[Congressional Record Volume 164, Number 84 (Tuesday, May 22, 2018)]
[Senate]
[Pages S2812-S2815]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. JONES. Mr. President, I come to the floor today and rise to speak 
on a challenge that our rural health communities face both in Alabama 
and across the country. People living in rural areas often face 
difficulty in finding healthcare providers. The challenges of 
consistent, quality healthcare for rural America are exponentially more 
difficult than in any other area in the country. These persistent gaps 
in healthcare inevitably lead to poor health outcomes.
  As a result, life expectancy for rural Alabamans is approximately 6 
months lower than for those who reside in

[[Page S2813]]

urban areas and 3\1/2\ years lower than for people living in the rest 
of the country. In some parts of my State, the outlook is even worse. 
In Wilcox County, for example, life expectancy is 9 years lower than 
the national average. That is unacceptable. The county of your birth or 
where you choose to live should not dictate the quality of your life, 
much less your life expectancy.
  Despite the prosperity some pockets of the country feel today, 
outcomes don't seem to be improving in many areas in rural America. 
Alabama's rural hospitals are at risk, and many are in immediate danger 
of closing. Sadly, some already have. Just last week, yet another 
hospital--this one in Jacksonville, AL--announced that they would 
close; it is about the 12th, I think, since 2011. It has become an all-
too-familiar pattern in Alabama and in other rural areas in America. 
That means the quality and number of treatment options in these rural 
areas and in Alabama continue to decline. Fifty-two of Alabama's rural 
counties are facing primary care shortages, and those numbers get worse 
for specialty practitioners like dentistry and obstetrics.
  Having spent nearly my entire life in Alabama--the only exception 
being 1 year in Washington, DC, working for this body on the Senate 
Judiciary Committee--I am acutely aware of the unique difficulties we 
face in keeping folks healthy. As I have traveled across Alabama over 
the last year, I have heard from folks who struggle to access medical 
care. I have heard from expectant mothers who didn't know if they would 
be able to make it to a hospital in time for delivery because the 
closest one was more than an hour away. I have heard from people who 
are impacted by the growing opioid epidemic and the lack of substance 
abuse and mental health treatment options in their communities.
  When I came to the Senate, I knew I needed and wanted to make 
increasing access to quality, affordable healthcare one of my first 
priorities. I also knew that finding the Holy Grail of true healthcare 
reform in today's world of partisan politics is a difficult and complex 
task. I am proud to say that we have made some progress since I got 
here in January. For instance, through bipartisan efforts, the expired 
Children's Health Insurance Program, CHIP, which provides coverage to 
150,000 Alabama kids as well as community health centers that serve 
350,000 Alabamans, was funded for an additional 10 years in the 
future. I am proud that we secured an additional 3 years of funding for 
community health centers in that bill, which provides the primary 
source of healthcare in many underserved communities.

