[Congressional Record Volume 163, Number 154 (Tuesday, September 26, 2017)]
[Senate]
[Pages S6108-S6121]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2018--MOTION TO 
                           PROCEED--Continued

  The PRESIDING OFFICER. The Senator from Rhode Island.


                               Healthcare

  Mr. REED. Mr. President, I wish to talk about the latest attempt from 
my

[[Page S6109]]

colleagues on the other side of the aisle to upend our health care 
system. They have been trying to sell this as a new and better health 
care bill, but in fact they somehow have managed to come up with 
something even worse than the previous TrumpCare bills. It would repeal 
the Affordable Care Act, gutting key protections for people with 
preexisting conditions and ending Medicaid as we know it.
  I want to recognize some of my colleagues, however, on the other side 
of the aisle who already stood up to this effort, because no matter how 
many changes have been made to gain the support of Senators, this bill 
would be devastating to every State, including my home State of Rhode 
Island.
  Senate Republicans are trying to hide the impact of the bill, 
potentially forcing a vote before the nonpartisan Congressional Budget 
Office is even able to publish a full score and analysis of the bill, 
including estimates for how many people would lose coverage and how 
healthcare costs would be affected.
  Late yesterday, we received a preliminary estimate from CBO saying 
that, similar to previous TrumpCare bills, this proposal would leave 
millions more Americans without health insurance because of massive 
cuts to Medicaid. We will not see a more detailed score for weeks. Yet 
the majority is attempting to rush this through in order to use budget 
rules that expire on Saturday that enable passage of this bill with 
just 51 votes.
  Fortunately, a number of nonpartisan organizations are publishing 
data on the latest bill, and they all agree that this bill would have a 
similar impact as the previous TrumpCare bills. Tens of millions of 
Americans would lose coverage, State budgets would be decimated, and 
costs would increase--especially for those with preexisting conditions, 
who would be priced out of the market entirely. According to one of 
these organizations, Avalere, Rhode Island is slated to lose $3 billion 
by 2027, and the cuts only get worse from there. Medicaid would be cut 
drastically, meaning our most vulnerable citizens would lose access to 
health care, including children, people with disabilities, and seniors.
  Over 60 percent of nursing home residents in Rhode Island access care 
through Medicaid, and half of Medicaid spending is on these long-term 
care services.
  It would become impossible to protect these programs from the cuts 
projected under this bill. In fact, States would be forced to cut not 
only health care but also education and infrastructure and other 
priorities to make up or try to make up--and I think ``try to make up'' 
are better words to use--the difference. This would be nothing short of 
a crisis in every State in this country.
  We have already spent so much time this year having this fight--time 
we could have spent working across the aisle to improve health care, to 
end sequestration, and to ensure a stable Federal budget to improve our 
economy.
  In fact, after the efforts to pass TrumpCare failed just 2 months 
ago, Republicans and Democrats on the Senate Health, Education, Labor, 
and Pensions Committee joined together in a bipartisan fashion to come 
up with a bill that would improve our healthcare system and lower costs 
for everyone. Significant progress on this effort has been made.
  However, by resurrecting this TrumpCare debate, we are again on the 
brink of voting on whether to kick millions of Americans off of their 
health insurance. With this effort, Republicans are taking our health 
care system hostage again, as deadlines approach this week for 
finalizing insurance rates for the next year. Health insurance 
commissioners and other experts have already said that the instability 
in Washington has caused rates to increase. Yet my colleagues on the 
other side of the aisle continue down this destructive path.
  What is especially egregious is that in addition to the jettisoned 
ACA stabilization efforts, we also need to extend funding for other 
critical bipartisan health care priorities, such as the Children's 
Health Insurance Program and the community health centers, whose 
Federal funding expires in just a couple of days. In fact, the Chairman 
and Ranking Member of the Senate Finance Committee had come to a 
bipartisan agreement to extend funding for CHIP for 5 years, providing 
stability and assurances for States and families across the country. 
However, that work is now on hold, just like the critical ACA 
stabilization effort.
  We must continue to make our voices heard and show the majority that 
this is not what the American people want. They want us to work 
together to strengthen health care, increase access, and keep costs 
down. The enormous outpouring of citizen opposition and health care 
experts criticizing TrumpCare over the summer was a very powerful 
statement about what the American people--my constituents and people 
across the country--believe should be the path forward on health care.
  As my colleagues work to make last-minute changes to the bill and 
conceal the real impacts by refusing to hold substantive hearings and 
rushing new versions of the bill to the floor with little or no 
warning, my constituents are not fooled. They continue to write to me, 
urging me to keep up the opposition to TrumpCare.
  Just a week or two ago, I heard from Barbara in Middletown, RI. Her 
mother has Alzheimer's diseases and relies on Medicaid for long-term 
care. Her sister has Down syndrome and has recently been diagnosed with 
Alzheimer's disease as well. She also relies on Medicaid for her health 
care. This new proposal, just like the previous proposals, would be 
devastating to Barbara and her family.
  I urge my colleagues to really think about who would be impacted by 
this legislation. Whether or not you like ObamaCare or voted for it 7 
years ago, this latest TrumpCare bill is not the solution.
  I will continue to oppose these efforts and hope to work with my 
colleagues to improve our health care system and lower costs for 
everybody.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.


          Puerto Rico and U.S. Virgin Islands Recovery Effort

  Mr. LEAHY. Mr. President, it was 6 years ago that Tropical Storm 
Irene tore through my home State of Vermont, and I remember it like it 
was yesterday. I remember going around the State the next day in a 
helicopter with the head of our National Guard and reviewing the 
damage. We are still trying to recover.
  In the days after the storm, I came to this Chamber, and I asked for 
the support that Vermont needed to recover and rebuild. I remember with 
gratitude that Republicans and Democrats alike in the Senate, from 
across the country, stood with the people of Vermont. I remember how 
much the calls of support from Republican and Democratic colleagues 
meant to me.
  Today, we have to do the same for the people of Puerto Rico and the 
U.S. Virgin Islands. More than 3\1/2\ million Americans--remember, 
these are Americans--have seen their homes and communities destroyed by 
the double blow of Hurricanes Irma and Maria. The destruction is 
catastrophic. The details are still coming in.
  The vast majority of Puerto Rico is without power and remains in the 
dark. At least 44 percent--almost half of its people--are without 
potable water, and some estimates put it even higher. The vast majority 
of hospitals in Puerto Rico are without power. The food supply is 
dwindling. Cell phone sites are down, crippling communication on the 
island. People can't find out what has happened to their families. We 
are on the verge of a humanitarian crisis right here on U.S. soil.
  President Trump, leaders of FEMA, the Department of Homeland 
Security, and the Department of Defense have all got to act quickly. We 
have to put the full force of the United States behind these efforts, 
as we would in any State where this might happen.
  Earlier this month, Congress approved $15 billion in emergency 
funding for disaster relief following Hurricanes Harvey and Irma. As 
vice chairman of the Appropriations Committee, I was happy to support 
that. These resources should be put to work in Puerto Rico and the U.S. 
Virgin Islands as well. But it is not going to last for long. This 
money will run out within a couple of weeks. We have to sustain our 
commitments to rebuilding and recovering from all of these hurricanes 
for the long haul--not just in the continental United States but in all 
parts of the

[[Page S6110]]

United States, which include Puerto Rico and the Virgin Islands.
  I would ask the administration to prepare an emergency aid request as 
soon as possible. The Appropriations Committee is ready to move on it, 
but the Congress--the House and Senate--should act very quickly. We 
have to stand by each other in times of disaster. When there is a 
storm, one of us braces for it, and the others have to help pick up the 
pieces. That is who we are. That is why we act. That is why we are 
Americans. We are the United States of America--all of us. Now we must 
make sure that we respond not just in Texas, as we should, not just in 
Florida, as we should, but in Puerto Rico and the U.S. Virgin Islands. 
They are part of our country.


                               Healthcare

  Mr. President, the Senate finds itself today in a familiar situation: 
Deeply partisan efforts to repeal and replace the landmark Affordable 
Care Act have hit a wall. By their own admission, the Senate majority 
has, with their backs against a wall and a looming deadline to advance 
legislation by a simple majority vote, put forward one last-gasp effort 
to roll back access to healthcare for millions of Americans--not 
because it is sound policy, but in an effort to meet a campaign 
promise, regardless of its harm to millions of Americans. It is as 
irresponsible as it is dangerous. These efforts put lives at risk. This 
zombie project should be abandoned, and we should get back to the 
constructive and promising bipartisan work toward strengthening 
troubled insurance markets.
  Instead of working on a responsible budget, or disaster relief for 
Puerto Rico, Florida, and Texas, or on any of the many pressing issues 
facing our country, we began this week in a situation virtually 
identical to where we were in July. In fact, it reflects the state of 
the Senate for much of this year, where policymaking has been replaced 
by partisanship and politics.
  When we considered a healthcare reconciliation bill in July, in spite 
of multiple drafts and a go-it-alone, hyperpartisan philosophy, the 
majority leader was still unable to garner enough support within his 
own Caucus to pass a sweeping healthcare bill. I joined with many 
Democrats to offer motions to get the Senate back to regular order and 
have the appropriate committees study the effects of these policies on 
Medicaid beneficiaries and those with disabilities, on women and 
children, on seniors, and the most vulnerable, but Republicans voted 
down those efforts and plowed ahead, seemingly unaware or willingly 
blind to the real-life impacts of what they were trying to do. During 
July's debate, the Senate also considered multiple amendments to 
rewrite the Affordable Care Act. Each of these amendments would have 
caused tens of millions of Americans to lose insurance and would have 
made it harder for those with preexisting conditions to obtain 
coverage. When those amendments failed, the Republican leadership 
attempted to fully repeal the Affordable Care Act. That did not work 
either.
  Instead of learning from that painful process, the Republican 
leadership emerged from the August recess with a new plan. Released 
just last week and revised several times since, the proposal of 
Senators Graham, Cassidy, Heller, and Johnson was intended to revive 
the healthcare reconciliation bill the Senate already defeated. 
Unfortunately, their bill contains all of the problems of previous 
versions and includes new, troubling provisions that would 
fundamentally change healthcare in this country for the worse.
  This Graham-Cassidy-Heller-Johnson bill--just the latest version of 
TrumpCare--would make dangerous changes to our healthcare system 
resulting in millions of Americans losing health insurance coverage, 
including Vermonters. In fact, based on previous estimates, a provision 
in this bill would cause 15 million Americans to lose insurance and 
premiums to increase by an average of 20 percent on day 1.
  This hasty proposal would allow insurance companies to charge 
seniors, those with disabilities, those with preexisting conditions, 
and women more for coverage. These are all discriminatory policies that 
the Affordable Care Act changed.
  Like previous versions of TrumpCare, this bill would end Medicaid as 
we know it by capping spending in the program and forcing States to cut 
eligibility, benefits, or both. What is worse, this new version of the 
bill would fully repeal the tax credits and subsidies created under the 
ACA and instead give States inadequately funded block grants with no 
requirement that the funding goes to those in need.
  States like Vermont have done the right thing. Because of Vermont's 
Medicaid expansion, thousands of Vermonters now have access to 
lifesaving health insurance and care. That is never been more critical 
than now as we continue to grapple with the opioid crisis.
  This latest Republican proposal would hurt States like Vermont, 
simply for doing the right thing and expanding coverage. In the latest 
version of the Graham-Cassidy-Heller-Johnson proposal, there seems to 
be no consistency to how block grant funds are divvied between States, 
leaving some to conclude the formula is merely a ham-fisted attempt to 
appease some reluctant Republican Senators to support this measure. By 
2027, all States lose under this proposal as the block grant funding 
created under this proposal runs out. You cannot consider legislation 
of this magnitude, with such far-reaching truly life-and-death 
consequences, with no debate and no meaningful consideration. This is 
not the way the Senate, the greatest deliberative body in the world, 
should conduct such expansive and impactful policies. This is not the 
Senate that I know and respect.
  Yesterday, the Senate Finance Committee held the only hearing in the 
Senate on TrumpCare. We heard how devastating this bill would be for 
millions of Americans who depend on subsidies to purchase health 
insurance. We heard how reduced funding would force States to choose 
what services to cover for children, pregnant women, and those with 
disabilities who depend on Medicaid. Benefits like maternity coverage 
or homecare will be at risk as States choose to relax the insurance 
requirements under the ACA. Remarkably, experts disagreed with the 
authors as to what this amendment would mean for those with preexisting 
conditions.
  One thing the hearing made abundantly clear is that this sweeping 
policy needs further examination. The Congressional Budget Office says 
it needs at least a couple of weeks to fully examine this proposal. How 
many will lose insurance? How much will premiums increase? How many 
will lose access to health care? These are fundamental questions to 
which we do not and will not have answers before the majority's 
arbitrary timeline is up. The preliminary estimate released late Monday 
by the CBO says that ``millions'' of Americans would be uninsured as a 
result of the Graham-Cassidy-Heller-Johnson proposal. What is more, I 
have not heard from a single health-related group that supports this 
measure.
  So why does the majority insist on pushing forward? It seems they are 
so intent on voting on anything that they would have us consider an 
unexamined, hastily cobbled together bill solely to repeal the ACA--for 
the express purposes of fulfilling a crassly partisan campaign promise. 
This would be nothing more than legislative malpractice. Their desire 
to undo any of the success of the Obama administration, at any cost, 
would have them push forward a proposal that would devastate our health 
insurance markets, cause millions to lose insurance, and fundamentally 
change the Medicaid Program, and the best reason the Republicans can 
come up with for supporting this new attempt is ``because we said we 
would.''

