[Congressional Record Volume 163, Number 127 (Thursday, July 27, 2017)]
[Senate]
[Pages S4349-S4361]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    AMERICAN HEALTH CARE ACT OF 2017

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of H.R. 1628, which the clerk will report.
  The senior assistant legislative clerk read as follows:


[[Page S4350]]


  

       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.
       McConnell (for Daines) modified amendment No. 340 (to 
     amendment No. 267), to provide for comprehensive health 
     insurance coverage for all United States residents, improved 
     healthcare delivery.

  The PRESIDING OFFICER. Under the previous order, the time until 2:15 
p.m. will be equally divided between the leaders or their designee.
  If no one yields time, time will be charged equally to both sides.
  The Senator from Delaware.
  Mr. CARPER. Mr. President, I spent many years of my life in Navy 
airplanes. I am a retired Navy captain. Senator Alexander said 
something the other day about the fact that a pilot doesn't start up 
and take off in an airplane unless he or she knows what the destination 
is. I thought that was pretty interesting. It is true.
  With respect to healthcare in this country, we have actually known 
for a long time what the destination is, and the destination is a 
combination of three things: better healthcare coverage for less 
money--and cover everyone. That is really our destination. It is not 
just the destination this year in this Congress; it has been our 
destination really since Harry Truman was President.
  For some years, we have argued and disagreed about how to get to the 
destination. I don't think anyone would argue about the need to get to 
that destination, but the question is how.
  In 1993--I mentioned yesterday in my remarks on the floor--Hillary 
Clinton was a brandnew First Lady and worked on something called 
HillaryCare. In response, Republicans came up with something that 
really has its roots and origin from the Heritage Foundation. They had 
more of a market-based approach, which called for every State having 
their own exchange, where people without coverage could get healthcare 
coverage. There would be a sliding scale tax credit that would help buy 
down the cost of premiums for folks who got the coverage in their 
State's exchange. Low-income people got a bigger tax credit. Higher 
income people had a smaller tax credit that would eventually fade away.
  The third piece of the Republican alternative to HillaryCare was the 
idea of an individual mandate, which basically said that everybody has 
to get coverage. If you don't, we can't make you, but you have to pay a 
fine. Over time the fine would go up.
  The fourth piece of the Republican proposal in 1993 was that 
employers of a certain size with a certain number of employees would 
have to make sure they provided coverage for their employees. I don't 
remember a lot of specificity of what that coverage would include, but 
if they had quite a few employees, they would have to provide coverage 
for them, make it available.
  The last piece was the idea that health insurance companies would say 
at that time: If you have a preexisting condition, sorry, we are just 
not going to cover you. The Republican proposal said: That is verboten. 
You can't do that, insurance companies.
  So that was their idea that was introduced here. There were, I think, 
about 23 cosponsors, led by John Chafee, who was a former marine, 
former Governor of Rhode Island, U.S. Senator, and highly regarded. The 
legislation he introduced in 1993 had 20, 22 cosponsors, I think, 
including some people who are still here--Senator Hatch, Senator 
Grassley, and a number of others. That idea became RomneyCare.
  In 2006, Governor Romney sought to cover everybody in the State of 
Massachusetts before running for President. It was a pretty good idea. 
It was such a good idea that when we worked on the Affordable Care Act, 
that idea was one of the major principles, one of the major pillars of 
the Affordable Care Act.
  Now--I said this yesterday--Barack Obama gets credit for coming up 
with that approach to provide healthcare. He is a smart guy, but that 
wasn't his deal. He didn't come up with that. I didn't come up with 
that. Governor Romney didn't come up with that. I don't think Senator 
John Chafee, beloved Senator from Rhode Island--neither he nor Senator 
Hatch nor Senator Grassley came up with that. I think it was an idea 
from the Heritage Foundation. It is probably heresy, as a Democrat, to 
say this, but it was a good idea. It was a good idea in 1993. It was a 
good idea in 2006 in Massachusetts, and it was a good idea when we 
folded it into the Affordable Care Act as one of the major pillars.
  I want to go back and revisit 2009 just for a little bit. There are 
those who believe that there was no bipartisan involvement and the ACA 
was just hustled through without a lot of thought or debate. As it 
turns out, I think we spent 80 days all total in the U.S. Senate in 
that Congress in 2009, debating the bill in committees--the two 
committees of jurisdiction. I served then and I serve now on the 
Finance Committee. We spent a heck of a lot of time in debates and 
markups where people had a chance to offer amendments, debate them. The 
Health, Education, Labor, and Pensions Committee spent a lot of time 
that year, 2009, similarly in bipartisan hearings, with bipartisan 
amendments, debate.
  All totaled, I believe, over 300 amendments were offered in Senate 
committees of jurisdiction, and I am told that 160 amendments offered 
by Republican Senators were adopted and made part of the legislation.
  I know our Republican colleagues believe that they were shut out of 
the process, but I think a closer review of that process in history 
would suggest that just wasn't so. Was it a perfect process? No. Could 
it have been better? Sure. You can always do things better. But it was 
a process that we went through in order to address this concern.
  In 2008, during that year's election, one of the things I learned was 
that we were spending in this country, as a percentage of GDP for 
healthcare, 18 percent of GDP. I have a friend who, when I ask him how 
he is doing, says: Compared to what?
  I would just say: Well, what were the Japanese spending in 2008 as a 
percentage of GDP for healthcare? It was 8 percent. Think about that. 
Well, maybe we got better results; maybe people live longer in this 
country or we have lower rates of infant mortality than the Japanese. 
No, it is not true. They got better results. They spent half as much, 
and they got better results.
  Well, maybe a lot of people in that country didn't have coverage and 
we covered everyone. Actually, just the opposite is true. They covered 
everyone. We had 40 million people who went to bed in 2008 without any 
healthcare coverage, and for a lot of them, access to healthcare 
coverage was the emergency room of a hospital.
  As you all know, as we know, when people get sick enough, they will 
get care in this country. It may not be cost-effective care. It may be 
expensive care because it is not just an emergency room visit. In many 
instances, it is the admission to the hospital and a stay that could 
last for days or even weeks. We do have some idea how much it costs to 
stay in the hospital. It is hugely expensive. Eventually, people would 
get healthcare coverage or healthcare attention, but a lot of times it 
costs an arm and a leg, literally and figuratively. So the question 
was, could we do better than that?
  What we came up with is a multifaceted approach, which includes that 
Heritage Foundation idea of the exchanges where people didn't have 
access to coverage. And the focus would be not just on spending money 
on people when they were sick, but to save us--not to have so much a 
sick care system, but to have a healthcare delivery system that focuses 
more on helping people to stay healthy and well, with a much bigger 
focus on prevention and wellness and frankly a focus on, for example, 
making sure people, when they reach the age of 50, get a colonoscopy 
and they don't have to pay a whole lot of money to get it because it 
would be part of their health insurance coverage.
  I have a friend whose mom died several years ago. My friend and I 
work out at the YMCA in Wilmington from time to time. She just turned 
50, and I said: Well, how old are your parents? My friend is really 
fit, and I said: How old are your parents now?
  She said: They are both deceased.
  I said: Really? What happened?
  She said: My mom died of colon cancer a number of years ago.
  I said: Didn't she get the colon screening--the colorectal screening 
and all?

[[Page S4351]]

  She said: No, no, no. She didn't like that, didn't want to do that. 
It costs a lot of money, and so she just didn't do it.
  We have other people who, over the years, have not had prostate 
screenings for prostate cancer, and we have had people who didn't have 
breast cancer screenings because, in some cases, it is unpleasant and, 
in some cases, just because it can cost a lot of money, and a lot of 
that was out of pocket, so people would forego that. We have changed 
that. We want people to get the screenings and to be able to get those 
screenings and find out and make sure that they are not going to get 
sick and cost a lot of money.
  My friend's mother was sick for many months. I can't imagine how much 
it cost--and all that for maybe a $1,000 colorectal screening that was 
not taken.
  We don't do that stuff in this country much anymore. We actually 
offer the screenings. They are free. With our focus on wellness and 
prevention and things like annual physicals, we want to catch problems 
when they are small.
  One of the reasons healthcare coverage in Japan--as a Naval flight 
officer, I flew a lot of missions in and out of Japan during the 
Vietnam war, and one of the things I learned about Japan is that, one, 
the people are very slender. In this country, about one-third of our 
people now are obese or on their way to being obese. Obesity is a great 
precursor, which says that this person is going to have healthcare 
problems and costly healthcare problems. There are a lot of people in 
this country who still smoke--not as many as before--but that is 
another predictor of people on whom we are going to have to spend a 
whole lot of money.
  The other thing that caught my eye in Japan was the access to primary 
healthcare close to where people live. In almost every neighborhood of 
any consequence, people had access to a clinic where they could go for 
a checkup, for a physical to catch problems when they are small and to 
address them when they are small. As we looked around the world at 
things that were working, that would seem to be something that worked, 
we tried to make sure that was part of our approach in the Affordable 
Care Act.
  Another thing we found that worked is, in some countries and 
literally here in this country--the Mayo Clinic, the Cleveland Clinic, 
and places like that--one of the secrets of their success, better 
results for less money, is the idea of coordinating the delivery of 
healthcare--coordinating the delivery of healthcare.
  My mom, now deceased, lived until she was 82. She had dementia. She 
had arthritis. She had congestive heart failure. She had any number of 
ailments. My dad had passed away several years earlier. She lived near 
Clearwater, FL. We had people--my sister had people living with her to 
take care of her until later in her life. At one time, my mom was 
seeing five or six doctors. They were prescribing a total of 15 
medicines for her. I remember we had in her home something that looked 
like a fishing tackle box--my dad's fishing tackle box. You may have 
seen one of these. If you open it up, it has all these medicines in it 
to take before breakfast, with breakfast, after breakfast, before 
lunch, all the way to bedtime, and they are all set up and 
arranged. Fifteen different medicines she was taking from five or six 
doctors who never talked to each other. Nobody had any idea what was 
being prescribed for my mom. Nobody was coordinating that care. That is 
foolish. I know a lot of those medicines probably interacted badly with 
each other and hastened my mom's decline and death.