  I was also a cosponsor of the Training the Next Generation of Primary 
Care Doctors Act, which was signed into law as part of the bipartisan 
budget deal. That legislation is critical for folks in my State, both 
in the training it provides to doctors in community health centers and 
in rural health clinics, but also because it ensures that talented 
individuals who choose to stay in the healthcare professions stay and 
practice in their community.
  Bipartisan legislation like that bill is one of the many ways that we 
can improve how folks receive healthcare in the United States. There 
is, of course, another option, which leaders in Alabama have failed to 
take, and that is to expand Medicaid. By failing to expand Medicaid, 
many of Alabama's most vulnerable citizens have been denied access to 
basic care, and we turned away literally billions of our own taxpayer 
dollars in the process. That decision just doesn't make sense. While I 
remain hopeful that my State's leadership will reconsider the 
shortsighted decision made solely for political reasons, I am going to 
continue to work to find ways to help. For example, I will continue to 
advocate for changes in the Medicaid wage index, which has been 
unfairly hurting Alabama healthcare providers and has been doing so for 
years.
  For my part, today, taking one additional step, I am proud to say 
that my very first piece of original legislation will focus on 
improving rural healthcare through making government more efficient. 
Today, along with my colleagues Senators Mike Rounds and Tina Smith, I 
am introducing the Rural Health Liaison Act. I wish to thank and 
acknowledge Congresswoman Cheri Bustos for her leadership on this issue 
in the House and her offer to partner in this important effort.
  The bipartisan Rural Health Liaison Act will streamline Federal 
investment in rural healthcare and improve coordination between Federal 
agencies and other healthcare stakeholders by creating a Rural Health 
Liaison within the U.S. Department of Agriculture.
  I believe the USDA is an appropriate spot for such a position because 
the Department plays a major role in rural development efforts. For 
instance, the USDA has the capability to finance the construction of 
hospitals, to implement telemedicine programs, and to carry out health 
education initiatives. We want to make sure that these efforts are 
fully coordinated and leveraged with the U.S. Department of Health and 
Human Services and other Federal agencies, as well as other important 
healthcare stakeholders.
  Among other things, the Rural Health Liaison would consult with HHS 
on rural health issues and improve communication with all Federal 
agencies. It will provide expertise on rural healthcare issues. It will 
lead and coordinate strategic planning on rural health activities 
within the USDA, and it would advocate on behalf of the healthcare and 
relevant infrastructure needs in rural areas.
  I thank Senators Rounds and Smith for their support on this important 
legislation, and I look forward to working together with them and other 
colleagues to move this bill forward. This is a great example of how 
Senators from both sides of the aisle can come together to propose 
commonsense legislation to make government work better and more 
efficiently. It is exactly the kind of work that I hoped to do when I 
arrived here just a few months ago.
  But this is just another step in a very complicated process. In the 
months ahead, I hope to have the opportunity to continue to work with 
colleagues on both sides of the aisle in this body to lower healthcare 
costs, to increase access to quality healthcare, and to improve the 
health and well-being of people living in rural Alabama, in rural 
America, and, in fact, for people all across this great Nation.
  Thank you, Mr. President.
  Mr. NELSON. Mr. President, will the Senator yield?
  Mr. JONES. Absolutely, yes.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON. This Senator from Florida wants to thank his neighbor and 
colleague for his comments and to say how true it is that there is an 
underserved part in healthcare that is not only the underserved in the 
inner city but, clearly, also in rural America. This Senator wants to 
thank the Senator from Alabama for coming forward with that piece of 
legislation. I look forward to discussing it with him.
  I also wish to thank the Senator for his comments about how 
shortsighted it is that the government, as he stated, in his State of 
Alabama, and, certainly, the government in my State of Florida, refuses 
to expand Medicaid and has so for almost 7 years, when, in fact, in the 
State of Florida, there is almost $5 billion a year that is sitting on 
the shelf that is Florida taxpayer money that is going elsewhere if not 
accessed, and it has not been accessed in my State of Florida. That is 
800,000 people--almost 1 million people--poor people and disabled folks 
who would be getting healthcare, and they otherwise are not getting 
healthcare.
  Would the Senator believe that when they don't get healthcare through 
Medicaid, for which they are eligible under the law, when they get 
sick, what do they do? They end up going to the emergency room. By not 
having any preventive care, it is now an emergency. Of course, when 
treated at the emergency room, it is the most expensive place at the 
worst time. Lo and behold, it is uncompensated care, and the hospital 
can't eat all of that uncompensated care. So what happens? All the rest 
of us pay through increases in our premiums.
  I thank the Senator for his statement about what is happening in my 
neighboring State of Alabama.
  Mr. JONES. I say thank you to Senator Nelson. I appreciate that. 
Although our numbers are not as staggering in our State of Alabama, 
they are still significant for the State of

[[Page S2814]]

