[Congressional Record (Bound Edition), Volume 163 (2017), Part 10]
[Senate]
[Pages 14618-14636]
[From the U.S. Government Publishing Office, www.gpo.gov]




                     EXECUTIVE CALENDAR--Continued

  The PRESIDING OFFICER. The Senator from Massachusetts.
  Ms. WARREN. Mr. President, I ask recognition to speak.
  The PRESIDING OFFICER. The Senator is recognized.


                                FREE Act

  Ms. WARREN. Mr. President, 12 days ago, Equifax, one of the Nation's 
largest credit reporting agencies, disclosed that hackers had breached 
its system and stolen highly personal information on nearly half of 
America. Social Security numbers, birth dates, home addresses, phone 
numbers, even credit card numbers--all in the hands of criminals.
  Since then, I have heard from working families in Massachusetts and 
all across the country. The Equifax hack is a nightmare. At best, it is 
a giant hassle--time on hold with the credit reporting agencies, fees 
for this service and that service, confusion about what has been stolen 
and what to do about it. At worst, it could be ruinous--a lifetime of 
responsible spending and borrowing wiped out by identity theft and 
fraud. People are outraged, and rightly so.
  Bad enough that Equifax is so sloppy that they let hackers into their 
system, but the company's response to the hack has been even worse. 
First, Equifax hid the information about the breach for 40 days--40 
days. Equifax gave criminals a 40-day headstart to use the information 
they had stolen, while the rest of us were left in the dark.
  Then, when Equifax finally decided to disclose the breach, they 
didn't call or send letters to the millions of Americans who were 
victims of the hack. No, they announced the breach and then made 
everyone go to an Equifax website and turn over more personal 
information to see if they were one of the people who had been 
affected. Once Equifax had the new information, they provided confusing 
and misleading information about whether the person had actually been a 
victim of the breach.
  Worse still, while Equifax was unclear about whether someone's 
information had been stolen, they were very clear about one thing: 
Everyone, whether or not their information was stolen, should sign up 
for a supposedly free Equifax credit monitoring service called 
TrustedID Premier. The terms of use for this program initially required 
anyone who signed up to have a credit card. Why? Because after the 
first year, Equifax could start automatically charging the credit card 
for the service if the customer hadn't already canceled. That is right. 
Equifax was trying to impose secret fees and profit off the hack of 
their own system.
  But wait, it got even worse. To sign up for this credit monitoring 
service, Equifax at first forced consumers to give up their right to go 
to court and sue Equifax if they had any disputes about the product. 
Equifax changed some of the terms after there was a lot of public 
pressure.
  Let me see if I can recap all this. After allowing hackers to steal 
personal information on as many as 143 million Americans, Equifax hid 
the breach from consumers for more than a month, failed to clearly 
inform people whether the information had been stolen, then tried to 
profit off the breach by tricking people into signing up for a costly 
credit monitoring product that also required them to give up their 
legal rights. Wow.
  In the last decade, there has been so much corporate misconduct, so 
much bald-faced contempt for consumers, that at times it seems as 
though we have all just grown numb to it. But even against that 
backdrop, Equifax's conduct is just jaw-dropping.
  It is time for us to fight back. It is time for all of us to fight 
back--Democrats, Republicans, Independents, Libertarians, vegetarians--
it doesn't matter. We have all been victims of the Equifax hack, or we 
know someone who has, and we all deserve better. That is why I 
partnered with Senator Schatz and 10 of our colleagues to introduce the 
Freedom from Equifax Exploitation Act, or FREE Act, last Thursday. Our 
bill empowers consumers to take back control of their personal credit 
data.
  The Equifax hack has highlighted the strange role of credit reporting 
agencies like Equifax and how they interface with our financial system. 
Banks and other big companies feed agencies like Equifax information 
about every financial transaction you make, from purchasing a car, to 
taking out a mortgage, to buying a home, to getting a student loan. 
They get information on every monthly payment you make, and they know 
where you live and how long you have lived there and what your phone 
number is. Every day, the credit reporting agencies package up that 
information about you into files that they then sell to other people. 
Sometimes it is people you know about, like when you apply for a 
mortgage or a car loan, but a lot of times, Equifax is selling data to 
people who want to sell you something--credit cards or student loan 
refinance or even a cruise.
  The bottom line is that companies like Equifax are making billions of 
dollars a year collecting, sharing, and selling highly personal 
information about you, all without your explicit permission or without 
paying you a penny.
  The FREE Act tries to level the playing field. First, it allows every 
consumer to freeze and unfreeze their credit file for free. If you 
freeze your credit file, no one can access it, and the credit reporting 
agency can't use it either. A freeze is like a ``do not call'' list for 
your credit information. It is about security. It means that even after 
the Equifax hack, thieves can't open credit cards or take out loans in 
your name even if they have your personal information. But it is also 
an easy way to give you the power to decide who gets your information 
for any other reason. The basic idea is simple: Equifax doesn't pay you 
when they sell your data, and you shouldn't have to pay Equifax to keep 
them from selling it.
  Our bill says that the same rules apply to all three credit reporting 
companies, and all three companies must refund your money if they 
charged you for a credit freeze in the aftermath of the Equifax breach. 
No one in this industry should profit from this hack.
  This bill doesn't fix all the problems in the credit reporting 
industry. It is only a first step.
  Congresswoman Maxine Waters, the top Democrat on the House Financial 
Services Committee, has been looking into the credit reporting industry 
for years, and she has introduced comprehensive legislation to reform 
the industry and empower consumers. The Senate ought to take a very 
close look at her bill.
  I have also launched an investigation into the Equifax breach and the 
whole credit reporting industry. In the upcoming weeks, I will be 
gathering more information from Equifax, other credit reporting 
agencies, Federal regulators, and legal experts. I want to keep 
fighting to make sure that credit reporting agencies can't exploit 
consumers and put their personal information at risk.
  This a test for Congress. Will we act quickly to protect American 
consumers, or are we going to cave in to firms like Equifax that have 
spent millions of dollars in lobbying Congress for weaker rules? Which 
is it?
  The FREE Act is a simple but important response to the Equifax hack. 
I hope my colleagues will join me and help pass this bill.

[[Page 14619]]

  Thank you, Mr. President.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CARDIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                               Healthcare

  Mr. CARDIN. Mr. President, there are reports that we may be having a 
vote next week, under reconciliation, dealing with the healthcare 
system of this country. We know that colleagues have filed a new bill, 
but it is basically the same bill we have seen in the past but this 
time even more consequential to our healthcare system and the people of 
this country.
  I mention first the process because this bill has not gone through 
any regular order. It has not been referred to a committee for 
consideration. It has not been marked up or debated in our committees. 
It is going to supposedly be brought up as an amendment but with us 
returning to reconciliation.
  Let me first explain what that means. That means there will be no 
chance for us to offer amendments to the legislation. That means there 
will be no opportunity in our committees to mark up legislation or to 
get the cost of the legislation or the technical help to do any bill, 
let alone a bill that affects a large part of our economy.
  The Presiding Officer and I both serve on the Finance Committee, 
which has jurisdiction over healthcare. We are not going to get the 
opportunity to get the expertise and help from our staff to look at the 
consequences of the Cassidy bill and have a chance to work on it to 
make it work. Instead, what is going to happen if the game plan goes 
forward is that this bill is likely to be on the floor next week during 
budget reconciliation, where a simple majority will be able to pass it. 
There will be no chance for debate on the floor because it is what is 
known as a vote-arama, and it will affect one-sixth of our economy. 
That is not the way we should be operating.
  I am also told that it will be done without a Congressional Budget 
Office score. That is unconscionable. We know from previous 
Congressional Budget Office scores on the other proposals that have 
been brought out that tens of millions of Americans would lose their 
health insurance coverage. Premiums would increase by, in some cases, 
20 to 25 percent. It was certainly information from our objective staff 
that caused many of us to say: What are we doing? But at least we had 
that information before we voted.
  We are now being told that we may get a one-liner from the 
Congressional Budget Office giving us the bottom-line impact on the 
deficit but not the specific information as to how many millions of 
Americans are going to lose their coverage and what is going to happen, 
for those of us who currently have insurance, with our premium 
increases.
  This is not the way we should be proceeding. It retreats from the 
progress we have made against the abusive practices of the insurance 
industry.
  Under the Cassidy bill, as I understand it, each State could 
basically set up its own rules for how they wish to have coverage. The 
entire Medicaid system of this country would be block-granted and would 
be capped. So the Federal Government could be getting out of the 
Medicaid business. The States would be given greater flexibility on how 
to operate the exchanges in their State and would no longer be subject 
to the same national requirements.
  We all pride ourselves that we eliminated preexisting conditions. 
But, in reality, if the State determines what benefits are going to be 
covered and under what conditions, preexisting conditions come back. 
That is something we should not ever allow to happen. Yet, under the 
Cassidy bill, we are going to be telling people that we may not be 
covering their mental health needs. We may not be covering the opioid 
addiction problems. We may not be covering maternity benefits. We may 
not be covering pediatric dental coverage.
  We don't know what plans will be offered. Today we know that under 
the Affordable Care Act we have the national protections so that 
everyone is on a level playing field. So a State could design a plan 
that would be totally unaffordable for people who need the coverage 
because they isolate the group into such a small number. That is not 
what we should be doing. That strategy would provide inadequate 
coverage.
  Let me explain what I mean. I have a young family that came to me and 
told me about the circumstance of their child being born prematurely 
with significant challenges. They said that, if that child had been 
born before the Affordable Care Act, the parents' policy would have 
reached their lifetime cap within the first year. Then, the family 
would have had to make some horrendous decisions on how to take care of 
their child. That is why we passed the protection against annual 
lifetime caps. That could return again under the bill that could be 
brought to the floor next week.
  I know circumstances where families have been able to get preventive 
healthcare and discover cancer at an early stage. That coverage wasn't 
there before the Affordable Care Act. There is no guarantee that 
coverage will be there afterwards.
  We could return again to bankruptcies. Healthcare costs were the 
leading cause of bankruptcy before we passed the Affordable Care Act. 
Now we are going to say that because of inadequate coverage and lack of 
coverage, American families are going to be faced with taking care of 
their family, running up bills, and ultimately facing bankruptcy.
  We are going to be affecting people's lives. Make no mistake about 
it.
  But the real tragedy of this proposal, and why it is so different 
from some others, is that it is an abandonment by the Federal 
Government of the Medicaid system. It would institute draconian cuts to 
the Medicaid system, to the extent that it would cripple it and make it 
ineffective. The States would be unable to respond.
  It is interesting that we just got a letter from 10 Governors in our 
country--five Democrats and five Republicans. All of these Governors 
said: No, don't do this. We can't do what you are asking us to do. We 
would have to make horrible decisions on whether we are going to 
continue to provide long-term care to our seniors, whether we are going 
to expand coverage, whether we are going to narrow benefits, whether we 
are going to cover prescription drugs, or whether we are going to cut 
providers who may not be able to treat Medicaid patients. These are 
decisions the States are going to have to make if this bill ever 
becomes law.
  It affects so many. Some of the things that maybe are misunderstood 
about the Medicaid system is that 1.75 million veterans are in the 
Medicaid system. Quite frankly, their coverage has never been enough, 
and the Medicaid system has helped fill the gap. That is going to cause 
a problem for our veterans.
  I will just give one example. We pride ourselves on federalism, and 
federalism, to me, is very important. I served for several years in the 
State legislature. I am the former speaker of the Maryland General 
Assembly. I take pride in the fact that Maryland has been an innovator 
in healthcare. They have been able to do that because of the 
partnership between the Federal Government and the States. That is 
federalism. It has worked.
  If this bill were to become law--the Cassidy bill--it would prevent 
the States from innovating. It is not giving them more flexibility if 
you don't give them the resources and tools to deal with this because 
you can't.
  For example, in Maryland we have what is known as an all-payer rate 
structure for hospital costs, regardless of who covers your insurance. 
Whether you are Medicare, Medicaid, or private insurance, or you pay on 
your own, you pay the same rate in my State for hospital care at the 
same hospital. It is an all-payer structure. We don't have cost-
shifting, and we don't have charity hospitals. Therefore, we have 
hospitals that are located in all of our

[[Page 14620]]

