[Congressional Record (Bound Edition), Volume 163 (2017), Part 3]
[Senate]
[Pages 4151-4168]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           EXECUTIVE SESSION

                                 ______
                                 

                           EXECUTIVE CALENDAR

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to executive session to resume consideration of the following 
nomination, which the clerk will report.
  The senior assistant legislative clerk read the nomination of Seema 
Verma, of Indiana, to be Administrator of the Centers for Medicare and 
Medicaid Services.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, I rise today to speak in favor of the 
nomination of Seema Verma to serve as the Administrator of the Centers 
for Medicare and Medicaid Services.
  I think we can all agree that this is a critical time for healthcare 
in America. Health costs continue to rise, and patients face growing 
uncertainty over coverage. At the same time, the health of too many 
Americans continues to decline, healthcare costs continue to grow, and 
millions of new baby boomers are becoming eligible for Medicare each 
and every year.
  I might add, you heard the minority leader talk today as if Democrats 
have had nothing to do with all of this mess. Much to the contrary. 
Congress and our new President face intense pressure to address these 
challenges, and the stakes are very high. I am confident that Ms. Verma 
is up for that challenge. She has over two decades of experience 
working with State healthcare and industry leaders to reform and 
improve services for the most vulnerable members of our community. Ms. 
Verma's experience as an entrepreneur and industry leader allowed her 
to work extensively on a wide variety of policy and strategic projects 
involving Medicaid, insurance, and public health in conjunction with 
the Indiana Governor's office, State Medicaid agencies, State health 
departments, State departments of insurance, the Federal Government, 
and private companies and foundations. She has had a tremendous amount 
of experience in those areas, and I have every confidence that she will 
be a great leader. There are few professionals in the country who have 
her level of close relationships with State leaders that will be 
critical as Congress and the administration work to repeal and replace 
the Affordable Care Act--the so-called Affordable Care Act; it is 
anything but affordable.
  Medicaid represents an enormous burden on State budgets, and we now 
have an unprecedented opportunity to reform a Federal entitlement 
program long in need of structural changes. Ms. Verma is the ideal 
candidate to oversee the reform of the Medicaid Program and take steps 
administratively to give States the flexibility they have been 
clamoring for.
  In Indiana, Ms. Verma worked with Governors Daniels and Pence to 
design a Medicaid expansion program that extended health coverage to 
nearly 400,000 low-income working Americans. She did so in a way that 
empowered people to take greater responsibility for their own health by 
providing incentives to use healthcare resources efficiently. The 
program ensured that many people got health care coverage for the first 
time. Now this innovative program has become a national model for other 
States.
  Ms. Verma's experience will be invaluable as we work together to 
improve healthcare across the country and bring down the costs thereof. 
In addition to her work in Indiana, Ms. Verma has developed several 
other Medicaid reform programs, including 1,115 Medicaid waivers for 
Iowa, Ohio, and Kentucky. Her firm helped design Tennessee's coverage 
expansion proposal and also provided technical assistance to Michigan 
when the State implemented its Medicaid waiver. She also helped guide 
the transition of Iowa's Medicaid Program to a managed care program and 
supported strategy efforts for Maine's Medicaid plan.
  Having dealt with CMS in her capacity as a consultant working on 
these myriad projects, she knows firsthand what is needed to make the 
programs work effectively. Her job as CMS Administrator will not be 
easy, and that is a heck of an understatement.
  CMS is the world's largest health insurer. It has a budget of over $1 
trillion

[[Page 4152]]

and processes over 1.2 billion claims a year for services provided to 
some of our Nation's most vulnerable citizens receiving Medicare and 
Medicaid. As such, this is a critical agency, and we need a qualified, 
dedicated leader at the helm. She is certainly that.
  In addition to ensuring that Medicare and Medicaid work effectively, 
Ms. Verma will also be charged with helping to ensure the longevity and 
solvency of the Medicare trust fund, which is projected to go bankrupt 
in the year 2028. Maintaining the solvency of the Medicare Program 
while continuing to provide care for an ever-increasing beneficiary 
base is going to require creative solutions, skillful administration, 
and a lot of knowledge and experience.
  All told, between now and 2030, 76 million baby boomers will become 
eligible for Medicare. Even factoring in deaths over that period, the 
program will grow from approximately 47 million beneficiaries today to 
roughly 80 million beneficiaries in 2030. This will also create 
challenges that will require steady leadership and, at times, decisive 
action.
  I believe Ms. Verma is especially qualified to lead CMS and modernize 
its programs to increase its effectiveness of healthcare delivery. She 
brings the experience and, importantly, bipartisan solutions that can 
and should unite people across the political spectrum in addressing 
some of the greatest challenges in our healthcare system.
  Ms. Verma has a keen understanding of patients' needs. She certainly 
has the expertise to create a healthcare law that this country needs 
and improve the lives of the 100 million Americans covered by Medicare 
and Medicaid.
  At a time when the healthcare challenges we face are very real and 
extremely complex, our Nation needs leaders, like Ms. Verma, who have 
demonstrated their ability to deliver results.
  I know that many people have different ideas about the best direction 
for the Medicare and Medicaid Programs and how we should meet the 
complex challenges facing CMS. While we can disagree on policy, we 
should all agree that the agency needs smart, experienced leadership at 
its helm.
  That being the case, I urge all of my colleagues to join me in 
supporting Ms. Verma's nomination to this important position. I 
personally am very grateful that she is willing to dive into this very 
difficult process and these problems right in the middle of politics 
being played and that she is willing to do the job America needs at 
this particular time, especially for those who need healthcare.
  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. LEAHY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                         Wiretapping Allegation

  Mr. LEAHY. Mr. President, there are a couple of issues that I will 
speak on, but I was asked earlier this morning about what President 
Trump has tweeted, basically charging former President Obama with 
having spied on him in a way that would be plainly illegal. Of course, 
President Obama's advisers have denied any such thing happened. If it 
did happen, of course, it would be a grave constitutional issue, and if 
such a thing did happen, it would be criminal conduct. Now, many people 
are saying: Well, is it true or not? Was Mr. Trump telling the truth in 
the tweet or not? There is a very simple response on this. There is one 
person who knows whether it is true or not, and he has been totally 
silent on this.
  They asked Attorney General Sessions. Attorney General Sessions made 
it very clear in his confirmation hearing--well, he said a number of 
things in his confirmation hearing, but one was, of course, that he 
would be independent. President Trump has leveled very serious charges 
against former President Obama. I happen to feel the charges are false, 
but let's have a definitive voice. The Attorney General should have the 
courage and independence to simply say whether Mr. Trump is telling the 
truth or not. It is a very simple matter. I would hope that the press 
and everybody else would keep asking because eventually somebody has to 
answer that question, and the Attorney General can.


                      Nomination of David Friedman

  Mr. President, the Senate will soon consider the nomination of David 
Friedman to be U.S. Ambassador to Israel. Unlike several of President 
Trump's other nominees, we know a great deal about Mr. Friedman's views 
on the challenges he would confront if he were confirmed. 
Unfortunately, this is because he has made a career of disparaging and 
inflammatory statements about U.S. policy in the Middle East, about 
former U.S. officials, about the Palestinians, even about American Jews 
who have views that differ from his own.
  We have all had the opportunity to read articles Mr. Friedman has 
written. We have heard the outrageous, unfounded verbal attacks he has 
launched against those who disagree with him. He has written falsely 
that President Obama and Secretary Kerry engaged in ``blatant anti-
Semitism,'' that the liberal American Jews are ``far worse than 
kapos,'' and that they ``suffer a cognitive disconnect in identifying 
good and evil,'' that the State Department has a ``hundred-year history 
of anti-Semitism,'' because diplomats appointed by both Republican 
Presidents and Democratic Presidents have not always seen eye-to-eye on 
every issue with Israel's leaders. He has said that Israel's policy of 
``criticizing disloyal Arab citizens while simultaneously bestowing 
upon them the benefits of citizenship simply isn't working.''
  Well, those comments alone should disqualify him for this sensitive 
position, and it is no surprise that tens of thousands of Americans 
have signed petitions circulated by pro-Israel groups opposing his 
nomination.
  Mr. Friedman has also raised millions of dollars for Israeli 
settlers, and he has bragged about the effort to remove the two-state 
solution from the Republican Party's platform, even though Democratic 
and Republican Presidents have supported it. Regarding the two-state 
solution, he wrote: ``It is more of an illusion that serves the worst 
intentions of both the United States and the Palestinian Arabs,'' in 
one of the many articles he has written for a rightwing Israeli media 
outlet. That unequivocal renunciation of longstanding U.S. policy 
should also by itself disqualify him from the job of Ambassador to 
Israel.
  These statements and actions not only indicate his rejection of 
decades of Republican and Democratic policy. They are the words of 
someone who makes a mockery of the term ``diplomat'' and who has 
demonstrated no ability to be objective and constructive on sensitive 
issues of immense importance to U.S. security.
  Our diplomats are supposed to be representing the American people and 
the policies of the United States first and foremost. They are not sent 
to a foreign country to represent the government or people of that 
country in a manner that is inconsistent with U.S. policies and U.S. 
interests. They are there to represent us.
  Mr. Friedman is certainly entitled to his own views as a private 
citizen, even if they are offensive and counter to U.S. interests and 
values. But can anyone honestly say that this nominee is qualified or 
suited to represent the American people in Israel?
  Five former U.S. Ambassadors to Israel who served under Republican 
and Democratic Presidents--from Ronald Reagan to Barack Obama--are 
among the thousands of Americans who say that the answer to that 
questions is no.
  We are being asked to reconcile Mr. Friedman's record, his personal 
views, and his deep ties to extreme factions in Israel with his 
responsibility to objectively advance and defend U.S. interests. Unless 
one believes, as he has repeatedly made clear he does, that the 
interests of the United States are always identical to Israel's, there 
is no way Mr. Friedman should be confirmed.

[[Page 4153]]

  For as long as I have been in the Senate--and I note that is longer 
than anybody who is serving here now--I cannot recall a time when we 
were not at a critical point in our relations with Israel, not because 
of doubts about the enduring value of the relationship but as a 
reflection of the importance of the deep partnership between our 
governments and our people--a deep partnership that we have all 
supported and that Republican and Democratic Presidents have supported. 
Most importantly, it is a result of our conviction that security, 
stability, and prosperity in Israel and the wider region are important 
to our own national security.
  That is why President Obama signed a memorandum of understanding with 
Israel that included the single largest pledge of U.S. military aid to 
any country--to any country anywhere in the world, ever--and why both 
Democratic and Republican administrations have put so much effort into 
pursuing peace between Israelis and Palestinians.
  An alliance as longstanding as ours with Israel, which has far-
reaching consequences for the entire Middle East and beyond, requires 
effective daily management by an experienced diplomat who has not only 
knowledge of the region but the necessary temperament and appreciation 
of our country's short- and long-term interests.
  I was here when President Sadat and Prime Minister Begin negotiated 
what was a very difficult peace agreement between the two of them, with 
both of them putting the interests of the region first. That agreement 
has lasted. I also remember when Prime Minister Rabin and King Hussein 
of Jordan--who had fought against each other--personally negotiated a 
peace agreement, and the United States strongly supported that. In 
fact, I was privileged to be there when they signed the agreement at 
Aqaba, as I was present when Prime Minister Begin and President Sadat 
signed their agreement.
  I do not see how anyone could conclude that Mr. Friedman possesses 
the requisite temperament, nor am I convinced that he appreciates the 
critical distinction between the interests of our country, the United 
States, and the parochial interests of an extreme constituency in 
Israel who he has fiercely advocated for over the course of his long 
career.
  Indeed, it is telling that the spokesman for Beit El, the Israeli 
settlement that Mr. Friedman has supported financially for years, said 
its inhabitants would regard him as their representative in the United 
States. These are Israelis. Their representative in the United States 
is the Israeli Ambassador. It is not the role of a U.S. Ambassador to 
represent another country, but that is how Mr. Friedman is perceived in 
Israel because that is the way he has behaved.
  Every U.S. President has understood the importance and the heightened 
sensitivity of this post, and they chose their nominees accordingly--
both Republican and Democratic Presidents--until now. That is why every 
previous nominee to be Ambassador to Israel has been confirmed by a 
voice vote or by unanimous consent, while Mr. Friedman was voted out by 
a narrow 12 to 9--largely party line vote--in the Foreign Relations 
Committee.
  Mr. Friedman's confirmation hearing provided him the opportunity to 
assuage concerns about his divisiveness, including the many disparaging 
remarks he has made and his close identification with and support for 
the Israeli settler movement.
  During the hearing he renounced his undiplomatic language, suggesting 
it was delivered in the heat of the election cycle and in his capacity 
as a private citizen. In fact, he recanted so much of what he had 
said--which far predates the election cycle--that Foreign Relations 
Committee Chairman Corker asked why he was willing to disavow so much 
of his past record in order to earn the committee's support.
  In response, Mr. Friedman described the role of the U.S. Ambassador 
to Israel as ``the fulfillment of a life's dream, of a life's work, of 
a life of study of the people, the culture, the politics of Israeli 
society.''
  I would say two things about that. One, I recall a nominee for 
another position who, when asked questions about extreme positions he 
had taken for years, started disavowing them all, and I finally asked 
him: Are you having a confirmation conversion? That nominee--the 
nominee of a Republican President--when he came before the Senate, was 
defeated because of Republican votes, as well as Democratic votes.
  I always worry about a confirmation conversion. When a nominee 
rejects years and years of deeply held beliefs during those 2 or 3 days 
of the confirmation hearing, I wonder how long it will last.
  There is an important distinction between knowing and respecting a 
country's history and people and believing that one's own personal 
ambition and that country's interests are inextricably linked. Mr. 
Friedman's remarkable confirmation conversion falls far short of 
convincing evidence that changing his title to ``Ambassador'' will 
cause him to divorce his life's work and objectively serve the national 
interests of the United States.
  If Mr. Friedman is confirmed, he should immediately untangle his 
business and personal interests in Israel and commit to being the 
representative of all Americans--conservative and liberal Jews, 
conservative and liberal non-Jews--and being a genuine partner in 
efforts to promote security and stability for Israelis and Palestinians 
alike, not just because it is in their interests, but because it is in 
the interest of the United States.
  We all want what is best for the American people. We also share a 
desire to find a viable solution to the Israeli-Palestinian conflict 
that protects the rights and security of both peoples. Neither goal can 
be achieved by pursuing policies that further inflame tensions in the 
region and erode the role of the United States as an honest broker for 
peace. There are a large number of qualified Americans from both 
parties who could capably support that role. Mr. Friedman is not among 
them.