Alabama with regard to Medicaid. So I will state that I appreciate the 
Senators comments very much, and I look forward to working with him on 
this bill and helping to move it forward.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON. Mr. President, I rise today regarding the nomination of 
Dana Baiocco to serve as a Commissioner on the Consumer Product Safety 
Commission, or, as we refer to it, the CPSC. It is a small, safety-
focused agency. It has about 500 employees, but it has a critically 
important mission to keep Americans safe from potential defects in 
thousands of consumer products, many of which are imported from China.
  We have seen the need to have a strong cop on the beat, and we have 
seen that many times over the years. For example, back in 2007, we saw 
what was referred to as a summer of recalls, when a number of 
children's toys were recalled for high levels of lead and other toxic 
substances.
  In response to that summer of recalls in 2007, Congress almost 
unanimously passed a law, the Consumer Product Safety Improvement Act 
of 2008, to address the safety of toys and other children's products. 
But there is still a lot more to do.
  Last summer, another tragedy played out in Florida, involving 
portable generators. People go and buy these portable generators in 
anticipation that they are going to lose electricity in their home, as 
is so often the case with a hurricane. In the wake of Hurricane Irma 
last year, 12 Floridians died and a number of others were injured by 
the use of portable generators because carbon monoxide poisoning is 
emitted from these portable generators. In many cases, the victims were 
just trying to clean up debris or provide power to their families after 
the storm, unaware that these generators give off large amounts of 
carbon monoxide, which is colorless, odorless, and deadly.
  For years we have been calling on the CPSC to ensure that portable 
generators are equipped with mechanisms that limit carbon monoxide 
emissions and automatically shut off the generators when the carbon 
monoxide level reaches a high, dangerous lethal level in an enclosed 
area that could cause death. It is a small modification to generators 
that would not affect the performance but definitely would save lives.
  This happens after every hurricane. People get generators because it 
is a number of days or weeks without electricity, and they still want 
to have electricity, and, of course, there are untold deaths. In the 
case of Florida, in the aftermath of Hurricane Irma, there were 12 
deaths. If small modifications had been in place last summer, it is 
very likely that some of those Floridians who lost their lives would 
still be with us.
  That brings me to Ms. Baiocco's nomination. She certainly has a 
distinguished legal career. She has been a partner of a major law firm, 
and I congratulate her on that.
  When she was in front of our Commerce Committee, she was asked 
whether she would support a mandatory standard requiring that 
generators have mechanisms that limit carbon monoxide emissions or 
other devices that switch the generators off when the carbon monoxide 
level rises to dangerous levels. Her response was that we should defer 
to a voluntary industry standard.
  I ask the Presiding Officer: Do you think the industry is going to 
voluntarily put on these shutoff mechanisms? Isn't the CPSC there for 
the purpose of protecting the public?
  When the next hurricane hits--perhaps in the Presiding Officer's 
State--do we want another dozen deaths as has occurred in Florida? I 
don't think so. I think that is the role of the CPSC, and yet Ms. 
Baiocco said she wants it to be voluntary with the industry. Well, that 
is exactly what we have been doing for years, and we just keep seeing 
more deaths and more injuries because the industry doesn't change it. 
In some cases, whole families have been wiped out. That is not a 
pleasant thought.
  Hurricane season starts June 1, and every day that the CPSC fails to 
act on portable generators, more Americans will die, especially where 
hurricanes hit. The place called ``hurricane highway'' is not only the 
peninsula of Florida but also the Gulf States and the gulf coast, which 
includes the Presiding Officer's State. The fact that Ms. Baiocco 
cannot recognize the need for a mandatory standard in this area makes 
me wonder if she is going to do anything about other hazards that 
impact our families.

