[Congressional Record Volume 165, Number 20 (Thursday, January 31, 2019)]
[Senate]
[Pages S802-S809]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. ERNST (for herself, Mr. Grassley, Mr. Sasse, Mrs. Fischer, 
        Mr. Tillis, Mr. Thune, Mr. Cotton, Mrs. Hyde-Smith, Mr. Moran, 
        Mr. Cassidy, Mr. Inhofe, Mrs. Blackburn, Mr. Scott of South 
        Carolina, Mr. Cruz, Mr. Roberts, Mr. Perdue, and Mr. Cramer):
  S. 285. A bill to require U.S. Immigration and Customs Enforcement to 
take into custody certain aliens who have been charged in the United 
States with a crime that resulted in the death or serious bodily injury 
of another person, and for other purposes; to the Committee on the 
Judiciary.
  Ms. ERNST. Thank you, Mr. President.
  Today I rise on the 3-year anniversary of the tragic death of a 
constituent of mine, Sarah Root. On January 31, 2016, the same day as 
her college graduation, Sarah was killed in nearby Omaha, NE, by an 
illegal immigrant named Edwin Mejia. He was drag racing with a blood 
alcohol level more than three times the legal limit.
  Despite requests by local law enforcement, Immigration and Customs 
Enforcement failed to detain Mejia because of a nonsensical policy that 
allows ICE to use discretion when determining whether to detain an 
illegal immigrant. He posted bond, he was released, and 3 years later 
remains a fugitive. It has been 3 years, and he is still a fugitive, 
denying Sarah's loved ones any sense of closure or justice.
  As a mom, I can't fathom the grief her family and friends continue to 
feel after such a devastating loss. My own daughter is approaching the 
age at which Sarah was killed.
  Just 21 years old, Sarah was bright, she was gifted, she was full of 
life and ready to take on the world. What a talented young lady.
  She had just graduated from Bellevue University with a 4.0 GPA. She 
was dedicated to her community, and she wanted to pursue a career in 
criminal justice. Sarah had her whole future ahead of her, but her 
opportunity to make her mark on the world was taken away from her. Her 
life was tragically cut short. Yet even in death, Sarah touched the 
lives of others. Sarah saved six different individuals through her 
organ donation.
  Sadly, what happened to Sarah Root is not an isolated incident.
  We have seen this story play out time and again in the 3 years since 
Sarah's killing--innocent lives taken by criminals who entered the 
United States illegally through a porous border. Crimes committed by 
those here illegally are truly among the most heartbreaking and 
senseless, and that is because these crimes are completely preventable, 
as the perpetrators should not be in the United States in the first 
place.
  Although nothing can bring Sarah back to her family, we can ensure 
that ICE never makes this same mistake again. That is why I rise today 
and, again, join with my colleagues from Iowa and Nebraska, including 
the Presiding Officer; thank you again for joining in this legislation. 
We are introducing Sarah's Law again in honor of Sarah Root.
  Sarah's Law would require that ICE take custody of a person who is in 
the country illegally and who is charged with a crime that seriously 
injures another person. Sarah's Law would also require better victim 
notification and amend the law to require that the Federal Government 
take custody of anyone who enters the United States legally but 
violated the terms of their immigration status or had their visa 
revoked and is later charged with a crime that resulted in the death or 
harm of another person.
  President Trump implemented parts of Sarah's Law through an Executive 
order in 2017, and I commend him for that. It included directing the 
Secretary of Homeland Security to prioritize the removal of criminals 
who are here illegally. The Executive order also establishes an office 
to implement notification requirements of Sarah's Law.
  Despite provisions of Sarah's Law being put into place by President 
Trump's order, it is critical that the Senate take up this legislation 
in order to codify these enforcement priorities so that any future 
administration cannot remove these provisions. No family should ever 
have to endure such a tragedy, especially one that could have been 
prevented. The fact remains that Sarah's killer would not have been in 
our country if it weren't for our country's broken immigration system.
  Sarah's Law is commonsense reform. It recognizes the simple fact that 
all criminals should be held accountable for their actions. How much 
more commonsense can this be, folks? Hold criminals accountable. We 
should not allow them simply to slip back into the shadows.
  I recognize that the immigration debate has become a political 
football. We see that every day here in Washington, DC, but the 
security of our borders and enforcement of our immigration laws is not 
a game. We must honor the lives of these innocent victims and do 
better. We must work to stop future crimes.
  I look forward to continuing to work with my colleagues to fulfill 
the promise I made to Sarah's loving parents, Michelle Root and Scott 
Root. I will do everything I can to ensure that not one more parent has 
to go through what the Roots have faced--the loss of their daughter and 
the promise of justice.
  Madam President, I thank you for joining me on this legislation. It 
means a lot to this family and many others.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself, Mr. Leahy, Mrs. Murray, Mr. 
        Wyden, Ms. Harris, Ms. Rosen, Mrs. Shaheen, Mr. King, Mr. 
        Carper, Ms. Duckworth, Mr. Sanders, Mr. Bennet, Mr. Coons, Mr. 
        Blumenthal, Ms. Klobuchar, Mr. Reed, Mr. Kaine, Ms. Hassan, Mr. 
        Markey, Mr. Murphy, Mr. Menendez, Ms. Cortez Masto, Mr. 
        Heinrich, Mr. Udall, Mr. Cardin, Mr. Booker, Mr. Whitehouse, 
        Mr. Merkley, Mr. Van Hollen, Mr. Casey, Ms. Hirono, Mrs. 
        Gillibrand, Ms. Cantwell, Ms. Warren, Ms. Stabenow, Ms. 
        Baldwin, Mr. Brown, Ms. Smith, Mr. Warner, Mr. Peters, Mr. 
        Jones, and Mr. Schatz):
  S. 292. A bill to limit the separation of families at or near ports 
of entry; to the Committee on the Judiciary.
  Mrs. FEINSTEIN. Mr. President, I rise today to reintroduce 
legislation that will finally put an end to the separation of families 
at our southern border. I have believed from the outset that the 
administration was wrong to pursue a zero tolerance policy of family 
separation, which is cruel and detrimental to children and parents 
alike.
  The President claimed to end this policy in June by executive order, 
but we have learned that the practice of separating families continues 
today. In fact, the separations may have been broader in scope than we 
previously knew.
  Last year, the American people were rightly horrified when thousands 
of children, including babies and toddlers, were taken from their 
parents, to be separated for weeks and months. Dozens of these children 
spent days and weeks in cages with nothing but thin mats and aluminum 
blankets.
  In response, people from all walks of life--Republicans, Democrats, 
clergy, the medical community, business leaders, labor organizers--
stood up and

