple sclerosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the

[[Page S4279]]

     effect of increasing health insurance premiums for people 
     with muscular dystrophy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with Parkinson's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with Lou Gehrig's disease (ALS).

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing health insurance premiums for people 
     with autism.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     pregnant women.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     children ages 3 to 10 years old.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     parents of infants.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     Korean War veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     Vietnam War veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     veterans of the Wars in Afghanistan.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     veterans of the War in Iraq.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     World War II veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     Social Security recipients.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     Medicare beneficiaries.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     individuals with pre-existing conditions.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     children with cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with brain cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with leukemia.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with cervical cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with colorectal cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with lymphoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with lung cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with melanoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with ovarian cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with pancreatic cancer.

[[Page S4280]]

  


                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with prostate cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with breast cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with asthma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with Alzheimer's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with cerebral palsy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with cystic fibrosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with Crohn's disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with ulcerative colitis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with lupus.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with rheumatoid arthritis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with AIDs.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with HIV.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with multiple sclerosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with muscular dystrophy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with Parkinson's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with Lou Gehrig's disease (ALS).

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of increasing out of pocket health care costs for 
     people with autism.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for pregnant 
     women.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for children ages 
     3-10 years olf.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for parents of 
     infants.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for Korean War 
     veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for Vietnam 
     veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for veterans of 
     the Wars in Afghanistan.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for veterans of 
     the War in Iraq.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for World War II 
     veterans.

[[Page S4281]]

  


                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for Social 
     Security recipients.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for Medicare 
     beneficiaries.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for individuals 
     with pre-existing conditions.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for children with 
     cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     brain cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     leukemia.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     cervical cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     colorectal cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     lymphoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     lung cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     melanoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     Ovarian cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     pancreatic cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     prostate cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     breast cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     diabetes.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     asthma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     asthma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     Alzheimer's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     cerebral palsy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     cystic fibrosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     Crohn's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     ulcerative colitis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     lupus.

[[Page S4282]]

  


                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     rheumatoid arthritis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     AIDs.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     HIV.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     multiple sclerosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     muscular dystrophy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     Parkinson's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could have 
     the effect of eliminating Medicaid coverage for people with 
     Lou Gehrig's Disease (ALS).

  Mr. VAN HOLLEN. Madam President, I ask unanimous consent that the 
text of my motions to commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with childhood cancer more for preventative 
     health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with metastatic cancer more for preventative 
     health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with Amyotrophic lateral sclerosis (ALS) more for 
     preventative health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with asthma more for preventative health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with autism more for preventative health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with blast injuries more for preventative health 
     care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with congenital heart defects more for 
     preventative health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with a mental health 
     illness.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with Alzheimer's disease.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with any rare disease.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with lupus.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with Down syndrome.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with breast cancer.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with blast injuries.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--

[[Page S4283]]

       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with autism.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with opioid addiction more for preventative 
     health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with a mental health illness more for 
     preventative health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with Alzheimer's disease more for preventative 
     health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with any rare disease more for preventative 
     health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with Down syndrome more for preventative health 
     care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with any lupus more for preventative health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with metastatic cancer.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with Down syndrome.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with childhood cancer.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate within 3 days, not 
     counting any day on which the Senate is not in session, with 
     changes that would ensure that no individual with income of 
     more than $750,000,000 annually would benefit from any of the 
     TrumpCare tax cuts.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with congenital heart 
     defects.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with diabetes.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with opioid addiction.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would threaten to make 
     prescription drugs unaffordable for individuals with asthma.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with Amyotrophic Lateral 
     Sclerosis (ALS).

  Mr. VAN HOLLEN. Mr. President, I intend to file a motion to commit 
the reconciliation bill to the Finance Committee with instructions to 
report the same back to the Senate within 3 days, not counting any day 
on which the Senate is not in Session, with changes that would 
eliminate provisions that threaten to make prescription drugs 
unaffordable for those with childhood cancer. I am offering this motion 
because the Finance Committee should review the implications of 
depriving millions of Americans of health insurance while at the same 
time providing tax breaks to the wealthiest Americans. I ask unanimous 
consent that the full text of my motion to commit be printed in the 
Record following my remarks.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with Multiple Sclerosis.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with Parkinson's disease.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with diabetes more for preventative health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate within 3 days, not 
     counting any day on which the Senate is not in session, with 
     changes that would ensure that no individual with income of 
     more than $1,000,000 annually would benefit from any of the 
     TrumpCare tax cuts.

[[Page S4284]]

  


                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate within 3 days, not 
     counting any day on which the Senate is not in session, with 
     changes that would ensure that billionaires would not benefit 
     from any of the TrumpCare tax cuts.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate within 3 days, not 
     counting any day on which the Senate is not in session, with 
     changes that would ensure that no individual with income of 
     more than $500,000,000 annually would benefit from any of the 
     TrumpCare tax cuts.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with blast injuries.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with autism.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with asthma.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with Amyotrophic Lateral 
     Sclerosis (ALS).

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with metastatic cancer.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with childhood cancer.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with Multiple Sclerosis.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with Parkinson's disease.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would weaken coverage 
     provided by Medicaid to individuals with breast cancer.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with congenital heart 
     defects.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with diabetes.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with opioid addiction.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with a mental health 
     illness.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with Alzheimer's disease.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with any rare disease.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to make prescription 
     drugs unaffordable for individuals with lupus.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would reduce financial 
     assistance, such as tax credits, for low- and moderate-income 
     Americans.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with breast cancer more for preventative health 
     care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with Parkinson's disease more for preventative 
     health care.

                   Motion to Commit With Instructions

       Mr. Van Hollen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate

[[Page S4285]]

     in 3 days, not counting any day on which the Senate is not in 
     session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that threaten to charge 
     individuals with Multiple Sclerosis more for preventative 
     health care.

  Ms. HEITKAMP. Madam President, I intend to offer the following 
motions to H.R. 1628, and I ask unanimous consent that they be printed 
in the Record. Both motions are supported by Senators Franken and 
Udall.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Heitkamp moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that all Native children with family incomes 
     that do not exceed 133 percent of the Federal poverty line 
     (as determined under section 1902(e)(14) of the Social 
     Security Act (42 U.S.C. 1396a(e)(14))) continue to receive 
     the same level of Medicaid benefits and protections that they 
     are eligible for under current law, such as early and 
     periodic screening, diagnostic, and treatment services, and 
     cost-sharing protections.

                   Motion to Commit With Instructions

       Ms. Heitkamp moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would limit access to health 
     care for Native American youth, including members of Indian 
     tribes and Native Hawaiians, with respect to services related 
     to--
       (A) mental and behavioral health care;
       (B) trauma-informed and trauma-specific interventions; and
       (C) suicide prevention.

  Mr. FRANKEN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Shaheen and Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

        Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that are within 
     the jurisdiction of the Committee and that strike provisions 
     that would unravel the rural health safety net by further 
     reducing revenue to rural providers, put health care and 
     other community jobs at risk, or otherwise force rural 
     providers to cut back on services.

  Mr. FRANKEN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask that it be printed in the Record. The motion is 
supported by Senator Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that are within 
     the jurisdiction of the Committee and that strike provisions 
     that would increase premiums and other health care costs for 
     farmers or other individuals and families living in rural 
     areas.

  Mr. FRANKEN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senator Udall.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no provision of the bill would--
       (A) exacerbate the state of emergency regarding opioids in 
     Indian country;
       (B) reduce funding for the Indian Health Service or 
     Medicaid such that Indians or Alaskan Natives would 
     experience a decrease in access or services; or
       (C) cause any cost or shift to the Indian Health Service 
     for services that are currently paid for by Medicaid.

