[Congressional Record (Bound Edition), Volume 163 (2017), Part 7]
[Senate]
[Pages 9865-9872]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           EXECUTIVE SESSION

                                 ______
                                 

                           EXECUTIVE CALENDAR

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to executive session to resume consideration of the following 
nomination, which the clerk will report.
  The senior assistant legislative clerk read the nomination of 
Kristine L. Svinicki, of Virginia, to be a Member of the Nuclear 
Regulatory Commission for the term of five years expiring June 30, 
2022.
  Mr. McCONNELL. Madam President, 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. SCHUMER. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                   Recognition of the Minority Leader

  The PRESIDING OFFICER. The Democratic leader is recognized.


                         Healthcare Legislation

  Mr. SCHUMER. Madam President, this week, the eyes of the American 
people should be and are on the Senate. The Republican majority 
endeavors to pass a massive remake of our Nation's healthcare system 
with the votes of only one party and the ideas of only one wing of one 
party in just 4 short days.
  The Republican majority kept their healthcare bill shrouded in 
darkness for as long as possible, only dragging it into the light last 
Thursday morning after it was forced to because there was so much 
outcry over the secrecy. That was only a week before it was set for a 
vote. There are still no hearings and no opportunity for a robust 
discussion of amendments. Just a few hours ago, they released a revised 
version, which, at the moment, is what we will apparently consider on 
the floor.

[[Page 9866]]

  There is a reason my Republican colleagues labored in secret. There 
is a reason they forsook the committee process and regular order and 
open debate. There is a reason they want to jam this bill through in 
just 1 week. They are ashamed of their bill. Now that we have seen it, 
we finally know why.
  The Republican healthcare bill--this new TrumpCare--unwinds the 
healthcare protections and programs that are designed to help the 
Americans who need it the most in order to give a tax break to the 
Americans who need it the least.
  The bill would gut Medicaid, making it harder for families with a 
loved one in a nursing home or for families with a disabled child to 
afford his care, so that they can give a massive tax cut to the 
wealthy.
  This bill would defund Planned Parenthood, making it harder for 
millions of women to obtain care, so that they can give people who make 
over $1 million a $57,000 tax cut, on average.
  The bill would slash tax credits, which help families afford health 
insurance, in order to give a nearly $1 trillion tax cut to the 
wealthiest Americans.
  The bill would also punish any Americans who experience a gap in 
coverage, locking them out of health insurance for 6 months. Every 
year, tens of millions of Americans have a gap in coverage through no 
fault of their own. Some lose their jobs, and others have temporary 
financial problems. It is inhumane to say to those Americans: You now 
have to wait an additional 6 months without insurance.
  Imagine someone who is struggling with cancer, and he has a lapse in 
coverage. The 6-month wait this Republican penalty imposes could well 
become a death sentence.
  That is why Republicans are ashamed of this bill--it carries a 
staggering human cost. You do not have to take my word for it; the 
bipartisan National Association of Medicaid Directors came out today in 
opposition to the bill, saying it would ``divert critical resources 
away from what we know is working today,'' particularly for opioid 
treatment.
  Madam President, I ask unanimous consent that their statement be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  [From the National Association of Medicaid Directors, June 26, 2017]

Consensus Statement From the National Association of Medicaid Directors 
(NAMD) Board of Directors on the Better Care Reconciliation Act of 2017

       Washington, DC.--The following statement represents the 
     unanimous views of the National Association of Medicaid 
     Directors (NAMD) Board of Directors. NAMD is a bipartisan, 
     nonprofit, professional organization representing leaders of 
     state Medicaid agencies across the country.
       Medicaid is a successful, efficient, and cost-effective 
     federal-state partnership. It has a record of innovation and 
     improvement of outcomes for the nation's most vulnerable 
     citizens.
       Medicaid plays a prominent role in the provision of long-
     term services and supports for the nation's elderly and 
     disabled populations, as well as behavioral health services, 
     including comprehensive and effective treatment for 
     individuals struggling with opioid dependency.
       Medicaid is complex and therefore demands thoughtful and 
     deliberate discussion about how to improve it.
       Medicaid Directors have long advocated for meaningful 
     reform of the program. States continue to innovate with the 
     tools they have, but federal changes are necessary to improve 
     effectiveness and efficiency of the program. However, these 
     changes must be made thoughtfully and deliberately to ensure 
     the continued provision of quality, cost-effective care.
       Medicaid Directors have asked for, and are appreciative of, 
     improved working relationships with HHS and are working hard 
     to streamline and improve the administration of the program. 
     The Senate bill does formalize several critical 
     administrative and regulatory improvements, such as giving 
     Medicaid Directors a seat at the table in the development of 
     regulations that impact how the program is run, and the 
     pathway to permanency for certain waiver programs. However, 
     no amount of administrative or regulatory flexibility can 
     compensate for the federal spending reductions that would 
     occur as a result of this bill.
       Changes in the federal responsibility for financing the 
     program must be accompanied by clearly articulated statutory 
     changes to Medicaid to enable states to operate effectively 
     under a cap. The Senate bill does not accomplish that. It 
     would be a transfer of risk, responsibility, and cost to the 
     states of historic proportions.
       While NAMD does not have consensus on the mandatory 
     conversion of Medicaid financing to a per capita cap or block 
     grant, the per capita cap growth rates for Medicaid in the 
     Senate bill are insufficient and unworkable.
       Medicaid--or other forms of comprehensive, accessible and 
     affordable health coverage--in coordination with public 
     health and law enforcement entities, is the most 
     comprehensive and effective way address the opioid epidemic 
     in this country. Earmarking funding for grants for the 
     exclusive purpose of treating addiction, in the absence of 
     preventative medical and behavioral health coverage, is 
     likely to be ineffective in solving the problem and would 
     divert critical resources away from what we know is working 
     today.
       Medicaid Directors recommend prioritizing the stabilization 
     of marketplace coverage. Medicaid reform should be undertaken 
     when it can be accomplished thoughtfully and deliberately.