                       Nomination of Neil Gorsuch

  Mr. President, on another matter, this week is Sunshine Week. It is a 
time when we rededicate ourselves to transparency in government. It is 
important to all of us. We celebrate one of our Nation's most defining 
characteristics: that a government of, for, and by the people does not 
operate in secret. Our democracy depends on an informed public, and it 
is critical that public officials be truthful with the American people; 
yet we are not even 2 months into this Presidency, and it is clear that 
the administration is not meeting that standard.
  The Attorney General has yet to come forward and tell us whether the 
President was telling the truth when he accused President Obama of 
breaking the law and spying on him, and the President's nominees have 
shown a real and stunning indifference to the truth. His nominees to 
lead the Treasury Department, the EPA, HHS, and the Justice Department 
have all misled Congress while testifying under oath.
  I am disturbed that Senate Republicans continue to look the other 
way. At some point, they must put country over party. But as these new 
officials take control of their agencies, I remind them that our laws 
demand an open and transparent government. Last year, Congress took a 
strong step to reaffirm our commitment to an open government. We passed 
the FOIA Improvement Act, which is a bipartisan bill. I coauthored it 
with the deputy Republican leader, Senator Cornyn of Texas. It was the 
most significant reform to the Freedom of Information Act in over 50 
years. It codified the ``presumption of openness.'' It put the force of 
law behind the notion that sunshine, not secrecy, is the default 
setting of our government. Given what we have seen thus far from this 
administration's nominees, transparency, accountability, and open 
government are more important than ever.
  I hope next week, when the President's Supreme Court nominee will 
appear before the Senate Judiciary Committee, he provides transparent, 
truthful answers to Senators' questions.
  I will insist on real answers from Judge Neil Gorsuch because there 
are real concerns about his record and his judicial philosophy. Judge 
Gorsuch went to some of the world's best universities--Columbia, 
Harvard, Oxford--

[[Page 4154]]

so it is not surprising that he knows how to make a good impression, 
but that cannot be the standard for a Supreme Court nominee. The U.S. 
Senate cannot simply rubberstamp a nominee because he went to the right 
schools and looks good on TV.
  Neil Gorsuch has been a judge for over 10 years, and it is clear from 
his writings on and off the bench that he has a well-developed judicial 
philosophy. He appears to strongly identify as an originalist, in the 
mold of Justice Scalia or Justice Thomas. It has been more than 25 
years since an originalist was nominated to the Supreme Court, so I 
expect that Senators will want to understand how Judge Gorsuch would 
apply his philosophy to the cases that would come before him, if he is 
confirmed to the Supreme Court. Would he rule in the same way as 
originalists like Justice Scalia, Justice Thomas, and Judge Bork, who 
have been deeply hostile to the individual rights and liberties 
protected by our Constitution? I want to hear directly from him on this 
important question.
  It is one thing for legal academics to debate their preferred 
theories, including originalism. But the Supreme Court is not a 
debating society that deals in abstractions--its decisions affect every 
one of us. Our Federal courts are where Americans go to have their 
rights vindicated, whether against big corporations or the government 
itself. Our Federal courts do not exist so that judges have a place to 
propound their particular philosophies.
  I want to make sure that Judge Gorsuch understands that distinction, 
and I want to understand just how his philosophy would have been 
applied to important cases. For example, how would someone with his 
philosophy have ruled in cases upholding fundamental rights, such as 
Miranda rights, a woman's right to make her own medical decisions, and 
marriage equality?
  We also cannot ignore the fact that Judge Gorsuch was nominated by 
President Trump only after being vetted by extreme interest groups who 
did all of that in secret. They are certainly not transparent. It is 
alarming and unprecedented for a President to outsource the nomination 
process in this way. The President's top adviser then assured attendees 
at a conservative conference that they knew Judge Gorsuch has ``the 
vision of Donald Trump.'' That is the same Donald Trump, of course, who 
called the media the ``enemy of the American people.'' The President 
could not be more wrong.
  As we note during Sunshine Week, our Constitution provides for the 
freedom of the press because a democracy cannot survive without it. 
Citing James Madison, the Supreme Court in New York Times v. Sullivan 
described the ``public discussion of the stewardship of public 
officials'' as ``a fundamental principle of the American form of 
government.''
  It was Supreme Court Justice Louis Brandeis, a staunch believer in 
open government, who famously said that sunlight is the best 
disinfectant. It is often the press that shines the sunlight in dark 
corners where we need it most. It serves as a critical check on our 
government. It shines a light on corruption, exploitation, and excess. 
My parents owned a weekly newspaper before they started their printing 
business. I was brought up to believe in the importance of the First 
Amendment. I question whether a Justice with ``the vision of Donald 
Trump'' would uphold the freedom of the press.
  Sunshine Week's emphasis on transparency will not be just this week; 
it should continue into the hearings next week. The Supreme Court has 
been the least transparent part of our government, and these hearings 
will be one of the only opportunities for the American people to get a 
glimpse into the institution that protects their most essential rights. 
There are real questions about the kind of Justice Neil Gorsuch would 
be. He needs to answer them openly and honestly, not with the kinds of 
dodges and misrepresentations we have heard from other Trump nominees.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded
  The PRESIDING OFFICER. Without objection, it is so ordered.


                       Republican Healthcare Bill

  Mr. DURBIN. Mr. President, last Friday, I went to Rockford, IL, and 
had a roundtable discussion about healthcare. There is a lot of debate 
about healthcare in the Congress and certainly in Washington. What I 
have tried to do is to take this issue home and ask the people who 
actually are responsible for providing healthcare, and the people I 
represent, what they think about the new Republican alternative to the 
Affordable Care Act. What I found is that with virtually no exceptions, 
they are all gravely concerned that the changes that are going to be 
made to the healthcare system in America, which represents a dramatic 
portion of our economy, could have a very negative impact on the real 
lives of people across my State and across the Nation.
  Hospital administrators were there to talk about this issue. Swedish 
Covenant is one of the hospitals well known and respected in the area; 
OSF as well, and the administrators of both of these hospitals talked 
about the negative impacts of cutting back Medicaid coverage.
  What the Republicans are suggesting in their proposal is that the 
expansion of Medicaid to provide health insurance for low-income 
Americans would continue until 2020 and then be cut off, and, they 
would argue, we will make it more cost efficient. We will let the 
Governors come up with alternatives. Well, the Governors aren't very 
happy with this because they know the cost of healthcare continues to 
go up and they are fearful that when you try to put this all together, 
the net result is fewer people covered by Medicaid.
  Over 600,000 people, because of ObamaCare--the Affordable Care Act--
in Illinois now have health insurance. Who are they? Well, I met Ray 
Romanowski. Ray, a big Polish American fellow from Chicago, is a 
musician, and he has made most of his income during his life doing work 
as a musician. Ray Romanowski, in his 60s today, has never had health 
insurance until now. Because of the Affordable Care Act, he qualifies 
for Medicaid, and because he has Medicaid--he patted his wallet and 
said: I finally have that card in my wallet where I can walk into a 
hospital or a clinic and get good treatment.
  It is the first time in his life, and he is in his sixties.
  Judy is a friend of mine in Southern Illinois, and she works at local 
motels there--in hospitality--at places where they serve breakfast to 
you. She gets up early in the morning. She is a hard-working lady. It 
is the kind of job she has had her entire life, and she never, ever had 
health insurance--not once. She worked 20, 30, 40 hours a week, 
sometimes two different jobs, but never with health insurance. Now she 
has it because of the Affordable Care Act, and thank goodness she does 
because she has been diagnosed with diabetes and she needs that kind of 
care.
  So what happened before, when people like Ray and Judy got sick? 
Before the Affordable Care Act, they would show up in the hospital, go 
to the emergency room, and they would get treatment, but they wouldn't 
be able to pay for it. What happens to those expenses at hospitals, 
under the old way of doing things? They are passed along. The rest of 
us pay. Anyone who has health insurance and goes in for treatment, part 
of it is going to be what your treatment is or for your family; the 
other part is to make up the difference for charity care, uncompensated 
care.
  Now the Republicans believe they have a new idea: Let's restrict 
access to Medicaid. Let's restrict the health insurance that is 
available to people like Ray and Judy. Well, they are still going to 
get sick, and they are still going to come to the hospital, and their 
costs are going to be passed along to others.
  The Speaker of the House, Paul Ryan, a neighbor from the State of

[[Page 4155]]

Wisconsin, said that it is all about competition and choice. Well, when 
it came to competition and choice, Ray and Judy didn't have a chance. 
They just didn't make enough money. But they did get coverage under the 
Affordable Care Act, and they stand to see that coverage endangered, if 
not lost, under this new approach.
  We also had representatives of the nursing association in Illinois. 
These are women and men who are the most respected medical providers. 
Just take a look and ask whether people have higher respect for doctors 
or whomever; it is always the nurses, No. 1, because the nurses are the 
ones who are there day in and day out, hour after hour, in the hospital 
rooms with the people we love who desperately need medical care. The 
nurses are opposed to this Republican replacement plan as well.
  The doctors--the American Medical Association and the Illinois State 
Medical Society--are also opposed to it because they looked at the 
Republican competition and choice alternative and said that at the end 
of the day, fewer people will have health insurance and the costs will 
go up dramatically for some. We had a representative of the American 
Association of Retired Persons there, and they are especially opposed 
to it. Why? We had a provision in the Affordable Care Act which said 
that the disparity in premiums can never be more than 3 to 1. Well, the 
Republicans decided as part of their replacement to make that 5 to 1. 
Who is going to pay five times instead of three times the base premium? 
Seniors, those over the age of 55. The Republicans built this into 
their proposal, and AARP has come out against it.
  The second thing to go is--the Affordable Care Act has really brought 
some savings to healthcare; we wish there were more. But that savings 
in healthcare is translated into 10 more years of solvency for 
Medicare. Medicare is a lifeline for 40 million or 50 million 
Americans. So we gave it 10 more years of solvency with the changes in 
the Affordable Care Act. Now we are waiting for a score from the 
Congressional Budget Office, but the early indications are we are going 
to lose 4 years of solvency in Medicare because the Republicans want to 
bring in ``competition and choice.'' It turns out that phrase is not 
going to be good for the future of Medicare--one of the other reasons 
the American Association of Retired Persons opposes the Republican 
proposal to replace the Affordable Care Act.
  This bill will be scored this week by the Congressional Budget 
Office. It was interesting to watch the Sunday shows and watch the 
procession of Republicans calling themselves fiscal conservatives who 
came in and discounted any conclusions from the Congressional Budget 
Office. Interesting.
  When we wrote the Affordable Care Act, we waited sometimes for weeks 
for the Congressional Budget Office to give us a score: Is this bill 
going to add to the deficit or reduce the deficit? We had to wait to 
find out. Is this bill going to cover more people with health insurance 
or not? We had to wait to find out. But the Republicans went ahead with 
their proposal without a Congressional Budget Office score, and what 
they have done over the weekend is downplay the credibility of an 
office which Democrats and Republicans have relied on for decades. It 
shows that they are very concerned. I think they know what they are 
going to find. They are afraid it is going to add to the deficit and it 
is going to dramatically reduce health insurance for Americans.
  There are some who estimate that 10 million to 15 million Americans 
could lose their health insurance. That is half of all of those in the 
past 6 years who have gained health insurance. It would also increase 
out-of-pocket healthcare costs for the average person--the Republican 
plan would--by $1,500 a year, seniors paying approximately $5,000 more 
a year because of that 5-to-1 premium change that I mentioned earlier. 
It would basically end Medicaid as we know it.
  The Governors are telling us that this is a bad idea because it would 
shift the cost onto the families and to the Governors to find ways to 
save money.
  It would shorten the solvency of the Medicare trust fund by 4 years.
  It would allow insurers to once again charge older people 
significantly more than younger people for health insurance.
  And--Republicans added a little grace note there--they defund Planned 
Parenthood and cut 12 percent of the funding for the Centers for 
Disease Control and Prevention.
  Here is something my colleagues may not know. Because of family 
planning efforts in America, in the last 30 years, we are now at the 
lowest point in teenage pregnancies and the lowest point in unplanned 
pregnancies. So information and education are paying off to reduce 
unwanted pregnancies, unplanned pregnancies, and, I might add, the 
likelihood of abortions. So now, as the Republicans say we are going to 
defund Planned Parenthood for hundreds of thousands of women, that 
means stopping their access to the healthcare they trust across 
America. So in the name of choice, the Republican plan reduces choices 
for women when it comes to healthcare by defunding Planned Parenthood.
  To top it off, the bill cuts taxes for the very wealthy. Those making 
over $1 million a year in income get a $50,000 tax cut because of the 
Republican proposal for this new health insurance approach. If you 
happen to be in the wealthiest 0.1 percent of Americans, the average 
tax cut is nearly $200,000. They just can't help themselves.
  We put together a revenue source so that we could dramatically expand 
health insurance coverage in this Nation. We now have the lowest 
percentage of uninsured Americans in our history, and the Republicans--
because they are opposed to it--have said: We are going to cut the 
taxes that help people pay for their health insurance, and we are going 
to reduce the options that are available to them. So for Americans, it 
means less coverage, higher costs.
  We will see when it goes to the House of Representatives on the 
floor. The most conservative Republicans don't like it; certainly the 
Democrats don't like it. The question is whether Speaker Paul Ryan has 
enough votes. It has united America. The Republican approach has united 
America, in opposition. I don't know of a major health-providing group 
that supports it--not one; not doctors, not hospitals, not clinics, not 
AARP. Patients' groups all say the same thing about TrumpCare.
  The American Medical Association said:

       We cannot support the [bill] as drafted because of the 
     expected decline in health insurance coverage and the 
     potential harm it would cause to vulnerable patient 
     populations.

  The American Medical Association goes on to say:

       We are concerned with the proposed rollback of the Medicaid 
     expansion. . . . Medicaid expansion has proven highly 
     successful in providing coverage for lower income 
     individuals.
       The AMA cannot support provisions that repeal the 
     Prevention and Public Health Trust Fund . . . and we cannot 
     support provisions that prevent Americans from choosing to 
     receive care from physicians and qualified providers . . . 
     [including] those associated with Planned Parenthood 
     affiliates.

  The American Medical Association is saying to the Republicans that 
they reject their proposal for healthcare and is warning them not to 
cut off funding for Planned Parenthood.
  What does the American Hospital Association say?

       We cannot support the [bill]--

  the Republican bill--

     in its current form.
       In addition to the lack of a CBO score, we have some 
     additional policy concerns with the proposal.
       For example, it appears that the effort to restructure the 
     Medicaid program will have the effect of making significant 
     reductions in a program that provides services to our most 
     vulnerable populations.

  That is from the American Hospital Association. They estimate that in 
our State of Illinois, we could lose up to 90,000 jobs by repealing the 
Affordable Care Act without a suitable substitute--90,000 jobs in my 
State. President Trump made a lot of news when he went to visit one of 
the manufacturing companies after he was first sworn in and saved a 
couple hundred jobs. Well, I am glad he saved those

[[Page 4156]]

jobs. I hope he saves a lot more. But if he is going to eliminate 
90,000 jobs in my State--people who work at hospitals, some of the 
best-paying jobs in downstate communities--for goodness sake, that 
isn't hiring American. It isn't really focusing on creating jobs in 
this country. It is just the opposite.
  Here is what the American Nurses Association says about the 
Republican bill:

       [The bill] threatens health care affordability, access, and 
     delivery for individuals across the nation. . . . [T]he bill 
     changes Medicaid to a per capita cap funding model, 
     eliminates the Prevention . . . Fund, restricts millions of 
     women from access to critical health services, repeals income 
     based subsidies that millions of people rely on. These 
     changes in no way will improve care for the American people.