  The focus we had on the Affordable Care Act, with coordinated 
delivery of healthcare among different doctors and different 
specialties and with hospitals, nursing homes, federally qualified 
community health centers, and the VA, we do a much better job at 
coordinating delivery of healthcare.
  In Delaware, we just don't have electronic health records for 
healthcare--we have those all over the country now. One thing that came 
out of the Affordable Care Act was we put the pedal to the metal and 
said we want a whole lot more electronic health records being used that 
talk to each other for coordinated delivery of healthcare--better care. 
Delaware took it a step further. In Delaware, we have something called 
the Delaware Information Network, which I signed into law, authorizing 
it in my last term as Governor. I had no idea really what the potential 
was of what we were doing, but with some help from the Federal 
Government, we have now just a terrific utility, a terrific mechanism 
to help us take this idea of coordinating delivery of healthcare and 
put it on steroids and further improve the quality of healthcare.
  I have been approaching this day with real concern. I am an 
optimistic guy. I am a glass half-full guy, but I have been troubled a 
lot more than not. I went home last night and my wife met me at the 
door and she said: You don't seem yourself. I said: I am troubled, and 
she said she was too. She had been watching too much TV. There are a 
lot of concerning things going on in this city, at the White House, and 
even in this building.
  We are at our best when we work together. We Democrats didn't create 
Social Security by ourselves. The GI bill--I was a beneficiary of the 
GI bill at the end of the Vietnam war, and so was my father at the end 
of World War II. There have been good ideas like Medicare. Democrats 
didn't create them by themselves, Republicans didn't create them by 
themselves. We worked together to create those landmark pieces of 
legislation and programs that all of us would agree are good for this 
Nation and good for our people.
  When you are dealing with a subject that involves maybe everybody in 
the country and perhaps one-sixth of our population, this is one we 
ought to do together. We ought to do this together.
  John McCain and I served during the Vietnam war. We came to the House 
of Representatives together, and we worked on normalizing relations 
with Vietnam. He was a Senator with John Kerry, and I was a House 
Member with a bunch of my colleagues over there.
  John McCain stood right over here a couple days ago. We were all 
happy to see him back. We welcomed him back because we need him and his 
leadership. He said a number of times during his remarks that what we 
need is regular order.
  I guess people who might have been watching on C-SPAN are wondering 
what is regular order.
  We have a new crop of pages here. Let me just say to our pages who 
are rising juniors and coming from States all over America and actually 
do a great job of helping make sure this place doesn't get too messed 
up in more ways than one, regular order is when people have a good 
idea, whether it is in healthcare, defense, or agriculture, and 
actually take their good idea and introduce legislation. I try to 
introduce legislation most times with bipartisan support. I have 
learned you get better results in the end if you do that.
  The idea of regular order is introducing legislation that reflects 
and addresses a need or an issue. That bill is introduced here in this 
Chamber. It is assigned by the Parliamentarian to the committee of 
jurisdiction. The sponsor or sponsors of the bill go see the chair of 
the committee where the bill is assigned and ask for a hearing. If they 
convince the chair of the committee it is a good bill, with a good 
idea, then there is a good chance they will have a hearing. At that 
hearing will be witnesses--expert witnesses, stakeholders. Those 
witnesses will say: I like this about that bill or I see a problem with 
that bill, and there are changes that should be made to the bill. In 
some cases, we invite the Congressional Budget Office, sometimes 
Senators or House Members to come in and testify as well.
  On an issue that is this important, we need regular order because 
whatever the Republican ideas are--and hopefully we will find out what 
their ideas are today--we need to check the tires, take the time to 
find out what is good about it and what is not and fix it in committee, 
where Democrats and Republicans can offer amendments, debate them. That 
would be done in the Finance Committee and also in the Health, 
Education, Labor, and Pensions Committee.
  That is what we ought to do. If we take that approach, we will end up 
with a better final result; rather than being a country that looks at 
other countries around the world, asking: Why does Japan get better 
results than

[[Page S4352]]

we do, spending half as much money and they can cover everybody--why is 
that?
  I am proud of much of what we do in this country with respect to 
healthcare; in many ways, we are on the right track, but as I said, in 
everything I do, I know I can do better. We can sure do a better job on 
healthcare.
  Last thought. I see we have been joined by the Democratic leader, and 
I will say a few words before yielding the floor. I was fortunate 
enough to visit Tanzania with my wife. We met our sons over there two 
summers ago. After going to a seminar, we went out across the country, 
had a chance to just see an amazing--for those who have never been 
there, and I never spent much time in Africa, it was an incredible 
experience, all the life and animals and nature and it was beautiful 
and incredibly exciting. One of the many things I learned there was 
this proverb, and it goes something like this:

  African proverb: If you want to go fast, go alone. If you want to go 
far, go together.
  If you want to go fast, go alone. If you want to go far, go together.
  We need to hit the pause button. We need to fix the exchanges in 
every State to stabilize the exchanges. There are three easy ways to do 
it: make clear that the individual mandate is going to be maintained or 
replaced by something that is at least as effective; a doctor 
reinsurance program that will help stabilize the program, much as 
reinsurance was used as a mechanism to stabilize and make successful 
the Medicare Part D Program; and, finally, we should make clear that 
the cost-sharing arrangements we have, the subsidies that help reduce 
the costs, the copays and deductibles for people getting their coverage 
in the exchanges, just make it clear they are not going to go away. The 
insurance companies tell us, if we would do those three things--secure 
the individual mandate or something as good as the individual mandate, 
reinsurance, and address the cost-sharing arrangements, that they are 
not going away--if we do those three things, they tell us the cost of 
premiums across the country would drop by as much as 25 percent to 35 
percent.
  Think about that. What you would have is the insurance companies not 
fearing they are going to lose their shirts because of not having a 
pool of people they can insure. They are fearful of having a pool of 
people to insure in the exchanges that are sick, crippled, and there 
are not a lot of young, healthy people who create a mix that can 
actually, effectively and predictably, be insured by insurance 
companies. The great thing about reducing premiums by 25 to 35 percent 
in the exchanges is this. People who get the coverage in the exchanges 
benefit. They save money.
  Do you know who else saves money? Uncle Sam, because we are paying a 
significant amount of support to help make sure the exchanges 
envisioned all those years ago by the Heritage Foundation--to make sure 
they work.
  That sounds like a pretty good step: hit the pause button; stabilize 
the exchanges; make sure we have coverage for people in every State 
through the exchanges in every county and bring down the premiums by 25 
percent to 35 percent; provide certainty and predictability for the 
insurance companies. With that predictability and certainty, we have 
more competition. The insurance companies get into the game, and they 
say we are going to offer policies as well.
  After we have done that, let's pivot and address, as Democrats and 
Republicans working together, fixing those parts of the Affordable Care 
Act that need to be fixed and preserve the parts that need to be 
preserved. Let's do that together.
  With that, I yield the floor.


                   Recognition of the Minority Leader

  The PRESIDING OFFICER. The minority leader is recognized.


               Thanking the Senior Senator from Delaware

  Mr. SCHUMER. First, let me thank my colleague, the senior Senator 
from Delaware, not only for his remarks but for his constant, 
conscientious concern about this country in just about every area. 
Whenever he speaks, he has a great deal of thought behind it because he 
is always thinking. My guess is, he is thinking while he sleeps at 
night. He has so many thoughts. It also comes from a good soul and a 
good heart because he really cares about making this country better and 
is working together in a bipartisan way to do that whenever he can. I 
thank my colleague.
  Mr. President, it is likely, at some point today, we will finally see 
the majority leader's final healthcare bill, the bill he intends to 
either pass or fail. Thus far, we have been going through a pretense, 
defeating Republican bills that never had enough support even within 
their own caucus to pass. Repeal and replace has failed. Repeal without 
replace has failed. Now we are waiting to see what the majority leader 
intends for the Republican plan on healthcare. If the reports in the 
media are true, the majority leader will offer a skinny repeal as his 
final proposal.
  As I mentioned last night, Democrats will offer no further motions or 
amendments until we see this skinny bill, but make no mistake, once we 
do see the bill, we will begin preparing amendments. In the event the 
bill fails, we can move directly to the NDAA, and out of deference to 
my dear friend Senator McCain, we will work to move that piece of 
legislation quickly.
  If the skinny bill passes, remember, Democrats have an unlimited 
right, after it passes, to offer an unlimited amount of amendments. 
Now, many of my colleagues have many amendments on healthcare. They 
have just been waiting to see the final bill Leader McConnell will 
bring to the floor.
  I want to put my colleagues on both sides of the aisle on notice, my 
Democratic and Republican colleagues, that they should prepare for 
numerous Democratic amendments if the skinny bill passes. With the 
skinny bill passing--I hope it doesn't, but if it does--it will not be 
the last vote. There will be many more after that to change it and to 
modify it. I want everyone to understand that.
  I also want everyone in this body to understand the consequences of 
the skinny repeal. We Democrats asked the nonpartisan Congressional 
Budget Office to score the skinny repeal based on the four or five 
provisions of the bill that seem to be what the majority leader is 
considering: get rid of the individual mandate, get rid of the business 
mandate, get rid of the Cadillac tax, get rid of the tax on medical 
devices, and get rid of some of--I believe they considered getting rid 
of some of the essential healthcare provisions as well. Even if the 
bill is slightly different from the one we asked to be scored, the 
score will be pretty much the same.