  Mr. SCHUMER. Madam President, the nonpartisan American Medical 
Association--a conservative organization--came out today in opposition 
to the bill, saying it ``will expose low and middle income patients to 
higher costs and greater difficulty in affording care.''
  I ask unanimous consent that their letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 American Medical Association,

                                       Chicago, IL, June 26, 2017.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Charles Schumer,
     Minority Leader, U.S. Senate,
     Washington, DC.
       Dear Majority Leader McConnell and Leader Schumer: On 
     behalf of the physician and medical student members of the 
     American Medical Association (AMA), I am writing to express 
     our opposition to the discussion draft of the ``Better Care 
     Reconciliation Act'' released on June 22, 2017. Medicine has 
     long operated under the precept of Primum non nocere, or 
     ``first, do no harm.'' The draft legislation violates that 
     standard on many levels.
       In our January 3, 2017 letter to you, and in subsequent 
     communications, we have consistently urged that the Senate, 
     in developing proposals to replace portions of the current 
     law, pay special attention to ensure that individuals 
     currently covered do not lose access to affordable, quality 
     health insurance coverage. In addition, we have advocated for 
     the sufficient funding of Medicaid and other safety net 
     programs and urged steps to promote stability in the 
     individual market.
       Though we await additional analysis of the proposal, it 
     seems highly likely that a combination of smaller subsidies 
     resulting from lower benchmarks and the increased likelihood 
     of waivers of important protections such as required 
     benefits, actuarial value standards, and out of pocket 
     spending limits will expose low and middle income patients to 
     higher costs and greater difficulty in affording care.
       The AMA is particularly concerned with proposals to convert 
     the Medicaid program into a system that limits the federal 
     obligation to care for needy patients to a predetermined 
     formula based on per-capita-caps. At the recently concluded 
     Annual Meeting of the AMA House of Delegates, representatives 
     of more than 190 state and national specialty medical 
     associations spoke strongly in opposition to such proposals. 
     Per-capita-caps fail to take into account unanticipated costs 
     of new medical innovations or the fiscal impact of public 
     health epidemics, such as the crisis of opioid abuse 
     currently ravaging our nation. The Senate proposal to 
     artificially limit the growth of Medicaid expenditures below 
     even the rate of medical inflation threatens to limit states' 
     ability to address the health care needs of their most 
     vulnerable citizens. It would be a serious mistake to lock 
     into place another arbitrary and unsustainable formula that 
     will be extremely difficult and costly to fix.
       We are also concerned with other provisions of the 
     legislation beyond those directly affecting insurance 
     coverage. The Affordable Care Act's Prevention and Public 
     Health Fund was, according to the Department of Health and 
     Human Services, established to ``provide expanded and 
     sustained national investments in prevention and public 
     health, to improve health outcomes, and to enhance health 
     care quality.'' These activities are key to controlling 
     health care costs and the elimination of support for them 
     runs counter to the goal of improving the health care system. 
     We also continue to oppose Congressionally-mandated 
     restrictions on where lower income women (and men) may 
     receive otherwise covered health care services--in this case 
     the prohibition on individuals using their Medicaid coverage 
     at clinics operated by Planned Parenthood. These provisions

[[Page 9867]]

     violate longstanding AMA policy on patients' freedom to 
     choose their providers and physicians' freedom to practice in 
     the setting of their choice.
       We do appreciate the inclusion of several provisions 
     designed to bring short term stability to the individual 
     market, including the extension of cost sharing reductions 
     payments. We urge, however, that these provisions serve as 
     the basis of Senate efforts to improve the ACA and ensure 
     that quality, affordable health insurance coverage is within 
     reach of all Americans.
       We sincerely hope that the Senate will take this 
     opportunity to change the course of the current debate and 
     work to fix problems with the current system. We believe that 
     Congress should be working to increase the number of 
     Americans with access to quality, affordable health insurance 
     instead of pursuing policies that have the opposite effect, 
     and we renew our commitment to work with you in that 
     endeavor.
           Sincerely,
                                              James L. Madara, MD.

  Mr. SCHUMER. Madam President, even several Republican Senators are 
expressing concerns.
  Republican Senator Heller said: ``The bill doesn't protect the most 
vulnerable Nevadans--the elderly, Nevadans struggling with mental 
health issues, substance abuse, and people with disabilities.''
  He continued: ``The goal of healthcare reform should be to lower 
costs here in Nevada, and I'm not confident--not confident--it will 
achieve that goal.''
  Republican Senator Susan Collins said about the bill: ``I'm very 
concerned about the cost of insurance for older people with serious 
chronic illnesses, and the impact of the Medicaid cuts on our state 
governments, the most vulnerable people in our society, and health care 
providers such as our rural hospitals and nursing homes.''
  Even my friend the junior Republican Senator from Texas said that 
under this bill, ``premiums would continue to rise.''
  My Republican friends are right to have these concerns. The bill will 
not lower costs for working families. It will leave the most vulnerable 
Americans out in the cold, devastate rural areas, and set us even 
further back in combating the opioid epidemic.
  This week, the Senate will witness a political exercise in that the 
majority leader will attempt to coerce the votes of these Senators and 
any other holdouts by adjusting the dials on the legislation a bit. 
There will be buyouts and bailouts and small tweaks that will be hailed 
as ``fixes'' by the other side.
  The truth is that the Republicans cannot excise the rotten core at 
the center of their healthcare bill. No matter what tweaks they add, no 
matter how the bill changes around the edges, it is fundamentally 
flawed at the center. No matter what last-minute amendments are 
offered, this bill will force millions of Americans to spend more of 
their paychecks on healthcare in order to receive fewer benefits simply 
so that the wealthiest Americans can pay less in taxes. That is why our 
Republican colleagues are ashamed of this bill and are rushing it 
through in 4 short days.
  Before we vote on the motion to proceed, I would ask my Republican 
friends to do one simple thing: Reflect on how this bill would impact 
your constituents. We are all sent here to serve the people of our 
States--to do right by them, to ease their burdens where possible and 
make sure our laws reflect a country that gives everyone an equal 
opportunity to succeed. The first rule of medicine is ``do no harm.'' 
So it should be with government. So it should be with this healthcare 
bill.
  But this bill will harm the middle-class family with a parent in a 
nursing home. It will harm the father whose son is struggling with 
opioid addiction and who is having trouble finding the money to put him 
through treatment. It will harm the child born with a preexisting 
condition, who may hit the lifetime cap on healthcare coverage before 
he or she even enters kindergarten.
  As the American Medical Association said today, this bill violates 
the ``do no harm'' standard on many levels. I believe my friends and 
colleagues on the other side of the aisle are men and women of good 
conscience. I would ask that they think with their conscience before 
they vote on the motion to proceed on Wednesday.
  Any bill that does this much harm to the American people ought to 
receive a ``no'' vote.