  Mr. FRANKEN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that are within 
     the jurisdiction of the Committee and that strike provisions 
     that would further limit the amount of revenues that States 
     could collect through provider tax arrangements to fund the 
     State share of Medicaid spending.

  Mr. FRANKEN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Baldwin, Casey, Coons, and 
Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that are within 
     the jurisdiction of the Committee and that strike provisions 
     that threaten the affordability of health plans offered by 
     employers to their employees, or otherwise fail to address 
     plan affordability for employees and their dependents.

  Mr. FRANKEN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Baldwin, Duckworth, Reed, 
Carper, Blumenthal, Brown, Warren, Stabenow, Booker, Udall, Feinstein, 
Shaheen, Coons, Nelson, and Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that are within 
     the jurisdiction of the Committee and that strike provisions 
     that result in increased prescription drug costs for patients 
     and families.

  Mr. FRANKEN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Cantwell and Klobuchar.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that are within 
     the jurisdiction of the Committee and that strike provisions 
     that would jeopardize funding for State basic health 
     programs, or otherwise force States to pay more for providing 
     health coverage under a State basic health program.

  Mrs. McCaskill. Madam President, I intend to offer the following 
motion to H.R. 1628, and I ask unanimous consent that it be printed in 
the Record. The motion is supported by Senators Donnelly and Stabenow.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mrs. McCaskill moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with--
       (1) changes that are within the jurisdiction of such 
     committee and are comparable to the amendment described in 
     paragraph (2); or
       (2) the following amendment: At the appropriate place, 
     insert the following:

     SEC. __. ACCESS TO COVERAGE FOR INDIVIDUALS IN AREAS WITHOUT 
                   ANY AVAILABLE EXCHANGE PLANS.

       Part 2 of subtitle D of title I of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18031 et seq.) is amended 
     by adding at the end the following:

     ``SEC. 1314. ACCESS TO COVERAGE FOR INDIVIDUALS IN AREAS 
                   WITHOUT ANY AVAILABLE EXCHANGE PLANS.

       ``(a) In General.--
       ``(1) Coverage through dc shop exchange.--Not later than 3 
     months after the date of enactment of this section, the 
     Secretary, in consultation with the Secretary of

[[Page S4286]]

     the Treasury and the Director of the Office of Personnel 
     Management, shall establish a mechanism to ensure that, for 
     any plan year beginning on or after the date described in 
     subsection (c), any individual described in paragraph (2) may 
     enroll in health insurance coverage in the small group market 
     through the Exchange operating in the District of Columbia, 
     including the health insurance coverage that is available to 
     Members of Congress and congressional staff (as defined in 
     section 1312(d)(3)(D)).
       ``(2) Individual described.--An individual described in 
     this paragraph is any individual who--
       ``(A) is eligible to purchase health insurance coverage 
     through the Exchange operating in the State of residence of 
     the individual; and
       ``(B) resides in a rating area or county in which the 
     Secretary certifies that no qualified health plan is offered 
     through an Exchange established under this title.
       ``(b) Premium Assistance Tax Credits and Cost-sharing.--Any 
     individual described in subsection (a)(2) who enrolls in 
     health insurance coverage through the Exchange operating in 
     the District of Columbia pursuant to subsection (a)(1) shall 
     be eligible for any premium tax credit under section 36B of 
     the Internal Revenue Code of 1986, or reduced cost-sharing 
     under section 1402, that the individual would otherwise be 
     eligible for if enrolling in health insurance coverage in the 
     individual market through the Exchange operating in the State 
     of the individual.
       ``(c) Date Described.--The date described in this 
     subsection is the date on which the Secretary establishes the 
     mechanism under subsection (a)(1).''.

  Mr. MURPHY. Madam President, I intend to offer the following motions 
to H.R. 1628, and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate all tax cuts in the bill for the 
     pharmaceutical industry.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate all tax cuts in the bill for--
       (A) the health insurance and pharmaceutical industries; and
       (B) the wealthiest 1 percent of Americans.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate all tax cuts in the bill for the health 
     insurance industry.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate all tax cuts in the bill for insurance 
     companies for the purposes of executive compensation.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate all tax cuts in the bill for the tanning bed 
     industry.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would reduce access to mental 
     health treatment.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would reduce access to health 
     care for cancer patients.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would reduce access to health 
     care for Medicaid beneficiaries receiving home and community-
     based services.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate all tax cuts in the bill that would 
     negatively impact the solvency of the Medicare Hospital 
     Insurance Trust Fund under section 1817 of the Social 
     Security Act (42 U.S.C. 1395i).

  Mrs. SHAHEEN. Madam President, I intend to offer the following five 
motions to commit to H.R. 1628, and I ask unanimous consent that they 
be printed in the Record.
  The first motion would send the reconciliation bill to the Health, 
Education, Labor and Pensions Committee with instructions to strike 
repeal of cost sharing reductions, CSRs, and advanced premium tax 
credits and replace this section with my legislation, the Marketplace 
Certainty Act, which would make CSRs permanent and extend them to those 
making up to 400 percent of the Federal poverty line. I want to 
reiterate what I previously said for the Record, that the Affordable 
Care Act, ACA, already prescribes that such payments are to be made 
from such a permanent appropriation pursuant to 31 U.S.C. 1324.
  The first motion is supported by Senators Carper, Reed, Murphy, 
Baldwin, Hirono, Klobuchar, Blumenthal, Heinrich, Coons, Heitkamp, 
Stabenow, Cardin, Markey, Warner, and Van Hollen.
  The second motion would send the reconciliation bill to the Finance 
Committee with instructions to strike repeal of cost sharing 
reductions, CSRs, and advanced premium tax credits and replace this 
section with my legislation, the Marketplace Certainty Act, which would 
make CSRs permanent and extend them to those making up to 400 percent 
of the Federal poverty line. Similar to the first motion, I want to 
reiterate what I previously said for the Record, that the ACA already 
prescribes that such payments are to be made from such a permanent 
appropriation pursuant to 31 U.S.C. 1324.
  The second motion is supported by Senators Carper, Reed, Murphy, 
Baldwin, Hirono, Klobuchar, Blumenthal, Heinrich, Coons, Heitkamp, 
Stabenow, Cardin, Markey, Warner, and Van Hollen.
  The third motion would send the reconciliation bill to the Finance 
Committee with instructions to strike provisions that would weaken or 
eliminate the small employer health insurance credit, prohibit the 
ability of entrepreneurs to purchase affordable health coverage through 
the individual marketplace, or allow discriminatory rating rules that 
prohibit small businesses from providing affordable, comprehensive 
benefits to their employees.
  The third motion is supported by Senators Blumenthal, Carper, Udall, 
Baldwin, Brown, Peters, and Stabenow.
  The fourth motion would send the reconciliation bill to the Health, 
Education, Labor and Pensions Committee with instructions to strike 
provisions that would allow insurers to establish diabetes as a 
preexisting condition or reduce funding for diabetes research, 
treatment, prevention and education.
  The fourth motion is supported by Senators Hirono, Klobuchar, 
Blumenthal, Menendez, and Van Hollen.
  The fifth motion would send the reconciliation bill to the Finance 
Committee with instructions to strike language that would remove mental 
healthcare services from the list of essential health benefits or 
prohibit States from providing Medicaid coverage for more than 30 
consecutive days of inpatient psychiatric services.
  The fifth motion is supported by Senators Hirono and Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page S4287]]

  


                   Motion to Commit With Instructions

       Mrs. Shaheen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that nothing in the bill would--
       (A) establish diabetes as a pre-existing condition such 
     that insurers could charge higher premiums for diabetes 
     patients; or
       (B) reduce funding allocated to diabetes research, 
     treatment, prevention, and education.