communities. It saves the Federal Government money, it saves the State 
government money, and it has proven to be more cost-effective. The 
State experimented and it worked, and the Federal Government has 
partnered with us.
  Can we continue that program if we get these draconian cuts in 
Medicaid? The answer is no. Can we continue this program if we see the 
uninsured rates go up in Maryland because of people losing their health 
coverage under this bill? The answer is no. You can't do this if the 
uninsured rates go from 6 percent to 12 percent to 15 percent of 
uncompensated care in our hospitals. That is what is at risk with the 
Cassidy bill.
  To me, it really is also an affront to federalism in that you are 
creating States versus States. I am in a State that did Medicaid 
expansion. As the Cassidy bill has been scored, it will cost my State 
$2.1 billion. I know that our legislature doesn't have that money. I 
know the Governor doesn't have it. He just recently went to the 
Maryland Board of Public Works and reduced the State budget because 
they were running a deficit and they are not allowed to run a deficit. 
They can't possibly cover the $2.1 billion.
  Here is another tragedy of this bill. The tragedy is that some States 
do much worse than other States. Why? Because Maryland expanded 
Medicaid, as did many other States and, therefore, we got more Federal 
funds because we had more people in the program. That seems fair. We 
are covering more people. But the Cassidy bill takes away from those 
States that expanded coverage, and we lose more.
  I thought this was the United States. I thought we were all in this 
together. The people of Maryland are proud to help the people of Texas 
or Florida because of the hurricane, and now you are coming back and 
saying you are going to hurt the people in Maryland because we did the 
right thing on Medicaid.
  Is that what this country is all about? Is that the United States? Is 
this body going to condone that type of discrimination against States? 
I hope that is not the case.
  So I hope, for many reasons, on substance and on process, that this 
bill is not brought up. Let's return to regular order. I heard Senator 
McCain say that so eloquently on the floor of the Senate.
  For the last two weeks I have been working with my Republican and 
Democratic colleagues to come up with bipartisan ways to improve our 
healthcare system. We have made progress. We have some good ideas that 
stabilize the individual marketplace and bring down the cost of 
healthcare, working together. Guess what. If we succeed in regular 
order and bipartisanship, we will not only do the right thing so people 
have stronger protections, but we will also have policy that will stand 
the test of time and give predictability to the healthcare system of 
this country. That is what we should be doing, in the best tradition of 
the Senate.
  So I urge my colleagues: Let's work together, and let's reject this 
proposal. Let's not bring it up. Let's continue our work on a 
bipartisan basis. Certainly, don't use reconciliation. Let's work 
together for the people of this country.
  With that, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Hoeven). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Ms. CANTWELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. CANTWELL. Mr. President, my colleagues have been here on the 
floor over the last few minutes, last night, this morning, and this 
afternoon to talk about our distress about people trying again to push 
the repeal of the Affordable Care Act without a successful strategy to 
move our Nation forward with more affordability.
  We just received a letter from 10 Governors basically telling us the 
same thing, to slow down and work on a bipartisan basis. They are 
basically telling us the proposal people are trying to rush through 
without regular order is not the kind of thing which will help us in 
making the necessary reforms.
  I think these bipartisan Governors--from the Governor of Colorado to 
the Governor of Ohio, to the Governor of Alaska, the spectrum of 
Democrats, Republican, and Independents is something people in the 
United States of America should listen to because it is important we 
get this right because the affordability of healthcare is so important.
  What I don't like about the proposal now being pushed by my 
colleagues--even though they want the States to have some flexibility 
and play a larger role--is that it basically ends the 52-year State-
Federal partnership we know as Medicaid today; that is, it changes the 
dynamic in saying that the States and the Federal Government are in 
business together to take care of a population that is the most 
vulnerable of citizens in our country and that giving them affordable 
access to healthcare is a priority because it actually reduces 
everybody's healthcare costs.
  When people think about the expense in healthcare, ask any provider, 
and they will tell you that 1 in 5 dollars spent on the Federal system 
drives the cost of everybody's insurance. If you leave people 
uninsured, they go to the hospital, they raise the cost to everybody. 
It is not a good strategy. We have seen States that have covered people 
on Medicaid actually raise people out of poverty, help their economies, 
and reduce the costs at individual hospitals, thereby driving down the 
cost of private insurance.
  Why would we want to destroy that by authorizing in legislation the 
end of this 52-year relationship between the Federal Government and 
States, trying to make sure our populations are covered; that if a 
State spends a dollar, they can count on the Federal Government to 
spend that dollar as well and to continue the partnership that works 
cost-effectively.
  What I also don't like is it sunsets Medicaid for 15 million people. 
If you are going to sunset Medicaid for these 15 million people, when 
are you going to sunset Medicaid for the rest of the Medicaid 
population? When are you going to try, by legislative action, to 
curtail the opportunities for millions of Americans who use Medicaid as 
a stabilizing force for health insurance in America? In our State, 
600,000 people--most of whom were previously uninsured--would be in 
that sunset of Medicaid.
  The legislation my colleagues are pushing would basically end the 
funding for this block grant program in 2027, which would leave States 
with an unfunded bill for those individuals of about $300 billion. I 
doubt States have the money. I doubt the individual market is going to 
take care of those individuals as cost-effectively as we are taking 
care of them through Medicaid. States will then cost shift these 
resources back to the public, raising everybody's rates again.
  Our job has to be about affordability. It has to be about driving 
down costs. It has to be about driving down costs in the individual 
market and driving down costs of the delivery system overall. There is 
nothing innovative about kicking 15 million people off Medicaid and 
sunsetting it in this bill.
  I also object to the notion, in this bill, of literally advocating 
the privatization of Medicaid. They are advocating that what you do 
with this population is take them off the current program and shift 
them onto the private individual market.
  Some people who are following this might say: Well, wait. Then they 
can go to the private market--and, yes, there is support to make sure 
we have affordable health insurance. No, because the legislation also 
says you stop that support by 2027. So this is just one more sneak 
attack by our colleagues at kicking people off Medicaid. To start the 
process and agree to privatize Medicaid, where is it going to end?
  I am the first to say we can improve our delivery system, that we can 
save money. I have advocated I think one of the most cost-effective 
ideas of the Affordable Care Act; that is, to move the

[[Page 14621]]

population of our citizens who need care in the later years of their 
life off nursing home care and into community-based care. It is one-
third the cost. Our State, the State of Washington, saved more than $2 
billion doing this over a 15-year period of time. If other States would 
do this, we could save $100 billion or more by having States give 
people the opportunity to age at home and have a long-term care 
delivery system which works in our communities. It is one-third the 
cost.
  That is innovation. Those are cost savings. That is improvement on 
our current delivery system, hopefully covering an aging baby boomer 
population that will reach retirement and a population of Americans who 
are going to live longer.
  There is nothing innovative about just privatizing Social Security, 
privatizing Medicaid, and kicking people off by shifting them over to 
an exchange and then cutting the resources for the exchange. I hope our 
colleagues will stop the notion that somehow this is innovation. It is 
not innovation. It is sunsetting, it is privatization, and it is 
cutting people off care. That is why we have heard from these Governors 
and others about why it is so important not to take this bait.
  We need to make sure we are continuing our bipartisan discussions, 
continuing to work together about what will drive affordability into 
the market. Bundling up a population and giving them clout to negotiate 
on rates and giving a State the ability to negotiate on rates--either 
on drug costs or on insurance--yes, this can save dollars. It is being 
done right now in New York and Minnesota, and it can be done in other 
places.
  Cost-shifting to the States this $300 billion or then making States 
make the draconian decision of, ``Wait. I already shifted that 
population onto the exchange. Oh, my gosh. The Federal Government just 
cut the funds we are going to get,'' and the next thing you know, this 
population is left without care.
  Privatizing Medicaid is not the way to go. I hope our colleagues will 
continue to discuss, on a bipartisan basis, the aspects of the 
Affordable Care Act that could be expanded to drive down costs and 
increase affordability. I hope they will continue to make sure things 
like basic health--the essential elements of what should be covered in 
a basic plan--are there for our consumers; that we are not going to 
take the bait in thinking that by cutting essential services to people, 
somehow that is the way to get a private insurance plan.
  We have the ability to work together. My colleagues and I have been 
working and discussing these ideas. My colleagues Senator Murray and 
Senator Alexander are working on various ideas in their HELP Committee, 
as we are working in the Finance Committee, in making sure we expand 
and fund the affordability of insurance for children and their families 
under the Children's Health Insurance or CHIP program.
  Let's not make this worse. Let us not end this 52-year relationship 
that has successfully covered a population of America, and let's not 
fall for the bait and think that somehow this is going to save the 
American taxpayer money. It is not. It is going to cost shift right 
back to the private individual, raise individual rates, and we can't 
afford it. Let's not privatize Medicaid. Let's fight to make it a more 
cost-effective program for the future.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  (The remarks of Ms. Collins pertaining to the introduction of S. 1835 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Ms. COLLINS. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, last week, the junior Senator from 
Vermont and a group of other Democrats unveiled a proposal to have 
Washington take over healthcare for everyone in America. Some refer to 
it as BernieCare. They intend to do this on the backs of American 
seniors, which is of grave concern to me as a doctor who has taken care 
of many senior citizens--many people on Medicaid--as part of my 
practice as an orthopedic surgeon. Their idea is to put everyone in 
this country on a new program that operates like Medicare. That is 
about 250 million Americans who would be added on to the Medicare 
Program, which is already being strained.
  One-third of the Democrats in the Senate have signed on to this plan. 
It seems to be the litmus test for the liberal left. Several of them 
came to the floor last night to criticize efforts by the Republican 
Party to save America's failing healthcare system. Problems with the 
American healthcare system, as a result of ObamaCare, continue to get 
worse, and the impacts, such as those that I hear every weekend in 
Wyoming, including this past weekend.
  From what I heard from the Democrats, they seem to want to let the 
system collapse in a way that they can then impose a complete 
Washington takeover of healthcare in America. To me, this plan they are 
proposing is going to be devastating to people currently on Medicare. 
These are the seniors who rely on Medicare today. What the Democrats 
are proposing is going to, in my opinion, undermine the stability, the 
integrity, and the certainty of the Medicare Program on which our 
seniors rely, and for them, it is truly their lives that depend upon 
it.
  Remember when President Obama promised that if people liked their 
insurance, they could keep their insurance, and that if they liked 
their plan, they could keep their plan? Well, people realize that is 
not exactly what happened. Many people lost their plan. They lost their 
insurance. It got more expensive, harder to afford, and millions ended 
up paying a fine, a fee, or a tax--whatever you want to call it--
because they weren't able to afford the premiums for the plan that 
President Obama said they had to buy, and they lost their own plans. 
Well, now it seems that if Democrats have their way, millions of 
seniors will find out that they are not going to be able to keep the 
insurance that they have right now that they depend upon and that they 
use on a daily basis.
  The Sanders plan will get rid of Medicare Advantage plans. We have 17 
million seniors in this country who are on a Medicare Advantage plan. 
The reason they sign up for Medicare Advantage is that for them 
personally, when they study it, there are advantages to Medicare 
Advantage for them in terms of preventive care and coordinated care. 
That would all go away under BernieCare.
  It is interesting to watch this whole process unfold because one in 
three people who are currently on Medicare have chosen to go outside 
the system the Democrats want to put them into. They want to put 
everyone into it, but a third of the people on Medicare have chosen a 
different way.
  What happens to these 17 million Americans who are currently on 
Medicare Advantage with the scheme that Senator Sanders and other 
Democrats have come up with? They don't say. Did the Democrats who came 
to the floor last night have anything to say about these 17 million 
seniors who would lose their Medicare, seniors who are on Medicare 
today? What is going to happen to them? They are going to lose what 
they have today.
  A lot of seniors are probably going to lose access to their doctors 
as well because when their plans change, their doctors change. That is 
because there are going to be doctors who won't be able to take care of 
these new Medicare patients whom ObamaCare has caused to have problems, 
but it is made worse with what is being proposed by Senator Sanders.
  Right now, it can be tough for a senior to find a doctor. These are 
seniors on Medicare. That is because today about one in four doctors 
doesn't take new Medicare patients or take any Medicare patients. But 
certainly as more and more people--and 10,000 baby boomers a day are 
turning 65 and going on Medicare. There are more and more people on 
Medicare without an expansion of the number of doctors to take care of 
them.
  Since the reimbursement is lower, what doctors and hospitals are paid 
to

[[Page 14622]]

take care of Medicare patients is lower than what those doctors or 
hospitals get paid for patients with private insurance. Their priority, 
when they are already crowded and loaded in their office and very busy 
taking care of patients, with waiting rooms full--their choice, of 
course, is to choose patients who pay them more than what they get from 
the government.
  You say: Why is that? Is that right?
  Well, having practiced medicine for 24 years and having run an 
office, there are issues related to paying nurses, healthcare 
personnel, rent, electricity--all the costs of running an office, let 
alone the high cost of medical malpractice insurance. We know the huge 
cost of that. A physician who wants to be able to pay his or her bills 
needs to take all those things into consideration. And with Medicare 
paying less than the current going rate for care at hospitals and with 
doctors, the concern is, Will Medicare patients be able to find a 
doctor in the first place?
  The Democrats' solution is to cram more people onto Medicare when we 
already have 10,000 people a day joining the ranks of Medicare and 
Social Security. If a doctor has a lot of Medicare patients, he or she 
has to make sure they have enough other patients who have insurance to 
make up for the lower rates Washington pays. Well, under the Democratic 
plan, doctors won't have the backup of private insurance companies 
because that is all going to go away.
  All those things will be lost to people who want to buy private 
insurance. Under the plan the Democrats are now--and it is not just 
Democrats in the Senate; a majority of the Democrats in the House of 
Representatives have cosponsored legislation by Representative Conyers 
that does exactly the same thing: puts everyone on a Medicare Program--
a government takeover of healthcare.
  When the Democrats came to the floor last night, I didn't hear them 
say anything about that. How are they going to guarantee that seniors 
will keep their doctors? Seniors are not going to be able to keep their 
doctors under the Sanders liberal-left plan that is being proposed and 
cosponsored by over half of the Democrats who are in the House of 
Representatives.
  We are already facing a shortage of doctors in this country. The 
Association of American Medical Colleges, which helps oversee the 
training of doctors, says that the shortfall could be as many as 
100,000 doctors across the country within the next decade. If we have 
fewer doctors and more people trying to get appointments, that means 
less access for seniors.
  It is not even clear if Washington can afford to add every man, 
woman, and child on to a government program like Medicare because 
Washington has done a terrible job in running Medicare as it is. The 
Medicare trust fund is supposed to be exhausted at the end of the 
2020s. That is what the Medicare trustees are telling us. In 12 years, 
they say, there will only be enough money coming in to fund about 8 or 
9 cents on the dollar of what the benefits for Medicare are supposed to 
be paying out. The program is going to have to start doing something--
either raising taxes or cutting benefits. From what I have seen 
proposed by Senator Sanders, it would be raising taxes a lot. The 
Medicare trustees say the program needs significant reform. They say it 
is already unsustainable. The Democrats' plan does nothing to change 
any of that. It does nothing to reform the program. All it does is 
crowd more people into a system that is already struggling financially.
  My concern is that the Democrats' plan is going to undermine the 
stability of the Medicare Program that our seniors desperately need. We 
should be taking steps now to shore up, to strengthen Medicare so that 
it is able to keep the promises that we made to our seniors. My goal is 
to save, to strengthen, and to simplify Medicare. That is not what we 
are seeing here.
  A few years ago, we knew the Medicaid Program needed help. Democrats 
just threw more people into the system with ObamaCare. That is what 
they did. With the expansion of ObamaCare, the majority of people who 
have new coverage under ObamaCare didn't get it through private 
insurance; they were put in to the Medicaid Program, which has 
significantly strained Medicaid and made it much harder for people on 
Medicaid, the people for whom it was originally designed--low-income, 
women, children, people with disabilities. It was designed to help 
them. It made it harder for them to get care because all these 
individuals who were working-age adults were put on in addition.
  Now it looks as though the Democrats want to do the same thing they 
did to hurt Medicaid--make it harder for our patients on Medicare. It 
won't work. An insurance card does not equal accessible, available 
access to care. The people who suffer the most are going to be the 
seniors who have no other options. These are seniors who are relying on 
Medicare today. They were promised that Medicare would be there for 
them. We need to keep that promise.
  Instead of protecting seniors today, however, Democrats are trying to 
give Medicare to everyone else. So 17 million seniors are going to lose 
access to the plans that they have chosen, that work for them, and that 
they want to keep.
  Seniors are going to lose access to the doctors that Democrats push 
out of the system as they continue to put more and more people on 
Medicare. Democrats should not be building their takeover of the 
American healthcare system on the backs of our seniors.
  Thank you.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that 
notwithstanding rule XXII, at 4 p.m. today, there be 2 minutes of 
debate, equally divided between the managers or their designees, and 
that following the use or yielding back of that time, the Senate vote 
on the motion to invoke cloture on the Emanuel nomination.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from New Hampshire.


