[Congressional Record (Bound Edition), Volume 163 (2017), Part 7]
[Senate]
[Pages 9608-9627]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           EXECUTIVE SESSION

                                 ______
                                 

                           EXECUTIVE CALENDAR

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will proceed to executive session to resume consideration of the 
Mandelker nomination, which the clerk will report.
  The senior assistant legislative clerk read the nomination of Sigal 
Mandelker, of New York, to be Under Secretary for Terrorism and 
Financial Crimes.
  The ACTING PRESIDENT pro tempore. The Democratic whip.


                         Healthcare Legislation

  Mr. DURBIN. Madam President, it was about a month ago that the House 
of Representatives, by a narrow vote, voted to repeal the Affordable 
Care Act and to replace it with their own creation. That effort by the 
House of Representatives passed by, I believe, 2, 3,

[[Page 9609]]

or 4 votes. It was very close, and it was a partisan rollcall--all 
Republicans voting for it and no Democrats voting for it. So it came to 
the floor of the House without any bipartisan preparation. It was only 
after the vote that the Congressional Budget Office took a look at the 
measure and reported to the American people its impact.
  Now, that is unusual because, when you take a big issue like the 
reform of America's healthcare system, historically, traditionally, 
Members of the Congress--the House and Senate--will send their versions 
of the bill to the Congressional Budget Office and ask for an analysis: 
Tell us how much this will cost. Tell us the impact on the deficit. 
Tell us what it will do in terms of healthcare coverage. But the House 
Republicans chose to vote before the analysis.
  Well, the analysis still came out, and when it came out, the report 
was unsettling because it had a dramatic negative impact on healthcare 
in America. The House Republican repeal, according to the Congressional 
Budget Office, would mean that 23 million Americans would lose their 
health insurance.
  Remember, we started this debate 6 or 7 years ago because we were 
concerned that too few Americans had health insurance and we wanted to 
expand the reach of health insurance and make sure that it was good 
health insurance, and that is why we passed the Affordable Care Act. We 
fell short in some respects, but we certainly achieved our goal of 
increasing the number of insured Americans with the Affordable Care 
Act. In my home State of Illinois, the percentage of those uninsured 
with health insurance was cut in half. In fact, it was even better than 
that. So more and more people ended up with coverage through Medicaid, 
as well as through private health insurance.
  Now comes the repeal of the Affordable Care Act, and the Republicans 
in the House decide to not only erase all of that progress in providing 
more health insurance for more families but to make it worse--to make 
the number of the uninsured even higher than it was. So if that is the 
starting point of healthcare reform, you ask yourself: Is that really a 
worthy goal? Why would you do that?
  Well, they were forced to do it. They really were. The House 
Republicans really, in fairness to them, had no choice, because they 
made the initial decision that their highest priority was to give a tax 
break of about $700 billion to the wealthiest people in America. So by 
creating this tax break--giving this money back to wealthy people--they 
took that same amount of money out of America's healthcare system. When 
you take $700 billion out of America's healthcare system, here is what 
happens. People who are currently receiving their health insurance 
through Medicaid, a government program, will have fewer and fewer 
opportunities to take advantage of Medicaid. In fact, they acknowledged 
that. The Republicans said in the House: We are just cutting back on 
Medicaid.
  Secondly, you reduce or eliminate the helping hand we give to working 
families who can't afford to pay their hospitalization premiums. If you 
are in certain categories, we give you a subsidy to pay for your 
premiums. So follow the logic: If you cut the taxes by $700 billion and 
take $700 billion out of the healthcare system, you have less money to 
provide Medicaid health insurance for those in low-income categories, 
and you have less money to help working families pay for their health 
insurance premiums.
  The Congressional Budget Office looked at that and said that the net 
result at the end of the day is that 23 million Americans will lose 
their health insurance because of this decision by the Republican 
House. In the State of Illinois, a State of about 12.5 million people, 
1 million people would lose their health insurance because of this 
action taken by the Republican House of Representatives.
  Well, from basic civics we know that here we are in the Senate and we 
get our chance once the House has acted. So we have been waiting--
waiting for almost a month for the process to begin. The sad reality is 
it never even started--not the ordinary, open, public, transparent 
process of debating a change in America's public health system.
  Instead, Senator McConnell, the Republican leader, said: What I am 
going to do is to take 13 of my male Republican Senators, put them in a 
room, and let them write an alternative to the House bill. Why he 
didn't initially include the women in his caucus, he can explain, but 
it was 13 of the male Republicans who would sit in a room to write, in 
secret, their alternative.
  We think: Well, most legislative ideas start with that kind of a 
meeting--a closed-door meeting in the quiet of a room, basic 
negotiation. But it is the nature of a democracy and our form of 
government that at some point this becomes public. Shouldn't it? If we 
are going to change the laws about health insurance--basic fundamental 
coverage for American families--shouldn't we know it? Shouldn't we know 
what the changes will be before we vote on them?
  Well, there is a pretty rampant rumor that tomorrow, for the first 
time, there will be a limited disclosure of this Republican effort over 
the last several weeks. We are told--and it is only a rumor--that the 
Senate Republican leadership will sit down with the Senate Republican 
caucus and show them for the first time what they want to propose that 
we vote on.
  One might say: Well, that sounds like the beginning of a good, long 
process.
  It is not. It is the beginning of a short process, because the 
Republican leader has said that this time next week we will be into 
debating that issue and voting on it to its conclusion--in 10 days. 
That is 10 days, start to finish, to rewrite the healthcare system of 
America, 10 days on a measure that has not been disclosed to the 
Republican Senators--not all of them--let alone the Democratic Senators 
and let alone the American people. That is what we are faced with.
  When we wrote the Affordable Care Act, which was widely criticized by 
the Republicans, let me tell you the process we followed with the 
Affordable Care Act. In 2009, the Senate HELP Committee--or the Health, 
Education, Labor, and Pensions Committee--held 13 public, bipartisan 
hearings, 20 walk-throughs of various proposals, and a markup in the 
committee that went on for 1 calendar month, and 160 amendments offered 
by the Republicans were adopted. That was in 2009 with the Affordable 
Care Act.
  The Senate Finance Committee, which writes the tax laws, held 17 
roundtables, summits, and hearings on the legislation, 13 Member 
meetings and walk-throughs, and 38 meetings and negotiations.
  Keep in mind that we still haven't seen the Republican proposal we 
are supposed to vote on next week--this secret proposal.
  The Senate Finance Committee on the Affordable Care Act held a 7-day 
markup and adopted 11 Republican amendments. At the end of the day, not 
a single Republican Senator voted for the measure, but they offered 
amendments, and those amendments were debated and many of them were 
adopted by the Democratic majority.
  When the Affordable Care Act came to the floor of the Senate, we 
spent--and I remember this well--25 consecutive days in session 
considering that bill--25 days. As to what Senator McConnell and the 
Republicans will offer to us in what we call reconciliation, we will be 
lucky to get 25 hours. We spent 25 days on the Affordable Care Act. In 
total, the Senate spent more than 160 hours on the Affordable Care Act 
and more than 150 Republican amendments were adopted, though not a 
single Republican Senator ended up voting for the bill. We opened it to 
their amendments and adopted their amendments. It was a bipartisan 
effort.
  What has been the process this time around? No hearings, no markups, 
no public input, no support from the medical advocacy community at all. 
I don't have a single medical advocacy group in Illinois that supports 
what the Republicans did in the House of Representatives--not one. 
Hospitals, doctors, nurses, pediatricians, and disease advocacy groups, 
like cancer and heart, are all opposed to what was done in the House of 
Representatives, and we are

[[Page 9610]]

being told, when it comes to the Senate's turn: Get ready, it is going 
to be fast. Don't blink, you might miss it.
  Let me tell my colleagues what else we have. We have a record of 
quotations from leaders on the Republican side who, even though the 
Affordable Care Act went through all of these hearings and all this 
deliberation, were very explicit in their criticism. Here is Majority 
Leader Mitch McConnell, a Republican of Kentucky, in December of 2009, 
on the Affordable Care Act. He said: ``This massive piece of 
legislation that seeks to restructure one-sixth of our economy is being 
written behind closed doors, without input from anyone, in an effort to 
jam it past not only the Senate but the American people.''
  I might say to Senator McConnell: How would you explain what you are 
doing now when it comes to rewriting the healthcare system behind 
closed doors without input from anyone? Is it an effort to ``jam it 
past not only the Senate but the American people''?
  Senator Marco Rubio last week was quoted as saying: ``The Senate is 
not a place where you can just cook up something behind closed doors 
and rush it for a vote on the floor.''
  I agree with Senator Rubio, but that is what they are trying to do.
  Senator Lisa Murkowski, a Republican of Alaska, said: ``If we had 
utilized the process that goes through a committee, I would be able to 
answer not only your questions but my constituents' questions.''
  Senator Murkowski, a Republican of Alaska, expressed what most of us 
feel. How could we even answer an honest, legitimate question from 
someone we represent when we can't even see the measure that is being 
produced by the Republicans.
  Senator Jerry Moran, a Republican from Kansas, said last month:

       I want the committees of jurisdiction to hold hearings, 
     bring the experts who know about healthcare from across the 
     country, bring the constituents to tell us their stories. 
     Then I want every Senator, all 100 of us, to have the chance 
     to offer amendments.

  Thank you, Senator Moran. I agree with you. That is how the Senate is 
supposed to work, but that is not how it is working now.
  Let me tell my colleagues what some of the groups have said about 
this Republican effort to repeal the Affordable Care Act. You expect: 
Oh, it is a partisan comment from a partisan Senator. These are 
nonpartisan groups.
  The American Heart Association, what do they say? They say: ``The 
House bill would seriously erode preexisting condition protections, 
including for patients suffering from cardiovascular disease.''
  About a third of us on Earth--or at least a third of us in America--
have some preexisting condition. For the longest time, insurance 
companies said: If you are a woman, it is a preexisting condition.
  Go figure. But now, at least a third of us have some condition which, 
in the old days, would disqualify us from insurance coverage or make it 
too expensive.
  So now we put in the Affordable Care Act a prohibition against 
discriminating against any American because they have a preexisting 
medical condition. I think that is pretty important. My family has 
certainly had the same experience as other families when it comes to 
preexisting conditions.
  Now the Republicans have said: We are going to take that out. We want 
to give you more choice. We want the insurance companies to give you 
more choice. Choice means another reason to say no. Choice means 
coverage that isn't there when you need it. Choice means restrictions 
on your health insurance policy. That may not bother you at all today, 
but tomorrow, when you go to that doctor for that diagnosis you will 
never forget as long as you live or get involved in an accident and 
finally take a close look at that health insurance policy, you want to 
make sure it is there if you need it, don't you?
  The Republicans say we need more choice. The American Heart 
Association says that, when it comes to preexisting conditions, the 
House Republican repeal bill would seriously erode protection of 
Americans.
  The American Medical Association, the largest group of physicians in 
America, said: ``We cannot support [the bill] that passed the House as 
drafted because of the expected decline in health insurance coverage 
and the potential harm it would cause to vulnerable patient 
populations.''
  The American Diabetes Association said: ``It would give insurers the 
ability to charge people with pre-existing conditions--such as 
diabetes--higher prices [for health insurance] . . . and would allow 
insurers to deny people with diabetes the care and services they need 
to treat their disease.''
  The American Association of Retired Persons has weighed in. Here is 
what they say: ``This 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.''
  AARP is working overtime to notify Americans over the age of 50 and 
their kids that the repeal of the Affordable Care Act that passed the 
House of Representatives is a bad deal for seniors and their families.
  There is something else going on, too. For more than 6 years, 
Republicans in Congress have been shouting ``repeal and replace'' from 
the rooftops, and they voted more than 60 times to repeal the 
Affordable Care Act. They never liked it from the start. They put 
language into bills to make it more difficult for the Affordable Care 
Act to work, such as funding needed to make individual insurance 
markets work as intended. Then, on his first day in office, President 
Trump signed an Executive order directing Federal agencies not to 
enforce the Affordable Care Act.
  The Trump administration cut the open enrollment timeframe in half, 
making it harder for people to sign up for insurance--meaning fewer 
people covered, fewer people in the insurance pools, and premiums going 
up as a result. The President, to this day, continues to make 
uncertainty in the insurance market. He refuses to say whether he will 
continue providing cost-sharing reduction payments to help 7 million 
Americans afford health insurance. Without the payments, insurers tell 
us premiums will skyrockets 20 percent next year.
  Let me mention one other thing that has happened as part of this 
health insurance debate. We decided to make a historic change in 
healthcare in America. I have told the story repeatedly, and I will not 
tell it in detail, but it was Paul Wellstone, a progressive from 
Minnesota, who sat right there, and Pete Domenici, a conservative from 
New Mexico, who sat right there, who came together--these two unlikely 
partners--because they each had members of their families who suffered 
from mental illness. They said: Why is it that we don't treat mental 
illness like an illness? Why is it that health insurance just covers 
physical illness?
  They were right. They fought the insurance companies for years, and 
they won. We put it in the Affordable Care Act. We said: If you offer 
health insurance, you have to cover mental illness. My friends, it is 
time for us to step out of the shadows, where mental illness was 
considered a curse and not an illness, and deal with it as something 
that can be successfully treated. We put it in the bill, and most 
Americans would agree that it was the right thing to do.
  There was another part of it, though, that slipped my attention and 
now I know it is critically important. It wasn't just mental illness. 
It was coverage for mental illness and substance abuse treatment.
  How important is substance abuse treatment in America today? Go to 
Maine, go to Iowa, go to Illinois, and ask the question: Are there any 
problems with opioids? Heroin? Overdosing? Death? Of course.
  When you go to the rehab and addiction treatment centers and you ask 
people: How is your family paying for this care to try to rescue this 
young child in your family or someone dealing with addiction, they say 
they are either under Medicaid, the government insurance program, or 
their health insurance policy covers substance abuse

