[Congressional Record Volume 164, Number 25 (Thursday, February 8, 2018)]
[Senate]
[Pages S794-S799]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               CHILD PROTECTION IMPROVEMENTS ACT OF 2017

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of the House message to accompany H.R. 
695, which the clerk will report.
  The senior assistant legislative clerk read as follows:

       House message to accompany H.R. 695, a bill to amend the 
     National Child Protection Act of 1993 to establish a national 
     criminal history background check system and criminal history 
     review program for certain individuals who, related to their 
     employment, have access to children, the elderly, or 
     individuals with disabilities, and for other purposes.

  Pending:

       McConnell motion to concur in the amendment of the House to 
     the amendment of the Senate to the bill.
       McConnell motion to refer the message of the House on the 
     bill to the Committee on Appropriations, with instructions, 
     McConnell amendment No. 1922, to change the enactment date.
       McConnell amendment No. 1923 (to (the instructions) 
     amendment No. 1922), of a perfecting nature.
       McConnell amendment No. 1924 (to amendment No. 1923), of a 
     perfecting nature.

  The ACTING PRESIDENT pro tempore. Under the previous order, the time 
until 11:30 a.m. will be equally divided between the two leaders or 
their designees.
  Mr. McCONNELL. Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.


                   Recognition of the Minority Leader

  The Democratic leader is recognized.


                            Budget Agreement

  Mr. SCHUMER. Mr. President, yesterday, after months of painstaking 
negotiations, the Republican leader and I reached a 2-year budget deal. 
Not only will it end the series of fiscal crises that have gridlocked 
this body, it will also deliver large investments in our military and 
robust funding of middle-class programs. It will also give a 
significant boost to our Nation's healthcare and provide long-overdue 
relief to disaster-stricken parts of our country.
  As I said yesterday, it doesn't include everything that Democrats 
want nor everything that Republicans want, but it is a good deal for 
the American people, and it is a strong signal that we can break the 
gridlock that has overwhelmed this body and work together for the good 
of the country.
  Let me run through a few of the benefits this agreement will provide.
  Our military has suffered from the uncertainty of endless short-term 
spending bills. This budget deal puts that to an end. It gives the 
military a significant boost in support and allows the Pentagon to make 
long-term decisions about its budget. It is the right thing to do.
  I want to credit two people--first, my dear friend Senator McCain. He 
talked to me repeatedly, even when he was ill, about the need for 
funding defense. He also talked about the need for doing immigration 
and tried to make them go hand in hand. Senator McCain has been our 
leader in this Chamber on both sides of the aisle in terms of making 
sure defense is funded, and I know that today he is proud of what we 
are doing for the military.
  I would also like to thank Secretary Mattis. He visited me 
repeatedly. He is a Cabinet Secretary who seems to be doing his job, 
rather than focusing on an ideological path that divides people. He 
worked hard for this and deserves a great deal of credit.
  We Democrats have always argued that we want to fund our military and 
our middle-class programs. We need good help on both. A mother whose 
child has died from opioid addiction, a veteran who is waiting in line 
to get help, college students with great debt on their shoulders, 
pensioners whose pensions might be greatly diminished need help too. To 
say that our military needs help to the exclusion of all of these other 
worthy causes is not fair to them and not good for America. I have 
always argued that we can do both, and this budget shows we can. We can 
do both--fund the military and help fund the middle class. For those 
naysayers who said it could not be done, it sure can with this budget. 
I am proud of what it does for the middle class.
  For a decade--we all know this; we all talk about it--our middle 
class has suffered from a needless and self-imposed austerity in 
Congress that has limited investments in jobs and education, 
infrastructure, scientific research, and more. This deal puts that to 
an end as well. For those who say we cannot do both, we can. I am proud 
of this budget, because it does. Let me go into a few specifics.
  There are billions of dollars of support for childcare, for helping 
middle-class families shoulder the very heavy burden of childcare. They 
need to take care of their kids in a way that they can have confidence 
when both parents