[[Page S803]]

said, ``enough is enough.'' Average Americans spoke out, marched, and 
called their members of Congress pleading for us to stand up to the 
President and demand he reverse his policy.
  But we still may not know the full scope of the harm that was caused. 
We still do not know just how many families were torn apart as a result 
of the zero tolerance policy.
  Litigation has identified over 2,700 children who were separated from 
their parents by DHS, including nearly 100 children under the age of 5. 
However, in January the Inspector General for Health and Human Services 
found that ``this number does not represent the full scope of family 
separations.'' Indeed thousands--thousands--more children may have been 
separated from their parents in 2017, before the start of the 
accounting period required by the court.
  We have also learned in recent weeks that this crisis is not over. 
Families are still being separated from one another.
  In June, the Trump administration issued an executive order that 
ended the ``zero tolerance'' family separation policy. Despite that 
order, the practice of family separation did not end.
  Instead, the Inspector General for Health and Human Services reported 
that separations are ongoing with little oversight or accountability. 
In fact, at least 118 children were separated from their parents 
between June 2018, when the executive order was issued, and early 
November.
  These family separations could not have happened if Republicans had 
joined me and all Senate Democrats to pass the Keep Families Together 
Act last Congress. The Keep Families Together Act prohibits Border 
Patrol from separating children from their parents or legal guardians, 
without good cause.
  Good cause is defined with a focus on the best interest of the child, 
and cannot be based on the parent's migration or crossing of the 
border. No separation can be made without consulting a child welfare 
specialist, and all presumptions are made in favor of family unity, 
including unity of siblings.
  The Keep Families Together Act includes vital oversight mechanisms 
that will ensure that every child separated under the zero tolerance 
policy is accounted for. These include a requirement for DHS to publish 
transparent guidance on separations, as well as annual reporting 
requirements and a requirement for a GAO report on criminal prosecution 
of asylum seekers.
  These are basic protections for children that should not be 
controversial. Parents who try to protect their children from violence 
and poverty abroad, should not be punished by having those children 
ripped from their arms. Children should not be subjected to severe 
trauma in the interest of deterring migration.
  Instead, families should be kept together and given a fair chance to 
present their cases for asylum. The Keep Families Together Act will 
provide these fundamental necessities and protect children from further 
harm. We have a fresh start in a new Congress. It is time to make these 
vital protections a reality.
                                 ______
                                 
      By Ms. COLLINS (for herself and Mr. Cardin):
  S. 296. A bill to amend XVIII of the Social Security Act to ensure 
more timely access to home health services for Medicare beneficiaries 
under the Medicare program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise to introduce legislation with my 
colleague Senator Casey that would reauthorize the only federally 
funded programs that are specifically designed to develop a health 
provider workforce to care for our older Americans. The Geriatrics 
Workforce Improvement Act would reauthorize the Geriatrics Workforce 
Enhancement Program and also reinstate the Geriatrics Academic Career 
Award Program.
  The number of Americans aged 65 and older is growing rapidly. In my 
State of Maine, we are reaching an aging milestone faster than are 
other States. By 2020, the number of Maine seniors is projected to 
exceed the number of Maine children. This is 15 years ahead of the 
nationally projected date of 2035, at which point the number of 
Americans aged 65 and older will outnumber those under the age of 18 
for the first time in our Nation's history.
  The United States is facing a critical shortage of geriatric health 
professionals and direct service workers to support our aging 
population. Today, we need 20,000 geriatricians. However, fewer than 
7,300 of our Nation's nearly 1 million physicians are board certified 
as geriatricians. By 2030, we will need 30,000 geriatricians and even 
more geriatric health professionals and direct service workers. To 
achieve this goal, we will need to train 1,600 geriatric specialists 
per year over the next 12 years.
  For the State of Maine, with an aging population of more than a 
quarter million Mainers over the age of 65 and with only 40 
geriatricians, there is an acute need to quickly train more geriatric 
health professionals and direct service workers to meet the growing 
demand. The University of New England, College of Osteopathic Medicine 
has joined the University of Maine this year in proposing the ``Aging 
Maine Transformation Collaborative.'' I was pleased to lend my support 
to this collaboration earlier this year. If funded, AgingME would 
become our State's first Geriatric Workforce Enhancement Program and 
would bring with it much needed assistance to communities and families 
throughout our State.
  Nationwide, our bill would reauthorize this workforce enhancement 
program at $45 million per year over the next 5 years and would 
reinstate the Geriatrics Academic Career Award Program at $6 million 
per year. Together, these programs would train the current workforce 
and family caregivers while simultaneously developing a cadre of 
emerging leaders in geriatric education in a variety of disciplines. By 
doing both, we will ensure that older Americans will be cared for, for 
decades to come, by a healthcare workforce that will be specifically 
trained to meet their unique and complex healthcare challenges. This 
training of using the most efficient and effective methods for older 
adults will result in improved care while reducing unnecessary costs.
  I am pleased to say that our legislation is supported by the leading 
organizations in gerontology and geriatrics, including the Eldercare 
Workforce Alliance, the American Geriatrics Society, the Alzheimer's 
Impact Movement, and the National Association of Geriatric Education 
Centers.
  I ask unanimous consent that these letters of support be printed in 
the Record.
   There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 Eldercare Workforce Alliance,

                                 Washington, DC, January 25, 2019.
     Hon. Susan Collins,
     Chair, Special Committee on Aging,
     U.S. Senate, Washington, DC.
     Hon. Bob Casey,
     Ranking Member, Special Committee on Aging,
     U.S. Senate Washington, DC.
       Dear Senator Susan Collins and Senator Bob Casey: On behalf 
     of the Eldercare Workforce Alliance (EWA), we are writing to 
     express our support of the Geriatrics Workforce Improvement 
     Act.
       EWA is a coalition of 32 national consumer, health care 
     professional, direct-care worker and family caregiver 
     organizations. The number of Americans over age 65 is 
     expected to reach 70 million by 2030, representing a 71% 
     increase from today's 41 million older adults. Today's health 
     care workforce is inadequate to meet the needs of older 
     Americans, many of whom have multiple chronic physical and 
     mental health conditions and cognitive impairments. Without a 
     national commitment to expand training and educational 
     opportunities, the workforce will be even more constrained in 
     its ability to care for the elderly population as the baby 
     boom generation ages.
       This bipartisan bill supports two critical objectives. 
     First, it would formally establish funding for the Geriatrics 
     Workforce Enhancement Program (GWEP). Second, it would 
     reestablish the Geriatric Academic Career Awards (GACAs), a 
     previously funded program for developing clinician-educators. 
     By supporting the GWEP and the GACAs, the Geriatrics 
     Workforce Improvement Act would:
       Foster education and engagement with family caregivers by 
     training providers who can assess and address their care 
     needs and preferences.
       Promote interdisciplinary team-based care by transforming 
     clinical training environments to integrate geriatrics and 
     primary care delivery systems.
       Improve the quality of care delivered to older adults by 
     providing education to families and caregivers on critical 
     care challenges like Alzheimer's disease and related 
     dementias.
       Reach underserved and rural communities by ensuring 
     clinician-educators are prepared to train the geriatrics 
     workforce of today and tomorrow.