  What about the U.S. Conference of Mayors? Here is what they said:

       States will be forced to end coverage and eliminate health 
     care for low-income seniors, people with disabilities, 
     children, and working families.
       The GOP plan is bad for cities, bad for people who live in 
     cities and bad for people who provide healthcare in cities.

  It is interesting. We had a representative at a Rockford meeting of 
the disabled community. They are scared to death of this Republican 
alternative because these folks many times are in serious need of very 
expensive healthcare. If they are pushed off into these so-called 
money-saving insurance plans that really are empty inside and don't 
provide coverage, it could be devastating to these families. They have 
been through it over and over.
  The American Association of Retired Persons said:

       This Republican bill would weaken Medicare's fiscal 
     sustainability, dramatically increase health care costs for 
     Americans aged 50-64 and put at risk the health care of 
     millions of children and adults with disabilities, and poor 
     seniors who depend on the Medicaid program for long-term 
     services and supports.
       It could hasten the insolvency of Medicare by up to 4 years 
     and diminish Medicare's ability to pay for services in the 
     future.

  I remember when Candidate Donald Trump was telling us he would do 
nothing to hurt Medicare. Now the first major piece of legislation that 
comes up threatens the solvency of Medicare.
  Here is what the National Committee to Preserve Social Security and 
Medicare said:

       [We] oppose the . . . bill to repeal the Affordable Care 
     Act because it would weaken Medicare's solvency . . . 
     threaten access to Medicaid long-term care benefits, and 
     require ``near seniors'' to pay more for less health care 
     coverage. The . . . bill puts seniors and people with 
     disabilities at significant risk of ending up uninsured or 
     losing access to needed care.

  In my own State, the Illinois Health and Hospital Association says:

       [This organization] has serious concerns with the direction 
     of the [bill]. It would cut coverage for hundreds of 
     thousands of Illinoisans and impose a cap on . . . federal 
     Medicaid funding--our state is unable to absorb funding cuts 
     without impacting healthcare for all patients.

  I was surprised last week when the Republican Governor of Illinois, 
Bruce Rauner, said of the Republican plan: ``My first blush read is 
Illinois won't do very well under the changes that they're 
recommending.''
  He is very careful not to say things about Federal legislation. This 
he understands: Cutting back on Medicaid is going to impose a new debt 
on our State and reduce coverage for hundreds of thousands of people in 
our State.
  So we said to the Republicans: You want to repeal the Affordable Care 
Act; you have been dead set on doing this for 6 years. Please come up 
with an alternative that at least expands the coverage of health 
insurance and makes it more affordable. They tried, and they failed. 
But now they are going to push it through as a matter of showing 
political purity. They don't care that there is not a single group of 
medical providers in this country who support their plan. They 
obviously don't care that the American Association of Retired Persons 
believes this is not good for seniors across the board.
  I heard the Director of OMB say: Oh, that group--they are going to 
end up opposing this and then they are going to ask people to donate. 
Well, it is true that they live on donations. But they are taking a 
bold position in saying that the Republican approach is going to hurt 
seniors across America. Talk to the disability community, and you will 
hear exactly the same thing. Talk to the advocates for children.
  I am really looking for the first group to stand up and say that this 
new Republican approach is good for this country or good for people 
when it comes to the cost or availability of health insurance, and I 
haven't found it yet. I don't know what they are waiting on, but they 
can't produce it.
  What we are looking for is just the opposite. If you will take repeal 
of the Affordable Care Act off the table, I will pull up a chair. It is 
not perfect, it can be improved, and I am ready to sit down and do it 
on a bipartisan basis. But it is ``our way or the highway'' when it 
comes to the Republican majority on this bill. I hope we can do better. 
I think the American people expect us to do better.
  At the end of the day, they want a better healthcare system, not one 
that is worse--not one that supposedly gives them ``competition and 
choice,'' yet they have less coverage in their insurance policies and 
end up paying more for it.


           Calling for an Independent, Bipartisan Commission

  Mr. President, I have been coming to the floor recently to discuss 
the Russian involvement in our last Presidential election. Remember 
that 2 months ago, some 14 different intelligence agencies all came to 
the same conclusion--that Vladimir Putin and the Russians were trying 
to impact the outcome of the Presidential election.
  The intelligence reports, which were unclassified and available to 
the public, said expressly that the Russian intent was to defeat 
Hillary Clinton and to elect Donald Trump. I quickly add, this was not 
a report from the Democratic National Committee; it was a report from 
our intelligence agencies. They went through all the efforts taken by 
the Republicans when they were hacking into computers and releasing 
information during the course of the campaign.
  I think this is serious business. It is the first time I know of that 
a foreign power has tried to influence the outcome of an American 
Presidential election. People in Eastern Europe and people in many 
parts of this world are used to the Russians getting involved in their 
campaigns, trying to run their favorite candidates and elect them. We 
shouldn't have to put up with that in the United States of America, so 
many of us have called for a real investigation of what the Russians 
were up to.
  I think we ought to have a bipartisan commission--an independent, 
transparent commission to look into the involvement of the Russians; 
otherwise, we are sitting ducks for them to try it again 2 years from 
now, in the next election. We know--and this is public information--
there were at least 1,000 people sitting at computers in Moscow, trying 
to hack into America to try to find enough information that they could 
release to influence the outcome of the election. They are not going to 
quit. They are going to continue to do this. The question is, What will 
we do about it?
  We have already seen the National Security Advisor to the President, 
General Flynn, resign when he misled the American people and Vice 
President Pence about conversations he had with the Russians. Just 2 
weeks ago, we saw that the Attorney General of the United States, Jeff 
Sessions, recused himself from investigations involving Russia in the 
campaign because of conversations he had had, which he didn't disclose 
before the Senate Judiciary Committee.
  Almost every week there are more disturbing revelations emerging--not 
by any honest or open disclosure, mind you, but about the curious 
alliance among President Trump and the inner circle and Vladimir Putin, 
if there were one. Key figures, such as the National Security Advisor I 
mentioned and the current Attorney General, were caught not disclosing 
communications with the Russians. Allied intelligence reportedly 
confirms that members of the Trump campaign had repeated communications 
with those thought to be in Russian intelligence. Close Trump associate 
Roger Stone appeared to have advance knowledge of when Russian-

[[Page 4157]]

hacked information of Hillary Clinton was going to be released by 
WikiLeaks, something he presumably could have known only if he was at 
least discussing it with the Russian hackers.
  All the while, the administration has been saying nothing about 
Putin's actions, about this attack on the United States, or about 
Russia's ongoing cyber and military aggression in Europe. In fact, 
instead of addressing and responding to this Russian attack head-on, 
the President has incredibly been parroting Russian strategic interests 
instead.
  Let me repeat that from my largely silent Republican colleagues--and 
there have been a few exceptions, but most of them will not come to the 
floor to even discuss this matter. The American President, the same 
party of Ronald Reagan, has failed to acknowledge this major attack on 
our Nation and has refused to take action in response. How is this 
possible? Why is the majority party so silent in the face of these 
major national security issues?
  There is a simple way to resolve these questions:
  First, President Trump should do what every Presidential candidate 
has done in modern history and disclose his tax returns. Why won't he 
do that? What is in there that is so worrisome to him that he has 
defied all requests from media and from others across this Nation for 
him to do exactly what every other Presidential candidate has done?
  The President should also be totally cooperative with any 
investigation about campaign contacts, including by his former campaign 
manager Paul Manafort; Michael Flynn, his former National Security 
Advisor; and his former foreign policy adviser, Carter Page. How do we 
explain repeated reports of these contacts between that campaign and 
Russian intelligence?
  The administration also needs to answer questions about Roger Stone's 
comments that suggest he had knowledge of WikiLeaks having and using, 
in strategically timed releases around periods when the campaign was 
struggling, the information that had been hacked by the Russians.
  Tell us why the administration has criticized hundreds by Twitter 
when there is any perceived slight--from entire States to Major League 
Baseball to United Steelworkers--but not the Communist KGB agent who 
conducted an attack on our Nation and democracy.
  We need to know why they not only repeatedly denied intelligence 
information about Russian attacks but, in fact, in July of last year 
encouraged Russia to hack into their opponent's campaign.
  All of these things are being watched closely by nations around the 
world. Several weeks ago, I went over to Poland, Lithuania, and 
Ukraine. One of the Polish leaders said to me: We're watching. If you 
don't take the Russian invasion of your Presidential election 
seriously, how will you take the Russian invasion of our country 
seriously? It is a legitimate question because the Russians are up to a 
strategy that we have seen over and over again. This time, the 
Americans were the victims.
  We need full cooperation by the White House. We need an independent 
commission. I have suggested we pick people who are beyond reproach, 
people we can trust. I mentioned General Colin Powell, a man who served 
our country so honorably in the military, then served in the Republican 
White House, and then served as a Republican Secretary of State. I 
would accept Colin Powell as the head of a commission to get to the 
bottom of this because it is a national security issue, which he has 
undoubtedly had some background in dealing with in years gone by.
  There are many good people to turn to, but until we get the straight 
answers, we can expect the Russians to continue to try to find ways to 
invade our political process.
  Mr. President, 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. ROBERTS. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mrs. Ernst). Without objection, it is so 
ordered.


                            Kansas Wildfires

  Mr. ROBERTS. Madam President, I rise today to speak about the 
historical and unprecedented wildfires that burned through southwest 
Kansas last week. We had fires in 21 of our Kansas counties, roughly 
one-fifth of our State. High winds and dry conditions caused fires of 
the highest classification that blazed across central and western 
Kansas some 30 to 40 feet high, burning more than 700,000 acres of 
land, making this the largest wildfire in our State's history. The 
Kansas Division of Emergency Management has said it could take weeks to 
determine the full extent of devastation from the fires. Clark County, 
KS, officials--that is the county that was the hardest hit--estimate a 
devastating loss of anywhere from 3,000 to 9,000 head of cattle. That 
is just in one county. As I indicated, Clark County was the hardest hit 
by the windblown fires, with over 85 percent of the land in the county 
consumed by these prairie fires. This is hundreds of thousands of acres 
in one county and over 700,000 in regard to our State.
  On Friday, I drove south from Dodge City, KS, through range and 
ranchland I didn't even recognize. What used to be gently rolling 
prairie, dotted with herds of cattle and crisscrossed by fencing, is 
now reduced to blackened dust. Friends of mine lost their ranch when a 
40-foot wall of fire roared out of the valley over the bluff and burned 
out their operation. We have unimaginable damage to land and property, 
but also heart-wrenching scenes of cattle and wildlife burned, wounded, 
and wandering.
  Many Kansans lost everything. According to Sheriff John Ketron of 
Clark County, 31 houses and over 440,000 acres were burned there. We 
have longtime friends there, John and Carol Swayze. We have known them 
for years. John said with tears in his eyes: ``Pat, it took me 43 years 
to build up this operation, and it took about an hour to take it all 
down.'' Riding with Sheriff Ketron, we were assessing the town of 
Ashland, where a volunteer firefighting force managed to save the town 
when it became surrounded in flames. Some volunteers were fighting 
fires elsewhere in the area and learned their own homes had been 
engulfed and lost.
  I met with brave people in the towns of Englewood and Ashland, KS, in 
the heart of Clark County, who had just come through frightening 
experiences fighting the unpredictable and unstoppable fires. Some were 
out driving cattle away from the fires and had become separated from 
loved ones. When the flames turned, they were left to pray for their 
safety.
  Kylene Scott, with the High Plains Journal, calls it ``the worst day 
of her life.'' She wrote a courageous and honest account of the day. I 
will read her words now:

       I think I had them going the right way, then the wind 
     switched. Now I just don't know. When I heard the crack in my 
     husband's voice yesterday afternoon, I knew it was bad. He is 
     normally the calm, cool, collected one.
       A family friend alerted him to the fire in Clark County 
     very near the Scott farm after we'd returned home from 
     burying my Dad yesterday.

  Coming back from a funeral.

       When they said the closest neighbor was being evacuated he 
     went as quickly as he could fearing for the cattle herd he'd 
     worked the last five years to build following the death of 
     his own Dad. I stayed behind with the boys at our house 40 
     miles away.
       When the wind switched at my house from south/southwest to 
     the north, I began to worry even more and called him. At this 
     point he was waiting out the fire and smoke in the wheat 
     field, helplessly watching the house and barn burn. I wanted 
     to be at the farm so bad, but there wasn't much that could be 
     done. When he made it home unscathed I was pretty happy, but 
     sad at the same time. Knowing there was nothing we could do 
     to fix what it took for Mother Nature mere minutes to 
     destroy.
       Fifty-two cows are on the farm, with about half or \3/4\ of 
     them with young calves. Most are accounted for. All the grass 
     is gone, as is the hay stockpile. He went and hauled water to 
     the cows this morning and some are scorched and others have 
     udders with burns. One cow was bawling for her missing calf. 
     ``Those poor mommas,'' was my text reply to him this morning.
       I made my way early this afternoon to see the farm or 
     what's left of it with my own

[[Page 4158]]

     eyes. As bad as I wanted to be down there, a piece of me 
     dreaded the drive. The closer I got to the farm, the worse it 
     got. Blowing dirt, darkening skies because of the dust and 
     awful winds. I pulled in the drive, like I had done a hundred 
     times in the nearly 20 years I have been part of the family, 
     and I had to stop my vehicle. The tears came and the 
     heartbreak overwhelmed me.
       I thought of the old white farm house with the wonderful 
     front porch, where my husband spent a large majority of his 
     childhood in and around. My fondest memory is when we'd stop 
     and see my husband's Grandma Pauline. She'd always have 
     something sweet to eat and a cold drink at the kitchen table. 
     The home had been around for 100 years and still had a large 
     portion of the family momentos in it. It was reduced to ashes 
     and rubble. All that's standing is the chimney.
       I couldn't see the barn around the trees, but I again had 
     to stop and sit when I pulled around the corner. The barn. 
     The old barn with its red siding. I remember when my father-
     in-law had it painted and how proud he was because it looked 
     so good. I remember when he laid the brick in front of the 
     tack room and built a new door for it. My boys explored every 
     inch of it when we worked calves last fall. You could 
     ``almost'' hear the horses munching in the stalls decades ago 
     when you stood in the center alley. Now it's just a charred 
     pile of tin.
       I realize the house and barn are just buildings. Things can 
     be replaced. But dang, it's so hard to see it all reduced to 
     ashes and rubble. To see part of the Scott family history, 
     more than a hundred years, just be gone. Just like that. It's 
     hard.
       We've had incredible friends and family offering help, hay 
     and feed, and it's heartwarming to know how much people care. 
     Like I heard an Ashland, Kansas resident on the news this 
     morning being interviewed, it's just what southwest Kansas 
     people do. Help and survive.