[[Page S795]]

work, and so often that happens. In single-parent families, that 
happens so often.
  What about college affordability? The debt burden on the shoulders of 
those who have just gotten out of college and graduate school is huge. 
We are focusing on providing help here.
  In this budget, we focus on police officers, teachers, and 
firefighters.
  What about infrastructure? Our infrastructure is crumbling throughout 
America. Much of it was built 50 or even 100 years ago--roads and 
bridges and water and wastewater. We need to help those, and then we 
need new infrastructure.
  How about broadband to rural areas and inner cities that are not 
getting it? Broadband is a necessity today. Kids cannot learn. Often, 
you cannot hold a job unless you can get broadband at home. In large 
parts of America, particularly rural parts, you cannot get it. We 
provide help, and rural America is very happy that we are doing this.
  We provide billions to rebuild and improve veterans hospitals and 
clinics so that when our brave soldiers come home, bearing the scars of 
war, their country serves them just as well as they served us.
  I mentioned opioids earlier. There is $6 billion, finally, to guard 
against the opioid-mental health crisis. The opioid crisis is 
widespread. The President has set up a whole bunch of commissions and 
given a whole bunch of speeches, but he hasn't funded it. We in this 
body have. We Democrats have led the charge. We have so many Members, 
like Senators Shaheen and Manchin; we have so many Senators, like 
Senators Heitkamp and Baldwin; we have so many Senators, like 
McCaskill, Donnelly, and Hassan, who have been talking about the opioid 
crisis for a long time. Their hard work has now produced the dollars 
that will give the treatment that so many who are addicted need and the 
infrastructure to prevent these bad drugs, particularly fentanyl, from 
coming into this country.
  My guest at the State of the Union was a woman named Stephanie 
Keegan, from Putnam County. She was the brave mother of a veteran who 
got hooked on opioids in the depths of PTSD. He waited 16 months for 
his first appointment at the VA, but he died of an overdose 2 weeks 
before he could get treatment. Stephanie Keegan has been fighting for 
this. She is a brave, strong woman who is lighting the candle. She was 
my guest at the State of the Union, and she is a happy woman this 
morning because all of her hard work after her son's passing is coming 
to fruition.
  Of course, there is so much more in this proposal that we can all be 
proud of as Americans, in that we will not be neglecting people who 
have been neglected for so long: support for community health centers, 
which serve over 25 million Americans; a full decade of funding for 
CHIP, or the Children's Health Insurance Program; an effort to lower 
prescription drug costs for millions of American seniors who are caught 
in the Medicare Part D doughnut hole; disaster relief and recovery 
funding, not just for Texas, Louisiana, and Florida--important as they 
may be and are--but for Puerto Rico and the U.S. Virgin Islands and the 
Western States; and a special select committee--we don't do this 
often--that will be empowered and under a deadline to deliver a 
legislative fix to the pension issue by the end of the year. It is this 
issue which has plagued so many working and middle-class Americans in 
many States, people who have paid into their pensions day after day, 
week after week, month after month, and who are now finding those 
pensions vanishing. We should provide relief for them just as we should 
provide relief for others. This commission is a strong, bright light 
that will focus on this issue and will create a path to a solution.
  I salute so many of my colleagues who have worked so hard on so many 
of these pieces: Senators Murray, Wyden, and Tester, on healthcare; 
Senators Brown, Casey, Stabenow, Manchin, Heitkamp, Donnelly, 
Klobuchar, Baldwin, and Smith, on the pension's piece; Senator Nelson, 
on the disaster package. Senator Leahy, the ranking member of 
Appropriations, has done a great job on the whole thing. A lot of 
credit is due to each of them and to so many more of our Members 
because the final product is something that will benefit so many 
Americans over the next decade. Senator McCaskill was also very much 
involved in the pension issue, as well as many others.
  I hope this budget agreement will pass the Senate in large numbers on 
both sides of the aisle. It will be easy to say: Well, I didn't like 
this, and I didn't like that. Yet this is the time to come together. 
This is the time to stand up for our soldiers, our middle class, and 
those aspiring to the middle class. I hope we will get a large 
bipartisan vote.