                   Motion to Commit With Instructions

       Mrs. Shaheen moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--
       (1) are within the jurisdiction of such committee; and
       (2) strike any language that would repeal advanced premium 
     tax credits under the Patient Protection and Affordable Care 
     Act to insurance companies.

                   Motion to Commit With Instructions

       Mrs. Shaheen moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate with instructions to report the same back to the 
     Senate in 3 days, not counting any day on which the Senate is 
     not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) strike any language that would repeal or prevent the 
     Federal government from paying cost sharing reductions under 
     the Patient Protection and Affordable Care Act to insurance 
     companies; and
       (3) increase cost sharing reductions under such Act such 
     that the plan's share of the allowed cost of benefits 
     provided under a plan is 95 percent, 90 percent, and 85 
     percent respectively, rather than 94 percent, 87 percent, and 
     73 percent as under current law.

                   Motion to Commit With Instructions

       Mrs. Shaheen moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that--
       (A) mental health care services are not removed from the 
     list of essential health benefits; and
       (B) States are permitted to provide Medicaid coverage for 
     more than 30 consecutive days of inpatient psychiatric 
     services.

                   Motion to Commit With Instructions

        Mrs. Shaheen move to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--
       (1) are within the jurisdiction of such committee;
       (2) strike any language that--
       (A) weakens or eliminates the tax credit to help small 
     businesses purchase health insurance under section 45R of the 
     Internal Revenue Code of 1986;
       (B) inhibits the ability of entrepreneurs to purchase 
     affordable health coverage through the individual 
     marketplace; or
       (C) employs discriminatory rating rules that prohibit small 
     businesses from providing affordable, comprehensive benefits 
     to their employees;
       (3) expand the tax credit for employee health insurance 
     expenses of small employers to include employers with a 
     greater number of employees, to extend the credit period, and 
     to raise the level of other limitations under the credit; and
       (4) offset such amendments with modifications to the rules 
     relating to inverted corporations.

  Mr. UDALL. Madam President, I intend to offer a motion to commit H.R. 
1628 to the Finance Committee to review the impacts of this bill on the 
Indian Health Service, Tribal Health Programs, Urban Indian Health 
Programs, or Indian Tribes or other Tribal organizations, or with 
respect to services provided to individuals who are American Indian or 
Alaska Native.
  I ask unanimous consent that it be printed in the Record, and it is 
supported by Senators Cantwell, Cortez Masto, Heinrich, Heitkamp, 
Franken, Murray, Merkley, Schatz, Stabenow, and Tester.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Udall moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) provide that any reduction or limitation of Federal 
     payments to help cover the cost of private health insurance 
     not apply with respect to private health insurance purchased 
     by American Indians or Alaska Natives; and
       (3) provide that any reduction or limitation of Federal 
     payments for spending under the Medicaid program shall not 
     apply with respect to services provided by the Indian Health 
     Service, an Indian Health Program, an Urban Indian 
     Organization, or Indian tribes or other tribal organizations, 
     or with respect to services provided to individuals who are 
     American Indians or Alaska Natives.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committe on Health, Education, Labor and 
Pensions with instructions to report the same back to the Senate in 3 
days, not counting any day on which the Senate is not in session, with 
changes that prohibit eliminating or reducing funding to States unless 
the Congressional Budget Office certifies that such changes will not 
increase the number of uninsured Americans, decrease Medicaid 
enrollment in Medicaid expansion States, reduce the likelihood 
nonexpansion States will expand, or increase the State share of 
Medicaid spending.
  I am offering this motion to ensure individuals who gained coverage 
due to the Affordable Care Act's Medicaid expansion do not lose their 
coverage and States that expanded Medicaid are not penalized by this 
bill.
  The following Senators support my motion to commit: Durbin, Heinrich, 
Udall, Booker, Shaheen, and Blumenthal.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

        Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) prohibit eliminating or reducing funding available to 
     States to provide comprehensive, affordable health care to 
     low-income Americans by eliminating or reducing the 
     availability of Federal financial assistance to States 
     available under section 1905(y)(1) or 1905(z)(2) of the 
     Social Security Act (42 U.S.C. 1396d(y)(1), 1396d(z)(2)) or 
     other means, unless the Director of the Congressional Budget 
     Office certifies any such changes will not--
       (A) increase the number of uninsured Americans;
       (B) decrease Medicaid enrollment in States that have opted 
     to expand eligibility for medical assistance under that 
     program for low-income, non-elderly individuals under the 
     eligibility option established by the Affordable Care Act 
     under section 1902(a)(10)(A)(i)(VIII) of the Social Security 
     Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII));
       (C) reduce the likelihood that any State that has not opted 
     to expand Medicaid under the eligibility option established 
     by the Affordable Care Act under section 
     1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C. 
     1396a(a)(10)(A)(i)(VIII)) would opt to use that eligibility 
     option to expand eligibility for medical assistance under 
     that program for low-income, non-elderly individuals; or
       (D) increase the State share of Medicaid spending under 
     that eligibility option.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Health, Education, Labor 
and Pensions with instructions to report the same back to the Senate in 
3 days, not counting any day on which the Senate is not in session, 
with changes that No. 1, are within the jurisdiction of such committee; 
and No. 2, ensure that the bill shall not take effect until the 
Secretary of Health and Human Services certifies under oath, with 
standing given to each State attorney general for any charges of 
perjury, that no individual with a preexisting condition will be unable 
to receive the necessary medications to sustain their life, limbs, 
eyesight, or other necessary healthcare and medications for the 
preexisting condition due to a State cutting essential health benefits, 
minimum services, or necessary medication from the insurance plans 
offered through their exchanges. I am offering this motion because 
individuals with preexisting condition must not lose access to the 
medications they need to manage their conditions and live full, 
productive lives.
  The following Senators support my motion to commit: Shaheen and 
Blumenthal.

[[Page S4288]]