[[Page S804]]

       This investment protects our most vulnerable elders and 
     invests in our country's future. We ask that you continue 
     your support for the programs at this crucial time, and thank 
     you for your leadership on this issue.
           Sincerely,
     Nancy Lundebjerg, MPA,
       EWA Co-Convener.
     Michele J. Saunders, DMD, MS, MPH,
       EWA Co-Convener.
                                  ____



                                  American Geriatrics Society,

                                   New York, NY, January 25, 2019.
     Hon. Susan Collins,
     Chair, Special Committee on Aging,
     U.S. Senate Washington, DC.
     Hon. Bob Casey,
     Ranking Member, Special Committee on Aging,
     U.S. Senate Washington, DC.
       Dear Senator Susan Collins and Senator Bob Casey: The 
     American Geriatrics Society (AGS), an organization devoted to 
     improving the health, independence and quality of life of 
     older adults, supports the Geriatrics Workforce Improvement 
     Act. The AGS is thankful for your support of the geriatrics 
     workforce training programs and for your efforts to improve 
     care of older Americans.
       The Geriatrics Workforce Improvement Act would authorize 
     the Geriatrics Workforce Enhancement Program (GWEP) and the 
     Geriatrics Academic Career Awards (GACAs) program under Title 
     VII of the Public Health Service Act. The AGS believes that 
     both programs must be authorized and funded if all Americans 
     are to have access to high-quality, person-centered care as 
     we grow older.
       The GWEP is currently the only federal program designed to 
     increase the number of providers, in a variety of 
     disciplines, with the skills and training to care for older 
     adults. The GWEPs educate and engage the broader frontline 
     workforce including family caregivers and focus on 
     opportunities to improve the quality of care delivered to 
     older adults, particularly in underserved and rural areas. 
     The GACA program is an essential complement to the GWEP 
     program. GACAs ensure we can equip early career clinician 
     educators to become leaders in geriatrics education and 
     research.
       The introduction of this important legislation follows 
     announcements of related funding opportunities from the 
     Health Resources and Services Administration (HRSA) in 
     November 2018. Authorization of the GWEPs and GACAs as 
     outlined in the Geriatrics Workforce Improvement Act will 
     help ensure that HRSA receives the funding necessary to carry 
     these critically important workforce training programs 
     forward.
       At a time when our nation is facing a severe shortage of 
     both geriatrics healthcare providers and faculty with the 
     expertise to train these providers, the AGS believes the 
     number of educational and training opportunities in 
     geriatrics and gerontology should be expanded, not reduced. 
     Thank you for your leadership on this issue.
           Sincerely,
     Laurie Jacobs, MD, AGSF,
       President.
     Nancy E. Lundebjerg, MPA,
       Chief Executive Officer.
                                  ____



                                  Alzheimer's Impact Movement,

                                 Washington, DC, January 31, 2019.
     Hon. Susan Collins,
     Chairman, Senate Committee on Aging,
     Washington, DC.
     Hon. Bob Casey,
     Ranking Member, Senate Committee on Aging,
     Washington, DC.
       Dear Chairwoman Collins and Ranking Member Casey: On behalf 
     of the Alzheimer's Association and the Alzheimer's Impact 
     Movement (AIM), including our nationwide networks of 
     advocates, thank you for your continued leadership on issues 
     and legislation important to Americans living with 
     Alzheimer's and other dementias, and to their caregivers. The 
     Alzheimer's Association and AIM are pleased to support the 
     Geriatrics Workforce Improvement Act.
       More than 5 million Americans are living with Alzheimer's 
     and, without significant action, nearly 14 million Americans 
     will have Alzheimer's by 2050. Today, another person develops 
     the disease every 65 seconds; by 2050, someone in the United 
     States will develop the disease every 33 seconds. This 
     explosive growth will cause Alzheimer's costs to increase 
     from an estimated $277 billion in 2018 to $1.1 trillion in 
     2050 (in 2018 dollars). These mounting costs threaten to 
     bankrupt families, businesses and our health care system. 
     Unfortunately, our work is only growing more urgent.
       The Geriatrics Workforce Improvement Act would develop a 
     workforce capable of providing complex, high-quality care 
     that improves health outcomes and reduces costs for a diverse 
     and growing aging population. It would reauthorize the 
     Geriatrics Workforce Enhancement Program (GWEP), and 
     reinstate the Geriatrics Academic Career Awards (GACAs) 
     Program, a previously funded program for developing 
     clinician-educators, two critical objectives to ensure 
     communities across the nation have access to health 
     professionals and other critical supports, improving care for 
     all of us as we age. By supporting the GWEP and GACAs the 
     Geriatrics Workforce Improvement Act would, foster education 
     and engagement with family caregivers by training providers 
     who can assess and address care needs and preferences, reach 
     underserved and rural communities by ensuring clinician-
     educators are prepared to train the geriatrics workforce of 
     today and tomorrow, and improve the quality of care delivered 
     to older adults by providing education to families and 
     caregivers on critical care challenges.
       The Alzheimer's Association and AIM deeply appreciate your 
     continued leadership on behalf of all Americans living with 
     Alzheimer's and other dementias. We look forward to 
     continuing to work with you and your colleagues to improve 
     care and support for individuals and families affected by 
     Alzheimer's disease and other dementias. If you have any 
     questions about this or any other legislation, please contact 
     Rachel Conant, Senior Director of Federal Affairs.
           Sincerely,
     Robert Egge,
       Chief Public Policy Officer, Executive Vice President, 
     Government Affairs, Alzheimer's Association.
                                  ____



                                       National Association of

                                  Geriatric Education Centers,

                                                 January 25, 2019.
     Hon. Susan Collins,
     Chair, Special Committee on Aging,
     U.S. Senate, Washington, DC.
     Hon. Bob Casey,
     Ranking Member, Special Committee on Aging,
     U.S. Senate, Washington, DC.
       Dear Chairman Collins and Ranking Member Casey: On behalf 
     of the HRSA Title VII and Title VIII funded Geriatrics 
     Workforce Enhancement Programs (GWEPs) across the country, 
     thank you for your past support of geriatric education and 
     for introducing the Geriatrics Workforce Improvement Act. The 
     National Association for Geriatric Education (NAGE) is 
     pleased to offer our support for the Geriatrics Workforce 
     Improvement Act, which will reauthorize the GWEP and once 
     again make the Geriatrics Academic Career Award program 
     (GACA) a part of the effort to prepare the geriatrics 
     workforce for the aging of our population. We and the growing 
     numbers of older adults, caregivers, and clinicians caring 
     for elders will urge Congress to move quickly to pass your 
     bill and provide the resources to address our nation's 
     growing demand for geriatric care.
       We appreciate the many discussions that your staff 
     facilitated with NAGE, as well as with the Eldercare 
     Workforce Alliance, the American Geriatrics Society, and The 
     Gerontological Society of America during the process of 
     developing this legislation. This authorization and related 
     funding are needed for the development of a health care 
     workforce specifically trained to care for older adults and 
     to support their family caregivers. Currently there are only 
     44 GWEP sites in 29 states. The modest increase in the 
     authorization in your bill will have an important impact on 
     training in geriatric care. Likewise, the funds you have 
     authorized for the GACA program complement the GWEP, and 
     support faculty that will teach and lead geriatrics programs. 
     The bill will also assist in ensuring that rural and 
     underserved areas will have geriatrics education programs.
       NAGE is a non-profit membership organization representing 
     GWEP sites, Centers on Aging, and Geriatric Education Centers 
     that provide education and training to health professionals 
     in the areas of geriatrics and gerontology. Our mission is to 
     help America's healthcare workforce be better prepared to 
     render age-appropriate care to today's older Americans and 
     those of tomorrow.
       Thank you for your continued support for geriatric 
     education programs.
           Sincerely,
     Catherine Carrico, PhD,
       President NAGE/NAGEC, Associate Director, Wyoming Geriatric 
     Workforce Enhancement Program, Wyoming Center on Aging, 
     Clinical Assistant Professor, College of Health Sciences, 
     University of Wyoming.
                                  ____