                               Healthcare

  Mrs. SHAHEEN. Mr. President, it feels like Groundhog Day again 
because, once more, we are seeing Republican leadership in the Senate 
advancing another bill to repeal the Affordable Care Act and to make 
radical cuts to the Medicaid Program.
  As with previous efforts, this new bill--they call it Graham-Cassidy, 
but it really is TrumpCare 3.0, the third version, and it is strictly 
partisan legislation, crafted in secret outside of regular order, 
without hearings or consultation with most Senators or stakeholders. 
But here is what is different: This bill is even more reckless and more 
destructive than previous bills to repeal the Affordable Care Act.
  It would take away healthcare coverage from an estimated 30 million 
Americans. It would effectively end protections for people with 
preexisting conditions by allowing insurers to charge exorbitant rates. 
It would make profound cuts to the Medicaid Program, which is a 
lifeline for 33 million children, 10 million people with disabilities, 
and 6 million seniors in nursing homes. It would be a tragic setback in 
the fight against the opioid epidemic because it would end access to 
lifesaving treatment for an estimated 1.3 million people with substance 
use disorders. In New Hampshire, where we are at the epicenter of the 
heroin and opioid epidemic, it would have a huge and tragic impact.
  President Trump said that the previous Republican bill to repeal the 
Affordable Care Act was ``mean,'' and make no mistake, this bill is far 
worse. As I have said repeatedly, the only constructive way forward is 
for Democrats and Republicans to come together in a good-faith, 
bipartisan effort to repair and strengthen the current law.
  As Senator McCain said to this Chamber in July: ``Let's return to 
regular order. We've been spinning our

[[Page 14623]]

wheels on too many important issues because we keep trying to find a 
way to win without help from the other side.''
  When Senator McCain said that, we gave him a standing ovation on the 
floor of this Chamber. In the weeks since the vote on the last attempt 
to repeal the Affordable Care Act, the Senate has actually been acting 
on his advice. We have been working under the leadership of Senators 
Alexander and Murray, the chair and ranking member of the Health, 
Education, Labor, and Pensions Committee, on bipartisan legislation to 
restore certainty to the health insurance markets, to fix problems with 
the Affordable Care Act that we all acknowledge. This effort includes a 
version of legislation that I have been working on to make regular 
appropriations for cost-sharing reduction payments. Those are payments 
that keep copays and deductibles affordable for low- and middle-income 
Americans.
  I have participated, as have so many Senators, in the bipartisan 
meetings they have held with Governors, providers, stakeholders, 
insurers, and State insurance commissioners to craft a positive way 
forward. It is very disappointing that we are here today with another 
attempt to blow up all of these bipartisan efforts by bringing to the 
floor yet another divisive, partisan bill.
  To understand why people are upset and fearful about this latest 
attempt to repeal the Affordable Care Act, I would call our attention 
to the many positive impacts the Affordable Care Act has had across the 
country--and in my home State of New Hampshire--and the consequences of 
repealing that law.
  Thanks to the Affordable Care Act, more than 49,000 Granite Staters 
have been able to get health insurance coverage through the 
marketplace. Thanks to the Medicaid expansion, more than 11,000 people 
in New Hampshire have gotten lifesaving treatments. The Medicaid 
expansion, which has been a bipartisan effort between then-Democratic 
Governor Maggie Hassan and a Republican legislature, has been a 
critical tool in our fight against the opioid epidemic, and hundreds of 
thousands of Granite Staters with preexisting conditions at one time or 
another no longer face discrimination by health insurance companies. In 
one fell swoop, this Graham-Cassidy TrumpCare legislation would put all 
of these gains in jeopardy.
  I would appeal to my colleagues in the Senate to stop and reconsider 
what is going on. Listen to the stories. Look at the faces of everyday 
Americans whose lives would be devastated by this legislation--from 
children, to seniors, to veterans.
  Several months ago on Facebook and other social media platforms, I 
asked people across New Hampshire to tell me their stories--stories 
about how the Affordable Care Act has made a lifesaving difference or 
has improved their lives and the well-being of their families. I was 
overwhelmed by the response.
  Here in Washington, some seem to think that repealing the Affordable 
Care Act, no matter how destructive the consequences, is just about 
politics; it is about notching a win for their team. But for the people 
in New Hampshire and across the country, repealing the Affordable Care 
Act and slashing Medicaid isn't about politics. It is about life and 
death. It is about people being cut off from vital, lifesaving 
treatment for substance use disorders. It is about families losing 
affordable health coverage, about seniors being unable to pay for 
nursing home care, and about millions of vulnerable people with 
preexisting conditions who would effectively be denied health coverage. 
It is about returning to the pre-ACA days when simply being a woman was 
considered a preexisting condition, justifying much higher rates.
  I urge Republican leaders to stop this latest effort of destructive 
partisanship. There should be no retreat from the progress we have made 
in recent years, including the progress against the opioid epidemic. I 
encourage Senators who support this ill-conceived legislation to listen 
to the Governors, listen to the insurance commissioners, listen to 
patient and provider groups, and, most importantly, listen to their 
constituents.
  Let's fix what is not working about the Affordable Care Act, and 
let's not pass legislation to take healthcare away from people. Let's 
support bipartisan efforts now under way in the Senate to stabilize the 
marketplaces and to provide access to quality, affordable healthcare 
for every American.
  Thank you.
  I yield the floor.
  I suggest the absence of a quorum
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. KING. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KING. Mr. President, over the past several weeks, there have been 
real discussions--bipartisan discussions about fixing the problems in 
the Affordable Care Act, about controlling the growth of premiums, 
about being sure that there is some certainty in the market to prevent 
the collapse of the individual market, which, by the way, will not only 
affect people who are participating in the Affordable Care Act 
exchanges but will affect all those in the individual market, and we 
could stop that.
  The Senate HELP Committee had 4 days of hearings, roundtables, 
coffees with other Senators to talk about what the problems are, what 
we can do to solve them, and we were making some real progress. Then, 
all of a sudden, up comes TrumpCare 4.0 or 5.0--I have lost track--
another bill to essentially repeal and not replace the Affordable Care 
Act.
  On July 21, 1861, there was an occurrence at the beginning of the 
American Civil War. It was the First Battle of Bull Run. The Union 
troops were routed that day, and there was a disorganized retreat back 
to Washington. That has been known historically as the Great Skedaddle, 
and that is exactly what is happening again today. This is the great 
healthcare skedaddle because what the Senate majority is doing is 
avoiding responsibility.
  You don't want to be discriminated against because of preexisting 
conditions? Well, that is not our decision. We are passing it on to the 
Governor. The Governor can make that decision; it is not we who are 
doing it.
  You don't want to have the bands for the differential between young 
people and old people changed so that elderly people pay twice, three 
times, four times, five times as much as young people for health 
insurance? You don't want responsibility for that? Fine. Pass this bill 
and give it to the Governor.
  That is what we are talking about--a copout. It is the Senate 
majority once again trying to jam down the throats of the American 
people a change they don't want. They don't want it.
  Everywhere I went in Maine in July and August after our vote back at 
the end of July, people said thank you. They said thank you, and they 
said to tell Susan Collins thank you for the vote to preserve our 
healthcare. Yet here we are, back at it again.
  I think we need to understand what this bill does. Essentially, it 
does two things. It shifts all the responsibility for the healthcare 
provisions for the most vulnerable Americans entirely to the States, 
with very little in the way of guardrails or protection, and it gives 
them less money in order to provide that kind of healthcare. That is 
called shift and shaft. Shift the responsibility, and shaft the people 
who have to try to meet that responsibility.
  I have been a Governor. What we are talking about here is cutting off 
the support and the dollars that are needed to meet those 
responsibilities. Everyone says: Well, this is all flexibility. We are 
providing flexibility--flexibility to make agonizing decisions between 
providing healthcare to seniors or to children, to people who are 
disabled or to people who are just trying to get on their feet and go 
to work without the specter of a healthcare disaster hanging over them.
  I suspect we will have more to say about this next week, but it is a 
travesty.

[[Page 14624]]

  I understand there is going to be a little hearing on Monday. I call 
it a figleaf hearing. There is going to be a hearing. We don't know who 
is going to be there. We don't know exactly what the testimony is going 
to be. It is going to be a hearing so people can say, yes, we had a 
hearing.
  Well, come on. This is not a responsible way to legislate, and the 
people of this country expect more of us. I hope both parties--both 
parties--will recognize the folly of what is being proposed here and 
say no. Then, let's go back to talking, on a bipartisan basis, and fix 
the problems with the American healthcare system which certainly need 
to be addressed.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Johnson). Under the previous order, there 
will now be 2 minutes of debate, equally divided between the two 
parties.
  Mr. CRAPO. Mr. President, I ask unanimous consent to yield back all 
time.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  All time is yielded back.


                             Cloture Motion

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

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     do hereby move to bring to a close debate on the nomination 
     of William J. Emanuel, of California, to be a Member of the 
     National Labor Relations Board.
         Mitch McConnell, John Hoeven, Joni Ernst, Thom Tillis, 
           Steve Daines, Mike Crapo, Jerry Moran, Tom Cotton, 
           Roger F. Wicker, Pat Roberts, James M. Inhofe, Johnny 
           Isakson, John Cornyn, James Lankford, John Boozman, 
           James E. Risch, John Thune.

  The PRESIDING OFFICER. By unanimous consent, the mandatory quorum 
call has been waived.
  The question is, Is it the sense of the Senate that debate on the 
nomination of William J. Emanuel, of California, to be a Member of the 
National Labor Relations Board, shall be brought to a close?
  The yeas and nays are mandatory under the rule.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Mississippi (Mr. Cochran), the Senator from Kansas (Mr. 
Moran), and the Senator from Alabama (Mr. Strange).
  Mr. DURBIN. I announce that the Senator from Hawaii (Ms. Hirono), the 
Senator from New Jersey (Mr. Menendez), the Senator from Florida (Mr. 
Nelson), and the Senator from Hawaii (Mr. Schatz) are necessarily 
absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 49, nays 44, as follows:

                      [Rollcall Vote No. 202 Ex.]

                                YEAS--49

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

                                NAYS--44

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Merkley
     Murphy
     Murray
     Peters
     Reed
     Sanders
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--7

     Cochran
     Hirono
     Menendez
     Moran
     Nelson
     Schatz
     Strange
  The PRESIDING OFFICER. On this vote, the yeas are 49, the nays are 
44.
  The motion is agreed to.
  The Senator from Arizona.
  Mr. McCAIN. Mr. President, I ask unanimous consent to address the 
Senate as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                        Tribute to Joe Donoghue

  Mr. McCAIN. Mr. President, this week marks 30 years of loyal service 
to the Senate by one Joe Donoghue, my legislative director--30 years 
working for the citizens of Arizona and trying to make me a better 
Senator. During those three decades, he worked his way from the 
mailroom to a position of considerable importance on my staff. He has 
made himself something of an expert not only on Senate procedure but on 
all the many issues our staff has worked on over the years--from budget 
matters to immigration reform, to national security.
  Joe is capable, intelligent, hard-working, and trustworthy--a 
justifiably proud professional staffer, a pro's pro. He is well liked 
by staff and Members on both sides of the aisle, especially by those 
who, like him, have dedicated most of their careers to the Senate. I 
have come to depend on his professionalism and his counsel. More than 
that, my wife Cindy and my children treasure his friendship, as do I--
as do I.
  Joe and I began our Senate careers around the same time. He started 
sorting mail and performing other entry-level duties in the first year 
of my first term. He was 18 years old. I wasn't quite that young, but 
it was a long time ago for both of us.
  When he came to work with us, I don't think Joe knew if I was a 
Republican or Democrat. He just knew he needed a part-time job to pay 
for books and beer. These were pre-internet and email days, and making 
certain the immense amount of mail we received from constituents was 
opened, given to me or to appropriate staff, and answered as quickly as 
possible was very labor intensive and challenging, but he acquitted 
himself well, as he has with every responsibility he has accepted on my 
behalf.
  His work ethic and reliability quickly made him indispensable. He 
worked his way up to legislative correspondent and then to legislative 
assistant, with the lead responsibility for, among other things, 
helping me fight years of pitched battles with appropriations bills, 
targeting wasteful spending, and the practice of earmarking. Those were 
the days when the Senate actually debated appropriations bills. I have 
many fond memories of Joe drafting thousands of amendments at my 
direction to strike wasteful earmarks, although I am not sure they are 
fond memories for the floor staff who had to process the amendments.
  As I mentioned, in addition to his legislative work, Joe was my 
driver for over 20 years. I travel an awful lot, back and forth to 
Arizona on weekends, campaigning for colleagues, and on overseas trips. 
During the week, when the Senate is in session, my nights are often 
consumed with meetings, dinners, and speeches. Joe worked a long shift 
in the office during the day and drove me to various appointments day 
and night--taking me to airports and picking me up, getting me safely 
and on time through Washington traffic to keep a schedule that was 
always impossibly crowded.
  We spent a lot of hours together--thousands of hours--and Joe was 
almost always good company, even when I was not. He always made a point 
on those drives to tell me a joke, and some of them got me in trouble 
when I repeated them in public.
  During my 2008 Presidential campaign, Joe worked as my assistant, 
traveling from campaign stop to campaign stop, doing all manner of 
small and large tasks for me, even once holding an umbrella overhead 
while I gave a speech in the rain in Manchester, NH.
  As my legislative director, Joe is someone everyone on my staff looks 
to for policy guidance and instruction on Senate procedure and for 
insights into the personalities and priorities of senior staff in other 
offices and for the leadership. He goes out of his way to

[[Page 14625]]

make sure each one of my staff knows they are appreciated and an 
integral part of our office. I am grateful for Joe Donoghue's faithful 
service to my office, the Senate, the people of Arizona, and to me.
  On their behalf and mine, I want to thank Joe. I have barked at you, 
teased you, laughed with you, and counted on you. We have been through 
a lot of highs and lows in our 30-year association--good times and bad. 
The good times were better and the bad times easier because of your 
help and friendship. Thank you, my friend, my dear friend. It has been 
quite a ride together. I cannot imagine serving here without you.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. Mr. President, I listened carefully to Chairman McCain 
talking about his long association with Joe. I thought maybe it was 
appropriate, I would say to my colleague from Arizona, to point out 
that he eliminated an awful lot of my earmarks over the years.
  Mr. McCAIN. Great job.
  Mr. McCONNELL. I will have fond reflections as well, in a sense. I 
want to join you, Senator McCain, in congratulating Joe for a great job 
for you and for our country for a very long time.
  Mr. McCAIN. Thank you.
  The PRESIDING OFFICER. The Senator from Virginia.