  To my colleagues on the other side of the aisle who are thinking of 
voting for this skinny bill, listen to what the CBO said, which is 
nonpartisan and headed by a Republican whom Senator McConnell and 
Speaker Ryan agreed to appoint. The Congressional Budget Office said 
that a skinny repeal would cause 16 million Americans to lose 
insurance, and millions of Americans would pay 20 percent more for 
their premiums starting next year. Premiums would go up 20 percent--not 
3 years from now but in January--according to the CBO.
  Let me repeat that.
  A skinny repeal means 16 million fewer Americans with insurance and 
premiums up 20 percent next year and will stay there. It is not that 
they go down later, as in one of these CBO estimates of one of the 
other Republican bills. They stay there, getting higher every year, 
with people paying more and more. The premiums will go up immediately, 
as early as January 1, as I mentioned--not 3 years forward but on 
January 1. One of the promises our Republican friends have made over 
and over is to bring down premiums, but a skinny repeal would break 
that promise, and the American people would see it in just 5 months.
  Yesterday, a bipartisan group of Governors sent a letter that urges 
us away from a skinny repeal--these are the Governors, bipartisan--
warning that it would ``accelerate health plans leaving the individual 
market, increase premiums, and result in fewer Americans having access 
to coverage.'' Republican Governors Sandoval and Kasich and a few other 
Republican Governors were on that letter.
  Now, the argument from the Republican leadership is for Republicans 
to vote for this bill because they made a campaign promise to repeal 
and replace the Affordable Care Act. Yet I ask my Republican friends: 
Did you

[[Page S4353]]

promise the American people that you would raise premiums on everyone? 
I didn't hear that in the promises. That is what a skinny repeal does. 
Did you promise the American people that you would take healthcare away 
from tens of millions? I didn't hear that. That is what the skinny bill 
does.
  No, the Republicans not only promised to repeal the Affordable Care 
Act, but they promised to replace it with something better. I do not 
know why, but, somehow, the first promise is more important than the 
second. The skinny plan manages to anger everyone--conservatives, who 
know it is a surrender and know it does not come close to the full 
repeal they promised, and moderates, who know that it will be terrible 
for their constituents.
  Is this the one plan that finally unites the Republican Senate--a 
plan that angers everyone--conservatives, moderates, and, perhaps, most 
of all, the American people? I cannot believe that, and I hope it would 
not.
  If the Republicans pass such a devastating plan, either one of two 
things could happen. The House could simply take up the skinny bill 
repeal, making all of those terrible possibilities a reality--premiums 
would go up in January, and insurance markets would collapse. In fact, 
if the House passed this skinny bill, our entire healthcare system 
could well implode. Everyone who voted for it, regardless of 
motivation, will regret it.
  Or they could take it to conference, which is a pathway to full 
repeal. In conference, the Freedom Caucus will demand a full repeal--or 
something close to it--with all of the associated cuts to Medicaid and 
tax breaks for the wealthy, which so many here in the Senate have 
labored months to undo.
  So this thing is turning into a game of hot potato. The House passed 
a bill that they do not like. They had to hurry it up. They had to do 
it twice and pass the hot potato to the Senate. Senator McConnell is 
juggling that hot potato. He cannot get the repeal, and he cannot get 
repeal and replace. So he comes up with this plan that no one likes, 
but they say: OK, we can send the hot potato back to the House.
  How many more months is this going to go on, when we could be sitting 
down, in a bipartisan way, as my good friend from Arizona has 
recommended, and work together in the committee process?
  In the gym this morning, I saw Lamar Alexander, the head of the HELP 
Committee. We see each other just about every morning in the gym. I was 
wearing, I think, my Syracuse T-shirt, and he was wearing his Tennessee 
Volunteers T-shirt.
  I said to Lamar: If this skinny bill goes down, as it should--and I 
spoke to Patty Murray, our ranking member--we will sit down and work in 
a bipartisan way to improve ObamaCare. We know that ObamaCare needs 
some work. We do not deny that. Let's do it in a bipartisan way instead 
of passing this hot potato back and forth, back and forth, back and 
forth, and not getting anything done.
  While our leaders are passing this hot potato, insurers will be 
setting their rates for 2018. That means that insurers will lock in 
rates for the next year with this massive uncertainty hanging over 
their heads, leading to huge rate increases or decisions to pull out of 
markets. A skinny repeal as a way to get to conference is a recipe for 
disaster. Beyond that, it is a shameful way of legislating.
  My Republican friends should listen to the wonderful speech that the 
man whom we admire gave--John McCain--when he came back. We should be 
working in a bipartisan way. My Republican friends, you should not be 
passing a bill that you do not support or believe in, that you pray 
will not become law. If you believe that this bill should become law, 
vote yes, but if you do not believe that the bill should become law, 
you vote no--plain and simple. Then we can resume in the Finance 
Committee and in the HELP Committee a bipartisan process of making the 
present healthcare system better, which needs to be done.
  You do not vote to advance terrible legislation and hope that it will 
magically get better in conference. Let's not forget that, months ago, 
many House Republicans justified their voting for their nightmare bill 
because they thought that it would get better in the Senate. It has not 
gotten any better. In fact, it has only gotten worse, and a conference 
will be no different. Voting yes on a bill that you do not support just 
to get it to conference is an unserious way of legislating, 
particularly on this issue, but that is, so far, what the Republican 
leader is doing.
  There may be no better example than the amendment offered by Senator 
Daines, which favors Medicare for all. I cannot believe that this is 
happening, because all of the Republicans are going to vote against it. 
It is just pure cynicism, pure politics, and is not a serious effort to 
legislate and make things better when people need help. Senator Daines 
does not support the bill. He just wants to get Democrats on the 
record. The majority leader has made pending an amendment that both he 
and the author of the amendment will oppose, and that is the very 
definition of a political game.
  We Democrats are not going to go along, because this is not a game. 
This is not a joke. It is not hot potato. We are talking about people's 
lives. We do not have time for phony amendments or phony bills. You do 
not play games with the healthcare of the American people.
  As I said, anyone who listened to the eloquent words of my dear 
friend from Arizona should blush at this process. His was a clarion 
call that both sides of the aisle can do better. He criticized his side 
for being partisan, and he criticized our side for being partisan. He 
is right on both counts. We all can do better. Let's start. The Daines 
amendment does not do that. That is for sure. The only answer is to 
start over together, to work together through regular order, and to get 
some legislation that we can all live with.


                            Russia Sanctions

  Mr. President, I have one other point, on Russia sanctions. It is 
apropos. I didn't know, when we read all of this stuff, that my good 
friend from Arizona would be here. Even as we debate other items on the 
floor, we should not delay this legislation on the Russia sanctions any 
longer.
  Last night, the chairman of the Foreign Relations Committee here in 
the Senate said that he was ready to move the package quickly. That is 
what Senator Corker said, and I am glad he did. I will work with the 
majority leader to send this legislation to the President's desk before 
the recess. We have already cleared this legislation on the Democratic 
side. We are prepared to move it by unanimous consent at any time.
  I hope the White House signs this. This morning, the White House 
Communications Director said that President Trump may veto the 
legislation so that he could make a tougher deal with Russia than could 
Congress. The idea that the President would veto this legislation in 
order to toughen it up is laughable. I am a New Yorker, too, and I know 
bull when I hear it. If the President vetoes this bill, the American 
people will know that he is being soft on Putin, that he is giving a 
free pass to a foreign adversary who violated the sanctity of our 
democracy by meddling in our election and who seeks to undermine 
democracy and American life in any way he can. I hope and expect, if 
the President decides to use the first veto of his Presidency on this 
bill, that Congress will swiftly override it.
  I see my friend here, the majority leader. I appreciate his work on 
making this Russia sanctions bill happen and being available. I hope 
that we will get the House bill to the President's desk, and I hope the 
President signs it.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Sullivan). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. McCAIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Is there objection to vitiating the quorum 
call?
  Without objection, it is so ordered.


                                  NDAA

  Mr. SCHUMER. Mr. President, I will just clarify, the Republican 
leader and the chair of the Armed Services Committee want to discuss 
NDAA. They will not make any motion to move to it. I have no problem 
with them discussing it.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Mr. President, while the Democratic leader is still on 
the floor, I just wanted to mention that I