  Ms. COLLINS. Mr. President, I urge all of my colleagues to support 
this bipartisan bill that would ensure geriatric education for our 
current workforce while it would optimize resources to bolster academic 
careers in geriatrics and help to attract the best and the brightest 
into this field. Together, these programs would develop exactly the 
kind of highly qualified workforce that we need to care for Americans 
as our Nation grows older.
  I thank the Presiding Officer.
                                 ______
                                 
      By Ms. COLLINS (for herself, Mr. Tester, Mrs. Capito, Mr. Jones, 
        Mr. Boozman, Mr. Manchin, and Ms. Harris):
  S. 304. A bill to reauthorize section 340H of the Public Health 
Service Act

[[Page S805]]

to continue to encourage the expansion, maintenance, and the 
establishment of approved graduate medical residency programs at 
qualified teaching health centers, and for other purposes; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. President, I rise today to introduce legislation with my 
colleague from Montana, Senator Tester, to fund Teaching Health 
Centers, a time-tested model for success to train the next generation 
of primary care doctors in communities where they are needed the most. 
I am pleased that Senators Capito, Jones, Boozman, Manchin, and Harris 
have joined us as cosponsors.
  Over the next decade, the severe shortage of primary care doctors 
could reach crisis levels in a growing number of rural and underserved 
communities in Maine and across our Nation. Alarmingly, these 
communities are often those hardest hit by the opioid epidemic. By 
2030, we will need an estimated 120,000 physicians to meet the growing 
demand for health care services across the Country. In clinics and 
health centers in Northern Maine, I frequently hear stories about 
vacancies forcing Mainers to travel many miles simply to see a primary 
care doctor or dentist.
  For the past eight years, one program, the Teaching Health Centers 
Graduate Medical Education Program, has worked to fill these gaps. This 
program trains medical residents in community-based settings, including 
low-income, underserved rural and urban neighborhoods. For example, 
since its inception in 2011, the Penobscot Community Health Care Center 
has trained 34 residents and served more than 15,000 dental patients in 
Bangor, Maine.
  Nationwide, this program has produced real results. Since the program 
began, 632 new primary care physicians and dentists have graduated and 
entered the workforce, and the number of Americans served is in the 
millions. Those who train at teaching health centers are very likely to 
practice primary care and remain in underserved or rural communities. 
Last Congress, this Committee considered and successfully passed my 
legislation to fund teaching health centers for two years. As a result, 
for the 2017-2018 academic year, this program supported the training of 
732 residents in 57 primary care residency programs, across 24 states.
  The legislation I have introduced today would reauthorize the 
Teaching Health Centers Graduate Medical Education Program for five 
years and provide additional funding for expansion and the creation of 
new programs. This bill is widely supported by leading community health 
and physician organizations, including the American Association of 
Teaching Health Centers, National Association of Community Health 
Centers, American Academy of Family Physicians, American Association of 
Colleges of Osteopathic Medicine, and Council of Academic Family 
Medicine.
  In the face of nationwide physician shortages, our legislation would 
provide a solution for communities today and a path forward to train 
the physicians of tomorrow. I urge all of my colleagues to join in 
support of this important legislation, the Training the Next Generation 
of Primary Care Doctors Act of 2019.
  Mr. President, I ask to include these letters into the Record.
  Mr. PRESIDENT: With no objection so ordered.

                                                        Council of


                                     Academic Family Medicine,

                                                 January 28, 2019.
     Hon. Susan Collins,
     U.S. Senate, Washington, DC.
     Hon. Shelley Capito,
     U.S. Senate, Washington, DC.
     Hon. Doug Jones,
     U.S. Senate, Washington, DC.
     Hon. Jon Tester,
     U.S. Senate, Washington, DC.
       Dear Senators Collins, Jones, Capito, and Tester: On behalf 
     of the Council of Academic Family Medicine (CAFM), including 
     the Society of Teachers of Family Medicine, Association of 
     Departments of Family Medicine, Association of Family 
     Medicine Residency Directors, the North American Primary Care 
     Research Group, we thank you for introducing the Training the 
     Next Generation of Primary Care Doctors Act of 2019. This 
     legislation is an important step to providing sustainable 
     funding and growth for a critical program that helps address 
     the primary care physician shortage in our country. We 
     appreciate your leadership on this issue and give you our 
     whole-hearted support for the legislation.
       To help sustain this important graduate medical education 
     program your legislation provides suitable funding for 
     current Teaching Health Center Graduate Medical Education 
     (THCGME) programs to help address the crisis-level shortage 
     of primary care physicians. The funding level included in the 
     bill will allow for a per resident amount to be paid for 
     training that is on par with the Health Resources and 
     Services Administration (HRSA) funded study identifying a 
     median cost of approximately $157,600 per trainee. It allows 
     for programs to regain previous losses of residency positions 
     due to lower funding levels and instability. We are 
     particularly pleased that the legislation would provide a 
     five year reauthorization, giving the program some much 
     needed financial stability.
       In addition, we are gratified that the proposed legislation 
     supports and funds the creation of new programs and/or 
     centers, with a priority for those serving rural and 
     medically underserved populations and areas. Evidence shows 
     that the THC program graduates are more likely to practice in 
     rural and medically underserved communities. Recognizing the 
     importance of growing this successful program to help address 
     geographic maldistributions of physicians across the country 
     is significant.
       The current authorization for this vital program expires at 
     the end of this fiscal year. Without legislative action, the 
     expiration of this program would mean an exacerbation of the 
     primary care physician shortage, and a lessening of support 
     for training in underserved and rural areas. Your efforts in 
     support for this program since its inception have been key to 
     keeping it alive. We are grateful to all of you for your 
     exceptional leadership in supporting and sustaining this 
     vital program by introducing this bill and helping to 
     shepherd it toward enactment.
       The CAFM organizations and our members are pleased to work 
     with you to secure this legislation's enactment.
           Sincerely,
     Beat Steiner, MD,
       President, Society of Teachers of Family Medicine.
     Fred Miser, MD,
       President, Association of Family Medicine, Residency 
     Directors.
     Judith Belle Brown, PhD,
       President, North American Primary Care Research Group.
                                  ____


                     Joint Statement for the Record


   Hearing of the Health, Education, Labor, and Pension Committee on 
      Access to Care: Health Centers and Providers in Underserved 
                     Communities, January 29, 2018

