[Congressional Record (Bound Edition), Volume 163 (2017), Part 7]
[Senate]
[Pages 9998-10019]
[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 Rao 
nomination, which the clerk will report.
  The senior assistant legislative clerk read the nomination of Neomi 
Rao, of the District of Columbia, to be Administrator of the Office of 
Information and Regulatory Affairs, Office of Management and Budget.


                   Recognition of the Majority Leader

  The PRESIDING OFFICER. The majority leader is recognized.


                         Healthcare Legislation

  Mr. McCONNELL. Mr. President, yesterday, Senate Republicans gathered 
down at the White House for another discussion on the way forward on 
healthcare. We had a productive conversation. I appreciate the 
administration's engagement, and I look forward to more discussions in 
the days that lie ahead.
  We will continue working so that we can bring legislation to the 
floor for debate and, ultimately, a vote. We know that we cannot afford 
to delay on this issue. We have to get this done for the American 
people. That is a sentiment that is widely shared in our conference, 
and I think I speak for everyone in acknowledging, once again, that the 
ObamaCare status quo is unacceptable and that it simply cannot 
continue.
  ObamaCare has caused premiums to increase by an average of 105 
percent in the vast majority of States on the Federal exchange. Next 
year, premiums will again increase across the country--by as much as 43 
percent in Iowa, 59 percent in Maryland, and 80 percent in New Mexico.
  ObamaCare has led to 70 percent of our counties having little or no 
choice of insurance on the exchange this year. Next year, dozens of 
counties are projected to have no choice at all, which could leave 
thousands trapped, forced by law to purchase ObamaCare insurance but 
left without the means to do so. Seven years after Democrats forced 
ObamaCare on our country, these are the painful realities for countless 
families across our country.
  It is unfortunate that our Democratic colleagues have refused to work 
with us in a serious way to comprehensively address ObamaCare's 
failures in the 7 years since they passed it. I regret that they 
continue to demonstrate an unserious attitude about all of this today, 
but it is increasingly clear that ObamaCare's negative trends will only 
get worse, hurting even more Americans all along the way, unless we 
act. This should not be acceptable to anyone.
  Sitting on the sidelines and accepting the status quo will not bring 
help to anyone's constituents. We have the opportunity to provide 
relief to those struggling families, and we should take it. Senators 
will have more opportunities to offer their thoughts as we work toward 
an agreement, and every Member will have the ability to engage in a 
robust debate out here on the Senate floor.
  But, if one thing is clear, it is this: ObamaCare is a direct assault 
on the middle class. It is getting worse, and we have to act to finally 
move beyond its failures.
  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. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Mr. President, the Senate will be going home this week 
for the Fourth of July recess, and most of us will be back in our homes 
with our families and in our hometowns and moving around. I still think 
the topic of conversation is going to be healthcare.
  I think this conversation and debate in Washington has really touched 
a lot of families and businesses and individuals across this country. 
The reason I say that is because about 6 years ago, I voted for the 
Affordable Care Act, what is known as ObamaCare. For the longest time, 
I was sure it was the right vote, and I am still sure today, but I 
wondered why people didn't appreciate it because what we tried to do--
and we achieved some success--was to provide health insurance for a lot 
of people in America who didn't have it. In my State of Illinois, we 
cut the percentage of uninsured people in half because of the 
Affordable Care Act. A large number of them are now covered by 
Medicaid, and a large number are able to buy health insurance through 
private insurance exchanges.
  But for the longest time, when we asked people across America ``What 
about ObamaCare? What about the Affordable Care Act?'' we got mixed 
reviews. Less than a majority supported it.
  Then we embarked on this conversation, this debate in Washington in 
the Senate over the last 6 months, and an interesting thing happened. 
When the Republicans, who are in the majority in the Senate and the 
House, who were determined to repeal ObamaCare, set out to do it, they 
found out it was a big, heavy lift.
  So now, today, we have an interesting thing that has happened. For 
the first time in the last several weeks, a majority of the American 
people support the Affordable Care Act. All of those years after we 
passed it, when we were talking about the good things it did, people 
were skeptical, but when the notion of repealing it came up, people 
started saying: Well, what would I lose if you repealed it? And when 
they

[[Page 9999]]

thought about what they would lose, they decided those things were 
valuable to them personally and to their families. And what were those 
things? Some pretty basic things--first, that you would have access to 
health insurance.
  I have repeatedly told the story of my friend Judy. Judy is in 
hospitality. She works in a motel down in Southern Illinois that I have 
stayed in from time to time. She is a sweetheart of a lady. She is 62 
years old and has had jobs that don't pay a lot of money, but she goes 
to work every day--there is not a lazy bone in her body. She is 62 
years old, and Judy had never had health insurance in her life until we 
passed the Affordable Care Act. Now she qualifies for Medicaid, and 
thank goodness she does because she has been diagnosed with diabetes, 
and she needs a good doctor she can count on, and she needs good 
medical advice.
  So when we said that we were passing the Affordable Care Act so that 
more people would have access to health insurance, it happened.
  We also said we were going to change the health insurance policies 
you buy so that you don't get tricked into buying something that is 
going to provide protection but only enough and not enough when you 
really need it.
  For example, there used to be lifetime limits. People would buy 
health insurance and say: I am going to keep the premium low. I will 
sign up for a lifetime limit. How could I ever need health insurance 
for more than $100,000 a year?
  Well, it is an eye-opener, but there are many diagnoses or accidents 
that could happen to you next week that would cost more than $100,000. 
So a lot of people found themselves facing personal bankruptcy because 
they had a limit on their health insurance policy and faced a cancer 
diagnosis and knew they would have to spend $150,000 or $200,000 for 
the most basic care.
  We also said: When you sell health insurance, you can't discriminate 
against people because of a preexisting condition.
  Well, it turned out that insurance companies defined ``preexisting 
condition'' to include everything, such as acne when you were a 
teenager or asthma--you name it. In fact, they went so far as to say 
that being a woman was a preexisting condition. Some of those things 
made no sense, so we said: That is over. We are not going to let that 
happen anymore.
  One out of three Americans has a preexisting condition. You can't 
discriminate against a person because they are of a family with a child 
who has survived diabetes or is living with diabetes or a spouse who 
survived cancer surgery. So we said that from now on, under the 
Affordable Care Act, when you buy a health insurance policy, it is 
going to cover the basics.
  We did something else that I want to mention because I don't want it 
overlooked. There used to be a Senator who sat back here in the last 
row, in the second seat, named Paul Wellstone of Minnesota. Paul 
Wellstone was a great guy. You couldn't help but love him whatever your 
politics. Over here was Pete Domenici, and he was a conservative 
Republican Senator from New Mexico. Wellstone from Minnesota, Domenici 
from New Mexico--what would those two have in common? What they had in 
common was that each of them had someone in their family with a mental 
illness, and they watched what happened to their loved one in their 
family. The two teamed up and said: From this point forward, when you 
buy health insurance in America, it is not going to be just physical 
health that it is going to cover, it is going to cover mental health as 
well.
  So many families are touched by mental illness, some very serious 
forms, some not so serious but need medical help, and they all should 
be covered. So they put that provision in the Affordable Care Act so 
that now, when you buy a health insurance policy in America, it is not 
hit or miss; it covers mental illness, as it should.
  Then they added a provision that most of us didn't pay attention to, 
and we should, and we do now: mental illness and substance abuse 
treatment. Think of this opioid and heroin epidemic and the people who 
are dying right and left. Think of families who are absolutely consumed 
by the addiction of a child, of a teenager, wondering if they can get 
them into treatment so they can save their lives. For many of them, 
that health insurance plan is paying for that treatment--treatment that 
otherwise would come out of their pocket if they could afford it.
  So we put all of these things into the law, and the law took place, 
and when the Republicans said they were going to repeal it, people 
stood up and said: Wait a minute. I have to face lifetime limits again? 
I have to face preexisting condition prejudice again? I am not going to 
have mental illness covered automatically or maternity care covered 
automatically?
  Well, when people reflected on this, they realized their 
vulnerability. So simple repeal was not enough; the Republicans needed 
to replace. If they were going to eliminate ObamaCare and all the 
people protected by it, they needed to replace, and that is when the 
process fell apart. In the House of Representatives, they went through 
a process of writing the replacement. When it was all over, they didn't 
wait for the Congressional Budget Office to analyze it because they 
knew what was coming. The Congressional Budget Office announced that 
some 23 or 24 million Americans would lose their health insurance 
because of the plan that passed the House of Representatives. They also 
knew that people could again face discrimination based on preexisting 
conditions. They knew basic health insurance didn't include the 
protections all of us really need to count on.
  Do you remember the provision in the Affordable Care Act that said 
your son or daughter could stay on your family health insurance plan 
until you reached the age of 26? It is pretty valuable, isn't it? That 
son or daughter, whom you like a lot and helped get through college, 
doing internships and looking for a job--you wanted to make sure they 
have health insurance, didn't you? That was part of the Affordable Care 
Act, and we want to make sure the guarantee remains in any future 
change of the law too.
  The House of Representatives passed their measure, and, 
unfortunately, it was a partisan roll call; only Republicans voted for 
it. It passed by four votes. If two Republican Congressmen had changed 
their votes, it would not have passed.
  Then the measure came over to the Senate, as we remember from our 
civics lessons, and the Senate had its chance. So what happened? We had 
a chance to take this question to the committees of the U.S. Senate--
Labor and the Health and Education Committee, which is chaired by 
Senator Lamar Alexander, a friend of mine, Republican of Tennessee, and 
the ranking member, Senator Patty Murray of Washington. We had a chance 
to take the bill to the committee and to debate a better approach in 
the Senate, to have public hearings and witnesses. But we didn't do 
that.
  Instead, the Republican majority said: We are going to do this on our 
own. We don't need any Democratic input. Thirteen Republican Senators 
will meet in a room and write the alternative to the House healthcare 
replacement bill, and they did. It went on for weeks, and no one saw 
it. There were no reports of what it included and what was inside of 
it. Then, 6 days ago--6 days ago--it was announced. We took a look at 
it, and it wasn't that much different from what the House had done.
  The Congressional Budget Office released a report on Monday of this 
week and said that 22 million Americans would lose their health 
insurance under the Republican healthcare plan--22 million. And--this 
part was really troubling--there would be a dramatic increase in 
premium costs for people between the ages of 50 and 64. Some of them 
would see increases of up to $8,400 a year in premium costs because of 
the Senate Republican plan.
  What was the reaction of the medical professionals across my State to 
both the House Republican plan and the Senate Republican plan? It was 
the same reaction. They said: Senator, vote against it.