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understand his concern about the healthcare issue and the amendments 
and the process for moving forward and the necessity for doing so. I 
made my views very clear; I won't repeat that eloquent speech I made. I 
would just like to say to my friend from New York that we do have a 
bill that passed through the committee 27 to 0--not a single person 
against it--after many days of debate, amendments, discussion, 
including a couple hundred amendments that were disposed of in the 
tradition of the Armed Services Committee. I believe it is in 
everybody's interest to go ahead and take up the Defense bill so that 
we can go to conference and resolve other issues, such as 
sequestration, et cetera.
  I understand the frustration my friend from New York feels, but where 
I have a disagreement with my friend from New York is saying that these 
two issues are inseparable. I believe that our obligation to the men 
and women in the military is transcendent.
  I understand the frustration of the Senator from New York. I was here 
when, with 60 votes, the bill was rammed through over Republican 
objections without a single amendment. I understand his frustration.
  What the majority leader and I are asking for is just that tomorrow 
we take up the NDAA bill. We can get it done in a few hours. We can 
send it to conference, take care of the equipment, training, all of the 
things the men and women who are serving in the military need.
  By the way, I understand the emotion on the other side. I felt the 
same emotion on this side some years ago, and I haven't forgotten it 
yet. So I would hope--and I know the Senator from New York has to 
discuss with his conference this issue of the Defense authorization 
bill. I would remind him and all of my colleagues that for 53 years 
now, we have passed and had the President of the United States sign the 
Defense authorization bill. That is a precedent that I really hope we 
do not break, because of our obligation to the men and women who are 
serving in the military. I know the Senator from New York feels exactly 
the same way.
  I am not impugning the integrity of the Senator from New York. I just 
ask that we consider it. I know the Senator from New York has to go 
back to his conference. I hope they all will consider it.
  Let me just finally say, I note, for example, the Senator from 
Virginia here on the floor, who has been a vital part of the--no, not 
the other one; not him. Both have been vital members of the Armed 
Services Committee. Yes, we have our disputes. Yes, we have our 
arguments. Yes, we are spirited. But we come out unanimously in favor 
of taking care of the men and women in the military.
  I hope the Senator from New York will consider this.
  Mr. SCHUMER. Will my colleague from Arizona yield so that I can 
answer him before the majority leader speaks?
  Mr. McCAIN. Yes.
  Mr. SCHUMER. First, I wish to express our respect for the Senator 
from Arizona. My dear friendship--really love for the man is unbounded.
  I am repeating in my head, as many of us have, the speech our friend 
from Arizona gave when he came back, and we were all so joyous that he 
did. He talked about going to regular order. He talked about working in 
a bipartisan way. He talked about doing this healthcare bill the right 
way--with hearings, with debate, with amendment. Even I accepted his 
chastisement that we passed a partisan bill. He knows the record shows 
I didn't want to do that. But we did have debate and amendments. We had 
a process where six people--three from each party--spent 6 months 
trying to come to an agreement. They did not.
  But I must say the reason that we must ask unanimous consent to go to 
the bill is because we are in reconciliation--the very process that has 
prevented us from debating, from having hearings, from having some kind 
of bipartisan input. I would say to my colleague, if you want to get 
rid of this reconciliation, fine. Let's recommit the bill to committee 
and start on a fair process, and we can go to NDAA immediately--in an 
hour--if we were to do that.
  The reason we can't do that is our dear friend the majority leader is 
insisting on the reconciliation process. And you can't say--we can't, 
because we feel defense is important and we feel the healthcare of tens 
of millions of Americans is equally important. And we can't say you can 
turn on and turn off the reconciliation process when you want to and 
when you don't. What is good for the goose is good for the gander.
  If reconciliation is poor and prevents NDAA from coming up 
immediately, it is equally poor--maybe more so--when it comes to 
healthcare.
  So my plea and suggestion: Let's not go forward with this bill. We 
don't even know what it is yet. Let's go back to committee.
  I spoke to Senator Alexander, I spoke to Senator Murray this morning. 
If this bill fails, they will go back and try to negotiate bipartisan 
improvements--just as my good friend from Arizona recommended when he 
came back and gave his moving speech.
  But my caucus--I have spoken to a few--feel very strongly that this 
process on healthcare has been awful, and it is because of 
reconciliation, and now reconciliation has put NDAA in a bind as well. 
Let's get rid of reconciliation, and we can do what the Senator from 
Arizona wants and what I think the American people want--a fair 
process.
  I yield the floor.
  Mr. McCAIN. Mr. President, reclaiming my time.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that my remarks 
count against leader time.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Arizona.
  Mr. McCAIN. Mr. President, I don't want to continue; our leader has 
important words to say. All I can say to the Senator from New York is, 
this is not the same. Defending the Nation is our first priority. That 
is what our Declaration of Independence says. That is the basis for all 
of our roles here. There are men and women who are in harm's way today, 
whose lives are in danger, who need this legislation in order to be 
better equipped and better able to defend themselves and this Nation.
  I am asking for a few hours because, as my two colleagues over there 
will state, we passed this bill 27 to 0 through the Armed Services 
Committee. We fight. We argue. We insult. But the fact is, we come out 
with a product that we are proud of, and then all of us have support.
  So all I am asking of the Senator from New York is if we could go off 
of this for a few hours, because we have basically an agreement on 
amendments, and get this thing to the President's desk so that he can 
protect and defend this Nation. That is all I am asking.
  Mr. SCHUMER. Mr. President, I would simply say once more to my 
colleague briefly--
  The PRESIDING OFFICER. The Democratic leader.
  Mr. SCHUMER. We can do both. We can do both. It is very simple. It is 
just what my dear friend from Arizona asked about 2 days ago: regular 
order on both. We can have both.
  You can't ask--it is unfair, in my judgment--and I have great 
respect--to ask for one and then continue to tie our hands on 
reconciliation on healthcare.
  I yield the floor.
  Mr. McCAIN. Mr. President, very quickly, that is equating these two 
issues at the same level of concern. I would argue that defending this 
Nation and the men and women who are serving it is our first priority. 
I don't wish to debate the Senator from New York.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. Mr. President, this is becoming overly complicated. 
The chairman of the Armed Services Committee and I are talking about 
what comes next after we finish the healthcare debate. As we discussed 
in my office a few moments ago, the chairman would like to turn to NDAA 
next. Healthcare, whether our friends on the other side like it or not, 
will come to a conclusion here at some point. The issue is what comes 
next.
  As the chairman of the Armed Services Committee has pointed out, this 
is a totally separate issue and, as he pointed out, a bill that came 
out of his committee 27 to 0. As we all know, he is available to manage 
that bill this week.
  What I am saying to our colleagues on both sides of the aisle is when 
we

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finish healthcare either the way I would like to finish it or the way 
our Democratic friends would like to finish it, we are going to try to 
turn to NDAA and accommodate the chairman's schedule and give him an 
opportunity to finish that bill while he is here. That is the issue.
  So I hope we will be able to work our way toward that when we finish 
healthcare. I will ask unanimous consent--not now, but I will be asking 
for unanimous consent to turn to the National Defense Authorization 
Act.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, last Wednesday at the White House, 
President Trump invited Republican Senators there, and he recommended 
to us that we repeal and replace ObamaCare at the same time, 
simultaneously. He said that before in his interview on ``60 Minutes'' 
in January--we should repeal and replace ObamaCare simultaneously, 
which means, to me, at the same time.
  That is one reason I voted yes on Tuesday for us to proceed to the 
House of Representatives' bill, because it would replace and repeal 
ObamaCare at the same time. That is one reason I voted on Tuesday for 
the Senate healthcare bill, which would have replaced and repealed 
ObamaCare at the same time. I agree with the President--we should 
replace and repeal ObamaCare at the same time. The House voted to do 
that, the President recommended we do it, and I agree we should repeal 
and replace at the same time.
  Why would I say it needs to be done at the same time? There was a 
time in the past where we might have just repealed it and said: In 2 
years, we may come up with an answer. But we can't do that now. 
Conditions have changed in Tennessee. Our State insurance commissioner, 
Julie McPeak, says our individual insurance market is ``very near 
collapse.'' That means that up to 350,000 individuals in our State--
songwriters, workers, farmers--who buy their insurance on the 
individual market are sitting there worrying in July and in August 
whether they will have any option to buy insurance in 2018.
  So I don't think we can wait 2 years to repeal and replace ObamaCare, 
which is why I voted twice on Tuesday to do it now and why I voted 
against an amendment yesterday that said: Repeal it now and replace it 
in 2 years, if you can. I don't think Tennesseans would be very 
comfortable canceling insurance for 22 million Americans now and 
saying: Trust Congress to find a replacement in 2 years. Pilots like to 
know where they are going to land when they take off, and so should we.
  We are proceeding ahead with our debate on the healthcare bill. It 
may be a little convoluted for people watching from the outside, but it 
is fairly straightforward. The House of Representatives has gone 
through a series of processes in committees and votes, and it passed a 
bill to repeal and replace ObamaCare now, to do both now. The Senate 
has been working for 6 months not just to repeal ObamaCare but to 
repeal and replace it now.
  There is some urgency about this. We have millions of Americans who 
are worrying they may not be able to buy insurance in 2018. That is a 
very personal worry for millions of Americans. They want us to address 
it now, not 2 years from now.
  How do we do that? Well, later today we will have an opportunity to 
vote for a bill which will take us to the place called a conference 
committee with the House of Representatives, where we can get a 
solution to our goal of repealing and replacing ObamaCare now. It is 
being called a skinny bill because it won't have much in it. It is not 
a solution to the Affordable Care Act problems, but it is a solution to 
how we get to a place where we can write the solution to the Affordable 
Care Act problems. And it is wide open. For those who want to watch 
late into the night or early into the morning, we are here. We will be 
offering amendments. People can see that. When we move to the 
conference committee with the House of Representatives, historically 
those deliberations have been open. People can watch that. They can see 
that. That will take place over the next several weeks.
  After the conference committee agrees--if it does--on a bill to 
repeal and replace major parts of the Affordable Care Act now, not in 2 
years, then it goes back to the House and back to the Senate for debate 
and approval on an up-or-down vote.
  That is the process. I want to make it clear to the American people 
that insofar as I am concerned, I am not interested in telling you we 
are going to repeal something now, and trust us--trust the Congress--to 
come up with some answer in 2 years. I don't want to say that to the 
American people.
  What I do want to say is, we have major problems with the Affordable 
Care Act. We can't repeal all of it in the budget process, but the 
House of Representatives showed we can make major changes and major 
improvements, and the Senate bill, which I voted for on Tuesday, to 
repeal and replace ObamaCare, shows that we can make major changes and 
major improvements.
  I am convinced that if we can move this process to a conference 
committee today, between the House of Representatives and the United 
States Senate--which is part of our regular procedure--we will be able 
to agree on a way to improve the Affordable Care Act. What that means 
is that we will repeal major parts of it, and we will replace those 
parts with parts that work better, parts that give Americans more 
choices of insurance, that give 350,000 Tennesseans in the individual 
market some peace of mind to know they will actually be able to buy 
insurance next year, whereas if we don't act, many of them won't be 
able to, just like millions of Americans may not be able to.
  If we do not act, there will be counties in the United States where 
some of the most vulnerable Americans will have zero insurance options 
in 2018, no support to buy insurance, and if they don't get a subsidy 
from the Federal Government, a hard-working American who might be 
earning $50,000 or $60,000 a year--no Federal subsidy--that person will 
have insurance so expensive, with such high deductibles, they won't be 
able to buy insurance either.
  So I think we are on a path toward a solution, and the solution 
means, No. 1, that we move the debate out of the Senate this afternoon 
on to the conference committee and that our goal when we get there is 
to repeal major parts of ObamaCare, the Affordable Care Act, and 
replace those parts with provisions that transfer responsibilities to 
the States to make decisions that give consumers more choices of health 
insurance at lower costs. That is a noble goal, one we are pursuing, 
and one in which I hope we succeed.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Mr. PETERS. Mr. President, life is at its core a series of votes. We 
forget the mundane choices: what we wore to work or what we had for 
lunch last week. We remember the momentous choices, however: taking a 
new job or starting a family.
  My colleagues in this Chamber on both sides of the aisle are here 
because they chose to answer the call of public service, and folks in 
our States chose us to represent them. Week in and week out, we choose 
how we will vote in committees, on the floor, on nominees, as well as 
on legislation. We choose to cooperate when we find consensus, and we 
choose to resist when we don't. We cast hundreds of votes every 
Congress, year in and year out. Some are memorable, and some are not.
  One of the most memorable choices of my career in public service was 
voting for the Affordable Care Act--a bill that, while imperfect, I 
knew would literally save thousands of lives and help millions of 
Americans afford the health insurance they need. In the months and 
years since, I have heard countless stories from Michiganders whose 
lives were changed for the better as a result of this law.
  A few weeks ago, I shared the story of a fellow Michigander named 
Stefanie. Stefanie is from Livonia and worked her entire adult life in 
the retail and restaurant industry. Stefanie had never been offered 
health coverage by her previous employers but was able to purchase a 
plan because of the Affordable Care Act.
  In December 2015, Stefanie's third-floor apartment caught fire, and 
an unthinkable choice was forced on her: Stay and die in the fire, or 
leap from a third-floor window in order to save her