  In Vermont, the effects of TrumpCare would be disastrous. Since the 
passage of the Affordable Care Act, Vermont has made exceptional 
progress to cut the rate of uninsured Vermonters by half. The number of 
uninsured Vermonters is now below 4 percent. Because of the Medicaid 
Program and the Children's Health Insurance Program, known as Dr. 
Dynasaur in Vermont, 99 percent of children have health insurance in 
our State. TrumpCare, in any version, places Vermont's progress at 
risk.
  Vermont has also worked on new and innovative ways of delivering 
healthcare, which has brought down

[[Page S6111]]

costs and increased coordination of care. One of the most significant 
ways Vermont has done this is through existing flexibility in Medicaid. 
It is through the Medicaid Program that Vermont has offered 
comprehensive treatment and counseling services for those suffering 
with opioid addition. In Vermont, 68 percent of those receiving 
medication assisted treatment for opioid addiction are Medicaid 
recipients. If hundreds of billions of dollars are cut from the 
Medicaid Program, States will be forced to limit coverage, jeopardizing 
Vermont's ability to overcome this crisis. Provisions that cap Medicaid 
spending do not create ``flexibility'' in Medicaid. This policy would 
instead force States to ration care.
  Let's talk about what that means to Vermonters. This week I heard 
from Deborah in Waterbury, VT, who wrote to me urging me to vote to 
protect Medicaid funding:

       For a while Medicaid paid for medical care my son and I 
     needed. Later Medicaid funding, and the cancer care it paid 
     for, literally saved my life. It turns out many Americans 
     find out that they or someone they love needs medical care or 
     disability services that only Medicaid covers. Medicaid not 
     only helps individuals and families who need medical care or 
     disability services in the community; it also pays for 
     approximately 64 percent of the people in nursing homes--
     financial help that is necessary because so many people spend 
     down their life savings in the first few years of care. I am 
     glad that over the years some of my tax dollars have paid for 
     needed services for others. I believe we must and can improve 
     the quality, affordability and effectiveness of health care 
     in this country; but we won't do it by denying so many 
     Americans basic health and disability services.

  Consider this deeply personal story from Allyson in Brattleboro:

       About a year ago, I got a migraine. it never went away. 
     Instead, it got worse and worse, and turned into what is 
     called a hemiplegic migraine. These migraines look and feel 
     like strokes, but are `just' migraines. I started having 
     seizures soon after that; they would later be diagnosed as 
     psychogenic nonepileptic seizures. I have also had rheumatoid 
     arthritis for five years.
       The saving grace in all of this has been Medicaid, made 
     available to me through the Obamacare Medicaid Expansion. I 
     have not had to worry about affording the care I've needed 
     (probably close to $100,000, plus $80,000 in prescriptions), 
     which has taken one huge worry off my plate. I could go to 
     the seizure monitoring unit at DHMC for a week without 
     stopping to wonder how I was going to pay for it. I could 
     fill my--prescription ($4,000 a month) without worry, and 
     continue to walk around and look after my kids. I could try 
     several medications for migraine to try to get better. And I 
     could get good, solid therapy for mental health treatment.
       Without these things, and the Medicaid that pays for them, 
     I would be far sicker than I am now. I would not be able to 
     care for my children, or work even a little bit. I would 
     likely die young. Instead, I am making it through, spending 
     time with my children, and healing.
       Please continue fighting for my healthcare, for my life.

  Vermonters came to Washington Monday in their efforts to attend the 
sole hearing on the hapless Graham-Cassidy-Heller-Johnson proposal. 
They waited in line for hours, and they were not granted access to the 
hearing, held in a smaller room despite the known public interest in 
this hearing.
  Waiting in line for a hearing he was not allowed to attend, Drew from 
Readesboro said:

       ``[T]his is my second time down here. I'm here to finally 
     kill this bill as it will result in the deaths of millions of 
     Americans and significant loses to Vermont's funding.''

  Todd from Bennington said:

       The reason I oppose the bill is being I'm a walking pre-
     existing condition. Diabetes, high blood pressure. It's 
     getting under control, but it wouldn't without healthcare.

  Mari from Lincoln said:

       I'm here because I have to. Like Marcelle [Leahy], I've 
     been a nurse for almost 30 years and if it weren't for the 
     Affordable Care Act many of the patients that I'm caring for 
     now in the inpatient cardiology unit at the University of 
     Vermont Medical Center would either not be alive or would be 
     in a much more devastating situation. Many of the young 
     adults that I care for in the cardiology unit have opiate 
     addiction and are there with serious infections because of 
     that. And if it weren't for the part of the Affordable Care 
     Act that allowed young adults up to 26 to still be covered by 
     their parents insurance, many of these young adults would not 
     be alive. So I've been fighting for health reform in Vermont 
     for decades now . . . This is THE most immoral bill I've seen 
     in my 58 years of life . . . I'm appalled and I'm angry, and 
     I'm very motivated. I wish we didn't have to be here but I'm 
     so proud to be here.

  These are real stories, real lives. This matters.
  These TrumpCare proposals are not healthcare bills. A true healthcare 
bill would not kick millions of Americans off health insurance. A true 
healthcare bill would not allow insurance companies to charge people 
more for less coverage. A true healthcare bill would not move us 
backwards to a time when healthcare was unaffordable.
  Where there are deficiencies, let's fix them. Where we can find 
common ground, let's act. One of the first things we should do is 
stabilize the insurance market by making cost-sharing payments 
permanent. Earlier this month, the Senate was doing just that. The 
Health, Education, Labor, and Pensions Committee held bipartisan 
hearings aimed at stabilizing our insurance market. This week, the 
Finance Committee reached an agreement on a 5-year extension of the 
Children's Health Insurance Program. This is important progress that 
should not be cast aside.
  We should also be working to shore up funding for our health centers, 
which will see a 70 percent cut at the end of the month if we fail to 
act. One of the issues I hear most about is the cost of prescription 
drugs, which is why I have introduced a bill along with Senator 
Grassley that would help reduce drug costs by helping generic 
alternatives come to market faster. The American people expect us to 
work on real solutions. We should not be pushing a plan that hasn't 
been vetted where the primary goal seems to be to get to 50 votes, 
rather than actually improving our health insurance system.
  Was the Affordable Care Act absolutely perfect when it was passed? 
No, and we acknowledged the need for continual improvement as the ACA 
would be implemented, but unlike with other important social programs 
that have been created over the years--such as Social Security and 
Medicare--Republicans have not allowed us the opportunity to improve, 
strengthen and perfect it over time. Those programs were also not 
perfect, but instead of playing partisan games, Republicans and 
Democrats came together to get something done, time and time again. We 
did not vote to repeal the Social Security Act. No, we came together, 
and we discussed what needed to be done to better help the American 
people, not unravel their safety net.
  We must end this dangerous exercise of considering sweeping policy 
solely for the purposes of fulfilling a nearly decade-long partisan 
campaign promise. We should move forward in a responsible way. We 
should act in the best interests of our constituents and not resort to 
cynical, bumper-sticker politicking. At its best, the Senate has been 
able to act as the conscience of the Nation. I hope now is such a time 
and that the Senate will rise to the occasion and abandon these harmful 
efforts.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. HEINRICH. Mr. President, after the rushed and secretive effort to 
repeal the Affordable Care Act failed earlier this year, I had hoped 
that we could finally turn the corner and move forward in a bipartisan 
fashion to find some real solutions to our Nation's remaining 
healthcare challenges.
  I still believe that most of us here in the Senate--including 
Senators Alexander and Murray in the HELP Committee--are willing to 
work across party lines to find consensus on pragmatic improvements. 
That is why I was so appalled that President Trump and Republican 
leadership are reviving a last-ditch effort to pass a disastrous bill 
that would upend our healthcare system and take away insurance coverage 
from millions of Americans.
  Worse yet and even harder to believe, the bill that Republican 
leadership is rushing to the floor for a vote this week potentially is 
actually worse than any previous versions of this legislation. The so-
called Graham-Cassidy bill they are hoping to vote on would mean higher 
premiums for worse coverage and millions of Americans losing their 
health insurance. It will permanently gut Medicaid. Let me say that 
again. It will permanently gut Medicaid. And despite promises to the 
contrary that Republicans have long made, it would end key protections 
for people with preexisting conditions, such as diabetes and heart 
disease. In short, it would throw our entire