[[Page 9611]]

treatment. Why? Because Wellstone and Domenici effectively included 
that in the bill. Now, under the bill that passed in the House of 
Representatives, an estimated 1.3 million Americans with mental 
disorders and 2.8 million seeking help with substance abuse will lose 
their coverage for treatment. It is no longer a priority under the 
Republican idea of giving you choice with your health insurance.
  Choice--when you are a father buying health insurance for your family 
and you are picking out a health insurance policy and you have a 
choice, could you anticipate the teenaged daughter you love with all 
your heart will one day face an addiction and desperately need 
substance abuse treatment to save her life? Did you think about that 
when you signed up for the right choice in a lower cost health 
insurance plan?
  I feel, and many feel, that this is essential when it comes to 
services and health insurance. Republicans say: No, it is an option; 
take it or leave it. People who leave it and then need it find 
themselves in a terrible predicament. They can't provide the lifesaving 
treatment their kids and other members of the family they love 
desperately need.
  I see my colleague on the floor, and I will not go any further other 
than to say this: Why are we in this position when, 10 days before the 
final vote on changing healthcare for 360 million Americans, it is in a 
proposal that no one has seen and no one has read and no one has 
analyzed? It is an embarrassment to this great institution, the Senate, 
that we are not deliberating on this measure--this lifesaving, life-
and-death measure--with the kind of respect that it deserves, with the 
kind of expertise that it deserves.
  My Republican Senate colleagues have said it well--Senator Murkowski, 
Senator Moran, and others: The Senate ought to do what the Senate was 
elected to do. Take up an important measure like this, read it 
carefully, debate it, amend it, bring in the experts, and don't move so 
quickly on it that you could jeopardize the healthcare of millions of 
Americans. I am sorry it has reached that point.
  If 3 Republican Senators out of 52--if three of them--will step up 
and say: This is wrong; we need to do this the right way, a transparent 
way, a fair way, a bipartisan way. If three will step up and do that, 
then we can roll up our sleeves and do the right thing for America.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Maine.
  Mr. KING. Just a moment, Madam President. I am looking for the 
healthcare bill. I know it is here somewhere. I haven't been able to 
find it and have been looking all morning. I suspect maybe we will find 
it in the next couple of days.
  I wish to talk about Medicaid. Medicaid is often perceived as a 
welfare program, and it isn't. It is essential medical support.
  Now, let's talk about who receives Medicaid. Seventy-two percent of 
the people who receive assistance from Medicaid are children, people 
with disabilities, and the elderly. Indeed, 85 percent of the 
expenditures for Medicaid, as opposed to enrollees--85 percent of the 
expenditures--are for those same groups--the children, the disabled, 
and the elderly.
  Particularly, what a lot of people don't realize is that Medicaid is 
one support--if not the principal support--for nursing home care 
throughout the country, and especially in my State of Maine. I suspect, 
if we surveyed people--perhaps some even in this body, but certainly in 
the general public: How are you going to cover Aunt Minnie's nursing 
home care when she has to have it later in her life, most people would 
say: Oh, we have Medicare. People I talk to at home say: Medicare is 
going to take care of me. No, except in very rare and limited 
circumstances, Medicare does not cover nursing home care. It doesn't 
cover long-term care. That is Medicaid.
  Sixty-eight percent of all the Medicaid spending in Maine was for 
elderly or disabled people in 2014. About one in three people 
nationwide is going to require nursing home care--one in three. 
Nationally, over three-quarters of nursing home residents are covered 
by Medicaid. So if we are talking in this bill, wherever it is--if 
anybody finds it, let me know--about significant cuts to Medicaid, we 
are talking about people's ability to have long-term care in nursing 
homes. Make no mistake about it. You cannot cut Medicaid by over $1 
trillion in 10 years and not have it affect those people.
  Now, some say we are giving the States flexibility. We are giving the 
States flexibility to make agonizing decisions between disabled people, 
children, and seniors. That is not flexibility. To quote the President, 
that is ``mean.'' That is cruel. The States are only going to have two 
choices. They are either going to have to cut people off and limit 
services--and remember that three-quarters of the people are disabled, 
elderly, and children--or they are going to have to raise taxes on 
their own citizens.
  Now, we are claiming we are going to help the Federal budget. We are 
going to reduce the deficit by $800 billion over 10 years by passing 
this bill. But we are just shifting the bill to the States. That is 
nice work, if you can get it. Why don't we shift the cost of the Air 
Force to the States? That would make the Federal budget look better. 
But it is not a real savings to our citizens if they have to pay out of 
their pocket at their home State or in their city, or if they have to 
pay part in their income taxes. That is no savings. That is a fake 
savings. That is a smokescreen to tell people: We are cutting 
government expenditures. No, we are not. We are just shifting them to 
another level of government where you are going to have to pay for them 
there as well.
  But to get back to Medicaid. Seventy percent of the nursing home 
residents in Maine are covered by Medicaid. Who are they? They are 
people who can't be cared for at home any longer. They require nearly 
constant care and support. These aren't welfare recipients. These are 
our former teachers, police officers, the people who looked after us, 
the carpenters who built our houses, the nurses who cared for us in 
hospitals, the wait staff who served us meals, the veterans who served 
in times of trouble and fought for our freedom.
  They and their families are simply part of our communities. They are 
not welfare recipients. They are people who have paid their fair share 
throughout their lives. They have worked hard. They have done all the 
things they were supposed to do, all the things that were expected of 
them. They stayed in their homes, by and large, as long as they 
possibly could. But at some point, after their assets and ability to 
pay were exhausted, they had Medicaid to help them in terms of long-
term care.
  I often say when I talk about this that it really frustrates me that 
we talk about this healthcare issue in terms of ideology and the free 
market and all of these kinds of things. No, this is about people.
  This is about Jim and Cora Banks from Portland, ME. They lived in 
Portland. He was a State employee, and she was a beautician, who worked 
out of her home and most of her energy went into raising four boys. 
Cora was a den mother and Scout leader. They worked on projects and--
can you believe it--all four of their boys were Eagle Scouts. That is 
an astonishing accomplishment, to have four sons as Eagle Scouts. They 
were active in the Kiwanis and taught Sunday school. One of their sons 
was involved in Little League. So Cora raised money to build a 
concession stand on the field, which is still used today.
  At 55, tragically, Cora began to have memory issues. Because they had 
health insurance--because they had health insurance--she could get 
great care at a geriatric practice in Portland. Friends and family were 
helpful, and Jim was the principal caregiver for many years. But at 70, 
it became clear that Cora needed full-time care, and Jim could not 
provide that level of care. The doctors said she needed to be in a 
residential setting. Her assets were exhausted. She qualified for 
MaineCare, which is what we call Medicaid. Her nursing home care was 
covered, and she lived for a year in that nursing home.

[[Page 9612]]

  Two-thirds of the income for all of our nursing homes in Maine come 
from Medicaid, from MaineCare. What happens to this resource of the 
nursing homes if suddenly their revenues are significantly cut? What 
happens? But, mostly, what happens to people like Cora?
  There is also an idea--and I heard the head of the OMB talk about it: 
We are not really cutting; we are just cutting the rate of growth. 
Well, if the demand is growing, the cost is growing, and you cut the 
rate of growth, you are cutting. Less money will be available than is 
necessary to meet the need. That is a real cut.
  All of us know we are facing a demographic bulge from the baby boom 
generation, who are aging and are going to require more and more 
medical treatment, and they are going to put a greater demand on our 
nursing homes.
  In Maine, we are projecting a 105,000-person increase in the next 10 
years of people over 65. One in four Maine people will be over 65 in 
the next two decades.
  The Alzheimer's Association projects that 35,000 Maine seniors will 
be afflicted with the tragic disease of Alzheimer's within 10 years; 
25,000 had the disease in 2014. People with dementia are 10 times more 
likely to live in a nursing home.
  There is a lot in the bill, I am told. I don't know; I haven't seen 
it. I have been looking for it. But the central premise seems to be, if 
it is anything like the House bill, a massive cut in Medicaid and a 
massive tax cut to the people in our society who least need it. The tax 
cut is targeted at the very wealthiest Americans. Yet the results of 
that decision will be to cut essential medical support for elderly 
people, disabled people, and children. I don't understand that bargain. 
I don't understand that equation--a gigantic tax cut to the wealthiest 
and a substantial cut in support for those who most need it.
  Maybe I will be pleasantly surprised when I see the bill, whenever 
that is. I hope it is more than a few hours before we are called upon 
to vote on it. Right now, what we are hearing and what we are learning 
and what the House bill looked like would be a tragedy for this country 
and a tragedy for real people.
  I don't understand the impulse to give a tax cut and to hurt people 
when we know that is going to be the case. And again, these are not 
welfare recipients; these are your friends and neighbors.
  In all of our States, almost two-thirds of the nursing home residents 
are on Medicaid. We are not going to be able to cut Medicaid in the 
dramatic way that has been proposed without affecting those people.
  I hope this body will take the time necessary to analyze this issue, 
to openly debate it, to argue about it, and to find solutions that make 
sense and will work for the people of America, not try to ram something 
through for the purpose of checking a box on a campaign promise made 
years ago.
  The reality is, we have an obligation, in my view, not only to solve 
the problem in a compassionate and rational and efficient way but also 
to develop and run a process here that respects the institution and 
respects the American people.
  This is not the way this place is supposed to run--to have a bill 
drafted in secret, brought to the floor within hours or a few days of 
voting, and then force a vote without the kind of consideration, 
hearings, input, argument, and debate that is supposed to be the 
hallmark of this institution.
  This is a very important decision, I think one of the most important 
any of us will ever make. I, for one, am going to be able to tell my 
children and grandchildren that I stood for Maine, for our children, 
for our elderly, for our disabled people. And when the chips are down, 
the United States Senate is going to do the right thing.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Tillis). The Senator from Iowa.
  Mrs. ERNST. Mr. President, no choice and a proposed 43-percent 
increase in premiums--that is what ObamaCare and its harmful impact 
will bring to Iowa in 2018. This year, it brought premium increases up 
to 42 percent. Last year, it brought increases up to 29 percent. 
ObamaCare is not sustainable and not affordable for Iowans.
  To anybody who has studied healthcare reform, this should come as no 
surprise. In the past, many States have tried to reform their 
individual market. Twenty-seven years ago, Kentucky made an attempt and 
implemented the Kentucky Health Care Reform Act of 1994. This bill was 
similar to ObamaCare in many respects. It contained more taxes, more 
regulations, and more mandates. Within 3 years--3 years--insurers fled 
the individual market and the State was hit with skyrocketing premiums.
  What happened in Kentucky then is eerily similar to what is happening 
in Iowa today as a result of ObamaCare. When it comes to affordability 
and choice, my home State of Iowa has been hit particularly hard.
  While traveling across the State, I hear from Iowans who are looking 
for affordable coverage. Far too often, I hear that high monthly 
premiums are squeezing pocketbooks and that soaring out-of-pocket 
costs, such as deductibles and copays, make coverage unaffordable to 
use for those who do have it. That is not what ObamaCare promised, but 
that is what it has brought.
  One Iowan who works at a small business in Hinton wrote to me and 
said:

       Over the past seven years, prices have jumped considerably 
     and the coverage employees are getting for the amount of 
     money spent is substantially less! We have tried to help our 
     employees by minimizing the changes in premiums, but these 
     last two years we had to start passing on some of the 
     increases in order to survive.
       We can no longer absorb the constant rate increases, nor 
     can we not offer a health plan to our employees. Therefore, 
     we find ourselves between the proverbial rock and the hard 
     place. We certainly are not the only small business facing 
     the same dilemma.

  Employees at this small business can breathe a small sigh of relief 
because their employer still has the ability to offer coverage, even if 
they are forced to pay more and more because of ObamaCare. Other Iowans 
are on the edge because their options for coverage are shrinking.
  In 2016, UnitedHealthcare left the individual market in Iowa. A few 
months ago, Wellmark and Aetna both announced they would be leaving the 
individual market in 2018. Medica is the only remaining statewide 
carrier, and while they appear to be staying for the next year, it will 
take a massive rate increase on Iowans for them to do so.
  The Iowa insurance commissioner said:

       Iowa has hit a point within our market's collapse that a 43 
     percent rate increase will drive healthier, younger, and 
     middle aged individuals out of the market. Iowa's individual 
     market remains unsustainable.

  If Medica leaves after next year, there is a very real possibility 
that tens of thousands of Iowans will have nothing to purchase on the 
individual market.
  To put this issue into perspective and show why it matters so much, I 
want to share concerns I received from a constituent in Ames, IA. This 
constituent is the parent of a child with a rare disease. The family 
purchased a plan from Wellmark to cover the child for 2017, but now 
that Wellmark plans to leave, the parents are unsure whether they will 
be able to find a plan for their child. They find this whole experience 
``disruptive and anxiety provoking.''
  Disruption and anxiety are not being felt just in Iowa; all across 
the country, premiums are skyrocketing and choices are limited and in 
some places, nonexistent. Recent data from the Centers for Medicare and 
Medicaid Services shows that 2.4 million people in 1,200 counties 
across the country will have one option for insurance in 2018. That is 
not an option at all. A recent report by HHS found that between 2013 
and 2017, premiums more than doubled on the exchange--more than doubled 
on the exchange. In some States, premiums tripled.
  Across the country and in my home State of Iowa, we don't have the 
option to continue with the status quo when it comes to our healthcare. 
The reality is, the status quo is truly unsustainable.
  I yield the floor.
  I suggest the absence of a quorum.

[[Page 9613]]

  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. REED. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REED. As a proud resident of Rhode Island and proud resident of 
Providence Plantations, I thank the Chair for the recognition.
  Mr. President, I want to join my colleagues in expressing strong 
opposition to the Republican efforts to repeal the Affordable Care Act 
and to ask my Republican colleagues to abandon these efforts. They are 
crafted behind closed doors, and they embrace a huge tax cut for the 
wealthy at the expense of the most vulnerable among us.
  Indeed, I implore Republicans to work with us on a bipartisan basis, 
in good faith, to make improvements to our healthcare system. We can 
make these improvements. I hope we can.
  Just a couple of weeks ago, the nonpartisan Congressional Budget 
Office told us that 23 million Americans would lose health insurance 
under TrumpCare. Let me say that again: 23 million Americans will lose 
health insurance under the Republican bill. That is more people than 
live in Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, New 
Hampshire, New Mexico, Nebraska, North Dakota, South Dakota, Vermont, 
West Virginia, Wyoming, the District of Columbia, and my home State of 
Rhode Island and Providence Plantations combined--a huge portion of 
Americans. That is a shocking number.
  What is worse is that my colleagues on the other side of the aisle 
plan to dismantle our healthcare system--one-sixth of the country's 
economy--without so much as a hearing to get input on the bill. Their 
bill is being written in secret, and from what we can glean of the 
process the Republicans are employing, we likely will not even see the 
text in the near future, although I am encouraged that there is some 
discussion of releasing the text tomorrow. Regardless of whether it is 
released tomorrow, there has been no deliberate consideration in a 
hearing. There has been no thoughtful interaction between Republicans 
and Democrats.
  In sharp contrast, I was a member of the HELP Committee while we 
drafted the Affordable Care Act. The Senate spent 25 consecutive days 
in session on consideration of the Affordable Care Act, the second 
longest consecutive session in the history of the Senate. The Senate 
Health, Education, Labor and Pensions Committee, which I served on at 
the time, held more than 47 bipartisan hearings, roundtables, and 
walkthroughs on health reform. In fact, the HELP Committee considered 
over 300 amendments over the course of a month-long markup, one of the 
longest in the history of the Congress.
  Over half of the accepted amendments were from Republicans. This 
bipartisan input, along with testimony and consultation from healthcare 
organizations representing hospitals, doctors, nurses, and patients, 
among others, over the course of a year led to a better, more informed 
bill.
  We have a lengthy legislative process for a reason. Yet the 
Republican leadership--up until this moment at least--continues to 
write their bill in secret as they look for ways to convince their 
caucus to support a bill that nearly every major healthcare 
organization opposes, to say nothing of the 23 million Americans across 
all of our States who would lose their health coverage, and millions 
more would seek increased costs because of TrumpCare.
  I would like to remind everyone that these are real people who will 
be hurt if we go forward as my Republican colleagues intend to. These 
23 million people are all our constituents, our family members, our 
friends and neighbors. In fact, since the beginning of this year, I 
have heard from thousands of my constituents from all walks of life, 
through phone calls, letters, emails, appearances at townhall events, 
and even those I see out and about shopping around the State or on the 
airplane to Washington and back to Rhode Island. They have all 
indicated how they have benefited from the ACA and how TrumpCare could 
have a devastating impact on their families.
  For example, David from Providence, RI, wrote to me to tell me how 
his life has been affected by the Affordable Care Act. He said:

       I don't usually write Senators, actually I've never written 
     a Senator. I have great concerns about my healthcare. I have 
     a preexisting condition, two heart attacks and open heart 
     surgery, triple bypass. I had medical issues and needed to 
     leave my position at a full-time job 3 years ago to get well. 
     During that leave, the company went chapter 11. I lost my 
     healthcare and had no income. I was able to acquire Medical 
     Insurance through the Affordable Care Act. I started my own 
     design business as a sole proprietor and worked a second job 
     to make ends meet. My healthcare was subsidized for two 
     years. I am now successful in my design business and will be 
     paying back the subsidy for this year and no longer need the 
     subsidy going forward. I am able to purchase affordable 
     healthcare through the Health Connection in RI. Affordable 
     healthcare and the subsidy were there when I needed it. This 
     allowed me to start my business and become a successful 
     business/sole proprietor in RI. It is critical for my 
     continued success to have access to affordable healthcare and 
     not be judged by preexisting conditions.