[[Page 10000]]

  The Illinois Hospital Association said that if we cut back on 
Medicaid, hospitals--particularly rural hospitals and downstate 
hospitals--will have to cut back in services and may face closure.
  The doctors in my State, the Illinois State Medical Society, came 
forward and said: Vote against the Senate Republican plan and the House 
Republican plan because we know what happens when people lose health 
insurance. They still get sick. They don't come to see us early on when 
we can prevent things from getting worse; they come to see us when 
things are pretty bad and pretty expensive and pretty dangerous.
  So the doctors opposed it, the nurses opposed it, the pediatricians 
opposed it. Not one single medical advocacy group in Illinois supported 
the Republican bill, which was unveiled 6 days ago.
  When it came to preexisting conditions, it wasn't just the medical 
groups that opposed the Senate bill. The cancer society, the heart 
association, the lung association--most of the major disease groups 
stepped up and said: The preexisting condition provisions in this bill 
are unacceptable, and, sadly, the policies that are going to be sold 
may not cover the basics that people absolutely need.
  Then the other thing came out. What drove this whole debate, what 
started healthcare reform in the House of Representatives and in the 
Senate was not healthcare reform, but a tax cut. You see, the 
Affordable Care Act imposed new taxes, particularly on higher income 
individuals, and the money from those taxes went into sponsoring people 
into Medicaid and helping people pay their health insurance premiums. 
The Republicans in both the House and the Senate said: The first thing 
we will do is cut those taxes--about $700 billion worth of taxes. 
Ultimately, they took $1.1 trillion out of our healthcare system with 
this tax cut and other cuts. When you pull that kind of money out of 
healthcare in America, fewer people have health insurance, fewer people 
have a helping hand when it comes to paying their premiums.
  The reaction to the Senate Republican bill over the last 6 days has 
been growing opposition--growing opposition, until yesterday. Senator 
McConnell announced: We are not going to vote on it this week. We were 
supposed to, but we are not going to vote on it this week. He said that 
he may return to it when we come back from the July 4th recess.
  Here is the point I wanted to make on the floor today. I am glad we 
have reached the point that these proposals from the House and the 
Senate are not going to move forward quickly to become the law of the 
land. Too many people would be hurt--too many innocent people. Too many 
families would lose their health insurance. The cost of health 
insurance would go up dramatically. The premiums would go up, 
particularly for people over the age of 50. We would see hospitals 
facing closure across our States. We would see cutbacks in treatment 
for mental illness and substance abuse. The list goes on and on. It 
would have been a terrible outcome, and certainly doing this in order 
to give a tax cut to the wealthy people of this country makes no sense.
  Incidentally, how much is the tax cut? If your annual income is $1 
million a year, under the Republican plan, your tax cut is over $50,000 
a year. The people who are wealthy aren't asking me for that tax cut, 
and the people who will suffer because of it are folks who aren't 
making anywhere near $1 million a year.
  Here is what we need to acknowledge: The current healthcare system in 
America needs to be improved. There are things in the Affordable Care 
Act that need to be addressed, and we need to do it in an honest 
fashion, and we need to do it on a bipartisan basis.
  I have talked to some Republican Senators. Senator McConnell has 
pulled this bill back, and they want to sit down and talk.
  Senator McConnell said that there will be no conversations with 
Democrats; Republicans will do it by themselves. I hope over the Fourth 
of July he reflects on that because there are Democratic Senators who, 
in good faith, want to sit down and make a better healthcare system for 
America so that more people have the peace of mind and security of 
health insurance and so that it is more affordable for families all 
across the board.
  The biggest, toughest part of healthcare today is the so-called 
individual health insurance market; 5 or 6 percent of people who need 
to buy health insurance plans don't have it where they work, and they 
don't qualify for Medicaid. Those are the ones who are seeing their 
premiums spike. Can't we take the collective wisdom of Senators--
Democrats and Republicans--and sit down and address that problem 
effectively? Of course we can, but we need to have a starting point.
  So my plea to the Republican leadership is to listen carefully, as 
our Democratic leader, Chuck Schumer, said yesterday. Once you take 
repeal off the table, once you take this massive tax cut for the 
wealthy off the table, we are ready to pull up a chair and sit down at 
the table.
  Wouldn't it be a breath of fresh air in America in this day and age, 
in light of all that is going on, if Democrats and Republicans worked 
constructively together to make the healthcare system better, more 
affordable, and stronger for families and businesses across our Nation? 
I think that is why we were sent here. I think that is the reason we 
are supposed to be here, and I sincerely hope that happens next.
  So we are ending the debate in the Senate this week, but we are not 
ending the debate in America. I urge those who think this is an 
important issue, and I am one of them, to speak up and to go home--I am 
going home soon--and to meet with people and have a conversation about 
where we go next as a nation. We can solve this problem, and I know we 
can do it in a constructive way.
  If we show that kind of bipartisan leadership in the Senate, I think 
the House will join us. I think they will do the same thing. I think 
they can have a bipartisan approach too. What a relief it would be, 
with all of the breakdown in comity, all of the breakdown in 
communications politically, the warring camps that have become the 
American political scene. If we can show why there is a Senate and why 
there is a House and why people run for these offices--it is to solve 
problems, not to put out a press release, not to stake out a political 
position, but to solve a problem. This is a problem that needs solving.
  I hope that over the next week, both parties will reflect on it, and 
when we return after the Fourth of July recess, we can roll up our 
sleeves and go to work.
  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. SCHUMER. Mr. 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 Democratic leader is recognized.