                               Healthcare

  Mr. KAINE. Mr. President, I rise to talk about a topic that is 
consuming much attention--our efforts to improve healthcare for 
Americans. Before the passage of the Affordable Care Act in 2010, 
Americans with preexisting conditions faced serious barriers. Since 
2010, the rate of uninsured Americans has declined to a historic low, 
with 20 million more Americans--the combined population of 16 or 17 
States--getting access to health insurance coverage.
  Over 410,000 Virginians have received care through individual 
marketplaces just last year. An additional 400,000 would be eligible to 
receive Medicaid if Virginia ever chooses to expand it. Since being put 
on the HELP Committee or being notified I would be put on it in 
December, I visited community health centers, medical schools, 
behavioral treatment centers, nursing programs all across Virginia 
talking to people about their healthcare needs. I am committed to 
working together with my colleagues to improve the healthcare of 
Virginians and Americans. There is a right way and a wrong way to do 
it.
  After there was the failure of an effort in late July or early August 
to pass a partisan repeal and replacement of ObamaCare using the budget 
reconciliation process, the success of which would have taken health 
insurance away from 20 million Americans, I am disappointed that we 
haven't learned the lesson about the right way to do this and are 
apparently poised to explore yet again doing it the wrong way.
  There is a proposal on the table that is designated the Graham-
Cassidy proposal, and it is just as threatening as the ACA repeal we 
voted on just 2 months ago. It restructures traditional Medicaid 
funding using per capita caps and block grants. The core of this bill 
is an effort to dramatically go after, restructure, and shrink 
Medicaid, which is critical to so many people.
  It ends protections for people with preexisting conditions by 
allowing States to essentially rewrite essential health benefits. It 
would eliminate Medicaid expansion and the Affordable Care Act 
subsidies and replace them with a block grant that would be 
insufficient to cover the needs of Virginians. Even that block grant 
funding would end after 2026--as if the need to help low- and moderate-
income people afford coverage would dramatically disappear overnight.
  The proposal is new and is newly on the floor. There isn't a full CBO 
analysis of it, but initial indication has led groups like the American 
Medical Association and the AARP to come out against it. They are 
worried it will leave insurance out of the reach of millions of 
Americans. In Virginia alone, more than 301,000 marketplace enrollees 
would have their tax credits to help them afford insurance jeopardized.
  What would it mean for the healthcare system? We are not completely 
sure. At least on the earlier versions we voted on, we had CBO scores 
telling us how many millions might lose insurance. There seems to be a 
desire to rush this through prior to a full CBO analysis. I can't 
understand why. But we do know it would be devastating to those on 
Medicaid. Sixty percent of those on Medicaid in Virginia are children, 
but the majority of spending on Medicaid is for our parents and 
grandparents, the elderly, and folks with disabilities.
  I was just in Bristol, VA, on the Virginia-Tennessee border this 
weekend. I heard very palpable requests for the need for better 
healthcare, especially in rural Virginia.
  Here is what we know about the Graham-Cassidy proposal, at least 
based on the analysis of it thus far by my State healthcare officials. 
We will see a $1.2 billion cut in Medicaid under this plan over the 
next number of years, and the cuts would impact families like those I 
visit as I travel around Virginia.
  I recently had a roundtable in Northern Virginia with parents of 
children with severe disabilities who, though they have disabilities, 
are doing some remarkable things because they receive support from 
Medicare for assistive technologies and in school programs.
  A mother, Corinne, told me about her son Dylan. Dylan has a very rare 
neuromuscular condition SMARD--spinal muscular atrophy with respiratory 
distress. He has a tracheostomy tube and relies on a ventilator to 
breathe. He also gets all of his nutrition through a G-tube. He 
requires in-home skilled nursing services, and he also requires a nurse 
to attend school with him. But he goes to public school, and he is a 
successful student because Medicaid funding enables him to go. Medicaid 
helps reimburse the school system for the services they provide him.
  ``For us, affordable and quality healthcare means that Dylan can lead 
a fairly normal life despite his medical issues.'' That is what his mom 
said. He can lead a fairly normal life on a ventilator with a 
tracheostomy tube in a wheelchair with a nurse. He can lead a fairly 
normal life, despite his medical issues. He can live at home, go to 
school, and participate in activities any kid his age enjoys. Without 
the assistance of Medicaid, he wouldn't be able to do those things.
  Reducing Medicaid spending would limit States' abilities to provide 
waivers for medically complex kids. The mother adds that ``the possible 
return of lifetime caps and limitations on preexisting conditions would 
be devastating.''
  I also met with a mother, Amy, from Richmond, who has a son, Declan. 
Medicaid covers her son's care, therapy, and medical supplies. Medicaid 
helps her son have the best quality of life possible and helps him with 
the prospect she prays deeply for--that one day, despite his medical 
condition, he can live independently as a productive adult. The Graham-
Cassidy funding cuts to Medicaid could take away this protection for 
countless Virginians, especially these children.
  Here is what I ask for: Why don't we have an open process to truly 
debate improvements to our healthcare system, instead of a rushed, 
closed, secretive process that threatens mothers like Amy and children 
like Declan?
  After the efforts last summer, I hoped that the colleagues in the 
world's greatest deliberative body would stop a secretive, harmful rush 
and, instead, embrace dialogue, hearing from experts and witnesses as 
we would improve healthcare, attempting to stabilize the individual 
marketplace, lower premiums, and expand care rather than reduce it.
  We gave a standing ovation on the floor of the Senate in late July 
when our colleague, Senator John McCain, returned from a very difficult 
diagnosis of brain cancer. We gave him a standing ovation after he 
spoke to us, and here is what he said. He talked about the fact that we 
had a challenge on healthcare. He talked about the skinny repeal bill 
that was on the floor of the Senate. He said:


[[Page 14626]]

       We've tried to do this by coming up with a proposal behind 
     closed doors in consultation with the administration, then 
     springing it on skeptical members, trying to convince them 
     it's better than nothing, asking us to swallow our doubts and 
     force it past a unified opposition. I don't think that is 
     going to work in the end. And it probably shouldn't.
       Why don't we try the old way of legislating in the Senate, 
     the way our rules and customs encourage us to act. If this 
     process ends in failure, which seems likely, then let's 
     return to regular order.
       Let the Health, Education, Labor, and Pensions Committee 
     under Chairman Alexander and Ranking Member Murray hold 
     hearings, try to report a bill out of committee with 
     contributions from both sides. Then bring it to the floor for 
     amendment and debate, and see if we can pass something that 
     will be imperfect, full of compromises, and not very pleasing 
     to implacable partisans on either side, but that might 
     provide workable solutions to problems Americans are 
     struggling with today.

  To my great satisfaction, after the skinny repeal bill went down--and 
this body decided that it didn't want to precipitously take healthcare 
away from 20 million people--that is the course that this body 
embraced. It is what our heroic colleague suggested that we embrace. 
The HELP Committee--which, as a member of this, I am very aware had 
refused to hold a hearing on any of the proposals in the House or in 
the Senate around the repeal of ObamaCare--decided finally to do what 
the HELP Committee should do. The ``H'' is for ``Health.'' To pass a 
bill reorienting one-sixth of the American economy around the most 
important expenditure that anybody ever makes in their life without 
letting the HELP Committee hear from it was foolish to start with.
  So now we have embraced doing it the right way. Under the leadership 
of Senator Alexander and Senator Murray, we have had four robust 
bipartisan hearings. We invited Governors to come from around the 
country. They had to turn their schedules topsy-turvy to do it--
insurance regulators, insurance executives, patients, doctors, 
hospitals. There were four hearings, each with multiple witnesses. We 
turned their schedules topsy-turvy. We had them here. We had coffees 
before each hearing and invited all Members of the Senate, not just 
those on the HELP Committee, to interact and hear from these experts. 
We have gotten advice from them on what we need to do to stabilize the 
individual insurance market and what we can do in the long term to make 
healthcare better for everyone. We should take advantage of those 
recommendations.
  When the fourth hearing was completed last week, the chairman of the 
Committee, Senator Alexander, and the ranking member, Senator Murray, 
with the support of this very diverse committee--left, right and 
center, Democrats and Republicans--have embarked on a bipartisan 
process to find, after a full and transparent airing of the issues, a 
way to stabilize the individual insurance market. We are on the verge 
of doing that.
  Yet what we are told is, instead of going through our committee 
process and hearing and airing it before the public, now there is a new 
bill that has just recently come out with no full CBO score. The idea 
is to force that through, with no CBO score, with no full committee 
process that would enable us to hear from witnesses, with no 
opportunity for members of any of the committees--Finance or HELP--to 
offer amendments, with no meaningful floor debate, and with no 
opportunity for amendments on the Senate floor.
  Why did we give Senator McCain a standing ovation just 6 weeks ago 
when he suggested that when it comes to something as important as 
healthcare, we should treat it with seriousness, so we can get it right 
and not rush and get it wrong?
  I stand here--and I hope I am on my feet a good bit more between now 
and the end of the month--to ask this question: Why backslide? Why go 
backward when we had embraced a process of bipartisan discussion?
  I am fully aware that as a Member of the minority party, I have no 
power except my ability to convince Republicans that I actually have a 
good idea. But a one-party process on the floor that tries to end run 
the relevant HELP Committee is guaranteed to fail. It might pass, but 
it is guaranteed to fail because it is guaranteed to hurt people. It is 
guaranteed to have some consequences that are harmful and known and 
other consequences that are harmful and unknown because it has been 
rushed, and it hasn't been done in the view of the public with the 
ability to fully listen to them. Just think about it this way: What 
does it say about your commitment to your legislation if you are not 
willing to have it subjected to a normal review by the committees that 
have jurisdiction over it?
  The Graham-Cassidy bill has some provisions in it that are relevant 
to the Finance Committee's jurisdiction, but Finance is apparently not 
going to do a markup of the bill, and they are not really going to hear 
from experts about the bill.
  There are other provisions in Graham-Cassidy dealing with essential 
benefits that are squarely within the jurisdiction of the HELP 
Committee, but the HELP Committee isn't going to have a hearing either. 
So in spite of the good recommendation we were given by our senior 
colleague who was just on the floor--who was characteristically here to 
talk in kind words about the public service of someone who has worked 
with his staff for 30 years--we gave him a standing ovation, and we are 
prepared to violate everything that he just suggested we do.
  As I conclude, I will just say this. This isn't about healthcare. 
Healthcare is important enough. No one ever spends a dollar on anything 
that is more important than their health. It is the most important 
thing that anyone ever spends a dollar on--health, my health, the 
health of my family. I think we can all share that. Nothing is more 
important. It also happens to be one of the largest sectors of the 
American economy. Between 15 and 20 percent of America's GDP is 
healthcare. This is a very important issue. If you are trying to 
reorient one-sixth or one-fifth of the economy, if you are touching the 
expenditure of priority that is the single most important priority in 
anyone's life, that is important enough.
  I would argue, in closing, that there is something I think is equally 
important; that is, this body. We celebrated the 230th anniversary of 
the Constitution this past Sunday. James Madison and others in 
Philadelphia, tried to figure out how this government should work. They 
made a very unusual decision that would be different from the decisions 
that are made in many countries; that is, they put the legislative 
branch first.
  There are three coequal branches. In most societies, the executive is 
first, but not here--first among equals. We are meant to really play an 
A game. We are really meant not to be an article-II-and-a-half branch 
reacting to a Presidential tweet or encouragement; we are supposed to 
be an article I branch.
  In the legislative branch in article I, the Senate is given a very 
particular role. We are called the world's greatest deliberative body. 
We are the saucer into which the partisan heat of the day is poured and 
allowed to cool, so the decisions made in the Senate are supposed to be 
more careful and more deliberate.
  This is a great body that has been sadly hobbled by partisan 
gridlock, and we have not achieved what the Senate should achieve. We 
learn in math as we grow up that the whole is equal to the sum of the 
parts, but what you find in life is that often the math doesn't work 
out. Sometimes the whole can be equal to or greater than the sum of the 
parts in life if teams work well together. But sometimes--and this 
describes the Senate now--there are 100 wonderful, accomplished people 
in this body. Yet again and again, and now for years, the whole has 
been equal to less than the sum of the parts.
  We have done very little of meaning, very little of substance. Yet 
now we are poised to tackle the most important issue that most affects 
people and the biggest sector of the American economy. If we get it 
right, we can send a message to the public that the Senate will once 
again be the Senate. We will once again be a deliberative body. We will 
once again do what we are supposed to do.