  To that point, I have some pointed words for some in the House's 
Freedom Caucus--the hard right--who are starting to squawk about this 
budget deal. They say it raises the deficit. They just voted and 
cheered a bill that would add $1.5 trillion to the deficit in the form 
of tax breaks for mammoth corporations. They were willing to increase 
the deficit on the defense side of the budget, but all of a sudden, 
when it comes to our schools or our roads or our scientific research: 
Oh, we can't do it because of the deficit. It is blatantly hypocritical 
to ignore the deficit when it favors corporate America but raise the 
alarm when it comes to helping our veterans, our students, and those 
addicted to opioids. That is selective enforcement. That doesn't fly.
  There is a lot of sophistry going on. Oh, when we reduce taxes, we 
will not have a deficit because it will keep the economy growing. Does 
anyone doubt that education keeps the economy growing, that scientific 
research keeps the economy growing, that building infrastructure keeps 
the economy growing? There is a lot of hokum flying around here that 
only when you cut taxes for big corporations do you grow the economy.
  What is good for the goose is good for the gander, and I think 
Americans are tired of the hypocrisy on the hard right, which treats a 
$1.5 trillion hole in the deficit by cutting corporate taxes with 
cheers--primarily taxes on the wealthy--and then says you cannot spend 
money on those who need relief from the student debt loans they have or 
who need help for healthcare or food stamps. It is utter, sheer 
hypocrisy.
  Let this budget go forward through both Chambers and go to the 
President's desk, where President Trump seems willing and ready to 
sign. President Trump was not involved in this process. He was not 
constructive when he spoke and tweeted. He asked for a shutdown. I 
think, in this body--and I hope my colleagues on the other side of the 
aisle are learning this--oftentimes, we can get a lot more done when 
working with one another and letting the White House just sit on the 
sidelines, because you do not know what its positions are. As I once 
said, negotiating with the President is like negotiating with Jell-O, 
and, oftentimes, his positions are just so far over to one side of the 
political spectrum--Koch brothers-type positions--that they would never 
pass. So this is a good motto.


                              Immigration

  Mr. President, now I have one more word on immigration.
  Based on my continued conversations with the Republican leader, once 
we pass this budget agreement, we are ready to proceed to a neutral 
bill--a shell bill--on immigration next week. The Republican leader has 
guaranteed an amendment process, fair on all sides, where we will 
alternate amendments. That means some of the people who are on the very 
conservative side will get amendments and some on the very liberal side 
will, but so will there be an opportunity for a bipartisan compromise 
that will focus on the Dreamers and border security that will have a 
real chance of getting 60 votes. We should all be working hard to get 
that done in this Chamber.
  I would say to my friends in America who care about the Dreamers to 
please let their Senators know, particularly those Senators who have 
not committed to helping the Dreamers, how important this is.
  Next week will be one of the most vital weeks when we will be able to 
deal with the Dreamer issue in a fair, compassionate way. It has been 
swept under the rug for too long, but because of the agreement the 
leader and I came to a few weeks ago--and he has confirmed to keep his 
commitment--we will be able to deal with it. The House should be able 
to deal with it as well.
  What Leader McConnell and I have agreed to should be something that

[[Page S796]]