[[Page S4356]]

life. Stefanie chose to jump. She sustained serious injuries, including 
a broken back and a shattered foot. Her total treatment costs came 
close to $700,000--an amount which would surely bankrupt nearly all 
Americans if they did not have health insurance. Because of the 
Affordable Care Act, Stefanie was able to receive treatment for her 
injuries and have a second shot at life.
  Last week, Stefanie traveled to Washington, DC, and I had the honor 
of meeting with her in my office. Her family, friends, and others in 
the community had actually pulled together funds to send her here to 
Washington, DC, so she could share her story with me and with others in 
Congress firsthand. I can't imagine how painful it is for Stefanie to 
relive this trauma, but she chooses to share because she wants others 
to have access to the same care she had.
  Any mother, father, sister, son, or daughter could someday face an 
unexpected emergency, just like Stefanie. Nobody chooses to get sick, 
and nobody should be denied health insurance when they need it.
  Having health coverage afforded Stefanie a new lease on life. Instead 
of filing for bankruptcy due to her medical bills, Stefanie now plans 
to go back to school and become a paralegal. Stefanie and others just 
like her--like you and me--deserve to know that when we get sick or 
when we get hurt, we still have a shot at life.
  My colleagues on the other side of the aisle face a very difficult 
choice of their own. They can choose to do what is politically 
expedient by passing legislation tonight to repeal parts of the 
Affordable Care Act. This would cause millions more Americans to go 
without insurance, create chaos in our insurance markets, and risk 
skyrocketing premiums. But my Republican colleagues can still do the 
right thing: Vote no on whatever flawed bill they finally put forward 
tonight, start over, work across the aisle in a bipartisan manner, keep 
what works, and let's fix what doesn't work.
  I urge my Republican colleagues to think about people like Stefanie 
who will be hurt by repealing the Affordable Care Act. I urge them to 
choose to work with us on a bipartisan healthcare plan that helps 
people by lowering premiums while expanding access to care. I urge my 
colleagues to stop this partisan process that is sure to hurt people 
and choose a path that improves healthcare for all Americans.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. PETERS. Mr. President, I suggest the absence of a quorum.
  Mr. President, I wish to withhold my suggestion of an absence of a 
quorum.
  The PRESIDING OFFICER. If no one yields time, time will be charged 
equally to both sides.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, let me begin by taking a moment to kind 
of summarize for the American people where we are in this enormous 
discussion which is causing a great deal of anxiety all over Vermont 
and all over America.
  Several months ago, the Republican-led House passed by, I believe, 
three votes legislation that would throw 23 million Americans off of 
the health insurance they currently have--23 million Americans, men, 
women, and children, people who are struggling with cancer, heart 
disease, diabetes, and with other life-threatening illnesses. They 
would simply be thrown off of the health insurance they have.
  That legislation also cut Medicaid by $800 billion over a 10-year 
period. That means children with disabilities in Alaska or Vermont who 
are now on Medicaid might no longer be able to get the help they need 
in order to survive or to live a dignified life. At a time when 
Medicaid provides two-thirds of the funding for nursing homes all over 
this country, it means that if the Republican legislation were to 
succeed, we don't know, but thousands and thousands of people all over 
this country with Alzheimer's, with terrible illnesses, who are now in 
nursing homes would be thrown out of their nursing homes.

  Where would they go? Nobody really knows. When you cut Medicaid by 
$800 billion and Medicaid funds two-thirds of nursing home care, 
needless to say, people in nursing homes would be forced to leave, to 
go--nobody knows where.
  Right now in my State of Vermont and across this country, we are 
dealing with a massive heroin and opioid crisis. Every day, people are 
dying from heroin, opioid overdoses. It turns out that Medicaid is the 
major source of funding in terms of treating heroin and opioid 
addiction.
  If you make massive cuts to Medicaid, the impact in States like 
Vermont, West Virginia, Kentucky--States that are struggling with 
opioid and heroin addiction--would be horrendous. People would no 
longer be able to get the treatment they need.
  I recall, during the campaign, Donald Trump said that he was a 
champion of working families; he was going to stand up for workers, 
take on the establishment. If the Republican House bill were to be 
passed, older workers--people who are 60, 62 years of age--would see, 
in many cases, at least a doubling of the premiums they pay. In many 
cases, they would go from $4,000 a year today to over $8,000 a year. 
That is not being a champion or a friend of the working class.
  My Republican friends, and you hear them even today, talk about 
freedom, choice. They love choice. They love freedom. People in America 
should have the right to get healthcare anyplace they want. It should 
be a right to have any insurance policy they want.
  Two and a half million women have made a choice. The choice they have 
made is they want to get quality healthcare through Planned Parenthood. 
If the Republican bill in the House were to pass, those 2.5 million 
women would be denied their choice.
  You have a Republican bill in the House that throws 23 million people 
off of health insurance. How many of those people will die? My 
Republican friends get very nervous when I raise that issue because 
they say--and I understand it--nobody here wants to see anyone die 
unnecessarily. No Republican does, no Democrat, no American does.
  According to study after study, including studies done at the Harvard 
School of Public Health, when you throw 23 million people off of health 
insurance--people with cancer, people with heart disease, people with 
diabetes, people with life-threatening illnesses--what do you think 
will happen? What these studies show is that thousands and thousands of 
Americans every year will die unnecessarily because they will not have 
the treatment they need to deal with their life-threatening illnesses. 
That is the reality. That is not Bernie Sanders talking. That is study 
after study. PolitiFact backed that up. They looked at all of the 
studies. They said: Yes, thousands of people will die. That is the 
result.
  In the House bill, after you throw 23 million people off of health 
insurance, raise deductibles, defund Planned Parenthood, after you make 
older people pay more for healthcare, $800 billion in cuts to Medicaid, 
what else is in the bill?
  Oh, there are some people who will do well in the bill--not the 
children, not the elderly, not the sick, not the poor. But there are 
some people--and we have to acknowledge that--who would do well under 
the Republican bill; that is, if you are in the top 1 percent. 
Congratulations. Republican legislation, after throwing disabled 
children off of healthcare, congratulations--you are going to get a 
massive tax break.
  Who in America believes that it makes sense to throw disabled 
children off of health insurance and tell people with cancer that they 
can't continue to get the treatment they need in order to get $300 
billion in tax breaks for the top 1 percent and hundreds of billions 
more in tax breaks for insurance companies and drug companies?
  Do you know what? My Republican colleagues may think that is a good 
idea. That is not what the American people believe. The latest poll 
that I saw, the USA Today poll, had 12 percent of the American people 
thinking that was a good idea. I can only believe those 12 percent had 
not really looked at this issue. There is massive opposition from 
Republicans, Democrats, and Independents to this absurd Republican 
proposal.
  It is not just the American people who think that it is absurd to 
give tax breaks to the rich and throw 23 million Americans off their 
health insurance. It is not just the American people. It is

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those people who are most engaged in healthcare in America--the people 
who know the most.
  It is important to understand that throughout this process, whether 
in the House or in the Senate, virtually every major healthcare 
organization in America--the people who treat us every single day are 
opposed to this Republican legislation.
  One might think that maybe my Republican colleagues would say: Well, 
wait a second. What is going on when those in the American Medical 
Association--our doctors, the people who treat us--think this 
legislation is a mistake? Doctors say no. The American Hospital 
Association says no because they understand that when you make massive 
cuts to Medicaid, rural hospitals in Vermont and all over this country 
may go under. Then what happens to a rural community that no longer has 
its hospital?
  The American Hospital Association is opposed to this legislation. The 
American Cancer Society is opposed to this legislation. They know what 
its impact will be for folks who are struggling with cancer. The 
American Heart Association, the American Academy of Family Physicians, 
the American Academy of Pediatrics, the American Psychiatric 
Association, the Federation of American Hospitals, the Catholic Health 
Association, the American Lung Association, the Cystic Fibrosis 
Foundation, the March of Dimes, the National MS Society, and the 
American Nurses Association--one might think, when virtually every 
major national healthcare organization in this country is opposed to 
legislation, that maybe, just maybe, my Republican colleagues might 
think twice about going forward.