[[Page 14627]]

  I think this country now needs to see some adults in the room, some 
group of people willing to work together--Democratic and Republican--to 
solve problems and do the right thing for the American public. If we do 
this right, we can send that message. If we do it wrong, we will hurt 
people, and we will also hurt the credibility of this institution in a 
way that I think will last for years.
  We have a choice. It is up to us. We either follow the advice that 
our colleague gave us on the floor 6 weeks ago, which we gave him a 
standing ovation for, and we gave him the ovation because we knew he 
was right--we either follow that advice or we decide to ignore it and 
continue the downward spiral of a great body.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. FRANKEN. Mr. President, in May, Jimmy Kimmel shared the story of 
his newborn son Billy, who was born with a life-threatening condition 
that required open-heart surgery. Kimmel said that he was fortunate to 
have had good health coverage and was able to pay for the care that his 
son needed, something he believed every American deserved.
  A few weeks later, as efforts to repeal ObamaCare were gaining steam, 
Senator Bill Cassidy explained that the bar he believed any healthcare 
bill had to clear to get his vote was what he called the Jimmy Kimmel 
test. He said: ``Will a child born with congenital heart disease be 
able to get everything she or he would need in the first year of 
life?''
  When Kimmel interviewed Senator Cassidy a few days later, Kimmel 
explained the test this way: ``No family should be denied medical care, 
emergency or otherwise, because they can't afford it.'' Well, I am here 
to report that this latest version of TrumpCare, offered by none other 
than Senator Cassidy himself, fails the Jimmy Kimmel test miserably.
  Over the past few weeks, there have been two ongoing conversations 
about the future of healthcare in the United States. The first has been 
conducted in an open, bipartisan manner in the Senate Health, 
Education, Labor, and Pensions Committee in full accord with the 
traditions of this body. In the HELP Committee, Republicans and 
Democrats alike have been talking with Governors, insurance 
commissioners, and other experts on ways to address concerns of States 
and consumers by stabilizing the individual market and lowering premium 
costs. That is how the Senate is supposed to work, and the bill that 
emerges from that process will be one that makes things better, not 
worse. It will create certainty. It will bring down costs for 
consumers. It is a bill that any Senator should be proud to vote for.
  The second conversation is a model of how things shouldn't work. It 
has occurred behind closed doors between Senate Republicans and party 
operatives. It is not about making the system work; it is about passing 
something--anything that can be said to repeal and replace the 
Affordable Care Act, and along the way, it destroys the Medicaid 
Program as we know it. As many of us have argued before, this 
conversation is an affront to the traditions of this body and, more 
importantly, to the will of the American people.
  I urge my Republican colleagues to oppose the Graham-Cassidy bill--
the newest iteration of TrumpCare--which will rip healthcare coverage 
from tens of millions of people, create higher costs for consumers, and 
ensure the destabilization of the individual health insurance market.
  While I have worked closely with Senators Cassidy and Graham on other 
bills, and I respect them, I have grave concerns with this legislation.
  First, the bill undermines protections for people with preexisting 
conditions.
  States could apply for waivers that would allow them to charge people 
more based on their health status, age, or any other factor other than 
race or ethnicity. This means premiums would be higher just for being 
older or sicker or having had an illness in the past. In other words, 
there would be no protection for people with preexisting conditions.
  Additionally, States can also seek waivers to remove the ACA's 
essential health benefit requirements, which mandate that insurers that 
are offering plans on the exchanges include coverage for vital 
services, such as prescription drugs, maternity care, mental health, 
and substance use disorder services.
  While the bill technically requires States to describe--just simply 
describe--how they will ``maintain access to adequate and affordable 
health coverage for individuals with preexisting conditions,'' there is 
no definition of what that means, and there are no enforcement 
mechanisms. Insurers would still be able to charge people with 
preexisting conditions more for their care or exclude services 
altogether. Under this plan, millions of people with preexisting 
conditions could face much higher costs, if they can get coverage at 
all. Again, this bill rips away protections for people with preexisting 
conditions.
  Second, the bill would undoubtedly reverse the significant coverage 
gains we have seen in recent years and drive up the number of Americans 
without health insurance.
  The Graham-Cassidy proposal eliminates the ACA's premium subsidies, 
eliminates the Medicaid expansion, eliminates cost-sharing reduction 
payments, and more. Instead of funding these critical aspects of the 
ACA, the bill would return some but not all of this funding to the 
States in the form of block grants, which are authorized in this bill 
from 2020 to 2026.
  The bill also proposes to dramatically reduce funds for States that 
have expanded Medicaid and have successfully enrolled more adults in 
ACA exchanges--States like Minnesota. Instead of incentivizing success, 
the bill will reward failure, initially increasing funds for States 
that refuse to expand Medicaid and have done little to encourage 
enrollment. But even these States lose out in the end. In fact, the 
funding stops completely after 2026, resulting in enormous losses for 
every State, and even prior to 2026, the Center on Budget and Policy 
Priorities estimates, most States will receive significantly less 
funding from the Federal Government under this block grant than they do 
under current law. Minnesota could lose $2.7 billion. Other Senators 
who have expressed various levels of concern with this legislation 
could see their States lose significant sums. Those include Arizona, 
which would lose $1.6 billion; Alaska, $255 million; Maine, $115 
million; Colorado, $823 million; and the list goes on. Healthcare isn't 
free. These shortfalls will mean that families don't get the services 
they need.
  On top of all that, the Graham-Cassidy proposal caps and cuts 
Medicaid--a program that provides coverage to seniors, families with 
children, and people with disabilities. In Minnesota alone, that is 1.2 
million people facing cuts to their benefits or losing coverage 
altogether.
  I believe many of us truly want to help our constituents access the 
care they need. As I have said before, the ACA is far from perfect, but 
it has resulted in significant improvements in millions of people's 
lives.
  I have heard from countless Minnesotans who have literally had their 
lives or the life of a loved one saved by the ACA--the same way that 
Billy Kimmel's life was saved by the treatment he was able to receive 
at the beginning of his life. Take Leanna, for example. Leanna's 3-
year-old son, Henry, has been diagnosed with acute lymphoblastic 
leukemia. His treatment will last until April of 2018. He often needs 
round-the-clock care to manage his nausea, vomiting, pain, and 
sleepless nights--a 3-year-old.
  Henry's immune system is so compromised that he is not supposed to go 
to daycare, so Leanna left her job to care for him. Leanna and Henry 
are supported by her spouse, but they couldn't pay for Henry's 
treatment on one salary.
  Leanna says:

       It is because of the ACA that Henry gets proper healthcare. 
     Henry can get therapy and the things he needs to maintain his

[[Page 14628]]

     health and work towards beating cancer. Henry is still with 
     us because of the ACA.

  Let me say that again: Three-year-old Henry is still with us because 
of the ACA.
  Consider Maria's story. Maria enrolled in Minnesota's Medicaid 
Program after finishing her graduate degree and while looking for full-
time employment. Maria was grateful for the coverage because she needed 
access to treatments for her endometriosis, which was diagnosed a few 
years prior while she had insurance through her employer.
  Soon, Maria found her dream job, but it came with a catch: no health 
insurance. Days before she was set to move and start work, she decided 
to go in for one last big checkup. The results were unnerving. At the 
age of 35, Maria was diagnosed with bilateral breast cancer. Maria had 
to give up her job offer and aggressively pursue treatment for the 
cancer.
  Fortunately, because Minnesota had expanded Medicaid, all of Maria's 
treatments were covered, and lucky for her, they worked. Maria's cancer 
is in remission. Maria said: ``The Medicaid expansion of the ACA 
literally saved my life.'' She told me that anyone could find 
themselves on Medicaid. She said: ``Without that comprehensive, 
affordable, accessible health insurance, I wouldn't be here.''
  But now that all of these programs are in jeopardy, my constituents 
are generally scared. They have come to me in tears, explaining that if 
the Affordable Care Act is repealed or if draconian changes and cuts to 
Medicaid go through, they don't know how they will care for their 
elderly parents, keep their rural hospital open, or afford treatments 
they or their children need.
  I believe it is legislative malpractice to pass partisan legislation 
that would undermine this progress, people's economic security, and 
their livelihood, all to achieve a destructive political end--to do it 
without holding thorough hearings in the committees of jurisdiction, 
without hearing from experts, and without a complete assessment from 
the Congressional Budget Office on how this legislation would affect 
the American people.
  I urge my Republican colleagues to once again abandon their efforts 
to ram through dangerous legislation that would fundamentally 
restructure our healthcare system. This new iteration of TrumpCare 
fails the Jimmy Kimmel test. It is the result of a horrible process 
that is not worthy of this body.
  We have a better option. Over the past few weeks, Chairman Alexander 
and Ranking Member Murray have held four bipartisan hearings on 
individual health insurance market reforms and are working to forge a 
legislative compromise to reduce premiums for consumers. We have heard 
from Governors, we have heard from insurance commissioners, and we have 
heard from experts--all of whom span the ideological spectrum. This is 
what regular order looks like, and this is the way the Senate is 
supposed to work.
  I have worked with all of my colleagues on this committee in good 
faith, and I am proud of what we have been able to accomplish so far, 
but all of that work is in jeopardy because of a destructive, partisan, 
last-ditch effort to repeal the Affordable Care Act and end the 
Medicaid Program as we know it.
  Do not shortchange those important legislative developments. Do not 
shortchange the American people. Think of the millions of children and 
families who need our help right now. Oppose TrumpCare, and, instead, 
let's work to improve care, lower costs, and ensure access to 
healthcare when people need it the most. It is within our reach.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Ms. HASSAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. HASSAN. Mr. President, I rise today to oppose the latest 
disastrous iteration of TrumpCare, the Graham-Cassidy proposal.
  It is disappointing that we are here once again. In July, Granite 
Staters breathed a sigh of relief when the Senate defeated a proposal 
that would have raised healthcare costs and stripped health insurance 
away from millions. When that bill failed, I was hopeful that we would 
move forward on a bipartisan process to make key improvements to the 
Affordable Care Act. That is exactly the process we have started on in 
the HELP Committee, focusing on bipartisan solutions to stabilize the 
health insurance market.
  Now, in direct conflict to this important bipartisan work, some of 
our colleagues are making one last-ditch effort to pass partisan 
legislation. Make no mistake, Graham-Cassidy is more of the same, and 
it is every bit as dangerous as the TrumpCare plans we saw this summer, 
if not worse.
  Granite Staters and all Americans should be concerned if this bill is 
rushed into law. My colleagues are moving so quickly to try to get this 
bill passed that the CBO says it will not be able to score it by 
September 30, but it is clear that this bill would make things worse 
for most Americans.
  If you have a preexisting condition, including cancer, asthma, or 
diabetes, you could once again be discriminated against with higher 
costs that make health coverage unaffordable. This bill would end 
Medicaid expansion, a program that Democrats and Republicans in New 
Hampshire came together on to pass and reauthorize. Medicaid expansion 
has provided quality, affordable health insurance coverage to over 
50,000 Granite Staters. Experts on the frontlines of New Hampshire's 
heroin, fentanyl, and opioid crisis say it is the one tool we have to 
combat this epidemic. Ending Medicaid expansion would pull the rug out 
from under those who need its coverage. It would put thousands of 
people at risk.
  In addition, Graham-Cassidy would cut and cap the Medicaid Program. 
Those words, ``cut'' and ``cap,'' are really just code for massive cuts 
to the funding that States receive, including New Hampshire, losing 
hundreds of millions of dollars in Federal funding for Medicaid over 
the next decade. This cut would force States to choose between slashing 
benefits, reducing the number of people who can get care, or, in some 
cases, having to do both. It would impact some of our most vulnerable 
citizens--children, seniors who need in-home care or nursing home care, 
and people who experience disabilities.
  Graham-Cassidy would allow States to get rid of important protections 
in current law--protections called essential health benefits, which 
make sure that all insurers cover things like maternity care, 
prescription drugs, and substance use disorder services.
  Finally, this bill would continue Republican efforts to roll back 
women's access to healthcare by defunding Planned Parenthood, which 
provides critical primary and preventive healthcare services to 
thousands of New Hampshire women.
  As we continue to debate the future of our Nation's healthcare 
system, we have to understand how things would actually play out on the 
ground for the people we are trying to serve. Over the course of this 
year, the people of New Hampshire have laid themselves bare and shared 
story after story of how they would be impacted by these dangerous 
attempts to roll back access to healthcare.
  It is people like the Keene resident who has a preexisting condition 
and had health insurance through his job, but when he lost that job, he 
was able to start a new successful small business all because he knew 
he would be able to get quality health insurance under the Affordable 
Care Act. It is people such as the Granite Staters who experience 
disability but are able to live independently in their home and 
community as a result of the personal care services they receive 
through Medicaid and people like the mom from Rochester who is 
benefiting from substance use disorder services that are included in 
Medicaid expansion and would be taken away under this bill.
  It really shouldn't be necessary for people to have to come forward 
and share their most personal stories, all in

[[Page 14629]]