  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill shall not take effect until the 
     Secretary of Health and Human Services certifies under oath, 
     with standing given to each State Attorney General for any 
     charges of perjury, that no individual with a preexisting 
     condition will be unable to receive the necessary medications 
     to sustain their life, limbs, eyesight, or other necessary 
     healthcare and medications for the preexisting condition due 
     to a State cutting essential health benefits, minimum 
     services, or necessary medication from the insurance plans 
     offered through their Exchanges.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with Instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, add automatic 
sunset to the bill and reinstate the Affordable Care Act if the 
uninsured rate increases 10 percent as compared to the rate at the 
beginning of fiscal year 2017. I am offering this motion because any 
bill that increases the uninsured rate is a giant step backward.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) add an automatic sunset to the bill and reinstate the 
     Affordable Care Act if the uninsured rate increases 10 
     percent as compared to the rate at the beginning of fiscal 
     year 2017.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, add an automatic 
sunset to the bill and reinstate the Affordable Care Act if the 
uninsured rate increases 20 percent as compared to the rate at the 
beginning of fiscal year 2017. I am offering this motion because any 
bill that increases the uninsured rate is a giant step backward.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) add an automatic sunset to the bill and reinstate the 
     Affordable Care Act if the uninsured rate increases 20 
     percent as compared to the rate at the beginning of fiscal 
     year 2017.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, ensure that the 
bill shall not take effect until the Secretary of Health and Human 
Services certifies under oath, with standing given to each State 
attorney general for any charges of perjury, that no domestic violence 
victim will have less coverage for any condition arising from the abuse 
than they have under current law. I am offering this motion because 
survivors of domestic or sexual abuse must receive the care they need 
to deal with their past trauma.
  The following Senator supports my motion to commit: Blumenthal.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill shall not take effect until the 
     Secretary of Health and Human Services certifies under oath, 
     with standing given to each State Attorney General for any 
     charges of perjury, that no domestic or sexual violence 
     victim will have less coverage for any condition arising from 
     the abuse than they have under current law.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, add an automatic 
sunset to the bill and reinstate the Affordable Care Act if, (A), 
premiums increase by more than 10 percent for the average senior aged 
50 to 64 within any 365-day period in the next 10 years; or, B, out-of-
pocket costs increase by more than 10 percent for the average senior 
aged 50 to 64 within any 365-day period in the next 10 years. I am 
offering this motion to provide relief for older Americans who will be 
harmed by harmful provisions in this bill.
  The following Senator supports my motion to commit: Shaheen. 
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) add an automatic sunset to the bill and reinstate the 
     Affordable Care Act if--
       (A) premiums increase by more than 10 percent for the 
     average senior aged 50 to 64 within any 365 day period in the 
     next 10 years; or
       (B) out-of-pocket costs increase by more than 10 percent 
     for the average senior aged 50 to 64 within any 365 day 
     period in the next 10 years.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, ensure that the 
procedure for distribution of funds from the State Stability and 
Innovation Program also factor in the number of uninsured in the State 
when reviewing the cost of premiums in the State as compared to the 
national average and prioritize States with a larger number of 
uninsured.
  I am offering this motion to ensure States with higher populations 
receive their fair share of the funds.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the procedure for distribution of funds 
     from the State Stability and Innovation Program also factor 
     in the number of uninsured in the State when reviewing the 
     cost of premiums in the State as compared to the national 
     average and prioritize States with a larger number of 
     uninsured.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the

[[Page S4289]]

same back to the Senate in 3 days, not counting any day on which the 
Senate is not in session, with changes that No. 1, are within the 
jurisdiction of such committee; and No. 2, ensure that no State can 
deny a woman who becomes pregnant Medicaid coverage regardless of 
income. I am offering this motion because all women deserve access to 
maternity care and we know a healthy pregnancy will help ensure a 
healthy baby.
  The following Senators support my motion to commit: Shaheen and 
Blumenthal.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no State can deny a woman who becomes 
     pregnant Medicaid coverage regardless of income.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, ensure that there 
is not a disproportionate impact on women and minorities from 
reductions in Medicaid funding.
  I am offering this motion because these healthcare repeal bills have 
one thing in common: the changes proposed will disproportionately harm 
women and minorities.
  The following Senators support my motion to commit: Shaheen and 
Blumenthal.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that there is not a disproportionate impact on 
     women and minorities from reductions in Medicaid funding.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Health, Education, Labor, 
and Pensions with instructions to report the same back to the Senate in 
3 days, not counting any day on which the Senate is not in session, 
with changes that No. 1, are within the jurisdiction of such committee; 
No. 2, strike section provision amending Section 2701(a)(l)(a)(iii) of 
the Public Health Service Act; and No. 3, preserve the existing 
permissible age variation in health insurance premium rates under the 
Affordable Care Act. I am offering this motion this change in 
permissible age variation will harm older Americans.
  The following Senator supports my motion to commit: Shaheen.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee;
       (2) strike the provision that amends section 
     2701(a)(1)(A)(iii) of the Public Health Service Act (42 
     U.S.C. 300gg(a)(1)(A)(iii)); and
       (3) preserve the existing permissible age variation in 
     health insurance premium rates under such section 
     2701(a)(1)(A)(iii), as added by the Patient Protection and 
     Affordable Care Act.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, ensure that the 
bill will not take effect until the Secretary of Health and Human 
Services certifies under oath--with standing given to each State 
attorney general to bring perjury charges--that no individual with 
autism or any caretaker of an individual with autism will have higher 
out-of-pocket costs as compared to average costs for similarly situated 
individuals in fiscal year 2017. I am offering this motion because 
individuals with autism and their caretakers face high costs of medical 
care and any legislation increasing those costs will prove burdensome 
for American families.
  The following Senator supports my motion to commit: Booker.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill will not take effect until the 
     Secretary of Health and Human Services certifies under oath 
     (with standing given to each State Attorney General to bring 
     perjury charges) that no individual with autism or any 
     caretaker of an individual with autism will have higher out 
     of pocket costs as compared to average costs for similarly 
     situated individuals in fiscal year 2017.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, eliminate 
provision that would harm children by reducing their access to 
affordable healthcare or limiting coverage or benefits under Medicaid.
  The following Senators support my motion to commit: Booker, Baldwin, 
Blumenthal, Whitehouse, Leahy, Brown, Peters, Van Hollen, Harris, 
Franken, Feinstein, Udall, Coons, Carper, Reed, Duckworth, Durbin, 
Gillibrand, Stabenow, Wyden, Hirono, Cardin, Casey, Bennet, Warren, 
Heinrich, Nelson, and Shaheen.
  I am offering the motion to protect American children from being 
harmed by the upheaval that will result in insurance markets from this 
bill becoming law.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would harm children by 
     reducing their access to affordable health care or limiting 
     coverage or benefits under Medicaid or in the private 
     insurance market.

  Mr. MENENDEZ. Madam President, I intend to offer a motion to commit 
the reconciliation bill to the Committee on Finance with instructions 
to report the same back to the Senate in 3 days, not counting any day 
on which the Senate is not in session, with changes that No. 1, are 
within the jurisdiction of such committee; and No. 2, ensure that 
States cannot waive essential health benefits for individuals with 
autism.
  I am offering this motion because individuals with autism should not 
lose access to these critical health insurance benefits.
  The following Senator supports my motion to commit: Booker.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Menendez moves to commit the bill H.R. 1628 to the 
     Committee on Finance with

[[Page S4290]]

     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that States cannot waive essential health 
     benefits for individuals with autism.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion to H.R. 1628, and I ask unanimous consent that it be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days, not counting any day on 
     which the Senate is not in session, with changes that ensure 
     that no tax cuts in the bill go to individuals making over 
     $200,000 per year and married people filing joint tax returns 
     making over $250,000 per year at the expense of funding for 
     Medicaid.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion, Conner's amendment, to H.R. 1628, and I ask unanimous consent 
that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that States would not be able to submit waivers 
     asking for the imposition of lifetime or annual out-of-pocket 
     limits on insurance coverage, or the removal of any essential 
     health benefits.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion to H.R. 1628, and I ask unanimous consent that it be printed in 
the Record. The motion is supported by Senator Shaheen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that there will be no Medicaid cuts in services 
     provided to veterans.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion, Sean and Frank's amendment, to H.R. 1628, and I ask unanimous 
consent that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

        Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no individual who is enrolled in Medicaid 
     and has or is recovering from a substance use disorder will 
     lose coverage or services.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion, Justice's amendment, to H.R. 1628, and I ask unanimous consent 
that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

        Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that mental health and substance use disorder 
     treatments and services are guaranteed as an essential health 
     benefit.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion, Gay's amendment, to H.R. 1628, and I ask unanimous consent that 
it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill will not increase the percentage 
     of individuals in our Nation who do not have health 
     insurance.

  Mr. BLUMENTHAL. Madam President, I intend off the following motion, 
Amelie, Amanda, and Evan's amendment, to H.R. 1628, and I ask unanimous 
consent that it be printed in the Record. The motion is supported by 
Senator Shaheen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no Medicaid beneficiary will lose coverage 
     or health services due to provisions or cuts in this bill.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion, Michelle's amendment, to H.R. 1628, and I ask unanimous consent 
that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Blumenthall moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no State may ask for a waiver allowing for 
     the imposition of pre-existing condition coverage 
     limitations.