       On behalf of the more than 145,000 osteopathic physicians 
     and medical students we represent, we applaud the committee's 
     leadership and bipartisan effort to address the shortage in 
     our health care workforce. We are thankful for the Chairman 
     and Ranking Member for introducing legislation that would 
     reauthorize the Teaching Health Centers Graduate Medical 
     Education Program (THCGME) In anticipation of the upcoming 
     hearing, Access to Care: Health Centers and Providers in 
     Underserved Communities, we would like to highlight the need, 
     and encourage the committee, to support funding for growth in 
     the reauthorization of the THCGME program to help address the 
     shortage in our health care workforce.
       The majority of THCGME programs are currently accredited by 
     the AOA or are dually accredited (DO/MD) programs, supporting 
     nearly 800 osteopathic resident physicians through their 
     training since the program's inception. Located in 27 states 
     and the District of Columbia, THCGME programs train residents 
     in much-needed primary care fields that have the largest 
     shortages nationally, including family medicine, internal 
     medicine, pediatrics, obstetrics and gynecology, psychiatry, 
     geriatrics, and dentistry. It is a vital source of training 
     for primary care residents to help expand access to care in 
     rural and underserved communities throughout the country.
       Osteopathic physicians (DOs) are fully-licensed to practice 
     in all specialty areas of medicine, with nearly 57% of active 
     DOs in primary care. Our training emphasizes a whole-person 
     approach to treatment and care, where we partner with our 
     patients to help them get healthy and stay well. Osteopathic 
     medical education also has a long history of establishing 
     educational programs for medical students and residents that 
     target the health care needs of rural and underserved 
     populations. Given this strong presence in primary care, 
     osteopathic medicine aligns naturally with the mission and 
     goals of the THCGME program that has proven successful in 
     helping address the existing gaps in our nation's primary 
     care workforce.
       Residents who train in THC programs are far more likely to 
     specialize in primary care and remain in the communities in 
     which they have trained. Data shows that, when compared to 
     traditional postgraduate trainees, residents who train at 
     THCs are more likely to practice primary care (82% vs. 23%) 
     and remain in underserved (55% vs. 26%) or rural (20% vs. 5%) 
     communities. It is clear that a well-designed THCGME program 
     not only plays a vital role in training our next generation 
     of primary care physicians, but helps to bridge our nation's 
     physician shortfall. The program also tackles the issue of

[[Page S806]]

     physician maldistribution, and helps address the need to 
     attract and retain physicians in rural areas and medically 
     underserved communities. In the 2016-2017 academic year, 
     nearly all residents received training in primary care 
     settings and 83% of residents trained in Medically 
     Underserved Communities.
       However, reauthorizing the THCGME program at its current 
     level funding, for the next five years, would lead to a 
     reduction of approximately 70 residency slots from the 
     currently funded 737 residency positions.
       We respectfully ask the committee to consider legislation 
     by Senators Susan Collins (R-ME), Doug Jones (D-AL), Shelley 
     Moore Capito (R-WV), and John Tester (D-MT) the ``Training 
     the Next Generation of Primary Care Doctors Act of 2019.'' In 
     addition to reauthorizing the THCGME program for the next 
     five years, this bill also provides funding and a pathway for 
     growth in the number of residents trained in underserved 
     rural and urban communities. This represents a much needed 
     expansion to address the physician shortages in our country.
       We would also like to briefly highlight the broader role 
     osteopathic physicians have in reducing our nation's 
     physician shortage. Since 2010, the number of DOs has 
     increased by 54%. Today, more than 65% of all DOs are under 
     the age of 45, and if current enrollment trends continue, DOs 
     are projected to represent more than 20% of practicing 
     physicians by 2030. Because of the whole-person approach to 
     patient care that is inherent in osteopathic medicine, the 
     increasing share of DOs in the physician workforce, and the 
     number of DOs in primary care specialties, we have a unique 
     and important perspective on the needs of our nation's health 
     care workforce and would welcome the opportunity to 
     contribute to your work on this issue.
       We appreciate your bipartisan effort to address the 
     shortage in our country's health care workforce, and we stand 
     ready to assist in your effort.
           Sincerely,
     American College of Osteopathic Family Physicians.
     American College of Osteopathic Internists.
     American College of Osteopathic Obstetricians and 
     Gynecologists.
     American College of Osteopathic Neurologists and 
     Psychiatrists.
     American College of Osteopathic Pediatricians.
     American Osteopathic Association.
                                  ____

                                               American Academy of


                                            Family Physicians,

                                                 January 28, 2019.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
     Hon. Shelley Moore Capito,
     U.S. Senate,
     Washington, DC.
     Hon. Doug Jones,
     U.S. Senate,
     Washington, DC.
     Hon. Jon Tester,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins, Jones, Capito, and Tester: On behalf 
     of the American Academy of Family Physicians (AAFP), which 
     represents 131,400 family physicians and medical students 
     across the country, I write to support your legislation to 
     reauthorize the Teaching Health Center Graduate Medical 
     Education (THCGME) program Thank you for your commitment to 
     this important, innovative program.
       The AAFP is pleased to support the Training the Next 
     Generation of Primary Care Doctors Act because it updates the 
     THCGME program for five years, authorizes adequate and 
     sustainable funding for existing residency programs, and 
     supports expansion into rural and underserved communities In 
     addition, the legislation maintains the program's strong 
     transparency and accountability requirements. The THCGME 
     program directly addresses three major physician workforce 
     challenges: the serious shortage of primary care physicians, 
     geographic maldistribution of physician training, and the 
     need to increase health care access for medically-underserved 
     populations. Recognizing the importance of supplying well-
     trained primary care physicians into communities that need 
     them most, we look forward to working with you to update and 
     expand the THCGME program early this year.
       Again, we are pleased to support this important 
     legislation. For more information, please contact Sonya Clay, 
     Government Relations Representative.
           Sincerely,
                                            Michael L. Munger, MD,
     FAAFP Board Chair.
                                  ____

         American Academy of Family Physicians, American 
           Association of Colleges of Osteopathic Medicine, 
           American Association of Teaching Health Centers, The 
           American College of Obstetricians of Gynecologists, 
           American Osteopathic Association, Council of Academic 
           Family Medicine, National Association of Community 
           Health Centers.

                           [January 29, 2019]

   Physicians, Medical Educators, Community Health Centers Strongly 
  Support Training the Next Generation of Primary Care Doctors Act of 
                                  2019

       Our organizations applaud the introduction of the Training 
     the Next Generation of Primary Care Doctors Act of 2019 and 
     urge the Senate to quickly pass this important legislation. 
     We thank Senators Susan Collins (R-ME), Doug Jones (D-AL), 
     Shelley Moore Capito (R-WV), Jon Tester (D-MT), and John 
     Boozman (R-AR) for their commitment to ensuring that our 
     nation has a strong and robust primary care workforce. 
     Furthermore, we thank Senate HELP Committee Chairman Lamar 
     Alexander (R-TN) and Ranking Member Patty Murray (D-WA) for 
     their leadership in introducing the Community and Public 
     Health Programs Extension Act, which will extend for five 
     years federal funding for the Teaching Health Center Graduate 
     Medical Education (THCGME) Program, community health centers, 
     the National Health Service Corps, and two other federal 
     health programs. These programs are set to expire at the end 
     of the fiscal year.
       The THCGME Program, established in 2010 and reauthorized in 
     2015 and 2018 has been, by any measure, an overwhelming 
     success. In the 2017-2018 academic year, the program 
     supported the training of 732 residents in 57 primary care 
     residency programs, across 24 states. Since 2011, the program 
     has supported the training of over 630 new primary care 
     physicians and dentists that have graduated and entered the 
     workforce. Importantly, physicians trained in teaching health 
     center programs are more likely to practice in underserved 
     communities, increasing access to care for the country's most 
     vulnerable patient populations.
       The value of primary care is well documented. In fact, 
     individuals who have a continuous relationship with a primary 
     care physician are more likely to be healthier and use fewer 
     health care resources. Research shows that our nation faces a 
     primary care physician workforce shortage. The THCGME Program 
     has proven its ability to efficiently increase the number of 
     primary care physicians trained.
       This highly successful and impactful program is set to 
     expire on September 30, 2019 unless Congress takes action to 
     reauthorize and fund it. The legislation introduced today not 
     only reauthorizes the program, but also provides enhanced 
     funding and a pathway for increasing the number of residents 
     trained. Most important, the legislation will continue to 
     build the primary care physician pipeline necessary to reduce 
     costs, improve patient care, and support underserved rural 
     and urban communities.
       We are extremely pleased that members of both parties are 
     working together to extend this vital program that brings 
     health care to medically underserved communities across the 
     nation. Our organizations strongly support Training the Next 
     Generation of Primary Care Doctors Act of 2019 and call on 
     the House of Representatives and Senate to ensure that the 
     THCGME Program is reauthorized and appropriately financed by 
     September 30.
                                  ____