Speaker Ryan agrees to. To just put President Trump's bill on the floor 
means no immigration bill and no help for the Dreamers. We all know 
that. It will lose Republican votes as well as Democratic votes. It 
will not pass in the House.
  I say to Speaker Ryan: Allow a fair and open process to debate 
Dreamers on the floor of the House, just as we are allowing in the 
Senate.
  Leader Pelosi shouldn't have to stand and speak for 8 hours--I 
respect her for doing it--just to secure a vote on an issue as 
compelling and pressing as the Dreamers. What Leader Pelosi is asking 
for is the same thing that we have here in the Senate--no more, no 
less--a vote and an open process. That is undeniably fair. I hope 
Speaker Ryan will relent and promise a vote. There is an appetite on 
both sides and in both Chambers to get this done--both to help the 
Dreamers and do border security.
  In the Senate, I know that everyone on the Democratic side and many 
on the Republican side are working hard to find a bill that can protect 
Dreamers and provide border security that can pass next week. We know 
this is a difficult task, and we know immigration is one of the more 
volatile issues in America, but we have to do it for the good of this 
country. The budget was a difficult process, but we came to an 
agreement. Let's do the same on immigration with a bipartisan 
agreement, where each side gives some, and we can all be proud that we 
got it done. The same effort and spirit that forged the budget deal 
should carry forward to the issue of the Dreamers. Let's get it done 
next week.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Sullivan). The Senator from Indiana.
  Mr. YOUNG. Mr. President, I ask unanimous consent to be recognized 
for up to 10 minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. YOUNG. Mr. President, I would like to take a moment to speak in 
support of two pieces of legislation I introduced that are included in 
the continuing resolution we will vote on today: the Social Impact 
Partnerships to Pay for Results Act and the Modernizing the Interstate 
Placement of Children in Foster Care Act. Both of these bills are very 
important to Hoosiers, and I am glad we will finally see them become 
law after 6 years of working in a bipartisan way to get them across the 
finish line.
  Let me tell you why these two measures are so important to Hoosiers 
and really to all Americans. The Social Impact Partnerships to Pay for 
Results Act empowers our public and private sectors to implement 
evidence-based social and public health interventions to address some 
of our Nation's most pressing social challenges.
  America has a celebrated and vibrant civil society. We have a history 
of not turning first to government to solve some of our thorniest 
social and public health challenges but instead turning to our 
neighbors, turning to our local communities, perhaps our local not-for-
profit groups or our community heroes, and we discover that oftentimes 
they are better situated to address these thorny challenges than are 
government programs. That is not to suggest in the slightest that 
government doesn't have a very important role in addressing these broad 
social challenges. Government can indeed make a difference but so can 
these other organizations.
  We have a growing evidence base without any partisan tinge to it. It 
is broadly agreed that we have a growing evidence base of those things 
that are working to address challenges such as homelessness, asthma in 
low-income communities, and getting the long-term unemployed back into 
the workforce. Name the social ill, and there is likely a not-for-
profit group or even a for-profit group in each of our individual 
States which is making a meaningful difference on this front.
  The challenge is, how do we scale up these evidence-based 
interventions in an era of scarce resources? Well, because social 
impact partnerships are focused on achieving results, taxpayer money is 
only paid out when desired outcomes are met. Government payments are 
made possible because when we really help somebody, when we really are 
able to help them achieve their goals and turn around their lives, that 
frees up government money. So we use those avoided costs and future 
government savings to pay back those who invest in scaling up things 
that really work to improve lives.
  Let me give an example of what has also been called pay for success. 
There is a service in Indianapolis that connects registered nurses with 
low-income pregnant women. The Nurse-Family Partnership helps ensure 
both mom and baby are healthy throughout the pregnancy and through the 
infant's life. They hit specific metrics that save the Federal 
Government money. Under this legislation, a philanthropic organization 
like Indiana's Lilly Endowment could invest in the Nurse-Family 
Partnership to scale up their work. As long as the metrics continue to 
be met, as long as success is achieved, the investor is paid a return 
out of those future government savings.
  It makes a whole lot of sense, which is why it passed unanimously out 
of the House of Representatives previously and why I believe it will be 
passed into law after passing this Chamber and be signed into law by 
the President in the coming days.
  Social impact partnerships address our moral responsibilities to 
ensure that social programs actually improve recipients' lives and do 
so in a fiscally prudent manner. They also respond to the imperative of 
improving our economic health by harnessing the capabilities of every 
able-bodied citizen.
  We ought to be treating every American like they are an asset to be 
realized, not a liability to be written off, not a consumer of programs 
but somebody with real potential. We want every American to achieve 
their full human potential.
  To recap, who is going to benefit? Well, the recipients of these 
services, through the public-private partnership, will benefit--the 
least among us--taxpayers will benefit, and every American will benefit 
as our communities become strengthened, as more enter the workforce, as 
public health is improved, and so forth.
  The next bipartisan measure, which I expect to get across the finish 
line today, is the Modernizing the Interstate Placement of Children in 
Foster Care Act. This bill expedites the time it takes to place 
children into loving homes, and we will see why it is so important and 
so timely that we pass this legislation today as well.
  Thousands of children in my State of Indiana have lost loving parents 
to opioid addiction. I have seen it up close and personal. I used to 
represent Scott County, IN. This was ground zero in our State for the 
opioid epidemic. It made national news, not in a good way. So many good 
people have been adversely impacted in this community, and I know there 
are communities like this across the country that are being impacted to 
varying degrees by the opioid crisis. I fear that if we do nothing, we 
will lose thousands in the next generation as well.
  Modernizing the outdated interstate child placement process is one of 
a number of proposals that are urgently needed. This legislation will 
incentivize States to connect to an electronic interstate case-
processing system that has already achieved substantial reductions in 
the time it takes to place these children into homes.
  Frankly, before I dove into this, I just assumed that our foster care 
system was digitized; that it had found its way into the 21st century; 
that we weren't using paper files that were being mailed back and forth 
several times to process adoptions, especially under these very trying 
circumstances, but that is not the case. We need to make sure a child 
will spend less time being shuffled from foster home to foster home, 
and this legislation will achieve that.
  We need to make sure a situation where children are taken in and out 
of school without a set routine is put to an end. For children caught 
up in a system struggling to meet community needs, we should do 
everything possible to get them immediately placed in a setting that is 
best for them, regardless of State boundary lines.
  In summary, these bipartisan, bicameral bills were developed over 6 
years, beginning during my time in the House of Representatives. I 
consulted with key stakeholders to make sure there would be broad 
support, and