  Mr. BLUMENTHAL. Madam President, I intend to offer the following 
motion to H.R. 1628, and I ask unanimous consent that it be printed in 
the Record. The motion is supported by Senators Carper, Brown, Reed, 
King, Coons, Warren, Stabenow, Feinstein, Klobuchar, Markey, Durbin, 
Casey, Franken, Shaheen, Cardin, Udall, Van Hollen, Hirono, and Murray.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Blumenthal moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that there will be no funding reductions for 
     disease prevention efforts of public health, including 
     funding for the Prevention and Public Health Fund established 
     under section 4002 of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 300u-11).

  Mr. BOOKER. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal, Duckworth, and 
Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Booker moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that consumers' deductibles in the private 
     health insurance market will not increase as a result of the 
     enactment of the bill.

  Mr. BOOKER. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal, Casey, 
Menendez, Shaheen, and Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Booker moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and

[[Page S4291]]

       (2) would ensure that the bill does not disrupt access to 
     long term services and supports.

  Mr. BOOKER. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal and Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Booker moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that individuals with household income between 
     350 percent and 400 percent of the poverty line do not lose 
     Federal financial assistance with the cost of health care.

  Mr. BOOKER. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal, Duckworth, 
Markey, Shaheen, and Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Booker moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that there would be no reduction in access to 
     the essential health benefits required under the Patient 
     Protection and Affordable Care Act, including for people with 
     employer-sponsored health plans, as a result of the enactment 
     of the bill.

  Mr. BOOKER. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask that it be printed in the Record. The motion is 
supported by Senators Stabenow, Blumenthal, Menendez, Shaheen, and Van 
Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Booker moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that our Nation's maternal morbidity and 
     mortality rates do not increase, and that disparities in 
     maternal morbidity and mortality do not increase, as a result 
     of the enactment of the bill.

  Mr. BOOKER. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Booker moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminates provisions of the bill that would increase 
     health disparities among certain populations, including 
     disparities on the basis of race and ethnicity, socioeconomic 
     status, gender, religion, disability status, geographic 
     location, and sexual identity and orientation.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal, Coons, and 
Carper.
  For years, Republicans painted a drastic, dire picture of the 
Affordable Care Act. Just this week, President Trump talked about the 
so-called forgotten victims of the ACA.
  The ACA isn't perfect--no law is--but to say it hasn't been a 
landmark achievement for our Nation and for my State would be 
absolutely wrong.
  Our country's uninsured rate is at the lowest level in our Nation's 
history. In Illinois, our uninsured rate has been cut in half. These 
insurance gains are thanks to the Affordable Care Act.
  Insurance companies can no longer deny someone coverage or charge 
them sky-high premiums because of a preexisting condition, benefitting 
roughly 5 million Illinoisans.
  Insurance companies can no longer charge women more than men, drop 
someone from coverage when they get sick, charge seniors exorbitantly 
more than younger people for insurance, or refuse to cover important 
and essential health benefits.
  I think these consumer protections represent a step forward in 
healthcare for people nationwide, and I don't believe we should get rid 
of them.
  So my motion would instruct the Finance Committee to report out a 
bill--within 3 days--that would let any State keep the ACA if they 
want.-
  These Republican repeal proposals are cruel and dangerous. States 
ought to be able to keep the ACA if they want, including all the record 
coverage gains, consumer protections and benefits, and Federal funding 
for the Medicaid expansion and tax credits.
  If Senator Cruz wants to rip away health insurance ``root and 
branch'' from his constituents, that is fine.
  But this motion protects any State who thinks we have made too much 
progress to turn back.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pension with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) permit a State to continue to implement the provisions 
     of the Patient Protection and Affordable Care Act (Public Law 
     111-148), as in effect on the date of enactment of this Act, 
     if the Governor of that State elects to continue such 
     implementation, including provisions relating to health 
     insurance coverage gains, consumer protections and benefits 
     (including protections related to coverage of pre-existing 
     conditions, essential health benefits, and the premium levels 
     that older enrollees may be charged relative to younger 
     enrollees), and Federal funding provided under that Act 
     (including levels of Medicaid funding for the Medicaid 
     expansion population, Federal funding for tax credits, and 
     cost sharing reduction subsidies).

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal and Carper.
  Some of the strongest opponents to the secretive and devastating 
Republican repeal effort are our hospitals, especially our rural 
hospitals, critical access hospitals, and safety net hospitals in 
underserved urban communities.
  In particular, they warn us that the devastating cuts in Medicaid 
will dramatically increase uncompensated care costs.
  The Illinois Hospital Association tells us that slashing Medicaid 
like these Republican repeal bills do will cost Illinois between 60,000 
and 95,000 healthcare jobs.
  You see, not only are our rural hospitals critical lifelines for 
healthcare in their communities, they are often the best jobs in town; 
yet these drastic Medicaid cuts will increase uncompensated care costs 
by billions, forcing cutbacks in services, staff, and expansion.
  So my motion would instruct the Finance Committee to report out a 
bill--within 3 days--that would protect funding for these hospitals and 
prohibit increases in uncompensated care costs for these critical 
facilities.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pension with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) would prohibit increases in uncompensated costs or 
     reductions in funding for rural hospitals, hospitals in 
     underserved areas, or critical access hospitals.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal and Carper.
  Medicaid covers one in two births in Illinois. It helps pay for two 
out of every three seniors in nursing homes, and it is the largest 
payor of opioid and substance abuse treatment.
  But guess what else Medicaid does? It helps 45 percent of school 
districts provide medical and therapy services for

[[Page S4292]]