[[Page S6112]]

healthcare system into chaos. That is just awful policy any way you 
look at it.
  How did we get here? For over 7 years, Republicans in Washington have 
cheered shortcomings in our healthcare system and blamed the Affordable 
Care Act for every single problem, under the premise that they would do 
better if we only put them in charge. The trouble has been that their 
opposition to the ACA has been more rooted in bumper sticker politics 
than it ever was about actual policy or plans to do better for the 
American people. The long-lasting effort on display throughout this 
year in the Senate is only further evidence that President Trump and 
Republicans in Congress don't have any real solutions to improve our 
Nation's healthcare system.
  After months of negotiations behind closed doors, when Senate 
Republicans released their secret TrumpCare bill in July, its contents 
proved too harmful for passage, even in their own caucus. Now they are 
hoping for one more last-ditch vote before the end of September to pass 
something, anything to follow through on their reckless mission.
  One consequence of this legislation that is so important to my home 
State of New Mexico is that if we pass this bill, it will spell the end 
to any progress we have made in fighting our Nation's opioid and heroin 
epidemic. It is nothing short of hypocrisy for President Trump to say 
they are taking this major public health crisis seriously when they are 
supporting this bill.
  Ironically, the bill before us actually does less to combat opioids 
than the bill that was too draconian and damaging to pass last time. It 
is not just the behavioral health system and opioid treatment that will 
be upended if we dismantle the Medicaid Program; Medicaid pays for 
seniors in nursing homes, for school nurses who care for our kids, and 
for Americans with disabilities, and Medicaid has been a financial 
lifeline for hospitals and health clinics in rural communities across 
this Nation. I know this because I have heard it directly from our 
rural health providers in New Mexico. If we pass these drastic cuts to 
Medicaid, some of our rural health providers in New Mexico may very 
well have to close up shop.

  This is not some partisan assessment; this is what will happen 
according to many experts and people in the healthcare field who have 
nothing political at stake in this debate. The Medicaid directors for 
all 50 States and the Republican and Democratic Governors alike have 
come out against this bill.
  Look, I am not outraged about all of this because I am a Democrat or 
because of what I think of President Donald Trump; I am outraged about 
this bill because of what it will do to New Mexico families and to the 
communities I represent.
  If we can halt this mad rush, we could all--Democrats and 
Republicans--get to work on the problems with healthcare that we all 
agree need attention. There is work to be done, no doubt about it. 
There is still time to do what is right for the American families who 
elected us to work together and make their lives better. The Graham-
Cassidy bill simply does not do that. There is still time to change 
course--to go through regular order, to hold hearings--plural--and to 
build a consensus on fixes and improvements to the healthcare system. 
As Senator McCain told us all earlier this year, ``We've been spinning 
our wheels on too many important issues because we keep trying to find 
a way to win without help from across the aisle.'' Well said.
  There is a better way forward. I am confident that most of us would 
welcome a bipartisan, regular order approach. We need to remember that 
there are real people's lives that hang in the balance in this debate. 
I have heard so many New Mexicans talk about what health coverage means 
to them and their families. I don't know about you, but that is whose 
interests I am looking out for.
  Real, bipartisan solutions to the challenges in our healthcare system 
are within reach if President Trump and the Republican leadership would 
just be willing to let us work together to find them.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Massachusetts.


          Puerto Rico and U.S. Virgin Islands Recovery Effort

  Mr. MARKEY. Thank you, Mr. President.
  I would like to start my remarks today by offering my prayers and my 
support to the people of Puerto Rico and to their family members and 
friends here in the United States, many of whom have still not been 
able to get information about their loved ones.
  Massachusetts is home to the fifth largest Puerto Rican community in 
the mainland United States. It is a vibrant community, an engaged 
community, and since Hurricanes Irma and Maria, it has been a mobilized 
community. They are horrified by the images that are emerging from the 
island, pictures and videos of destroyed homes and of the massive 
flooding and widespread devastation. These images are difficult for any 
of us to see, and for those who have family there, these scenes beg for 
immediate action. Thousands of families are homeless, infrastructure is 
almost beyond repair, and much of the population will be without power 
for an indefinite period of time going into the future.
  We need to act now. We must treat Puerto Rico just like any other 
U.S. State that is experiencing a natural disaster. That means that the 
United States should continue deploying its military and civilian 
assets to provide lifesaving search-and-rescue, food, shelter, and 
power to residents of the island. Congress must also act to immediately 
provide additional aid and funding so that the island can begin the 
long process of rebuilding.
  Puerto Ricans, like Texans, like Louisianans, and like Floridians, 
are U.S. citizens. They are our sisters and brothers, and it is our 
moral obligation to provide them with help and relief in this time of 
their greatest need.
  As we debate healthcare, let's remember that in the wake of these 
devastating storms, Puerto Rico and the U.S. Virgin Islands will have 
enormous public health needs. They will be subject to an increased risk 
of disease transmission from a lack of clean drinking water, to 
physical injury from the storm, and to mental and behavioral trauma 
from the remarkable losses they are suffering. For those who are 
suffering from chronic conditions, such as diabetes and cancer and 
heart disease, finding and accessing treatment will be a daily 
struggle. Puerto Rico is a medical tragedy that is happening right 
before our eyes. History will judge us by how quickly we respond to 
this catastrophe.


                               Healthcare

  Mr. President, we should remember that this debate over healthcare is 
not confined to just this week, and it is certainly not confined to 
this building or even to this mainland.
  Yesterday, I held an emergency roundtable with the leading healthcare 
leaders in Massachusetts. These are the healthcare heroes who provide 
compassion and treatment each day to their patients. They all spoke 
poignantly about the devastation that would come from repealing and 
replacing the Affordable Care Act.
  Dr. Peter Slavin, president of Massachusetts General Hospital, said: 
``To repeal the [Affordable Care Act] would be a horrible sin for this 
country.''
  Yet that is exactly what the Graham-Cassidy bill is. It is a cruel 
and inhumane sin that would damn millions of American families.
  In some cases, this most recent TrumpCare proposal is even worse than 
the failed bills before it. The bill proposed the use of a totally 
subjective formula which was changed at the whim of the bill's sponsors 
to entice more Republicans to vote in favor of it. The bill was nothing 
more than something that had political plastic surgery that had been 
performed, but it was fundamentally the same bill.
  At the roundtable I held in Boston yesterday, Dr. Henry Dorkin, 
president of the Massachusetts Medical Society, said: ``I fear that if 
Graham-Cassidy were to pass, we would go back to attending more 
funerals of children.''
  There is simply no reason to go back to a time when people died of 
preventable or treatable conditions simply because they did not have 
access to insurance.
  Just moments ago, we learned that the Republican leadership will not 
hold a vote on this disastrous bill. They simply did not have the 
votes. Right now, millions of Americans are again breathing a sigh of 
relief.

[[Page S6113]]

  I applaud my colleagues Senator John McCain of Arizona, Senator Susan 
Collins of Maine, and others in this Chamber who are calling for a 
bipartisan process to strengthen and improve our healthcare system. We 
have done it before on the opioid crisis. We have done it on 
Alzheimer's and other medical research funding. I still believe we can 
do it here. We need to do what we have done so many times before and 
focus on bipartisan solutions instead of partisan exercises.
  I hope we can put Graham-Cassidy and other TrumpCare proposals behind 
us and embrace bipartisan negotiations led by Senators Alexander and 
Murray to stabilize the individual health insurance market.
  Just last week, Senators Wyden and Hatch introduced bipartisan 
legislation to reauthorize the Children's Health Insurance Program for 
5 more years. There are a number of bipartisan healthcare issues that 
need immediate attention this week, such as the funding for community 
health centers and extending the number of Medicare policies.
  This bill was not our only option. It is not even really an option, 
at least not for those Americans with preexisting conditions, who are 
on Medicaid, or who need opioid treatment.
  We need to work together in this Chamber to improve health in a way 
that works for all Americans regardless of where they live or who their 
Governor is. That is the responsibility of those who serve here, and 
now let us have a new beginning, where we begin to work together to 
solve those problems.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, while the Senator from Massachusetts is 
still with us on the floor and in other ways as well, I just want to 
say a couple of things.
  One, good for the Senator. He just said a mouthful, and he said what 
needs to be said. What he said is that there is not just one or two 
choices. Somebody said to me yesterday: Well, it is a choice between 
either a single-payer or Graham-Cassidy. Those are our choices.
  Uh-uh. No. No. I think a far better choice for us to take is in the 
example of leadership set by Senators Alexander and Murray on the 
Committee of Health, Education, Labor, and Pensions. As the Presiding 
Officer knows, in a span of 2 weeks, they held four bipartisan 
roundtables with Governors from all over the country, insurance 
commissioners from all over the country, healthcare providers, 
insurance, and health economists to ask: What should we do? What should 
we do right now in our being faced with the challenge and maybe the 
possibility of repealing the Affordable Care Act? What should we do?
  They all said the same thing--stabilize the exchanges. Every State 
has a health insurance exchange, an individual marketplace. Stabilize 
them. They all basically said to do mainly three or four things to 
stabilize them:
  No. 1, make clear that these cost-sharing subsidies, which help lower 
income people in the exchanges with their copays and deductibles, are 
not going away. Make it clear that they are going to be around for at 
least a couple of years.
  No. 2, either give the States the ability to create their own 
reinsurance plans or create one for the Federal Government, by the 
Federal Government, involving the Federal Government.
  The third thing they said is, if we are not going to enforce the 
individual mandate--I, personally, think we should--then make sure 
there is something that is just as effective as the individual mandate 
in order to make sure that young people--millennials like my sons--are 
getting their healthcare. They are in the exchanges, and they are 
helping to make sure there is a healthy mix of people to insure.
  Those were almost word by word, panel by panel, what we heard in four 
different hearings by the HELP Committee during four different 
bipartisan roundtables that preceded those hearings. They all said to 
fix the exchanges.
  I have an old friend who is now deceased. He was a Methodist minister 
for many years in southern Delaware. He used to give me this advice 
when I was Governor: Just remember this, Tom--the main thing is to keep 
the main thing the main thing.
  That is what he said. The first time he said it, I didn't know what 
he was saying. It took me a while, but I finally figured it out. The 
main thing is to keep the main thing the main thing.
  Right now, the thing that we can do and ought to be able to agree on 
is to stabilize the exchanges. Premiums do not have to go up in the 
exchanges by 30, 40 percent. If we would simply do one thing and make 
it clear that these cost-sharing subsidies are not going away and give 
that green light to the insurance companies, insurance commissioners 
across the country will reduce significantly the increases in the 
premiums.
  I have been told by more than a few health insurance companies that 
if we would do that and make sure there is some kind of reinsurance 
program in place, in effect, and also make it clear that the individual 
mandate must continue to be enforced--and if it is not, then replace it 
with something that is just as good--if we would do those three things, 
we would see premiums go down anywhere from 30 to 35 percent in the 
exchanges across the country. Who mostly benefits from that? Who 
benefits from a 30- or 35-percent reduction in premiums in the 
exchanges? The folks who are getting their insurance in the exchanges 
benefit, but do you know who else probably benefits even more? Uncle 
Sam. The reason is that most of the people who get their coverage in 
the exchanges benefit from a sliding scale tax credit that buys down 
the cost of the premiums. If the premiums go down by 30 or 35 percent, 
that means that Uncle Sam, out of the U.S. Treasury, pays less money in 
the form of those tax credits. That is not a bad deal.