[[Page S797]]

there is. I have had countless discussions with Hoosiers and other 
experts about how to tackle these challenges.
  The continuing resolution we will vote on today isn't perfect. I 
remain concerned about our spending levels, and I maintain that we need 
to take long-term action for the fiscal health of our country. However, 
with our commitment to our military and the inclusion of these two 
important pieces of legislation, I will be voting for the CR for the 
good of all Hoosier children, families, and communities.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. MARKEY. Mr. President, I ask unanimous consent that I be 
recognized to speak for up to 10 minutes followed by Senator Cardin for 
up to 10 minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


                                  DACA

  Mr. MARKEY. Mr. President, I rise to speak about the need to protect 
our Dreamers from deportation. When we talk about Dreamers, we are 
talking about immigrants who came to this country as children. We are 
talking about immigrants whose parents brought them here when they were 
young to give them a better chance than they had in their own 
countries. We are talking about young immigrants who, when they were 
children, had no choice in the decision to come to the United States.
  These Dreamers know no other home than these United States. Many of 
them have spent their lives in limbo, identifying as Americans but 
lacking legal status and under the constant threat of being sent back 
to countries that are completely foreign to them.
  In 2012, President Obama took steps to protect some of these Dreamers 
from deportation. Through an Executive order, he established the 
program known as DACA or the Deferred Action for Childhood Arrivals 
Program. DACA created security and opportunity for hundreds of 
thousands of young Dreamers, allowing them to live and work in our 
great Nation without the threat of deportation. So what DACA really 
stands for is ``Deserving a Chance in America,'' DACA, and a protection 
for these innocent young people who deserve a shot at the American 
dream.
  I would like to take a moment to speak about one of these 
Massachusetts Dreamers who benefited from DACA. Her name is Estefany. 
She came to the United States at 9 years of age to escape violence in 
El Salvador. She was brought here by her grandmother, along with her 
two sisters and a baby cousin. The journey took 22 days. It was 
arduous. Estefany was so scared at one point she asked to be left 
behind. When she finally got to the United States, she found it 
difficult to adjust to this whole new world, but Estefany was overjoyed 
to be reunited with her mother, who had come to the United States a few 
years before the rest of the family was able to come.
  Estefany was grateful for the opportunity she was given and did not 
want to squander it. She wanted to succeed in school and live up to her 
mother's sacrifice. Estefany, who only spoke Spanish when she arrived, 
struggled with elementary school and tried to do her homework every 
night. Working as hard as she could, in 2 years she was moved on from 
her English as a Second Language class. Her hard work paid off in even 
greater dividends when she was accepted into the prestigious Boston 
Latin Academy for high school.
  Her work ethic and desire to deserve her family's sacrifices were 
what motivated Estefany and got her through the many hardships that 
come with being undocumented--fear, uncertainty, anxiety. When Estefany 
began her college application process, she fully understood, for the 
first time, what it meant to be undocumented.
  Although she wanted to go to college and have a career, she was 
afraid to tell her guidance counselor and her teachers of her fears 
about her legal status. Once Estefany opened up to them, she confronted 
applying and attending college the same way she had always faced up to 
the other struggles in her life--with strength, courage, and 
perseverance. She fought the battle that many aspiring college students 
wage--figuring out how to pay for it. It wasn't easy. As she researched 