                                           American Association of


                             Colleges of Osteopathic Medicine,

                                                 January 28, 2019.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
     Hon. Shelley Moore Capito,
     U.S. Senate,
     Washington, DC.
     Hon. John Boozman,
     U.S. Senate,
     Washington,DC.
     Hon. Doug Jones,
     U.S. Senate,
     Washington, DC.
     Hon. Jon Tester,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins, Jones, Capito, Tester, and Boozman: 
     On behalf of the American Association of Colleges of 
     Osteopathic Medicine (AACOM), thank you for your unceasing 
     bipartisan commitment and leadership in championing the 
     Health Resources and Services Administration's Teaching 
     Health Center Graduate Medical Education (THCGME) Program by 
     introducing the Training the Next Generation of Primary Care 
     Doctors Act of 2019. We offer our strong support of this 
     legislation.
       AACOM represents the 35 accredited colleges of osteopathic 
     medicine in the United States. These colleges are accredited 
     to deliver instruction at 55 teaching locations in 32 states. 
     In the current academic year, these colleges are educating 
     more than 30,000 future physicians--25 percent of all U.S. 
     medical students. Six of the colleges are public and 29 are 
     private institutions. AACOM was founded in 1898 to support 
     and assist the nation's osteopathic medical schools, and to 
     serve as a unifying voice for osteopathic medical education. 
     The association leads and advocates for the osteopathic 
     medical education community to improve the health of the 
     public.
       With your introduction of the Training the Next Generation 
     of Primary Care Doctors Act of 2019, the osteopathic medical 
     education community commends your bipartisan efforts to 
     support this critical program that produces primary care 
     physicians in medically underserved communities across our 
     country by reauthorizing it for five years

[[Page S807]]

     and providing enhanced funding and a pathway for growth in 
     the number of residents trained.
       Established in 2010 and reauthorized in 2015 and 2018, the 
     THCGME Program has been a notable success. In the 2017-2018 
     academic year, the program supported the training of 732 
     residents in 57 primary care residency programs, across 24 
     states. Since 2011, the program has supported the training of 
     over 630 new primary care physicians and dentists that have 
     graduated and entered the workforce. Importantly, physicians 
     trained in THC programs are more likely to practice in 
     underserved communities, increasing access to care for the 
     country's most vulnerable patient populations.
       As you know, the continuation of this program is vital to 
     addressing primary care physician workforce shortages and 
     delivering health care services to vulnerable patients in 
     need. It has encouraged greater connections and services 
     between traditionally underserved areas and the emerging 
     physician workforce by creating opportunities for medical 
     students to carry out their required training where their 
     services are most needed. The THCGME Program has been highly 
     effective in transitioning residents into medically 
     underserved areas, with more than 80 percent remaining in 
     primary care practice and over half remaining in high-need 
     communities.
       On behalf of the nation's osteopathic medical schools and 
     the students they train, thank you for your steadfast 
     leadership, and I look forward to continuing our work 
     together to support a health care system that will enable 
     osteopathic medical students and future physicians to provide 
     primary health care to the patients they serve. We look 
     forward to working together on this important legislation.
           Respectfully,
                                      Stephen C. Shannon, DO, MPH,
                                                President and CEO.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself and Ms. Harris):
  S. 308. A bill to direct the Secretary of the Interior to convey 
certain Federal lands in San Bernardino County, California, to the San 
Bernardino Valley Water Conservation District, and to accept in return 
certain non-Federal lands, and for other purposes; to the Committee on 
Energy and Natural Resources.
  Mrs. FEINSTEIN. Mr. President, I am pleased to reintroduce the 
``Santa Ana River Wash Plan Land Exchange Act.'' This legislation would 
help implement a consensus-driven regional land management plan by 
directing the Bureau of Land Management to exchange land with the San 
Bernardino Valley Water Conservation District in San Bernardino, 
California.
  Before I continue, I would like to thank Senators Lisa Murkowski and 
Maria Cantwell, as well as their staffs, for their hard work to move 
this bill forward last Congress. With their assistance, this 
legislation passed out of the Senate Energy and Natural Resources 
Committee in August 2018 and was included in a bipartisan public lands 
package.
  I thank Senator Murkowski for introducing a bipartisan lands package 
bill this Congress and including this legislation in it. I look forward 
to working once again with Senator Murkowski, as well as the newly 
designated Ranking Member, Senator Manchin, to maintain our momentum 
and pass this bill as quickly as possible.
  I also would like to express my gratitude to Representative Paul Cook 
and his staff for their continuing work and collaboration on this 
legislation. Lastly, I welcome working with Representative Cook and 
Representative Aguilar who are cosponsoring companion legislation in 
the House of Representatives. Lastly, I thank Senator Harris for 
cosponsoring this legislation.
  This bill is an excellent example of how smart, sustainable, land 
planning can be accomplished through interagency cooperation. Federal 
and State agencies, private industry, and municipalities representing 
mining, flood control, water supply, wildlife conservation, and other 
interests all came to the table to develop a land management plan that 
accounts for the array of land uses in this area.
  The land exchange facilitated by this bill is broadly supported, 
including by: County of San Bernardino, City of Redlands, City of 
Highland, San Bernardino Water Conservation District, San Bernardino 
Valley Municipal Water District, East Valley Water District, Endangered 
Habitats League, CEMEX Construction Materials Pacific, Robertson's 
Ready Mix, Inland Action.
  This diverse group of entities formed the ``Wash Committee'' in 1993 
to address mining and land management in the upper Santa Ana River wash 
area.
  I applaud the Committee, along with federal, state and local 
stakeholders, for working together to develop a strategy for 
comprehensive land management planning for the area. This group has 
shown that through cooperation, it is possible to both protect the 
environment and support local business and community interests.
  The land exchange between the San Bernardino Water Conservation 
District and the Bureau of Land Management will consolidate open space 
for conservation purposes and optimize the efficiency of mining 
operations and water conservation efforts.
  The exchange will also set aside new land for conservation purposes 
near land already managed by BLM.
  This bill will lead to increased habitat protection, groundwater 
recharge, and public access while allowing for the continued use of 
land and mineral resources.
  I look forward to working with my colleagues to pass the ``Santa Ana 
River Wash Plan Land Exchange Act'' as soon as possible.
  Thank you Mr. President, I yield the floor.
                                 ______
                                 