an attempt to get their elected representatives to work together in a 
bipartisan manner and not take coverage away. We actually should be 
able to do that in the U.S. Senate on our own.
  Now, just as we are starting to work on a bipartisan basis, as our 
constituents asked us to do, the American people are faced with another 
harmful, partisan TrumpCare bill that will destabilize our healthcare 
system, drive up premiums, and make care less affordable.
  We must come together to build on and improve the Affordable Care Act 
and ensure that every American has meaningful, truly affordable access 
to the type of care each of us would choose for our own family. We must 
reject this proposal and continue moving forward on the bipartisan path 
we have started on in the HELP Committee.
  I am going to keep standing with my Democratic colleagues, and I urge 
the people of New Hampshire and all Americans to continue to speak out 
and to share their stories. Together, we will, once again, defeat this 
attempt to undermine the healthcare of millions of Americans, and we 
will make clear that in the United States of America, all of our people 
must be able to get quality, affordable care.
  Thank you, Mr. President.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Rubio). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. BLUNT. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BLUNT. Mr. President, I want to talk about healthcare and what it 
means to families and what it means to communities. It is the most 
personal thing that families deal with. Every family knows that at some 
point they are going to deal with not one but multiple healthcare 
issues as life progresses, as things happen in life--at times you don't 
expect them to happen in life--and nothing is more riveting or focusing 
than healthcare.
  Somebody told me one time--and I have said this on the floor of the 
Senate before because I think it is such a good observation about what 
happens in healthcare. Somebody told me that when everybody in your 
family is well, you have lots of problems. When somebody in your family 
is sick, you have one problem.
  So it is not like tax policy or energy policy or the intricacies of 
this or that; it is something that every family and every individual 
identifies with in a unique way. It is one of the reasons the debate is 
so passionate, and I think it may be one of the reasons why sometimes 
we see exaggerated claims about how a plan I may be for is going to 
cause more people to have healthcare problems than if that plan didn't 
pass. I certainly wouldn't intend for that to be the case. What we are 
all looking for is the best plan that addresses this problem in the 
best way.
  In the debate we had 6 weeks ago, I remember looking across the 
Senate floor at one of my colleagues who stood up and said: If the plan 
passes that many of my colleagues are going to vote for--he may have 
said the people across the aisle are going to vote for--health 
insurance rates are going to go up next year by 20 percent. Missourians 
have already seen a 145-percent increase, under the plan we have now, 
in 3 years. The rates that were just filed have ranged from a 35-
percent increase to a 47-percent increase. So it is a pretty safe 
prediction by my friend on the other side who said that if the plan I 
was for passed, health insurance rates would go up 20 percent.
  The plan he had been for--the plan they were defending--is out of 
control. There is no argument that what we have now is not working.
  Families who have coverage don't really have access. So many families 
with coverage have these high-deductible policies with insurance rates 
that, first of all, they can't afford the premium. If they are somehow 
able to scrape the money together to afford the premium--I think the 
average deductible in the bronze plan was $6,000 per individual, and 
for almost all of those plans, if you had more than one individual in 
your family, you had to hit the per individual rate twice if two people 
got sick. So you were paying maybe $1,000 or more a month, and that was 
for insurance coverage. Then, if somebody got sick, you had another 
$12,000 that potentially would kick in before your insurance plan 
helped at all.
  Not only was that not real coverage, but it clearly wasn't access. It 
clearly didn't provide the opportunity to go to the doctor and have the 
kind of healthcare you need so you don't have a tens of thousands of 
dollars healthcare crisis that arises needlessly. Some of us will have 
those problems no matter how well we take care of ourselves, but access 
to healthcare matters, and healthcare that works where you live 
matters. Frankly, that is the plan Senators Cassidy and Graham have 
come up with--a plan that would take the decision making for 
government-assisted healthcare out of Washington and put it back in the 
States.
  When one of my Congressmen from Southwest Missouri was a freshman 
Congressman, decades ago in the House of Representatives, he was on the 
committee at the time that wrote the laws and regulations for 
Washington, DC. Somebody asked him why he thought he was smart enough 
to write the laws for Washington, DC. His hometown happened to be 
Sarcoxie, MO.
  He said: In my hometown, almost everybody knows where Washington, DC, 
is, but here in Washington, almost nobody knows where Sarcoxie is. Does 
that mean the people in Sarcoxie are a lot smarter than the people in 
Washington? Maybe not, but it meant they probably knew what was better 
for Sarcoxie than the people in Washington did.
  So what Senators Graham and Cassidy are talking about is looking at 
taking all the money we are currently spending in this government-
assisted healthcare world and divide it up among the States in a more 
equitable way. Right now, four of the States get about 37 percent of 
all the money. You don't have to be a math genius to figure out that 
means the other 46 States must get about 63 percent of all the money. 
Now, if 37 percent of all people in the country lived in those four 
States, that might be a reasonable way to divide up the money or even 
if 37 percent of people with income and health needs that were so 
significant they needed more help than everybody else lived in those 
four States, that might be a reasonable way to divide up all the money, 
but neither of those things are true. What this plan would do would be 
to look for a new way to more fairly allocate the money we spend on 
healthcare and then let State governments experiment with what to do 
about that.
  Jefferson said, in our system, the States had the unique ability to 
be laboratories for change because they could try things and see if 
they worked and then share with the other States what worked, but there 
was no vision at the time that the Federal Government was the best 
place to do everything. This is really sort of a debate between are you 
for federalism or are you for government-run everything.
  I guess 30 percent of the Democrats in the Senate, just a few days 
ago, said they were for government-run everything in healthcare. They 
were for single-payer healthcare. I am not for that. I don't think that 
is the best way for our system to work or to find the healthcare 
innovations we need or the access to healthcare people in desperate 
moments should always have, but I do think we could do a better job 
serving healthcare needs for people in the 50 States and the 
territories if, in fact, we gave them more authority to do that.
  First of all, in all likelihood, you will get your healthcare in the 
place you live, and you are more likely going to be able to get access 
to the same healthcare your local State representative gets, where it 
is not just me arguing for what is good for Missouri or my colleague in 
the Senate arguing for what is good for our State or the eight people 
we have in the House. It takes all 163 house members in our State, the 
34 senators, and the Governor leading to have a real understanding of 
where 200 legislative families get their

[[Page 14630]]

healthcare and where 200 people who are making that decision--who see 
people at school and the grocery store--that is a lot different than 
just seeing 10 people, sending them to Washington, and saying: Why 
don't we adjust the one-size-fits-all system so it serves our State 
better.
  If you have ever bought any one-size-fits-all clothes, you are a very 
unique person if they actually fit you. One-size-fits-all almost never 
fits anybody. Even in a State, it is hard enough to come up with a plan 
that fits everybody in the State in the best possible way, but we would 
be much more likely to do that than we would to suggest what happens in 
Manhattan and what happens in Marshfield, MO, are the same thing 
because they are not. People in New York are going to come up with a 
more likely way to address those issues and figure out what healthcare 
is there, what they need to do to augment it, what they need to do to 
be sure it is available to the most people in the most cost-effective 
way, and in Jefferson City, MO, they are more likely to answer all of 
those questions for our State than, frankly, they are at the Department 
of Health and Human Services in Washington, DC.
  Even if they want to do that--even if they are all Missourians who 
take over the Department of Health and Human Services, their goal would 
not be to figure out what is best for where I live. Their goal would be 
to come up with one plan that is best for the whole country, and it is 
just not working very well.
  First of all, it is not working very well because it is clearly not 
divided in an equitable way. No matter what formula you put in place, 
four States having that much of the money spent in their States is not 
the right kind of system to have. There are ways to adjust for need, 
there are ways to adjust for location, but those ways are not going to 
be found in waivers Governors would ask for but are more likely to be 
found in State capitols than they are here.
  This is the classic example of why our government has worked as long 
as it has in so many areas, but every time we try to become responsible 
for everything at every level, we mess up. Every time we think 
different regulations have to be passed by city government, county 
government, State government, Federal Government, that never works very 
well.
  This is an opportunity to say to States: We are going to let you be 
responsible for devising a system for people in your State that meets 
the needs of people in your State, and we are going to do that in a 
more effective way than has been done in the past. The growth of 
healthcare programs has never been allowed to be looked at in a way 
where you look at all the programs and put them together in a way that 
really works.
  So we are going to have an opportunity to make a big decision about 
the future of healthcare. We are going to be deciding, among other 
things, do we trust people to make that decision who are closer to the 
problem or do we think it is better to try to solve the problem further 
away from the problem. I think the right answer here is, clearly, what 
we are doing isn't working.
  Let's take advantage of the Constitution and the Federal system of 
government, and let's come up with a plan that uniquely can work--in 
Florida where you live, in Missouri where I live, in Louisiana where 
Senator Kennedy lives--that has a unique opportunity to serve the 
families where the No. 1 thing they take most personally is the health 
and welfare of their family. Everybody has to deal with this. Let's try 
to create an environment where everybody gets to deal with this where 
there is the greatest opportunity, greatest sensitivity, greatest 
availability, and greatest understanding of how, if those things aren't 
working, to uniquely come up with a solution to the problems in that 
State that are very likely not the problems that need to be solved in 
the entire country.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.


                               Tax Reform

  Mr. KENNEDY. Mr. President, I wish to change the subject slightly. I 
will be back on the floor next week to defend my good friend and 
colleague Senator Cassidy's ideas on the reform of healthcare for 
America. He received a letter today from our Governor and the Secretary 
of our Department of Health and Hospitals, which, in my opinion, 
espouses points of view on healthcare that are not in the best 
interests of the people of Louisiana.
  Just for a moment, I want to talk about tax reform because that is 
the other big issue in front of us.
  Like the Presiding Officer, I have been in government for a while. I 
have great respect for professional economists, but it has been my 
experience that for every economist, there is an equal and opposite 
economist, and they are both usually wrong.
  Economics today is more art than science. That is why I say it 
doesn't take an expert economist to see that something is wrong with 
the American economy.
  Mr. President, 2016 was the 11th straight year our economy failed to 
achieve 3 percent annual growth, which has been our average annual 
growth every year since 1960. I have heard numerous pundits act like 
returning to 3 percent growth is something special, something 
extraordinary. No, sir, look at the numbers. It is just average, and I 
think the American people deserve better than just average growth, but 
even average growth is optimistic if we keep hamstringing the men and 
women who create the jobs in this country.
  Our 40 percent business tax rate--let me say that again. Our 40 
percent business tax rate and our broken Tax Code are chasing our 
ideas, our jobs, and our investors into the open, waiting arms of 
foreign countries. Our 40 percent business tax rate and our broken Tax 
Code are keeping wages and productivity low, they are crippling our 
small business women and small business men, and they have to go.
  When we are talking about tax reform, I think it is very important 
that we not forget the primary vehicle--not the only vehicle but the 
primary vehicle for economic growth in America is the middle class, 
which is what I want to talk about for a moment, tax relief for 
ordinary people.
  My constituents tell me every day: Kennedy, we look around in our 
economy today, and we see too many undeserving people at the top 
getting bailouts, we see too many undeserving people at the bottom 
getting handouts, and we are in the middle and we get stuck with the 
bill.
  They say: Kennedy, we can't pay it anymore because our health 
insurance has gone up--thanks to ObamaCare--our kids' tuition has gone 
up, and our taxes have gone up. I will tell you what hasn't gone up, 
our wages and our income.
  They feel that we in Washington don't listen and we don't care. They 
feel like they have no voice and no chance, and that anger is 
understandable.
  This bar graph shows U.S. real median household income going all the 
way back to 1999. We can see where it was in 1999: slightly over 
$58,000. This is median household income. Of course, it took a dip in 
2012 as a result of the recession, but look where we are in 2016. We 
are practically right where we were in 1999.
  The middle class--the ordinary people of America--has made virtually 
no progress, and they have every right to be angry about that. It has 
been 16 years since President Bush's tax cuts, since the middle class 
has gotten a tax break. That is why I wanted to come to the floor 
today. Somebody has to speak up for the ordinary people of America and 
for our middle class.
  Middle-class families drive our economic engine. We are a consumer 
economy. Seventy percent of our economy is based on consumers. They buy 
the goods and services our businesses are selling. They work hard to be 
able to spend and save and invest. Most middle-class Americans get up 
every day, go to work, obey the law, pay their taxes, try to do the 
right thing by their kids, and they are falling further and further and 
further behind. Now, as they are trying to balance a checkbook, nearly 
one-third of their income

[[Page 14631]]

is automatically withheld and sent off to Washington, DC. They never 
even see it. Come April, they may owe even more on their savings and 
investments. If you don't believe me, look at the numbers. You think 
America is broke? Between October 2016 and January 2017--just one 
quarter--the U.S. Treasury set a brandnew tax revenue record of $1 
trillion--$1,084,840,000,000. A lot of that money came out of the hides 
of ordinary people.
  I will give you an example. Right now, if you are a middle-class 
family in Alexandria, LA--right smack dab in the middle of my State--
you have a household income of $59,000. You have two children. You want 
your children to have a better future than you had. You claim all your 
exemptions and you take the standard deduction. You are going to be 
paying the Federal Government about $3,500 a year.
  That is not even counting what that middle-class family has to pay in 
State and local taxes or their payments to Social Security or Medicare. 
By the time their bills are paid and by the time they put gas in the 
car, that doesn't leave them much to work with.
  I have an idea about how tax reform can target the middle class and 
bring ordinary people some badly needed relief. Seventy percent of 
Americans opt to take the standard deduction when filing their taxes--
70 percent. They do that because it is simple, it is fair, and it 
requires less documentation than itemizing. In 2014, this option--this 
standard deduction--saved taxpayers of America about $217 billion. Yet 
they are still having trouble getting ahead. If Congress were to make 
one simple change as we enter upon this endeavor that we call tax 
reform--I call it tax cuts--like doubling the standard deduction across 
the board for everybody, including but especially the middle class, 
that would potentially inject about $600 billion back into our economy 
over 10 years. That is according to a 2014 CRS report. That would be an 
immediate shot in the arm to the American economy.
  That family of four in Alexandria, LA, whom I just talked about would 
have their Federal tax bill cut to $1,700, freeing up almost $2,000 of 
their hard-earned income. That is $2,000 toward a new car, a new lawn 
mower, fixing their home, putting money back into their business, or 
saving money for their children's college education. It is pretty 
simple. It is also $2,000 right back into the economy.
  As the cost of earning more is reduced, people will want to work 
harder. I believe people respond to incentives--not just Americans, but 
that is human nature. That means more productivity and more growth. It 
is economics 101. Unless you were throwing a frisbee in the quad, you 
were in an economics 101 class, and you know that if you give people 
more to spend and they spend it, the economy is going to grow in the 
process. I believe, Mr. President, as I know you do, that people can 
spend their own money better than the government can.
  The strength of the middle class was the cornerstone of our past 
economic growth, and I think it will be the key to our future.
  I have said it before, and I will say it again: We do need tax reform 
for businesses. I repeat: We do need tax cuts for businessmen and 
businesswomen--not just for the large C corporations but also for the 
passthroughs, the LLCs, the LLPs, the sub S corporations, and the sole 
proprietorships and family farms.
  If tax reform does not include relief for the middle class, if it 
doesn't include relief for ordinary Americans, then we will lose a 
historic opportunity. It will be another generation before we will have 
this opportunity again, and we will never get our economy back on track 
unless we can close that loop.
  We need to liberate the middle class and their power to spend and 
their power to save and renew their belief in the American dream. A tax 
reform policy that provides relief to the middle class, such as 
doubling the standard deduction--that certainly is not the only way to 
do it, but it would certainly do the trick--will give people the 
incentive to work and to save and to invest.
  Our economic fate is tied to the health of our middle class. I am not 
saying that other parts of our great Nation, our economy, are not 
important, but the bedrock is the middle class. The bedrock is small 
business. And it is high time that we offer ordinary Americans a tax 
code that believes in them.
  With that, Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                             Climate Change