                         Healthcare Legislation

  Mr. SCHUMER. Mr. President, yesterday afternoon, my friend the 
Republican leader announced that the majority would delay the vote on 
the motion to proceed to this particular Senate Republican healthcare 
bill. We Democrats take no solace in that fact. Unfortunately, the 
majority seems intent on continuing their efforts to pass this 
healthcare bill.
  Over the next few days and weeks, I expect to see buyouts and 
bailouts, backroom deals and kickbacks to individual Senators to try 
and buy their vote. What I don't expect to see yet is a dramatic 
rethink of the core of the Republican healthcare bill, but I am hopeful 
we can get to that point.
  So far, every single version of the Republican TrumpCare bill in the 
House and the Senate has the same basic core to it. The details have 
changed a bit around the edges, but the core remains the same in each 
and every version: slash Medicaid to the bone in order to give a 
massive tax break to a very small number of wealthy Americans, cut 
support for Americans in nursing

[[Page 10001]]

homes, those suffering from opioid addiction, and those with a 
preexisting condition to pay for a tax break for the wealthiest few.
  The basic premise of every Republican healthcare bill so far is to 
cut back on healthcare for Americans who need it most in order to give 
a tax break to the people who need it the least. There is just no moral 
calculus to justify it. It doesn't fix any of the problems in our 
current healthcare system like high premiums, high deductibles, 
counties where there are not enough insurance options, and it is not 
what the American people are for. The American people are not for tax 
breaks to the wealthiest of Americans, nor are they for cutting 
Medicaid.
  A USA TODAY poll this morning showed only 12 percent of Americans 
support this bill. At a level of 12 percent, even huge numbers of Trump 
supporters are opposed to this bill. The level of popular support is 
not going to change one bit with a tweak that wins over this Senator or 
that. A bill with this twisted idea at its core will fail time and time 
again. That is why the vote had to be pulled yesterday. You can be 
sure, if it were popular with the American people, it wouldn't have had 
to be pulled.
  I make my friends on the Republican side and President Trump an 
offer. Let's turn over a new leaf. Let's start over. Let's abandon more 
tax breaks for the rich. Let's abandon cuts to Medicaid, and discuss 
what the American people are really concerned about: premiums, 
deductibles, the cost and quality of healthcare.
  President Obama invited both parties, Democrats and Republicans, to 
Blair House to discuss healthcare reform in front of the American 
people early in his first term as President. President Trump, I 
challenge you to invite us--all 100 of us, Republicans and Democrats--
to Blair House to discuss a new bipartisan way forward on healthcare in 
front of all the American people. It would focus on what you, Mr. 
President, have talked about in your campaign: lower costs, better 
healthcare, covering everybody--not on tax cuts for the rich, not on 
slashing Medicaid. President Trump, you said you wouldn't cut Medicaid. 
We don't want to either.
  We Democrats are genuinely interested in finding a place where our 
two parties can come together on healthcare. We want to bring down 
premiums. We want to bring down deductibles too. We want to stabilize 
the marketplace. We want to control the outrageous costs of 
prescription drugs--another thing the President talked about in his 
campaign.
  There is plenty of common ground for us to come together around. We 
believe our healthcare system has made important progress over the past 
8 years, but it still needs to be improved in many ways. We admit the 
Affordable Care Act isn't perfect. There are ways we can improve on 
that law and on our entire healthcare system. So let's talk together 
about how we can achieve that in a bipartisan way.
  If my Republican friends abandon cuts to Medicaid, highly unpopular 
with the American people; abandon tax breaks for the wealthiest few, 
highly unpopular with the American people, we Democrats are more than 
willing to meet with them and the White House to talk about how to 
improve healthcare for the American people, how to lower deductibles, 
how to provide better healthcare for more people at a lower cost 
because that is what we Democrats are fighting for: the average 
American family, not the wealthy few.
  Today, we can turn over a new leaf and discuss healthcare legislation 
the way our Founders intended our government to discuss legislation: as 
a true debate between all of our country's representatives.
  Yesterday, the majority leader reminded Republican Senators that if 
they failed on their partisan healthcare bill, they would have to 
negotiate with me, the minority leader, and by implication, our 
Democratic colleagues. When did the prospect of bipartisanship become a 
cudgel instead of an opportunity? When did bipartisanship become a 
threat? That is not how Congress is supposed to work. Negotiations with 
the minority to seek a compromise should be the first option, not the 
last resort.
  Let's start over and get back to legislating in a way deserving of 
the grand tradition of the Senate as the world's greatest deliberative 
body. Providing affordable and quality healthcare is an issue we should 
grapple with, all of us together. It is one of the most important 
things we can do for our country. We can do it but only if we do it 
together and put the partisan ideology aside.
  So I challenge the President, invite us all to Blair House. Let's see 
what we can come up with. Let's try. We Democrats have, on several 
occasions, sent letters to our Republican colleagues asking for 
bipartisan talks on healthcare. So far we have been rebuffed. Now, with 
the demise of this bill yesterday--its inability to get enough votes to 
proceed--we have an opportunity to go back to the drawing board.
  We are willing to debate and compromise on healthcare, but we have to 
be included, and it has to be a discussion on how to actually improve 
our healthcare system for the American people, not slash Medicaid to 
pay for tax cuts for the wealthy. We can meet, and we can try or the 
Republicans can stick to the same partisan approach on healthcare, 
which so hurts working families and so benefits millionaires.
  President Trump, my Republican friends, the choice is yours.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Tillis). The Senator from Indiana.
  Mr. DONNELLY. Mr. President, for all of the discussion about delays, 
politics, the process, vote counts, budget scores and analysis, it is 
critical we remember that this healthcare debate is first and foremost 
about people, our friends and neighbors, and their families. It is 
about moms and dads, sons and daughters, sisters and brothers, grandmas 
and grandpas.
  We all agree everyone needs access to quality, affordable healthcare. 
Regardless of how healthy you are today, everyone needs the peace of 
mind that if they get sick, they will be able to get the care they 
need. We all know someone who has fought cancer, diabetes, multiple 
sclerosis, or has a child battling a chronic condition or disease.
  In our shared experiences and relationships are shared values. Each 
of us wants our loved ones to be healthy and to live long, full, happy 
lives. We want what is in the best interests of our families, our 
friends, and our neighbors.
  I have seen these values firsthand through the stories of Hoosiers 
who recently wrote to me out of desperate concern about the Senate 
healthcare bill. I have heard from everyone--from working parents to 
students, to seniors--that access to quality and affordable healthcare 
is critical to their ability to raise a healthy family, to contribute 
to our communities, and to live our final years in dignity.
  Take Conor, who is a lawyer, and Sarah, a nurse practitioner, and 
their family in Fort Wayne, as an example. In 2015, Sarah was diagnosed 
with multiple sclerosis, an autoimmune disease that attacks the nerves 
in her brain and spinal cord. As Conor wrote me, ``Like everyone else 
who suffers from MS, my wife didn't make this choice. She did not 
choose this disease . . . sometimes people get sick or are diagnosed 
with chronic conditions through no fault of their own.''
  If untreated, she would become severely disabled, and her condition 
would get progressively worse. The best possible outcome for Sarah is 
controlling the disease and limiting the spread of the symptoms because 
there currently is not any cure.
  Conor and Sarah worry that under the Senate healthcare proposal, they 
would be subject to annual and lifetime caps, making Sarah's treatment 
unaffordable. Through the Senate healthcare bill, States could seek 
waivers that would allow them to get rid of essential health benefits 
and implement annual and lifetime caps, even for health insurance plans 
that people receive through their work, just like Sarah does. For Conor 
and Sarah and others who suffer from conditions like MS, the reforms 
that prohibit limits on

[[Page 10002]]

coverage allow them to have the peace of mind that they can live full 
lives, despite their disease and their diagnosis.
  It is stories like Sarah's and Conor's that remind us why this is 
such an important debate. It is inherently personal. It is about the 
health, the well-being, and it is even about the life and death of our 
loved ones. It is about not going to the ER just to visit a doctor. It 
is about financial security. It is about financial security so our 
families aren't one illness or one sickness away from bankruptcy.
  Take, for example, Beth and Brad from Plainfield, IN. They are the 
proud parents of Kyle. Kyle has special needs, and he relies on 
Medicaid, not only for his healthcare but literally to help keep the 
family together. Beth recently wrote me:

       Kyle is on a home and community-based Medicaid waiver, 
     which is not mandated. If Medicaid is cut, Kyle and others 
     like him are in real danger of losing coverage for home 
     nursing and nutrition among many other things. Without home 
     nursing, Brad or I will also have to quit working. And 
     without enough income to pay for it ourselves, we'll be 
     placed in the horrific situation of either not being able to 
     give our child what he needs at home, or institutionalizing 
     our precious boy. We want to care for our son at home. We 
     want to work and pay for his primary insurance that reduces 
     the amount of Medicaid money needed. We want the 
     independence, freedom and responsibility that the minimal 
     supports through Medicaid allows.

  And Lori from Kokomo, IN, wrote to me about her 3-year-old daughter 
Savannah:

       She has a long list of medical issues. She has had 2 open-
     heart surgeries, 8 heart catheterizations, 1 pacemaker 
     placement, and countless other procedures. Her medical bills, 
     at 3 years old, are in the millions, and she still will need 
     more cardiac surgery in the future. Her annual care--just her 
     medications, appointments with specialists, therapies, etc--
     are more than our annual income, despite my husband working 3 
     jobs. The Senate GOP bill puts her life in grave danger.
       Lifetime limits and waiving of Essential Health Benefits 
     means she will lose her private insurance. Allowing 
     alteration or waiver of Essential Health Benefits will be 
     catastrophic for Savannah and others with preexisting or 
     chronic conditions. I will be forced to look at my child and 
     say, ``I'm sorry honey, Mommy and Daddy don't have enough 
     money for your surgery.''