  As David describes, the Affordable Care Act gave individuals and 
families control over their healthcare for the first time. He was able 
to get the care he needed, regardless of preexisting conditions, and 
able to start a new business. This is something I have heard a number 
of times from my constituents.
  I have also heard from Andrew and his wife in Little Compton, RI, who 
decided to strike out on their own and open a dairy farm after the 
Affordable Care Act was implemented. Andrew said: ``We took this plunge 
and started a business knowing that the stability of health care was 
there--we have a four year old daughter--and if it goes away, we are 
not sure what we will do.''
  Time and again, I hear from Rhode Islanders who are now free to take 
risks and start new businesses and other creative pursuits knowing that 
they will be able to access affordable healthcare. I ask my Republican 
colleagues: Do you want to go back to the days when people are locked 
into their jobs for health insurance? The only reason they are there is 
for health insurance. Their creativity, their ability to innovate and 
to invigorate our economy is stifled literally because they need the 
health insurance. Do you want to discourage your constituents from 
starting new businesses? Under TrumpCare, people like David, with 
preexisting conditions, would not have the option, and Andrew and his 
wife may not have been willing to take on the risk of leaving a job 
with health insurance to start a new business.
  However, as we speak, my Republican colleagues are meeting in secret 
planning to take away these opportunities. I encourage my Republican 
colleagues to meet with their constituents, to hear their stories about 
the ACA. They are not unique to Rhode Island.
  It is not enough to just ban insurance companies from denying 
coverage to people with preexisting conditions. The ACA eliminated 
annual and lifetime limits. In fact, yesterday I bumped into a family--
two families--one with an adorable little girl who had a tracheotomy 
and who was being pushed around in a stroller. She is about 2 or 3 
years old. And I met some other children, another young boy named Tim 
with a tracheotomy. Today I found out that their problem is lifetime 
limits. These are very young children, 2 years, 3 years old. Most 
insurance policies, except for the ACA, would have a lifetime limit. 
Now, you might be able to go buy it, but before these youngsters are 
10, 12, or 13 years old, they will not have health insurance for the 
rest of their life.
  So it is not just the preexisting conditions. The ACA eliminated 
annual and lifetime limits. When I saw those darling children 
yesterday, I just knew that has to be the law. Otherwise, it is just a 
matter of time. Maybe in 5 years, maybe in 6 years, but the kind of 
conditions they have, at some point, they will hit that limit and at 
some point the insurance company will say: No thanks.
  We made those changes in the ACA. They are going to be disposed of in 
the proposals I have seen. The ACA requires coverage of basic 
healthcare

[[Page 9614]]

services like maternity care. That is not guaranteed.
  Before the ACA, insurance companies would cut off coverage just when 
it was needed most and priced people with health conditions out of the 
market. These are not abstract concepts. I hear from constituents each 
and every day about the importance of the critical consumer protections 
under the ACA, and TrumpCare would undermine all of these.
  Susan from Warwick wrote me to say:

       ObamaCare saved my life. Please keep fighting to make 
     affordable healthcare available to all Americans. I was 
     diagnosed with Acute Myeloid Leukemia in 2012. I have my own 
     business and pay for my own health insurance. We always 
     purchased what we thought was adequate, but I'd reached the 
     limit on my policy within just a few weeks of cancer 
     treatment. That left me with huge bills, a need for more 
     expensive coverage in order to obtain lifesaving treatment . 
     . . and technically with a ``preexisting condition--cancer.''

  Susan knows that insurance doesn't mean much if you are sick and have 
limits on your care. She goes on to say:

       I am horrified by the Republican plan to replace Obamacare. 
     Health care is not a luxury. It should be available to all. I 
     never want anyone else to experience the fear I did when my 
     insurance ran out and I realized the care that could save my 
     life might not be available to me. Before we found additional 
     insurance--and jumped through hoops to get it--we looked at 
     selling the house, emptying our IRAs and savings account to 
     pay for my care. It would not have been enough.

  Cynthia from Woonsocket, RI, wrote to me to tell me about how 
TrumpCare would undermine care for people like herself with Parkinson's 
disease. Specifically, Cynthia wrote about how patients with 
Parkinson's rely on the essential healthcare benefits required under 
the Affordable Care Act, including rehabilitative services, mental 
healthcare, and access to prescription drugs. TrumpCare would do away 
with these benefits.
  Cynthia also points out that the average age of diagnosis of 
Parkinson's is around 60 years old. However, TrumpCare creates an age 
tax, leading to skyrocketing costs for this very population. Cynthia 
also said in her letter that one-third of patients with Parkinson's 
access care through Medicaid. She says TrumpCare puts all of those 
patients at risk of losing care. As a patient, she knows better than 
most that without these existing protections, health insurance will not 
actually cover the care that is needed.
  To add more detail on how critical Medicaid can be, especially to 
seniors, a constituent living in a nursing home in Pascoag wrote to me 
to say:

       I am 101 years old and enjoy every day to the best of my 
     ability. I am petrified that many of the programs that I rely 
     on for my health and well-being, indeed my life, will be 
     reduced or even eliminated. Please protect my access to 
     Medicaid. DO NOT make Medicaid a block grant to the states. 
     My daughter is helping me to send this communication to you. 
     Please do not forsake me.

  So I ask my colleagues: How do you intend to protect her access to 
nursing home care while cutting Medicaid by over $800 billion? Block-
granting Medicaid, as Republicans have proposed to do, will reduce 
Medicaid funding by at least 25 percent over the next decade and leave 
States unable to maintain current Medicaid programs, leaving behind our 
most vulnerable.
  Indeed, the most significant costs for Medicaid in my State and every 
other State is nursing home care. It is exactly those men and women, 
like my constituent from Pascoag, a vigorous 101-year-old, who will be 
forced to pay more, who will be forced because of cutbacks in service 
at the facility not to have two or three people on duty but just one. 
All of that we can foresee, and we only can prevent it if we reject 
this attempt to replace, to repeal, to undercut affordable care.
  Now, this Medicaid crisis is serious, and it is not just going to 
affect the healthcare sector because we know the pressure is on the 
States to make up some of this lost funding. It will not just be by 
transferring funds within healthcare efforts. They will have to go 
everywhere through their budgets: That is K through 12 education. That 
is infrastructure. That is law enforcement. That is all the things 
States and localities do but particularly States. They will try to plug 
the gap because they will have people, like I have described who have 
written me, coming and not just demanding but obviously in need of 
healthcare, and they will try to respond, but the response will affect 
our competitiveness, our education systems, our productivity, when you 
can't fix infrastructure, and it will be a profound impact.
  In fact, a significant number of jobs in my State and a significant 
number of jobs projected for the future are in the healthcare industry. 
When this significant reduction of resources to the healthcare sector 
comes about, the jobs will go, too, because without the resources, you 
will not employ people--you can't employ people.
  Let me share a letter from one of my constituents because it 
succinctly describes what TrumpCare will really mean for this country. 
Glenn and Paula from Wakefield, RI, shared a letter from their 
daughter, Gianna, who has type 1 diabetes, saying:

       Let me offer you a translation of what your votes mean: I 
     will die younger and sicker. Probably much sicker. My kids 
     will have a mother for less of their lives. Your votes are 
     what will cause this. Because no matter how consciously I 
     care for myself, no matter how responsible I am, it won't 
     matter if my insurance refuses to cover me. And it won't 
     matter for you either, if you are one of the vast majority of 
     Americans who will end up with a pre-existing condition over 
     the course of your life. If you think you can simply pay the 
     costs yourself, you are in for a rude awakening.

  These are only a few examples of the letters, calls, and emails I 
have received from constituents. The response in opposition to 
TrumpCare has been overwhelming by the very people whom it will impact 
the most. I hope my colleagues will listen to these concerns, not just 
the Rhode Island stories I am sharing today but also from their own 
constituents. People's lives are at stake.
  I urge my colleagues on the other side of the aisle to abandon this 
effort to pass TrumpCare and start working with us on bipartisan 
solutions to improve our healthcare system.
  Mr. President, I yield the floor.
  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. BARRASSO. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Cotton). Without objection, it is so 
ordered.
  Mr. BARRASSO. Mr. President, I come to the floor today, having 
returned from the weekend in Wyoming, talking to people as a physician, 
and talking to former patients of mine. What I see is that the pain of 
ObamaCare is continuing to worsen around the country for men, women, 
families, and people who have been living under the Obama healthcare 
law for a number of years now.
  This is an important day, when insurance companies have to come up 
with the filings and the plans on what they plan to do for next year 
with regard to plans that meet the ObamaCare mandate. So very soon, 
millions of people will find out if they are going to be able to buy an 
insurance plan in their own communities, regardless of the cost. We 
have seen that the Blue Cross Blue Shield group in Maryland has 
proposed rate increases up to 58 percent for next year in the State of 
Maryland. This is after they went up 24 percent last year. How many 
families can afford such a thing? But that is what we are dealing with.
  That is why it is so critical that we get involved in trying to 
provide relief for American families at this time, with the Obama 
healthcare insurance market, certainly, collapsing. The head of Blue 
Cross Blue Shield in Maryland, which is the largest insurer in the 
State, has said that they see their system is in the early throes of 
what is known as the insurance death spiral. Prices are continuing to 
go up, fewer people are signing up, and, as a result, prices are going 
to have to be raised even more. We saw last year that they went up 24 
percent, and this year the proposal, going forward to next year, is 58 
percent. This is a terrifying reality for people on ObamaCare today.

[[Page 9615]]

  One of the big reasons we have been working so hard on healthcare 
reform is to improve access to healthcare--not empty coverage, but 
actual healthcare. So what we want to do as Republicans is get rid of 
some of the excessive mandates, the expensive mandates, things that are 
driving up the cost of care and certainly driving up the cost of 
coverage for that care.
  When prices come down, people are able to afford insurance and 
companies are ready to sell that insurance. I know we have people in 
Wyoming who are ready to buy it. That is how you improve access to 
insurance. It is how you also improve access to care. You don't do it 
by forcing the prices up and then requiring people to buy coverage, 
which is what the Democrats who voted for ObamaCare did. They said: You 
have to buy it, it is a mandate, whether you like it or not. We know 
better than you do. That is what we heard from the Democrats during the 
debate on President Obama's healthcare law. That is what they passed. 
They passed it. They voted for it. They didn't know what was in it. 
Actually, it was the Speaker of the House, Nancy Pelosi, who said: 
First you have to pass it before you even get to find out what is in 
it.
  President Obama gave a big speech to a joint session of Congress and 
said that if people like their plans, they can keep their plans. One of 
the newspapers called that the ``Lie of the Year.'' So millions of 
Americans then got letters from insurance companies; over 5,000 in 
Wyoming got that letter. It said: Sorry, your insurance plan isn't good 
enough for government.
  People ought to be able to make that decision for themselves. 
Families ought to make that decision, not Democrats in Washington who 
voted for the ObamaCare law. They shouldn't have the right to tell the 
people of my State or any State what is best for them and their family. 
It is interesting because the Democrats don't seem to want to remember 
that anymore. They have selective amnesia.
  It turned out that if people liked their plan, they weren't really 
allowed to keep it. I heard about it again a week ago at a Wyoming 
stock growers meeting--farmers and ranchers from around the State of 
Wyoming who come together each year, an organization that has been in 
existence longer than the State has been a State. These are hard-
working people who know what works best for them, what works best for 
their families. Some of these outfits have been in those families for 
100 years. We have something called the Centennial Ranch program where 
they gather all the family members when an outfit has been in that 
family for 100 years, and they have been able really to survive so much 
over the years. Often they would say, you know, whether they deal with 
floods, whether they deal with fire, the biggest problem they have is 
often dealing with the Federal Government. We have seen it all across 
the board, and healthcare is just one of the last things to add to a 
long litany of Federal Government involvement in the lives of the 
people of our State of Wyoming.
  So here we are today with this incredible government overreach and 
the failure of that overreach, and even the insurance companies, some 
of whom supported the passage of the healthcare law, are saying that 
this is not working. How they reflect the fact that it is not working 
is they say: OK, we are not going to sell insurance anymore. You can't 
make them sell insurance. The prices have to go up too much, and it is 
just not worth the effort.
  One of the big insurance companies, Humana, is dropping out of the 
ObamaCare exchange entirely next year. They made the announcement. 
Aetna said that it is quitting the internal markets in Delaware, Iowa, 
Nebraska, and Virginia. Anthem is pulling out of Ohio. The list goes 
on.
  Now, so far, there are over 40 counties across the country that are 
expected to have no one selling insurance on the exchange--no one. In 
Wyoming, we are down to one company that sells it. We had two; one lost 
so much money, they were pulled off of the market. The second one, 
which does sell insurance in Wyoming, continues to lose money by 
selling on the exchange. They are committed to stay, but they just 
scratch their heads about what the potential future may hold. We are 
now seeing over 40 counties across the country where no one is selling 
insurance. That is the reality of ObamaCare.
  Remember, President Obama said: If you pass this, there will be huge 
competition, big marketplaces. If there is only one selling insurance, 
it is not a marketplace; it is a monopoly.
  Next year, the Centers for Medicare and Medicaid Services has said 
that about 40 percent of all the counties in America will have just one 
company selling on the exchange--just one--forty percent of the 
counties all across America. That is a monopoly. What happens when 
those companies decide to drop out?
  Even for people who get an ObamaCare subsidy, if there is no one in 
that community, in that county selling ObamaCare insurance, the subsidy 
has no value whatsoever. It can't be used.
  That is another part of the story that the Democrats refuse to talk 
about. In fact, Democrats say a lot of things about insurance coverage 
that aren't really telling the whole story. They have talked about the 
Congressional Budget Office report; they talk about a number of things. 
One of the interesting things about the Congressional Budget Office 
report--the CBO report, kind of the scorekeepers that take a look at 
things--on the bill that passed the House said that there will be 
millions of people fewer who will have insurance if the Republican-
passed bill becomes law. Well, the news headlines screamed that the 
House bill would mean millions of people lose their insurance. Well, 
that is wrong. That is not at all what will happen.
  According to the Congressional Budget Office, when you look at it and 
see why is it that there will be fewer people with insurance under 
ObamaCare if you eliminate the individual mandate--the part of the law 
that says you must buy a government-approved program--the Congressional 
Budget Office says that if you don't mandate it, a lot of people don't 
want to buy it. They don't view it as a good benefit to them. They 
don't view it as worth their money.
  If people aren't required to buy insurance, millions of them will 
choose not to purchase the insurance, especially when they believe it 
is not a good deal for them personally. I believe Americans have that 
right. Apparently, the Democrats don't believe that Americans have that 
right. They like the mandate. They like making people do things. That, 
to me, is the difference between a Republican approach, which provides 
for freedom, and a Democratic approach of government and mandates.
  We want to give people the right to decide what is right for them and 
their families. That is what I hear in Wyoming at the Wyoming Stock 
Growers Association and as I travel around the State. People know what 
is best for them and their families. Then, when all of a sudden what 
they had is taken off the market because the government says that you 
can't sell it anymore, that is an affront to their ability to choose 
what works for them and their family, and it is things they have had in 
the past. Then they got stuck buying some very expensive plan that 
covered a lot of things they didn't need, didn't want, and couldn't 
afford, but the government said: We know better than you do, the people 
of Wyoming, the people of America.
  So the Congressional Budget Office says that 8 million people who get 
coverage in the individual market will decide it is just not worth 
buying. They also said that there will be 4 million people on Medicaid 
next year, and if you eliminate the mandate, they aren't going to sign 
up for it, even when it is free, because they realize that, for many 
people, being on Medicaid--a failing system--isn't providing much for 
them at all.
  So insurance isn't being taken from people; these are people who are 
making a decision as free individuals--Americans--of how they want to 
spend their money and what they want to sign up for, or not.

