[Congressional Record Volume 164, Number 17 (Wednesday, January 24, 2018)]
[Senate]
[Pages S492-S493]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                        Nomination of R.D. James

  Mr. BARRASSO. Mr. President, I rise in support of the nomination of 
R.D. James to serve as Assistant Secretary of the Army for Civil Works. 
The Assistant Secretary establishes policy direction and provides 
leadership for the Civil Works programs at the U.S. Army Corps of 
Engineers.
  In this position, Mr. James will play a central role ensuring the 
navigability of America's ports and inland waterways. He will oversee 
the Army Corps' flood and storm risk management and responses to 
emergencies like the hurricanes we saw in Florida and Texas this past 
fall.
  Mr. James will also play a central role in modernizing America's 
aging water infrastructure. This month, the Committee on Environment 
and Public Works, which I chair, has held two hearings on the needs and 
challenges facing America's water infrastructure. These hearings are 
important steps as the committee works toward a new Water Resources 
Development Act, which will be reauthorized this year.
  It is critical to have Mr. James confirmed so he can partner with us 
in this important process. I look forward to working with Mr. James on 
projects and issues that are important to my home State of Wyoming. He 
has already committed to me that he will work to find a permanent 
solution to preventing ice-jam floods, like those that caused the Big 
Horn River to flood the city of Worland, WY.
  There is no reason this confirmation should be delayed any further. 
His nomination was unanimously approved by voice vote in both the 
Senate Armed Services Committee and the Environment and Public Works 
Committee. Mr. James is well qualified for this position.
  He has served as a civil engineer member of the Mississippi River 
Commission since 1981. That is 37 years. He was appointed to that 
position by both Democratic and Republican Presidents. Mr. James is 
also an accomplished farmer and businessman. He is experienced, 
qualified, and ready to start.
  It is time for the Senate to confirm his nomination.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Cotton). The Senator from Missouri.
  Mr. BLUNT. Mr. President, I wish to thank Senator Barrasso and 
Senator Carper for their bipartisan work to get this nomination to the 
floor.
  I have known R.D. James for a long time. He understands the projects 
involved, the work involved, and the challenges involved. He is a civil 
engineer and brings a lot of experience to this job.
  The work of Senator Carper and Senator Barrasso is deeply 
appreciated. I think it will be appreciated by the Corps and the 
Department of Defense.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, the Senate has been running a bit behind. I 
wanted to accommodate my Republican colleagues.
  I ask unanimous consent that the vote be moved to 2:20 p.m., rather 
than 2:15 p.m., on Mr. Azar.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WYDEN. Mr. President, a year ago, the President stormed into 
office promising better, cheaper healthcare for everyone. He said he 
would bring prescription drug prices down because, in his words, drug 
companies were ``getting away with murder.''
  So as we move to this vote, as the senior Democrat on the Finance 
Committee, I wanted to make sure we took stock after year 1. The Trump 
record on healthcare is worse than your garden variety case of a 
President failing to live up to his campaign promises. This President 
has surely hurt the people he promised to help. Very shortly, the 
Senate will vote on the nomination of Alex Azar to be the Secretary of 
Health and Human Services. In this position, he would be the captain of 
the President's healthcare team. So in my view, this debate is about a 
lot more than Mr. Azar's resume. It is a referendum on a year of 
healthcare failure, particularly on prescription drug costs, and it is 
a referendum on what I consider to be a healthcare agenda of 
discrimination.
  I am going to begin with the skyrocketing prescription drug prices 
because they are a gut punch for millions of Americans each time they 
step up to the pharmacy window. Few promises the President made with 
respect to healthcare resonated more than his promise to bring down 
prescription drug prices, but now, a year later, he has chosen Alex 
Azar, a drug company executive with a documented history of raising 
drug prices.
  From 2012 until last year, he was the head of Eli Lilly's American 
subsidiary, Lilly USA. He chaired its U.S. pricing, reimbursement, and 
access steering committee, which gave him a major role over drug price 
increases for every product Lilly marketed in America. On Mr. Azar's 
watch, Lilly more than doubled the prices of drugs used to treat 
diabetes, osteoporosis, heart disease, and ADHD. And these are only 
some of the drugs under his purview.
  He told the Finance Committee staff that he had never once approved a 
decrease in the price of a drug at Lilly. Mr. Azar said: That is just 
how the system works. Prices always go up. I would say that Mr. Azar 
may have had his facts straight about the system, but that doesn't make 
it right. Mr. Azar was a part of this broken system, and despite the 
cheerful overtures that he has made to Senators on both sides of the 
aisle over the last few weeks about how he wants to work on the issue, 
he has not offered even a single concrete example of how he would 
actually change the system he said is broken. He will not give us an 
example of how he would change it to make it better.
  Members of this body, Democrats and Republicans, have come forward 
with specifics about what they would do to help those Americans getting 
clobbered at the prescription drug windows across the land. We have 
colleagues who are for drug importation. We have colleagues who are for 
more negotiating power for Medicare. We have colleagues who understand 
the challenge with the pharmaceutical benefit managers, where there is 
so little transparency. We asked Mr. Azar repeatedly for examples, but 
all he had to say about this system that was so broken is that he would 
be ``open'' to ideas.