  As a dad, the health and well-being of my family is on my mind every 
day, and I know that every mom and dad across our country feels the 
same way. My faith teaches me that we are all God's children, and every 
man, woman, and child should have a shot at being able to live up to 
their God-given potential. We will move Heaven and Earth to take care 
of our kids. These values are shared across Indiana and across our 
entire beloved country.
  My faith also teaches me that we all deserve to live with dignity.
  Claudia from Muncie wrote to me:

       I am a 55-year-old, medically-retired flight paramedic and 
     RN. My career was cut short when I was diagnosed with ALS--
     Lou Gehrig's Disease--in 2005. Without Medicaid and the 
     waiver I would be institutionalized. Because of the things 
     Medicaid covers, I am still able to be a mother.
       For two decades, I was the person who came to the aid of 
     others. Please, don't fail me or my family now.

  This bill would fail Claudia and millions of others. It would force 
Claudia's family and families across the country to pay more, not less, 
or to even put critical healthcare out of reach. You don't have to take 
my word for it, though.
  The American Heart Association calls this bill ``heartless.'' The 
Catholic Health Association says the bill is ``devastating.'' The 
American Academy of Pediatrics says it ``fails children.'' The American 
Cancer Society says the bill could ``greatly harm millions of cancer 
patients, survivors, and those at risk for the disease.'' AARP, the 
American Medical Association, the American Hospital Association, and 
Catholic Charities oppose this bill.
  Here in the Senate, we have been hired by the people we represent to 
continue the proud American tradition of leaving our children a country 
that is even better than when it was given to us. We owe it to the 
people we serve to ensure they have healthcare that is affordable and 
accessible.
  Ohio's Governor, John Kasich, recently said, when he talked about the 
challenges with our healthcare system, that this will never, ever be 
solved with a one-party approach. He is right.
  In order to strengthen our healthcare system, we would be a lot 
better served by working together with a bipartisan effort and with 
input from those who provide healthcare every single day--the doctors, 
the nurses, the hospitals in urban communities and in rural communities 
all across our country. Most importantly, we need to remember the 
patients and the caregivers who rely on our healthcare system. We can 
do this together, and a big dose of Hoosier common sense would be a 
huge part of it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Mr. PETERS. Mr. President, I have always believed that elected 
officials should do more listening than talking.
  The breadth of issues that we address here in the Senate is as vast 
and diverse as our Nation. We rely on input from experts, from 
stakeholders, and from constituents to craft responsible, meaningful 
policy. In the past month alone, I have had the opportunity to attend 
bipartisan hearings on cyber security, countering violent extremism, 
self-driving cars, rural broadband, nuclear defense policy, and the 
posture of our Armed Forces, just to name a few. These issues are vital 
to our economy and our national security, and they are worthy of the 
time and effort that went into convening these very important hearings.
  But over the same timespan, the Senate did not hold a single hearing 
on healthcare, while a handful of Republican Members drafted a flawed 
healthcare bill behind closed doors.
  Healthcare policy is unique. It is very complex, while also being 
deeply personal. Throughout our lives, doctors and nurses are with us 
for some of our most significant moments. Whether it is responding to 
trauma in an emergency, helping us live with chronic conditions, 
devising treatment plans for an ailing parent, or delivering a newborn 
child, our medical professionals are there for us when we are at our 
most vulnerable.
  We are all vulnerable. Life does not discriminate. Anyone can get in 
a car accident and need months of physical therapy. Anyone can be 
diagnosed with cancer and require surgery, radiation, or chemotherapy. 
Anyone can have a son or daughter born with cystic fibrosis. But in 
this great country, I believe no one should ever go bankrupt because 
they get sick, and no one should ever die because they cannot afford 
quality health insurance.
  I believe healthcare policy is very complex, and we have to work very 
hard at it, but I am also guided by a very simple moral concept: No 
matter who you are and no matter where you live in this country, no 
citizen should ever be forced into bankruptcy because they are sick and 
no one should ever die because they can't afford quality insurance.
  I urge my colleagues to use the coming days to think about their 
goals for healthcare in our Nation and be guided by their own moral 
conscience. Passing a politically expedient proposal that can get 51 
Republican votes after significant arm-twisting so that the Senate can 
move on to tax reform is not in the best interest of the American 
people, and I believe it is simply irresponsible.
  I believe that we should provide the best care possible to as many 
Americans as possible while making sure that it is affordable. Now, I 
honestly can't say whether my Republican colleagues share these goals, 
but I can say that the Senate healthcare bill that we saw this week 
does not hit the mark. I urge my colleagues to use the coming days to 
really think about what this bill will mean for the families in their 
State.
  I feel fortunate that Michiganders have been willing to share their 
heartfelt stories with me in recent years. They are fearful that 
repealing the Affordable Care Act will not only put them in jeopardy 
but also their friends, family, and neighbors.
  I have heard from Amy from Metro Detroit. She is 53 years old and has 
type 1 diabetes, also known as juvenile

[[Page 10003]]

diabetes. Amy is a self-employed small business owner. Before the 
Affordable Care Act, insurance companies viewed her diabetes diagnosis 
as a preexisting condition and were able to charge her more because of 
it. After the Affordable Care Act was implemented, Amy was able to shop 
around and find a much more affordable plan with the same level of 
benefits that she had before. While Amy does not qualify for subsidies 
to help purchase insurance, she was still able to cut her healthcare 
costs in half because of the Affordable Care Act. Amy fears--and 
rightfully so--that if the Republican healthcare bill passes, her costs 
may skyrocket, jeopardizing her business and everything she has worked 
her entire life for.
  I have heard from Tammy, who lives in Marne, MI. Tammy's daughter 
Erin is 10 years old. Erin was diagnosed with cystic fibrosis at 18 
months. She takes 23 pills and does 2 hours of breathing treatments 
each and every day. She is a fighter, and her whole family has pulled 
together to support her, but they are also very worried about her 
future. Erin's family has private insurance, but they supplement the 
high cost of her care through Medicaid. Tammy is afraid that the $800 
billion cut to Medicaid will jeopardize their ability to afford Erin's 
care and would cast an absolutely devastating blow to their family.
  Finally, take Stefanie from Livonia, MI. Stefanie worked her entire 
life in the customer service industry, primarily in retail and in 
restaurants. She was never offered health insurance by her previous 
employers, and, until the Affordable Care Act, she never had health 
insurance as an adult. Then, in December 2015, Stephanie's third floor 
apartment caught fire, and she was left to make a horrific decision 
about whether to jump from her third floor apartment or die inside the 
burning building. Well, Stefanie jumped from the window to save her 
life, and she sustained serious injuries, including a broken back and a 
shattered foot. Because of the Affordable Care Act, she was able to 
receive treatment for her injuries, which included a month's stay in 
the hospital, multiple surgeries, and absolutely excruciating physical 
therapy to finally heal in the end. Stephanie's treatment came in close 
to $700,000, an amount that would surely bankrupt nearly any American.
  These stories and many more are what health insurance is truly about. 
For people like Stefanie, Amy, and Erin, we should do more listening 
than talking. We should listen to Stefanie, Amy, and Erin, and we 
should listen to the hundreds of healthcare experts who have expressed 
their strong opposition to this bill and the impact that it will have 
on the healthcare system in this country.
  I would urge my colleagues to listen to the AARP, the American 
Academy of Pediatrics, the American Diabetes Association, the American 
Hospital Association, the American Heart Association, the American 
Medical Association, the Children's Hospital Association, the National 
Alliance on Mental Illness, the National Breast Cancer Coalition, and 
the National Council on Aging, just to name a few.
  I am not just hearing from these national groups. I am also hearing 
from local healthcare professionals all across my State. Hospitals and 
community clinics in Michigan--particularly, the ones in the rural 
areas--are telling me this bill could cause them to close their doors. 
This will jeopardize access to care in communities that are already 
medically underserved. Costs will go up for seniors and individuals 
with preexisting conditions, like Amy.
  No one chooses to get sick. But when we are confronting a disease or 
injury, health insurance is a lifeline. It allows us to get better, to 
get back on our feet, and it simply allows us to keep living.
  In American society, healthcare coverage is our promise that if you 
work hard and you play by the rules, you will have the healthcare you 
need when you need it the most. As I have already said, no one in this 
great country should be forced into bankruptcy because they are sick, 
and no one--no one--should ever die because they can't afford quality 
insurance.
  The Republican healthcare bill is irresponsible. This bill will strip 
away health insurance from 22 million Americans. This bill would put 
more and more Americans at risk of financial ruin from unpaid medical 
bills, and it would put more Americans at risk of dying because they 
can't afford the care they so desperately need.
  This bill cannot and should not be salvaged with minor tweaks and 
arm-twisting to win a few votes.
  I urge my colleagues to go back to the drawing board and begin an 
open, bipartisan process where we all listen to our constituents, hold 
hearings with experts, and work together to keep what works and to fix 
what doesn't. Let's let common sense rule the day and not partisan 
ideology. We should do what is best for our folks back home and ensure 
that everyone has access to quality, affordable healthcare. 
Michiganders and all Americans deserve nothing less.
  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. 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 as the pain of 
ObamaCare around the country continues to worsen. Healthcare prices 
continue to rise. ObamaCare is collapsing, basically, more and more 
every day. People in every State of this Union have seen their 
healthcare costs skyrocket. It has happened everywhere around the 
country.
  We must do something to help the American people who are suffering 
under the heavy weight that ObamaCare has placed on their lives.
  I was at a hospital this past weekend in Casper, WY, my hometown, and 
I talked to doctors, nurses, and patients. What I hear at home in 
Wyoming is that there is an urgent need to do something about the high 
costs and the limited choices under the Obama healthcare law. We are 
having discussions right now about the very best way to do that. 
Whatever we come up with, it is going to be a fundamental change in a 
direction away from ObamaCare. That is what America wants. That is what 
America needs. It is what the American people are asking us to do.
  One of the biggest steps we need to take is to get rid of the 
ObamaCare mandates and penalties. I hear about it day in and day out. I 
heard about it in my office yesterday from a woman who was in town 
visiting on another matter, but she talked about her experience with 
the ObamaCare situation where her premiums have gone way up, and the 
deductibles are up so high that even though they are counted under 
ObamaCare as having insurance, her husband would tell you that he will 
not go to a doctor because, with a $6,500 deductible, he feels he 
cannot afford to. But he is counted under ObamaCare. He wants more 
choices. He wants more control of his own life. And he wants to 
eliminate the taxes and the mandates.
  I am sure the Presiding Officer hears this at home: People hate the 
fact that there is a mandate that says they have to buy insurance that 
Washington says they have to buy--that the Democrats have said they 
have to buy--rather than what might work for them and their family and 
be cheaper and work better for them and be more tailored to their 
family's needs.
  There are more than 19 million people across the country who have 
decided that they are going to pay a penalty to the IRS or they 
received a waiver so they didn't have to get ObamaCare insurance--
either pay the penalty or get a waiver. These are people who made the 
fundamental decision that ObamaCare insurance was not a good deal for 
them.
  The second thing we need to do, I believe, is to repeal the 
burdensome and expensive ObamaCare taxes. Healthcare costs have been 
soaring under ObamaCare. One of the reasons is because the healthcare 
law added almost $1 trillion of additional taxes on