                            Russia Sanctions

  Finally, Madam President, I have a word on Russia sanctions. 
President Trump has spent the last few days firing off tweets that 
point fingers at President Obama's handling of Russia's interference in 
our election. It is good that the President has finally acknowledged--
albeit implicitly--that Russia interfered in our election, something 
that the intelligence community has long agreed upon.
  Let me give the President some heartfelt advice. Mr. President, you 
have to stop the name-calling, finger-pointing, and deflection when it 
comes to something as serious as Russia's meddling in our democracy. 
This is very, very serious stuff.
  Whatever President Trump thinks of President Obama's actions during 
the election is moot. Mr. Trump is now President, not Barack Obama, and 
the Russian threat is still there. If President Trump is concerned by 
Russian interference in our election, he can step up to the plate and 
try to stop it. Blaming Obama is not going to solve the problem, even 
though that blame may be wrongly placed.
  The best thing President Trump can do is to support the Russia 
sanctions bill the Senate passed 2 weeks ago by an overwhelming, 
bipartisan, 98-to-2 vote--a bill that is currently languishing at the 
clerk's desk in the House, at what appears to be, at least, the request 
of the White House.
  It would be unconscionable--unconscionable--to let sanctions stay 
where they are or, worse, to weaken them, when Russia has interfered 
with the wellsprings of our democracy and, if not punished, will likely 
do so again.
  If President Trump doesn't support the bill and tries to block it or 
water it down, Americans are going to be asking: What is his 
motivation? What is the reason President Trump is afraid to sanction 
Russia after they interfered in our elections? The American people are 
going to ask a lot of questions.
  I would advise the President to stop casting blame and step up to 
protect the vital interests of this country, to get tough on Russia, 
get serious about safeguarding our elections, and tell Speaker Ryan to 
pass our Russia sanctions bill so that President Trump can sign it.
  Otherwise, President Trump is going to be in an even deeper hole with 
the public on the matter of Russia.
  Thank you, Madam President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. LEAHY. Madam President, I thank the distinguished Democratic 
leader for his comments. I ascribe to them.


                    Trump Administration Cuba Policy

  Madam President, on June 16, in a campaign-style speech glorifying 
the failed Bay of Pigs invasion of Cuba in 1961, President Trump spoke 
of freedom and democracy for the Cuban people.
  Those are goals every one of us in this body shares, not only for the 
people of Cuba but for people everywhere. But the hypocrisy of the 
President's remarks in Miami, where he announced his decision to roll 
back engagement between the United States of America and Cuba, was 
glaring, if not surprising.
  This is a President who has praised, feted, and offered aid and 
weapons to some of the world's most brutal despots. A President who, 
when he was in Saudi Arabia, never uttered the words ``freedom'' or 
``democracy'' or ``women's rights.'' In fact, he said he did not 
believe in lecturing other governments about such things. Freedom House 
ranks Saudi Arabia as less free than Cuba.
  This is a President who welcomed at the White House President 
Erdogan, who has imprisoned tens of thousands of teachers, journalists, 
and civil servants as he dismantles the institutions of secular 
democracy in Turkey.
  President Trump praised Philippine President Duterte, who brags of 
committing murder and who defends a policy of summarily executing, 
without any legal process, thousands of suspected petty drug users.

[[Page 9868]]