  Our Republican friends like to talk about dynamic scoring. I am not 
sure I believe dynamic scoring is real, but I believe if we actually do 
help drive down the cost of premium increases, Uncle Sam is a big 
beneficiary of that.
  The last two things I want to say are, No. 1, I thank Senator 
Alexander and Senator Murray for the great bipartisan leadership they 
have shown. I had a chance to go to four bipartisan roundtables a 
couple of weeks ago. They welcomed people not on the HELP Committee. I 
am on the Finance Committee, as is the Presiding Officer. We have 
shared jurisdiction with the HELP Committee. But we have the 
opportunity in our committee to sort of follow the lead, if you will, 
of what they are doing on the HELP Committee and do bipartisan hearings 
and bipartisan roundtables of our own.
  Why don't we sort of pick up where we were about a week and a half 
ago when the prospect of debating and voting on Graham-Cassidy came out 
of nowhere and led to yesterday's 5-hour hearing in the Finance 
Committee? Why don't we pick up where we left a week and a half ago and 
get to work again?
  This is not something we ought to take weeks or months to do. Let's 
just do the main things; that is, stabilize the exchanges, and if we do 
nothing else in the next week or so, let's make it clear that these 
cost-sharing subsidies are not going to go away. We help people on the 
exchanges, the premium increases go down, and we actually help the 
Treasury. That is not a bad deal.
  The last thing I want to say is for those people who say that 
Democrats believe the Affordable Care Act is perfect and nothing needs 
to be changed. That is just nonsense. The Presiding Officer and I can 
sit down and tick off a number of things that ought to be addressed and 
fixed. He and I probably, as smart as we are, are not smart enough to 
figure out all of them. We need to have a good hearing and good 
conversation amongst ourselves and with a broad section of shareholders 
and stakeholders across the country. As a recovering Governor and 
former chair of the National Governors Association, I want to hear the 
voices of the Governors. I want to hear the voices of the insurance 
commissioners and a whole lot of other people who are affected by this.
  Every President, I think, since Harry Truman has called for providing 
healthcare coverage for just about everyone in our country--every 
President. Along the way we made some advances with Medicaid and 
Medicare with Lyndon Johnson. We made some

[[Page S6114]]

advances in the Clinton administration with Orrin Hatch and Ted 
Kennedy's legislation creating the CHIP Program, the Children's Health 
Insurance Program. We are still a long way from where we ought to be 
for health insurance in this country.
  Here is the trifecta of where we would like to go and where 
Presidents and leaders have said forever that we ought to go. No. 1, 
provide quality healthcare for people in this country; No. 2, do it in 
a cost-effective way; and No. 3, cover everybody. We are doing a lot 
better job of covering everyone. We have 20-some million people who 
don't have coverage. That is down from 50 million people years ago.
  We still have people without coverage. We spend a lot more money in 
percentage of GDP in this country than most other advanced nations. We 
have to continue to get better results for less money and have a real 
focus on value.
  There is a lot of encouraging work going on in my State. I know in 
Ohio there are places like the Cleveland Clinic. There are places like 
Christiana Care in my State. There is a lot of encouraging work going 
on, and we ought to build on it and find out what works and do that.
  Lastly, I want to give a shout out to Senator Gary Peters and 
Senators Duckworth, Stabenow, myself, and a couple of others who have 
been focused on a veterans' health motion to commit. I want to say a 
few words about healthcare as it pertains to veterans. This has been 
lost sometimes in the shuffle.
  The Medicaid Program in our country covers about 25 percent of the 
people who get healthcare in this country. Medicare is about 15 
percent. The majority of people who get healthcare coverage in this 
country get it through their large group plan. We have 6 percent or 7 
percent who get coverage through the exchanges.
  As a navy veteran, an ROTC guy, retired Navy Captain, we know that 
not every veteran actually gets their healthcare coverage from the VA. 
A number of them aren't eligible for that. As it turns out, among the 
people who receive coverage under Medicaid today, a lot of them are 
old, a lot of them are like our parents, grandparents, aunts, and 
uncles. The reason they are eligible for Medicaid is they have spent 
down their resources and assets, and they are old. A bunch of them have 
dementia. Maybe the family is unable or unwilling to take care of them, 
and they end up in a nursing home, and Medicare picks up the tab.
  I described it yesterday in our Finance Committee hearing. It is like 
a tsunami. My generation, the baby boomers, are moving into their 
retirement and moving into their seventies, eighties, and nineties, in 
some cases. A lot of them are old, and they have dementia. A couple 
million of them are veterans who get their healthcare coverage through 
Medicaid.
  In Ohio and other places, and certainly in Delaware, we have huge 
problems with opioids and heroin. The biggest form of treatment, as the 
Presiding Officer knows, for people with drug addiction in this country 
is Medicaid. Those are some reasons we think it is important not to 
touch one hair on the head of Medicaid, if you will, but to try to 
figure out how to make changes in a smart and humane way.
  Let me say a word or two about veterans' healthcare. My understanding 
is that the last version of the Republican healthcare proposal was 
pulled today, not to be voted on. It totally cut several hundreds of 
billions of dollars from Medicaid. I believe most everyone says that is 
true. Not every veteran has access to the VA for healthcare. Nearly 2 
million veterans, as I mentioned earlier--that is 1 in 10 veterans in 
this country--rely on Medicaid for their healthcare, and that includes 
some 6,000 veterans who are living in my own State of Delaware.
  The Affordable Care Act provided healthcare coverage to some 340,000 
veterans in the States that expanded Medicaid. For our veterans who 
rely on Medicaid, the most recent TrumpCare proposal would 
significantly scale back benefits or cause them to lose their benefits 
altogether. Veterans who rely on those benefits would see higher 
healthcare costs and lower quality care if they could access it at all. 
All the while, we know veterans are at high risk for serious and 
complex issues because of their service.
  I want to close by saying in a heartfelt way that we all know 
veterans. We have an obligation to those who have served us to make 
sure we take care of them later in their lives. We do that in a variety 
of ways.
  The VA system is much maligned in my State. It is not perfect, but I 
think they do a darn good job. We have one big hospital in Northern 
Delaware and two community-based outpatient clinics--one in Dover and 
Centerville and another one in the southern part of our State. They do 
a very good job.
  We are about to open a brandnew, 10,000-square foot community 
outpatient clinic in Georgetown, DE, the county seat of our 
southernmost county. Having said that, not every veteran in Delaware 
can access those facilities. For them, Medicaid is useful, and in some 
cases it is critical to having any care at all. We should keep that in 
mind. The challenges of the focus that were created by the possible 
vote here on this floor are now averted on the Graham-Cassidy proposal. 
As we go forward in a bipartisan way, let's work together to fix the 
things in the Affordable Care Act that need to be fixed and preserve 
those that need to be preserved, and for the aspects that need to be 
dealt with or dropped, let's figure out how to do that in a smart and 
humane way. We need to also keep in mind that a couple million people 
who use Medicaid are veterans themselves.
  With that, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mrs. GILLIBRAND. Mr. President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


          Puerto Rico and U.S. Virgin Islands Recovery Effort

  Mrs. GILLIBRAND. Mr. President, I rise to speak about the 
humanitarian crisis in Puerto Rico and the U.S. Virgin Islands. This is 
one of the worst disasters our country has ever seen.
  The men, women, and children who live on these islands are American 
citizens. Do not forget that. They are suffering, and they need our 
help. They have no food to eat, no water to drink, no power, and no 
refrigeration. If we don't give them help now, then many more people 
there will die--far more than those who were killed during the 
hurricane itself.
  I urge my colleagues to think about our fellow American citizens in 
Puerto Rico and the U.S. Virgin Islands and what they are suffering 
through right now. Listen to their cries for help. Listen to what one 
of my constituents said to me:

       We need help getting my grandparents to come to New York. 
     Their house is damaged and not safe. My grandfather is 93 
     with Alzheimer's. He is bed bound. He has not been able to 
     walk for over 18 months. My grandmother is 92 and diabetic 
     with a heart problem. My aunt is 68, and we think had a brain 
     aneurism and needs medical care. Please help them. Help get 
     them to New York. We can pay for the plane ticket. We need 
     help getting them to the airport and putting them on the 
     plane.

  Another New Yorker told me that her father is a veteran of Vietnam 
and is a retired police department lieutenant who now lives in Puerto 
Rico. This veteran of the U.S. military told his daughter that he 
suffered from head trauma because he slipped and fell while clearing 
water from his house. He told his daughter that Puerto Rico is 
devastated and looks like an atomic bomb has struck the island. He is 
without power, cell phone use, and water. He told her that Mother 
Nature had unleashed a monster on them.
  He said, ``God have mercy on us,'' and then told his daughter that he 
loved her.
  This man is a veteran. He served in our military alongside so many 
other Americans from Puerto Rico. He protected our country when we 
needed him, so we need to protect him now.
  How would you respond if this humanitarian crisis happened in your 
State or in my State or any other State around the country?
  Can the Presiding Officer imagine what this would be like if it were 
Ohio? Can you imagine what this would be like if it were New York? We 
would act as quickly as we could. We would give people there every 
resource they need to recover. We wouldn't hesitate even

[[Page S6115]]

for a moment. This is urgent and serious, and we have to help our 
fellow citizens now.
  Congress must provide the funding necessary to send every resource 
available. Help them clean up. Help them recover without further delay. 
That includes providing disaster community block grant funding, just as 
we did for the people of Texas and Florida. We cannot turn our backs on 
our fellow citizens.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. UDALL. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                              Health Care