[[Page 10004]]

to the backs of hard-working Americans. These are the taxes that 
specifically raised the cost for people needing health insurance and 
healthcare. They put taxes on things needed by people who are in need 
of medical care. Somebody who needs a pacemaker, someone who needs a 
walker, a wheelchair, an artificial joint--additional taxes on all of 
these users of medical devices, medical supplies, of over-the-counter 
pain medicines, over-the-counter medicine for fever, sore throat, as 
well as prescription medications. The taxes are on just about 
everything, and then, of course, the tax on health insurance itself. So 
if you buy health insurance, you have to pay a tax on that. What is 
that going to do to the cost of health insurance? It is going to raise 
the cost for people who have health insurance.
  When the Democrats were debating and voting in support of the 
ObamaCare law on this floor of the Senate, they conveniently failed to 
mention all of these new taxes to the American people.
  The third important thing that Republicans are committed to doing is 
to give much more flexibility to the States when it comes to making and 
developing healthcare solutions for the future.
  I served 5 years in the Wyoming State Senate. We always felt that we 
could do a lot better job if we just had a little more local control, a 
little less in terms of government mandates, and make that same amount 
of money work that much better and go that much further and take care 
of that many more people.
  Medicaid is the prime example. I had a State legislator in from 
Wyoming today, and in the office we were talking about Medicaid and 
what role the States play and what role the Federal Government plays, 
how to make dollars go further at home. ObamaCare increased the amount 
of money that Washington sends to States that chose to expand their 
Medicaid Programs. Of course, that is taxpayer money. Then ObamaCare 
paid a bonus--a bonus--to States that decided to not focus on the area 
where Medicaid was intended originally to be focused, which was on poor 
women, children, and the disabled. They didn't get a bonus--not at all. 
No bonus money to help those people. The bonus money went to help able-
bodied, working-age adults. That is not whom Medicaid was set up to 
help in the first place.
  Why should Washington collect money from people at home and then send 
it back out to the States with all of these new Washington mandates and 
restrictions on how the money is spent? I have much more confidence in 
the people of my home State of Wyoming and in the people of the 
Presiding Officer's State of Arkansas than I do in any bureaucrat in 
Washington, DC. When it comes to developing good ideas about improving 
America's healthcare, I always believe in more flexibility and local 
control and patient control. The more we are working with doctors and 
communities, working with State legislators, the better. We need more 
flexibility in every State; we don't need Washington telling all of us 
what to do. If we give people and States more options, there will be 
more affordable options for insurance as well as for care.
  Democrats tried their goal of a one-size-fits-all, Washington-
mandated approach. That is what ObamaCare was all about, and it did not 
work.
  I want to talk about one other thing Republicans are committed to 
doing with our healthcare reform plan, and that is stabilizing 
insurance markets while other reforms can take effect.
  The ObamaCare exchanges are completely falling apart. Week after 
week, there is another story, another headline about the disaster that 
is ObamaCare. We look at a headline in a Chicago paper: ``Another 
Obamacare rate shock.'' ``Another'' and ``shock'' with rates--that is 
what people are seeing around the country.
  Last week, we learned that another 77,000 people in Indiana will lose 
their ObamaCare plans. Two more insurance companies are leaving the 
market there. Across the country, there are more than 40 counties where 
no one will be selling ObamaCare insurance next year--no one.
  Premiums have already doubled because of ObamaCare in the last 4 
years. Next year, people's rates may go up another 40 percent, 50 
percent--well above that in other places. We cannot allow this to 
continue. The American people cannot afford it, it is not good for our 
country, and it is not good for the people living in this country.
  We need to make sure we help support people who do need help paying 
their premiums. We need to give insurance companies more flexibility to 
offer the kinds of plans that people actually want to buy. We need to 
give States the ability to support their markets in ways that make 
sense for people in that State.
  The discussion draft of our plan includes ideas to help keep the 
individual market going in a much stronger way than it is under 
ObamaCare today. It stabilizes the markets.
  The insurance company Anthem put out a statement on Monday. The 
company said that these kinds of ideas ``will markedly improve the 
stability of the individual market and moderate premium increases.''
  Anthem has been dropping out of exchanges across the country because 
the markets are unsustainable under ObamaCare. That has to be one of 
our goals as we continue to discuss legislation--stabilizing the 
markets and reducing premiums. There are a lot of good ideas on ways to 
do it. We are committed to exploring those ideas and putting together a 
plan that will help give people the care they need, from a doctor they 
choose, at lower costs. That is what the American people want us to do. 
That is what we are working on.
  There are limits under the Senate rules that keep us from doing some 
things we would all like to do. If Democrats are ready to work with us 
and to be part of the conversation, I think we can do some things to 
make this bill even better. But the situation we have today in this 
country for healthcare is not working. ObamaCare has collapsed. 
Healthcare is in a state of crisis. Those who supported ObamaCare and 
voted for it have caused it. We are just trying to clean up the mess.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, after weeks of secrecy, after not 
engaging with the public, after an effort to prevent not only Democrats 
in this body but women in this body from participating in putting 
together a new healthcare bill, last week we saw Senate Republican 
leaders put forward their bill to repeal the Affordable Care Act.
  Like its companion bill in the House, this legislation imposes 
draconian cuts to Medicaid, our Nation's principal program for insuring 
children, people with disabilities, and seniors in nursing homes. It 
drives up costs for middle- and low-income Americans while delivering 
huge new tax cuts to the wealthiest in this country.
  I start with the premise that you can't take health insurance away 
from 22 million Americans and call it reform or better care. I think 
President Trump was accurate when he described this approach simply as 
mean. The fact is, this legislation is a direct threat to the health 
and well-being of millions of Americans, including tens of thousands in 
New Hampshire.
  The opioid epidemic in the country and in New Hampshire is the worst 
public health crisis in modern history. In New Hampshire, thanks to the 
expansion of Medicaid, done by a Republican legislature and a 
Democratic Governor, my colleague from New Hampshire who is now in the 
Senate, who is here with me today--thanks to their bipartisan work, 
nearly 11,000 Granite Staters have been able to access lifesaving 
treatment under the Medicaid Program for substance use disorders. By 
completely reversing the Medicaid expansion, the Senate bill released 
last week would cost who knows how many lives and would be a crippling 
setback in our fight against the opioid crisis.
  Medicaid covers one out of three children in New Hampshire, as well 
as people with disabilities and seniors in nursing homes.