  President Trump says he admires President Putin, and he acts like a 
soulmate to President El-Sisi, both of whom show no reluctance to order 
the imprisonment and, in Russia, even the assassination, of critics of 
their autocratic rule.
  Despite all of this--praising these tyrants around the world--
President Trump has decided to make a point of going after tiny Cuba, 
whose government, for all its faults, doesn't hold a candle to these 
other autocracies.
  If the hypocrisy were not enough, it gets a whole lot worse, because 
in doing so he is trampling on the rights of Americans--of the 
Presiding Officer, of me, and of everybody else in this country.
  I wonder how many, if any, Members of Congress have read the details 
of the President's announcement in Miami, other than the couple of 
Cuban-American Members of Congress--neither one of whom has ever set 
foot in Cuba--even though it is only a few miles off our coast. They 
publicly took credit for writing the new White House policy.
  Now, that, in and of itself, speaks volumes about the 
administration's so-called policy review. That turned out to be largely 
a sham. Apparently, every Federal agency recommended continuing down 
the path of engagement begun by President Obama, as did the U.S. 
business community and the rapidly growing number of private Cuban 
entrepreneurs who are benefiting from U.S. engagement.
  It is especially ironic that those hard-working Cubans and private 
American citizens are the ones who will be hurt by this change in 
policy. Instead, the President decided to toss a political favor to a 
tiny minority of the President's supporters in Miami.
  Now, the President's party has long claimed to be a party devoted to 
individual freedom, as we all should be. But let me give my colleagues 
a few examples of what his policy means for the freedom of individual 
Americans.
  First, remember that Americans can travel freely to any of the other 
countries I have mentioned, despite the repressive policies of their 
governments. Americans can travel to Saudi Arabia, the Philippines, 
Turkey, and Egypt, as well as to Iran, Vietnam, and China. We can go to 
any of those countries without restriction.
  Of course, Americans can travel freely to Russia, Cuba's former 
patron. I would note that Russia is now investing heavily in Cuba's 
transport sector and, taking advantage of the fact that we are turning 
our back on Cuba, they are seeking a military base there. And Americans 
can travel freely to the dictatorship of Venezuela, Cuba's source of 
cheap oil. In fact, Americans can travel freely to any country they 
want, provided that country will let them in, no matter how 
undemocratic, no matter how tyrannical, no matter how repressive. 
Apparently, President Trump could care less about that. But not to 
Cuba, whose people have far more in common with us than those of any of 
the other countries I named.
  No, President Trump says you can go to Iran, you can go to Vietnam, 
you can go to Russia, you can go to Turkey, and you can go to Saudi 
Arabia. You can go anywhere you want, but you can only go to Cuba under 
conditions that the White House and bureaucrats in the Treasury 
Department, who have never been to Cuba, permit.
  Rather than make your own decision about where to take your family 
for a vacation or to experience a foreign culture, the White House will 
make that decision for you.
  You must be a part of an organized group, and the purpose of your 
trip must fit within 1 of 12 licensing categories determined by 
bureaucrats at the Treasury Department. I suspect they have never been 
to Cuba.
  You must have a designated chaperone to verify that, Heaven forbid, 
you do not stray from the program submitted to and approved--you hope--
by the Treasury Department, whose employees and bureaucrats you have 
never met. If your application is interminably delayed or denied--for 
whatever reason--you are out of luck. There is no appeal.
  Now, that is how the White House says that Cuba will become a 
democracy. By curtailing the freedom of Americans to travel and spend 
their hard earned money there. By behaving the way we would expect of a 
communist dictatorship--not of the world's oldest democracy, where the 
government's job is to protect individual freedom, not trample on it. 
The example we set for Cuba is by trampling on the rights of our own 
people.
  How well did restricting travel by Americans to Cuba work from 1961 
until 2014, when President Obama relaxed those Cold War restrictions, 
decades after the Russians had abandoned the island and Cuba no longer 
posed any threat to us? It failed miserably. At the same time, it 
treated the Cuban and American people as pawns in a political game.
  Throughout those many years, the Castro government had a ready excuse 
for its own failings and repressive policies. They could blame it on 
the United States, and for many years, the Cuban people believed it 
because we, with our embargo, wouldn't let Americans travel to Cuba or 
do business there. But with the possible exception of the Pope, I don't 
think any foreigner has been received as warmly or engendered as much 
hope for the future as President Obama did when he and First Lady 
Michelle Obama visited Havana. It was amazing to watch the reaction of 
the people in Cuba.
  President Trump claims President Obama got a bad deal when our flag 
went up at the U.S. Embassy a little less than 2 years ago, after more 
than half a century. But President Trump has yet to say what the deal 
he believes he could obtain would look like. His so-called deal could 
be described in one word, ``capitulation,'' which hasn't worked for 
over 50 years.
  The White House decries the decrepit Cuban military's role in the 
economy, as if it poses a threat to us or is somehow an aberration. 
They should look at the role of Egypt's military and Russia's and 
Indonesia's and Pakistan's. They have their hands in all kinds of 
business and real estate ventures.
  They point out the number of people arrested in Cuba has increased. I 
have condemned the arrests of peaceful protesters. These arrests are 
wrong, but they are also wrong in the countries whose repressive 
governments the President has praised, some of which he regards as 
close allies of the United States.
  Now, like Americans, the Cuban people know that fundamental change 
will not happen quickly and that the revolutionaries who overthrew one 
dictator only to be replaced by another will hold on to power while 
they can. But they also know that their time is ending, that Cuba is 
changing, and that the American people can support them best by 
engaging with them.
  Secretary of State Tillerson says the administration is ``motivated 
by the conviction that the more we engage with other nations on issues 
of security and prosperity, the more we will have opportunities to 
shape the human rights conditions in those nations.'' Apparently, this 
administration should have added: ``except for Cuba.''
  On May 25, Senator Flake and I, along with 53 Democratic and 
Republican cosponsors, introduced the Freedom for Americans to Travel 
to Cuba Act. It is, frankly, absurd that such legislation is even 
necessary to restore the American people's freedom to travel that the 
Federal Government should never have taken away.
  Fifty-five Senators of both parties are on record in support of doing 
away with the restrictions in law that even President Obama could not 
fix; and, frankly, if there is a vote on this bill, it will pass 
overwhelmingly. I hope the majority leader will strike a blow for 
democracy and actually let us have that vote so we can show the Cuban 
people what real democracy looks like when people are allowed to vote.
  We support freedom not only for the people of Cuba, we support it for 
the American people because we reject the idea that any government 
should deny its citizens the right to travel freely, least of all our 
own government. We actually believe Secretary Tillerson's rhetoric. We 
believe that restoring the punitive policy of the past is little

[[Page 9869]]

more than a misguided act of vengeance rooted in a half-century-old 
family feud that will do nothing to bring freedom to Cuba.
  Who do we see now coming to Cuba to build a railroad? The Russians. 
Who do we see as we turn our back on Cuba planning to invest there? The 
Chinese. Let's not repeat the mistake we made for 50 years.
  The Cuban people and the American people want closer relations. Every 
single poll shows that. I wish President Trump would listen to the 
American people rather than to a tiny minority who want to turn back 
the clock.
  If we really care about freedom in Cuba, we should flood Cuba with 
American visitors and make it possible for American farmers and 
American companies to compete there as they would in any other country.
  If we really care about freedom, our government should stop playing 
Big Brother with the lives of Americans. It doesn't work. It has never 
worked. Frankly, it is wrong.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Moran). The Senator from Rhode Island.