  Mr. UDALL. Thank you, Mr. President, for your recognition.
  I rise today with my colleagues from the Senate Committee on Indian 
Affairs, Senator Heitkamp and Senator Cortez Masto, to talk about how 
the Republicans' latest and most heartless healthcare bill hurts 
American Indians and Alaska Natives.
  I have just heard some good news that this bill might not be brought 
up for a vote this week, but Republicans insist that they will continue 
their efforts to repeal the Affordable Care Act and raid the Medicaid 
expansion program, which will devastate Indian Country. So this latest 
withdrawal is great, but they are saying that it is not going away. So 
we have to maintain vigilance on this issue.
  We came together before, in July, when Republicans' Better Care 
Reconciliation Act threatened to roll back healthcare for Native 
communities. With that bill's defeat, we hoped the debate over 
legislation that jeopardized healthcare for Native communities was 
behind us, and we hoped we could begin to work in earnest in a 
bipartisan way to address the real healthcare problems that Americans 
face.
  Given this new threat, my Indian Affairs Committee colleagues and I 
must remind this Chamber, once again, that the Federal Government bears 
a solemn trust, treaty responsibility, and obligation to ensure that 
Native Americans receive quality healthcare. Each version of the 
Republican repeal we have seen so far violates that trust 
responsibility by taking healthcare away from hundreds of thousands of 
Native Americans and abdicating the Federal Government's Native 
healthcare responsibilities. If any of these proposals pass, Native 
Americans' health and lives will be in danger. These efforts must be 
stopped.
  Everyone familiar with Indian Country knows that the Indian Health 
Service is severely underfunded. ``Don't get sick after June'' was a 
familiar refrain on many reservations, pueblos, and villages. Limited 
funding meant medical services were often rationed to only emergency 
care or life and limb. IHS patients were not guaranteed access to 
comprehensive medical services, specialized services, or preventive 
care.
  The Affordable Care Act and the Medicaid expansion changed this 
equation and changed it dramatically. The ACA alone has increased 
third-party billing revenues to IHS more than 25 percent, and Medicaid 
funding for IHS has increased nearly 50 percent. Tribal and urban 
health facilities have been able to move away from healthcare 
rationing.
  Medicaid expansion has provided health insurance to an additional 
290,000 Native Americans from 492 Tribes--almost 90 percent of all 
Tribes. This includes 45,600 Tribal members from my home State of New 
Mexico.
  Uninsured rates in Indian Country have decreased from 53 percent to 
39 percent, and many Tribal communities' uninsured rates are even 
lower. At the Santa Domingo Pueblo in New Mexico, 22 percent of Kewa 
Pueblo Health Corporation's patients were uninsured in 2013. In 2016, 
the uninsured rate was down to 7 percent. At the IHS Sante Fe Service 
Unit in New Mexico, 84 percent of our patients now have some sort of 
insurance. On the Turtle Mountain Reservation in North Dakota, they 
have seen a 14-percent reduction in uninsured Tribal members. At the 
Portland Urban Indian Health Center, the rate of uninsured has gone 
from 56 percent to 8 percent, solely due to Medicaid expansion. This is 
impressive. Let me just say that again. It has gone from 56 percent 
uninsured to 8 percent.
  Medicaid expansion has helped to make up for this historic 
underfunding in IHS services. Third-party billing revenue through 
Medicaid is now up to 35 percent of the Kewa Pueblo Health 
Corporation's total budget. For the Jicarilla Apache Tribe in New 
Mexico, Medicaid makes up more than 75 percent of their third-party 
billing revenue. At the Navajo Crownpoint IHS hospital, 50 percent of 
their budget comes from Medicaid third-party billing revenue. For 
Seattle's urban Indian health clinic, operated by the Seattle Indian 
Health Board, Medicaid and Medicare expansion have resulted in a 
revenue increase of 146 percent since 2012.
  Medicaid expansion has allowed IHS to expand services and build new 
facilities. Kewa Pueblo Health Corporation has used some of its third-
party billing to offer new specialty-care services, like obstetrics and 
podiatry, and to build new clinic space. Santa Fe IHS used its 
additional funds to build new examination rooms for Santa Clara Pueblo, 
establish a mobile health unit for San Felipe Pueblo, and update 
outpatient rooms at the main clinic in Santa Fe. The Seattle urban 
Indian clinic uses its additional revenue to expand patient services to 
include a pilot opioid addiction program.
  In the words of the National Council on Urban Indian Health, Medicaid 
expansion has been an ``unqualified success.'' The ACA brought new hope 
to Native families and communities.
  But this latest Republican plan will undo this success. Thank 
goodness it has been withdrawn. In that plan, they claim they will 
preserve Medicaid expansion eligibility rules for Tribes. This offers a 
false hope.
  Like most people on Medicaid, Tribal members go on and off the rolls 
as their income fluctuates. Proposals like Graham-Cassidy would require 
that they be continuously enrolled in Medicaid expansion and work to 
receive benefits. If not, they would be dropped permanently from the 
program.
  Section 128 of Graham-Cassidy is also being pushed as helpful to 
Indian Country. This section expands IHS's Federal reimbursement rate 
to non-Native providers, but really it is a veiled attempt to buy 
off State leaders concerned about massive cuts to the Medicaid Program. 
It will not improve Tribal healthcare facilities. It will undercut the 
IHS, and it will undermine the Tribal self-determination by bypassing 
Tribal input in the Federal Medicaid reimbursement process.

  There are 30,000 Native Americans who now have private individual 
health insurance thanks to the ACA. Every Republican plan so far strips 
away the ACA's cost-sharing subsidies and tax credits, which help make 
private insurance affordable for many of these Tribal members and for 
millions of working Americans. The Republican bill does nothing to help 
these Native Americans keep their health insurance.
  The sponsors can try to dress this bill up, but the glaring reality 
is that TrumpCare 2.0 would be terrible for Indian Country. In fact, it 
is worse for Tribes than any other proposed repeal plan so far.
  It is no surprise that prominent Native organizations--the National 
Indian Health Board, the National Congress of American Indians, and the 
National Council of Urban Indian Health--oppose Graham-Cassidy and 
proposals like it. They join virtually all major patient advocate 
organizations and medical organizations in their opposition, including 
the American Heart Association, the American Cancer Society, the 
American Lung Association, and the American Medical Association.
  Eighty percent of the American people disapprove of the Republicans' 
attempts to undermine healthcare. Graham-Cassidy is woefully out of 
touch with the American people and, especially, with Indian Country. I 
am glad this bill will not receive a vote this week.
  Just like tens of millions of our fellow Americans, Tribes, Tribal 
organizations, and individual Native Americans all around the country 
are worried about what Republicans will do to their healthcare. I have 
received a record 15,000 calls, emails, and letters from constituents 
about healthcare this year. Almost all of them have been

[[Page S6116]]

opposed to the Republicans' relentless attacks on healthcare, and not a 
single Tribe has reached out to my office in support of this bill.
  These attacks are happening behind closed doors. There was only one 
rushed hearing, and it was yesterday. There is no formal Congressional 
Budget Office analysis, and there has been no meaningful consultation 
with Tribes. Although many of us have called for that, there has been 
no consultation. It is difficult to adequately describe the 
recklessness, cruelty, and cynicism in the Republicans' rush to tear 
down the ACA.
  The Senate Health, Education, Labor, and Pensions Committee started a 
bipartisan effort to address the real healthcare needs in this country, 
but Republicans froze it once Graham-Cassidy was introduced. I am 
really hoping now that Chairman Lamar Alexander and Vice Chairman Patty 
Murray can get back to the bipartisan work that needs to be done. Other 
time-sensitive legislation with broad, bipartisan support--like 
reauthorization of the Children's Health Insurance Program and the 
Special Diabetes Program for Indians, which need to be enacted before 
the end of September--was pushed aside.
  Congress needs to change focus. We need to work across the aisle to 
meet the needs of the American people, and we need to improve Native 
American healthcare. We have come a long way under the Affordable Care 
Act and the Medicaid expansion, but we are far from being able to 
declare victory. I echo our colleague from Arizona, Senator McCain. 
Given the enormous impact of healthcare on the lives of Americans and 
our economy, we need to find bipartisan solutions through the regular 
order.
  Partisan repeal of the ACA is not right for Indian Country or for 
America.
  Now, Mr. President, I would yield the floor to my colleague from 
North Dakota, Senator Heitkamp. I worked for many years as attorney 
general with Senator Heitkamp. She was a great champion during those 
years for Native Americans and, specifically, for Native American 
children. She has been an incredible advocate on the Affordable Care 
Act and the good that it has done for Native Americans.
  The PRESIDING OFFICER. The Senator from North Dakota is recognized.
  Ms. HEITKAMP. Thank you, Mr. President.
  To my great colleague and one of the nicest people here, Senator 
Udall, who always leads with his brain, we know that his heart isn't 
far behind, and he has been a tremendous leader, a tremendous advocate, 
and a tremendous collaborator on this all-important issue.
  I think first that we have to acknowledge how grateful and thankful 
we are that the Republican bill, known as Graham-Cassidy, will not be 
advanced this week. I don't think it is the last that we have heard of 
it, but it is critically important that now we have time to talk about 
the impacts and we have time to talk about why it is that we found this 
bill so objectionable, and we have an opportunity to raise the issues 
that may have been forgotten. I think one of those issues is the unique 
challenges that Native American people have in receiving and affording 
quality healthcare in America.
  All of the Tribes in my State have a treaty right to healthcare. It 
is kind of like when they say that, under the Affordable Care Act, you 
have access to care, but if the care is low quality, if the care is 
unavailable, if the care is not something you can afford or that will 
actually provide the kinds of services that you need, it is really not 
fulfillment of the treaty obligation.
  One of the things we know is that many of the programs within the 
Affordable Care Act have gone a long way toward meeting the Federal 
Government's treaty responsibility to provide healthcare to Native 
American people. We talk about how Graham-Cassidy would hurt seniors, 
children with disabilities, individuals with preexisting conditions 
like asthma or cancer, those receiving treatment for opioid abuse, and 
many more. But too often in those statistics, which would encompass 
many Native American people who unfortunately have high rates of 
chronic conditions, the specific and unique needs of Native populations 
are forgotten during debates in the Congress. It happened when 
Republicans tried to pass their initial healthcare bill over the 
summer, and it nearly happened again.
  Here we are on the Senate floor to make sure that Native communities 
are not left behind during these discussions in the future. We will be 
watching to make sure that communities in our State, unique and 
discreet, and, in fact, treaty Tribes, which are entitled to healthcare 
by contract, by treaty with the U.S. Government--that their interests 
are heard and that their voices are heard.
  In July, when the Senate was discussing the last Republican 
healthcare bill that would have taken healthcare away from North Dakota 
families, I worked with Senator Udall, vice chairman of the Senate 
Indian Affairs Committee, to hold a discussion on Tribal healthcare. 
The purpose was to hear directly from Tribal leaders, including the 
chairman of the Turtle Mountain Band of Chippewa Indians from North 
Dakota, about how bad that bill would have been for Indian Country.
  During that discussion in July, we lamented--those of us who are on 
the committee, especially the minority members--that what happens in 
the Indian Affairs Committee all too often stays in the Indian Affairs 
Committee. What do I mean by that? I think the stories we hear and the 
challenges we hear about Native people, which we respond to many times 
with great empathy, are never taken out of that committee room. They 
are never understood broadly by Senators in this Chamber. We vowed that 
day that we are never going to leave those challenges in that committee 
room. We are going to take those challenges to this forum and to this 
floor. We want to share our concern about the lack of Tribal 
consultation in the healthcare debates so far.
  Unfortunately, the Graham-Cassidy healthcare bill still does not 
remotely or adequately protect Native people. Just look at the 
opposition to the bill from the National Congress of American Indians, 
the National Indian Health Board, and the National Council of Urban 
Indian Health. This bill is just as bad as, if not worse than, the 
previous bill. To push it through without adequate consultation in ways 
that would fundamentally change our healthcare system is in no way 
putting the healthcare needs of people first; it is putting politics 
first. It is irresponsible and unconscionable.
  Those of us on the Indian Affairs Committee know undoubtedly that the 
Indian Health Service is severely underfunded and, some of us would 
argue, inappropriately managed. It has been that way since I have been 
here. We have experienced those challenges of lack of leadership, lack 
of funding, and, really, an attitude that this is the way we have 
always done it. It has resulted in very many of our institutions losing 
their CMS certification. That is unacceptable.
  The stories are unacceptable, but we also cannot just pin it on 
Indian health. We have to recognize and understand that this is also a 
funding problem. So it is essential that we find resources to fill 
those gaps and enter the Affordable Care Act, where we not only have 
traditional Medicaid eligibility, but we also have expanded Medicaid, 
which now has given extra hope to Indian healthcare providers that this 
resource can be made available without constantly having to beg for 
additional resources for Indian health. So it is particularly because 
of these severe challenges at the Indian Health Service that 
traditional Medicaid, Medicaid expansion, and private health insurance 
access have been critical for Indian Country, making sure Native 
Americans can access quality, affordable care to keep them and their 
families healthy.
  Thanks to the increase of third-party payments, we are no longer 
limited to life and limb care at Tribal and IHS facilities in the Great 
Plains IHS service area. But the Graham-Cassidy healthcare bill would 
undo all of that progress. It would slash Medicaid expansion and cap 
the Federal contributions to traditional Medicaid, pushing those 
remaining costs onto States and counties that can ill afford it.
  Medicaid expansion has significant impact on IHS services at Turtle 
Mountain, increasing the funding and