  Here is a picture that was taken on Kylene and Spencer Scott's 
wedding day in 2009 up here. It is a beautiful sight. Off in the 
distance is the Clark County Lake. It is rolling hills, cattle country, 
cattle, and grass. Looking at this picture now, it is not hard to 
wonder how this land will come back to provide for so many, as it has 
for generations of Kansas farm and ranch families whose sweat and blood 
have produced for Kansas, our Nation, and, yes, the world, as well.
  There is the other picture. They got married here. It was the 
happiest day of their life. They saw this, and that became just about 
the worst day of their life. And yet, having seen this devastation 
firsthand, I don't wonder about Kansas and our ability to rebuild. It 
is in our State motto: Ad astra per aspera--to the stars through 
difficulties.
  In one of the emergency management centers I met Joyce Edinger. When 
I asked her what I could do to help, she just said: ``The Lord will 
provide.'' She had lost virtually everything. I think that pretty well 
sums it up. The faith of Kansans gives us courage to rebuild--the 
courage to come through fire. Ashland banker Kendall Kay emotionally 
said:

       Senator, we are going to need help. We really don't want 
     it, but we are going to need it.

  I am so proud of the people of my State who have come in with that 
help before they were even asked. I had been in contact with all of our 
producer groups in Kansas--the Kansas Livestock Association, the Kansas 
Farm Bureau--who along with our State agencies had been leading the 
voluntary relief effort. I commend them for their efforts in collecting 
hay for cattle, as well as monetary donations, coming in from all parts 
of the United States, and volunteer coordination for repairs to 
property and fencing.
  With Congressman Roger Marshall of the First Congressional District, 
and my colleague here and friend in the Senate, Jerry Moran, we have 
been in touch with the Department of Agriculture with regard to 
assistance that should be available to farmers and ranchers in counties 
that have suffered losses.
  Here is what we are trying to fix. This fellow is walking across here 
to that bluff that overlooks that valley that Spencer and Kylene looked 
over, and this fellow here is Chad Tenpenny, my top guy in Kansas. That 
is me with my hands in my pockets. It is pretty rough to see ground 
like this that was grass and to look at the utter devastation. Folks, 
when that wind blows and when that dust starts up again, we could be in 
for even more trouble. So cleanup is under way, but we are trying to 
get help to cut through the redtape and get a disaster declaration.
  I talked to the Governor this afternoon. Primarily, it is the 
Emergency Conservation Program, the Livestock Indemnity Program, and 
Environmental Quality Incentives Program, or EQIP, that are the key 
programs. It won't make people whole by any means, but it will give 
them hope. So cleanup is under way.
  Kansas is a bootstrap State. It is not just about building new 
fencing. We have families who have lost the farmhouse and all the 
equipment they need to rebuild. Many livestock producers have had the 
gruesome task of euthanizing cattle that have been badly burned. We 
have to remove the carcasses. We have to find land for the survivors to 
graze. And we have a lot of uncertainty. How long will it take for the 
grasses to come back? When can we get rain to avoid a dust bowl? It is 
really too soon to tell. But we have been through disasters before. 
Almost 1 year ago, we had the Anderson Creek fire, and we have come 
through tornadoes and ice storms. Recovery from disasters of this 
magnitude, however, requires us to cut through the redtape. It requires 
getting the right information to producers so they know how to apply 
for aid and then to expedite it. Yes, it requires us to look at our 
programs to see where we can improve them.
  Now, this fire has not received much attention in the national media. 
You see, we are a flyover State. All we do is produce food and fiber 
for Kansas and our Nation and for a troubled and hungry world. But I do 
want to commend members of the press in Kansas, especially photographer 
Bo Rader of the Wichita Eagle, who took this photo of my State Director 
Chad Tenpenny and me walking through rangeland outside of Ashland.
  The Wichita Eagle has gone out of their way to show the world what 
this fire looks like to real people. The Hutchison News, the High 
Plains Journal, and the Dodge City Daily Globe have all told and are 
telling this story. The same is true for the TV and the radio crews who 
have helped get the news of town evacuations safety notices to our 
people. This is what they do.
  Rest assured that, as chairman of the Senate Agriculture Committee, I 
am committed to the Kansans I serve. They know me. I know them.
  I know that Clark County and the other 20 counties will come back. We 
will ensure they get the help they need. Ad astra per aspera--to the 
stars through difficulty. It is not just a motto; it is who we are.
  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. CORNYN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                        American Health care Act

  Mr. CORNYN. Madam President, last week our colleagues in the House of 
Representatives introduced the American Health Care Act--legislation 
that will deliver on a promise we made to repeal ObamaCare and to 
replace it with healthcare options that won't force people to buy an 
insurance product just because the government tells them to do so or 
penalize them if they don't but will replace it with one that actually 
fits the needs of their families at a price they can afford.
  It is no secret that ObamaCare was oversold back in 2010 when the 
President said: If you like your policy, you can keep your policy. If 
you like your doctor, you can keep your doctor. And by the way, an 
average family of four, he said, would save $2,500. That has not proven 
to be true.
  ObamaCare, to boot, has wreaked havoc on our economy and on American 
families just trying to stay healthy. In my State of Texas, it has led 
to fewer healthcare options, skyrocketing premiums, and deductibles so 
high that insurance plans are rendered almost useless. By one estimate, 
about one-third of Texas counties have only one insurance option, and 
that is the case throughout the Nation. Nearly

[[Page 4159]]

one-third of all counties in the country have only one insurance 
company offering plans on their States' exchanges.
  The truth is, ObamaCare has never added up to better coverage at a 
more affordable price; it has never delivered more options--just the 
opposite; and it never kept its promises when it was being sold to the 
American people.
  Now is the time for us to do right by the American people by 
delivering more access to quality healthcare at a price Americans can 
afford.
  The American Health Care Act doesn't just tinker around the edges of 
ObamaCare; it is a complete do-over.
  This bill, for example, repeals ObamaCare's individual mandate, the 
requirement that you buy government-approved insurance, and if you 
don't, we are going to fine you. That is repealed.
  It repeals the employer mandate. I still remember being in Tyler, TX, 
and talking to a gentleman who owned a restaurant and who said he had 
to lay off some of his full-time staff, putting them on part time, just 
to avoid the penalties that go along with the employer mandate. And by 
the way, he introduced me to the single mom who now, instead of working 
one full-time job, had to work two part-time jobs just to keep food on 
the table for her family.
  This bill also repeals the medical device tax. This was an incredible 
tax on medical innovation which wasn't on income but literally on gross 
receipts, forcing jobs to move from the United States to places like 
Costa Rica and Central America.
  This bill repeals ObamaCare's Medicare payroll tax increase, the net 
investment tax increase, the ObamaCare tax on prescription drugs, and 
the ObamaCare health insurance tax.
  This is the full repeal of ObamaCare that we have been promising for 
years now.
  I want to point out that this bill also provides unprecedented 
entitlement reform. Some of the main cost drivers for the Federal 
Government are not the 30 percent of Federal funds that we appropriate 
each year that are largely divided between defense and nondefense 
spending. Entitlements are driven by the fact that they are not capped 
or pegged to an inflation rate for Medicare, Social Security, and 
Medicaid.
  This legislation actually begins to put Medicaid--the healthcare plan 
for the most vulnerable in our country--on a reasonable path to 
sustainment. This bill also makes sure that the States that share in 
the cost of Medicaid can manage their own State budgets in a much more 
responsible way.
  This bill is the first real Medicaid reform since the program was 
created which, perhaps most importantly, gives more authority, more 
flexibility to the States to manage the dollars they spend, to manage 
not only the dollars they come up with through their own tax rolls but 
the Federal portion as well. And as I said, it puts the Medicaid 
Program on a path toward fiscal responsibility.
  I believe this legislation is critically important across the country 
and for my State of Texas, too. In Texas, every other year, when the 
legislature meets and tries to determine how to allocate its budget, 
they work very hard to try to make sure that Medicaid isn't the single 
largest expenditure in the State budget. Right now, about a third of 
that total budget is spent on Medicaid alone, and the Federal 
Government essentially ties the hands of the State in terms of managing 
the healthcare delivery system to help those most vulnerable low-income 
folks in our State.
  With this legislation, not only do States like Texas have the ability 
to manage the expenditure of the money to focus on chronic diseases--
people who are using our healthcare system a lot because of the nature 
of the illnesses they have--but also to help encourage medical homes so 
that people have ways of managing their healthcare to stay healthy 
longer and to reduce healthcare expenditures.
  This legislation will help Texas and the rest of the country have a 
way to rein in spending while serving those who need Medicaid the most. 
You will hear some of our friends across the aisle saying that this is 
about kicking people off of Medicaid. Well, that is not true. For those 
people currently on Medicaid, Medicaid expenditures will not change at 
all as long as they remain on the rolls. That includes those who live 
in States that expanded the Medicaid coverage from 100 percent of 
Federal poverty to 138 percent. Those people will stay on Medicaid as 
long as they are eligible. Under this new legislation, Medicaid is put 
on a sound fiscal footing so the program is still around for our 
children and grandchildren.
  Another important feature of the American Health Care Act is that it 
establishes a patient and State stability fund to equip Texas and other 
States to meet the specific healthcare needs of their patients, 
particularly those, as I have said, with low incomes and those 
suffering from chronic illnesses.
  It will provide more money to community health centers that do a lot 
of heavy lifting to make sure that families are healthy and that people 
get access to the treatment they need regardless of whether they 
actually have health insurance. In Texas, we have hundreds of community 
health centers serving more than 1 million Texans each year. Under the 
American Health Care Act, they will be able to do their job more 
effectively and keep more Texans healthy.
  Responsible entitlement reform is something we should be all about. 
It serves the American people not just for tomorrow but for decades 
down the road. Most importantly, I believe what this legislation does 
is it finally delivers on the promise we made back during the debate 
over the Affordable Care Act.
  Now that the Affordable Care Act has proven itself to be 
unsustainable and does not deliver on the basic promises, the 
fundamental promises upon which it was sold to the American people, I 
believe it is important that we keep our promise to repeal it and 
replace it with more choices of affordable healthcare at a price people 
can afford. It is the conservative answer to healthcare that will 
empower individuals, provide more options and competition, and 
responsibly help those who need care have more access to it.
  Madam President, I yield the floor.
  Mr. LEAHY. Madam President, as the Senate continues to consider 
nominees to lead Federal agencies, I am concerned that once again there 
is a nominee before us with a stunning lack of expertise to run an 
agency that affects so many American lives. Seema Verma is another such 
nominee.
  The Administrator of the Centers for Medicare and Medicaid Services, 
CMS, has an incredible responsibility to ensure some of America's most 
important programs run smoothly. For decades, Medicare and Medicaid 
have offered coverage to some of our Nation's most vulnerable 
populations. Medicare and Medicaid currently cover more than 100 
million Americans--nearly one in three patients. The Administrator is 
responsible for overseeing more than $1 trillion in annual spending and 
a staff of about 4,000 people. This is a position of vital importance 
where a new Administrator should hit the ground running, instead of 
learning on the fly.
  And learning on the fly is what she will have to do, as evidenced by 
her testimony before the Finance Committee. When asked to name a 
specific program she would commit to improving as Administrator, she 
could not identify even one. She also demonstrated a lack of commitment 
to protect healthcare for women, saying that coverage for prenatal and 
maternity care should be optional and paid for separately. Does Ms. 
Verma really want to return us to a time when women are discriminated 
against in healthcare solely because of their gender? It appears so. 
When asked about provider payment systems, she stumbled to answer, 
showing little knowledge about a system that directly impacts millions 
of providers across the Nation. Furthermore, the only fact she could 
name about Medicare Part D, a benefit that supports more than 40 
million seniors, was about an online plan finder tool.
  Supporters of her nomination point to her involvement and design of 
Indiana's Medicaid program as her qualification to run CMS. Directed by 
then-

[[Page 4160]]

Governor Mike Pence, Indiana's plan requires even the poorest patients 
to pay a monthly fee in order to access health insurance. The plan also 
restricts those who miss a payment to be locked out of care for 6 
months. Instead of working to find ways to help Indianans gain 
insurance coverage, she contributed to a system that bars access to 
vulnerable patients. Conversely, Vermont also has a Medicaid waiver 
that, combined with Vermont's All Payer Waiver, has a goal of insuring 
all Vermonters. Vermont's is the standard that we should all be trying 
to meet. I am not confident that Ms. Verma is up to the task.
  What is more concerning is how Ms. Verma fits into a world where 
Republicans are engaged in an effort to not only rip apart the 
Affordable Care Act, but also to end the Medicaid Program as we know 
it. The current proposals before the House of Representatives would cut 
hundreds of billions of dollars from Medicaid, leaving States in the 
lurch and causing millions to go uninsured or to have substandard care. 
As Republicans continue these efforts, it will be critical for the 
Administrator of CMS to understand and care about the impacts of such 
efforts on the millions of Americans who rely on these health 
protections day to day.
  Confirming someone with such a lack of experience to run a trillion-
dollar agency would be unfair to the American people. And as a core 
player in the effort to unravel the Affordable Care Act, she 
demonstrates values that are counter to the very agency which has been 
supported and improved by key provisions in the law. I do not believe 
Seema Verma is qualified or fit to serve as the Administrator of CMS, 
and I encourage all Members to join me in opposing her nomination.
  Mr. VAN HOLLEN. Madam President, the Centers for Medicare and 
Medicaid Services, or CMS, is a major part of the Department of Health 
and Human Services. A third of the Nation--more than 100 million 
Americans--get access to quality healthcare through CMS's programs--
Medicare, Medicaid, the Children's Health Insurance Program, and the 
Affordable Care Act Marketplace. CMS also includes the Center for 
Medicare and Medicare Innovation and several other activities to 
improve access and affordability in our Nation's health system for all 
Americans--regardless of income, gender, or health status.
  President Trump, Secretary Price, and congressional Republicans seek 
to drastically restructure our Nation's healthcare, threatening to 
leave millions without coverage. In the face of that threat, we need a 
CMS Administrator who knows how to lead CMS and is willing to do 
whatever she can to protect Americans' healthcare. After hearing from 
several organizations that deal directly with CMS and familiarizing 
myself with President Trump's nominee, I cannot support the nomination 
of Seema Verma for this important role.
  Ms. Verma does not have the experience or appropriate knowledge 
needed to head this vital agency. Her limited scope of experience with 
just Medicaid, lack of familiarity with Medicare, and willingness to 
restructure CMS's rules that protect millions are cause for deep 
concern.
  If confirmed, Ms. Verma would manage 85 percent of the HHS's $1 
trillion budget, which in turn is more than a quarter of the Federal 
Government's, and Ms. Verma would oversee 4,000 employees. Running CMS 
requires significant experience with healthcare and is best done by a 
person who has held significant positions in private industry and 
government.
  But nothing in Ms. Verma's career shows her to have the skills to 
operate a budget or team of this magnitude. She has never managed a 
large organization and has little experience with Medicare. Ms. Verma 
has operated a small, 10-person company, SVC, Inc., and consulted on 
various State Medicaid programs. Her experience is inadequate for the 
important role for which President Trump nominated her.
  The next CMS Administrator will have an important voice forming 
healthcare policy. HHS Secretary Price has been on the forefront of 
efforts to slash Medicaid and turn Medicare into a voucher program. 
President Trump, Secretary Price, and congressional Republicans have 
made it a priority to repeal the Affordable Care Act. We need a CMS 
Administrator who will provide a reality check in the face of these 
reckless proposals. We need a CMS Administrator who will work to uphold 
President Trump's promise that ``there will be no cuts to Social 
Security, Medicare, and Medicaid.''
  Ms. Verma, however, could not make that commitment during her Senate 
Finance Committee confirmation hearing. To the contrary, during her 
hearing, Ms. Verma expressed openness to block-granting Medicaid or 
instilling per-capita caps--putting the coverage of nearly 70 million 
vulnerable Americans at stake. These policies would end the Federal 
guarantee of matching funds to States and would dramatically cut 
Federal funding to States. Analyzing a 2012 congressional Republican 
block grant proposal, the nonpartisan Congressional Budget Office found 
that, for States to manage their Medicaid programs at reduced funding 
levels, they would have to limit Medicaid eligibility, reduce benefits, 
cut payment rates, or increase out-of-pocket costs for beneficiaries. 
These proposals would result in the denial of healthcare and long-term 
care to millions of vulnerable Americans.
  We need a leader at CMS who will defend the historic gains of the 
Affordable Care Act The Affordable Care Act set standards for consumer 
protection and significantly expanded coverage. Repeal could cause 22 
million Americans--and 400,000 Marylanders--to lose quality, affordable 
health coverage. Repeal would imperil new access to life saving 
substance-use-disorder and mental health treatment Repeal would 
endanger coverage for children who now have access to comprehensive 
health services. Repeal could significantly raise premiums and erode 
consumer protections for Americans who have coverage outside of the 
Marketplace.
  Under the Affordable Care Act, insurance plans must provide maternity 
care as an essential health benefit. But during her nomination hearing, 
Mrs. Verma said that, while some women want maternity coverage, ``some 
women might not choose that,'' signaling her view that the law should 
not require insurance companies to provide this critical coverage. This 
is unacceptable. Ms. Verma's position would put the health of mothers 
and families at risk and drive up costs for plans that did provide the 
coverage. We will not turn back the clock to when maternity coverage 
was optional. We need an Administrator who will stand with mothers and 
families on this issue.
  Because of Ms. Verma's lack of adequate healthcare experience and her 
willingness to consider rash policies that are far out of the 
mainstream, I do not believe that she is equipped to appropriately 
advise the President and Secretary on these policies that affect 
millions of Americans. I will not support her nomination to head CMS.
  The PRESIDING OFFICER. The Senator from Arkansas.