  In this process, they have not had the opportunity, amazingly enough, 
to hear from doctors, to hear from hospital administrations, to hear 
from patient advocates. As you well know, despite the fact that we are 
dealing with an issue that impacts every single American--which is what 
healthcare does--an issue that impacts one-sixth of the American 
economy, over $3 trillion a year, there has not been one hearing, one 
public hearing on this bill. This bill has been written behind closed 
doors. Senator McCain the other day made that point.
  How do you deal with one-sixth of the economy and their desire to 
transform the American healthcare system without listening to one 
doctor, without listening to one hospital administration, writing a 
bill with a few Republican Senators behind closed doors?
  This is an unprecedented and disastrous process for healthcare. On 
those grounds alone, what every Member of this Senate should agree to--
and Senator McCain made this point; this process has been awful. Kill 
it now. Go back to what is called regular process, regular order. Go 
back to the committee and start this discussion. Please do not throw 
22, 23 million people off of health insurance without hearing from 
doctors, patient advocates, hospital administrators.
  No, that is not where the Republicans are today. They want to rush 
this through behind closed doors and get a quick vote on it.
  Interestingly enough, as I understand it, Senator Daines of Montana 
today is going to introduce legislation for a Medicare-for-all 
healthcare system. That is very interesting. I hope this is really a 
breakthrough on the part of my Republican colleagues. I very much hope 
they finally recognize that maybe the United States of America should 
join every other major country on Earth in guaranteeing healthcare to 
all people as a right and not a privilege.
  I hope that when Senator Daines comes down here, he will say: No, it 
does not make sense to throw 23 million more people off of healthcare, 
but, in fact, we have to move forward, do what Canada does, what 
Germany does, what the UK does, what France does, what every major 
country on Earth does, and guarantee healthcare to all people as a 
right. I hope very much that is what Senator Daines will be saying.
  Do you know what? I kind of think that is not what he will be saying. 
I kind of think that in the midst of this discussion in which millions 
of Americans are wondering whether they are going to continue to have 
healthcare, what is going to happen to their kids, what is going to 
happen to their parents, I suspect what Senator Daines is doing is 
nothing more than an old political trick: trying to embarrass 
Democrats. Will they support the Medicare-for-all bill introduced by 
Congressman John Conyers?
  At a time when we are engaged in a very serious debate about the 
future of healthcare, I think this is not a time for political games. 
If Senator Daines is serious about a Medicare-for-all proposal, let's 
work together, but now is not the time for political games.
  Senator Daines, as I understand it, is going to offer an amendment, 
but we don't know what he is amending because we don't even know what 
is in the legislation the Republicans will bring forward.
  How do you amend something when we don't even have a base bill to 
amend? This is, I suspect--I hope I am wrong. I hope Senator Daines has 
seen the light, but I suspect not, and I suspect it is just a political 
game. I do hope, by the way, at some point within this debate, if we 
can--if not, certainly in the near future--to, in fact, be introducing 
a Medicare-for-all single-payer program. It will be somewhat different 
than my friend John Conyers' bill in the House, but what it will do is 
say that in America, if you are rich or if you are poor, if you are a 
man, woman, and child, yes, you are entitled to healthcare as a human 
right and not a privilege.
  As you may or may not know, our current healthcare system is the most 
expensive, bureaucratic, and wasteful system in the entire world. While 
the healthcare industry makes hundreds of billions of dollars a year in 
profits--and in many ways what our healthcare system is about is not 
providing quality care to all of us but seeing how the insurance 
companies and the drug companies can rip us off. The truth is, even 
today, we have some 28 million people who have no health insurance so 
our goal should be to say to those 28 million: We are going to provide 
health insurance to you, to all Americans, and not throw 22, 23 million 
more people off of health insurance.

  All of us recognize that the Affordable Care Act is far from perfect. 
What the American people want us to do--and poll after poll suggests 
this--is they want us to improve the Affordable Care Act, not destroy 
it. The American people are paying deductibles that in many instances 
are far too high, keeping people from going to the doctor when they 
need to. Today, copayments are much too high; premiums, much too high. 
I do find it interesting that when Donald Trump campaigned for 
President, he talked about the high cost of prescription drugs. He is 
right. In this country--and I am going to get into that in a moment--we 
pay, by far, the highest prices in the world for prescription drugs. 
That is what the American people want us to deal with in healthcare 
legislation, not throw 22 million people off of healthcare. They want 
us to lower the cost of prescription drugs. I have not heard one word 
from the Republicans about the need to lower the cost of prescription 
drugs.
  The United States spends far more per capita on healthcare than any 
major country on Earth. We often have worse outcomes. If we go back to 
regular order, if we go back to committee process--which is what we 
should do--the very first question a Member of the Senate should ask 
is, How does it happen that here in America we spend far more per 
capita on healthcare than do the people of any other country? Here is 
the chart. The United States is spending $9,990 per person on 
healthcare, almost $10,000 per person on healthcare. What do they spend 
in Germany? Well, they spend $5,300, almost half of what we spend. What 
about Canada? I live 50 miles away from the Canadian border. It is a 
really nice country. They spend $4,533. How does it happen that we are 
spending more than double per person compared to the Canadians and 
almost double what the Germans do? The French spend less than half of 
what we do. Australians spend less than half of what we do. The 
Japanese spend less than half. The UK spends about 40 percent less.
  Don't you think the very first question a Member of the Senate might 
ask is, Why do we spend so much compared to other countries? By the 
way, all of these other countries guarantee healthcare to all of their 
people. In many instances, the outcomes, the

[[Page S4358]]

health outcomes in those countries, are better than our country. They 
live longer. The life expectancy is longer. Their infant mortality rate 
is lower. In some particular diseases, they do better in treating their 
people. Here is a simple truth. The truth is, if we took a hard look at 
countries around the world--all of which have one form or another of 
national healthcare programs, all of which said healthcare is a right, 
whether you are rich or you are poor--maybe we might want to learn 
something, but, no, we have not had one hearing in order to discuss why 
we spend twice as much per capita on healthcare and why we pay the 
highest prices in the world for prescription drugs.
  You know why we haven't had any hearings on that, fellow Americans? 
Because it might get the insurance companies a little bit nervous. 
Insurance companies pour hundreds of millions of dollars in campaign 
contributions into the political process. The pharmaceutical industry 
spends a huge amount of money on campaign contributions and lobbying 
efforts.
  I say to my colleagues in the Senate, maybe, just maybe, we might 
want to stand up for working people and the middle class rather than 
for the owners of the insurance companies and the pharmaceutical 
industry.
  It is interesting. One never knows what to expect from the President. 
Every given day there is another adventure out there, but a couple of 
months ago, the President met with, I believe, the Australian Prime 
Minister. That was in May. President Trump said during that meeting: 
Australia has a ``better healthcare'' system than the United States. 
That is what Donald Trump said. To my Republican friends here who 
support President Trump, listen to what he said. On this one instance--
he is not right very often--but I will confess on this issue, he is 
right. In Australia, everyone is guaranteed healthcare as a right. 
Australia has a universal healthcare program called, ironically, 
Medicare, that provides all Australians with affordable, accessible, 
and high-quality healthcare. While the United States has the most 
expensive, bureaucratic, wasteful, and ineffective healthcare system in 
the world, Australia, it turns out, has one of the most efficient.
  President Trump was right. In 2014, Australia's healthcare system 
ranked sixth out of 55 countries in efficiency. The United States 
ranked 44. Not only does Australia guarantee universal healthcare 
coverage, it spends less than half what we spend on healthcare per 
capita. In 2015, they spent $4,500 while we spent almost $10,000. While 
the Australian Government spent 9 percent of its GDP on healthcare, the 
United States spent nearly double that, 17 percent. Further, many 
healthcare services are far cheaper in Australia. An MRI costs about 
$350 in Australia versus $1,100 in the United States. One day in a 
hospital costs about $1,300 in Australia versus $4,300 in the United 
States. An appendectomy costs about $5,200 in Australia versus roughly 
$14,000 in the United States, et cetera.
  Not only does Australia guarantee universal healthcare, spend less on 
healthcare per capita, and pay less than we do for many health 
services, they have better health outcomes. In 2014, the average life 
expectancy in Australia was 82.4 years compared to 78.8 years in the 
United States. They live longer in Australia. For context, according to 
a 2014 report from the World Health Organization, Australian men have 
the third longest life expectancy and Australian women have the seventh 
longest life expectancy in the world. The United States doesn't even 
crack the top 10 for life expectancy, despite spending so much more 
than any other country on healthcare.
  What all of this comes down to is the fact that America is the 
wealthiest country in the history of the world. The question we have to 
ask ourselves--and I hope Senator Daines will address that question as 
he introduces his Medicare-for-all bill--is how does it happen that in 
Canada, every man, woman, and child is guaranteed healthcare? The same 
is true in the UK, in Germany, France, Australia, Japan, and every 
other major country on Earth. How does it happen that every 
industrialized country understands that healthcare is a right of all 
people, because all of us get sick? All of us have accidents, not just 
the rich. How does every major country on Earth say healthcare is a 
right except the United States? How is it today we have 28 million 
without any health insurance--more who have high deductibles and high 
copayments, who are underinsured--and the response of our Republican 
friends is to say: Twenty-eight million uninsured? That is not enough. 
Let's throw another 22 million people off of health insurance.
  Our response should be to move forward and guarantee healthcare to 
all people, not throw another 22 million people off of health 
insurance. I don't have the time to go into great detail as to why our 
wasteful and bureaucratic healthcare system ends up spending almost 
twice as much per capita as systems around the world. That is a subject 
for a lot of discussion, and I intend to play an active role in that 
discussion, but let me just give you some examples: because we have 
such a bureaucratic and complicated system; because hospitals in 
America have to deal with this person who has a $5,000 deductible, that 
person who has an $8,000 deductible; this person who has this, that 
person has that--they have to deal with dozens and dozens of different 
configurations for insurance. It requires an enormous amount of time, 
energy, and manpower to deal with those myriad of insurance companies. 
The result of that is, the United States spends far more on hospital 
administrative costs than most other countries. These costs accounted 
for one-quarter of total U.S. hospital spending from 2010 to 2011, more 
than $200 billion--over twice what was spent in Canada and in Scotland.
  What I would hope--if we don't sit around just worrying about the 
profits of the insurance companies--what I would hope is, all of us 
would agree that when we spend a dollar on healthcare, we want that 
dollar to go to doctors, to nurses, to medicine. We want that dollar to 
go to the provision of healthcare, not to advertising, not to 
profiteering, not to dividends, not to outlandish CEO insurance company 
salaries but to the actual provision of healthcare which keeps us well. 
Yet we do that worse than any other major country on Earth.
  The large health insurance and drug companies are making hundreds of 
billions of dollars in profits every single year, and they are 
rewarding their executives with outrageous compensation packages. Once 
again, the function of healthcare, in my mind, is to provide quality 
care to all in a cost-effective way, not to make CEOs of insurance 
companies and drug companies even richer than they are today.
  In 2015, the top 58 health insurance companies made $24 billion in 
profits. Should the function of healthcare in America be to allow 
insurance companies to make huge profits or should we make sure all of 
our people get quality healthcare? Not only do the insurance companies 
make huge profits, but their CEOs make outlandish salaries, while 28 
million Americans have no health insurance at all, and others have very 
high deductibles. In 2015, Aetna's CEO made $17.2 million in 
compensation. Now, Aetna, like every other insurance company, spends 
half their life trying to tell people they are not covered for what 
they thought they were covered, but they do manage to find $17 million 
in salary compensation for their CEO. CIGNA's CEO made $17.3 million in 
compensation. UnitedHealth Group's CEO made $14.5 million in 
compensation. Anthem/Wellpoint's CEO made $13.6 million. Humana's CEO 
made $10.3 million. Is the function of healthcare in America to make 
CEOs of insurance companies outlandishly wealthy, or is it to provide 
healthcare to all people?