[[Page S6117]]

resources available to its patient population by increasing healthcare 
services, increasing Purchased/Referred Care, or PRC, services, and 
increasing revenue generation.
  Here are just some of the statistics that show how Turtle Mountain's 
IHS hospital has been impacted by the Medicaid expansion: a 13-percent 
decrease in uninsured patients; a 30-percent increase in Medicaid 
coverage; a 13-percent increase in traditional Medicare coverage; a 57-
percent increase in private insurance coverage; a 9-percent increase in 
the number of individuals served; a 43-percent increase in revenue 
generation, i.e., collections; and a 32-percent increase in Purchased/
Referred Care referrals. That may sound as if it is good for the 
institution, but when it is good for the institution--the healthcare 
provider--it is good for the families who get their services there.
  Third-party billing revenue has also allowed the hospital to make 
renovations to emergency rooms and clinics, purchase new medical 
equipment, including neonatal monitors, recruit and hire additional 
staff, including licensed professionals, increase staff training and 
education, provide Wi-Fi throughout the hospital, and expand its all-
important behavioral healthcare facility to serve more patients.

  But the Republican healthcare bill would have eliminated these cost-
sharing payments that make private health insurance affordable and 
accessible to American Indian families and North Dakota Indian families 
for the first time. All through the country you hear this over and over 
again, in pockets of poverty in this country. For the first time in 
people's lives, they have an insurance card, and that is a ticket to a 
future. Without an insurance card, many times people are left behind. 
This is an issue I have spoken about multiple times because it is so 
important.
  In North Dakota, the Republican bill would have caused an estimate of 
almost 1,000 Native Americans to lose their cost-sharing reduction 
payments. The Republican healthcare bill would also jeopardize all-
important mental health services for Native youth and could remove a 
trauma-informed approach to students' education. The Mandan, Hidatsa, 
Arikara Nation from my State is working to set up a mental health pilot 
program in their schools by next year in this partnership with Nexus 
and PATH in North Dakota, which will bring social workers and a 
satellite clinic to school campus. This pilot program will be paid for 
by Medicaid.
  The Graham-Cassidy healthcare bill would cut $5.5 billion from 
traditional Medicaid in North Dakota by 2036, affecting 36,000 low-
income--not people--but low-income children. The Tribe and the North 
Dakota Department of Public Instruction are relying on those Medicaid 
dollars to keep this mental health program possible, which will keep 
kids in the classroom and in the communities while they are provided 
services. Quite honestly, keeping children with their families is a 
longstanding challenge, as we see the history of childhood trauma 
beginning at the time of not only the westward movement of families, 
like my ancestors, but the trauma that was experienced when children 
were ripped out of their homes and taken to boarding schools--a trauma 
from which many Native American communities have not yet recovered.
  Sadly, this plan would take a significant step backward in healthcare 
for all Americans and certainly fall short on our promises and our 
treaty obligations to Native Americans. With so much at stake in our 
healthcare system, it is critical that we take a thoughtful and 
inclusive approach to healthcare--in fact, healthcare reform that 
considers the needs of all Americans, including, in my case, the first 
Americans, Native Americans.
  Republicans need to work with Democrats. I was saddened when I heard 
last night during the debate a discussion about how there isn't any 
opportunity for bipartisanship. I, like 30 of my other colleagues, 
attended meetings held by the HELP Committee before their hearings. 
Think about this. Thirty U.S. Senators, at 8 in the morning, without a 
mandate, with no obligation to be there, completely voluntary, came 
together during three mornings to talk about how we can work together 
as a bipartisan group on healthcare. So when people say it is not 
happening, it clearly is happening. It is happening, and we can, in 
fact, get to yes on many of the challenges that we have in healthcare. 
But we can't get to a lasting system if it is something that is done in 
a back room in the dead of night without consultation, not just with 
other Members of this body but without consultation for groups like 
Native American Tribes and Native American people.
  Over the past 4\1/2\ years, I have offered reasonable reforms that 
should be bipartisan to make the current healthcare system work better 
for Dakotans and better for those citizens and my constituents in 
Indian Country. Over the past few months and years, I have met with a 
group of Republican and Democratic Senators to talk about reasonable 
reforms that would make healthcare work better if we just focus for a 
minute on what unites us and what we can do if we just set aside 
partisanship, if we simply believe that we can, in fact, bury partisan 
hatchets and begin the work of working together.
  I want to mention one last discussion item. Many times, when you hear 
people talk about treaty obligations for healthcare or education, it is 
usually people on this side of the aisle who are talking about Tribal 
sovereignty, Tribal treaty rights. Well, I was gladdened to hear my 
colleague from South Dakota talk about a treaty right that Tribes in 
his State have to healthcare. The solution there was to ask the Federal 
Government--if, in fact, the citizen of that State were Native American 
enrolled--to say that really is a Federal treaty right. So the Federal 
Government should pay 100 percent of that, even though your State match 
would be 50-50. That makes sense. I can buy that. But do you know what? 
That does nothing to expand healthcare to Native people--nothing. What 
that does is say that 50 percent that you are currently paying is 
because these are citizens of your State, not some kind of 
nonresidents. These are residents of your State, citizens of your 
State, whom you pay that additional 50 percent for. If the argument had 
been that we are going to take that additional 50 percent, the Federal 
Government is going to pay it, and we are going to augment what we do 
in healthcare for this population, then we are actually getting 
somewhere. Then we are actually accomplishing something for Native 
American people and Native American children.
  I want you to understand that this is a population that suffers 
diabetes at record rates--hypertension, behavioral and mental health, 
including serious addictions, with record and epidemic suicides among 
young people all through Indian Country, record and epic amounts of 
opioid and meth addiction, children being born addicted.
  We need interventions now. We do not need to see a reduction in 
support to healthcare--both behavioral and mental healthcare--right 
now, at this time. It is a crisis, and we need to do everything we can 
to consult with the Tribes, to consult with Indian healthcare leaders, 
to consult with the people who do this work for a living, and fashion a 
system that will expand and grow access to healthcare. It is critically 
important.
  Make no mistake, these are the first Americans, and way too often, 
the ``asterisk Americans.'' What do I mean by that? They are not large 
enough to have a demographic category, so their challenges are not 
tracked, whether it is human trafficking, whether it is addiction. If 
we do not begin to focus on this, we will fail in our treaty 
obligations.
  The United States of America signed a treaty with Indian people. 
Let's keep our word. Let's work together. Let's work in collaboration 
with many of the people in my State who are struggling to make ends 
meet. Let's not reduce services and resources. Let's not take a step 
backward.
  Thank you.
  I yield the floor back to the Senator from New Mexico.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. UDALL. Mr. President, let me thank my colleague Senator Heitkamp 
for her great advocacy today for Native Americans. I have known her for 
a long time. In every public service job she has had--whether it was 
the State tax commissioner of North Dakota or the

[[Page S6118]]

attorney general and now U.S. Senator--she has always been a great 
advocate for the Tribes. We so much appreciate that. I can tell you, 
she is one of the hardest working members of the Senate in the Indian 
Affairs Committee. She really brings what you talked about--a great 
bipartisan approach to this. We look forward to doing more of that in 
the future.
  I also wish to say to the Presiding Officer that he has shown 
bipartisanship on opioids, and we have an epidemic. So we can show that 
there is bipartisanship.
  With that, Mr. President, I ask unanimous consent for myself and 
Senator Cortez Masto to engage in a colloquy and then yield to her.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. CORTEZ MASTO. Mr. President, I thank Senator Udall, the ranking 
member of the Senate Indian Affairs Committee. I am honored to be 
working with him on that committee in a bipartisan way, as he talked 
about.
  I am also very honored to represent the great State of Nevada, a 
State that is home to civically active Tribes. Nevada's Tribal 
communities deal with many of the same challenges that plague Native 
communities throughout the United States. Indigenous people suffer from 
higher rates of poverty, illness, and substance abuse than the general 
population.
  I recently received this communication from the Walker River Paiute 
chairman, Amber Torres, about the importance of the Medicaid expansion 
for her community. Chairman Torres wrote:

       I feel that the impacts on cutting Medicaid expansion for 
     Nevada would be detrimental to the people. With this coverage 
     we have been able to obtain services for our male and 
     childless adult population. Our people have been able to 
     obtain services that have not been approved or do not qualify 
     through Indian Health Services.

  She then goes on to say:

       A large portion of our reservation is covered by the 
     expansion and have seen their health ailments being addressed 
     in a timely manner due to alternative means of coverage.

  She said:

       We have seen our covered recipients percentage go from 20 
     percent to 45 percent, with our numbers continuing to rise 
     daily. If Medicaid expansion is repealed, what is the 
     alternative for these people . . . ?
       Historically Indian Health Services has only been at a 
     Medical Level Priority 1 for our service delivery area, which 
     means bleeding, blind, broken or dying. Is this what we need 
     to look forward to going back to?