and applied for scholarships, she found out that most were for citizens 
only. Because of scholarships provided by immigrant support 
organizations like the wonderful Massachusetts Immigrant and Refugee 
Advocacy Coalition, MIRA, Estefany is now attending the University of 
Massachusetts in Boston, where she is pursuing a degree in 
international relations and a minor in public policy.
  So it sounds like a happy ending, but, sadly, it is not. On 
Estefany's first day as a freshman at UMass Boston, President Trump 
repealed DACA. He callously terminated the program, with no guidance on 
what should be done next for these young Dreamers. That heartless 
action by the President left Estefany unable to focus on school. She no 
longer had any certainty about her future here in the United States and 
at UMass Boston. As Estefany put it, ``After so many tears and 
sleepless nights, it felt like all my hard work was being thrown 
away.''
  Estefany is a fighter, and she is not giving up on her college 
education or career. I know she will succeed if she is just given the 
chance because she, like so many other Dreamers, deserves that chance.
  Over the 5 years that DACA was in effect, the program protected some 
800,000 Dreamers, nearly 8,000 in Massachusetts. These are young people 
like Estefany who study, who serve, who work, and who live next door to 
us every single day. They are our friends, our neighbors, and our loved 
ones. They are not ``too lazy.'' They are not ``bad hombres.'' They are 
some of the best and brightest in our country.
  Now, because of President Trump's unconscionable decision to end 
DACA, Estefany and so many young people like her are living in darkness 
again. It is heartbreaking to watch this administration strip 
protections away from people who are Americans in every way that should 
matter. Leaving them to live under a threat of deportation is 
unconscionable.
  We should not abandon these young people whom we urged to come out of 
the shadows. We should not abandon the larger community of Dreamers who 
have no other home than the United States. The American people 
understand this. In January, a poll found that 87 percent of Americans 
favor allowing immigrants who were brought to the United States 
illegally as children to stay here--87 percent; nearly all Americans 
are with our Dreamers.
  You would think that extending these protections would be a no-
brainer for the Republicans. Right here, right now, we could pass a 
bill to protect these young immigrants, but, instead, the Republicans 
have decided to use the Dreamers as a bargaining chip in budget 
negotiations. They hope that by leveraging the lives and futures of 
Dreamers, they will get their laundry list of hard-liner immigration 
demands.
  I am so glad that Senator McConnell has agreed with Senator Schumer 
that we are going to open up a debate here on the floor of the U.S. 
Senate. We are going to try to find a way to resolve this issue, 
although there is no guarantee that President Trump will, in fact, 
agree with any resolution here. There is no guarantee that the tea 
party Freedom Caucus Republicans in the House of Representatives will 
agree with any understanding that is reached here on a bipartisan 
basis, if we can reach one on the floor of the U.S. Senate.
  I just think, for better or worse, the Dreamers should know that we 
are going to continue to fight for them and that we are going to 
continue to work toward creating a pathway for them to be able to live 
in our country without fear. I think that is going to be the signature 
moment we can create for our country this year. Yes, we have a budget 
agreement, but we have so much more work to do to help these young 
people who will be great Americans once we create a path to citizenship 
for them.
  At this point, I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, first, I want to thank Senator Markey and 
concur in his comments in regard to the Dreamers. Yes, we are pleased 
that we have a bipartisan agreement today. I am still in the process of 
reading all the details before making a final judgment, but it is 
certainly good news that the Democrats and Republicans--