[[Page 9616]]

  So the legislation that passed the House really makes no changes in 
Medicaid in 2018. Yet, the CBO says millions of people on Medicaid will 
drop it when the mandate goes away.
  The Senate is coming up with its own solution. We are looking at ways 
to make sure that Americans have access to insurance that works for 
them, not just what works for Democrats in Washington. We roll back 
some of the worst parts of ObamaCare. Prices for health insurance will 
go down. People will have better options than the one-size-fits-all 
plans that Washington has forced on the American people. They will have 
other options that will work better for them and their families.
  Our goal is to not do what the Democrats did. ObamaCare actually 
kicked people off insurance that worked for them, pulled the rug right 
out from under them; Republicans don't want to pull the rug out from 
anyone. Our goal is to reform the American healthcare system so that 
insurance costs less and it meets the needs of the people who buy it. 
Republicans' goal is to focus on care, not just useless coverage that 
ObamaCare had provided for many, with narrower networks so you can't 
keep your doctor, you can't go to the hospital in your community, you 
can't get the care you need, you can't see certain specialists, which 
is what we have seen with ObamaCare.
  If Democrats want to talk about people losing their insurance, they 
need to look at what ObamaCare is doing to people right now. They need 
to look at people who are losing their insurance because their insurers 
are walking away from them. They need to look at people who are losing 
their insurance because of the premium increases we are seeing 
requested in Maryland; 24 percent is actually how much it went up last 
year and 58 percent in certain areas requested for this year.
  Now I hear the Democrats say that they are worried about whether 
people with preexisting conditions get insurance. As a doctor, I will 
tell you, my wife is a breast cancer survivor; we are absolutely 
committed as Republicans to make sure that no one with a preexisting 
condition is left out. Democrats can't make that claim. They have made 
it over the years. But if there is no one selling insurance where you 
live, there is no exchange being offered, and you live in those 40 
counties right now with no one selling--none--zero, and that number of 
counties is going to expand next year--if you have a preexisting 
condition and you are living under ObamaCare, you cannot get insurance 
no matter what any Democrat says, because no one is willing to sell it 
to you, even if you get a government subsidy--no one. You are left out. 
That is what the Democrats have given us in this country with their 
failed ObamaCare system.
  So ObamaCare continues collapsing. It is going to harm more Americans 
who have preexisting conditions.
  The other day, Senator Schumer admitted that ObamaCare isn't 
providing affordable access to care. I think it is an important 
admission from the minority leader. Now it is time for him and the 
Democrats to join with Republicans in the Senate--join us in providing 
Americans the care they need from a doctor they choose at lower costs.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CORNYN. Mr. President, as the Senate knows--and I suspect a lot 
of people outside of the Chamber know--we will move forward on the 
healthcare reform effort to repeal and replace ObamaCare very soon. A 
bill will be released as early as tomorrow morning, representing a 
discussion draft.
  I think it is important to remind all of our colleagues of the 
urgency that we face. We already know that insurance premiums have gone 
up since 2013 alone for those in the individual market--those would be 
individuals with small businesses--by 105 percent. This is 2013. Can 
you imagine in 2013 paying a premium only to realize that over the next 
4 years, it would quadruple in just a short period of time?
  Most Americans can't absorb that additional cost. We know that many 
people are struggling from the high cost and the lack of quality of 
care and the choices available to them.
  Again, on the cost issue, when ObamaCare was being sold to the 
American people, I still remember President Obama saying that the 
average family of four would see a decrease in their premiums of 
$2,500. I think the correct figure is based on experience. They have 
seen their premiums go up $3,000.
  I shared a story last week about a small business owner in Texas who 
had lost his healthcare. He lost his doctor, and yet he had to pay 
astronomically more for what ends up to be less coverage. I would say 
he is only one person who I have heard from. I have heard from many, 
many more under similar circumstances.
  Even those who receive their healthcare from their employer are 
feeling trapped by ObamaCare. I had a constituent, for example, from 
Needville, TX, and his story, yet again, is all too familiar. After his 
employer renewed their healthcare plan, premiums rose 50 percent, and 
his current doctors refused to accept his plan from the ObamaCare 
marketplace. While his healthcare costs rose, of course, his salary did 
not follow suit.
  He has been forced to dramatically cut back on his standard of living 
and is living from paycheck to paycheck. In his letter, he said he is 
worried about being able to provide for his family. Can you imagine 
what that must be like? And not thinking of himself, but what this 
means for his coworkers, as well, and his community.
  This is one of the endless stories that my constituents have sent me 
over the past few years, and I know Texas isn't alone, which causes me 
to wonder who our colleagues are listening to or not listening to in 
their States.
  I mentioned yesterday that I had one colleague, whose name I won't 
mention out of respect for his confidential communication--this is a 
Democratic Senator--who has a son who has seen his insurance premiums 
go up to $7,500. Sorry, that is the deductible. But his premium has 
gone up $5,000. He told me that his son's out-of-pocket costs for 
healthcare was $12,500 a year.
  That is another casualty of ObamaCare. Yet, when we are looking 
around to see how many Democrats are willing to join us to come to the 
rescue of people who are being hurt by the destruction of the 
healthcare markets, we see no one raising their hand or coming forward.
  For our Democratic friends to attack us for trying to fix the havoc 
that they wreaked in our healthcare system is really ridiculous. Our 
friends on the other side of the aisle had their chance. They passed 
ObamaCare by a party-line vote. In the interim, it demonstrated that 
this is an experiment in big government and massive spending that has 
simply failed.
  Our friends on the other side know that. They also realize that, 
regardless of who won the election in November, we would be moving 
towards a new, better healthcare alternative, but they are simply 
unwilling to participate and are sitting on their hands and waiting. 
Indeed, they are hoping that we will fail in our efforts to save many 
Americans--millions of Americans--from a healthcare system they were 
promised but one that was not delivered.
  Instead of working with us, they effectively are throwing what could 
only be called a temper tantrum. They are trying to shut down any 
productive activity in the Senate, including bipartisan committee work.
  I was in three committee hearings this morning, one involving the 
Intelligence Committee and our investigation into Russian active 
measures involving the 2016 election. I was in another important 
Finance Committee hearing where we talked about the importance of 
modernizing the North American Free Trade Agreement, or NAFTA, and then 
another one in the Judiciary Committee, where we talked

[[Page 9617]]

about the influx of dangerous gangs into the United States, including 
MS-13, from Central American countries. Yet our Democratic colleagues 
are so bent out of shape over the healthcare debate that they are 
willing to shut down legitimate bipartisan concerns for each of those 
issues by not letting our committees operate as they should.
  Here is the rub. If they actually had a better plan, we would be more 
than happy to listen. We would be more than happy to work with them. 
But the only thing they have offered has been offered by the Senator 
from Vermont--one of their Presidential candidates--Mr. Sanders, who 
said that what he wants is nothing less than a complete Federal 
Government takeover of healthcare, the so-called single-payer system. 
That would wipe out all private insurance, and you would be looking to 
the government for all of your healthcare.
  We know that hasn't worked particularly well in places like Canada 
and England and elsewhere. We also know that it is completely 
unaffordable. The Urban Institute, which did a study of Senator 
Sanders' single-payer healthcare system, said that just in 2017 alone, 
it would add more than a half trillion dollars to Federal spending, and 
it would add trillions and trillions of dollars more over ensuing 
years. This isn't a solution. This is creating a bigger problem.
  Unfortunately, our Democratic colleagues have let the far left 
faction of their own conference hold them hostage to pushing for a 
single-payer system that would make ObamaCare look like a wild and 
resounding success.
  As I said, we need only look to our neighbors to the north, who under 
a single-payer system have their healthcare decisions decided for them 
by the government, while they see their taxes go up every single day.
  Canada is marketed as an affordable outcome, but only if your 
procedure is deemed necessary by the government. In other words, if the 
government doesn't think the procedure you need is necessary, good luck 
with that.
  Would you want somebody in the government making your medical 
decisions for you or your family without considering your individual 
medical history? I certainly wouldn't. Under a single-payer system, 
this could lead to many families having to buy supplemental health 
insurance on top of the taxes they have already paid or simply pay 
cash, rewarding high-income individuals with a better level of 
healthcare above that offered to the rank-and-file citizens under a 
government program.
  Single-payer systems are not a solution, certainly not in this 
country. Not only is choice and cost threatened under a single-payer 
system, but so is quality of care.
  Just last year in Canada, it took an average of 20 weeks for patients 
to receive medical care that was deemed necessary--the longest recorded 
wait time since wait times began to be tracked. One report estimated 
the Canadians are waiting for nearly 1 million healthcare procedures.
  Can you imagine having to wait up to 38 weeks for some medical 
procedure, the whole time worrying about your health or the health of 
your loved one?
  Single-payer is a costly, inefficient, and unfeasible option, and, 
perhaps because of that, we are not hearing many people on the floor 
stating what I believe to be the case, which is that it is the only 
choice being offered by our friends across the aisle. They are not 
willing to come here and debate the merits of what we are proposing, 
which is a market-driven, individual-choice system, which is designed 
to keep premiums down in a way that makes it more affordable. They are 
not willing to debate that and a government takeover known as a single-
payer option with all of its assorted problems.
  The reforms we are seeking are patient-centered and market-driven. 
These are the sorts of things that many of our colleagues across the 
aisle said they would like to see as well, but they have somehow fallen 
in line with part of their political base, which makes it impossible 
for them to have an open, rational discussion about the merits of each 
proposal.
  We are left with no option but to finalize our discussion draft and 
introduce that tomorrow so that the world can see it and so it can be 
put on the internet, so we can have a fulsome debate and we can have 
unlimited amendments in the so-called vote-arama process, which I know 
is very popular around here. We will vote dozens of times or more on 
proposed amendments to the bill. That is the kind of transparency and 
openness that I think are important when you are dealing with something 
as important as healthcare.
  Here are the goals of what we are going to propose tomorrow in this 
discussion draft.
  First, we need to stabilize the markets that have left millions in 
the country with no choices when it comes to insurance providers. Under 
ObamaCare, insurance markets have collapsed. In Texas, one-third of 
Texas counties have only one option for health insurance, which is no 
choice whatsoever. Of course, in addition to threatening competition, 
it also lowers quality while doing nothing about rising costs.
  Second, we have to address the ballooning price of ObamaCare premium 
increases. I mentioned, just in the ObamaCare exchanges since 2013, 
they have gone up 105 percent. If we do nothing about it, they are 
going to go up by double digits again next year, so doing nothing is 
not an option. Again, without competition, there is no room for these 
prices to go anywhere but up, and we have to come to the rescue of the 
millions of Americans who are simply being priced out of the health 
insurance market.
  Third, something our Democratic colleagues have repeatedly called for 
is that we have to protect people with preexisting conditions. If we 
want our healthcare system to work, we must be able to provide 
coverage, particularly for preexisting conditions, for all Americans. 
We will do that in the discussion draft proposed tomorrow.
  Lastly, I believe we need to give the States greater flexibility when 
providing for the low-income safety net known as Medicaid, in a way 
that is more cost-efficient and effective. For example, in my State, we 
have asked for a waiver in order to provide managed care for people on 
Medicaid. More than 90 percent are on managed care, which means if you 
have a chronic illness--if you have a particularly complicated medical 
problem--you have a medical home and somebody keeping track of your 
treatment, making sure you get the treatment you need and are entitled 
to.
  Now we have the opportunity to make Medicaid a sustainable program. 
We know that it is not, as currently written. What we are proposing is 
to spend more money each year on Medicaid but to do so at a cost-of-
living index that will be affordable and sustainable by the American 
taxpayer. We have the opportunity to address the quality issues and 
redtape issues and provide this important entitlement to make sure that 
it remains on a stable path.
  The American people have made clear, time and again, that the status 
quo of ObamaCare is not working. All you have to do is look around. 
There were 60 Democratic Senators in 2010 who voted for ObamaCare. They 
were in the majority--a big majority. How many are there today? Well, 
there are not 60 anymore. They have gone from the majority to the 
minority, I believe, in large part because of the unfulfilled promises 
of ObamaCare.
  I encourage our colleagues across the aisle--indeed, I encourage all 
of us to listen to the stories from our constituents. There are too 
many families asking us to step up and come to their aid. We need to do 
more than just give floor speeches or loft impossible single-payer 
options, which simply won't work. We need to actually deliver on the 
promises we made to deliver healthcare reform and to do so to the best 
of our ability.
  I am under no illusion that this will be perfect. Indeed, when you 
are operating under the constraints of the budget rules, with Democrats 
taking a walk and sitting on their hands, it is impossible for us to 
come up with the best possible product we could under the 
circumstances. But I dare say, it

[[Page 9618]]

will be better than the status quo, which is a meltdown in the 
insurance markets, and we will take large steps forward in not only 
stabilizing the markets but bringing premiums down, while assuring 
coverage for preexisting conditions and putting Medicaid on a 
sustainable path forward.
  We invite our Democrat colleagues to join us, if they will. But under 
present circumstances, it doesn't look as though they plan to do so.


             Requests for Authority for Committees to Meet

  Mr. President, I have nine requests for committees to meet during 
today's session of the Senate. They do not have the approval of the 
Democratic leader; therefore, they will not be permitted to meet today 
beyond 2 p.m. But I ask unanimous consent that a list of the committees 
requesting authority to meet be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       Committee on Commerce, Science, and Transportation
       Committee on Finance
       Committee on Foreign Relations
       Committee on Homeland Security and Governmental Affairs
       Committee on the Judiciary
       Committee on Intelligence
       Subcommittee on Seapower
       Subcommittee on Public Lands, Forests, and Mining

  Mr. CORNYN. Mr. President, if I could take 30 seconds more--because 
my colleague from Louisiana is here--I, frankly, think the objection to 
nine committees meeting in the Senate is indefensible. I mentioned the 
three committee hearings we had this morning, but they are just an 
indicator of important issues, such as the investigation by the 
Intelligence Committee of Russian involvement in our election; the 
Judiciary Committee looking into the role of MS-13, one of the most 
dangerous and violent street gangs in America, with about 10,000 gang 
members present in the United States. We are looking at things like 
trade and the importance of modernizing NAFTA and the 5 million jobs 
that binational trade supports with Mexico or the 8 million jobs with 
Canada.
  For our Democratic colleagues to object to our being able to meet in 
committees because of their pique over healthcare--which they have 
voluntarily taken themselves out of--is just beyond indefensible. I 
hope the American people realize exactly what they are doing. This is 
the temper tantrum I talked about a moment ago. This is not about 
having an open and honest debate and trying to solve a problem that, 
frankly, is not just our problem; it is a problem for all Americans. We 
ought to do better than that. We ought to hold ourselves to a higher 
standard than that. But this is the kind of temper tantrum, 
unfortunately, you get when a political party is not willing to 
participate in the debate and where they have no ideas that are 
actually workable, other than a single-payer system that will bankrupt 
the country and will fail to deliver quality healthcare to all our 
citizens.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Toomey). The Senator from Louisiana.