  Chairman Torres's question is one a lot of Native Americans are 
asking right now and a question I wish to pose to Ranking Member Udall.
  The Federal Government has a sacred trust and responsibility to the 
Native communities of Nevada and throughout the country. I ask the vice 
chairman, would rolling back Medicaid expansion in Nevada and other 
States like mine result in pre-ACA Indian Health Service coverage and 
care, as Chairman Torres discussed?
  Mr. UDALL. I say to Senator Cortez Masto, thank you so much. Thank 
you for bringing the statements forward from Chairwoman Torres. She has 
every right to be concerned.
  The short answer to her question is, yes, we don't want to go back. 
Chairwoman Torres is right to be concerned. Tribal leaders across the 
country want to know how this bill would impact their members, but, as 
Senator Heitkamp highlighted, Republican leadership has not engaged in 
any meaningful Tribal consultation.
  I know that is something that concerns you a lot. Working with you on 
our committee, you always raise that issue--Tribal consultation and how 
important that is. That did not occur before these proposals were put 
before us.
  Repeal of the Medicaid expansion would pull millions of dollars out 
of critical funding at the Indian Health Service and would return the 
entire system to life or limb. Medicaid funding at IHS has increased by 
over $240 million since the Affordable Care Act passage, and that is an 
increase of 43 percent.
  Under the ACA, Tribes and urban Indian health facilities have started 
offering a much wider range of healthcare services to Native Americans, 
such as OB-GYN, podiatry, and behavioral health.
  I have mentioned the old official IHS motto several times: ``Don't 
get sick after June.'' This was a motto because the Indian Health 
Service would run out of money after June. So what people would say 
with regard to their healthcare in Indian Country is ``Don't get sick 
after June''--a pretty outrageous situation. In practical terms, that 
motto translated to exactly the sort of healthcare rationing Chairwoman 
Torres described in her letter.
  Imagine living in that sort of healthcare system, where diabetics are 
told that help is only available once their kidneys start to shut down, 
where expectant mothers can't access prenatal care.
  The reality is that Graham-Cassidy--and we hope another proposal 
doesn't come forward like Graham-Cassidy; we know they buried that 
today--would turn back the clock in Indian Country, taking us from this 
current era of Tribal healthcare innovation back to the days of life 
and limb.
  I thank Senator Cortez Masto for her great advocacy for Native 
Americans. I know very well her work as State attorney general. I know 
she worked with Tribes and wanted to try to work through problems 
rather than litigate them all the time.
  I wanted to say to your chairwoman in Nevada that we really 
appreciate her hard work on behalf of her Tribal members and other 
Tribes around the country.
  I yield to the Senator from Nevada.
  Ms. CORTEZ MASTO. I thank the vice chair.
  It is true that Indian Country made significant gains under the 
Affordable Care Act. Before the ACA, the Indian Health Service 
regularly denied Tribal members' claims for basic care and preventive 
services, such as mammograms, women's health screenings, or diabetes 
management care.
  Because of the chaos the Trump administration has created in the 
healthcare markets, this problem is not being confronted, it is being 
exacerbated across the country. We have seen it in Nevada. Insurers are 
pulling out of the ACA exchanges in rural areas, thanks to the 
uncertainty these continued efforts to repeal the ACA, such as Graham-
Cassidy, are creating in the healthcare market.
  Democrats are ready to work with Republicans to fix the problems with 
the Affordable Care Act. We want to provide certainty that brings 
insurers back into the health insurance marketplaces, lower premiums 
and prescription drug prices, and improve healthcare. We can't kick 
millions of people--including the members of the Walker River Paiute 
Tribe and the 27 other Tribes and community organizations in the State 
of Nevada--off of their healthcare.
  No one in this country should be forced to choose between paying 
their medical bills and putting food on their table. All too often, our 
Tribal members are confronted with that very choice.
  I will not stop fighting to oppose these efforts to take away the 
healthcare of Native communities in Nevada and millions more Americans 
throughout our country. It is time we work together.
  I thank the vice chair.
  I yield the floor back.
  Mr. UDALL. Thank you very much, I say to Senator Cortez Masto. Today, 
you can at least tell your chairwoman that this bill has been 
withdrawn. There is not going to be a further vote on it. But I would 
urge her--and I know you know this well--we need to stay vigilant. This 
can be brought up at any time. It can be attached to a major piece of 
legislation moving forward. So urge her to continue this great 
advocacy. We really appreciate your advocacy.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. NELSON. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                       Hurricane Recovery Efforts

  Mr. NELSON. Mr. President, I want to express my appreciation to the 
fellow Senators who have come up innumerable times to express their 
regrets for what has happened to Florida, as we did with our colleagues 
from Texas with regard to the hurricane in Texas. Indeed, that was an 
unusual storm.

[[Page S6119]]

  The almost gold standard storm of Hurricane Andrew 25 years ago 
crossed the State of Florida in 4 hours. It was small in diameter 
compared to this present hurricane that hit Florida and traveled right 
up the peninsula and, therefore, covered up the entire State.
  For the past few weeks, in my traveling all around, there was vast 
devastation either by the wind or by flooding. It is really hard to 
believe that a State as large as ours could be virtually covered up by 
a storm. There was limited access to critical supplies like gasoline, 
and some places sustained considerable damage. I remember down in the 
Keys, in the part that hit the northeastern quadrant of the eye wall, 
in Big Pine Key, I went to a trailer park--a place of mobile homes--and 
there was not one mobile home that was sitting upright. They were all 
turned on their sides or turned over on their roofs. It was something 
that you just cannot believe--the force of the wind.
  The cost of rebuilding is going to be in the billions. We have passed 
a temporary measure of $15 billion, and that is running out. We are 
going to have to do something immediately for the Virgin Islands and 
Puerto Rico, but there is going to be a continuing cost in Texas and a 
huge cost in Florida. Many people have been dislocated, and they are 
unable to move back into their homes.
  Take people in the Florida Keys. There is a tourism economy there, 
and to have a tourism economy, you have to get the service personnel 
back in. Well, they don't have any homes. So you have to bring in 
temporary housing. In the Keys, there is one way in and one way out. So 
that is going to take some time.
  Then, sadly, in the tragedy of all tragedies, 11 frail, elderly 
seniors died in a hot box that was a nursing home that had lost power, 
and the generators that were required under the existing law and 
existing regulations of the State of Florida were for putting the 
lights back on. They were not generators that were sufficient in order 
to run the air conditioning systems. The 11 senior citizens perished 
after there were a number of calls that had been made to the Governor's 
cell phone and calls that were made to Florida Power & Light.

  There is a criminal investigation that is underway that will answer 
some of the questions of why, as they pled for help to come and get 
back on the power, those calls were never answered. As a result, 11 
people died. Something like that simply just shouldn't happen in 
America, a country that has the resources and the compassion that our 
people have.
  I want to state that, if people can't get through in an emergency 
like this to a Federal or State agency, I want them to call me at my 
office at 407-872-7161 or on the WATS line at 888-671-4091 or to visit 
the website at billnelson.senate.gov. We will get to the bottom of it, 
because in an emergency situation like that, with people's lives on the 
line, that should never happen again.
  I am so proud of the people who worked in our office so diligently. 
We had many of the employees here in the Washington office go to 
Florida as eyes and ears out there in the community before FEMA could 
get in to register people for individual assistance because they 
couldn't get through. If they had cell phones and the cell phone 
service was spotty, they couldn't get through. We had people out there 
in the field signing people up and getting it to FEMA for individual 
assistance.
  Our folks on the Florida staff as well as the Washington staff who 
went down there did a wonderful job. They worked their fingers to the 
bone, and they worked their hearts out. I want them to know how much I 
appreciate that, serving the people of Florida in need.
  It is important that those of us in public service respond with 
urgency and purpose when somebody calls for help. That applies to all 
of us in public service. I was really heartened when I saw all over 
Florida people helping people. I saw frail and elderly persons who had 
no place to go who were taken into a girl's dormitory that had air 
conditioning. They took care of them for 4 nights--eight frail, elderly 
women.
  I saw people helping people in Belle Glade. Senator Rubio and I went 
to Belle Glade together and served food. We went and thanked those 
students in that dorm near Immokalee. We thanked them together for 
people helping people.
  Now what we need to do is to take that same effort that we saw in 
Texas and that we have seen in Florida of people helping people and we 
have to help the people of the Virgin Islands and Puerto Rico. Over the 
weekend, the full scale devastation of the third hurricane became 
clearer. The first was in Texas, the second was in Florida and on up 
into the Southeast, and now the third one was not only hitting the 
Virgin Islands, like the former one did, but was just ripping up Puerto 
Rico.
  I have talked to the Governor, and he says the island faces a 
humanitarian crisis. The devastation over this past week has become a 
lot clearer to us as we start to see all of the devastation on our TV 
screens. According to one report, ``Hurricane Maria whipped Puerto Rico 
with Irma-level winds, drenched the island with Harvey-level flooding, 
crippled communications, decimated buildings and damaged the dam that 
puts the downstream residents at risk of catastrophe.''
  That is what our fellow Americans are facing right now down in the 
Caribbean. We need to act with urgency and purpose to aid Puerto Rico 
in their time of need. I will have a chance to go down there on Sunday. 
I want to see it firsthand. I will continue to carry this message: The 
U.S. Congress has to come to the aid of our friends and our fellow 
citizens in the Virgin Islands and Puerto Rico.
  I have talked to the Department of Defense and said: Do everything 
that you can do to assist. They are trying. I talked to the FAA 
Administrator. There is just the simple thing of being able to have 
instrument landings after so many of the radars got knocked out. Here 
is one example of just a practical problem facing the island, as if 
they didn't have enough practical problems to begin with.
  Look at the financial crisis. The Medicaid funds are going to run 
out. That is before the hurricane. Look at the Zika crisis in Puerto 
Rico. That is before the hurricane. Think what it is like now.
  Here is an example. One of the radars on the top of a mountain gets 
taken out by the storm. All right, we need to get it back up there. We 
need a helicopter, and can get a helicopter to take a radar up to place 
it there, because the roads are impassable, but now there is cloud 
cover up in the mountain, and they can't fly up. So one problem 
compounds another, just so we can get instrument landings coming into 
Puerto Rico instead of the visual flight rules where we have to keep so 
much more distance from the planes. Just think if we end up having to 
have an airlift in order to get food and supplies into Puerto Rico to 
keep them alive.
  Now is not the time to talk about the former financial problems or 
about the debt payments to bondholders. In a crisis, all that matters 
is saving lives and giving the people the resources they need to get 
back on their feet. I am hopeful that our colleagues will see the 
urgency of the situation in Puerto Rico and the U.S. Virgin Islands, in 
addition to the ongoing troubles in Florida and, I expect, Texas, as 
well, which will continue for some time.
  I hope we can work together to get an aid package soon that helps all 
of those affected by the storms as soon as possible. Why? Because we 
are all Americans, and we need to act like it. We need to come together 
and get on the long road to recovery.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Daines). The Senator from Ohio.
  Mr. PORTMAN. Mr. President, I thank the Senator from Florida for the 
report from his State and for his words about the devastation in Puerto 
Rico. Our hearts go out to those in Florida, Texas, the Virgin Islands, 
and Puerto Rico. We do have a responsibility to respond quickly. They 
are responding to some devastating storms, especially when they are 
combined.
  Our thanks also go to the first responders and the many volunteers, 
including some in the State of Ohio and those from my hometown, who 
stepped forward to help the people in need. It is extraordinary.
  Again, I look forward to working with my colleagues to come up with 
additional assistance as we have done

[[Page S6120]]

already for some of the initial damage in Texas. There is so much more 
now that we must do.