  Mr. WHITEHOUSE. Mr. President, each week that you see me standing 
here means another week in which the Senate of the United States has 
sat out doing anything to address climate change and another week of 
carbon pollution streaming into our atmosphere and oceans. Carbon 
dioxide from burning fossil fuels is changing our atmosphere and our 
oceans. We see it everywhere. We see it in storm-damaged homes and 
flooded cities. We see it in drought-stricken farms and raging 
wildfires. We see it in fish disappearing from warming, acidifying 
waters. We see it in shifting habitats and migrating contagions.
  All these harms we see carry costs--real economic costs--to 
homeowners, business owners, and taxpayers. That cost to homeowners, 
business owners, and taxpayers is known as the social cost of carbon 
pollution. It is the damage that people and communities and States 
suffer from carbon pollution and climate change. The Office of 
Management and Budget last calculated the social cost of carbon to be 
around $49 per ton of carbon dioxide emitted. If you just do some 
simple math, you can multiply the total measured U.S. emissions coming 
from energy production alone in 2016--that is emissions of over 5.7 
billion tons of CO2--by the $49 cost per ton. It is pretty 
simple math: $49 times 5.7 billion tons gives you about $280 billion. 
So $280 billion is the annual cost that the fossil fuel industry 
offloads onto the American public in harm from the carbon dioxide 
emissions. That is a big number and a big consequence--$280 billion per 
year.
  There was a more complex analysis than my simple math that was done 
by the International Monetary Fund. The International Monetary Fund has 
a lot of smart people. They don't have any conflict of interest that I 
am aware of in dealing with this issue. Their calculation puts the 
annual subsidy just in the United States of America for the fossil fuel 
industry at $700 billion per year.
  So is it my simple math where the social cost of carbon is $280 
billion per year or is it what the International Monetary Fund 
calculated at $700 billion per year? Whichever it is, it is a big 
enough harm to the American public that you would think we might do 
something about it here in the Senate. But of course, we don't because 
that huge social cost of carbon, that huge subsidy gives the fossil 
fuel industry the biggest incentive in the world to--instead of fixing 
up its situation and cleaning up its mess--come over here and instead 
mess with our politics so that our ability to deal with this issue is 
silenced by their political muscle and manipulations.
  One way in which they play this game is to populate the climate 
denial machinery with one-eyed accountants--accountants who can only 
see the pollutants' side of the ledger. Honestly, we hear their 
testimony. The only thing they see is the cost to polluters of reducing 
their pollution. They don't see the public harm side of the ledger. 
They pretend it is a liberal conspiracy cooked up by the Obama 
administration. Or say you are the Republican chairman of the House 
Science Committee and you say: The social cost of carbon is a ``flawed 
value . . . to justify the [EPA's] alarmist reasoning for support of 
the Clean Power Plan and other climate regulations.''
  Actually, if you take away the bad words ``flawed'' and ``alarmist'' 
and all of that stuff, the statement is actually

[[Page 14632]]

true. There is a value to avoiding carbon pollution, and defending that 
public value from the polluters does justify the Clean Power Plan. This 
is the social cost of carbon. Let's go back for a minute to 2006, when 
the Bush administration's National Highway Transportation Safety 
Administration put out a rule for vehicle fuel economy standards. There 
was some dissatisfaction with that rule. States and other stakeholders 
complained that this rule failed to take into account the social cost 
of carbon emissions from cars--something that should matter for a rule 
that is looking to reduce emissions from cars. Well, that went up on 
appeal to the U.S. Court of Appeals for the Ninth Circuit, and in 2007, 
the Circuit Court of Appeals agreed. The court acknowledged that there 
is a cost of carbon pollution, and that cost is ``certainly not zero.'' 
So it told the agency to go back, redo the rule and to come up with a 
real social cost of carbon. Thus was born the legal requirement that 
agencies consider a social cost of carbon in decisions.
  Because of this decision, the Bush administration produced a wide 
range of numbers up to $159 per ton of carbon emissions. The Obama 
administration continued the effort to calculate a social cost of 
carbon. An interagency working group, including scientists and 
economists from across the Federal Government, relied on existing 
scientific literature and on well vetted scientific models to produce a 
first standard in 2010, with additional updates in 2013, 2015, and 
2016.
  When Federal agencies didn't apply any social cost of carbon, courts 
corrected them. In 2014, a Federal judge in Colorado faulted the Bureau 
of Land Management for failing to account for greenhouse gas emissions 
when it approved an Arch Coal mine expansion in the Gunnison National 
Forest. The court suspended the approval until the Bureau of Land 
Management either used the social cost of carbon or gave a valid 
explanation as to why not. When agencies did use the social cost of 
carbon, their decisions were upheld. In 2016 the U.S. Court of Appeals 
for the Seventh Circuit upheld the Department of Energy's use of the 
social cost of carbon in the agency's standards for commercial 
refrigeration equipment. The industry objected, and on appeal, the 
Seventh Circuit said: No, they did the right thing putting that in 
there.
  Just last month, a three-judge panel from another U.S. circuit court 
of appeals--in this case, the U.S. Court of Appeals for the District of 
Columbia Circuit--ruled that the Federal Energy Regulatory Commission 
has to consider the effects of carbon emissions that would result from 
building three pipelines in the Southeast. Specifically, the ruling 
directed FERC to either better calculate the project's carbon 
emissions, using the social cost of carbon, or explain why it didn't 
use it.
  Also last month, another U.S. district court blocked another coal 
mine expansion in Montana, citing the agency's failure to assess the 
environmental effects of coal. Specifically, the judge referenced the 
agency's failure to include any social cost of carbon.
  Just last week a Federal appeals court in Denver told the Bureau of 
Land Management that its lack of analysis on the climate effects of 
four coal leases in the Powder River Basin was ``irrational'' and told 
them to start over.
  It is not just Federal courts. Agencies at the State level are also 
using the social cost of carbon pollution in their activities. The New 
York Public Service Commission affirmed the importance of the social 
cost of carbon in its zero-emissions credit program. The Illinois State 
legislature also incorporated a social cost of carbon into its zero-
emissions credit program, and prevailed in a challenge in the courts. 
These State zero-emissions programs were the programs that were rolled 
out to help existing nuclear energy providers against competition by 
natural gas plants. The carbon price allowed carbon-free nuclear 
generation to better compete in the wholesale markets.
  Up in Minnesota, since 1993, the Minnesota Public Utilities 
Commission has required utilities to consider the estimated cost of 
carbon emissions in planning for new infrastructure projects. This 
year, the commission voted to raise its social cost of carbon to $43 
per ton.
  The Colorado Public Utilities Commission recently ordered the local 
utility Xcel to use the social cost of carbon in its resource planning 
documents. Colorado told its utilities to use $43 per ton starting in 
2022 and to ramp up to nearly $70 per ton by 2050.
  It is not just Federal courts and State agencies. Private companies 
in the United States and around the globe are incorporating the social 
cost of carbon into their own operations and accounting. Investors are 
beginning to demand that corporations perform this kind of analysis in 
order to qualify for investment. Big investors like Black Rock have 
taken on big companies like Exxon in order to break through the denial.
  Just last week, the Washington Post reported that 1,200 global 
businesses either have adopted or are adopting a carbon price in some 
form. The Center for Climate and Energy Solutions found that companies 
like Microsoft, Disney, the insurance giant Swiss Re, Unilever, Shell, 
BP, the mining corporation Rio Tinto, and General Motors have all taken 
steps to put a price on their own use of carbon.
  Courts have made it the law for agencies to use the social cost of 
carbon. States are deploying the social cost of carbon. The business 
community recognizes and is incorporating into its financial planning 
the social cost of carbon. Yet here in Congress and down at the Trump 
White House, the leaders of the Republican Party continue to ignore 
climate change, pretend it doesn't exist, and ignore the very real 
costs that society bears from carbon pollution.
  It goes without saying that the storm that has just ravaged Florida 
was spun up by warmer ocean waters, carried more rain because of warmer 
air, dumped more rain, and pushed storm surge further into Florida 
because of risen seas and those other characteristics.
  Are we seeing any action? No. The President in March issued a 
sweeping Executive order rolling back Federal energy and environmental 
standards. It disbanded the interagency working group, and it asserted 
that the social cost of carbon was ``no longer representative of 
governmental policy.'' Nice try with that, given where the courts are.
  Of course, the House and the Senate Republicans followed suit by 
introducing a pair of bills by Congressman Evan Jenkins on the House 
side and our colleague from Oklahoma, Senator Lankford, on our side 
that purport to prohibit the Federal Government from using the social 
cost of carbon in rulemaking and in regulatory processes. Of course, 
you can't do that, and those laws aren't going anywhere. Why? Because 
they violate a very basic principle both in courts and in 
administrative agencies. That very basic principle is at the heart of 
the rule of law, and it is that facts have to be factual and that 
conclusions have to be logical. Any decision that fails this standard--
that is, to use the administrative law terms ``arbitrary and 
capricious'' or ``not based on substantial evidence''--fails as a 
matter of law. Although Congress, of course, is bound and gagged by the 
polluters and their front groups, it is going to be hard for those 
polluters to try to stop the social cost of carbon in courts and 
administrative agencies. Despite the efforts of ExxonMobil and the Koch 
brothers to make America their fossil fuel banana republic, we still 
are a rule-of-law country and those rule-of-law principles that facts 
must be factual and that conclusions must be logical are too basic for 
our courts and administrative agencies to ignore.
  In our courts and administrative agencies, lying and misleading can 
be exposed on cross-examination, for instance, and lying and misleading 
gets you punished, unlike in Congress where lying and misleading have 
been fossil fuel tactics for decades and sickeningly successful ones 
backed up by huge political muscle.
  The failure in Congress and the remedy in the courts is one reason 
the Founding Fathers designed our government that way so that even 
where political branches of government were

[[Page 14633]]

captured by special interests, there would still be a path for the 
truth, and there would still be a means for justice to have its way.
  If the courts and the States and so many major businesses are all 
behind recognizing the social cost of carbon, who is behind the 
President and our Republican colleagues in denying that it is real? In 
my experience, it is powerful trade associations like the American 
Petroleum Institute, the American Chemistry Council, the National 
Association of Manufacturers, the U.S. Chamber of Commerce, and others 
that have a distaste for any honest assessment of the social cost of 
carbon.
  Right now, since the costs of those industries' pollution is 
offloaded onto the rest of us for free, why not? Why would they want to 
start paying for the harm they cause right now?
  Think tanks and front groups funded by the Koch brothers and other 
polluters have vigorously fought against recognizing the fact of the 
social cost of carbon for years. These groups have neutral sounding 
names--maybe even friendly sounding names--like the Competitive 
Enterprise Institute, the American Energy Alliance, the Heritage 
Foundation, FreedomWorks--my personal favorite--the Heartland 
Institute, a group so good that it put up billboards comparing climate 
scientists to the Unabomber. It is really a classy contribution to the 
debate.
  One thing this crowd of bad actors does know is how to throw its 
weight around, especially since the Citizens United decision threw open 
the floodgates of special interest money into our politics. That is 
what has put Congress in the thrall of the polluters. It is an indecent 
and wrong place for us to be, but with any luck, the adherence of 
courts and administrative agencies to the rule of law--the principles 
that facts must be factual and conclusions must be logical--will help 
us get out of the political trap that the fossil fuel industry has 
constructed.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mr. Kennedy). The Senator from Florida.


                        Hurricane Irma Recovery

  Mr. RUBIO. Mr. President, 2 weeks ago this very evening, I had just 
finished my time as Presiding Officer over the Senate, and I made the 
decision that early the next morning I would be returning to Florida 
instead of staying here the following day. The reason was that at that 
time and in that moment, the strongest storm ever recorded out of the 
Atlantic was bearing down first on the Caribbean and headed not just 
toward Florida but actually toward the city in which I live. Then the 
Nation and State watched over the next few days as that storm took its 
track.
  There has been a lot said about Hurricane Irma since that time. I 
have heard some say that it could have been worse, and I imagine in 
some particular instances perhaps that is true. Had that storm entered 
through Tampa Bay, FL, the loss would have been incalculable. Had it 
hit directly throughout the southeast coast, right through the major 
metropolitan areas of Miami-Dade, Broward, and Palm Beach Counties, the 
economic costs would have been very significant. So it is possible that 
the storm could have had an even greater impact, but it is difficult to 
say that to the people who were impacted by it.
  It was a unique storm in a lot of different ways, like the sheer 
scope of it. One of the things that really perplexed people in Florida, 
including myself--we were thinking perhaps we should move our families 
to another part of the State. We have a very good building code in 
Florida, but there are no structures under our building code that can 
withstand the hurricane winds of a category 4 storm. It is very 
difficult to do that, given the height and level of construction.
  One of the difficult things about figuring out where to go is that 
the whole State was covered by it. It was a huge storm in its size and 
an enormous storm in its impact. I know for a fact that dozens of 
people left South Florida, as an example, and drove to another part of 
the State, only to find themselves actually worse off than they would 
have been had they stayed home. There was no way to know that at the 
time.
  I can tell you, maybe it is because of our history with hurricanes. 
Obviously, in 1992, as a student at the University of Florida, I was 
home, the semester was about to begin, and Hurricane Andrew came 
barreling through there. It fundamentally altered what South Dade 
looked like.
  Whether it was the impact of the storms in 2004 or 2005 or perhaps it 
was the images from Harvey from just a few weeks ago and the impact it 
has had on Houston and the State of Texas, people took the threat 
incredibly seriously, and there was a massive evacuation, perhaps the 
single largest evacuation in the history of the United States.
  In any event, the storm did come. We measure the impact of the storm 
first and foremost by the loss of life, and there were 59 people who 
lost their lives--directly related to the storm in one way or another. 
Eleven of those people died after the storm from carbon monoxide 
poisoning. When power is lost, people run generators, sometimes even 
running them inside their homes. Carbon monoxide gets on them, and 
before you know it, they are dead. At least a dozen more didn't die, 
but they had been poisoned. It is an incredible threat after storms 
that we see every single time.
  Nine people died in Monroe County, some from natural causes, although 
it is hard to imagine that having a heart attack in the middle of the 
storm or in the aftermath wasn't somehow related to the stress such a 
storm brings.
  Of course, we all heard the horrifying news last week that eight 
senior citizens had lost their lives because a nursing home's air-
conditioning unit failed them in the middle of the night. The heat 
became unbearable, and they passed.
  You can only think, despite these horrible tragedies of losing 59 
people, how many more would have died had they not heeded the warnings 
to evacuate.
  So I begin talking about the storm today by thanking the men and 
women who responded before and after the storm--and even during it--who 
kept so many people safe, and they did so even though their own 
families were being impacted by the storm. If you see a police officer 
or a firefighter from a community in Florida, they have homes, they 
have children, they have families, and they, too, are concerned about 
the impact it could have on them. Even as they are out there getting 
the rest of us ready, they have to think about themselves and about 
their own families. We thank them for the extraordinary work they do 
every day but in particular--at this moment--because of the storm.
  We think about the National Guard. These were people who, on Monday 
or Tuesday of that week, were at the accounting firm or doing whatever 
their job might be. They were called up, and within a matter of hours 
found themselves on the road and headed toward an uncertain number of 
days that lay ahead.
  We think of all the people throughout the emergency operations 
centers--from the State center in the capital to all of the counties--
who put in over a dozen hours a day, if not more, preparing to handle 
the storm.
  We thank the Coast Guard for the extraordinary work they do and the 
Department of Defense, particularly the Navy, which were prepared to 
respond--and did so--to the storm, even as many of them were coming off 
similar duty just a few weeks earlier responding to Harvey.
  Of course, we thank the first responders, who came in from all over 
the country. I was in the Florida Keys on Friday, and I ran into 
firefighters and police officers from as far away as Colorado, and we 
thank them for coming all the way to Florida to help us. We could not 
have done it without them.
  I would also be remiss if I didn't thank the National Hurricane 
Center. The improvements that have continued to happen year after year 
have helped improve not just the forecast track of the storm but its 
intensity, even though I can tell you, all hurricanes are bad. 
Obviously, the stronger they get, the more damaging they become. I 
would just say that the work they do--