                         Healthcare Legislation

  Mr. REED. Mr. President, I come to the Senate floor, once again, to 
urge my colleagues to work in a bipartisan, transparent fashion to 
improve our healthcare system and help bring down costs.
  Over the weekend, members of the American Medical Association--the 
Nation's largest organization of doctors--had a chance to finally read 
the proposed Republican bill and found it violates their ``do no harm'' 
principle. According to a letter they wrote to Leaders McConnell and 
Schumer, ``Medicine has long operated under the precept of Primum non 
nocere, or, `first do no harm.' The draft legislation violates that 
standard on many levels.''
  That is the conclusion of the American Medical Association, and they 
are correct. This bill will not lower costs, and it will not improve 
our healthcare system. Instead, it will remove health insurance 
coverage for millions of Americans. Indeed, the CBO has just released 
their estimate that 22 million Americans will lose their health 
insurance coverage. It will increase costs for everyone and decimate 
State budgets, creating a ripple effect throughout our economy.
  The bill my colleagues worked in secret to craft is, in a sense, a 
sham. It will not lower costs, and it will not improve our healthcare 
system, as they insist. Instead, it will remove health insurance 
coverage for millions of Americans--22 million, according to the CBO--
increase costs for everyone, as I said, and decimate State budgets. In 
fact, their bill essentially is a huge tax cut for the wealthiest 2 
percent of Americans at the expense of everyone else.
  If you need any further proof of the real driver of this bill, one of 
its biggest giveaways is a retroactive tax break on investment income 
for people making at least a quarter of a million dollars. Dozens of 
leading economists, including six Nobel laureates, have criticized this 
plan as, in their words, a ``giant step in the wrong direction'' that 
prioritizes tax breaks averaging $200,000 annually per household in the 
top 0.1 percent of Americans over the well-being of working families. 
In fact, President Trump himself will get an estimated $2 million tax 
break each year from the giveaways in this bill. Let's call this bill 
what it is: a massive giveaway to the wealthiest Americans. Meanwhile, 
the rest of the country--all of our constituents--will be the ones 
paying the price for these tax breaks for those well-off. So much for 
the President's claim that he would end a rigged system.
  Now, how do Republicans pay for these tax breaks? For starters, they 
are proposing to end the Medicaid expansion under the Affordable Care 
Act, which is providing health insurance to nearly 15 million 
Americans, but then they go even further by effectively block-granting 
Medicaid, cutting hundreds of billions of dollars from the program over 
the next decade. These are not reforms designed to lower costs. This is 
a cut, pure and simple, which will sharply curtail and eliminate needed 
healthcare services to many across this country. In fact, the Center on 
Budget Policies and Priorities published data that shows a stark 
contrast of who gains and who loses under this bill. The 400 households 
in the country with the highest incomes will get tax breaks totaling 
$33 billion because of the Senate TrumpCare bill. As a result, over 
725,000 Americans will lose Medicaid coverage in just four States to 
equate to that $33 billion: Alaska, Arkansas, Nevada, and West 
Virginia. That doesn't even scratch the surface as to who will lose 
access to care in the remaining 46 States.
  Medicaid has played a critical role in ensuring access to care for 
millions of Americans, including children, seniors, and people with 
disabilities. In fact, across the country, and in my home State of 
Rhode Island, about half of all Medicaid funding is spent on nursing 
home care. Over 60 percent of nursing home residents access care 
through Medicaid. If you think nursing home care will be protected, you 
are in for a rude awakening because the math just doesn't work. It will 
be impossible to cut Federal funding for State Medicaid programs by 
hundreds of billions of dollars and not impact the most significant 
Medicaid expenditures, which are nursing homes.
  I would also like to talk about the role Medicaid plays in 
emergencies like a recession or public health crisis. We know all too 
well how an economic downturn impacts communities. With job loss, comes 
loss of health insurance, pensions, and other benefits. The tax base 
shrinks, and State budgets suffer. Medicaid, as currently structured, 
is able to adapt to this. As the need increases, the program grows to 
cover everyone who is eligible, including those who have just lost 
jobs. This saves families from having to choose whether to take their 
kids to the doctor or put food on the table.
  Under the Senate TrumpCare bill, States will be hamstrung by 
arbitrary caps and limits on Medicaid. In fact, States will be unable 
to expand coverage during a recession to those in need, and they will 
likely have to make cuts across the board, from healthcare and 
education to transportation infrastructure, to make up for the lost tax 
revenues. This is not strictly going to be an issue of healthcare 
policy in States. The cuts are so dramatic that after they have taken 
all they can from other healthcare programs, they will inevitably go to 
education funding--the biggest expense most States have--and then to 
transportation and then to public safety. Even then, I don't think they 
can keep up with these cuts.
  Like most of the country, Rhode Island was hard hit by the recession. 
It took many years for the economy to even begin to turn around in the 
right direction. It seemed my colleagues are forgetting how Medicaid 
has been a critical safety net through tough economic times.
  I am also concerned that my colleagues are not aware of the impact 
Medicaid has on our Nation's veterans. The uninsured rate among 
veterans has dropped by 40 percent since implementation of the 
Affordable Care Act. Nationwide, nearly 1 in 10 veterans is covered by 
Medicaid, including approximately 8,000 veterans in my home State of 
Rhode Island. The cuts to Medicaid that have been proposed by my 
Republican colleagues put the care of our veterans at risk. We have all 
promised to provide the best care possible to our brave men and women 
when they leave the service, but the Senate TrumpCare bill would do the 
opposite.
  That is not the only way this bill would damage veterans' care. Many 
veterans seek help for mental health care by going outside of the VA 
system. TrumpCare puts mental health and substance abuse treatment at 
risk by saying insurance companies no longer need to cover these 
services. For the over 15,000 veterans in Rhode Island who access 
mental and behavioral healthcare outside of the VA, they would be out 
of luck. For all the bipartisan work in this Chamber to increase 
veterans' access to these services, it would all be for naught if 
Senate Republicans pass their TrumpCare bill.