                       Tribute to Dr. Jim Rollins

  Mr. BOOZMAN. Madam President, I rise today to honor Dr. Jim Rollins, 
an Arkansan who has dedicated his life to public education. Dr. Rollins 
is the superintendent of the Springdale, AR, public schools, where he 
has served since 1980.
  Dr. Rollins started his career in the classroom as a science teacher 
in North Little Rock. Since that time, he has consistently sought to 
provide students with a quality education. The work he has done leading 
Springdale's public schools speaks for itself.
  Dr. Rollins' motto when it comes to education is ``Teach them all.'' 
This worthy goal has been especially important in Springdale, where 
enrollment has grown from 5,000 students when Dr. Rollins arrived in 
1980 to nearly 23,000 students today. Many of these students are part 
of immigrant families where English is not their first language. More 
than 55 percent of the district's students are not proficient in 
English, and around 75 percent qualify for free and reduced lunches. As 
you might imagine, this has presented unique challenges to educators in 
Springdale.
  In order to meet these challenges and ensure that the school system 
is doing

[[Page 4161]]

everything it can to provide these students with a great education, Dr. 
Rollins has introduced innovative programs that cater to immigrant 
families, including the unique Marshallese population in Springdale.
  As superintendent, Dr. Rollins has fostered an atmosphere where 
families feel welcome and understood so that parents, students, 
teachers, and administrators are working together to create a 
supportive environment that leads to growth in the classroom. In the 
spirit of engaging the entire family in the education of every child, 
Dr. Rollins has helped lead an effort in Springdale's schools to 
promote English as a second language instruction for students and 
parents.
  This year, Dr. Rollins is once again being recognized for his 
outstanding efforts in the achievements Springdale public schools have 
enjoyed under his leadership. Dr. Rollins is being recognized as one of 
Education Week's 2017 Leaders to Learn From, which highlights forward-
thinking district leaders who are working to enact and inspire change 
in our Nation's public schools. Dr. Rollins is certainly very deserving 
of this honor. You only need to look at the work he has done over 
several decades to understand that he has dedicated his professional 
life to improving public education outcomes for every child in the 
Springdale education district. The teachers and parents in his district 
have also had wonderful things to say about Dr. Rollins and his 
leadership in their community. I am so pleased that his trailblazing 
work in Springdale public schools is being noticed by national 
education organizations.
  Dr. Rollins has made Arkansas very proud, and we are so grateful for 
his leadership and commitment to educating children no matter where 
they come from or their station in life. I am honored to know Dr. 
Rollins, appreciate his friendship, and look forward to his continued 
stewardship of the public school system in Springdale and the positive 
influence he has on education throughout Arkansas.
  Congratulations, Dr. Rollins, on a job well done.
  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. WYDEN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WYDEN. Madam President, the hard numbers are now in on TrumpCare, 
and there is no sugarcoating them for the American people, as 24 
million Americans get kicked off their insurance plans, as $880 billion 
is slashed from Medicaid in the first decade, and as a payday worth 
hundreds of billions of dollars goes out to the wealthiest and the 
special interests. That is what is going to be dropped on Ms. Verma's 
plate if she is confirmed and if the bill passes. It is her nomination 
that is up for debate right now, and we should make no mistake that she 
is going to be in charge of the specifics.
  If TrumpCare passes, under section 132, the new Administrator would 
be able to give States a green light to push sick patients into high-
risk pools when the historical record shows that these high-risk pools 
are a failure when it comes to offering good coverage that is 
affordable.
  The new Administrator would be in charge of section 134 and could 
decide exactly how skimpy TrumpCare plans would be and how many more 
Americans would be forced to pay out-of-pocket for the care they need.
  The new Administrator would handle section 135, which paves the way 
for health insurers to make coverage more expensive for those who are 
approaching retirement age. That is just the start.
  The fact is that TrumpCare is about enormous tax breaks for the 
fortunate few, financed by raiding Medicare, gutting Medicaid, and 
hurting older people and the sick and those who are of modest income. 
Ms. Verma would have the job of implementing all of this at the Centers 
for Medicare and Medicaid Services.
  My view is that the Senate cannot debate this nomination without 
debating the matter of the TrumpCare program itself because it will be 
a very huge part of the job. Today, I am going to walk through some of 
the specifics with regard to TrumpCare, beginning with the scheme that 
I call ``Robin Hood in reverse.''
  If you look at the funds, it is clear that this is an eye-popping 
transfer of wealth away from older people, from women and kids--from 
the most vulnerable--directly into the wallets of the fortunate few. No 
part of the TrumpCare bill shows this more clearly than the fact that 
it steals from the Medicare trust fund to pay for a tax cut that goes 
only to the most fortunate--only to those who make a quarter million 
dollars or more per year.
  Everybody in America who brings home a paycheck has a little bit 
taken out each and every time for Medicare. It is right there on the 
pay stub. It is automatic. Under TrumpCare, the only people who are 
going to see a Medicare tax cut are the people who need it the least. I 
want to repeat that. Everybody in America, when one gets a paycheck, 
sees a Medicare tax, and everybody pays it, and we understand why it is 
so important. There are going to be 10,000 people turning 65 every day 
for years and years to come. The only people who are going to get that 
Medicare tax cut are the people who need it the least, and that tax cut 
that is going to go to the fortunate few will take 3 years off of the 
life of the Medicare Program, depleting the program in 2025 instead of 
in 2028.
  That particular cut breaks a clear Trump promise not to harm 
Medicare. All through the campaign, then-Candidate Trump was very, very 
firm in his saying that he would do no harm to Medicare.
  He said:

       You can't get rid of Medicare. Medicare's a program that 
     works . . . I'm going to fix it and make it better, but I'm 
     not going to cut it.

  The promise not to cut Medicare lasted about 6\1/2\ weeks into the 
Trump administration before it was broken. The bottom line is that 
TrumpCare raids Medicare. It raids Medicare and causes harm to Medicare 
in violation of an explicit Trump promise during the campaign, and it 
brings Medicare 3 years closer to a crisis to pay for a tax cut for the 
wealthiest in America.
  So you have this enormous, eye-popping transfer of wealth from 
working people, seniors, and people of modest means to the most 
fortunate. Yet, somehow, people have the chutzpah to say it is a 
healthcare bill? I do not think so. It is a huge, huge tax windfall for 
the fortunate.
  There is also the tax break on investment income. Once again, this is 
a break that is going to only go to the most fortunate among us, and, 
with the investment tax break, the overwhelming majority of the 
benefit--nearly two-thirds of it--will go to the top one-tenth of one 
percent of earners in America. That looks like an awful lot of money 
that is going to be going to the fortunate few, but we are not even 
done there.
  On top of all of this, there is yet another juicy tax--this time for 
health insurance executives' salaries. It is another juicy tax cut for 
executives who are making over $500,000 per year.
  It is not just Medicare that is getting raided under this proposal. 
Some of those who are hit the hardest by TrumpCare are those who are 
approaching retirement age. If you are an older American and are of 
modest income--55 or 60--and you have to get insurance in the private 
market, TrumpCare is going to cause your prices to go through the 
stratosphere. In parts of my home State, especially in rural areas, a 
60-year-old who brings home $30,000 a year could see his insurance 
costs go up by $8,000 or more.
  Much of this is due to what we call an age tax. It is a key part of 
TrumpCare. It is another key part of what Ms. Verma will be in charge 
of implementing. The bill would give health insurance companies the 
green light to charge older people five times as much as they charge 
younger people. If you are a person of modest means, are a few years 
away from

[[Page 4162]]

qualifying for Medicare, and your insurance premiums jump by $8,000, 
that means you are just out of luck. You are going to be locked out of 
the system. You are, basically, going to have to hope that you just do 
not get sick before you are eligible for Medicare.
  Those tax credits that you hear so much about from TrumpCare 
advocates are not going to be of much consolation to you. That is 
because TrumpCare puts a hard cap on your tax credit as an older 
person--just $4,000--and the odds are good that it would not come close 
to covering the expense of a decent insurance plan.
  Now, I am going to turn to Medicaid because TrumpCare does not just 
make little changes around the margins. It does not strengthen or 
preserve this program that covers 74 million Americans. TrumpCare hits 
Medicaid like a wrecking ball, and it has particular implications for 
seniors. I am going to walk through those.
  The Medicaid nursing home benefit is very much at risk now because of 
the TrumpCare cuts as it relates to Medicaid. Medicaid picks up the 
bill for two out of three nursing home patients. These are the people 
who have worked a lifetime, raised kids, put them through school, and 
scrimped and saved all they could. These are the people who, in Kansas 
and in Oregon and across the country, never went on the special 
vacation, who never bought a boat. All they did was to try to scrimp 
and save and educate their kids. The fact is that growing old in 
America is pricey, and after a few years of balancing the rent bill 
against the food bill and the food bill against the medical costs, what 
happens is that a lot of seniors just exhaust their savings.
  When I was director of the Oregon Gray Panthers, what I saw in my 
State--and it is duplicated everywhere--was older people walking every 
single week on an economic tightrope. They were balancing the food 
bills against the medical bills and the medical bills against the rent 
bills, and they just couldn't keep up. They burn through all of their 
funds and they burn through their modest savings, so when it is time to 
pay for nursing home care, they have to turn to Medicaid.
  Today in America, the Medicaid nursing home benefit is a guarantee 
that those vulnerable older people--the people who are walking on that 
economic tightrope--are going to be taken care of. TrumpCare breaks the 
Medicaid nursing home guarantee, and it goes even further than that. A 
lot of States--mine is one--worked hard to give more care choices to 
seniors as well as those with disabilities. Maybe instead of living in 
a nursing home or an institution, they would rather be in the 
community. Maybe they would rather live at home where they are most 
comfortable. TrumpCare could mean that those home- and community-based 
choices could disappear as well.
  So what we are talking about is that with these cuts in Medicaid, at 
a time when, in Kansas and in Oregon and across the country--what we 
have tried to build for older people is a continuum of services. There 
would be help at home. There would be help in terms of long-term care 
facilities. There would be a wide array of choices. And because of 
Medicaid, there was enough money to fund these choices, to fund this 
continuum of care for vulnerable older people. Now, as a result of the 
Medicaid cutbacks, my concern is that there is not going to be enough 
money for any of these choices--not going to be enough money for the 
nursing home benefit, not going to be enough money for home- and 
community-based services. Suffice it to say that my own home State has 
indicated to me that they are very concerned about the cutback in home- 
and community-based services.
  Nobody wants to see older people get nickled and dimed for the basics 
in home care they rely on and good nursing home benefits. Yet, when it 
comes to Medicaid, TrumpCare would effectively end the program as it 
exists today, shredding the healthcare safety net for older people and 
millions of others in our country.
  It puts an expiration date on the Medicaid coverage that millions of 
Americans got through the Affordable Care Act. For many, it was the 
first time they had health insurance. It brought an end to an era where 
those individuals could turn only to emergency rooms for care. And now 
TrumpCare is going to cap the Medicaid budget and just squeeze it and 
squeeze it and squeeze it some more until vulnerable people will not be 
able to get care.
  The program is particularly important for seniors and the disabled, 
and I want to make sure that people understand what it means for 
children as well, for those in the dawn of life as well as those in the 
twilight of life.
  Medicaid pays for half of all births, and kids make up half of 
Medicaid's enrollees. It is important to remember that in many cases, 
these are kids who already have the odds stacked against them. They are 
from low-income families. They are foster kids. They are kids with 
disabilities. We know they are already facing an uphill climb. 
Medicaid, though, has been there now with the Affordable Care Act to 
make sure they could see family practitioners and even pediatric 
specialists. That was just unheard of for these youngsters before the 
Affordable Care Act. And when a kid needs emergency care, Medicaid is 
what makes it affordable. TrumpCare puts that in danger.
  I have talked about what it means for older people and what it means 
for the disabled and what it means for kids, and I am just going to 
keep on going because now that we have the hard numbers in--the hard 
numbers have arrived here in real time from the budget office that is 
charged with giving us this analysis--it is important to talk about 
what it means, because budgets are not just facts and figures and cold 
sheets of paper; they are about people's hopes and aspirations. And the 
hopes and aspirations that I have had since those days when I was 
director of the Oregon Gray Panthers were to make sure that people had 
affordable, quality, decent healthcare choices because in America, if 
you don't have your health, you really are missing much of what makes 
life so special in our country.
  The bill also takes an enormous toll in other areas, and I want to 
mention next opioid abuse. By slashing Medicaid, TrumpCare is going to 
make America's epidemic of prescription drug abuse-related deaths even 
worse.
  The papers this morning had accounts about how families were losing 
most of their children to opioid addiction--most of their children lost 
to opioid addiction--on the front pages of the papers. Medicaid is a 
key source of coverage for mental health and substance abuse disorder 
treatment, particularly after the Affordable Care Act, but this bill 
takes away the coverage for millions who need it.
  Republican State lawmakers, to their credit, have spoken out about 
this issue. Frankly, it just ought to be a head-scratcher for anybody 
who remembers the last Presidential race when, in the primary race, a 
parade of candidates rolled through State after State that had been hit 
hard by the opioid crisis, and all of those candidates were trying to 
outpromise the one who had spoken previously in terms of how they would 
help solve the opioid crisis. Then-Candidate Trump was one of the most 
outspoken on saying that he would fix the opioid crisis. He said he was 
the guy who could end the scourge of drug addiction and get Americans 
the help they need. Instead, what we have is TrumpCare, which makes the 
opioid crisis worse, and there is no getting around it.
  TrumpCare puts States in the unimaginable position of having to 
decide whose Medicaid to slash. Are they going to tell seniors that the 
nursing home benefit is no longer a guarantee and they are going to 
have to get in a long waiting line for an opportunity to get a place in 
the local nursing home? Should they tell pregnant women that births are 
no longer covered? What about telling mothers and fathers that their 
kids are cut off and they will have to hope for the best or make their 
way back to the emergency room?
  I also want to touch on a final point that really deserves some 
discussion and hasn't gotten much, and the finance staff has been 
looking at it; that