  As important as that is, there is a whole lot more for Senators to 
reflect on as they think about this vote. After a year in office, the 
Trump administration is steadily and relentlessly enacting a healthcare 
agenda of discrimination--discrimination against those with preexisting 
conditions, discrimination against women, discrimination against LGBTQ 
Americans, discrimination against those struggling to get ahead. The 
question up for debate today ought to be whether or not this nominee to 
head this critical office of healthcare policy is going to end that 
discrimination.
  Colleagues, as you think about this vote, all I can tell you is that 
when you review the record--in the face of an administration moving 
relentlessly to promote discrimination in healthcare--there is not a 
shred of evidence that Mr. Azar is going to try to stop it, reform it, 
or in any way try to make sure that those Americans--all of them--get a 
fair shake.
  From day one, in addition to this pattern of discrimination, the 
administration has been on a campaign of sabotage against the 
Affordable Care Act and the private health insurance markets. They cut 
the open enrollment period in half. They slashed the advertising 
budgets. They made it harder for people to sign up in person. That is 
the major reason why the number of Americans without insurance coverage 
increased by more than 3 million last year. Our friends and our 
neighbors are one sudden illness or injury away from the nightmare of 
personal bankruptcy

[[Page S493]]

as a result of the healthcare policies this administration has pursued 
and cheered.
  Even worse--and I touched on this yesterday--the administration is 
bringing back to life junk insurance, letting fraudsters get back into 
the insurance business with health plans that aren't worth the paper 
they are printed on. It takes me back to my days as codirector of the 
Oregon Gray Panthers. Back then, I met older people who sometimes had 
15 or even 20 private insurance policies to supplement their Medicare. 
Those policies were junk. Some of them were just out-and-out scams.
  So the Congress passed a law. I was proud to be a part of that 
bipartisan coalition to change it to protect older people. The law 
worked. We drained the swamp when it came to those fraudsters ripping 
off seniors. Then 8 years ago, some of the key parts of the Affordable 
Care Act put consumer protections in place so that nobody of working 
age would get ripped off with junk insurance. It is those policies and 
those people that the Trump administration would let the fraudsters 
exploit because the Trump administration wants to undo those 
protections against fraudsters who are ripping off those of working 
age.
  They have already taken steps on what are called Association Health 
Plans. Next up are short-term plans that are likely to be even worse.
  What this comes down to is the Trump administration's tradition of 
turning back the clock on healthcare and allowing junk insurance to 
discriminate over preexisting conditions and age. This is going to be a 
big test for Mr. Azar if he is confirmed.
  I would just ask my colleagues: We will see if Mr. Azar is going to 
look the other way and allow scam artists to peddle junk coverage, or 
is he going to protect Americans who need care and health coverage they 
can count on?
  There is also an array of discriminatory policies with respect to 
women's health. They tried to take away guaranteed no-cost access to 
contraception, essentially taxing women for their gender. Fortunately, 
that move has been held up in the courts. They overturned longstanding 
protections dealing with States and family planning--what amounts to an 
attack on a woman's right to see the doctor of her choosing and an 
attack on Planned Parenthood.
  They are broadening exceptions that give employers and universities 
say over what healthcare women can access. When asked on these issues 
during his nomination hearing, Mr. Azar said: ``We have to balance, of 
course, a woman's choice of insurance that she would want with the 
conscience of employers and others.'' My counter to that is absolutely 
not. There is no balancing women's choices against anything. In 
America, a woman's choice of healthcare ought to be her choice and 