lower-income kids and those with special needs.
  That is right, Illinois schools currently receive about $144 million 
in Medicaid funding each year.
  They use this money to provide dental screenings, therapy services 
for kids with disabilities, to purchase handicap equipment, and 
employing trained staff.
  What would happen to kids nationwide if the $4 billion in Medicaid 
funding for schools went away?
  My motion would to commit would instruct the Finance Committee to 
report out a bill--within 3 days--that would protect funding for 
schools and students and says, if you want to slash Medicaid, it won't 
be on the backs of our kids.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. DURBIN moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensures no reduction in Medicaid funding for items or 
     services provided in, or under arrangements with, any 
     kindergarten through grade 12 elementary school in the 
     Nation.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal and Carper.
  When thinking about Medicaid, we often talk about low-income children 
or pregnant women. But do you know the most expensive part of Medicaid?
  It is providing long-term care for your grandmother, your 
grandfather--at home or in the nursing home.
  When Social Security and Medicare aren't enough, Medicaid steps in to 
care for millions of seniors over age 65.
  Medicaid helps pay for two out of three seniors currently in nursing 
homes.
  These Republican proposals to slash Medicaid are so devastating that 
the American Association of Retired Persons, AARP, has come out in loud 
opposition to all the repeal bills.
  My motion to commit would instruct the Finance Committee to report 
out a bill--within 3 days--that protects the millions of seniors who 
rely on Medicaid for their care and says, if you want to slash 
Medicaid, it will not be on the backs of our vulnerable seniors.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensures no seniors on Medicaid lose benefits, have 
     reduced provider payments for services furnished to them, or 
     have any increase in out-of-pocket costs.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senator Blumenthal.
  Over the past few months, I have met with many heroes in the 
disability community, including a woman in Illinois who has a 23-year-
old son with autism. She told me that Medicaid allows her son to be at 
home and function independently.
  She told me that, without Medicaid, her son would have to be in a 
facility she couldn't afford.
  You know what else all of these advocates and fighters tell me? They 
tell me that the Republican healthcare repeal proposals--all of which 
decimate the Medicaid Program in order to give tax breaks to the 
wealthy--would be devastating for people with disabilities.
  Medicaid is a lifeline for 11 million people with disabilities. It is 
the core of our commitment to care for them, and it helps us meet our 
basic obligations as a society.
  That is why my motion to commit would instruct the Finance Committee 
to report out a bill--within 3 days--that protects children and adults 
on Medicaid with disabilities from increased costs and fewer benefits.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensures no individuals with disabilities on Medicaid 
     lose benefits, have reduced provider payments for services 
     furnished to them, or have any increase in out-of-pocket 
     costs.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senator Blumenthal.
  Under the ACA, our Nation has seen the largest decline in the child 
uninsured rate, and in Illinois, we have seen a 40 percent drop. Today 
more than 95 percent of kids in our country are insured.
  Half of all children born in Illinois are covered by Medicaid.
  That means they are guaranteed quality, comprehensive health 
coverage, from vaccinations and vision checks, to dental health, mental 
health, and lead poisoning screenings.
  Medicaid serves low-income children in schools, and -I have visited 
many school-based health clinics that provide critical access and 
services for our kids.
  But every single Republican healthcare repeal proposal would slash 
Medicaid for our most vulnerable kids, jeopardizing the services they 
receive and their ability to access care.
  That is why my motion to commit would instruct the Finance Committee 
to report out a bill--within 3 days--that protects our kids and tells 
Republicans they will not be a bargaining chip in this cruel repeal 
effort.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensures no children on Medicaid lose benefits, have 
     reduced provider payments for services furnished to them, or 
     have any increase in out-of-pocket costs.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal and Carper.
  Thanks to the Affordable Care Act, Medicare is now financially stable 
for an additional 11 years.
  Because of the healthcare reforms that improve the delivery of 
healthcare, seniors are now paying $700 less annually in premiums and 
cost-sharing.
  The ACA is also closing the dreaded Medicare ``donut hole''--the gap 
where seniors were faced with high costs for their drugs--saving 11 
million seniors an average for $2,127 each year on their medications.
  But Republicans want to jeopardize this progress.
  Instead of strengthening Medicare for the long run, many of the 
Republican repeal bills would give a huge tax giveaway to wealthy 
Americans--cutting years off Medicare's solvency.
  That is why my motion to commit would instruct the Finance Committee 
to report out a bill--within 3 days--that does not shorten Medicare's 
solvency.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill will not shorten the solvency of 
     the Federal Hospital Insurance Trust Fund under section 1817 
     of the Social Security Act (42 U.S.C. 1395i).

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed the 
Record.
  When Republicans talk about the challenges facing Obamacare, they

[[Page S4293]]

tend to be a bit misleading. Let's set the record straight.
  What they are really talking about is within the individual market, 
where 6 percent of Americans get their coverage and more than 70 
percent of those people get subsidies to help cover their costs.
  One problem Republicans like to cite is lack of competition, that 
private, for-profit insurers are pulling out, leaving few choices.
  We call these ``bare counties,'' and they are more common in rural 
areas and in States that did not expand Medicaid.
  I agree that we need more competition in the individual market.
  As a solution, my motion to commit instructs the Finance Committee--
within 3 days--to report out a bill that requires insurers offering 
Medicare Advantage plans in a particular county, to also offer an 
individual market plan in that county.
  Medicare Advantage insurance plans make huge profits off the Federal 
Government, yet many of those same insurers are refusing to participate 
in the individual exchange.
  To address bare counties, my motion says that, if you have a provider 
network and you are making money off the Federal Government, then you 
should also help improve choice by offering a plan in the exchange.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) require each insurer who offers a Medicare Advantage 
     plan under part C of the Medicare program in a specific 
     county to also offer health insurance coverage through the 
     individual market in that county.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senator Blumenthal.
  All of these Republican repeal bills shift costs onto consumers, 
patients, hospitals, and State budgets.
  None of them do anything to actually address what is driving the 
increase in healthcare costs. And one of those biggest drivers? 
Pharmaceutical costs--Blue Cross of Illinois tells me they spend more 
on prescription drugs than inpatient hospital care.
  So what can we do to address prescription drugs? Listen to the 
American Medical Association, which called for a ban on direct-to-
consumer pharmaceutical advertising.
  According to the AMA, these ads are, ``driving demand for expensive 
treatments despite the clinical effectiveness of less costly 
alternatives.'' In short, pharma advertises their drugs because they 
know you will tell your doctor you need it--driving up the cost--
regardless of whether it's right for you. That is why they spend 
billions on it.
  But the moment of truth on when patients find out about the cost is 
when they are checking out at the pharmacy. That is wrong.
  So my motion to commit would instruct the Finance Committee--within 3 
days--to report out a bill that helps lower the cost of healthcare by 
tackling the driving cost of prescription drugs, requiring 
pharmaceutical companies to disclose the price of their drug in their 
ads.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pension with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) would require pharmaceutical companies to disclose the 
     price of their drug to doctors as part of their educational 
     outreach, or to patients through direct-to-consumer 
     advertising.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senator Blumenthal.-
  All of these Republican repeal bills shift costs onto consumers, 
patients, hospitals, and state budgets.
  None of them do anything to actually address what is driving the 
increase in healthcare costs. And one of those biggest drivers? 
Pharmaceutical costs--Blue Cross of Illinois tells me they spend more 
on prescription drugs than inpatient hospital care.
  So what can we do to address prescription drugs? Have Medicare 
negotiate drug prices on behalf of seniors. Even the President says he 
supports this policy.
  Medicaid can negotiate drug costs, the Veterans Administration can 
negotiate drug costs, why shouldn't Medicare be able to leverage its 50 
million beneficiaries to get a better deal?
  This motion is simple; it is something the President has talked 
about, something the American people support.
  This motion to commit would instruct the Finance Committee--within 3 
days--to report out a bill that would require the Secretary of Health 
and Human Services to begin negotiating drug prices on behalf of 
seniors in Medicare.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) require the Secretary of Health and Human Services to, 
     beginning not later than one year after the date of enactment 
     of this Act, negotiate the price of drugs covered by the 
     Medicare program on behalf of Medicare beneficiaries.

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senator Duckworth.
  The process Republicans have undertaken to repeal our healthcare law 
has been secretive, wrong, and undemocratic.
  At first, it was 13 chosen apostles--all men--meeting in secret to 
craft their repeal measure.
  At this moment, I don't know who is hiding in the shadows writing 
their repeal measure.
  But what I do know is that there have been no hearings, no 
opportunity for public input, and no opportunity for myself and Senator 
Duckworth--as representatives of Illinois--to offer input.
  If myself and Senator Duckworth have been locked out of the process 
from the beginning, why then should our constituents have to pay the 
price for this partisan Republican effort?
  So our motion is simple. It says that this Republican repeal bill 
cannot unfairly impose hardships on our Illinois constituents. It 
cannot increase costs on my constituents, cut services or benefits or 
eligibility for my constituents, eliminate essential health benefits 
for my constituents, or impose lifetime limits or discriminate against 
my constituents with preexisting conditions.
  If Senator Cruz who has been allowed to have input on this repeal 
bill--wants to rip away health insurance ``root and branch''from his 
constituents, that is fine.
  But this motion protects my constituents in Illinois.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pension with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee;
       (2) prohibit increases in health insurance premiums or out-
     of-pocket health care costs for residents of Illinois;
       (3) prohibit reductions in eligibility or services, or any 
     increases in cost-sharing (including premiums and co-
     payments) related to the eligibility of residents of Illinois 
     to participate in the Medicaid program;
       (4) prohibit health insurance issuers from imposing annual 
     or lifetime limits on residents of Illinois;
       (5) prohibit health insurance issuers from charging 
     residents of Illinois who have pre-existing conditions more 
     than the amount charged to healthy residents; or
       (6) prohibit health insurance issuers from stopping 
     coverage of any essential health

[[Page S4294]]

     benefits provided under section 1302 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18022).