[[Page 4163]]

is, how TrumpCare really creates a disincentive to work, because I 
think TrumpCare and Ms. Verma's role implementing it are going to have 
a substantial effect on American workers and entrepreneurs.
  It is my view that TrumpCare creates a substantial, significant 
disincentive to work. Today, if you are on Medicaid, you are able to 
pick up a few extra hours at work or go out and accept a higher paying 
job without the fear that you will lose access to care. That is because 
under the Affordable Care Act, low-income Americans get the most help 
when it comes to paying insurance premiums. A lot of persons can get 
health insurance for less than $100 a month.
  Let's compare that with the TrumpCare approach. Under the TrumpCare 
plan, those who are walking an economic tightrope, bringing home barely 
more than the minimum wage, don't get the most help. They don't get the 
most help, and they could see their insurance costs go up by thousands 
and thousands of dollars each year, which would effectively mean they 
would be locked out of the healthcare system. So for millions of 
persons, staying on Medicaid would suddenly look a lot more attractive. 
Making a little more money and losing your Medicaid coverage could mean 
losing your access to high-quality healthcare altogether. So my view is 
nobody has been able to counter this. TrumpCare, in effect, would keep 
Americans trapped in poverty.
  Entrepreneurs and Americans who want to go back to school to pursue a 
degree would face the same dilemma. Somebody who wants to quit their 
job and pursue their dream of starting their own business ought to be 
able to do it without a fear that they won't be able to any longer 
afford healthcare. The same goes for those who want to go back to 
school full time to pursue a degree or certification. TrumpCare makes 
insurance unaffordable for those persons.
  TrumpCare is going to be the big issue on Ms. Verma's plate if she is 
confirmed this afternoon in the Senate to administer this office. We 
all understand that this bill has been taking a pounding from all 
sides. Moderate Republicans and those who consider themselves 
conservative Republicans are against it. Governors from both parties 
are against it. Democrats are united. The AARP, the American Hospital 
Association, the American Medical Association, and the American Nurses 
Association have all come out against the bill--not any surprise to me. 
I don't think these groups think that healthcare and healthcare 
legislation is primarily about ladling out big tax breaks for the 
fortunate few, but that is what this so-called healthcare bill does. 
And it is financed by raiding Medicare, by gutting Medicaid, and by 
hurting older and sicker and lower income Americans.
  There has been a lot of happy talk about why we ought to support this 
bill, but what I have tried to do this afternoon is lay out the broken 
promises. This weekend, for example, the new Secretary of Health and 
Human Services said: ``I firmly believe that nobody will be worse off 
financially in the process that we're going through, understanding that 
they'll have choices, that they can select the kind of coverage they 
want for themselves and for their family.'' That statement from the 
Secretary of Health and Human Services is disconnected from the facts. 
The simple math shows that TrumpCare forces millions of people--
particularly older people and less affluent people--to pay thousands of 
dollars more for their health insurance.
  The OMB Director, Mick Mulvaney, was pressed on why TrumpCare breaks 
the President's promise of ``insurance for everybody.'' His response 
was that TrumpCare is about access, and the bill ``helps people get 
healthcare instead of just coverage.'' But we all understand that 
access doesn't mean a lot if people can't afford to get coverage. That 
is the future that TrumpCare is going to bring for millions of 
Americans.
  I asked Ms. Verma the most basic questions during her confirmation 
hearing so we could get even a little bit of an insight into how she 
would approach these issues. I asked for one example--these are not 
``gotcha'' questions; these are the questions you ask if you want to 
know about running a program involving $1 trillion. I asked Ms. Verma 
for one example of what to do to bring down the cost of prescription 
medicine. I gave her three or four to choose from. I particularly would 
like to see more transparency by lifting this cloud of darkness 
surrounding how medicines are priced. She didn't have any answers to 
any of these questions.
  So here is where this nomination stands. Ms. Verma gave the Finance 
Committee and the public virtually nothing to go by in terms of how she 
would approach this job, but the fact is that, if confirmed, she would 
be one of the top officials to implement TrumpCare--a bill that raids 
Medicare, slashes Medicaid, and kicks millions of Americans off their 
health plan to pay for a tax cut for the wealthy.
  I am unable to support this nomination, and I urge my colleagues to 
oppose it.
  Mr. President, over the past decade, the Trump administration's 
nominee to be CMS Administrator, Seema Verma, has demonstrated a 
conflicting pattern of working directly for the State of Indiana on its 
health programs while also contracting with a handful of companies that 
provided hundreds of millions of dollars in services and products to 
the very same programs she was helping the state manage.
  Those companies are Hewlett Packard, Health Management Associates, 
Milliman, Inc., Maximus, and Roche Diagnostics. All were vendors to the 
State's Healthy Indiana Program agencies, while Ms. Verma helped design 
and direct that Program--first for Governor Daniels and then for 
Governor Pence. As she describes her role on her company's website, 
``Ms. Verma is the architect the Healthy Indiana Plan (HIP), the 
Nation's first consumer directed Medicaid program under Governor Mitch 
Daniels of Indiana and Governor Pence's HIP 2.0 waiver proposal. Ms. 
Verma has supported Indiana through development of the historic program 
since its inception in 2007, from development of the enabling 
legislation, negotiating the financing plan with the state's hospital 
association, developing the federal waiver, supporting federal 
negotiations and leading the implementation of the program, including 
the operational design.''
  Ms. Verma collected more than $6 million from Indiana taxpayers while 
overseeing the State's Medicaid reform and ACA implementation. At the 
same time, while under contract with the State as a consultant, Ms. 
Verma also collected more than $1.6 million from Milliman Actuaries, 
more than $1 million from Hewlett Packard, $300,000 from Health 
Management Associates, and tens of thousands of dollars from Roche 
Diagnostics and Maximus. All while these companies held important 
contracts with the State.
  In addition to being on ``both sides of the table,'' in at least two 
cases involving her contracts with Hewlett Packard and Health 
Management Associates--her duties for the State of Indiana overlapped 
directly with the tasks those firms were also billing the state to 
complete.
  While there are questions about Ms. Verma's work for the several 
companies above, I want to focus for the moment on what I believe to be 
the clearest conflict: her work on behalf of Hewlett Packard.
  Hewlett Packard Conflicts. In 2014, the Indianapolis Star newspaper 
reported:

       ``Verma's work has included the design of the Healthy 
     Indiana Plan, a consumer-driven insurance program for low-
     income Hoosiers now being touted nationally as an alternative 
     to Obamacare. In all, Verma and her small consulting firm, 
     SVC Inc., have received more than $3.5 million in state 
     contracts. At the same time, Verma has worked for one of the 
     state's largest Medicaid vendors--a division of Silicon 
     Valley tech giant Hewlett-Packard. That company agreed to pay 
     Verma more than $1 million and has landed more than $500 
     million in state contracts during her tenure as Indiana's go-
     to health-care consultant.''

  While this in and of itself is deeply concerning, Indiana state 
contract records show that Ms. Verma was instrumental in helping the 
state determine this contract was even necessary in the first place.

[[Page 4164]]

  Let me say that again: Ms. Verma, in her role of advising Indiana, 
helped the state determine there was a need for the services of a 
vendor like Hewlett Packard. She then joined the company on a bid to 
provide those services, received a contract, and was ultimately paid 
more than $1 million. Hewlett Packard bought the company that 
originally contracted with the state, Electronic Data Systems in 2008. 
That company, in a January 2008 press release characterized the Indiana 
contract in this way:

       ```The EDS solution will provide Indiana with enhanced 
     transparency as it implements Gov. Mitch Daniels' package of 
     Medicaid reforms such as the Healthy Indiana Plan . . .' `At 
     the conclusion of the procurement process, it was evident 
     that EDS was able to bring great value and experience to the 
     taxpayers of Indiana,' said Mitch Roob, Family and Social 
     Services Administration Secretary. `The technology and 
     insight that EDS has to offer will be a tremendous asset as 
     we continue to make great strides in new, innovative 
     programs, such as the Healthy Indiana Plan.'''

  Ms. Verma helped Indiana outline Medicaid reform policy goals as 
State contractor before joining a vendor in its bid to fulfill those 
duties--and then remained a paid participant on both sides. 
Furthermore, it appears that Ms. Verma was billing Hewlett Packard and 
Indiana, in some cases, for the same work she was already performing 
under her own contracts with the State. In written responses for the 
record to the Finance Committee, Ms. Verma provided a 2013 presentation 
from Hewlett Packard and herself to Indiana health program executives.
  The presentation identified several functions that Ms. Verma would 
provide to the State through the Hewlett Packard contract. Many of 
those duties are exceptionally similar to duties the State had already 
contracted with her directly to provide in 2012 and 2013.
  For example, that 2013 presentation outlined specific duties HP was 
paying her to perform that included: monitoring the Federal regulatory 
environment, providing Medicaid policy expertise, and supporting 
Indiana's State Plan Amendment waivers and process. These were things 
Verma was already under contract to provide the state directly.
  On February 21, 2012, Verma's firm was contracted by the State to 
review Federal regulations that would impact Indiana's Healthy Indiana 
Plan.
  On May 13, 2013, she was contracted to provide the State with advice 
on the impact of new ACA regulations related to Medicaid.
  To me, that sounds a lot like monitoring the federal regulatory 
environment in the HP presentation.
  Under the February 21, 2012 contract, Verma's firm was contracted by 
the State to provide general policy expertise to the Healthy Indiana 
Program--also known as Indiana's Medicaid program.
  To me, that sounds a lot like providing Medicaid policy expertise in 
the HP presentation.
  Under this same February 21, 2012 contract, Verma's firm was 
contracted by the State to develop State Plan Amendments and waivers--
these are the agreement between the State and Federal Governments that 
ensures the State adheres to Federal rules for Medicaid and CHIP.
  To me, that sounds a lot like supporting Indiana's State Plan 
Amendment waivers and process in the HP presentation.
  Ms. Verma has not addressed how being paid twice for what appears to 
be largely similar work was ethical. She has, however, consistently 
denied that any conflicts of interest existed while she worked both 
sides of these deals in Indiana. During her confirmation hearing before 
the Senate Finance Committee on February 16, 2017, Ms. Verma claimed 
she had her staff recused themselves when potential conflicts arose:

       ``When there was the potential or when we were working on 
     programs, we would recuse ourselves. So we were never in a 
     position where we were negotiating on behalf of HP or any 
     other contractor with the state that we had a relationship 
     with.''

  That all sounds well and good but that claim has been disputed by the 
former head of Indiana's Family and Social Services Agency. As first 
reported in 2014 by the Indianapolis Star,

       ``Verma's arrangement with HP also came as a surprise to 
     former FSSA Secretary Debra Minott, who said she learned 
     about it sometime in 2013. `We had delayed paying an HP 
     invoice because of an issue we were trying to resolve, and HP 
     sent Seema to our CFO to resolve the issue on their behalf,' 
     Minott said. `I was troubled because I thought Seema was our 
     consultant.'''

  Ms. Minott made this allegation again just last month in a February 
14, 2017 story by the Associated Press about Ms. Verma's conflicts,

       ``There was at least one instance where Verma crossed the 
     line in Indiana when she was dispatched by HP to help smooth 
     over a billing dispute, said Minot. `It was never clear to me 
     until that moment that she, in essence, was representing both 
     the agency and one of our very key contractors,' said Minot, 
     who was removed as head of the agency by Pence over her 
     disagreements with Verma. `It was just shocking to me that 
     she could play both sides.'''

  Additionally, in response to questions for the record that I 
submitted to Ms. Verma, she said that her firm worked directly with HP 
for the state, and that representatives from SVC participated in 
meetings between the state and HP,

       ``SVC worked with the State of Indiana and its vendors, 
     including HP, to design systems for implementation of the 
     Healthy Indiana Plan. We helped vendors translate the policy 
     and waiver language into system operations. We did not 
     oversee HP or any other vendor in this regard, and did not 
     negotiate or participate in change orders or contract 
     amendments. To the best of my recollection, State officials 
     participated in all meetings with HP regarding the Healthy 
     Indiana Plan work at which SVC representatives were also 
     present.''