  Mr. President, I ask for 60 more seconds.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. NELSON. Mr. President, this is serious. There are things like 
potentially toxic flame-retardant chemicals in children's products. 
Remember all of those Chinese toys that were defective? Or what about 
recycled crumb rubber that is used in playgrounds that have high levels 
of toxic substances?
  Sadly, it seems that with the administration's recent appointments to 
the CPSC, the Commission could soon become known as the ``commission to 
protect shareholders and companies.''
  This Senator believes that the people appointed to protect us have to 
display a desire to protect the consumers first. The stakes are just 
too high. Unfortunately, this Senator, a member of the Commerce 
Committee, has concluded that Ms. Baiocco does not meet this standard. 
Therefore, I must oppose her nomination.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. THUNE. Mr. President, I ask unanimous consent to be able to 
conclude my remarks regarding this upcoming vote prior to the vote.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. THUNE. Mr. President, I rise today to voice my strong support for 
the nomination of Dana Baiocco to be a Commissioner at the Consumer 
Product Safety Commission. Ms. Baiocco has dedicated her career to 
product safety and liability matters, and it is my firm belief that her 
depth of experience and familiarity with consumer product safety issues 
will bring an important perspective to the Commission once she is 
confirmed.
  Born and raised in Yorkville, OH, Ms. Baiocco attended the Duquesne 
University School of Law, graduating cum laude in 1997. While still in 
law school, Ms. Baiocco served as a law clerk for the U.S. District 
Court for the Western District of Pennsylvania. In 1998, she joined the 
law firm of Jones Day and became a partner in 2007, where she has 
dedicated her legal career to counseling clients on product safety and 
liability issues. In 2011, she became one of the founding partners of 
Jones Day's Boston office, which opened that same year.
  Currently, the CPSC retains a 3-to-1 Democratic majority. While the 
Commerce Committee has favorably reported Ms. Baiocco's nomination, as 
well as Acting Chairman Anne Marie Buerkle's nomination twice this 
Congress, both have been unfairly held up by some on the other side. 
The CPSC deserves a fully constituted Commission of Senate-confirmed 
leaders. Ms. Baiocco's confirmation is a crucial measure of good 
governance to restore balance to the Commission.
  To date, I have not heard a single argument against Ms. Baiocco's 
abilities. Notwithstanding her extensive qualifications to be an 
effective Commissioner at the CPSC, however, some of our colleagues on 
the other side have voiced concerns about her nomination on the grounds 
that her career representing business clients in the consumer product 
and liability space may impact her impartiality when considering issues 
before the Commission. A few have also raised concerns about her 
impartiality on the basis of her spouse's career as a litigator and 
partner at the law firm of White and Williams.
  Well, to my colleagues who harbor such concerns, I would note that 
the Senate routinely confirms nominees who are lawyers with private 
practice backgrounds, and we expect such officeholders to advocate for 
the public interest just as zealously as they once advocated for their 
clients.
  I would also remind our colleagues of the role the Office of 
Government Ethics plays in ensuring that nominees have resolved any 
actual or apparent conflict of interests before they are even 
considered by the Senate. The Office of Government Ethics has closely 
scrutinized Ms. Baiocco's financial disclosures to ensure compliance 
with all requirements and evaluated Ms. Baiocco's finances and 
background for conflicts of interest.

[[Page S2815]]

  Further, Ms. Baiocco has formerly pledged in her ethics agreement 
that she would recuse herself from matters involving her firm, Jones 
Day, or its clients unless issued a waiver. She also specifically 
stated in her ethics agreement that she will not ``participate 
personally or substantially in any particular matter involving specific 
parties in which [she knows] a client of her spouse is a party or 
represents a party'' unless authorized. Additionally, she has complied 
with all matters concerning the management of her financial assets in 
the future.
  It is my firm belief that Ms. Baiocco's experience will afford a 
unique perspective as a commissioner and serve the CPSC well. There is 
no legitimate reason to delay her confirmation any further. I, 
therefore, urge my colleagues to support her nomination.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Cruz). All time has expired.
  The question is, Will the Senate advise and consent to the Baiocco 
nomination?
  Mr. THUNE. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Colorado (Mr. Gardner) and the Senator from Arizona (Mr. 
McCain).
  Further, if present and voting, the Senator from Colorado (Mr. 
Gardner) would have voted ``yea.''
  Mr. DURBIN. I announce that the Senator from Colorado (Mr. Bennet), 
the Senator from Maryland (Mr. Cardin), and the Senator from Illinois 
(Ms. Duckworth) are necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 50, nays 45, as follows:

                      [Rollcall Vote No. 103 Ex.]

                                YEAS--50

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

                                NAYS--45

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

                             NOT VOTING--5

     Bennet
     Cardin
     Duckworth
     Gardner
     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.

                          ____________________