  It is not just the insurance companies. If you ask people in my State 
of Vermont what their major concern is--and I think they would say the 
same in Iowa and probably any State in America--they would say: I am 
sick and tired of being ripped off by the drug companies. I go into my 
pharmacy, have a medicine I have been using for 10 years, and suddenly 
the price has doubled, tripled, for no particular reason other than the 
pharmaceutical industry could get away with it.
  We are the only major country on Earth not to control the prices of 
the pharmaceutical industry. The result is--and this is an outrage, and 
it speaks to everything that should be discussed but which is not being 
discussed in the Republican bill--is that

[[Page S4359]]

today, one out of five patients under the age of 65 who gets a 
prescription from their doctor is unable to afford that prescription. 
How crazy is that? What kind of dysfunctional healthcare system allows 
somebody to go to a doctor because they are sick, the doctor writes a 
prescription, and one out of five Americans can't even afford to fill 
that prescription. What happens to that person? Well, the likelihood is 
they get even sicker, and then they end up in the emergency room at 
outrageous costs or, maybe even worse, they end up in the hospital. How 
crazy is that?
  I have not heard one word--not one word--from our Republicans about 
addressing the absurdity of Americans paying by far the highest prices 
in the world for prescription drugs. I have a chart over here that just 
deals with half a dozen drugs, but we can list many, many more.
  Lantus, a diabetes drug, costs $186 in the United States. Diabetes is 
a very serious problem. Lantus costs $186 in the United States and $47 
in France. It is the same drug.
  This is a healthcare reform debate. I have yet to hear one Republican 
raise that issue, but I think the people in Iowa and the people in 
Vermont want us to raise that issue.
  Crestor, a popular drug for high cholesterol, costs $86 in the United 
States and $29 in Japan.
  Advair, which is used to treat asthma--another very serious problem--
costs $155 in our country and $38 in Germany.
  The list goes on and on and on. That is why millions of people, by 
the way, are now buying their medicine in Canada and other countries, 
because they are sick and tired of being ripped off by the 
pharmaceutical industry--an industry that spends billions of dollars 
over a period of time on lobbyists here and campaign contributions.
  You might think--just might--that when we deal with healthcare 
reform, one Republican--just one--might stand up and say: Well, you 
know, maybe we might want to stand with the elderly and the sick in 
this country and not just with the pharmaceutical industry. I have not 
heard one Republican in this debate talk about that issue.
  To give an example of the greed of the pharmaceutical industry--and I 
can go on and on. They are the greediest, maybe with the exception of 
Wall Street. It is hard to determine which one of these institutions is 
more greedy, but the pharmaceutical industry certainly can make a claim 
for being the greediest industry in this country. Out in California a 
few months ago, there was an effort to lower the cost of prescription 
drugs in their State. It is called proposition 61. The big drug 
companies spent $131 million to defeat that ballot initiative--$131 
million to defeat a ballot initiative in California that would have 
lowered the cost of prescription drugs. And all over this country, the 
American people cannot afford the medicine they need, but the drug 
companies had $131 million to spend just on one initiative.
  Meanwhile, while the American people are getting sicker and sicker 
and sometimes dying because they cannot afford the medications they 
need, I have received--and I think every Member of the Senate has 
received--communications from oncologists, people who are dealing with 
patients who have cancer, who are saying: My patients cannot afford the 
high cost of cancer medicine. And it is not just cancer, of course.
  While the American people are getting ripped off by the drug 
companies, in 2015 the five largest drug companies in America made over 
$50 billion in profits--five companies, $50 billion in profits. Yet 
one-fifth of the American people cannot afford to buy the prescriptions 
they need. How outrageous is that? And my Republican colleagues are 
telling us they are dealing with healthcare reform without mentioning 
one word about the high cost of prescription drugs. Give me a break. 
You are dealing with many things, but you are not dealing with 
healthcare reform.
  Again, it is not just the pharmaceutical companies that are making 
huge profits; we are seeing executives from these large drug companies 
making outrageous compensation. In fact, in 2015, the top 10 
pharmaceutical industry CEOs made $327 million in total compensation. 
Elderly people walking to the drugstore can't afford the prescription 
drugs they need, and yet CEOs of major drug companies are making $327 
million in total compensation.
  Former CEO of Gilead, John Martin, became a billionaire because his 
drug company charged $1,000 a pill for Sovaldi, a hepatitis C drug that 
costs $1 to manufacture and can be bought in India today for just $4. 
In this country, it sold for $1,000 a pill, and he became a billionaire 
as a result of it. That is a healthcare system out of control.
  I know it is a radical idea here in the Senate, but maybe--just 
maybe--we might want to represent the American people and not the CEOs 
of the drug companies and the insurance companies.
  Some of my Republican colleagues have been spending the last few days 
using words like ``freedom,'' ``choice,'' and ``opportunity'' to try to 
convince the American people about their abysmal healthcare 
legislation. This is the same language that rightwing ideologues, like 
the billionaire Koch brothers, use when they try to discredit 
government programs and move to privatize them. What the Koch brothers 
mean by ``freedom'' is their own freedom. And by the way, they are the 
second wealthiest family in America, worth some $80 billion. What they 
mean by ``freedom'' is their own freedom to profit off the misery of 
ordinary Americans who rely on a wide variety of government programs 
that make life bearable and, in some cases, even possible.
  I want to say a word about freedom. This is a 203-foot yacht. This is 
a yacht owned by a billionaire that costs about $90 million to 
purchase. Like everybody else, I think, in this Chamber, I think the 
American people--every American should have the freedom to purchase 
this $90 million yacht, and I would urge all Americans to go on the 
internet, find out where the yacht stores are--wherever they sell 
yachts--and go out there and say: Hey, I got the freedom to buy this 
$90 million yacht. We all believe in that. You got the money; you buy 
it.
  Here is a picture of a home, and this home is worth tens and tens of 
millions of dollars. It looks to me like it has 30 or 40 or 50 rooms, 
probably 5, 10 bathrooms. It is a very nice house, and it is owned by a 
billionaire.
  You know, I think every American who wants to own a home worth tens 
and tens of millions of dollars, go to your local Realtor. You go out 
and you buy that home.
  What we are talking about today in terms of freedom is not freedom to 
buy a yacht or freedom to buy a mansion; we are talking about the 
freedom to stay alive, the freedom to be able to go to the doctor when 
you are sick, the freedom not to go bankrupt if you end up in the 
hospital with a serious disease.
  So when my Republican friends talk about freedom of choice, fine, we 
all agree: You got the money, you go out and buy any big house you want 
or buy any big yacht you want. But where there is a serious 
disagreement is, we say that the children of this country who have 
serious illnesses have the freedom to stay alive even if their parents 
do not have a lot of money; that older people who are now in nursing 
homes should have the freedom to get dignified care in a nursing home 
even if they have Alzheimer's and even if they don't have a lot of 
money. Healthcare is not another commodity. Healthcare is not a 
mansion. Healthcare is not a yacht. Healthcare is whether we stay alive 
or whether we don't, whether we ease our suffering or whether we don't. 
And I believe--unlike, unfortunately, many of my Republicans--that 
right to get healthcare when you need it is something every American 
should be able to get.
  Here in the Senate, we have good health insurance. Over the last 10 
years, a number of Senators have had serious illnesses, and they have 
gotten some of the best care in the world. If it is good for the 
Senate, it is good for every American. Healthcare must be a right of 
all people, not a privilege. Quality care must be available to all, not 
just the wealthy.
  Senator Daines is going to come down here in a while to offer a 
Medicare-for-all proposal. Again, I hope this is a breakthrough. I hope 
our Republican colleagues understand that we have to join the rest of 
the industrialized world. And if Senator Daines comes down here and is 
prepared to

[[Page S4360]]

vote for that legislation, prepared to get his other Republican 
Senators prepared to vote for that legislation, my God, we can win this 
vote overwhelmingly and move this country in a very different 
direction.
  But I have a feeling that is not what Senator Daines has in mind. I 
think this is another joke, another game, another sham as part of a 
horrendous overall process. So I will not be supporting that amendment, 
unless Senator Daines and Republicans vote for it as well. But this I 
will do: Whether in this debate--and I hope I have the opportunity--or 
in the very near future, I will offer a Medicare-for-all, single-payer 
program which finally has the United States doing what every other 
major country on Earth does--guarantee healthcare to every man, woman, 
and child in a cost-effective way. And when we do that and when we 
eliminate the need for families to spend $15 or $20,000 a year for 
health insurance, we will save the average middle-class family 
substantial sums of money.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Ernst). The Senator from Kansas.
  Mr. MORAN. Madam President, I come to speak about healthcare, and I 
begin by paying tribute to our colleague from Arizona, Senator McCain, 
on his return earlier this week. I wish him the very best as he begins 
a process of cure, treatment, and a bright future in his life. I 
appreciate the remarks he indicated that were so heartfelt to his 
colleagues here in the Senate. We welcome him back and thank him for 
his service to the Senate, to the people of Arizona, to the people of 
America, but I also thank him most especially for his service in the 
U.S. military.
  Another great hero in my life and in our country's history is my 
predecessor in the Senate, Senator Bob Dole, who earlier this week 
celebrated his 94th birthday. Service to Kansans and all Americans 
exemplify Bob Dole's life. While I admire him for his time in the 
Senate, I respect him even more so for his service to our country 
during World War II and for his efforts ever since then to care for 
those who have come into harm's way as a result of their service. I 
often see him at the World War II Memorial when there is an Honor 
Flight from Kansas or across the country, and he is such a role model 
for so many people.