  Mr. DURBIN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  The Commonwealth of Kentucky has benefitted immensely from the 
Affordable Care Act.
  Its uninsured rate has fallen 61 percent, one of the sharpest 
declines of any State.
  Kentucky chose to expand Medicaid, allowing 150,000 people to gain 
coverage.
  More than 1.4 million Kentuckians are no longer subjected to lifetime 
or annual caps on their benefits.
  Kentucky, sadly, has been one of the States hardest hit by the opioid 
epidemic. Thanks to the ACA, substance abuse treatment has increased 
740 percent among Kentucky residents on Medicaid.
  Today, 881,000 Kentuckians--33 percent of adults--have a preexisting 
condition that, before Obamacare, could have left them uninsurable.
  So to ensure the health cand well-being of the residents of my 
neighboring State, Kentucky, this amendment says you cannot increase 
costs; cut services, benefits, or eligibility; eliminate essential 
health benefits; or impose lifetime limits or discriminate against 
Kentuckians with preexisting conditions.
  If the Senators representing the Commonwealth want to rip away health 
insurance from their constituents, undermine protections for 
Kentuckians with preexisting conditions, and raise costs on older 
Kentuckians, well, count this neighboring Senator in to fight on their 
behalf.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Durbin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pension with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee;
       (2) prohibit increases in health insurance premiums or out-
     of-pocket health care costs for residents of Kentucky;
       (3) prohibit reductions in eligibility or services, or any 
     increases in cost-sharing (including premiums and co-
     payments) related to the eligibility of residents of Kentucky 
     to participate in the Medicaid program;
       (4) prohibit health insurance issuers from imposing annual 
     or lifetime limits on residents of Kentucky;
       (5) prohibit health insurance issuers from charging 
     residents of Kentucky who have pre-existing conditions more 
     than the amount charged to healthy residents; or
       (6) prohibit health insurance issuers from stopping 
     coverage of any essential health benefits provided under 
     section 1302 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18022).

  Ms. STABENOW. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Cardin, Murphy, Durbin, 
Baldwin, Blumenthal, Brown, Coons, Duckworth, Feinstein, Franken, 
Heinrich, Klobuchar, Markey, Menendez, Nelson, Peters, Shaheen, Van 
Hollen, and Warren.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Stabenow moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no American will face reduced access to 
     mental health care and services, and that the bill will not 
     reduce the number of individuals with mental illness enrolled 
     in health insurance coverage.

  Ms. STABENOW. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Booker, Baldwin, 
Blumenthal, Brown, Carper, Casey, Coons, Feinstein, Gillibrand, Hassan, 
Hirono, Markey, Menendez, Peters, Shaheen, Van Hollen, and Warren.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Stabenow moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill would not reduce the percentage or 
     number of health plans that cover pregnancy, maternity, and 
     newborn care, and would not increase out-of-pocket costs for 
     such care.

  Ms. STABENOW. Madam President, I intend to offer the following 
motions to H.R. 1628, and I ask unanimous consent that they be printed 
in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Stabenow moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) lower the cost of prescription drugs, including costs 
     for families with private health insurance coverage and 
     seniors enrolled in the Medicare program under title XVIII of 
     the Social Security Act (42 U.S.C. 1395 et seq.).

                   Motion to Commit With Instructions

       Ms. Stabenow moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days, not counting any day on 
     which the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) establishes a refundable tax credit for out-of-pocket 
     health care costs for which a deduction is otherwise allowed 
     under current law.

                   Motion to Commit With Instructions

       Ms. Stabenow moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days, not counting any day on 
     which the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) reinstates, increases, and simplifies the small 
     employer health insurance tax credit.

                   Motion to Commit With Instructions

       Ms. Stabenow moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) increase competition in the individual health insurance 
     market in order to reduce premium costs and out-of-pocket 
     expenses.

                   Motion to Commit With Instructions

       Ms. Stabenow moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no American loses coverage of the essential 
     health benefits under section 1302(b) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18022(b)), 
     including ambulatory patient services, emergency services, 
     hospitalization, maternity and newborn care, mental health 
     and substance use disorder services, prescription drugs, 
     rehabilitative and habilitative services, laboratory 
     services, preventive and wellness services and chronic 
     disease management, and pediatric services.

  Ms. HASSAN. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Casey, Baldwin, Brown, 
Booker, Franken, Kaine, Stabenow, Duckworth, Leahy, Coons, Blumenthal, 
Durbin, Warren, Wyden, Peters, Warner, King, Markey, Cardin, Menendez, 
Nelson, Reed, Udall, Carper, Bennet, Hirono, Cantwell, Heinrich, and 
Van Hollen.
  I would like to take a moment to thank my colleagues for their 
support.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Hassan moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no provision in the bill would reduce or 
     eliminate the amount, duration, or scope of Medicaid services 
     available in schools under current law.

  Mr. MARKEY. Madam President, I intend to offer the following motion 
to

[[Page S4295]]

H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Warner, Brown, Carper, 
Reed, Blumenthal, Warren, King, Klobuchar, Menendez, and Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Markey moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that nothing in the bill would increase costs or 
     decrease benefits for any individual with Alzheimer's disease 
     or another dementia, including provisions that would reduce 
     long term care coverage under the Medicaid program for 
     Americans with Alzheimer's disease.

  Mr. MARKEY. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Manchin, Whitehouse, Brown, 
Blumenthal, Warren, King, Nelson, Warner, and Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Markey moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that nothing in the bill would increase out-of-
     pocket costs or reduce access to treatment, including 
     medication-assisted treatment for Americans suffering from 
     substance use disorders, including those with an opioid use 
     disorder.

  Mr. MARKEY. Madam President, I intend to offer the following motion 
to H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Carper, Warren, Casey, 
Brown, Hirono, Stabenow, Menendez, and Van Hollen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Markey moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that nothing in the bill would increase the 
     amount of uncompensated care provided by hospitals.

  Mr. BENNET. Madam President, I intend to offer the following motions 
to H.R. 1628, and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the health insurance coverage made 
     available to Members of Congress shall not be more generous 
     than the coverage available to Medicaid enrollees who are 
     subject to the per capita cap under section 1903A of the 
     Social Security Act, as added by the bill.