[[Page 9870]]

  These are just some of the things Republicans are sacrificing in the 
name of tax breaks for the wealthy. It is, frankly, unconscionable. 
More importantly, this will not be lost on the American people. I have 
heard from thousands of my constituents since the beginning of this 
year, and if Senate Republicans press forward with this legislation, I 
think we will all hear from many more of these constituents for many 
years to come.
  TrumpCare is fundamentally flawed and cannot be fixed. We would 
welcome the opportunity to work across the aisle on improvements to the 
Affordable Care Act, like those to lower costs, especially prescription 
drug costs, any time.
  I, once again, urge my colleagues to drop their efforts and to work 
with us to instead make improvements to the ACA.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON. Mr. President, last week, I spoke with a very brave 
mother. She had endured what not one of us ever wants to have to endure 
while she watched her child go through cancer, over and over and over 
again. That mother is Elaine Geller from my State of Florida. I want to 
show you her daughter. This is her daughter Megan. She was working as a 
kindergarten teacher when she was diagnosed with leukemia in 2013 at 
the age of 26. At the time Megan was admitted to the hospital, her 
blood count was four. She had pneumonia, and she had water on her 
heart.
  She ultimately checked into one of the very good cancer centers at 
the University of Miami, and she stayed there for 7 months. She went 
through the regimen of chemo. She spent months in the hospital, 
receiving multiple rounds of chemo, biopsies, and various other 
treatments. Eventually, Megan's doctor told her she had to have a 
transplant, which required a $150,000 upfront payment. I think you see 
where I am going with this story. Very few families would be able to 
afford a 150-grand payment, especially a single mother.
  I heard this story last week from Megan's mother. She said that 
thanks to the Affordable Care Act, she didn't have to write a check for 
the transplant. In fact, she didn't have that money. Because that 
transplant was provided for under the Affordable Care Act coverage, she 
knew that was one worry that could be taken off of her mind. She had 
enough to worry about as a mother, what she should be doing in such a 
situation, and of course she wanted to give all of her attention to her 
daughter.
  The cancer went into remission after the transplant; however, after 
leaving the hospital, 63 days later, the cancer came back. This time, 
they went to MD Anderson Cancer Center in Houston. I asked the mom why 
she wanted to do that. She said: ``When your child is dying, there's 
nothing that you won't do.'' I think all of us as parents can identify 
with that, but we are so very fortunate that we haven't had to go 
through it.
  Maybe, as we get ready to vote on this healthcare bill, on the 
Republican alternative--which, by the way, just came out of CBO today--
the Congressional Budget Office--and they said that if the Senate bill 
were enacted, 22 million people would lose health insurance coverage. 
Remember, that is not too much different from what CBO said when the 
House bill was passed a couple of months ago, the bill to which there 
has been such a negative reaction. CBO said that 23 million people in 
this country would lose their coverage as a result of the House bill. 
We just got the score from CBO minutes ago. Twenty-two million people. 
Is that the direction we want to be going in?
  Megan is still going through treatment, and the cancer was only in 
remission for 32 days before it came back again. Megan received 
multiple blood transfusions. Remember, this is a single mom trying to 
keep her daughter, a schoolteacher in her twenties, alive. This time, 
all of the blood transfusions started to take another toll on Megan. 
She became so weak. When trying to walk, she faltered, she fell, she 
hit her head, and at age 28, she passed away.
  Let's get to the bottom line of this discussion, other than that our 
hearts go out to all the Megans all across America. The bottom line is, 
that whole treatment over 2 years cost $8 million. There was not a cap 
on the total amount of money that could be paid under the existing law, 
the Affordable Care Act. An insurance company cannot put a cap on the 
amount of your medical bills that can be reimbursed. Suppose before the 
ACA that cap was $50,000. This single mom could not even have come up 
with money for the initial transplant, which looked as though it worked 
and did work for several months. In fact, $8 million over time--2 
years--how in the world could any one of us afford that?
  A lot of people say: Well, the ACA isn't doing it. Well, why don't we 
all get together in a bipartisan way and fix it? And one of the fixes 
would be, because certain healthcare problems, like Megan's, cause the 
insurance company to pay out a lot of money--do you know what we can do 
about it? We can create a reinsurance fund, which is a bill that I had 
filed, and it is to reinsure against that catastrophic healthcare 
problem like Megan's of $8 million, to reinsure the insurance company. 
Do you know what that would do in the State of Florida, if we passed 
this as a fix to the ACA? It would lower the premiums in the ACA in 
Florida 13 percent. That is reinsurance.
  It is not unlike what we have done for hurricanes. A catastrophic 
hurricane could cost so much more than the insurance company has assets 
for, and therefore they buy insurance from a company like Lloyd's of 
London or other reinsurance companies. They buy insurance in case of a 
catastrophe--the insurance company does that. If an insurance company 
did not have to pay out this $8 million because it had insured against 
that kind of catastrophic loss, everybody else's premiums are going to 
come down. Otherwise, they have to make premiums actuarially sound, and 
they have to raise them in order to take care of the cases that are 
prohibitively expensive.
  All of this sounds down in the weeds, but the bottom line is this: If 
we want to fix the ACA, we can fix it, but we can't do it one party 
against the other. We have to have the will to come together in a 
bipartisan agreement to fix it.
  Of course, if the mom of this girl had been faced with this without 
insurance coverage, she would be bankrupt. She wouldn't have been able 
to even afford the first transplant, much less the 2 years of extra 
life her daughter had while fighting for her life. Anybody who goes 
through something like Elaine and her daughter Megan did knows that 
every second counts.
  That is what this healthcare debate is about--giving people peace of 
mind, giving them that financial security, that certainty, putting 
people's health ahead of other things, such as company profits. You can 
do it all and solve everybody's problem, including the insurance 
company's, which obviously is in business to make a profit. You can do 
it.
  Elaine said her daughter would be proud to know that we are telling 
that story today. It matters. It matters to her, albeit deceased. It 
certainly matters to her mom. It matters to their Senator. It matters 
to a lot of other people.
  The ACA, the existing law--the one there was such a fractious fight 
over 5 to 7 years ago--is working. Here is a good example. Then we see 
that the aim of our friends on that side of the aisle is--they want to 
repeal it. They don't want anything that has the taint of ObamaCare, 
and so they concoct something in the House. You see what kind of 
greeting that has gotten in the country. I think it was in the upper 
teens--a poll that showed it was viewed favorably. In other words, it 
is viewed very unfavorably.
  In order for the Senate majority leader to come up with something 
that he can repeal ObamaCare with, in the dead of night, in secret--
even the Republican Senators didn't know what it was until they hatched 
it in the public last Friday. This bill is just as bad as the House 
bill.
  They will claim, in trying to stand up this bill--by the way, it is 
going to