  Again, I admire him for his commitment to other veterans and to 
making certain that veterans receive the care and the gratitude that 
they deserve.
  Madam President, one of the most important ways we can demonstrate 
that we honor those who served our country is by making certain that we 
live up to our commitment--the commitment that was made to them--to 
provide the benefits that they deserve, including access to timely and 
quality healthcare. Unfortunately, today, we find ourselves in another 
crisis moment in regard to veterans' healthcare and, in particular, the 
Veterans Choice Program, which was designated to provide access to 
veterans who were in danger of an inability to access that care because 
the VA did not provide the service, could not provide it in a timely 
manner, or the service was so far from where the veteran lived that he 
was unable to obtain that service because of distance.
  So, in 2014, this Congress passed and the President then signed what 
has been labeled the Choice Act. It came about in the wake of a 
scandal, particularly in Phoenix but across the country, in which we 
saw fake waiting lists and the belief that there were veterans who died 
as a result of not obtaining the care that they were entitled to in the 
VA system.
  The Choice Program has helped thousands of veterans across the 
country, especially those in rural communities, where distance remains 
a problem. I have heard from many veterans in my State as to how 
important the Choice Program is to them. Instead of driving for 4 hours 
to see a physician at the VA, they can drive 4 minutes to see a 
physician in their hometowns.
  This Choice Program is set to expire on August 7 of this year. Just a 
few days from now, it is scheduled to come to an end. At the start of 
2017, the VA estimated that there would be more than $1 billion 
remaining in the Choice account that the VA told us would last until 
January 2018. Rather than letting those funds expire, I joined Senator 
McCain, Senator Isakson, Senator Tester, and others in a Choice 
extension bill to remove that August 7 deadline and sunset the program 
until the funds expired, which, as I said, was believed to be in 
January of 2018.
  The President signed that bill on April 19, but less than 6 weeks 
later, we learned from the VA that the VA had made unfortunate 
miscalculations. As a result of poor budgeting and finance, the dollars 
for the Choice Program are not going to last until January and are soon 
to expire, just within the next few days. Demand for the Choice Program 
is up 30 or 40 percent, and it is clear by that increase in demand that 
veterans need Choice, that they like Choice, that it is working for 
them, and we now owe it to those veterans to make certain that the 
Choice Program continues and that the funds are available to accomplish 
that goal.
  With Choice, the funds that they had anticipated would last until 
January now will run out sometime in August--we think in the next 
couple of weeks. Those depleted funds will mean that Kansas veterans 
and veterans across the country who have been using the Choice Program 
will no longer be able to, and it means that those who could use the 
Choice Program into the future will be without that option. We run the 
real risk--the likelihood is almost a certainty--that the Choice 
Program will be discontinued in a matter of days.
  I chair the Appropriations Subcommittee that funds the Department of 
Veterans Affairs, and when I learned of the budget miscalculations, we 
immediately contacted the Secretary of the Department to get his 
understanding of the circumstance that we were in. We only learned of 
the shortfall after we learned that veterans at home were being denied 
access to the Choice Program. The Secretary had made a decision to 
reduce those veterans who are eligible. We asked him to withdraw that 
guidance to his regional officers across the country, and he did. 
However, when the Secretary then testified before our subcommittee, the 
subcommittee on Military Construction, Veterans Affairs, and Related 
Agencies, we learned that new guidance had been issued because of the 
fear of depleting those dollars. It again limited the access of 
veterans to the Choice Program.
  We now hear of veterans who are forced to drive hours to get 
appointments at VA facilities when, just 2 weeks ago, they were 
receiving that care in their hometowns and in their neighborhoods--
nearby opportunities that no longer exist.
  Dr. Shulkin of the VA recognized that their projections and budgeting 
were off and must be fixed. I hope that turns out to be the result and 
that we have a better ability at the Department of Veterans Affairs to 
make the calculations necessary for Congress and the Department to make 
wise decisions. The system has to be fixed, and it has to be fixed 
quickly. There is an immediate crisis.
  One of the things that now happens as a result of reduced use of 
Choice is that the networks that were created to support Choice--the 
third-party administrators of the Choice Program--because of a lack of 
volume, are no longer financially viable to stay in the business of 
being the network to connect the VA, the private sector, and the 
veterans in a way that cares for those veterans, gets them their 
appointments, and establishes the payment process by which the 
provider--the physician or the hospital--is paid.
  This is not just a circumstance in which the third-party 
administrators can leave the business and return if we get our work 
done here and the VA Choice Program is defunded. Those networks will 
disappear, and we will not be able to easily restart the Choice 
Program, so if we do not make a fix shortly--today, tomorrow, by the 
weekend--and pass legislation in a timely fashion, it is not as if we 
can come back in September and say: OK. Let's appropriate the money 
now, and Choice can restart.
  It will not happen. Choice will be gone.
  There are big consequences at play for the future of community care. 
The funding crisis and the inability to sustain Choice risk shutting 
down--shuttering--the entire networks, and it will diminish the faith 
that veterans and our providers were slowly beginning to have in the 
Choice Program.

[[Page S4361]]

  Early in the Choice Program, many veterans were discouraged because 
of the bureaucracy and paperwork associated with Choice. Providers then 
were not often paid in a timely fashion, and they became discouraged by 
the program. In recent months, that confidence in the program had 
returned as veterans were beginning to get their care at home, and 
providers were being paid for the services that they provided veterans. 
Now, if the third-party administrators--the network--go away, we will 
send one more message to veterans and to those who wish to serve them--
the healthcare community--that the program is not a viable or a 
valuable one.
  Fortunately, both the House and Senate have been working to fix this 
situation. Since June, my colleagues on the Senate Veterans' Affairs 
Committee have joined me in working to find a solution that protects 
access to community care for veterans. The Choice Program is funded by 
mandatory spending. We have also been working with the House as they 
have tried to develop a solution that maintains Choice and that is 
fiscally responsible.
  There has been a lot of back and forth, a lot of conversation, a lot 
of talk, and a lot of negotiations going on, and I support the efforts 
of our chairmen and ranking members of the Veterans' Affairs 
Committees, both in the House and Senate, who are trying to work on an 
agreement to come together for our Nation's veterans. I would hope and 
I expect that a bill will come from the House yet this week.
  My point to my colleagues here today is that we do not have the 
luxury of then trying to figure out something different to do than what 
the House sends us. We need to have our plan in place, and we need to 
have something that can pass both the House and Senate in the next 2 
days. I want to motivate my colleagues to do what is right for veterans 
and set aside the differences that have prevented the necessary 
cooperation to see that we have one bill that can pass both the House 
and Senate and save Choice.
  I stood here in 2014 to implore my colleagues to support the passage 
of the Choice Act in the first place, and I stand here again today to 
implore my colleagues to come together and support the passage of this 
critical funding for the continuation of the Choice Program and 
community care for veterans. I am here to make certain that we end the 
delays and find a way to understand the differences and accept that we 
must act quickly on behalf of veterans. It has to happen immediately. 
We owe our veterans better than what we have been providing them.
  I am, once again, partnering with the Senator whom I honored in my 
opening comments--Senator McCain--and others to introduce legislation 
that will put funds back into the Choice Program and make sure that our 
veterans do not experience a lapse of care at home or a termination of 
the program.
  We are working hard with our colleagues across the aisle and in the 
House to determine the future of this program and what community care 
will look like. While we work to create that system that will serve 
future generations of veterans for years to come--how we make Choice 
better--we cannot allow the program to expire at this critical point in 
time. Taking care of veterans must be a priority above any one specific 
``ask'' or ``must have'' in the funding. Not acting is not an option.
  Upon his return to the Senate, Senator McCain's words remind us of 
the importance of this task and many others before us. I am honored to 
work with him on this effort to save Choice and to serve our veterans. 
I ask my colleagues to help us save this important program that 
benefits rural and urban veterans, that makes care more timely, that 
provides care in the circumstances in which the VA does not have the 
capabilities, either in a timely or a quality fashion, to provide the 
services to veterans.
  This does not diminish the role or necessity of the Department of 
Veterans Affairs or their hospitals and clinics across the country. 
Veterans continue to use VA hospitals, and they continue to use our 
outpatient clinics, but we ought not allow for the elimination of the 
third opportunity for veterans' care--the Choice Program--that serves 
so many veterans in so many communities.
  Again, I thank Senator McCain for his leadership and his bipartisan 
work that originally created this program--this opportunity--with 
Senator Sanders.
  We seek bipartisanship to put veterans first and to put their 
healthcare access above everything else. I am urging my colleagues 
today to know that this issue exists, not to walk away from it, to make 
certain that we accomplish our goals, and that this critical funding be 
provided before we depart for the weekend.
  Preserving this important benefit honors our heroes--Senator Dole, 
Senator McCain, and the thousands of Americans who did not ask about 
whether it was Republicans who served the country or Democrats who 
served the country. They are those who believe that having served their 
country is what motivated them to see that their families were safe and 
secure and to see that America had a bright future. We ought not deny 
them that kind of service today.
  Madam President, I thank you for the opportunity to address the 
Senate.
  The PRESIDING OFFICER. The Senator from Arizona.

                          ____________________