      By Mr. SANDERS:
  S. 309. A bill to amend the Internal Revenue Code of 1986 to 
reinstate estate and generation-skipping taxes, and for other purposes; 
to the Committee on Finance.
  Mr. SANDERS. Mr. President, all across our country--in Vermont, in 
Illinois, in California--all across this country, people are asking a 
very simple question. That question is, How does it happen that in the 
midst of the extraordinary wealth that exists in our country--how does 
it happen that so many people continue to hurt financially and struggle 
desperately to keep their heads above water economically?
  Today, despite unemployment being relatively low, some 40 million 
Americans continue to live in poverty. We don't talk about poverty very 
much here in the Senate, but we have 40 million Americans living in 
poverty. Many of them are struggling to adequately feed their kids. 
Many of them are forced to go, despite working, to emergency food 
shelters just to stay alive.
  Despite the United States having a GDP--gross domestic product--of 
more than $20 trillion, we in this country embarrassingly continue to 
have the highest rate of childhood poverty of almost any major country 
on Earth. We don't talk about that either. Children are obviously the 
future of America, and we continue to have one of the highest rates of 
childhood poverty of any major country, and that includes 29 percent of 
African-American children who live in poverty.
  How does it happen that in a so-called booming economy--and we hear 
from President Trump every other day about how the economy is booming--
the bottom 40 percent of our population does not have $400 in cash in 
order to address a financial emergency? Think about that. The bottom 40 
percent--almost half of Americans--don't have $400 in their pocket, in 
the bank to address a financial emergency. Maybe the car breaks down, 
maybe the kid gets sick, maybe one loses one's job, maybe one undergoes 
a divorce; something happens, and 40 percent of the American people 
don't have $400 in the bank to address that crisis.
  In other words, today--and we saw this in the recent government 
shutdown; today in America, many, many millions of families live 
paycheck to paycheck in order to survive. That should not be happening 
in the wealthiest country on Earth, and it is time we begin to talk 
about that. It is not good enough to talk about a so-called booming 
economy, forgetting about tens of millions of families who are not 
seeing that booming economy but, in fact, are living under incredible 
financial stress.
  How does it happen that, in the so-called booming economy, tens of 
millions of American workers today are working for wages that are so 
low they cannot afford the escalating cost of housing? Some of them are 
spending 40, 50 percent of their limited incomes on housing. For many 
of these people, there is no health insurance available; the idea of a 
vacation for the family is something not even to be thought about; and 
the idea of being able to send one's kids to college is something that 
is also not on the table. By the

[[Page S808]]

way, many of these individuals are working two or three jobs, 50, 60, 
70 hours a week, just to survive.
  This, again, is the wealthiest country in the history of the world. 
Yet 30 million Americans today, as we speak, have zero health 
insurance--no health insurance at all; 41 million people are 
underinsured--which means their deductibles and their copayments are so 
high that even though they have insurance, they still can't afford to 
go to the doctor, and one out of five Americans today cannot afford the 
prescription drugs their doctors prescribe.
  In my view--a view I have held for a very, very long time, and it is 
a view shared by people not only in this country in wide numbers, but 
all over the world--healthcare is a human right, not a privilege. 
Whether you are rich or whether you are poor, you have the right to go 
to a doctor when you get sick, and you have the right to know that if 
you end up in a hospital, you are not going to go bankrupt or suffer 
from financial distress.
  We are an aging population--no great secret there. We are an aging 
population. In this Congress, instead of dealing with government 
shutdowns precipitated by the President, we should be talking about how 
we respond to the reality of an aging population. Yet what we don't 
talk about is that about half of older Americans--half of older 
Americans, those 55 and older--have no retirement savings and no idea 
about how they will retire with dignity.
  Think about what that means. Somebody is 60 years of age, they are 
coming to the end of their work-life, and they have no money--or 
virtually no money--in the bank. Maybe all they are going to get is 
Social Security. They turn on the TV, and they hear folks around here 
talking about cutting Social Security. Talk about why people in this 
country are angry and why they are stressed out.
  Here is the bottom line. We are the wealthiest country on Earth. In 
fact, we are the wealthiest country in the history of the world, but 
despite that wealth, a significant percentage of our population--our 
children, our elderly people, our working men and women--struggle each 
and every day to keep their heads above water economically. Not only 
are they struggling, I think the pain they are feeling has to do with 
the worry they have about the future for their kids because they know, 
as many of us know, that unless we make some bold changes in our 
economy, the younger generation today will have a lower standard of 
living than their parents.
  Imagine that--a so-called booming economy, yet we are looking at a 
situation where the younger generation may well have a lower standard 
of living than their parents.
  I want to also say a word about another reality that currently 
exists. While so many of our people are struggling, while so many of 
our children are living in poverty, while 20 percent of folks on Social 
Security are trying to live on less than $13,000 a year, there is 
another pervasive reality in American society today; that is, the 
people on top--the very wealthiest people in this country--have never 
had it better, and the gap between the very, very rich--I am not just 
talking about the rich; I am talking about the very, very rich--is 
growing wider.
  Here is the simple truth, a truth that we virtually never talk about 
here in the Senate, a truth that is not heard much in the corporate 
media; that is, the United States of America today has the most unequal 
distribution of wealth and income of almost any major country on Earth, 
and that level of inequality is worse today than at any time since the 
1920s, the so-called Gilded Age of American society.
  Today, if you can believe it, the three wealthiest people in this 
country--three--own more wealth than the bottom half of America, 160 
million people. Let me repeat that. The three wealthiest people in this 
country own more wealth than the bottom half of America, 160 million 
people. Today, the top one-tenth of 1 percent--not 1 percent; one-tenth 
of 1 percent--own almost as much wealth as the bottom 90 percent. 
Today, and since the Wall Street crash in 2008, about 46 percent of all 
new income goes to the top 1 percent. Roughly speaking, half of all new 
income goes to the bottom 99 percent, and half goes to the top 1 
percent, and our great task here in the U.S. Senate is to keep the 
government open while Trump tries to shut it down. Maybe, just maybe, 
we should be talking about those issues. Maybe, just maybe, we should 
be talking about an economy that works for all of us, not just the 
people on top.
  Today, the top 25 hedge fund managers on Wall Street--25 hedge fund 
managers--earn nearly double the income of all 140,000 kindergarten 
teachers in America.
  What all of the psychologists tell us is that the most important 
years of a human being's development are 0 to 4. Those are the most 
impressionable years in terms of how we develop intellectually and 
emotionally, and our childcare workers, our kindergarten teachers play 
a very important role. Does anybody think it makes sense that you have 
25 hedge fund managers on Wall Street who, today, earn nearly double 
what 140,000 of our kindergarten teachers make? By the way, public 
teachers in America are falling further and further behind other 
occupations.
  Having stated that reality--the fact that the middle class is 
struggling and the fact that the people on top are doing phenomenally 
well--I think it is fair to ask what the views are of the Republican 
leadership here in the Senate--Republicans control the Senate--and what 
our Republican President, President Trump, is proposing to address 
these massive levels of injustice and inequality. Three people own more 
wealth than the bottom half of America. What does the President and 
what does Leader McConnell have to say about that? The sad truth is 
that the Republican leadership today wants to make an embarrassingly 
bad situation even worse.
  After passing a $1 trillion tax giveaway for the top 1 percent and 
large corporations last year, Republican leadership is coming back and 
saying: Hey, we only gave 83 percent of the tax benefits to the 1 
percent. That is not good enough. That is not good enough. We have to 
do even better for our billionaires and corporate sponsors.
  This time, the Republican leadership and the President want a tax 
break of hundreds of billions of dollars that would go exclusively to 
the wealthiest of the wealthy. I am not talking about the wealthy; I am 
talking about the wealthiest of the wealthy--the top one-tenth of 1 
percent, the wealthiest 1,700 families in America.
  We have 127 million families in our country--a population of some 320 
million people. As I have indicated, many of these families are 
struggling. Many of these families are hurting. Today, many of these 
families are wondering how they are going to pay their rent, pay their 
mortgage, keep their lights on. Yet the legislation to repeal the 
estate tax that Senator McConnell and President Trump are proposing 
would benefit less than the top one-tenth of 1 percent of them--99.9 
percent would see no tax reduction from the legislation.
  Can anyone actually imagine bringing forward a piece of legislation 
that does not help the bottom 99.9 percent? Can you imagine that? The 
middle class are struggling. The gap between the rich and the poor is 
growing wider. There are 30 million people without health insurance. 
Our infrastructure is crumbling. And they come forward with a piece of 
legislation that is designed to protect and benefit the top one-tenth 
of 1 percent. The legislation would be of no benefit to 99.9 percent of 
the people of this country.
  I think it is clear that when the people of this country look at 
Congress and say ``Those folks in Washington are not representing me. 
They are representing their wealthy campaign contributors. They are 
representing the billionaire class,'' there can be no clearer example 
of that reality than this proposed legislation.
  Once again, with all of the economic problems, all of the inequality 
we face, imagine legislation that comes forward from the Republican 
leadership and the President that benefits the top one-tenth of 1 
percent--the 1,700 wealthiest families in this country.
  It is no secret that our infrastructure--our roads and our bridges, 
water systems, airports, wastewater plants--is crumbling all over this 
country. All over this country, there are major infrastructural 
problems. But I hear over and over again: We don't have the