[[Page 9871]]

wither, the more it is examined in the glare of the spotlight. They 
claim that it maintains the ACA's protections for those with 
preexisting conditions. Can anybody really say that with a straight 
face? It leaves it up to the States.
  Before I came to Washington and the Senate service, I was the elected 
insurance commissioner, State treasurer of Florida. It was my job to 
regulate the insurance companies--all kinds of insurance companies, 
including health insurance companies. I can tell you that I have seen 
some insurance companies use asthma as a preexisting condition, and 
therefore that was the reason they would not allow the person who 
needed insurance to be covered. They said: If you have a preexisting 
condition, we are not going to insure you. I have even seen insurance 
companies use as an excuse a rash as a preexisting condition, and that 
means they are not going to insure you. Under the existing law, the 
ACA, they can't do that. You are going to have the security of knowing 
you are going to have coverage.
  Do you know something else you are going to have the security of 
knowing? You are not going to deal with some of those insurance 
companies that I regulated. Of your premium dollar for health 
insurance, they would spend 40 percent of that dollar not on your 
healthcare, but they would take 40 cents of that premium dollar that 
you paid and that was going to executive salaries. It was going to 
administrative expenses. It was going to plush trips. Don't tell me 
that is not a true story. I saw it over and over in the 1990s as the 
elected insurance commissioner of Florida.
  You know what the existing law says? It says that of every premium 
dollar you pay, 80 cents of that premium dollar has to go into 
healthcare. It can't be commissions. It can't be executive salaries. It 
can't be the executive jets for the corporate executives. Eighty cents 
of that premium dollar has to go into healthcare so you get what you 
pay for in that premium dollar. At some point there is going to be an 
attempt to undo that. If you start leaving things up to the States, 
watch out.
  When Megan was in the ICU, she had a respiratory failure that cost 
thousands of dollars more, and thanks to the ACA, her insurance carrier 
covered it. But under the Republican bill that has been now released, 
States could let their insurance companies pocket more of those premium 
dollars to pay for those things I just shared, which I had seen back in 
the decade of the 1990s as the insurance commissioner. Well, we 
shouldn't be padding their pockets. The premium dollar for health 
insurance ought to go to healthcare.
  The Senate bill cuts billions in Medicaid. We haven't even talked 
about that. Who gets Medicaid? Millions of people in this country do. 
It is not only the poor. It is not only the disabled. It is 65 to 70 
percent of all seniors in nursing homes who are on Medicaid, and it is 
also some children's programs. Let me just give you one example. I went 
to the neonatal unit at Shands Hospital in Jacksonville, a hospital 
affiliated with the University of Florida, but in Jacksonville. The 
doctors and nurses were showing me how miracles occur for premature 
babies; they keep them alive.
  Then what they wanted to show me was--with the opioid epidemic, which 
has hit my State just like all the other States, they wanted me to see 
and understand that when a pregnant mom is addicted to opioids, she 
passes that on in her womb to her unborn child. When born, that baby is 
opioid-dependent. The doctors showed me the characteristics--that high, 
shrill cry, the constant scratching, the awkward movements. Do you know 
what they use to wean those little babies off opioids over the course 
of a month? They use doses of morphine.
  Do you want to devastate Medicaid? Do you want to take over $800 
billion over 10 years out of Medicaid? What about those single moms? 
The only healthcare they get is Medicaid. And what about those babies I 
just described, who are also on Medicaid? If you start capping the 
amount of money that goes to the States on a Federal-State program for 
healthcare--Medicaid--you are going to throw a lot of people off any 
kind of healthcare, including senior citizens in nursing homes.
  A Medicaid block grant, or a cap, would end the healthcare guarantee 
for millions of children, people with disabilities, pregnant women, and 
seniors on long-term care. There are 37 million children in this 
country who rely on Medicaid for care. The seniors, the poor, the 
disabled, the children--they are all vulnerable to the cuts that would 
occur.
  If that is not enough to vote against this bill that is coming to the 
floor this week, the Senate bill actually imposes an age tax for older 
Americans, allowing insurance companies to charge older Americans up to 
five times more for coverage than a young person. You say: Well, older 
people have more illnesses and ailments; older people ought to cost 
more. If that is your argument, well, that is true.
  The age rating in the existing law, the ACA, is three to one. This 
changes it to five to one, and five to one means one thing: higher 
premiums for senior citizens--I am talking about all insurance 
policies--until they reach that magic age of 65 and can be on Medicare. 
Do you want an age tax on older Americans as a result of this bill? I 
don't think so. But that is what is in there.
  Fixing our Nation's healthcare system shouldn't be a partisan issue. 
That is why I have joined--bipartisan--with colleagues to introduce a 
bill that I described a moment ago, which would lower healthcare 
premiums by 13 percent. That bill would stabilize the ACA's insurance 
marketplace through the creation of a permanent reinsurance fund. I 
have seen the policies work, as I described, with catastrophic 
hurricane insurance. There is nothing magic about my idea. It is just 
an obvious fix to the existing law, and ideas like that can bubble 
forth in a bipartisan way to make the existing law that we have 
sustainable.
  What we ought to be doing is trying to look for ways to help people 
like that single mom Elaine and her daughter Megan. We should be 
working together to make the ACA work better. We shouldn't be plotting 
behind closed doors in the dead of night with a secret document--a 
secret document that we now know will make it worse.
  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. CARPER. 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. CARPER. Mr. President, it is good to see you this afternoon.
  I rise in support of the nomination of Kristine Svinicki to hold a 
third term as a member of the Nuclear Regulatory Commission, known as 
the NRC. Many Senators heard from our chairman on the Environment and 
Public Works Committee in support of this nominee last week, just prior 
to our cloture vote. I want to add my voice in support of her 
nomination as well.
  Since joining the Environment and Public Works Committee, I have 
worked closely with my colleagues to strengthen what we call the 
``culture of safety'' within the U.S. nuclear energy industry. In part, 
due to our collective efforts and the NRC leadership and the 
Commission's dedicated staff, the NRC continues to be the world's gold 
standard for nuclear regulatory agencies. However, as I say time and 
again, that does not mean we can become complacent when it comes to 
nuclear safety and our NRC oversight responsibilities, a perspective 
that I am certain is shared by every Member of this body.
  Ensuring that the Nuclear Regulatory Commission continues to have 
experienced and dedicated leadership is one of the most important 
things that our committee, the Committee on Environment and Public 
Works, and the Senate can do to maintain a high level of safety and 
excellence in our Nation's nuclear facilities.
  I am quite impressed with our NRC Commissioners, and I am encouraged 
with their ability to work cooperatively with each other. Each 
Commissioner, including our current chair,