  That sounds to me like Ms. Verma and her team were in meetings with 
both HP and the State discussing issues where her duties clearly 
overlapped and when she was being paid by both parties. In fact it 
sounds like the only safeguard in place was that State officials sat in 
on these meetings between her firm and HP.
  Finally, with regard to her claim that she always recused herself, I 
specifically asked her to provide for the record any documentation that 
she had of the process for determining when she needed to recuse 
herself and documentation of the recusals actually taking place. She 
replied that there were none.
  Consequently, it's hard to believe Ms. Verma was truly able to avoid 
very real conflicts of interest while she and/or her firm were guiding 
HP's work on behalf of the State and sitting in on meetings with both 
the state and HP while being paid by both.
  In the case of Health Management Associates, Verma also had contracts 
with the state that covered the exact same work HMA was separately 
being paid by Indiana to fulfill and while she was also being paid by 
HMA. For example, in 2007, the State awarded Verma's firm a non-
competitive contract to develop the Request for Proposal for a company 
to implement the Governor's Healthy Indiana Program. On the same day, 
Indiana gave HMA its own non-competitive contract to develop the very 
same proposal. This occurred while HMA was also paying Verma's firm on 
a separate but related contract. Again, as in the case of HP, she was 
helping the State manage key programs while being paid by contractors 
performing work for those programs. In this case, what she was doing 
for the State was essentially the same thing that the contractor was 
being paid to do--develop a Request for Proposal to implement the 
Healthy Indiana Plan.
  Ms. Verma claims there was no conflict because she did not directly 
oversee these two contractors--HP and HMA--in her role with State. She 
also points to the fact that in 2012 she received an opinion from the 
Indiana Ethics Commission that stated her work for HP was not in 
violation of state conflict of interest laws because she was a 
consultant, not a State employee.
  I do not believe that her work for the State and her work for these 
contractors was a true arms-length relationship. As the Associated 
Press recently highlighted, Ms. Verma maintained an office in the State 
government center and that the AP characterized her work as ``usually 
reserved for state administrators.'' The existence of this

[[Page 4165]]

opinion, in my view, does not absolve Ms. Verma from what look to be 
very clear and obvious conflicts of interest.
  I am not alone in this opinion, as President George W. Bush's ethics 
lawyer Richard Painter--hardly a liberal partisan--said Ms. Verma's 
consulting arrangement in Indiana, ``clearly should not happen and is 
definitely improper.'' Ms. Verma helped the State decide it needed a 
vendor like HP, and then went to work for HP on the resulting contract. 
She was also under contract with yet a third company--Health Management 
Associates--which was being paid to develop the Request for Proposal 
for the same contract. That certainly seems like a conflict of interest 
to me.
  When I asked her in writing whether she had obtained similar ethics 
opinions with regard to her work for any of the other state contractors 
who had hired her--Milliman, Roche Diagnostics, Maximus, or Health 
Management Associates, she said she hadn't.
  All of these companies continue to do business with the State of 
Indiana and with other State and Federal health programs that will be 
under Ms. Verma's purview at CMS. Maximus, for example, is the largest 
provider of enrollment services for these programs in the U.S.
  Just because Indiana chose to play fast and loose with conflicts of 
interest doesn't mean that these practices were right.
  I have no confidence that Ms. Verma will take her responsibilities to 
avoid such conflicts at CMS any more seriously than she did in Indiana.
  Mr. President, I ask unanimous consent to have the following 
documents printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     [from INDYSTAR, Nov. 29, 2016]

 Seema Verma, Powerful State Health-Care Consultant, Serves Two Bosses

                             (By Tony Cook)

       President-elect Donald Trump has tapped Seema Verma, a 
     consultant who helped craft the state's Healthy Indiana Plan, 
     to serve as head of the Centers for Medicare and Medicaid 
     Services. Verma worked closely to shape the health care 
     policy of both former Gov. Mitch Daniels and Gov. Mike Pence.
       The health policy consulting company she heads, SVC Inc., 
     also has provided its services to Iowa, Ohio, Kentucky, 
     Tennessee and Michigan. A 2016 recipient of the Sagamore of 
     the Wabash award, Verma also served as vice president of 
     planning for the Health and Hospital Corporation of Marion 
     County. She also holds a master's of public health from Johns 
     Hopkins University.
       Meet the architect of Gov. Mike Pence's signature health-
     care plan, Seema Verma.
       For more than a decade, the little-known private consultant 
     has quietly shaped much of Indiana's public health-care 
     policy. The state has paid her millions of dollars for her 
     work--amid a potential conflict of interest that ethics 
     experts say should concern taxpayers.
       Largely invisible to the public, Verma's work has included 
     the design of the Healthy Indiana Plan, a consumer-driven 
     insurance program for low-income Hoosiers now being touted 
     nationally as an alternative to Obamacare. In all, Verma and 
     her small consulting firm, SVC Inc., have received more than 
     $3.5 million in state contracts.
       At the same time, Verma has worked for one of the state's 
     largest Medicaid vendors--a division of Silicon Valley tech 
     giant Hewlett-Packard. That company agreed to pay Verma more 
     than $1 million and has landed more than $500 million in 
     state contracts during her tenure as Indiana's go-to health-
     care consultant, according to documents obtained by The 
     Indianapolis Star.
       Verma's dual roles raise an important question: Who is she 
     working for when she advises the state on how to spend 
     billions of dollars in Medicaid funds--Hoosier taxpayers or 
     one of the state's largest contractors?
       In a written statement, Verma said unequivocally that she 
     played no role in HP's contracts with the state. ``SVC has 
     disclosed to both HP and the state the relationship with the 
     other to be transparent,'' Verma said. ``If any issue between 
     HP and the state presented a conflict between the two, I 
     recused myself from the process.''
       But the recently ousted head of the state agency 
     administering Verma's contract told The Star that Verma once 
     attempted to negotiate with state officials on behalf of 
     Hewlett-Packard, while also being paid by the state.
       HP said it can find no one in its company with any 
     recollection of such a meeting. Verma declined to answer 
     further questions about her work with the state or HP.
       Verma's dual roles have surprised some leading Republican 
     lawmakers and expose one of many loopholes in Indiana's 
     government ethics laws.
       Ethics experts consulted by The Star called the arrangement 
     a conflict of interest that potentially puts Indiana 
     taxpayers at risk. If Verma were working for the federal 
     government, they point out, she would have to show how the 
     government was protected, or step aside.
       ``If I were a taxpayer in Indiana, I would be concerned 
     about whether the advice the government was receiving from 
     her was tainted by her own financial interest and the 
     financial interest of her other clients,'' said Kathleen 
     Clark, a professor at Washington University School of Law in 
     St. Louis who specializes in government ethics.
       But in Indiana, government consultants aren't required to 
     disclose such potential conflicts, even when they have 
     offices in state government, as Verma does.
       So the nature of Verma's work--and the extent to which it 
     benefited HP--remains unclear.
       HP referred any other questions on the matter to the state. 
     Verma's spokesman, Lou Gerig, noted in a statement that ``all 
     contracts between the state and SVC Inc., or between the 
     state and SVC Inc. as a subcontractor, have been reviewed and 
     approved in accordance with all requirements of state law.''
       Pence's office issued a written statement in response to 
     The Star's questions.
       ``Seema has played a valuable role in the state's health-
     care policy since the O'Bannon administration, and we 
     appreciate her advice and counsel, especially on the 
     continuation of the Healthy Indiana Plan and HIP 2.0,'' said 
     Christy Denault, a spokeswoman for Pence.
       State officials didn't directly address questions about 
     Verma's work for HP. But James Gavin, spokesman for the 
     Indiana Family and Social Services Administration, said the 
     state does take steps to prevent conflicts in the bidding 
     process.
       He said the state's procurement guidelines ``clearly 
     require that all decision-making authority lie with state 
     employees and agency executives. These guidelines are 
     designed to eliminate conflicts of interest.''


                          Powerful contractor

       Verma enjoys a tremendous amount of sway for a private 
     contractor. She has her own office at the state government 
     center. Earlier this year, Pence turned to her to broker a 
     deal with the state's hospital industry to help finance his 
     plan to expand the Healthy Indiana Plan. And when Verma and 
     one of Pence's Cabinet members--Family and Social Services 
     Administration Secretary Debra Minott--butted heads over how 
     soon to roll out the program, it was Minott who lost her job.
       Verma's influence reaches back at least a decade and across 
     the administrations of four governors, two from each party. 
     During his first term, Gov. Mitch Daniels tapped Verma to 
     help create a new health-care plan to address the state's 
     uninsured population. Her solution: the Healthy Indiana Plan, 
     a new low-income health insurance program that features high 
     deductibles and requires participants to contribute a portion 
     of their income to a health savings account.
       ``This structure melds two themes of American society that 
     typically collide in our health-care system, rugged 
     individualism and the Judeo-Christian ethic,'' Verma wrote in 
     a 2008 Health Affairs blog article co-authored with former 
     FSSA Secretary Mitch Roob. ``HIP combines these diametrically 
     opposed themes by promoting personal responsibility while 
     providing subsidized health protection to those who can least 
     afford it.''
       The plan won the support of both Republicans and Democrats 
     in the Indiana legislature and was implemented in January 
     2008. Today, 52,000 Hoosiers are enrolled in the program.
       Now, Pence wants to expand the plan to an additional 
     350,000 low-income Hoosiers through what he's calling HIP 
     2.0. And like Daniels, he turned to Verma for help in 
     developing the plan and negotiating a financing agreement 
     with the state's hospital industry. If approved by the 
     federal government, billions of new Medicaid funds would flow 
     to the state.
       And because HIP 2.0 would generate significantly more 
     claims, some of that money would likely go to Hewlett-
     Packard, Verma's other client.
       The extent to which Verma's advice has benefited HP is 
     difficult to determine, given that none of the parties 
     involved will talk much about the subject. Further obscuring 
     the issue: Several of her most recent contracts weren't 
     publicly available on the state's online transparency portal 
     until The Star began making inquiries. Denault said that was 
     because ``some of them were mistakenly coded as not for 
     publication.'' The contracts have since been added to the 
     online list.
       What they show is that her duties involve crafting 
     requirements for contractors. negotiating with contractors 
     and supervising vendors. Her company's website also says she 
     provided ``requirements for the state's three technology 
     vendors to support HIP.'' That would include Hewlett-Packard. 
     One contract gives her the authority to ``initiate and/or 
     track'' a contract or contract amendments with the state's 
     fiscal intermediary,

[[Page 4166]]

     which is HP. Another puts her in charge of technical changes 
     to the state's medical management information system, which 
     is operated by HP.
       Those responsibilities put Verma in the position of making 
     decisions about a state contractor that is also paying her 
     hundreds of thousands of dollars. HP's claims management and 
     information system contracts show it has agreed since 2007 to 
     pay Verma's company $1.2 million as a subcontractor for 
     ``health consulting services.''
       During that time, HP received more than $500 million in 
     state contracts, including millions of dollars in contract 
     changes to accommodate the Healthy Indiana Plan that Verma 
     helped create and other new programs.
       ``Certainly on the face of it, there is the appearance of a 
     conflict,'' said Trevor Brown, an expert on government 
     purchasing and director of Ohio State University's John Glenn 
     School of Public Affairs.
       If Verma was a federal contractor, her dual roles ``would 
     certainly raise tremendous concern for regulators and 
     purchasing officials,'' he said. ``This is exactly the kind 
     of thing that would land an agency in a hearing before a 
     legislative oversight committee.''
       Lawmakers in Indiana, however, were unaware of Verma's work 
     for HP.
       ``I was only aware she was working for the state,'' said 
     Sen. Patricia Miller, R-Indianapolis, chairwoman of the 
     Senate Health Committee.
       ``There certainly appears to be the potential for conflict, 
     and appearances matter,'' said Ed Clere, R-New Albany, 
     chairman of the House Health Committee.
       Verma's arrangement with HP also came as a surprise to 
     former FSSA Secretary Debra Minott, who said she learned 
     about it sometime in 2013.
       ``We had delayed paying an HP invoice because of an issue 
     we were trying to resolve, and HP sent Seema to our CFO to 
     resolve the issue on their behalf,'' Minott said. ``I was 
     troubled because I thought Seema was our consultant.''
       HP spokesman Bill Ritz said the company ``checked with a 
     number of its employees and can find no one with any 
     recollection of such a meeting.''
       Gerig, Verma's spokesman, said Verma's work for HP was a 
     matter of public record because she is listed as a 
     subcontractor in HP's contracts with the state.


                            A lack of rules

       Ethics experts say that kind of scenario would be unlikely 
     at the federal level, where government purchasing officers 
     are required to identify and avoid ``organizational conflicts 
     of interest,'' which occur when a person is unable or 
     potentially unable to render impartial assistance or advice 
     to the government because of other business relationships.
       Many states, including Maryland, Virginia, Minnesota and 
     Illinois, have adopted similar rules at the state level, 
     according to Dan Forman, a Washington, D.C.-based government 
     procurement attorney. Other states, such as Tennessee and 
     Washington, have implemented rules at the agency level. Still 
     others, such as California and Maine, have introduced rules 
     via standard state contract provisions.
       But in Indiana, that's not the case.
       Minott said when she brought her concerns to FSSA's ethics 
     officer, she was told Indiana's ethics rules didn't apply to 
     conflicts of interests among state contractors.
       The lack of any such rule is just the latest in a litany of 
     loopholes that good government advocates say Indiana needs to 
     address.
       In recent months, The Star has reported on several high-
     profile cases--including those of state Rep. Eric Turner, 
     former highway official Troy Woodruff and former state 
     schools chief Tony Bennett--where ethics officials criticized 
     the behavior of public officials but took little or no action 
     due to exemptions in state ethics rules.
       The issues raised in Verma's case are not unique to 
     Indiana, said Brown, the Ohio State professor. State 
     governments across the country are increasingly grappling 
     with potential conflicts of interest as more private 
     contractors perform what has traditionally been government 
     work.
       ``Historically, the practice was these decisions would be 
     made by the leadership of the agency, and in many states they 
     are,'' he said. ``But Indiana is not alone in having to rely 
     on advice and services of a private actor to perform what is 
     at the boundary of, if not a clear instance of, a government 
     function.''
       State reliance on private contractors is especially common 
     in the health-care arena, where rapid changes in federal 
     health-care law have put a premium on speed. And indeed, 
     several executive summaries of Verma's contracts emphasize 
     the need to quickly utilize her services amid the threat of 
     losing federal grant money.
       ``Over the short run, it sounds like you're going to get 
     speed,'' Brown said. ``And you may get some cost savings over 
     the short run.''
       But in the long run, states can become dependent on private 
     contractors, who can then jack up their prices.
       ``They essentially become a monopoly, and there's a risk 
     that they can raise costs over time,'' he said. Verma's 
     arrangement with the state demonstrates how difficult it can 
     be to control such costs.
       An amendment to her contract in January added $300,000 
     without increasing her workload or extending the term of the 
     contract. The reason listed: ``to cover claims.'' State 
     officials declined to elaborate.
       The hourly rates listed in her contracts also have 
     increased over time, from $110 in 2007 to $135-$165 this 
     year.
       Lawmakers expressed surprise when told by The Star that the 
     state paid Verma's company $1.15 million in the past year 
     alone.
       ``I had no idea her firm received that much money. I think 
     it would come as a surprise to most legislators,'' Clere 
     said. ``I think there's a larger issue of transparency and 
     accountability as the state increasingly relies on 
     contractors, including consultants. I'm all for harnessing 
     the power of the private sector, and the key word is 
     `harness,' which suggests the state is in control. The 
     question here is, `Whose hands are on the reins?'''
                                  ____


               [From the Associated Press, Feb. 15, 2017]

      Pick for Medicare Post Faces Questions on Indiana Contracts

                (By Brian Slodysko and Carla K. Johnson)