[[Page S798]]

the leadership--have come together in an agreement.
  I join Senator Markey and am pleased that the majority leader is 
going to bring before the floor of the Senate in a fair manner next 
week the immigration issue to protect Dreamers. I would also add that 
those in temporary protective status, TPS, should also be considered.
  We have a process, and I hope that the spirit that we have seen on 
the budget agreement will continue next week as the Senate works, as it 
should, in a bipartisan manner to protect the Dreamers and do what is 
right. I also want to acknowledge that there is no such commitment from 
the Republican leadership in the House. I join with Leader Pelosi in 
urging Speaker Ryan to set up a similar process in the House so that we 
can get a bill to the President and signed into law to protect the 
Dreamers. The President created this problem by putting a date on their 
backs, and it is our responsibility to respond in a timely way. I am 
glad to see that the Senate is prepared to take action.


                       Prudent Layperson Standard

  Mr. President, I took this time because I want to talk about one 
specific provision in healthcare that was passed by Congress in the 
nineties, but let me just preface that by saying that in this budget 
agreement, I am pleased to see there are bipartisan agreements on 
advancing healthcare in America. A bill that I have worked on since we 
imposed the therapy caps way back in the nineties, which made no sense 
at all, will finally correct that mistake permanently and allow those 
who are in need of the most severe therapy services--those who are 
stroke victims or in similar situations--to be able to get that care 
without a cap as to the amount of services they need.
  I am also pleased to see that we are going to be dealing with 
telemedicine--an issue I have worked on and many Members have worked 
on--improving dialysis treatment. Some of the issues we have all worked 
on include community health centers, the 10-year extension of the 
Children's Health Insurance Program, and rural healthcare. There are a 
lot of good things in this bipartisan agreement to advance healthcare, 
and I am pleased about them.
  I just want to remind my colleagues that if we are successful in 
getting that enacted into law, we still have to make sure it is 
implemented in the manner in which we intended. I give as an example 
the prudent layperson standard on emergency medical treatment. I was 
involved in that process in the 1990s. The reason this came to our 
attention is that insurance practices in the 1990s were such that it 
was not unusual for an insurance company to deny payment for emergency 
services. An individual would have the classic symptoms, for example, 
of a heart attack--the pain, the sweating--and then did what a prudent 
layperson would do, which is go to the nearest emergency room to get 
treatment. Well, after the examination was complete, if they found out 
the person did not have a heart attack, the person would be discharged 
from the hospital and go home. A few days later they would get the bill 
for that visit and then almost have a heart attack when the insurance 
company would not pay the bill. We recognized that as not being right, 
so we took action to change that.
  In response to these dangerous and unfair requirements, Maryland 
enacted the prudent layperson standard in 1992. If it was prudent to go 
to the emergency room for care, the insurance company had to reimburse 
it. Later, in 1997, I led the national effort to extend the prudent 
layperson standard to all Medicare plans and Medicaid managed care 
plans as part of the Balanced Budget Act of 1997. I worked with 
President Clinton, who eventually signed an Executive order in 1998 to 
have the standard apply to all government insurance programs.
  Then I fought to have my patient's bill of rights amendment, which 
included the prudent layperson standard, enacted as part the Patient 
Protection and Affordable Care Act for individual and group health 
plans. So now it is effective for all plans in this country. There is a 
definition of what an emergency medical condition is and when it is 
prudent to do that. It is spelled out in the statute dealing with the 
seriousness of the symptoms, as it could deal with bodily harm, et 
cetera.
  Despite the Federal law, private insurers are, once again, using 
tactics to prevent people from seeking care in an emergency room. 
Several newspapers, from the Los Angeles Times to the Columbus 
Dispatch, have reported that Anthem--one of the Nation's largest 
insurers--has implemented an avoidable emergency room program to reduce 
what it deems as unnecessary ER visits and address rising healthcare 
costs. This program has been rolled out in several States, including 
Kentucky, Missouri, Ohio, Indiana, Georgia, and New Hampshire.
  According to these news reports, patients who believe they have 
emergency symptoms go to the ER for emergency medical care. After 
several tests, the physicians and nurses determine there is no 
emergency medical condition. The patient returns home, relieved to be 
OK. A few weeks later, they receive a letter from the insurance company 
refusing to cover the care received in the hospital. This is wrong. We 
said it was wrong in the 1990s, and we took steps to change that. We 
now have laws that make it very clear.
  The Anthem avoidable ER policy forces people who are in some sort of 
acute distress to determine, before they even leave their homes, if 
their symptoms are really serious enough to go to an emergency room. 
What we had back in the 1990s was preauthorization for emergency care. 
Can you imagine trying to make a phone call before you go to an 
emergency room to talk to somebody as to whether you should go there or 
not, wasting valuable time, or being told to go to a hospital different 
from the closest hospital, again, causing really serious jeopardy? That 
is what we had. People should not be forced to act as their own doctor 
and second-guess themselves when they truly believe they are having a 
medical emergency.
  A wrong decision based upon economic considerations--the ability to 
pay the bill--could be deadly. We should not discourage people from 
seeking necessary medical treatment, and we should not allow insurance 
companies to return to the time when they could callously refuse to 
cover emergency care provided to individuals who genuinely and 
reasonably believe they need it.
  As we will be considering shortly additional improvements in our 
healthcare system to eliminate the cap that we have on therapy caps, to 
make it clear that we want to make telemedicine more available, to help 
dialysis patients, to deal with our children in the Children's Health 
Insurance Program, to deal with rural healthcare, let us also make sure 
that we set up the ability to make sure that our policies, in fact, are 
carried out. We should not allow an insurance company such as Anthem to 
act as if what Congress did does not exist. I think that is our 
responsibility.
  I look forward to working with our colleagues in a bipartisan way to 
improve healthcare and access for all Americans.
  With that, I yield the floor.