                         Healthcare Legislation

  Mr. CASSIDY. Mr. President, I am also here to comment, as Senator 
Cornyn has, on the state of play, if you will, and the repeal and 
replacement of ObamaCare. I think sometimes the American people feel 
like collateral damage as Republicans and Democrats go back and forth 
as to what is the best policy.
  I am a physician, a doctor who worked in a public hospital for the 
uninsured for decades before I went into politics. I guess from my 
perspective, the primary thing is not Republican versus Democrat, but 
that patient who is struggling to pay her bills, her premiums, or the 
fellow who can't afford medicine. What are we doing for them?
  There is a gentleman who went on my Facebook page--again, cutting 
through this kind of political noise. This is Brian from Covington, LA:

       My family plan is $1,700 a month, me, my wife and 2 
     children. The ACA has brought me to my knees. I hope we can 
     get something done. The middle class is dwindling away. Can 
     everyone just come together and figure this out?

  If that is not a plaintive plea of someone who is drowning under the 
cost of premiums for insurance, which he knows he has and, as a 
responsible father and husband, he will work to pay for--nonetheless, 
he says that he is being crushed by these high premiums.
  The American people need relief. We have to lower those premiums. I 
have always said, though, that whatever we do must pass the Jimmy 
Kimmel test; that is, to say that if Brian's wife or children or he 
himself has a terrible illness, there will be adequate coverage to pay 
for the care their family would need for that member of their family 
with that terrible disease. It kind of brings us to where we are now--
two aspects to what we are considering.
  By the way, when folks say that we are redoing one-sixth of the 
economy, that is not true. The Affordable Care Act, ObamaCare, again, 
attempted to address one-sixth of the economy that is healthcare. We 
are focused on the individual market, which is about 4 percent of those 
insured, and Medicaid. We are not touching Medicare. We are not 
touching the employer-sponsored insurance market. It is important to 
realize that this is not as comprehensive as the Affordable Care Act. 
It is something far more focused.
  Let's first talk about Medicaid. I am very concerned about what has 
been proposed for Medicaid, but also concerned about current law 
regarding Medicaid. Under the Medicaid expansion in the Affordable Care 
Act, States got 100 percent of all the cost of the patients enrolled 
for the first 4 to 5 years. As you might expect, States were quite 
generous in their payments for these patients as they contracted with 
Medicaid-managed care companies to care for them, so much so that those 
folks enrolled in Medicaid expansion. Taxpayers are paying 50 percent 
more than taxpayers are paying for those in traditional Medicaid. And 
States enrolled roughly 20 million people in the Medicaid expansion 
program. The combination of enrolling so many people in the Medicaid 
expansion program and paying 50 percent more than for traditional 
Medicaid means that when States finally have to foot 10 percent of the 
bill, which they will by 2020--when States have to finally foot that 10 
percent of the bill, they cannot afford that 10 percent.
  Unfortunately, under the Affordable Care Act, State taxpayers will 
not be able to pay what in California is $2.2 billion extra per year as 
the State's 10-percent share. Similarly in Louisiana, my State, our 
taxpayers--me, my colleagues, my friends, my neighbors--would be on the 
hook for $310 million per year. Our State is having a budget crisis 
because we can't afford $300 million. Now it is a $310 million 
recurring bill every year.
  One thing that is not said is that Medicaid expansion in its current 
format is not sustainable. We have to do something--again, to preserve 
benefits for that patient. We have to take care of that patient, but we 
have to make it sustainable, both for the Federal taxpayer and the 
State taxpayer. By the way, whoever is watching this is both a Federal 
and State taxpayer. You are getting caught both ways.
  Let me speak a little bit about the process. If you want to speak 
about Medicaid, we just laid it out. Let's speak a little about the 
process, as much has been said about it. I don't care for how the 
process transpired, but I certainly understand Leader McConnell's 
concerns that Democrats would not collaborate. I find that a sorry 
state of affairs.
  What do I mean by that? Susan Collins and I, and four other 
Republican Senators, put forward a bill that would allow Democratic 
States to continue in the status quo--to get the money they would have 
ordinarily received under the Affordable Care Act and to continue a 
system--as much as they desire to have--for the whole Nation.
  The minority leader, Chuck Schumer, condemned our bill before we 
filed it, meaning before he had a chance to read it. Without reading 
our bill, he condemned it, even though his State of New York would have 
been allowed to continue in the program that they are currently in and 
receive the dollars to support that program. He condemned

[[Page 9619]]

the bill before he read it, even though it would have allowed his State 
to continue in the status quo.
  Similarly, we approached other Senators--10, at least, on my part. 
None would help us with our bill, even though their State could have 
continued in its current status quo, receiving the income it currently 
receives. That tells me that even a good faith effort to reach across 
the aisle was not going to get cooperation. That is too bad, and that 
is why, I think, there is kind of a political back-and-forth in which 
the patient--the American like Brian, struggling to support and cover 
his family--gets lost in the crossfire. A goodwill bill, designed for 
States to do that which they wish to do, would not even be considered 
by the other side.
  I have always pointed out that if even two Democrats had walked into 
Mitch McConnell's office and said ``We will work with you to pass a 
bill,'' they could have gotten far many more things for their State 
than saying ``No, we have not been invited to the party; therefore, we 
will not participate.'' I say that as an observation, not as a 
criticism, but also as an explanation to the American people of how we 
have ended up in this position.
  Now, as to the bill that will be before us, I have not seen the 
written language. I reserve judgment until I have seen that, but I will 
say that there are some things I like. If our desire, again, is to take 
that patient, the American citizen, and make sure his needs or her 
needs are met--a family such as Brian described here who cannot afford 
their current premiums--there are things in this bill which will lower 
those premiums. There is the so-called cost-sharing reduction payments 
for the next couple of years that would continue to provide certainty 
to the insurance companies so that when they market insurance on the 
individual market, there would be certainty. They would be able to know 
those dollars are coming from the Federal taxpayer to support folks for 
the next couple of years, and they could lower their premiums 
accordingly.
  There will be a so-called State Stability Fund that going forward, 
States could use to create what was called the invisible high-risk 
pool--a reinsurance program, if you will--so that if you are a patient 
on dialysis, a patient with cancer, very expensive to care for, you 
would continue to get the care you require, but everyone else in that 
insurance market has their premiums lowered because there is a little 
bit of help for those folks with those higher cost conditions. By that, 
we lower premiums.
  President Trump, when he was running for President, said he wanted to 
continue coverage, care for those with preexisting conditions, 
eliminate the ObamaCare mandates, and lower premiums. What I have seen 
or, at least, heard is we are on the path to fulfilling President 
Trump's pledge. Now, again, reserving judgment until I have seen 
written language, I will say that what I have seen so far keeps the 
patient as the focus, would address someone like Brian, the needs of 
his family, the needs of their pocketbook as well as their health, and 
build a basis so that going forward, States would have the ability to 
innovate, to find a system that works best for them.
  On behalf of those patients, I hope that we as a Senate--whatever our 
party--are successful. I hope going forward we, as a Senate, no matter 
what our party, put the patient as the focal point, hoping that our 
combined efforts--again, no matter what our party--will address her 
needs or his needs, both financially and particularly for their health.
  I yield the floor.
  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. BLUMENTHAL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered
  Mr. BLUMENTHAL. Mr. President, earlier this week, on Monday morning 
at 9 a.m., I held a last-minute emergency field hearing on healthcare. 
With our colleagues on the other side of the aisle refusing to hold any 
official hearing on the bill and refusing to even show us the bill--
what almost certainly is almost bad policy that is contained in the 
bill--I wanted the people of Connecticut to know that their voices and 
their faces would be heard and seen here in Washington, DC, and their 
stories would be told with or without an official committee hearing.
  When I say this emergency field hearing was last minute, it was truly 
last minute, with many people having not even days but hours of advance 
notice to come and speak and share with me and others what the 
Affordable Care Act has meant to them, to their families, to their 
communities, and what losing it would mean to them.
  To say the room was full would be a gross understatement. Every seat 
was filled, and when those seats were gone, people lined the wall two 
or three deep and squeezed in through the door. They were so anxious to 
be heard, and they were loud and clear. They were heard by me, and now 
I want their voices to be heard here.
  We are continuing this hearing. In fact, we are having a second 
hearing on Friday afternoon at 1:30 in New Haven. We are sending out 
notices, blasting them to the people of Connecticut. We will have a 
third, if appropriate and necessary.
  The people who came to this emergency field hearing in Connecticut 
were no different from millions of other people around the country, and 
they were speaking, in a sense, for all Americans. In my mind, they 
were speaking for parents who are suffering, providers who are healing, 
kids fighting back against dreaded diseases. They came because the 
closed-door discussions held in secret here by a small number of 
colleagues across the aisle will impact them every single day for the 
rest of their lives. My constituents and the people of Connecticut and 
the people of the country are unrepresented in those discussions. That 
is a travesty and a betrayal of our trust and our job.
  So, on Friday, we are going to do the same thing. We are holding 
another emergency hearing in New Haven so people of my State can be 
heard, despite this disgraceful process that has left them and so many 
others on the outside looking in. They are excluded from democracy, and 
that is unconscionable.
  If nothing else, I hope my colleagues will realize one thing. This is 
what democracy looks like. This is how we are meant to make decisions 
with many opinions--much debate, diversity of viewpoint, sometimes 
messy but always transparent, open, and clear to people whose lives are 
affected by it. That is what this emergency field hearing was designed 
to do.
  Since it is becoming increasingly clear that this bedrock principle 
of our democracy--the right to open and honest debate--is being denied, 
I want to share some of the stories I heard on Monday, just some of 
them, and I will be sharing more of these stories over the coming days.
  Justice Brianna Croutch was described by her mother as a beautiful 
free spirit, as you can see from this side of the photo. She was filled 
with compassion and at 21 years old had a beautiful and meaningful life 
ahead of her, all of her life ahead of her. She was a full-time student 
in a dental program, and she had a 4.0 average.
  Justice, like far too many people, particularly young people in 
Connecticut and around the country, had a substance use disorder, and 
she needed effective, long-term treatment to begin that road to 
recovery. For Justice, this treatment came too late, and on August 23, 
2015, she overdosed on heroin. It led to a brain injury. It is likely 
she will never recover from that injury.
  ``More likely than not,'' her mother said, ``I will have to make the 
decision to bring my daughter home with hospice care. No parent should 
be faced with these decisions.'' That is what Jennifer Kelly said at 
the hearing on Monday.
  That is a picture of Justice as she is today.
  I want to read exactly what Jennifer Kelly said because her words are 
far more powerful and meaningful than mine could ever be.


[[Page 9620]]

       The American Health Care Act--

  The House version of the so-called replacement for the Affordable 
Care Act--

     would reduce Medicaid funding by $800 million, which provides 
     coverage to an estimated 3 in 10 adults dealing with an 
     opioid addiction. This will be so devastating to those 
     seeking treatment for an opioid addition. In a system where 
     families are already seeking help, this will be a tremendous 
     step backwards.
       So here I am, almost two years later, pleading for life, 
     fighting once again for families I have never met, because I 
     believe that no one should have to fight to get help for 
     addiction in this country like my daughter did. So my 
     question is, Mr. President and the members of the Senate, 
     what number of lives lost will be enough? What is the magic 
     number of sons and daughters, mothers and fathers, aunts and 
     uncles that we as a nation will have to lose before you 
     realize this country needs help?

  I ask that same question of my colleagues today. I ask the question 
that Jennifer, a brokenhearted mother, asked. What number of lives will 
be enough? How many is enough? When will others in this body realize 
that gutting our healthcare system and stripping millions of care will 
simply make this opioid epidemic worse?
  Jennifer was unfortunately not the only person who came to speak 
about the opioid epidemic. For me, the most moving and powerful among 
those moments came from Maria Skinner, who runs the McCall Center for 
Behavioral Health in Connecticut, who was there to give her thoughts 
and share the stories of two young people. I was actually lucky enough 
to meet both of them. Once again, I am going to share her words 
directly:

       What I want to do is talk to you about two people and make 
     that a real, personal, granular, human story. . . . And you 
     know these two people very well; it's Frank and Sean.

  She was speaking to me.

       [You] have met Frank and Sean, who were able to access care 
     and get clean and sober because of the Medicaid expansion, 
     because they were able to have coverage.
       And they've come here, to these rooms, to speak 
     courageously and publicly about their struggle and about 
     their recovery, and about how grateful they are to be able to 
     be clean and sober because of the access of care afforded 
     them through their insurance coverage.
       We went to Sean's funeral on Saturday, and . . . Frank 
     would be here today if he wasn't as brokenhearted as I am. 
     Sean was 26 and had been doing really well, was on 
     Naltrexone, was taking a Vivitrol shot, and he had to have 
     surgery for a hernia, because he raced motorbikes 
     professionally and the hernia hurt him. He wanted to go back 
     and was doing so well, he was speaking publicly to youth and 
     was anxious to go back into doing what he loved. So he had 
     that surgery and had to come off of his medication to do 
     that. He was very vulnerable after his surgery, and he 
     slipped once, and he used.
       I've been to too many funerals and seen too many mothers 
     and fathers brokenhearted at the coffins of their sons and 
     daughters. We can't make this any harder than it already is. 
     To me, it is unconscionable.

  Maria is right, and so is Jennifer. Gutting Medicaid would be 
unconscionable. Weakening the protections afforded to those with mental 
health or substance use disorder would be truly unconscionable. 
Repealing the Affordable Care Act and the provisions within it that 
have meant more coverage, more healthcare, and more healing for those 
suffering from substance use disorder and struggling to break the grip 
of this opioid epidemic would be unconscionable and costly beyond 
words.
  Alternative funds, as some reports say Republicans have considered, 
will never replace a permanent insurance program like Medicaid because 
Medicaid guarantees that coverage is there when families need it. No 
alternative can do that.
  In Connecticut, nearly half of all medication-assisted treatment for 
people with substance use disorders is paid by Medicaid. My fear is 
that the Republican bill in place will mean that these people would 
have no place to go. They would have no support for medications, 
counseling, and help, no chance to get better, no place to go. I refuse 
to let us find out the answer to what would happen to them if Medicaid 
were gutted. I refuse to allow it to happen, if I have anything to do 
with it.
  People with substance use disorder are not the only ones who will see 
their coverage threatened by a weakening of protections for those with 
preexisting conditions. In Connecticut on Monday, Shawn Lang of AIDS-
Connecticut expanded on what this bill would mean for the people living 
with HIV in this country.

       Some of us lived through the early days of the plague when 
     we went to funeral after funeral, memorial service after 
     memorial service, week after week, month after month, 
     watching our friends wither away and die. The healthcare bill 
     that is currently secretly weaving its way through Congress 
     would bring us back to the early days of the plague.
       HIV is a preexisting condition. Over half of the people 
     living with HIV in the country and in this state are over the 
     age of 50 and rely on Medicaid as their primary source of 
     insurance. Most of those people also have other co-
     morbidities like substance abuse disorders and mental health 
     disorders. What little we know about this bill would be 
     devastating to people with HIV and AIDS, and it essentially 
     would amount to a death sentence. Once again, having lived 
     through those early days, we don't want to go back there.

  Shawn's story is one of many I heard about the fear of losing 
coverage due to a preexisting condition.
  Gay Hyre, a 60-year-old breast cancer survivor, has similar concerns 
about what gutting the Affordable Care Act would mean not just for her 
but for everyone around her. She said this about why she came to speak 
at the hearing:

       I'm not just worried for me about my own care, although I 
     will be on the receiving end of a lot of bad parts of this. I 
     care passionately about the other 23 million Americans who 
     are my fellow citizens of every age, type, and need. It's 
     about the future, it's about our kids, it's about our 
     grandkids who won't have access to treatments, who won't have 
     access to doctors.