       Indianapolis.--President Donald Trump's pick to oversee 
     Medicare and Medicaid advised Vice President Mike Pence on 
     health care issues while he was Indiana's governor, a post 
     she maintained amid a web of business arrangements--including 
     one that ethics experts say conflicted with her public 
     duties.
       A review by The Associated Press found Seema Verma and her 
     small Indianapolis-based firm made millions through 
     consulting agreements with at least nine states while also 
     working under contract for Hewlett Packard. The company holds 
     a financial stake in the health care policies Verma's 
     consulting work helped shape in Indiana and elsewhere.
       Her firm, SVC Inc., collected more than $6.6 million in 
     consulting fees from the state of Indiana since 2011, records 
     show. At the same time, records indicate she also received 
     more than $1 million through a contract with Hewlett, the 
     nation's largest operator of state Medicaid claims processing 
     systems.
       Last year, her firm collected an additional $316,000 for 
     work done for the state of Kentucky as a subcontractor for HP 
     Enterprises, according to documents obtained by AP through 
     public records requests.
       In financial disclosures posted this week, Verma reported 
     she has an agreement to sell SVC Inc. to Health Management 
     Associates of Lansing, Michigan, within 90 days of her 
     confirmation.
       In a statement, a spokesman for Verma said there was no 
     conflict of interest and added that she has the support of 
     former officials who served with her under Pence.
       Her firm was ``completely transparent in regards to its 
     relationship with HP and that there was never a conflict of 
     interest,'' spokesman Marcus Barlow said in a statement.
       A spokesman for Pence did not respond to a request for 
     comment.
       Verma faces a Senate Finance Committee hearing on Thursday. 
     Democrats in Washington are aware of many of her consulting 
     arrangements, and have broader concerns about her philosophy 
     about government entitlement programs, lack of background in 
     Medicare and inexperience leading a large organization.
       As a trusted adviser to Pence, she had an office in the 
     state government center and took on duties usually reserved 
     for state administrators. Verma was also widely respected for 
     her grasp on policy and designed a federal Medicaid waiver 
     that allowed Pence to undertake his own conservative 
     expansion of the program while still accepting money made 
     available through the Affordable Care Act.
       Verma did not specifically address how she would handle 
     decisions related to HP in a letter to the Department of 
     Health and Human Services that was released this week. The 
     letter outlined her plan for managing potential conflicts of 
     interest should she be confirmed by the Senate to lead the 
     Centers for Medicare & Medicaid Services. Her relationship 
     with HP was first reported by the Indianapolis Star in 2014.
       Legal and ethics experts contacted by AP say Verma's work 
     for Hewlett, and offshoot HP Enterprises, raised questions 
     about where her loyalties lay--to the company, or to state 
     taxpayers.
       Richard Painter, former President George W. Bush's chief 
     ethics lawyer, called Verma's arrangement a ``conflict of 
     interest'' that ``clearly should not happen and is definitely 
     improper.''
       Such arrangements are typically prohibited for rank-and-
     file state employees under Indiana's ethics rules and laws, 
     but they're murkier when it comes to consulting work. 
     Contractors have often replaced state employees in a GOP bid 
     to drive down the number of public employees, distinctions 
     between the two can be hard to discern.
       ``She was cloaked with so much responsibility and so much 
     authority, people thought she was a state employee,'' said 
     Debra Minot, a former head of Indiana's Family and Social 
     Services Agency under Pence who worked with Verma.
       Indiana University law professor David Orentlicher compared 
     Verma's dual employment to an attorney who represents both 
     the plaintiff and the defense in a lawsuit. It's

[[Page 4167]]

     also similar to federal contract negotiator with a side job 
     for a company they regularly negotiate with, he said.
       ``If you have one person on both sides of the negotiating, 
     they can't negotiate hard for both sides,'' said Orentlicher, 
     a former Indiana Democratic state lawmaker.
       There was at least one instance where Verma crossed the 
     line in Indiana when she was dispatched by HP to help smooth 
     over a billing dispute, said Minot.
       ``It was never clear to me until that moment that she, in 
     essence, was representing both the agency and one of our very 
     key contractors,'' said Minot, who was removed as head of the 
     agency by Pence over her disagreements with Verma. ``It was 
     just shocking to me that she could play both sides.''
       State contracts show Verma's duties to Indiana and Hewlett 
     have overlapped at times. One agreement she held with the 
     state's social services agency required her to ``provide 
     technical assistance'' to state contractors, as well as the 
     governor's office. Another duty was ``contract development 
     and negotiation'' with vendors, which included HP and HP 
     Enterprises.
       Verma reported her salary with SVC is $480,000 and her 
     business income from the company as nearly $2.2 million.
                                  ____


        [From Electronic Data Systems Corporation, Jan. 7, 2008]

         Indiana Awards EDS New $209 Million Medicaid Contract


       Agreement Extends 16-Year Relationship with Hoosier State

       Indianapolis.--EDS, Indiana's Medicaid partner since 1991, 
     has been awarded a $209.9 million, six-and-a-half-year 
     contract to upgrade and continue to maintain the state's 
     Medicaid Management Information System.
       The new contract will leverage EDS' leading-edge 
     interchange Health System, which serves as an industry model 
     and is in operation or being implemented in more than a dozen 
     states, including Kansas, Oklahoma, Pennsylvania and 
     Kentucky. Among the upgrades are a Web-based tool that will 
     enable health care providers to electronically enroll in the 
     Medicaid program as well as a number of internal processes.
       EDS will continue as fiscal agent to the state and its 
     27,000 health care providers, who care for more than 800,000 
     recipients and comprise the nation's 17th-largest Medicaid 
     program.
       The agreement includes a seven-month phase to design, 
     develop, test and implement the additional features followed 
     by a six-year management term.
       The contract, which was signed in late December, extends a 
     16-year relationship between EDS and Indiana.
       The EDS solution will provide Indiana with enhanced 
     transparency as it implements Gov. Mitch Daniels package of 
     Medicaid reforms such as the Healthy Indiana Plan, which 
     provides health coverage to previously uninsured Indiana 
     residents, and the movement of aged, blind and disabled 
     residents to a care management model. It also will continue 
     claims processing coverage for other Indiana health programs.
       ``At the conclusion of the procurement process, it was 
     evident that EDS was able to bring great value and experience 
     to the taxpayers of Indiana,'' said Mitch Roob, Family and 
     Social Services Administration Secretary. ``The technology 
     and insight that EDS has to offer will be a tremendous asset 
     as we continue to make great strides in new, innovative 
     programs, such as the Healthy Indiana Plan.''
       ``As Indiana's technology partner for more than a decade 
     and a half, EDS understands the Healthy Indiana Plan and the 
     state's goal to cover its uninsured residents,'' said Sean 
     Kenny, vice president, EDS Global Health Care. ``Our 
     continued relationship will provide stability not only for 
     the current Medicaid program, but also for future reforms.''
       ``Long relationships are reflections of earned trust and 
     understanding of cultures and goals,'' said Barbara Anderson, 
     vice president, EDS U.S. Government Health Care. ``Over the 
     years, Indiana and EDS together have delivered program 
     efficiencies to enable reforms and help push forward vital, 
     new programs to improve health outcomes for Hoosiers.''
       EDS is the nation's largest provider of Medicaid and 
     Medicare process management services, administering more than 
     $100 billion in benefits a year. EDS processes about 1 
     billion Medicaid claims annually, more than any other 
     company, and provides fiscal agent services/Medicaid 
     information technology support for 21 states. Through its 
     global healthcare services and solutions, EDS touches more 
     than 200 million patient lives each day.


                               About EDS

       EDS (NYSE: EDS) is a leading global technology services 
     company delivering business solutions to its clients. EDS 
     founded the information technology outsourcing industry 45 
     years ago. Today, EDS delivers a broad portfolio of 
     information technology and business process outsourcing 
     services to clients in the manufacturing, financial services, 
     healthcare, communications, energy, transportation, and 
     consumer and retail industries and to governments around the 
     world. Learn more at eds.com.
       The statements in this news release that are not historical 
     statements, including statements regarding the amount of new 
     contract values, are forward-looking statements within the 
     meaning of the federal securities laws. These statements are 
     subject to numerous risks and uncertainties, many of which 
     are beyond EDS' control, which could cause actual results to 
     differ materially from such statements. For information 
     concerning these risks and uncertainties, see EDS' most 
     recent Form 10-R. EDS disclaims any intention or obligation 
     to update or revise any forward-looking statements, whether 
     as a result of new information, future events or otherwise.
                                  ____


       [From Hewlett-Packard Development Company, Nov. 21, 2013]

                          FSSA Executive Tour

                           (By John Wanchick)


                               Presenters

       John Wanchick, Account Executive; Scott Mack, HPES Regional 
     Manager, State Health and Human Services; Jason Schenk, HPES 
     Sales; Heather Lee, Claims Director; Doug Weinberg, CFO and 
     Third Party Liability Director; Sandra Lowe, Provider and 
     Member Services Director; Rebecca Siewert, Managed Care 
     Director; Beth Steele, Long Term Care Director; Lisa Pierce, 
     Audit and Compliance Director; Maureen Hoffmeyer, 
     Publications Director; Patrick Hogan, System Director; Darren 
     Overfelt, ITO Director; Bev Goodgame, PMO and Business 
     Analysis Director; Julie Sloma, DDI Project Manager; Pat 
     Steele, Operations Manager; Seema Verma, Executive Healthcare 
     Policy Consultant.


                  Indiana Core MMIS HP-SVC Partnership

       Provides innovative services to support Medicaid Policy; 
     External Scan: Monitoring federal regulatory environment, 
     Financial, demographic, utilization, public health data, Best 
     practices; Support Goal & Objective Setting Process; Develop 
     and Maintain Program Policy; State Plan Maintenance: Support 
     with State plan and waivers.
                                  ____

                                                   March 30, 2012.
     Ethics Opinion
       Dear Ms. Verma: Thank you for contacting our office. I 
     understand you are requesting ethics advice to determine 
     whether a conflict of interest would arise under the Indiana 
     Code of Ethics set forth in 41 I.A.C. 1-5 (``Code of 
     Ethics'') if SVC, Inc. d/b/a Seema Verma Consulting (``SVC'') 
     entered into a consulting agreement with Hewlett-Packard 
     Company (``HP'') to assist HP on a contract HP has and/or 
     would have with the Indiana Family and Social Services 
     Administration (``FSSA''). In your inquiry, you explain that 
     SVC is an Indiana Corporation that provides a range of 
     consulting services on health policy, including policy and 
     legislative analysis, grant and proposal development, project 
     and grants management, managing community and stakeholder 
     relationships, survey and evaluation design and data 
     analysis. You further explain that SVC is currently a 
     contractor to the State of Indiana (``State''), specifically 
     FSSA. Pursuant to this contractual relationship, I understand 
     that SVC provides overall management, project leadership and 
     support for the Indiana State-Operated Health Insurance 
     Exchange Level One Grant Activities. You also state that SVC 
     has been a long-standing contractor to HP and its 
     predecessors-in-interest, Electronic Data Systems Corporation 
     and EDS Information Services L.L.C. You indicate that SVC and 
     HP have entered into discussions about a new contractual 
     arrangement between the parties. Generally, the draft 
     proposal you've submitted along with your request for an 
     informal advisory opinion indicates that SVC would assist HP 
     in their efforts relating to work on State's Medicaid 
     Management Information System (MMIS).
       The threshold question in this case is whether the Code of 
     Ethics applies to SVC. The Code of Ethics applies to a 
     current or former state officer, employee, and special state 
     appointee and a person who has a business relationship with 
     an agency. SVC is neither a state officer nor a special state 
     appointee. The term ``employee'' is defined in 1.C. 4-2-6-
     1(a)(8) to include an individual who contracts with an agency 
     for personal services. In this case, the contract between SVC 
     and FSSA appears to be a personal services contract. However, 
     SVC is not an individual, it is a corporation. Because SVC is 
     not an individual, SVC would not be considered to be an 
     ``employee'' as the term is defined.
       It would appear that SVC would be a ``person who has a 
     business relationship with an agency.'' Specifically, the 
     term ``person'' is defined to include a corporation. I.C. 4-
     2-6-1(a)(12). SVC is a corporation. Furthermore, a business 
     relationship includes the dealings of a person with an agency 
     seeking, obtaining, establishing, maintaining, or 
     implementing a pecuniary interest in a contract with an 
     agency. I.C. 4-2-6-1(a)(5)(A)(i). SVC has a contract with 
     FSSA, a state agency. Accordingly, the Code of Ethics would 
     apply to SVC as it applies to a ``person who has a business 
     relationship with an agency.''
       While the Code of Ethics contains fifteen rules, including 
     two that specifically address conflicts of interest, the only 
     rule in the Code of Ethics that applies to a person who has a 
     business relationship with an agency is

[[Page 4168]]

     the Donor Restrictions rule set forth in 42 IAC 1-5-2. The 
     Donor Restrictions rule prohibits a person who has a business 
     relationship with an employee's agency from providing any 
     gifts, favors, services, entertainment, food, drink, travel 
     expenses or registration fees to the employee if the employee 
     would not be permitted to accept the item under 42 IAC 1-5-1, 
     the Gifts rule.
       As a person who has business relationship with an agency, 
     SVC is not subject to the conflict of interest rules set 
     forth in the Code of Ethics. Accordingly, a conflict of 
     interest under the Code of Ethics would not arise for SVC if 
     it entered into a consulting agreement with Hewlett-Packard 
     Company (``HP'') to assist HP on a contract HP has and/or 
     would have with FSSA.
       Thank you again for contacting our office. I hope this 
     information is helpful. Please note that this response does 
     not constitute an official advisory opinion. Only the State 
     Ethics Commission may issue an official advisory opinion. 
     This informal advisory opinion allows us to give you quick, 
     written advice. The Commission will consider that an employee 
     or former employee acted in good faith if it is determined 
     that the individual committed a violation after receiving 
     advice and the alleged violation was directly related to the 
     advice rendered. Also, remember that the advice given is 
     based on the facts as I understand them. If this e-mail 
     misstates facts in a material way, or omits important 
     information, please bring those inaccuracies to my attention.
           Sincerely,

                                               Cyndi Carrasco,

                                 Executive Director, Indiana State
                                                Ethics Commission.

  Mr. WYDEN. Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Moran). Under the previous order, the 
question is, Will the Senate advise and consent to the Verma 
nomination?
  Mr. WYDEN. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The assistant bill clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: The Senator 
from Georgia (Mr. Isakson).
  Mr. DURBIN. I announce that the Senator from Michigan (Mr. Peters) is 
necessarily absent.
  The PRESIDING OFFICER (Mr. Lankford). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 55, nays 43, as follows:

                       [Rollcall Vote No. 86 Ex.]

                                YEAS--55

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

                                NAYS--43

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

                             NOT VOTING--2

     Isakson
     Peters
       
  The nomination was confirmed.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. Mr. President, I move to reconsider the vote, and I 
move to table the motion to reconsider.
  The PRESIDING OFFICER. The question is on agreeing to the motion to 
table.
  The motion was agreed to.

                          ____________________