[[Page 9872]]

Kristine Svinicki--let me say her name again: Svinicki. People have a 
hard time saying her name. It is Svinicki. She brings a unique set of 
skills to the table--something that has served the Commission and our 
country well.
  I continue to have ongoing discussions with our friend, the chairman 
of the committee, Senator John Barrasso, about the strong interest I 
and our minority members of the committee have with ensuring parity, as 
the Senate looks to confirm other nominees to the NRC. This is in order 
to ensure that we have a balance of Democratic and Republican members 
on the Commission for years to come. It continues to be a priority for 
me and our Democratic colleagues.
  At this time, I support moving Chairman Svinicki through the 
confirmation process. I do so out of respect for her long service to 
the NRC and for the need to ensure certainty and predictability within 
the NRC and its leadership. I hope my colleagues will join me in 
supporting her nomination.
  Mr. President, as to this particular nominee, not everybody on the 
committee or probably in the Senate will support the nomination of 
Kristine Svinicki. They could have held her up. No one has, and she has 
moved through our committee expeditiously. She, in my view, should have 
moved through expeditiously and will be coming before us for an up-or-
down vote in a few minutes.


                         Healthcare Legislation

  Mr. President, I want to suggest, as we approach our business later 
this week with respect to healthcare legislation, that maybe the way we 
have handled this nomination might be a little bit of a model for the 
way we can actually work together.
  We need to. People in this country say to me all the time and people 
in my State say to me all the time: Just work together. Get something 
done.
  I know the Presiding Officer and the Senator from West Virginia, who 
has just entered the Chamber, want to work that way, too, and so do I. 
What I think we ought to be doing on healthcare in this body is to look 
at the ACA and study it up and down. God knows we had enough hearings, 
roundtables, opportunities to debate it, vote for it, and amend it--
over 80, I think, or maybe over 400 amendments, all told, and 80-some 
days of working on it in 2009.
  Rather than have legislation that just Democrats or just Republicans 
vote to put on the table and to try to push through here on Thursday, 
my hope is that we will hit the pause button. My hope is that we will 
hit the pause button, and we will focus--Democrats and Republicans--on 
trying to figure out what in the Affordable Care Act needs to be fixed 
and fix it, and figure out what needs to be maintained and preserved 
and preserve it. That is what I think we should do.
  Lo and behold, if we were to do those things, I think we would end up 
with a better healthcare system with better healthcare coverage and 
maybe actually make true of the word of the Presidential nominee, 
Donald Trump, who said he favored healthcare legislation that would 
actually cover everybody and get better results for less money. That is 
not a bad goal for us to shoot for. What I have laid out here just very 
briefly is this: Figure out what needs to be fixed in the Affordable 
Care Act and fix it, figure out what needs to be preserved and preserve 
it, and do it not just as Democrats or Republicans, but do it together. 
I think if we would do that, in the words of Mark Twain, we would 
confound our enemies and amaze our friends.
  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. MANCHIN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  All time has expired.
  The question is, Will the Senate advise and consent to the Svinicki 
nomination?
  Mr. MANCHIN. 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.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Arizona (Mr. Flake), the Senator from Georgia (Mr. 
Isakson), and the Senator from Alabama (Mr. Strange).
  The PRESIDING OFFICER (Mr. Lankford). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 88, nays 9, as follows:

                      [Rollcall Vote No. 154 Ex.]

                                YEAS--88

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

                                NAYS--9

     Booker
     Cortez Masto
     Gillibrand
     Harris
     Heller
     Markey
     Merkley
     Sanders
     Warren

                             NOT VOTING--3

     Flake
     Isakson
     Strange
  The nomination was confirmed.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the motion 
to reconsider with respect to the Svinicki nomination 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.

                          ____________________