  I know my colleagues across the aisle don't want to hear these 
stories. If they wanted to hear these stories from people in 
Connecticut and around the country, millions of stories, we would have 
hearings--not just emergency field hearings; we would have hearings 
here in Washington before the Committee on Health, Education, Labor, 
and Pensions and before the Committee on Finance and other committees 
that have jurisdiction on the House side as well as in the Senate. We 
would be having a real debate, a robust discussion, and everyone of us 
here would have a chance to review this bill, if there is a bill, and 
comment on it and hear from the people we represent. But unfortunately 
my colleagues across the aisle don't want to hear about the details of 
repealing the Affordable Care Act.
  One witness at my hearing, Ellen Andrews of the Connecticut Health 
Policy Project, really summed up the reason. Here is what she said:

       We have been working on expanding health coverage, high-
     quality, affordable coverage to everyone in the state and now 
     everyone in the nation. I looked back, actually, at 2010, how 
     many people were uninsured in this state before the 
     Affordable Care Act, it was 397,000 people, almost 400,000. 
     Last year it was down by 262,000. That is 262,000 fewer 
     people living in our state without insurance because of the 
     Affordable Care Act.

  I want to share one final story. It is about a little boy in 
Connecticut who has a lot to lose if the Affordable Care Act is 
secretly gutted behind closed doors, as is now happening in real time 
right before our eyes, in secret, invisibly, in this body. I want to 
tell you about Connor Curran.
  Two years ago, when Connor was 5 years old, his parents noticed that 
he was lagging behind his twin brother. They brought him to a doctor. 
Rather than receiving a simple diagnosis, they learned that Connor has 
Duchenne muscular dystrophy, a degenerative terminal disease that has 
no cure. Most people with the disease don't survive past their 
midtwenties. Connor's family wrote that their sweet boy, who was just 5 
and full of life, would slowly lose his ability to run, to walk, to 
lift his arms. Eventually, they said, he would lose the ability to hug 
them at all.
  Connor needs complex care from multiple specialists, costing an 
estimated $54,000 a year. Thanks to the Affordable Care Act, he cannot 
be denied coverage and has the coverage he needs to receive care. His 
family also wrote that any elimination of lifetime caps or elimination 
of essential health benefits will hinder his family's ability to access 
the care that Conner needs.
  This is Conner in a picture that has been provided by his family.

[[Page 9621]]

  The ACA removed barriers to Conner's care, and they are concerned--
and so am I--that this reckless, reprehensible bill will put them back 
to the place that they were when they first learned about Conner's 
diagnosis.
  Should Conner's disease progress, he will very likely need access to 
Medicaid in order to offset the costs of living with a disability, but 
for his family, the question now is, Will Medicaid even be there? If 
that devastating day comes, will he continue to receive the care he 
needs?
  Conner's family is not about to give up. They have come to my office 
annually since he was diagnosed in order to fight for a cure and to 
fight for the Affordable Care Act--sometimes with tears in their eyes. 
They raise awareness, and they fight for their little boy. I know they 
would do it a million times over again if it meant that Conner could 
get better and live a long and healthy life.
  Conner and others like him are why I am here. Conner and others like 
him are why I will continue this fight against any attempts to repeal 
the Affordable Care Act and replace it with a shameful, disgraceful 
bill that has been written behind closed doors--destroying lives and 
degrading the quality of life for millions of Americans.
  The people whom I have met in Connecticut who came to this hearing--
and countless others who have talked to me about the Affordable Care 
Act--are fighting for their lives and their health and for others who 
need it as well.
  Those people whom I met in Connecticut and the others who will come 
to our hearing on Friday and, perhaps, afterward are the reason I am 
fighting for better coverage for all of the people of Connecticut and 
our country.
  Those people are the best of our country with their fighting spirit 
and dedication to the people they love, and they deserve to be heard. 
They are the voices and faces of the Affordable Care Act who have been 
turned away at the door of this Capitol. I refuse to allow them to be 
silenced.
  As I have mentioned, we will be back at it again on Friday because 
hearing from our constituents is part of our job. It is the bedrock of 
democracy. It is the fundamental core of what we do--listening to the 
people whom we represent. Failing to do so is unconscionable just as 
destroying the Affordable Care Act would be unconscionable, just as 
denying Conner what he needs would be unconscionable, just as ignoring 
Justice and Sean and Frank would be unconscionable. I hope my 
colleagues will listen.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, I am pleased to yield 5 minutes to the 
distinguished Senator from Georgia.
  The PRESIDING OFFICER. The Senator from Georgia.
  Mr. ISAKSON. Mr. President, I thank the distinguished President pro 
tempore of the Senate, the chairman of the committee. I am honored to 
take that 5 minutes.


                          Veterans Healthcare

  Mr. President, a lot of us wake up in the morning with a plan for the 
day, and we know what we are going to do each hour--and every 5 minutes 
if you are a Member of the Senate. Some days surprise you. I went to 
breakfast this morning for Members of the Senate who are veterans of 
the U.S. military. There were three of us at that breakfast. There were 
supposed to be more, but some did not come at the last minute.
  One of the people at the breakfast handed me a piece of paper--four 
pages as a matter of fact--and asked: Have you seen this?
  I did not know what it was, but I turned and looked at it. It was a 
white paper on the impact of President Trump's proposed budget on the 
American veteran.
  The guy said: You are the chairman of the Veterans' Affairs 
Committee. I want you to explain why all of this is true.
  I quickly turned through it, from one page to another, and looked at 
each of the headlines and subtitles. Every one of them was wrong. There 
was not a statement of fact in it, but there was a purpose to the 
paper.
  So I thought all morning about what I would do today to try and get 
the word out about what is true without getting into a partisan or a 
bickering battle on the floor of the Senate about documents that have 
been sent out circuitously by one Member of the Senate or another. 
Facts are facts, and facts are stubborn things. It is very important 
for me as chairman of the committee to make sure that the Members of 
the Senate know what we are dealing with as we lead up to making 
important decisions.
  This white paper alleges that President Trump's budget is a 
circuitous route to privatize VA health services for our veterans, 
which is patently untrue and wrong, and the authors of this in the 
Senate who have written it know it is untrue because they are on the 
committee. It further alleges that the funding of healthcare for 
veterans has been cannibalized by privatization programs in order to 
take healthcare out of the Veterans Health Administration and put it 
into the private sector.
  I know, within a few weeks, that I am going to be coming to the floor 
with, hopefully, the entire Veterans' Affairs Committee and will be 
seeking additional funds for the Choice Program so as to continue to 
meet the demand for our veterans and their healthcare.
  It was 2\1/2\ years ago that this Senate and this Congress and the 
former President passed and signed legislation that guaranteed that 
every veteran, no matter where he lived, could get services within the 
private sector in his community that were approved by the VA--services 
that he could not get from the VA anywhere. In other words, he got a 
choice. If he were denied an appointment within 30 days, he got a 
choice if he lived more than 40 miles from the service area. It became 
known as the Choice Program--popular but difficult to manage. It was 
popular in that 2.7 million appointments were held in the next 2 years 
over the previous 2 years because of the increased accessibility of 
healthcare for our veterans.
  I come to the floor to say that the Veterans' Affairs Committee is 
working with the appropriators and the authorizers to see to it that 
the healthcare money that needs to be appropriated for our veterans is 
appropriately done in the budget proposal that we pass out of this 
body.
  I want everybody on the floor to remember, every time you allege as a 
Member of the Senate that money for veterans is being cannibalized and 
that they are not going to get their health services, you are accusing 
the Congress and the Senate of not doing their constitutional duty of 
providing the funds we guarantee these men and these women when they 
voluntarily sign up to serve our country, serve for the eligible time 
necessary, and get VA status.
  I am never going to forsake my obligation to the men and women who 
serve us today, have served us in the past, and will serve us in the 
future. I am never going to be one of those politicians who is not 
trustworthy in standing behind every promise that is made.
  We have made a great promise to the veterans of America, and we are 
going to keep it because they made the greatest promise of all--that 
they would risk their lives for each of us.
  So, if you get a document that reads ``The Impact of President 
Trump's Proposed Budget on America's Veterans'' and read it and it 
talks about the cannibalization of VA healthcare and its going to a 
privatized system of healthcare, put it in the trash can because that 
is where it belongs. It is full of quotes that have been taken out of 
context and that have been put together to tell a story to frighten 
folks.
  Today and every day, we are in the process in the Veterans' Affairs 
Committee of working toward seeing to it that we meet the funding 
shortfalls that exist, to see to it that our veterans get the 
healthcare that they deserve and they come to our Veterans Health 
Administration for or that they have a choice, and we will continue to 
do so.
  I have but one responsibility in the U.S. Senate, which is of 
paramount importance, and that is my chairmanship

[[Page 9622]]

on the Veterans' Affairs Committee. I am not going to let our veterans 
down, and I am not going to let somebody else allege that we on the 
committee are trying to do something that would not help the veterans 
or guarantee them their healthcare. On the contrary, we are going to 
see to it that nobody else takes it away. We are going to do for our 
veterans what they have done for us--pledge our sacred honor to see to 
it that they get the service they deserve, have fought for, and have 
risked their lives for.
  I thank the Senator from Utah for yielding the time.
  The PRESIDING OFFICER. The Senator from Utah.


                         Healthcare Legislation

  Mr. HATCH. Mr. President, for the last several weeks, I have been 
hearing quite a bit about process here in the Senate, particularly as 
it relates to the ongoing debate over the future of ObamaCare.
  My friends on the other side of the aisle have, apparently, poll-
tested the strategy of decrying the supposed secrecy surrounding the 
healthcare bill and the lack of regular order in its development. They 
have come to the floor, given interviews, and even hijacked committee 
meetings and hearings to express their supposedly righteous indignation 
about how Republicans are proceeding with the healthcare bill.
  Of course, hearing Senate Democrats lecture about preserving the 
customs and traditions of the Senate is a bit ironic, but I will get 
back to that in a minute.
  Last week, the Senate Finance Committee, which I chair, held a 
routine nominations markup to consider a slate of relatively 
uncontroversial nominees. On that same day, several of our colleagues 
and congressional staffers had been viciously attacked by an armed 
assailant, and a Member of the House of Representatives, of course, was 
in critical condition in the hospital.
  I opened the meeting by respectfully asking my colleagues to allow 
the committee to use the markup as an opportunity to demonstrate unity 
in the face of a violent attack against Congress as an institution. 
Even then, my Democratic friends were, apparently, unable to pass up an 
opportunity to try to score partisan points and rack up video clips for 
social media by playing for the cameras as they lamented the 
committee's position in the healthcare debate.
  Once again, the situation is dripping with irony. As I said, I will 
get to that in a minute.
  If my Democratic colleagues are going to continue grandstanding over 
the healthcare debate, I have a few numbers I would like to cite for 
them.
  Under ObamaCare, health insurance premiums in the State of Oregon 
have gone up by an average of 110 percent. In Michigan, they have gone 
up by 90 percent. In Florida, they have gone up by 84 percent. In 
Delaware, they have gone up by 108 percent. In Ohio, they have gone up 
by 86 percent. In Pennsylvania, they have gone up by 120 percent. In 
Virginia, they have gone up by 77 percent. In Missouri, they have gone 
up by 145 percent.
  I have not picked those States at random. Each of these States is 
currently represented by a Democrat on the Senate Finance Committee. Of 
course, those trends extend well beyond the committee.
  In Illinois, where the Senate minority whip resides, premiums have 
gone up by 108 percent.
  In West Virginia and Wisconsin, both of which are also represented by 
Democratic Senators, premiums have gone up by 169 percent and 93 
percent, respectively.
  Montana is in a similar situation with premiums rising by 133 percent 
under ObamaCare.
  Now, just so people do not go thinking that I am picking on the 
Democrats, I will note that, in Utah, health insurance premiums have 
gone up by an average of 101 percent.
  In Wyoming, they have gone up by 107 percent, and, in Nebraska, they 
have gone up by 153 percent.
  I can go on, but I think my point is clear: Health insurance premiums 
have skyrocketed all over the country by an average of 105 percent. I 
will repeat that. Under ObamaCare, the average health insurance 
premiums in the United States have seen triple-digit increases.
  These are the fruits of the so-called Affordable Care Act. This is 
the burden that ObamaCare has placed on patients and families 
throughout our country, and people are feeling that burden whether they 
vote for Democrats or Republicans.
  The only difference is that, for 7\1/2\ years, my Republican 
colleagues and I have been talking about the failures of ObamaCare, and 
for 7\1/2\ years, Senate Democrats have done virtually nothing to 
address these problems.
  For 7\1/2\ years, Republicans like myself have pleaded with our 
Democratic colleagues and with the previous administration to work with 
us to address the failures of ObamaCare, and for 7\1/2\ years, it has 
been virtually impossible to get any Democrat in Washington to even 
acknowledge that there have been any problems with ObamaCare to begin 
with.
  As the cost of healthcare in this country has skyrocketed out of 
control and the system created by the so-called Affordable Care Act has 
been collapsing under its own weight, Democrats in the Senate have been 
cherry-picking what few positive data points they can find and telling 
the American people that everything is fine and that ObamaCare is 
working.
  Give me a break.
  By no honest or reasonable measure is ObamaCare living up to the 
promises that were made at the time it was passed. As a result, the 
American people are saddled with a healthcare system that has been 
poorly designed and recklessly implemented.
  Sure, it has made for partisan political theater for my colleagues to 
express shock and dismay at the current state of the healthcare debate. 
I am quite certain the strategy has poll-tested very well among the 
Democratic base, and the Senate minority leader clearly has an 
elaborate media campaign in mind.
  Before they begin berating Republicans, I hope my Democratic 
colleagues were able to come up with something to tell their 
constituents whose healthcare costs have exploded as a result of 
ObamaCare. I have just mentioned a few things.
  I hope they have answers for their voters for wondering why they only 
have one insurance option available to them, if they even have that, 
and, most importantly, I hope they have an explanation as to why they 
have been more or less silent while the law they supported--and still 
support--has wreaked havoc on our Nation's healthcare system.
  Until they can answer those questions and provide those explanations, 
my good friends should spare anyone within earshot their lectures about 
what is currently happening in the Senate.
  Finally, let me address the irony of my Democratic colleagues' 
process complaints. Some of them have selective memories when it comes 
to the history of ObamaCare. We have heard our colleagues talk about 
the number of committee hearings held in advance of ObamaCare's 
passing. What we don't hear is that there was not a single hearing held 
in the Senate on the ObamaCare reconciliation bill, which was an 
essential element that ensured passage of the Affordable Care Act in 
the House.
  We have heard our colleagues talk about the markup process in 
committee and the number of amendments that were filed and accepted. 
What we don't hear about is the fact that the bills reported by the 
Finance and HELP Committees were tossed aside so the healthcare bill 
could be rewritten behind closed doors in Senator Reid's office, who 
was then the majority leader. The final product was only made public a 
few days before the Senate voted on it.
  The truth is this: Senate committees--including the Finance 
Committee--have had literally dozens of hearings wherein the failings 
of ObamaCare--both the structure of the law and its implementation--
have been thoroughly examined. Between all the relevant committees, 
there have been