                         Tribute to Tim O'Neill

  Mr. President, I rise today to talk about one of our colleagues here 
in the Senate, who has an inspiring story and is celebrating an 
important anniversary this week.
  I want to mention this week Doorkeeper Tim O'Neill, who works with us 
in the Senate and celebrates 27 years of Government service. He has 
been a doorkeeper since 2010, during which time I have had the pleasure 
of getting to know him, as have many of my colleagues in the Senate.
  His career has been a remarkable journey. He started in the Senate as 
a legislative director, and he later went on to work in the White 
House--not during one Presidential administration but during four 
Presidential administrations. Tim worked for President Ronald Reagan, 
President George H.W. Bush, President Bill Clinton, and President 
George W. Bush.
  He worked in the Department of Treasury and at the Federal Housing 
Finance Board, eventually becoming the chairman of that agency. After 
that he went to the House of Representatives, where he was senior 
legislative counsel for the Financial Services Committee. We are happy 
to have Tim back here on the Senate side, where he works today.
  Tim has had an impressive career which I outlined, but the most 
amazing thing about his career doesn't reside in what he has done but 
what he has overcome.
  One weekend in January of 1989, when Tim was at the Treasury 
Department, his life was altered forever. Tim's life had first changed 
on Friday morning when he found out his wife Ginny was pregnant with 
their first child. But later that weekend, on a Sunday, as he was 
putting on his shoes to go jogging, at 34 years old, he suffered a 
major stroke that affected two-thirds of his brain.
  The doctors didn't immediately tell Ginny how serious it was. Later 
she would find out that they did not believe he would live through the 
night, and, if he did, they believed his lasting brain damage would 
mean he would never walk again and never talk again.
  Despite this very grim prognosis, Tim had a few things going for him. 
First, there was an incredible positive attitude that we all see in the 
Senate. Second, he was young and athletic, which improved his chances 
of recovery. He also talks about his Irish determination, which made 
him resilient. And he had the knowledge of knowing that Ginny was 
pregnant, and he was absolutely committed to being part of his 
daughter's life. In fact, one of the few things he said he remembered 
in his initial stages of recovery was that Ginny was pregnant and that 
he had a daughter coming. And when he began regaining his speech, the 
first thing he told Ginny was that he was going to recover.

  The path was not easy. In those first few months, he worked 8 hours a 
day, trading his government job for a rehabilitation facility. He 
worked with speech and physical therapists. And with Ginny at his side, 
he put in overtime every day. The extensive road to recovery was 
daunting. Tim, a Harvard-educated lawyer in the middle of a successful 
career, had to totally relearn things. He had to relearn how to read, 
and he had to relearn how to write.
  I know Tim will agree with me that his wife Ginny was the unsung hero 
of this story of recovery.
  The O'Neills felt the support and generosity of those around them. As 
I mentioned, he worked at the Treasury Department. Those close to Tim--
and some who hardly knew him at all--donated their personal leave time 
to allow him to keep receiving a paycheck during this recovery process, 
and the Treasury Department assured him that his job would be waiting 
when he was ready and able to return.
  Shortly after the stroke that he wasn't supposed to ever recover 
from, Tim was home, self-mobile in a wheelchair. Soon he taught himself 
how to walk again. He never regained use of his right hand at all--one 
of his only lasting handicaps to this day--so do you know what he did? 
He learned to write with his left hand. His resilience and 
determination are really amazing.
  He went back to work. His stroke was in January of 1989. Again, that 
Sunday, doctors didn't think he would live through the night, and if he 
did, they thought his life would be in a wheelchair. In 1995, only 6 
years later, he was sworn in as a Director of the Federal Housing 
Finance Board, a position he was nominated for by President Clinton. 
Later, in 2001, President George W. Bush elevated him to Chairman of 
that Board. In 2005, he became a senior legislative counsel to the 
House Financial Services Committee, until his first retirement from 
government in 2007. He had 20 years of service.
  He had had a good career and a recovery story that was respected by 
everyone who knew about it. He could very well have sat back and 
enjoyed that retirement after those 20 years, but Tim's life is defined 
by purpose and service and people. So after trying retirement for a 
little while, Tim returned to the place he loved and the people he 
knew, coming back here to the U.S. Senate as a doorkeeper in 2010.
  Tim's extensive knowledge of Capitol Hill has benefited the U.S. 
Senate, and I will tell you what--his good spirits have had an effect 
on countless Senators, including me, countless members of our staff, 
and many visitors. His attitude is infectious. He exemplifies the power 
of positive thinking. He certainly brightens my days, and I know he has 
inspired many.
  By the way, I just heard today that he is also a leader among 
doorkeepers, including organizing periodic team-building events at the 
Nats games with his fellow doorkeepers.
  This month, as we recognize Tim's 27 years of public service, we also 
recognize his incredible life journey and his resilience in the face of 
adversity. Strokes can affect people in a variety of ways. In Tim's 
case, I must say I think it made him a stronger person.
  Guided by his love for his wife Ginny and their three children now 
and his dedication to public service, Tim has had a career and a life 
worthy of celebration and recognition.
  So, Tim, today, this week, we all congratulate you on 27 years of 
honorable service and wish you many more to come.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.


          Puerto Rico and U.S. Virgin Islands Recovery Effort

  Mr. BLUMENTHAL. Mr. President, I want to talk about the terrible 
humanitarian crisis faced by the people of Puerto Rico and the U.S. 
Virgin Islands, as well as the gulf coast and the people of Florida, 
who have endured the fury and ferocity of Mother Nature at its worst.
  All of the people who live in Puerto Rico and the U.S. Virgin Islands 
are Americans. First and foremost, they are Americans who are going 
through one of the toughest periods of their lives, a time that no 
American wants to face alone.
  My message to the people of Puerto Rico and the U.S. Virgin Islands: 
You are not alone. You are not alone in this humanitarian crisis. 
Congress will act. We will provide the kind of relief package--food, 
medicine, whatever supplies are necessary not only to endure and 
survive but to eventually thrive.
  That is more than just rhetoric; that is a promise this Senate must 
make to our fellow Americans. These Americans citizens in Puerto Rico, 
for example, have lost their homes, their businesses, their 
livelihoods, and, some of them, loved ones.
  I come to this floor on this issue that has preoccupied me and others 
because it is truly a story of two storms. It is a tale of two 
catastrophes--one of them resulting from nature's fury but the other 
manmade.
  We know very visibly and dramatically about the storm that directly 
hit Puerto Rico, and it is called Maria. It was side-glanced by an 
earlier storm that missed it with its full fury, but Maria was a direct 
hit, leaving more than 60,000 American citizens without power, passing 
within miles of San Juan, home to 400,000 people. It was the strongest 
storm to hit the island in 80 years. The winds tore off the trees and 
dumped more than 2\1/2\ feet of rain on the island. It razed houses 
there and on the U.S. Virgin Islands, leaving a wasteland, crumpled 
structures, scarred concrete, shells of buildings, no electricity, and 
virtually no telecommunications for most people.
  There are 3.4 million people in dire need of housing, food, water, 
medicine,

[[Page S6121]]

diesel, gasoline--the necessities of life. There is a humanitarian 
crisis in Puerto Rico that requires an immediate and unconditional 
response from Congress--not from just the Senate but from the House and 
from the President.
  One area where the President had made an announcement today concerns 
the potential matching amounts of money that Puerto Rico and the U.S. 
Virgin Islands may have to provide. There should be no match. There 
should be no requirement that Puerto Rico or the U.S. Virgin Islands 
provide a share of the money needed for rebuilding and recovery, and 
the President should waive every bit of the required matching share. 
Every dime, every nickel should be waived.
  That leads me to talk about the second storm that has hit Puerto 
Rico. It is less visible and less recent. It is the result of a 
continually building set of headwinds, a financial storm that had built 
over many years and has now reduced Puerto Rico to a state of near 
insolvency, virtual bankruptcy--$74 billion in debt that would have 
been a severe storm for the people of Puerto Rico--not of their 
making--even without the hurricane that directly hit the island.
  We have an obligation as immediate and dire with respect to 
rebuilding and recovering from that second storm as we do for the 
first. That is the reason I have been involved over a period of many 
months in seeking to construct solutions, beginning with the PROMESA 
Act. And I intend--and I commit that I will continue seeking that kind 
of solution, not just solutions to the buildings that have been 
collapsed but to an economy that will collapse if we do not act. That 
is an important obligation that we share to fellow Americans, because 
this storm is not due to their neglect or profligacy; it is due to the 
tax laws and healthcare laws that unfortunately failed to treat them 
fairly.
  Delay in meeting the astronomic costs of Hurricane Maria would be 
unacceptable and unconscionable. We must act promptly. I am hopeful 
that it will be this week. I am talking to our leader, Senator Schumer, 
who has provided such strong vision and courage in this area. He has 
been a champion of Puerto Rico, and I hope he will help us craft a 
solution that is immediate, vigorous, and prompt.
  The administration and Congress must ensure as well that the Federal 
Government plays a robust and responsible role in funding and financing 
these recovery efforts so that no additional damage is done to Puerto 
Rico's already fragile economy. It is time to forgo the miasma and 
bureaucratic rigmarole of Federal redtape and financing constraints, 
while flooding is still an acute risk to life and health and recovery 
efforts are just beginning.
  The Puerto Rican Government must be granted direct and instant tools 
to bring electricity back to the people, to feed the hungry, to provide 
drinking water and shelter to lives that have been upended by this 
unforgiving storm. All arms of the Federal Government should be brought 
to bear to help our fellow citizens in Puerto Rico.
  This morning, I asked the Chairman of the Joint Chiefs of Staff, 
Joseph Dunford, whether he would be ready, willing, and able to help 
and provide additional assistance on behalf of the Department of 
Defense and the military that he commands, and his unequivocal response 
was yes. I commend and thank him for that willingness to help our 
fellow Americans. And he affirmed they are our fellow Americans, they 
serve in our military, and they give back to communities in this 
country.
  I am proud to represent 300,000 fellow Americans who have come from 
Puerto Rico to Connecticut, and they, in turn, reflect families there. 
I have spoken to friends in Puerto Rico who described to me the dire 
images outside their window--similar to the images we have seen on 
national television.
  Puerto Rico's debt troubles are no secret to anybody here today. We 
have discussed them, debated them, and failed to provide adequate 
assistance to meet them. We must work on two tracks--the immediate 
recovery effort in the face of this truly destructive hurricane but 
also the financial peril that continues to put Puerto Rico's economy at 
risk, jobs in jeopardy, and the island's precarious financial position 
as much at risk as its water and roads are.
  Puerto Rico's infrastructure, energy, water, schools, hospitals, 
transportation, and other vital facilities necessary for a functioning 
economy must be rebuilt and made whole. That is our obligation. And the 
same is true of the Virgin Islands, where fellow Americans are equally 
at risk, their safety in jeopardy, and their economy potentially 
struggling.
  We owe it to our fellow Americans and friends and families--there are 
people in Connecticut who have friends and family there--and all of us 
who share a love for these islands that are populated by patriotic 
Americans dedicated to our country.
  Thank you.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The majority leader.

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