[[Page 10005]]

  In concert with the President's budget, this bill being proposed by 
the Senate would cut Medicaid funding in half by the year 2027. Cuts of 
that magnitude simply cannot be done without having devastating effects 
on children and other vulnerable people across New Hampshire.
  Then, of course, this legislation blocks all Federal funding for 
Planned Parenthood. We have more than 12,000 Granite State women and 
men who depend on Planned Parenthood for essential health services, 
including cancer screenings.
  According to the nonpartisan Congressional Budget Office, nearly 
45,500 Granite Staters would lose coverage under the Republican 
leader's bill. These are people who rely on that coverage for basic 
care, as well as for treatment of cancer, heart disease, diabetes, and 
other chronic illnesses, and they are deeply afraid that they will be 
among the 22 million Americans who will lose their health coverage if 
the Senate bill becomes law.
  Last Friday, Senator Hassan and I convened an emergency public field 
hearing in Concord. We wanted to hear directly from Granite Staters who 
would be affected by the Senate bill. I have to say--and I am sure my 
colleague agrees with me--it was an extraordinary event, with over 200 
attendees. They overflowed the overflow room. This is a picture of the 
room where we held the hearing, and we can see people lined up on 
either side of the room, waiting to take their turn to testify.
  Senator Hassan and I heard firsthand from healthcare providers, from 
people in recovery from substance use disorders, from parents of 
children with chronic diseases and disabilities, and so many others who 
are concerned about this legislation. We listened to emotional, 
heartfelt statements about the uncertainty, anxiety, and anger this 
Senate bill has caused. I was especially moved by testimony from 
parents who are worried their children will lose access to the 
lifesaving treatment they need that for so many of these kids is the 
difference between life and death.
  People like Paula Garvey, of Amherst, NH, who talked about her 19-
year-old daughter Rosie, who was diagnosed with cystic fibrosis just 2 
weeks after birth. Rosie also suffers from juvenile rheumatoid 
arthritis. Rosie must follow a strict regimen of medications to keep 
the cystic fibrosis under control. Paula fears that the repeal of the 
Affordable Care Act and cuts to Medicaid will leave her daughter 
without coverage for her preexisting condition and that insurance 
companies will once again impose a lifetime dollar limit on benefits.
  For Paula, and for any parent, the prospect of not being able to 
access lifesaving care for a child is profoundly upsetting. Paula said: 
I don't know what I am going to do if the Affordable Care Act goes 
away. What will Rosie do when she is off of our insurance and she is 
not able to find insurance again?
  Sarah Sadowski of Concord, NH, testified about her 9-year-old 
daughter who has cerebral palsy. She said:

       The Affordable Care Act was a huge moment of hope. I cannot 
     face what life would look like with pre-existing conditions, 
     lifetime limits, and countless hours on the phone with 
     insurance companies.

  At the field hearing, we also heard important testimony about others 
who rely on Medicaid. For example, Medicaid provides coverage for more 
than 10 million Americans with disabilities and nearly 6 million 
seniors in nursing homes. In fact, these two groups alone account for 
nearly two-thirds of all Medicaid expenditures. Yet the Republican 
leader's plan to cut Medicaid funding in half over the next decade 
would have dire consequences for these Americans.
  Brendan Williams, CEO of the New Hampshire Health Care Association, 
told our hearing that 63 percent of nursing home residents in New 
Hampshire rely on Medicaid. As was reported on Sunday in the New York 
Times, the deep cuts to Medicaid included in the Senate bill would 
force many retirees out of nursing homes or lead States to require 
residents' families to help pay for care. For many families, this is 
just not an option. They don't have the finances to be able to do that. 
So what happens? Their loved ones get kicked out of their residential 
care.
  We also heard compelling testimony from healthcare providers who 
treat people with substance use disorders. Melissa Fernald is a private 
clinician in Wolfeboro, NH. She told us:

       For the majority of [Medicaid expansion] patients, it is 
     the first time they have had health insurance. It allowed me 
     to assist them in properly diagnosing their mental health 
     conditions . . . and securing primary care providers to treat 
     their medical needs. It has been a powerful experience to 
     watch them heal and grow as a result of receiving proper 
     care. . . . My clients are more motivated and capable of 
     getting a job and gaining financial independence.

  Again, if your heart is not moved by the morality of these kinds of 
stories and by the values I think we should have in this country to 
help people who need help, we should be moved by the economics of this. 
It is going to cost a whole lot more when we kick people with substance 
use disorders off of their insurance, when they go to emergency rooms 
to get their care, or when they die than to make sure they get the help 
they need.
  The Senate bill to repeal the Affordable Care Act and radically cut 
Medicaid is a threat to healthcare coverage for people in New Hampshire 
and in every other State in this country. I am so grateful to all of 
those Granite Staters who attended our field hearing on Friday. I know 
that in other States across this country, large numbers of people are 
turning out to express overwhelming opposition to the Republican 
leader's bill. I heard this morning that polling shows that just 17 
percent of Americans support this legislation. We need to listen. We 
need to stop this headlong rush to pass a cruel and heartless bill.
  For ordinary people in New Hampshire--the people whom Senator Hassan 
and I heard from on Friday--repealing the Affordable Care Act and 
gutting the Medicaid Program isn't about politics. It is a matter of 
life and death. We need to listen to the voices of ordinary people 
whose lives and finances would be turned upside down by this bill.
  There is a better way forward for both the Senate and our country. It 
is time for Republicans and Democrats to put ideology and partisanship 
aside and come together to do what is right for ordinary working people 
in this country.
  The majority leader's decision to delay a vote on the bill is an 
opportunity for all of us in the Senate. When we come back after next 
week's July 4th recess, let's come together in an open and inclusive 
process. The right way forward is for Republicans and Democrats to work 
together to strengthen the parts of the Affordable Care Act that are 
working, including Medicaid expansion, and to fix what is not working.
  According to poll after poll, this is what the majority of the 
American people want us to do. It is time now to respect their wishes 
and to strengthen the Affordable Care Act so it works for all 
Americans.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Ms. HASSAN. Mr. President, I rise today to join my friend and 
colleague, Senator Shaheen, to discuss the stories and concerns we 
heard from our constituents in New Hampshire about how they would be 
hurt if TrumpCare becomes law.
  Even though Republican leadership has delayed a vote on TrumpCare 
this week, we know that the fundamentals of what is wrong with 
TrumpCare will not change.
  TrumpCare would force Granite Staters to pay more for worse 
insurance, all to give billions of dollars in tax breaks to corporate 
special interests--including Big Pharma--at the expense of hard-working 
Americans and the programs they rely on. This is the basic principle of 
TrumpCare, and it is unacceptable.
  TrumpCare would be a disaster for people in New Hampshire. Granite 
Staters know this, and they have been standing up and speaking out 
against this dangerous bill.
  As Senator Shaheen discussed, we held an emergency hearing last week 
in

[[Page 10006]]

Concord to hear from our constituents about how TrumpCare would impact 
them. We held this emergency hearing at 2 p.m., on a Friday afternoon, 
in the summer, and with just a day's notice. Yet hundreds of people 
showed up.
  Over 50 people shared their personal stories about the importance of 
healthcare, of how they have benefited from the important protections 
that are provided under current law--including maternity care, 
prescription drug coverage, and coverage for substance use disorder 
services--of the protections against insurance company abuses, of 
Medicaid expansion, and of traditional Medicaid. They told us what 
their lives were like and why TrumpCare would be devastating to them 
and their families. I wish to share some of those stories today.
  We heard from Ariel, from Rochester, NH, a mother who is benefitting 
from substance use disorder services that are included in Medicaid 
expansion and would be taken away under TrumpCare. Ariel said:

       I am a mother of 3 children and I have a substance abuse 
     disorder. I come from a long line of women who never had much 
     opportunity. With the opportunity to have Medicaid I have 
     been given the chance of treatment.
       Without the chance of treatment I wouldn't have been taught 
     that there is a solution and a way to live a full, beautiful 
     life as a woman in recovery . . . as a mother of 3 beautiful 
     children. . . . As a woman of dignity and grace. . . .
       If the opportunity of Medicaid is taken away, the chance of 
     positive change in this world is going to drastically drop. . 
     . . Women like me may never know a world outside of drug use 
     and hopelessness.