[[Page 9623]]

at least 66 healthcare hearings in the Senate since ObamaCare became 
the healthcare law of the land. More than half of those were in the 
Finance Committee.
  Committees have conducted countless oversight investigations and 
inquiries into these matters over the years. Few matters in the history 
of our country have received as much of the Senate's attention as 
ObamaCare has received. Very few laws have been examined as extensively 
as the so-called Affordable Care Act, which is anything but affordable. 
ObamaCare is the very definition of well-covered territory.
  The majority leader has made clear that Members will have an 
opportunity to examine the forthcoming healthcare bill, and I expect 
that to be the case. He has always made assurances that when the bill 
is debated on the floor, we will have a fair and open amendment 
process, as required under the rules. There is really no reason for 
anyone to expect otherwise.
  Let's recall that when ObamaCare was passed, the Democratic Speaker 
of the House, with a plain face, stated that Congress had to pass the 
bill in order for people to see what was in it.
  Let's also recall that a couple of years later, one of the chief 
architects of the so-called Affordable Care Act bragged about the lack 
of transparency that surrounded its passage and said it was necessary 
to, in his words, take advantage of the ``stupidity of the American 
voter.''
  Any argument that the process that resulted in ObamaCare was a 
picture of transparency and deliberation is so off base that it would 
almost be humorous if the issue was something less important.
  As I said in committee last week, I want to welcome my Democratic 
colleagues to the healthcare debate. Ever since ObamaCare was signed 
into law, Democrats have more or less assumed that the debate was over 
and that all they had to do was keep telling the American people that 
everything was just fine, as if repetition alone would make it come 
true.
  Everyone is going to see the bill, and everyone is going to get their 
chance to say their piece about it.
  For now, I simply hope my Democratic colleagues will spare us their 
lectures and maybe look in the mirror when they are ranting about the 
degradation of the process and traditions of the Senate.
  I have been around healthcare for most of my 41 years in the Senate. 
A lot of the healthcare bills that work in this country have my name on 
them. This is one of the worst bills I have ever seen in all my time in 
the U.S. Senate. If I were a Democrat, I would not be claiming success 
because of that bill. It is a pathetic piece of legislation that is 
going to put this country down and make healthcare not available for 
everybody but make everybody have the worst healthcare system they 
could possibly have.
  Now, it is one thing to cherry-pick a few things that the healthcare 
bill can help with, but it would be a totally stupid bill if it didn't 
have something in it that was good. If you look at the overall bill and 
you look at the overall cost to America and you look at what it is 
doing to America and you look at how the medical profession is starting 
to really wonder if they want to be in the profession anymore--you 
can't do all of this and look at all of these things without asking, 
What in the heck have we done here? Are we so stupid that we believe 
the Federal Government is the last answer to everything?
  Well, we will see, because I think some people are that stupid and, 
frankly--I don't want to name anybody, and I hope I am wrong, but I 
have been here 41 years and I have seen a lot of stupidity around this 
place and you have to really go a long way to find anything worse than 
the so-called ``affordable'' healthcare bill.
  This is a pathetic piece of legislation that is going to wreck our 
country if we don't, as Democrats and Republicans, get together and 
reform it. This is an opportunity for my friends on the Democratic side 
as well as the Republican side to see what we can do about this and to 
get this thing straightened out.
  This is the greatest country in the world. There is nobody in this 
country who should go without basic healthcare. When we have terrible 
cases like my distinguished friend and colleague from Connecticut has 
mentioned, yes, we want to make sure people who suffer like that are 
taken care of, and there are some on our side who could be a little 
more humane and compassionate, but there are some on the other side, 
too, who could be a little more humane and compassionate and maybe a 
little more honest when they talk about this bill.
  We are a long way from solving the healthcare problems in this 
country, and if we go down this road any further, we will be an even 
longer way from solving these problems, and we may very well bankrupt 
the American economy, which will then really show us how bad we are 
with regard to healthcare in this country.
  My friends on the other side never ask, Where is the money going to 
come from? Who is going to pay for this? Who is going to help us to get 
through this? We are just going to throw money at it, and we are $100 
trillion in unfunded liability in this country and $20 trillion in 
national debt. It is astounding. Who is going to pay for it, especially 
when it doesn't work any better than that.
  I spent some of my prior life in medical malpractice work defending 
doctors and hospitals and healthcare providers, and some of that was 
really astounding to me because some of those cases were brought just 
to get the defense costs, which were always pretty high because those 
cases were very expensive to defend. Most of them were not good cases, 
but once they got in court, if they had any kind of basis at all--but 
even if they were dismissed, it still cost a lot of money.
  All I can say is, there is a lot wrong with our healthcare system in 
this country, but it is still the best healthcare system in the world, 
and it is about to go down if we don't get together as Republicans and 
Democrats and straighten this mess out. We can make our political 
points all we want to. Both sides have been right in some cases and 
both sides have been wrong on some things, but we are wrong if we think 
that the current system is going to work, and we ought to be working 
together as Republicans and Democrats or Democrats and Republicans to 
straighten it out.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Mr. PETERS. Mr. President, I rise with the understanding that the 
Senate will be voting on a Republican healthcare bill next week, a bill 
that has been written entirely behind closed doors.
  The bill has been hidden from the American people, the press, and, as 
far as I can tell, almost every Senator. I have not been allowed to see 
it and neither have any of my Democratic colleagues.
  I was elected to the Senate in 2014 during the same election that 
Republicans regained the majority, and I remember a pledge by their 
leadership that the Senate would return to regular order. Well, regular 
order means public hearings on legislation. Regular order means 
committees have a chance to gather input from expert witnesses, 
consider a policy's potential impact, and amend bills before they come 
to the floor.
  Prior to enacting ObamaCare, the Senate Finance and HELP Committees 
held nearly 100 hearings, roundtables, and walkthroughs on healthcare 
reform. In the House, where I served at the time, there were over 79 
bipartisan hearings and markups that included an opportunity for our 
Republican colleagues to offer input and amendments in the bill. Dozens 
of Republican amendments were adopted during the House committee 
markups of the Affordable Care Act. That is an open process.
  What we are seeing now is a bill drafted entirely in secrecy and 
hidden behind closed doors. But why? Is it because Republicans know 
that this bill is not a good deal for the American people? You could 
call the recent process a lot of things, but you can't call it

[[Page 9624]]

open, and you can't call it regular order.
  Supposedly, the bill has been assembled by a working group of 13 of 
my Republican colleagues, but just yesterday--just yesterday--one of 
these Members complained that he had not yet seen a draft. In fact, he 
went on to say--this is a Republican colleague of mine in this working 
group:

       It has become increasingly apparent in the last few days 
     that even though we thought we were going to be in charge of 
     writing a bill within this working group, it's not being 
     written by us. It's apparently being written by a small 
     handful of staffers for members of the Republican leadership 
     in the Senate.

  This quote makes it clear that this working group is--well, it is not 
working.
  When Senators in the majority party are unable to tell you who is 
writing the bill, let alone what is in the bill, we have a problem. 
While we clearly have a problem with the secretive, rushed process, 
this process is a symptom, not the disease. The underlying disease is 
that this bill, which we reportedly will see tomorrow, is almost 
certainly terrible for the American people.
  There are two explanations for keeping a product under wraps: Either 
you want to build excitement for it or you are worried about the 
weaknesses that would be exposed by the daylight. I don't believe for a 
moment that Republicans are trying to build excitement by hiding this 
bill. This bill is not next year's model of the Ford Mustang or Chevy 
Camaro waiting to be unveiled at the Detroit auto show to great 
fanfare. This bill is like a disaster that will negatively impact 
millions of Americans. This bill is the iceberg that sunk the Titanic, 
and Republican leadership has turned off the ship's radio and are 
furiously shoveling coal into the engines.
  While the Senate moves full steam ahead to vote next week on a bill 
we haven't even seen yet, I am worried that my colleagues across the 
aisle, along with too many political commentators and pundits, are 
simply asking the wrong questions. They are asking: Will moderate 
Republicans vote for it? Will the tea party wing support it? Will it 
take sweetheart deals to get to 51 votes?
  Well, folks, this is not a game. This is not about if and how the 
majority can count to 51 votes and solve their political problems with 
the far-rightwing base of their party. This is about people's lives.
  There are serious policy questions we need to ask, and the American 
people deserve to have answers. There are questions like these: What 
are your policy goals here? How do you think this will help people 
afford quality insurance coverage? What will the bill do for tens of 
millions of Americans who have gained healthcare coverage in recent 
years? What will the bill do for patients with preexisting conditions? 
What will the bill do for the hundreds of thousands of Michiganders 
covered under the successful Healthy Michigan Program? What will the 
bill do for small business owners and employees? What will the bill do 
for seniors who need affordable, long-term care options? What will the 
bill do for individuals battling opioid addiction? These are questions 
I am asking, along with all of my Democratic colleagues.
  I serve on the Permanent Subcommittee on Investigations, and just a 
few weeks ago we held a hearing on opioid abuse and how the epidemic is 
simply ravaging our Nation.
  I had the opportunity to speak with a police chief from our southern 
border State of Ohio. He was very clear that if Medicaid expansion were 
to go away--as we saw in the House bill and expect to see in the Senate 
bill--it will make it much more difficult for local police departments 
to tackle this crisis because of dramatically scaled-back availability 
of addiction treatment. I spoke with a coroner, a medical doctor, and 
an addiction expert on the panel as well.
  These are professionals dealing with a public health crisis each and 
every day--not people with political agendas. They all agreed that 
Medicaid expansion is critical to combating addiction, improving public 
health, and helping individuals suffering from addiction have an 
opportunity to be productive citizens and have a second chance at life.
  The bottom line is that this bill--this secretive, rushed bill that 
we will supposedly see tomorrow--will move us backward and rip 
healthcare away from millions of Americans. When you take health 
coverage away from people, people will die.
  As a Member of the House, I voted for the Affordable Care Act because 
I knew that, at the end of the day, it would save people's lives. As 
elected officials and public servants, there are only a handful of 
votes we cast that are literally about life and death. Next week, we 
will see one of those votes.
  I urge my colleagues on both sides of the aisle to read the bill, 
whenever we get it, and then talk to doctors, patients, families, 
clinics, and hospitals in their State. I also urge my colleagues to 
vote no next week and to start a truly bipartisan process that keeps 
what works, fixes what doesn't, but, most importantly, helps all 
Americans afford quality healthcare in their communities.
  I stand here ready and willing to be a partner in a bipartisan 
process and to work with my Republican colleagues to improve our 
healthcare system. Show us and the American people you are serious 
about health reform. Let's have an open and honest process and pass a 
bill that is genuinely in the best interest of the American people.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Gardner). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                             Climate Change

  Mr. WHITEHOUSE. Mr. President, I come weekly to the Senate whenever 
we are in session to give my ``Time to Wake Up'' speech, talking about 
climate change and, quite often, talking about the climate denial 
campaign that prevents us from taking action and, quite often, talking 
about the campaign finance problems in our country that make climate 
denial effective. Here, in Congress, it is not hard to connect the dots 
from campaign finance to climate denial.
  The Supreme Court's Republican majority's disastrous Citizens United 
decision was requested by the fossil fuel industry, and the fossil fuel 
industry took instant advantage of it--almost like they saw it coming. 
The industry and its front groups instantly used their new power 
conferred by Citizens United to come after politicians--Republicans in 
particular. Ask Bob Inglis, who backed responsible climate policies. 
Citizens United created new American dark-money emperors, and--no 
surprise--the new emperors love their new political power.
  Their first payoff was that Republicans in Congress fled from any 
legislative action on climate change. Before Citizens United, there 
were multiple bipartisan climate bills. Year after year--when I was 
here in 2007, 2008, 2009--there were bipartisan climate bills to the 
left of you, bipartisan climate bills to the right of you, bipartisan 
climate bills cropping up all over. Today, we watch our Republican 
President trying to undo curbs on carbon emissions and, to the cheers 
of Republicans in Congress, withdrawing the United States from the 
historic Paris Agreement. We join Syria and Nicaragua as the only 
nations to reject this common cause. That, my friends, is the heavy 
hand of fossil fuel influence, driving us into isolation and abdication 
of American leadership.
  Of course, right now, no Republican can safely sponsor any bill to 
limit carbon dioxide emissions, and so none do. Very different than 
before the Citizens United decision in January of 2010. That changed 
everything. When those five Republican justices opened up unlimited 
political spending to the big Republican special interests, that 
unlimited political spending was inevitably going to find dark-money 
channels. Dark-money channels hide the identity of the political donor, 
so that big special interests can pollute our politics with their money 
with seemingly clean hands.

[[Page 9625]]

  The climate denial scheme of the fossil fuel cartel is powered 
politically by dark money. Whether through the lure of dark money 
coming in for you in a political race or the threat of dark money 
coming in against you in a political race, dark money powers climate 
denial. Well, we have just learned something new about dark money.
  Chairman Graham and I held hearings in our Judiciary Subcommittee on 
Crime and Terrorism to look at Russian interference in the recent 2016 
election and what it portends for elections to come. Our witnesses 
warned us that Russia has strategically manipulated politics in Europe 
for decades. They started working in the former Soviet Union countries, 
and they expanded to where they are manipulating politics in France, 
Germany, Holland, England, and all over Europe. The witnesses warned us 
that we in America must be prepared for that. They jumped the Atlantic 
to manipulate the 2016 elections, and they are not going away.
  One identified weakness of the United States against Russian 
influence was this dark money in our politics. Why is that? Well, it is 
obvious. Once you allow dark money in, dark is dark. Cash from Vladimir 
Putin is no more traceable than cash from Charles and David Koch. One 
witness, a former Republican national security official, told us: ``It 
is critical that we effectively enforce the campaign finance laws that 
would prevent this type of financial influence by foreign actors.''
  ``It is critical that we effectively enforce the campaign finance 
laws'' against foreign influence by foreign actors.
  The two best studies of Russian influence in Western Europe in their 
elections and in their politics are ``The Kremlin Playbook,'' by CSIS, 
or the Center for Strategic and International Studies, and ``The 
Kremlin's Trojan Horses,'' by the Atlantic Council. Both of them report 
that Russia takes advantage of nontransparency in campaign financing to 
build its shadowy webs of influence and control. If you leave dark-
money channels lying around, it is likely that Vladimir Putin and his 
oligarchs will find them.
  The ``Trojan Horses'' report warns this: ``The Kremlin's blatant 
attempts to influence and disrupt the U.S. presidential election should 
serve as an inspiration for a democratic push back.'' That is a lower 
case ``d'' for ``democratic push back,'' and it points to one key way 
we need to push back.
  I will quote them again.

       Electoral rules should be amended, so that publically 
     funded political groups, primarily political parties, should 
     at the very least be required to report their sources of 
     funding.

  That is, end dark money.
  Likewise, the ``Kremlin Playbook'' report warns:

       Enhancing transparency and the effectiveness of the Western 
     democratic tools, instruments, and institutions is critical 
     to resilience against Russian influence.

  Enhancing transparency means ending dark money.
  Our hearing and these reports reveal another political influence tool 
used by the Kremlin: fake news. As we shore up our democracy to defend 
against Russia's fake news information warfare, we must remember this: 
Climate denial was the original fake news.
  To give an example, here is a story that may sound familiar. An 
unknown hacker illegally breaks into and steals an organization's 
emails. The organization's emails are held until they can be released 
at a politically strategic moment. At the strategic moment, emails are 
leaked to a website with shady ties. The leaks are then amplified and 
spun by fake news, driven into the regular media, and have their 
desired political effect. Does any of that sound familiar? Of course, 
it is the methodology of the Russians' hack of the Democratic National 
Committee, right? Unknown hacker, stolen emails, strategic release, 
caching them until they can be used, shady website, fake news spin-up, 
regular media takes the bait, political damage.
  If you step back and look at just the methodology, we have seen this 
pattern before--so-called climategate, the fake scandal years ago 
cooked up by the climate denial machine. It was 2009, not 2017. The 
organization hacked was not the DNC but the Climate Research Unit at 
the University of East Anglia in the United Kingdom. The release was 
timed to the U.N. climate conference in Copenhagen, not the 
Presidential election. The documents went to climate skeptic blogs--
with, interestingly, the first upload in Russia--instead of to 
WikiLeaks, but the mainstream media took the bait, and the political 
damage was done.
  At the time, the New York Times wrote:

       The[se] revelations are bound to inflame the public debate 
     as hundreds of negotiators prepare to negotiate an 
     international climate accord at meetings in Copenhagen next 
     month.