[[Page 14634]]

we had 5, 6 days to get ready for this, and it all began because of the 
National Hurricane Center. They don't always have that much time, but 
they were able to give us and everyone proper notice. You can't carry 
out these evacuations unless you have accurate meteorological 
information, and they did an extraordinary job and continue to do so 
now, monitoring the new storm that tomorrow is going to make landfall 
over the island of Puerto Rico, potentially as a category 5 but 
certainly a category 4; I will talk about that more in a moment. We 
thank them and so many others. There are so many to mention that we 
would run out of time, but we thank them.
  Let's first talk about some of the challenges. The first challenge, 
as I said earlier, is the scope of the storm. If you know anything 
about Florida, it is a peninsula, the third largest State in the 
country in terms of population. But it is a peninsula that sticks out 
into the Gulf of Mexico and into the Caribbean Basin in the Florida 
Straits. It is a huge State.
  From Jacksonville, FL, in the northeast all the way down to Key West 
is a long distance, and we are talking about a storm that had damage in 
Key West, damage in Jacksonville and the southwest in Naples and the 
central part of the State and the southeast. Literally, the entire 
State of Florida was impacted by the storm because of its size and 
because of the route that it took, and that poses all kinds of 
challenges.
  Our emergency operations system is built on the idea that if two 
counties are hit, all the other counties help respond. Well, every 
county was being hit. Every county was getting ready. So that right 
away put a real strain on our emergency operations system. We were 
counting on other counties being able to help us, but they couldn't 
because they themselves were getting ready to deal with the impact of 
the storm.
  There were prepositioned assets in Alabama and Georgia getting ready 
to come down and help us, but they themselves were also in the track of 
the tropical storm and winds headed in their direction, not to mention 
the impact it had on their ability to get there. So it impacted the 
entire State.
  You know, we have gotten trained, in watching these storms, to see 
images of destroyed buildings. Obviously, that is a terrible thing. We 
lived through that with Andrew, and we have our share of that. If you 
see the images of the Florida Keys, you can tell quickly that a storm 
went through there. But underneath the surface, underneath the 
structures that might still be standing and the roofs that might still 
be intact are deep scars and damage that will be around and will impact 
us for months if not years to come.
  Think, for example, of the Florida Keys. If you haven't been there, 
it is an incredibly unique place. There is only one way in and one way 
out. It is a chain of small islands built on a coral rock formation, 
and it is truly unique. The further south you get in the Keys and the 
further southwest you get as it turns, the more unique it gets. It is a 
place where I have spent many days, especially with our family. Some of 
our best memories with the family were made in the Florida Keys. We 
spent a number of days there not long ago before the storm.
  If you know anything about the Florida Keys, this is not a place with 
Johnny Rockets or TGI Fridays. It has a lot of small businesses, not 
just in the restaurant industry but in the hotels, the bait shops, the 
charter captains, and everything in between. There are a lot of small 
businesses, and many of them are generational businesses. The families 
have been there and have been doing it for 60 years. Those businesses 
are literally going to have no customers now or for the foreseeable 
future. They still don't have power in many places. They don't have 
internet. They don't have fuel. They certainly don't have tourists.
  Imagine for a moment that you are the owner of a small restaurant and 
you have to go 30 to 60 days without any revenue. I can tell you that 
most businesses don't have that kind of reserve, not to mention your 
employees who may not get paid.
  When you think about the Florida Keys, it is an expensive place to 
live because it is a valuable piece of land right on the water, which 
is an enormous challenge for the workforce. The people who work in the 
Keys don't want to drive 3\1/2\ hours a day from South Dade to get down 
to the Lower Keys, or anywhere, for that matter, depending on the day. 
That housing stock in many places is trailer parks, mobile homes, or 
small apartments. The trailers are gone. The apartments have suffered 
water damage, and they certainly are not livable now, in many cases 
because of water and wind damage.
  Think about agriculture. I know Florida is not thought of as an 
agricultural State. I promise you, there is an extraordinary presence 
of agriculture in our State and a great variety of crops.
  Florida is one of the largest cattle producers in the country. You 
don't associate Florida with cattle, but it is an enormous part of our 
agriculture. Our signature crop is citrus, the sugar cane growers, 
fresh vegetables, and the nurseries. The nurseries produce tropical 
plants that you see in big developments or all of the indoor plants. 
Much of that is grown in Florida.
  There are also dairies. Florida is a dairy provider to much of the 
Southeast. Every single one of them has suffered significant damage 
and, in the case of a couple of them, catastrophic damage.
  The citrus industry was already being hurt by citrus greening, a 
disease that kills trees. Senator Nelson and I went to a grove two days 
after the storm, and more than half the fruit was already gone and more 
was dropping. That fruit is gone. Those farmers live off of that fruit. 
The whole fruit goes to the whole fruit market, and the bulk of it goes 
to the juicing market. Much of it was green. So it wasn't even ready to 
pick. But once it hits floodwater, it cannot be used or sold. The FDA 
says it can no longer be consumed safely. They lost all of it, on top 
of the fact that their yields were already lower because of greening. 
They lost the fruit they had.
  It gets worse. They lost trees. It is not simple. You don't just go 
to Home Depot and buy an orange tree and next year it produces oranges. 
These new trees take at least 4 years before they begin to produce the 
fruit to sell, if it survives greening. They lost trees, and they are 
still losing fruit, and they will still lose more trees because all of 
those groves are under water. All that water is sitting on the roots, 
and those trees will not survive. This is a catastrophe.
  I don't mean to leave anything out. I can tell you the truth that 
there will be no Florida fresh vegetables. There will be no Florida 
vegetables in November. Those green beans that many of you eat on 
Thanksgiving Day will not come from Florida. We will have to make up 
the gap from foreign producers because that crop is gone entirely. I 
don't mean to leave anything out. I am just stating that the hit to 
agriculture was extraordinary. Unfortunately, for agriculture, this has 
happened, but there has not been a lot of media coverage about it 
because not a lot of agriculture is near metropolitan centers. There is 
not a lot of media coverage.
  Look, I am not here to beat up on the media. I thank the media, and I 
have done so because a lot of the work they did on the national and 
local news was what got people motivated to get up and go and get out 
of harm's way. But there are not a lot of camera crews stationed live 
in a citrus grove. So the power gets put back on and the schools 
reopen, and most people forget that these farmers--most of them--are 
not wealthy landowners. Some of these are fourth generation growers who 
have been on that land and are producing and are already stretched 
because of some of the challenges they have, whether it is with trade 
or citrus greening or whatever the challenges might be. It has just 
gotten worse for them.
  Do you know who else got hurt? The entire industry that serves them. 
Everyone in the towns built around them. This is big trouble. It is 
truly a catastrophic agricultural event in every part of the State. 
Virtually none of

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Florida's agriculture went without being impacted by this.
  I think about the migrant workers who work there. Some were afraid to 
come forward because of their immigration status. They thought that, if 
they showed up at a shelter, they would be deported, but more 
importantly, in terms of life, some of them have nowhere to live. Their 
housing, to begin with, is precarious. A lot of the mobile homes are 
damaged by water. There is no electricity. They are not near a 
metropolitan center, and they are afraid to come out. Thank God for so 
many groups that have come forward to try to help them.
  We scoff about power outages. I don't know how people lived in 
Florida before the invention of air conditioning with the heat and 
humidity. It is an inconvenience for a lot of people, but it is life 
threatening in the case of senior citizens or people who require 
refrigerated pharmaceuticals for their survival. It has had an 
extraordinary impact on them.
  All of these circumstances have a true impact and are among many of 
the challenges that we now face. There is a special focus, for example, 
on Monroe County, in the Florida Keys. This storm threatens to 
fundamentally alter the character of Monroe County if we do not help 
the Florida Keys, because these trailer parks are on valuable land, and 
the owners of that land are going to be tempted to build on them, not 
mobile homes, again, but to build structures designed for visitors that 
have more money. That means that we will lose our housing stock, but 
ultimately it means that we will lose the character of the place--all 
of the small businesses that service the fishing boats and the diving.
  We have some of the greatest collections of coral reefs in the world 
right off Marathon, by Sombrero Key in the Florida Keys. All of that 
will be out of business for a long time. Can they survive? I don't 
know.
  There are small business owners that might own an apartment building. 
They use it in the summer for their family and rent it in the winter. 
It is damaged. So they can't rent it this year. So guess what. They may 
not be able to pay the mortgage, which will lead to foreclosures.
  I mentioned agriculture. I don't know how Florida agriculture--
particularly citrus--can recover from the storm without significant 
help.
  This storm exposed a real vulnerability to a State with so many 
senior citizens. It is not just the nursing homes and the ALFs. We have 
apartment buildings, section 8 HUD housing and the like--entire 
apartment buildings with 13, 14 stories. There are towers of apartment 
buildings populated by senior citizens. What happens when the power 
goes out? The first thing is that all of the food in their 
refrigerators rots. So within 48 hours, I don't care how much they 
stored for the hurricane, they can no longer eat a lot of the food they 
need for their nutrition.
  You might say: Why don't they get up and go see to a relative's or go 
somewhere where they are handing out food?
  They are on the 13th or 12th floor of a building where the elevator 
doesn't work. They can't walk down 13 flights of stairs. This exposed a 
real vulnerability that we will have to examine.
  Then there is debris removal. Some of these counties are small 
counties. Some of these counties still owe money from storms last year. 
FEMA dispersed the funds to the State. The State hasn't dispersed it to 
them yet. Now they have to go out and hire, and they need hundreds of 
millions of dollars to clean up these roads, and they don't have that 
in their budget. There is a huge strain in that regard.
  Senator Nelson and I spent 2 days together traveling last week. We 
will continue to work together to help so many different people. On 
Friday we had an event in Immokalee, which is a migrant community in 
Southwest Florida, and 800 people applied for assistance.
  We were in St. Augustine yesterday, and close to 1,000 people applied 
for assistance.
  In Jacksonville today, there were 1,800 people applying for 
assistance. We will be going to Naples, FL, and Fort Myers later this 
week. We will be back in Immokalee again on Friday, and we are about to 
start out in the Florida Keys helping people.
  It is funny. They say: FEMA--go online and apply there. Here is the 
problem, when you have no internet and no power, how do you go online 
and apply? So we are trying to get out there to help as many people as 
we can.
  Now, I don't want to leave on a negative note. There is nothing 
positive about a storm, but there are some uplifting things to point 
out. I will be brief and to the point. I am uplifted by these crews 
sent down by the Church of Jesus Christ of Latter Day Saints, or the 
LDS church, who are out there helping people who can't afford it or who 
don't know how to do it. Professionals are out there helping people cut 
down trees and remove debris from their homes and put tarps on their 
roofs. They are volunteers who came on their own to do it. I was 
uplifted on Saturday by visiting the North Carolina Baptists' men's 
relief society, who were in South Florida, and 120 people were 
preparing hot meals to send down to the Florida Keys. They have fed 
thousands of people in a very impressive operation. I am uplifted by 
the Red Cross volunteers from New York and New Jersey who I have run 
into who flew down, rode out the storm, and were there working in the 
shelters. I am uplifted by stories of school principals who took over 
these shelters because people didn't show up to run them who were 
supposed to show up. So these principals, custodians, and cafeteria 
managers showed up and took care of all these people. I am uplifted by 
stories like the one today in Jacksonville, where a gentleman and his 
wife who were disabled came forward. They lost their home and they had 
to be saved from floodwaters. They were living in temporary housing. A 
donor had put them up for a week. It ran out, and they had nowhere to 
go tonight. We were able to match them with a donor, who insists on 
remaining anonymous, for another week of temporary housing while, 
hopefully, we can get them the housing they need.
  One of my favorite stories--and I believe Senator Nelson shared this 
the other night--is this one that I wanted to close with. He and I ran 
into this at Ave Maria Catholic University, which is literally out in 
the Everglades, between Naples and Miami. We went out there to visit, 
and we were told extraordinary stories of some of their students.
  On the night before the storm, there were about 300 migrants from 
nearby communities--many of whom are probably undocumented, in the 
country illegally--who didn't want to evacuate. They were afraid of 
being deported. Ultimately, they saw that the storm was bad. They 
showed up at Ave Maria. Ave Maria opened its doors and welcomed them 
into the gym. There were students who stayed behind and played with the 
kids, entertained the kids throughout the storm, and took care of them.
  What was really uplifting was the story of two nursing students. 
Right before the storm hit, right before you could no longer go out, 
the sheriff's office shows up at Ave Maria with eight seniors from a 
nearby ALF. The staff at the ALF quit. They literally left. They didn't 
show up. They abandoned them. The sheriff's office brings them, and 
these two nursing students bring the eight seniors into their dorms. 
They brought them into the women's dorm and cared for them for two 
days, triaging the medicine they needed to take, understanding how to 
do this, that, and the other. These are amazing stories about these 
young people. If there is any doubt about the future of America, think 
about the extraordinary work these young people put in. Nobody told 
them to do it. They could have left. They could have gone back to 
wherever they were from, but they stayed and took care of them.
  We have a long way to go, but we want to thank all the people for the 
great wishes we got from all of my colleagues and from people around 
the country. This is a storm that impacts Florida in ways we are going 
to feel for a long time.
  Let me close by asking all of you to take a moment tonight, if you 
can and

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you wish, to pray for the island of Puerto Rico, a U.S. Territory, 
where millions of our fellow Americans are staring down the barrel of 
the most powerful storm that ever has perhaps hit that island, and this 
after already getting hit by Irma just a week ago. It has the potential 
to be an extraordinary catastrophe. We pray that is not the case. I 
hope we stand ready to assist our fellow Americans on the island of 
Puerto Rico. Let's pray for them tonight because tomorrow morning is 
going to be a very difficult time for them as this extraordinary 
hurricane, Hurricane Maria, is about to slam right into them.
  With that, I yield the floor.
  The PRESIDING OFFICER. The majority leader.

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