nobody else's.
  In much the same way as going after women's healthcare, this 
administration is permitting discrimination against LGBTQ Americans in 
need of healthcare.
  Then, finally, there is Medicaid. In just the last few weeks, the 
administration has been giving States a green light to slap punitive, 
new requirements and limitations on Americans covered by State Medicaid 
Programs. This action by Health and Human Services goes after people 
across the country who are working on an economic tightrope. They are 
people who are taking care of kids or elderly parents or who are 
struggling with a chronic condition.
  These punitive new requirements aren't going to improve anybody's 
healthcare. As the first waivers are coming out from the Department of 
Health and Human Services, the public is learning some disturbing 
details. In Kentucky, the State is introducing what sounds a lot like a 
literacy test for healthcare. Nobody in this body should have to be 
reminded that the history of literacy tests is an ugly and 
discriminatory one. That is the wrong direction to take on healthcare.
  I close by saying that the record after 1 year shows that the Trump 
agenda on healthcare isn't about improving care for all Americans. The 
Trump agenda on healthcare is about discrimination and ideology.
  So the question, as my colleagues come over to this floor to cast 
their votes, is whether the Trump administration is going to be allowed 
to continue to turn back the clock and advance discrimination. Given 
the opportunity to demonstrate that he would actually lead the 
Department in a new direction, he came up short. So I will not support 
his nomination.

  Through my time in public service, back from those early days working 
with the senior citizens, I have always said: Healthcare has to be a 
bipartisan issue. To do healthcare right, you have to find a way to 
bring people together.
  If Mr. Azar is confirmed, I hope he will make his stated willingness 
to listen to ideas a reality and begin to work closely with colleagues 
on both sides of the aisle to actually make some changes in these key 
areas I have described. From policies where we just sit on the 
sidelines with our skyrocketing drug prices, to sitting out in the 
fight against opioids, to allowing discrimination against women, to 
rolling back the protections on Medicaid--these are issues that go 
right to the heart of the health and safety of millions of Americans.
  Mr. Azar certainly does not carry the ethical baggage of his 
predecessor, Tom Price. The question for the Senate this afternoon--
after we have asked him again and again and again to give any examples 
of how he would break with these harmful policies of the last year, we 
have come up short. So I regret to say to the Senate that I am going to 
oppose this nomination.
  I yield the floor.
  The PRESIDING OFFICER. Without objection, all time is yielded back.
  Under the previous order, all postcloture time has expired.
  The question is, Will the Senate advise and consent to the Azar 
nomination?
  Mr. BURR. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Tennessee (Mr. Corker) and the Senator from Arizona (Mr. 
McCain).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 55, nays 43, as follows:

                       [Rollcall Vote No. 21 Ex.]

                                YEAS--55

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Carper
     Cassidy
     Cochran
     Collins
     Coons
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Donnelly
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heitkamp
     Heller
     Hoeven
     Inhofe
     Isakson
     Johnson
     Jones
     Kennedy
     King
     Lankford
     Lee
     Manchin
     McConnell
     Moran
     Murkowski
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                                NAYS--43

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

                             NOT VOTING--2

     Corker
     McCain
       
  The nomination was confirmed.
  The PRESIDING OFFICER. Under the previous order, the motion to 
reconsider is considered made and laid upon the table and the President 
will be immediately notified of the Senate's action.

                          ____________________