  This climategate scheme worked so well that in November 2011, the 
climategate operation did it again just before the U.N. climate 
conference in Durban in what was dubbed climategate 2.0. Of course, the 
whipped-up climategate hysteria was all fake news.
  As the Guardian wrote in February 2010:

       Almost all the media and political discussion about the 
     hacked climate emails has been based on soundbites publicised 
     by professional [climate] sceptics and their blogs. In many 
     cases, these have been taken out of context and twisted to 
     mean something they were never intended to.

  Eight times, everyone from the inspector general of the U.S. 
Department of Commerce, to the National Science Foundation, to the 
British Parliament found no evidence of any misconduct by the 
scientists, but for the climate denier groups, the truth was never the 
point.
  This climategate stunt was the product of a fake news infrastructure 
built by the fossil fuel industry to attack and undermine real climate 
science--disinformation campaigns, false-front organizations, stables 
of paid-for scientists, and propaganda honed by public relations 
experts. This denial operation aspires to mimic and rival real science, 
and it is an industrial-strength adversary with big advantages. It does 
not need to win its disputes with real science; it just needs to create 
the public illusion of a real dispute. It doesn't have to waste time in 
peer review, and it doesn't have to be true; it just has to sound like 
it might be. This industrial fake news operation isn't going anywhere. 
It is too valuable to the big polluters.
  As we prepare to face down Russia's campaign of election 
interference, we will have to face up to these two hard facts:
  If the Kremlin wants to deploy fake news information warfare in our 
country, the climate denial fake news infrastructure already exists. 
Remember, climate denial was the original fake news.
  If the Kremlin wants to deploy a surreptitious financial influence 
campaign, the dark money infrastructure already exists. The fossil fuel 
industry's dark money election manipulation machinery is ready to go. 
Putin doesn't have to build a thing. The fossil fuel dark money and 
fake news infrastructure stands ready to go.
  Unfortunately, we know it works because it has worked for years for 
the fossil fuel cartel, particularly since Citizens United allowed the 
fossil fuel industry to enforce silence on the Republican Party.
  The dangers of fake news, dark money, climate denial, and foreign 
interference in our elections are all intermixed. They have brought us 
to the point where the President of the United States will leave the 
Paris Agreement, betraying the country's interests, in the service of 
the fossil fuel industry, the Koch brothers' climate denial operation, 
and Breitbart fake news.
  This calls for an American response. Dark money and fake news are a 
sinister combination, whoever is behind them. America must address the 
twin threats of fake news and dark money. It is bad enough when these 
are the tools of the fossil fuel industry's climate denial operation, 
but we are on notice now. We are on notice from these reports and from 
multiple witnesses that the Kremlin can borrow these tools too.
  I will close by asking that we clean up this mess. It may take 
citizen action, given the stranglehold dark

[[Page 9626]]

money and fake news have on Congress, but this is a fight worth having. 
There is no good that comes out of dark money and fake news, whoever is 
behind them. We should rid ourselves of this sinister combination.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.


                       Remembering Otto Warmbier

  Mr. PORTMAN. Mr. President, I rise today to talk about a promising 
young man from Wyoming, OH--just outside of Cincinnati, my hometown--a 
young man whose life was drastically cut short at just 22 years of age. 
I rise to talk about Otto Warmbier.
  Otto had all the smarts and talent you could ever ask for. He was a 
homecoming king and the salutatorian of the Wyoming High School class 
he graduated from a few years ago. He spent a summer at the London 
School of Economics. He was a smart kid. He won a prestigious 
scholarship to study at the University of Virginia. As everyone 
expected he would, he excelled at UVA. He got great grades. He had a 
thirst for learning. He loved meeting new people and hearing about 
their lives and their perspectives. His future was as bright as it 
could possibly be.
  It was this smart, kindhearted young man--a college kid--who was 
taken prisoner by the North Korean regime for nearly 18 months. Otto's 
detainment and sentence were unnecessary and appalling. Neither one 
should have ever happened in the first place. At some point soon after 
being sentenced to 15 years of hard labor, from what we know, Otto 
suffered a severe brain injury--from what, we don't know, and we may 
never know.
  Whom did the North Korean Government tell about this? No one. For the 
next 15 months or so, they kept this a secret. They denied him access 
to the best medical care he deserved, and they refused repeated 
requests for consular access that would normally be provided to those 
who have been detained--requests from our government, from the Obama 
administration, from the Trump administration, requests from the Red 
Cross, requests from the Swedish Government, which provides consular 
service for Americans in North Korea, requests from many of us here in 
the Capitol.
  The regime unjustly imprisoned him and then lied about his severe 
medical condition. By the way, they continued to tell stories that make 
no sense. Doctors at the University of Cincinnati--some of the best 
doctors in the world and just the type of medical professionals Otto 
should have been able to see from the start--say that North Korea's 
claims as to what happened simply don't stand up to the evidence.
  They called him a prisoner of war, but they also violated the Geneva 
Convention. For North Korea to imprison Otto Warmbier with no consular 
access for more than a year with his medical condition and severe brain 
injury--it goes well beyond that. It demonstrates a complete failure to 
recognize fundamental human rights. Because of these actions by the 
North Koreans, Otto is dead. His promise has been cut short.
  If there is ever any doubt about the nature of the North Korean 
regime--that pariah country--then Otto's case should erase all doubt. 
We know this regime has no regard for the rule of law or the freedoms 
we enjoy here, but they also have no regard for basic human rights and 
dignity. They have subjected hundreds of thousands of their own people 
to mistreatment, torture, and death for decades. They are now extending 
that treatment to innocent Americans. North Korea should be universally 
condemned for its abhorrent behavior and be held accountable for its 
actions.
  Otto's family--God bless them--tried everything they could to bring 
Otto home. For 18 months--and for almost 16 months not knowing of his 
dire condition--they were steadfast and resilient, trying everything 
they could.
  I was there with Fred and Cindy Warmbier when Otto finally returned 
from North Korea. He came home. It was incredibly emotional to watch 
Otto be reunited with his loving family. I believe he knew he was back 
home. I believe he knew he was among those who loved him.
  I want to thank State Department Special Representative Joe Yun, 
Deputy Secretary Sullivan, and Secretary Tillerson for their work to 
help secure Otto's release last week and to bring him home.
  There are still three Americans who are being detained by the North 
Koreans. They should be released immediately, and we should do 
everything we can do as a country to secure their release.
  Otto's case is a reminder that we must, on the one hand, increase 
pressure on North Korea to force them to change. There will soon be 
more to discuss on that. At the same time, we have to maintain an open 
line of communication to deal with the deadly serious issues we face. 
Those are some of the lessons I have taken from the last 18 months.
  Fred, Cindy, and the entire Warmbier family have been incredibly 
strong through this ordeal. No one should have to go through what that 
family has experienced. My wife Jane and I will continue to be at their 
side, including at the funeral service tomorrow in Wyoming, OH.
  I urge my colleagues and everybody listening at home to continue to 
hold up this family in prayer, but also let's ensure that this tragedy 
is a wake-up call about the true nature of this brutal regime.
  Mr. President, I yield back.
  The PRESIDING OFFICER. The Senator from Massachusetts.


                         Healthcare Legislation

  Ms. WARREN. Mr. President, President Trump said last week that the 
healthcare bill passed by the House was ``mean,'' and then he said the 
Senate should make the bill more ``generous, kind [and] with heart.'' 
It sounds like the President is having second thoughts about this 
Republican bill.
  So now, Mr. President, you are waking up and noticing just how 
heartless this bill is; you know, the bill your Republican buddies in 
Congress slapped together in a back room; you know, the one you 
celebrated with a big press conference in the Rose Garden a few weeks 
ago; you know, the bill that you and House Republicans gave each other 
high fives over for taking away healthcare from millions of people, and 
now it sounds like you want a do-over.
  Too bad no one explained to the President that mean is just part of 
the deal the Republicans have struck. Mean is baked into every sentence 
of this bill. When you set out to trade health insurance of millions of 
American families for massive tax cuts for the wealthy, things get real 
mean fast.
  This mean bill does a lot of things, but some of the meanest things 
about it are how hard it will hit American women. To pay for the 
hundreds of billions of dollars in tax cuts for this bill, Republicans 
chose to make one of their classic moves--a sort of old reliable for 
Republican men: attack women's healthcare.
  Let's run through just a few examples. Today, most people helped by 
Medicaid are women. The Republican bill cuts Medicaid by $834 billion. 
Republicans say millions of women who lose healthcare will do just 
fine.
  Today, plans on the individual market have to cover maternity care 
and treatment for postpartum depression. The Republican bill says: 
Forget it. Let the States drop those benefits. Women are the only ones 
using them anyway.
  Today, the law says you can't charge women more by labeling things 
like pregnancy as preexisting conditions. The Republican bill says: Who 
cares? Go for it.
  Today, women can choose healthcare providers they trust the most, but 
the Republicans want to eliminate that choice by cutting funding for 
Planned Parenthood. Republicans say women can do just fine without the 
care they need.
  Frankly, I am sick of many coming down to the Senate floor to explain 
to Republicans what Planned Parenthood does. I am sick of explaining 
that it provides millions of women with birth control, cancer 
screenings, and STI tests every year. I am sick of pointing out, again 
and again, that Federal dollars do not fund abortion services at 
Planned Parenthood or anywhere else. Women come to the floor, we 
explain, we cite facts, but Republicans would rather base healthcare 
policy on politics than on facts.

[[Page 9627]]

  Speaker Ryan called this mean bill pro-life, but this is just the 
biggest political play of all. Calling something pro-life will not keep 
women from dying in back-alley abortions. It will not help women pay 
for the cancer screenings that could save their lives. It will not help 
them take care of their families, have safe sex, or afford their 
medical bills. The pro-life label is the Republicans playing politics 
with women's lives.
  Let's be blunt. The Republican bill will make it more likely--not 
less likely--that women and their children will die. Women aren't 
fools. We can feel the difference. We can tell the difference between 
reality and lies, and that is why we are here today. That is why we are 
fighting back on the Senate floor today.
  Right now, 13 Senators--all men--are sitting in a room writing 
revisions to the secret Republican bill. These 13 men will not show us 
the bill and will not hold hearings on its contents. Just in case 
anyone missed the point, please note that all 13 of these men have 
already voted during their time in the Senate to reduce women's access 
to contraception and abortion. Republicans have told the press that 
Americans shouldn't worry about the fact that women are shut out 
because ``reduc[ing]'' the 13 men to their gender is a ``game . . . of 
identity politics.''
  This is not identity politics, and it is certainly not a game. This 
bill will affect every woman in this country, and we know what is going 
on behind closed doors: 13 men are trading away women's healthcare for 
tax cuts for the rich.
  American women deserve better than this mean Republican bill, and 
American women are here to fight back.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. CRAPO. Mr. President, I ask unanimous consent to speak 5 minutes 
before the vote.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                   Nomination of Marshall Billingslea

  Mr. CRAPO. Mr. President, I rise in support of Mr. Marshall 
Billingslea, who has been nominated to serve as Assistant Secretary of 
the Treasury for Terrorist Financing.
  Mr. Billingslea proved at his nomination hearing before the Banking 
Committee that he is exceptionally qualified for this job. As Assistant 
Secretary for Terrorist Financing, Mr. Billingslea would be in charge 
of coordinating Treasury's efforts on terrorist financing, anti-money 
laundering, and other illicit financial threats to the domestic and 
international financial system.
  Mr. Billingslea would work with the entire national security and law 
enforcement communities, the private sector, foreign governments, and 
other entities to carry out this mission.
  As demonstrated at his confirmation hearing, his unique background 
includes 22 years of experience working with these entities to protect 
the Nation, and it also includes time in the legislative and executive 
branches, as well as the private sector. After 9/11, Mr. Billingslea 
served in senior positions in the Department of Defense and NATO. Prior 
to that, he worked on national security affairs at the Senate Foreign 
Relations Committee, where he drafted numerous pieces of sections of 
legislation intended to combat weapons of mass destruction and disrupt 
terrorist networks.
  Mr. Billingslea's qualifications and capabilities were affirmed when 
he received bipartisan support from the Banking Committee in a 19-to-4 
vote.
  Before we proceed to the cloture vote on Mr. Billingslea, we will 
have a final vote on Ms. Sigal Mandelker's nomination to be Under 
Secretary of the Treasury for Terrorism and Financial Crimes, which I 
spoke about yesterday.
  These two positions are critically important to defending our Nation 
from threats and securing our interests. As Assistant Secretary, Mr. 
Billingslea would work closely with Ms. Mandelker as head of the policy 
and outreach apparatus for the Office of Terrorism and Financial 
Intelligence, which Ms. Mandelker would lead.
  As we saw with the Senate passage of the Iran sanctions bill and our 
Russia sanctions amendment last week, there is strong bipartisan 
support in Congress to remain strong against these Nations. As with the 
passage of that bill, I urge my colleagues to confirm Ms. Mandelker and 
to move forward with Mr. Billingslea's nomination so they can carry out 
the important work for which we have already shown such strong 
bipartisan support.
  Thank you. I yield the floor.
  The PRESIDING OFFICER. Under the previous order, the question is, 
Will the Senate advise and consent to the Mandelker nomination?
  Mr. STRANGE. 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 senior assistant legislative clerk called the roll.
  The result was announced--yeas 96, nays 4, as follows:

                      [Rollcall Vote No. 150 Ex.]

                                YEAS--96

     Alexander
     Baldwin
     Barrasso
     Bennet
     Blumenthal
     Blunt
     Boozman
     Brown
     Burr
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Cassidy
     Cochran
     Collins
     Coons
     Corker
     Cornyn
     Cortez Masto
     Cotton
     Crapo
     Cruz
     Daines
     Donnelly
     Duckworth
     Durbin
     Enzi
     Ernst
     Feinstein
     Fischer
     Flake
     Franken
     Gardner
     Graham
     Grassley
     Hassan
     Hatch
     Heinrich
     Heitkamp
     Heller
     Hirono
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kaine
     Kennedy
     King
     Klobuchar
     Lankford
     Leahy
     Lee
     Manchin
     Markey
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Paul
     Perdue
     Peters
     Portman
     Reed
     Risch
     Roberts
     Rounds
     Rubio
     Sanders
     Sasse
     Schatz
     Schumer
     Scott
     Shaheen
     Shelby
     Stabenow
     Strange
     Sullivan
     Tester
     Thune
     Tillis
     Toomey
     Udall
     Van Hollen
     Warner
     Whitehouse
     Wicker
     Wyden
     Young

                                NAYS--4

     Booker
     Gillibrand
     Harris
     Warren
  The nomination was confirmed.
  The PRESIDING OFFICER (Mr. Lee). The majority leader.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the motion 
to reconsider be considered made and laid upon the table and the 
President be immediately notified of the Senate's action.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.

                          ____________________