                   Motion to Commit With Instructions

        Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--

       (1) are within the jurisdiction of such committee; and
       (2) strike the repeal of the tax on excessive remuneration 
     of health insurers, and direct the savings from not repealing 
     such tax to funding for treatment of opioid addiction.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would ensure that, if the annual number of deaths due 
     to opioid overdoses increases in any one of the 50 States or 
     the District of Columbia in any year after the date of 
     enactment, sections 126 (relating to the repeal of the 
     Medicaid expansion) and 133 (relating to the per capita caps 
     on Federal Medicaid spending) shall be repealed and the 
     provisions of title XIX of the Social Security Act affected 
     by such sections shall be restored as if such sections had 
     not been enacted.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pension with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) would reinstate funding for risk corridors in order to 
     increase health plan choices and affordability and to prevent 
     the further collapse of cooperatives.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill will not result in increased 
     uncompensated care payments to hospitals under the Medicare 
     program in order to protect the solvency of such program.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) provide that if the Secretary of Health and Human 
     Services determines that uncompensated care at rural 
     hospitals (defined as low-volume or critical access 
     hospitals) has increased as a result of the implementation of 
     this Act, then this Act shall be repealed and those 
     provisions of law that were amended or repealed by this Act 
     (including provisions of the Patient Protection and 
     Affordable Care Act (Public Law 111-148), the Internal 
     Revenue Code of 1986, and the Social Security Act) shall be 
     restored or revived as if this Act had not been enacted.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pension with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) provide that if the United States Census Bureau 
     determines in its 2018 Health Insurance Coverage in the 
     United States report that at least 2,000,000 individuals have 
     lost their health insurance coverage, as compared to the 2016 
     Health Insurance Coverage in the United States report, as a 
     result of the implementation of this Act, then this Act shall 
     be repealed and those provisions of law that were amended or 
     repealed by this Act (including provisions of the Patient 
     Protection and Affordable Care Act (Public Law 111-148), the 
     Internal Revenue Code of 1986, and the Social Security Act) 
     shall be restored or revived as if this Act had not been 
     enacted.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would protect all children who are currently eligible 
     for Medicaid.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) would exempt any group of individuals that is eligible 
     for Medicaid under current law, including children, adults 
     with disabilities, pregnant women, seniors, those who need 
     access to opioid addiction treatment, adults in school, and 
     caretakers, from the Medicaid per capita caps; and
       (3) would establish under title XIX of the Social Security 
     Act a $10,000,000 fund to eliminate waste, fraud, and abuse 
     in State Medicaid programs.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) would strike section 207 of the bill and prohibit 
     States from waiving essential health benefits.

                   Motion to Commit With Instructions

       Mr. Bennet moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days,

[[Page S4296]]

     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) would strike section 205 of the bill and prohibit 
     States from changing the medical loss ratio.

  Mr. MANCHIN. Madam Pesident, I intend to offer the following motion 
to commit that would send H.R. 1628 to the Finance Committee with 
instructions to eliminate any provision that would hurt the clinics 
serving miners with Black Lung by increasing the number of uninsured 
individuals. I ask unanimous consent that it be printed in the Record. 
The motion is supported by Senators Manchin, Brown, Warner, Kaine, and 
Coons.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Manchin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would eliminate any provision that would weaken the 
     financial viability of the Black Lung Clinics serving coal 
     miners with pneumoconiosis, including any provision that 
     would cause an increase in the rate of uninsured individuals 
     in the communities served by those clinics.

  Mr. MANCHIN. Madam President, I intend to offer the following motion 
to commit that would send H.R. 1628 to the Finance Committee to include 
provisions of S. 523, as introduced in the Senate on March 2, 2017, the 
Budgeting for Opioid Addiction Treatment Act, commonly referred to as 
the LifeBOAT Act. This amendment would increase funding for substance 
use disorder treatment by establishing a 1-cent fee on every milligram 
of an opioid medication. It would exempt medication assisted treatment 
and include a rebate for cancer and hospice patients. I ask unanimous 
consent that it be printed in the Record. The motion is supported by 
Senators Manchin, Murphy, Whitehouse, King, Klobuchar, Nelson, 
Heitkamp, Shaheen, Baldwin, and Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Manchin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) include the provisions of S. 523, as introduced in the 
     Senate on March 2, 2017, the Budgeting for Opioid Addiction 
     Treatment Act (commonly referred to as the ``LifeBOAT Act''); 
     and
       (3) offsets any increased spending that results from such 
     changes.

  Mr. MANCHIN. Madam President, I intend to offer the following motion 
to commit that would send H.R. 1628 to the Finance Committee with 
instructions to include provisions that would improve health literacy 
and access to wellness programs and provisions to encourage State and 
local governments to educate their constituents about healthy choices. 
I ask unanimous consent that it be printed in the Record. The motion is 
supported by Senator Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Manchin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would--
       (A) improve health literacy and access to wellness 
     programs, including through Medicaid managed care and health 
     insurance plans that offer education and wellness incentives; 
     and
       (B) encourage State and local health officials to expand 
     health literacy and wellness programs, particularly among the 
     newly insured.

  Mr. REED. Madam President, I intend to offer the following motion to 
H.R. 1628 and ask unanimous consent that it be printed in the Record.
  I move to commit the bill, H.R. 1628, to the Committee on Finance 
with instructions to report the same back to the Senate in 3 days, not 
counting any day on which the Senate is not in session, with changes 
that, No. 1, are within the jurisdiction of such committee; and No. 2, 
ensure that no senior will lose access to long-term care service 
including nursing home care and home and community-based care under the 
Medicaid Program. Medicaid is the largest payer of nursing home care, 
with 900,000 individuals across the country and 4,756 individuals in 
Rhode Island who reside in nursing homes having their care paid for by 
Medicaid. This bill would decimate Medicaid, harming seniors and their 
families. This motion is supported by Senators Blumenthal and Shaheen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                  Motion to Commit With Instructions  

       Mr. Reed moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no senior will lose access to long term 
     care services (including nursing home care and home and 
     community-based care) under the Medicaid program.

  Mr. REED. Madam President, I have a motion to commit the bill, H.R. 
1628, to the Committee on Finance with instructions to report the same 
back to the Senate in 3 days, not counting any day on which the Senate 
is not in session, with changes that, No. 1, are within the 
jurisdiction of such committee; and No. 2, ensure that any cuts to 
Medicaid shall cease to apply in States with fewer than 26 weeks of 
unemployment insurance under State law and shall be reversed in States 
with increased unemployment in a quarter and include a study on 
available job opportunities for those most likely to lose health 
insurance coverage in the next 10 years as a result of the bill. Like 
most of the country, Rhode Island was hit hard by the recession, and 
Medicaid provided a critical safety net. Medicaid can adapt to cover 
those who have lost their jobs or are facing other economic hardships, 
saving families from having to choose whether to take their kids to the 
doctor or put food on the table. Under this bill, States will be unable 
to expand coverage during a recession to those in need and will likely 
be forced to make devastating across the board cuts.
  I ask unanimous consent that the motion be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Reed moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that any cuts to Medicaid shall cease to apply 
     in States with fewer than 26 weeks of unemployment insurance 
     under State law and shall be reversed in States with 
     increased unemployment in a quarter, and include a study on 
     available job opportunities for those most likely to lose 
     health insurance coverage in the next ten years as a result 
     of the bill.

  Mrs. MURRAY. Madam President, with the support of Senators 
Gillibrand, Blumenthal, Shaheen, Stabenow, Hirono, Baldwin, Cortez 
Masto, Hassan, Van Hollen, Leahy, Whitehouse, Brown, Harris, Franken, 
Feinstein, Udall, Kaine, Coons, Cantwell, Menendez, Reed, Duckworth, 
Durbin, Warren, Booker, Baldwin, Carper, Nelson, Heinrich, and 
Klobuchar, I intend to make a motion to commit H.R. 1628, the American 
Health Care Act, to the Senate Committee on Health, Education, Labor, 
and Pensions for further consideration to ensure that it does not 
endanger the health of women. This closed-door, fast-track process is 
no way to make decisions that affect the health of every single woman 
in this country. It is imperative that we fix this legislation in an 
open, regular-order committee process.
  I ask unanimous consent that the motion be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mrs. Murray moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days,

[[Page S4297]]

     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that make it harder for women to 
     access health care, by--
       (A) preventing women from accessing care through trusted 
     health care providers;
       (B) allowing or requiring insurance companies to offer 
     plans that do not fully cover women's health care needs;
       (C) charging women more for coverage; or
       (D) ripping away women's access to the coverage they 
     receive today.

  The PRESIDING OFFICER. The Senator from Wyoming.

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