  She goes on to say:

       Today because of the opportunity of change, I am able to be 
     a positive role model to my children and most importantly our 
     future.

  When we met Ariel, she was pregnant with that third child, and she 
went into labor immediately following our field hearing. She told us 
over the weekend that she had a healthy baby boy. Because of the 
treatment Ariel received through Medicaid, she is in a better position 
to take care of that new baby boy.
  Our Medicaid Program is not only critical to providing key support to 
combat the substance misuse crisis, but, as Senator Shaheen mentioned, 
it also helps seniors and those who experience disabilities get the 
care they need--services that would be taken away under TrumpCare.
  This is something we heard from a Granite Stater named Jeff, who has 
a form of muscular dystrophy. Jeff said:

       I am able to live a life that's independent in my own home, 
     pursuing my own career, only by virtue of the fact that I am 
     able to receive Medicaid services. Specifically, all this 
     discussion about private insurance is well and good, but I 
     think what some Senators aren't remembering or don't know is 
     that private insurance doesn't cover many of the types of 
     services that Medicaid does. . . . Especially personal care 
     services that allow us to live independently in our homes and 
     communities, which is where all of us would like to be, if 
     we're able to. So, I'm concerned about that.

  He continued:

       I'm concerned about the fact that my understanding is that 
     this bill would allow states to opt out of providing optional 
     Medicaid services, many of which are the waiver programs here 
     in the state that frankly are so vital to folks with physical 
     disabilities, developmental disabilities, acquired brain 
     injuries, and all sorts of other conditions. So that part 
     concerns me.

  Medicaid coverage makes it possible for Jeff and so many others to 
work and participate in their communities. Jeff also said that he was 
concerned about the fact that TrumpCare cuts and caps Medicaid, which 
we know is really just code for massive cuts that would force States to 
choose between slashing benefits, reducing the number of people who can 
get care, or both.
  Senator Shaheen and I also heard from several Granite Staters who 
have benefited from the Affordable Care Act and who are concerned that 
TrumpCare would reduce the care they receive while raising their costs. 
One of these people was Enna, from Exeter, NH. Enna said:

       I am self-employed and purchase health insurance through 
     the Marketplace here in New Hampshire. The ACA had given me 
     the opportunity to purchase affordable health insurance for 
     myself and my family of four.

  She explained:

       We were unable to maintain insurance consistently prior to 
     the ACA, and even when we did have it, critical preventative 
     care--for myself, as a woman--was not covered by our previous 
     policy.

  She said this about TrumpCare:

       [It] would make our health coverage less comprehensive and 
     less affordable. I am certain that our risk of financial and/
     or health catastrophe would be significantly greater [under 
     TrumpCare].

  There is no doubt that we should all be working together in order to 
improve the Affordable Care Act, build on the progress we have made, 
and lower healthcare costs for all of our citizens. I am willing to 
work with any of my colleagues on bipartisan solutions in order to make 
that happen, but we know that TrumpCare is not the answer. While my 
Republican colleagues have delayed a vote on this bill, no one believes 
that TrumpCare is dead yet.
  I am going to continue to share the stories of Granite Staters who 
would have to pay more money for less care under TrumpCare. I will keep 
working to ensure that TrumpCare never becomes law. I urge my 
colleagues to take the time to listen to their constituents who would 
be hurt under TrumpCare.
  The people of New Hampshire have been so brave. They have come 
forward, and they have talked about their most personal, difficult, and 
challenging experiences. They have laid themselves bare before the rest 
of us so we could understand what they have gone through and so we 
could understand that if we are not committed to a healthcare system in 
which every American--citizens in a democracy--have meaningful, truly 
affordable access to the type of care that each of us would want for 
our own family, then we are not doing our job as a democracy at all.
  We need to protect and defend what we have, and, then, we need to 
improve what we have. We need to come together and make sure that 
healthcare is truly available to every one of us, so that we can be 
healthy and productive and so that we can lead together.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. KING. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KING. Mr. President, I want to talk about the healthcare bill, 
the healthcare issue, and talk a bit about how we can find a solution 
and then what the solution should look like.
  For the last 2 days, as a member of the Armed Services Committee, I 
have been in our markup. In that markup, we considered somewhere in the 
neighborhood of 250 to 300 amendments. Of those 250 amendments, 
approximately 210 of them were either compromised--an agreement was 
worked out between the proponents of the amendment and those who had 
reservations--and they were either withdrawn or became part of the bill 
by unanimous consent. Of the 25 or 30 that were left for votes, 
however, we had good debate. The members talked about their point of 
view. The people who opposed them gave their points of view. We had a 
vigorous discussion and debate and then we voted. The important thing 
to me--and I am pretty sure I am right about this, I kept a mental note 
as we went through the votes--I don't believe there was a single party-
line vote in the Armed Services Committee on any amendment. The votes 
were sometimes more Republicans, more Democrats, but there wasn't a 
single party-line vote. In other words, the process worked as it was 
intended to work, as it should work, and as it can work.
  So I have a radical suggestion for those who are seeking a solution 
to this healthcare issue; that is, submit a bill and put it before the 
requisite committees, have hearings, have debates, have information, 
get information from around the country, from experts, from people who 
know about the topic, and that is how we make good laws. A bill that 
doesn't go through any of that process, that is concocted in secret and

[[Page 10007]]