                             Cloture Motion

  The PRESIDING OFFICER. Pursuant to rule XXII, the Chair lays before 
the Senate the pending cloture motion, which the clerk will state.
  The legislative clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     do hereby move to bring to a close debate on the motion to 
     concur in the House amendment to the Senate amendment to H.R. 
     695, a bill to amend the National Child Protection Act of 
     1993 to establish a national criminal history background 
     check system and criminal history review program for certain 
     individuals who, related to their employment, have access to 
     children, the elderly, or individuals with disabilities, and 
     for other purposes.
         Mitch McConnell, John Cornyn, Mike Crapo, Jerry Moran, 
           Richard Burr, David Perdue, Tom Cotton, Shelley Moore 
           Capito, Deb Fischer, James M. Inhofe, Pat Roberts, 
           Roger F. Wicker, John Hoeven, John Barrasso, John 
           Boozman, Steve Daines, Mike Rounds.

  Mr. GARDNER. Mr. President, I ask unanimous consent that the 
mandatory quorum call be waived.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  By unanimous consent, the mandatory quorum call has been waived.
  The question is, Is it the sense of the Senate that debate on the 
motion to

[[Page S799]]

concur in the House amendment to the Senate amendment to H.R. 695 shall 
be brought to a close?
  The yeas and nays are mandatory under the rule.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Arizona (Mr. McCain).
  The PRESIDING OFFICER (Mr. Perdue). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 55, nays 44, as follows:

                      [Rollcall Vote No. 29 Leg.]

                                YEAS--55

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

                                NAYS--44

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

                             NOT VOTING--1

       
     McCain
       
  The PRESIDING OFFICER. On this vote, the yeas are 55, the nays are 
44.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The majority leader.

                          ____________________