[[Page S809]]

funding to rebuild our crumbling infrastructure and put millions of 
Americans to work at good-paying jobs rebuilding that infrastructure. 
We just don't have the money.
  Our schoolteachers are underpaid, but we don't have the money to 
provide attractive salaries in order to get the best and the brightest 
to do the most important work in this country; that is, teaching our 
young people.
  Today, we have veterans--people who put their lives on the line--
sleeping on the streets, but we don't have the money to house them.
  Families in America cannot afford childcare, and public schools are 
underfunded.
  We don't have the money to address those crises, but somehow we do 
have hundreds of billions of dollars available to provide tax breaks 
for the top one-tenth of 1 percent.
  We apparently have enough money to provide the Walton family--the 
wealthiest family in America, the folks who own Walmart, the people who 
pay their own employees starvation wages--by repealing the estate tax, 
as Senator McConnell and President Trump would like to do, we have 
enough money to provide the Walton family, the wealthiest family in 
America, with a tax break of up to $63 billion. Veterans sleep out on 
the street, teachers are underpaid, and 30 million Americans have no 
health insurance. We can't address those issues, but we do have 
legislation that would provide up to $63 billion in tax breaks for one 
family.
  We have, apparently, enough money available to provide the Koch 
brothers--a family who spent some $400 million during the midterm 
election to help elect Republican candidates; the Koch brothers, one of 
the wealthiest, most politically active families in America--we have 
enough money to provide them with up to a $39 billion tax break.
  Under this legislation, we can provide a tax break of up to $27 
billion to the Mars candy bar family and up to a $13.4 billion tax 
break to the Cox cable family.
  In other words, at a time of massive needs in this country, we don't 
have enough money available to protect working families and the middle 
class, but we certainly have more money than we know what to do with in 
order to give incredible tax breaks to the richest people in this 
country.
  The estate tax that we are going to be proposing does not give 
massive tax breaks to the wealthiest people in this country--quite the 
contrary. It says to those people that at a time of massive income and 
wealth inequality, instead of repealing the estate tax, we must 
substantially increase this tax on the multimillionaires and 
billionaires of this country and in doing that, not only come up with 
much needed revenue to address the needs of working families but also 
to reduce wealth inequality in America.
  That is why this week I will be introducing legislation for an estate 
tax bill that would do exactly the opposite of what my Republican 
colleagues propose to do. Let me briefly explain what is in the 
legislation I am offering.
  Under my bill, anytime someone inherits an estate in America of $3.5 
million or less, that person will not pay one penny in estate taxes. 
They will get to keep that inheritance tax-free. That population 
includes 99.8 percent of the American people. The legislation I am 
proposing would not raise taxes by a penny on 99.8 percent of the 
American population.
  If you are in the top two-tenths of 1 percent of the population--the 
population that inherits over $3.5 million--your taxes will, in fact, 
be going up, and they should be going up.
  My legislation establishes a 45-percent tax on the value of an estate 
between $3.5 million and $10 million, a 50-percent tax on the value of 
an estate between $10 million and $50 million, a 55-percent tax on the 
value of an estate in excess of $50 million, and a 77-percent tax on 
the value of an estate above $1 billion. In other words, this bill 
begins to create a progressive tax system in America, which is based on 
ability to pay.
  I know some may think otherwise, but the truth is, this is not a 
radical idea. From 1941 through 1976, the top estate tax rate was, in 
fact, 77 percent on estate values above $50 million. Back to 1976, the 
top estate tax rate was 77 percent.
  This bill would also close tax loopholes that have allowed 
billionaire families, such as the Waltons, to pass fortunes from one 
generation to the next without paying their fair share of taxes.
  Under this legislation, the families of all 588 billionaires in our 
country, who have a combined net worth of over $3 trillion, would pay 
up to $2.2 trillion in estate taxes.
  Let me make a confession here. This idea, this approach, was not 
developed by Bernie Sanders. It is not a new idea. More than a century 
ago, a good Republican President named Teddy Roosevelt fought for the 
creation of a progressive estate tax to reduce the enormous 
concentration of wealth that existed during the Gilded Age.
  What is really quite remarkable is that what Teddy Roosevelt talked 
about over 100 years ago during the Gilded Age of the 1920s, when 
little children were working in factories and fields and the wealthiest 
people were enjoying incredible wealth and luxury--the idea Teddy 
Roosevelt proposed then is as relevant today as it was back then. Let 
me quote what Teddy Roosevelt said more than 100 years ago:

       The absence of effective state, and, especially, national 
     restraint upon unfair money-getting has tended to create a 
     small class of enormously wealthy and economically powerful 
     men, whose chief object is to hold and increase their power. 
     The prime need is to change the conditions which enable these 
     men to accumulate power. Therefore, I believe in a graduated 
     inheritance tax on big fortunes, properly safeguarded against 
     evasion and increasing rapidly in amount with the size of the 
     estate.

  That was Teddy Roosevelt over 100 years ago. What Roosevelt said then 
is absolutely true for today.
  From a moral and an economic perspective, our Nation will not thrive 
when so few people have so much wealth and power and so many people 
have so little wealth and power. This wealth and income inequality is 
not only unjust and unfair; the truth is, it is a real threat to our 
economy and our democracy.
  We need a tax system in this country that tells the billionaire class 
that they are going to have to pay their fair share of taxes so that we 
do not have 30 million people without health insurance, so that we do 
not have young people graduating college $50,000, $100,000 in debt, so 
that we do not have an infrastructure that is crumbling, and so that we 
do not see our great country moving toward an oligarchic form of 
society where a handful of families enjoy incredible wealth and power 
at the expense of everybody else.
  In my view, the fairest way to reduce wealth inequality, to invest in 
the middle class and working families of our country, and to preserve 
our democracy is to enact a progressive estate tax on the inherited 
wealth of multimillionaires and billionaires. That is exactly what I 
will be proposing.

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