sprung on the Congress at the last minute, almost by definition will 
not be a good bill. Bad process--bad bill, and that is what we had 
happen in this case.
  I think this is a time--we are going into a recess at the end of this 
week. Let's take a deep breath, and instead of trying to tinker around 
and attract a few extra votes and find something that will barely pass 
by the skin of its teeth, let's step back and submit this issue to the 
Finance Committee and the HELP Committee. Let's try to work through to 
find a real solution involving both parties, involving all of the 
wisdom that has been accumulated in this country on this incredibly 
complex and difficult and incredibly important issue. We don't have to 
try to do it in the dark. Let's do it in the light of day. Let's have 
open hearings and considerations, votes and amendments, discussion and 
debate, and then as our system is designed, we can come to a good 
result.
  Let's talk about the bill that is currently before us. I guess it is 
before us. It hasn't really been submitted to any of the committees, 
but I am told it is coming to the floor. It was going to be this week. 
Now it is going to be the week, I guess, after the recess--at least 
that is what we were told yesterday.
  Why is this a bad bill? I have been watching some of the commentary 
on this bill, and there is a lot of discussion about the Congressional 
Budget Office analysis: Is it correct, did they use the right baseline, 
are they good at projecting how many people are going to sign up for 
healthcare, and all of those kinds of questions. People are questioning 
the Congressional Budget Office. I happen to think they tend to be 
pretty nonpartisan, straightforward, good, scientific, and quantitative 
analysts of these kinds of issues. They issued their report saying 22 
million people lose their healthcare. This is about people. It is not 
about ideology. It is about real people.
  There is a really easy way to cut through all of the questions about 
whether they analyzed it properly and who is going to lose and who is 
going to win; that is, to look at a simple chart that is on, I think, 
the third page of the Congressional Budget Office analysis. This is 
really all you need to know about this bill: Medicaid loses $772 
billion over the next 10 years, and the tax credit and selective 
coverage provisions--that is the ACA--loses $400 billion. It is $1.1 
trillion out of the healthcare system. You cannot take $1.1 trillion 
out of the healthcare system and not hurt people. You can't do it. We 
don't have to argue about how many here, what age, and all of that kind 
of thing. We are talking about a massive cut to the support that is 
enabling American people to get healthcare.
  In Maine, if you cut all these numbers back, as near as I can tell, 
it is about $400 to $500 million a year. I was the Governor of Maine. I 
know that $400 and $500 million a year is huge. People talk about: 
Well, we are going to cut Medicaid back. We are going to trim the 
growth rate. We are going to lower the way it is calculated and make it 
a per capita cap, all of these things, and we are going to give the 
States flexibility. The magic word ``flexibility''--as if the 
flexibility enables you to somehow conjure up $1 trillion. What you are 
really giving the States is the flexibility to decide between the 
elderly and the disabled or children. That is what this is all about.
  There is another option, by the way. The States can always raise 
taxes to make up for this difference, and that is one of the most 
frustrating things to me, again, as a former Governor. We are talking 
about this reduces the Federal deficit by $330 billion over 10 years. 
Yes, because you shifted almost a trillion dollars to the States. That 
is nice work if you can get it. That is balancing the Federal books on 
the backs of the States. If we want to make the Federal budget look 
better, why don't we just let the States pay for the Air Force? That is 
a Federal expenditure. Shift that to the States. That will help us with 
our budget deficit, but it is a fake balancing of the budget because 
you are simply shifting the cost over to somebody else--another level 
of government.
  The shorthand for that is shift and shaft. That is what we are 
talking about, either the State government is going to be shafted 
because they are going to have to raise taxes or the people who are 
going to lose the support are going to be shafted. We are talking about 
real people.
  Let me talk about Medicaid for a minute. Medicaid is sometimes 
characterized--and I have even heard some of my colleagues use Medicaid 
and welfare in the same breath, as if Medicaid is a welfare program. It 
is not. It is a critically necessary support for healthcare for people 
who need it, many of whom are not welfare people--as we would denote 
them--not welfare recipients. They are getting a lifeline, a true 
lifeline that is actually keeping them alive.
  In Maine, 70 percent of the people in nursing homes are on Medicaid. 
Nationwide, the number is 62 percent. So when you talk about Medicaid 
and cutting Medicaid, you are talking about Aunt Minnie in the nursing 
home. You are not talking about some welfare recipient who is ripping 
off the system. You are talking about your relatives who are in nursing 
homes, and 70 percent of the people in nursing homes are being 
supported by Medicaid. In Maine, we call it MaineCare.
  So you can't shrink this amount of money and think it is not going to 
have impacts on people, and that is why this bill is so pernicious. 
Here is what the bill is all about: a one-half trillion-dollar tax cut 
to the top 2 percent of wage earners in America. Let's be clear what is 
going on here. There is an equation of one-half trillion dollars of tax 
cuts and more than one-half trillion dollars of cuts to benefits--money 
to the wealthy; healthcare away from those who need it. That is the 
equation. That is what this bill is all about. This isn't a healthcare 
bill. This is a tax cut bill dressed up like a healthcare bill, and it 
is also an ideological bill because people don't like Medicaid.
  Here is the problem: Our healthcare system is the most expensive in 
the world. We pay the most per capita for healthcare as anyone on the 
planet, by far--just about twice as much as most other countries. If 
you do the math and you take the annual healthcare bill and divide it 
by the number of people in America, you get about $8,700 a year per 
person. That is what we spend on healthcare. So for a family of four, 
that is $35,000 a year. That is what healthcare costs us. By the way, 
that is the real problem. When we are talking about Medicaid and 
Medicare, Anthem and private insurance, and all of those things, we are 
really talking about who pays. The deeper issue is how much we are 
paying. The problem is--and the reason we need Medicaid and the reason 
we need Medicare and the reason we need the Affordable Care Act--
American people can't afford it without help. It is as simple as that. 
They can't afford it. The government has to provide some support. If it 
doesn't, it would break every family in America. We have to have the 
support. Right now, in the private sector, it is breaking our companies 
that are trying dutifully to keep up with the increase in costs of 
healthcare.
  Don't fall for this idea that somehow the Affordable Care Act caused 
all the increases. I remember--again, harking back to when I was the 
Governor of Maine in the late 1990s, early 2000s--healthcare costs were 
going up 6 percent, 8 percent a year--10 years before the Affordable 
Care Act went into place. The private--the individual market for health 
insurance was already on a drastic upward climb. So to blame it somehow 
on the Affordable Care Act just doesn't wash in terms of the history.
  The deep problem, as I say, is the overall cost of healthcare. We 
have to start talking about that issue. That is a separate issue from 
what we are talking about here as to who pays. We have to talk about 
different kinds of delivery systems. We have to talk about a huge 
increase in preventive care. We have to talk about helping people stay 
out of the hospital, stay out of the medical system. The cheapest 
medical procedure of all is the one you don't have to perform. So many 
of our diseases--our chronic diseases like diabetes--are based upon the 
choices people

[[Page 10008]]

are making and their lack of adequate care early in the disease. That 
is a separate discussion. I think that is one we really have to look 
at. However this debate is resolved in the next few weeks or few days, 
we have to talk about the deeper issue of the overall cost. If we don't 
get a handle on that, then all of this other stuff is going to be--it 
is not going to solve the problem because the deeper issue is the 
enormous cost we pay in this country, which is almost twice as much as 
anybody in the world per capita.
  You could say: But we have the best healthcare in the world. Yes, we 
do, for the people who can afford it. But for millions of people who 
can't afford it, who have either no or skimpy care, it is not the best 
healthcare system in the world.
  There are no statistical indicators that tell us we are doing very 
well. On things like longevity, prenatal care, infant mortality, we are 
way down. We are like 17th, 20th. You would think that if we are 
spending the most money in the world, we ought to have great results. 
We don't. So that is something we have to talk about.
  The cost of pharmaceuticals, the cost of drugs is higher here than 
anywhere else in the world. Why is that? That is a problem we have to 
discuss.
  I had a tele-townhall Monday night. It was sponsored by the AARP of 
Maine. At the peak, they tell me there were 10,000 people on that call. 
I took questions, and the questions from seniors in Maine were full of 
concern--``fear'' may be too strong a word, although in several cases 
it wasn't, but very deep concern about what the effect of this will be 
on them, on their mothers, on people who are depending on Medicaid for 
their care.
  One lady who called pays $8,000 a month for her chemotherapy drugs. 
If it weren't for her support under the Affordable Care Act and 
Medicaid, she said on the phone, ``I'd be dead.'' That is what we are 
talking about here. We are talking about real people.
  The final sort of general point I want to make before I talk about 
some of the people who are going to be affected by this is that I hear 
sometimes the proponents saying: The free market is going to solve this 
problem. The free market is miraculous; it can solve all problems.
  I am a huge believer in the free market. I am a thoroughgoing 
capitalist. I started a business. I ran a business. I understand the 
free market. The problem is that healthcare is not a free market. If 
you go to buy a car, that is a free market. You can go online and 
compare. You can test drive. You can find the prices at the four 
dealers that are in your neighborhood. You can do all of those things. 
That is a free market. You don't have that in healthcare.
  No. 1, you don't know the price. You call your local hospital and 
say: What will it cost me to get my knee replaced? Nobody can tell you. 
You don't know the price.
  No. 2, it is very hard to compare products. You can do it if you can 
really dig and get word of mouth on who is a good doctor and who isn't.
  No. 3, you don't say what you want; the provider tells you what you 
need. Imagine going into a car dealership and the car dealer saying: I 
am going to tell you I think you need this Mercedes over here. I think 
that is what you need, and by the way, you pay for it.
  Our system is set up such that providers are paid for delivering a 
service, not keeping you well. They get paid by procedures, fee-for-
service, not for keeping you well. There is no money in prevention. We 
have to change that. We have to change that.
  Now let me talk about people. These are some people I have talked 
about before, and I just want to sort of go through them.
  You know who this is. This is a Maine lobsterman. This is a guy; his 
name is David Osgood. The ACA gave them a chance to get insurance. It 
gave them an opportunity to get insurance where before it was 
practically impossible. He said it has given them some comfort, some 
reassurance. He said: ``We'll be okay.'' That is the Maine way. ``We'll 
be okay.'' This is one of the most independent, toughest professions 
there is in this country, but he is not part of a big corporation, and 
he doesn't have somebody to pay part of his healthcare. He has to make 
it work, and the ACA gave him an opportunity that he didn't have before 
to give some confidence to his family and to his life.
  By the way, there are about 75,000 people in Maine just like him who 
got coverage under the ACA, many of them for the first time, and those 
are the calls we are getting in my office.
  This is Jonathan Edwards and Jen Schroth. This is sort of a funny 
story; it tells you what Maine is like. I know Jen's mother. I worked 
with Jen's mother in the early eighties. Maine is a big small town with 
very long roads. We all know each other. And it just happens that here 
we are, 25 years later, and I have become acquainted with Jen.
  She and her husband are farmers. They are small farmers in coastal 
Maine. She thinks it is irresponsible to go without health insurance, 
especially when you have a family, but it was so expensive, they 
couldn't get it. They couldn't acquire health insurance in the 
individual market because they are not a member of a big corporation. 
The ACA gave them access to insurance for the first time--real 
insurance that covers what they need, not skinny insurance that only 
covers certain things and doesn't cover other things and just gives you 
the illusion of coverage until you go to make a claim.
  Jonathan Edwards and Jen Schroth are farmers in Brooklin, ME--that is 
the real Brooklin, by the way, Brooklin, ME. Forget about that place in 
New York; this is Brooklin with an l-i-n. They are farmers in Maine to 
whom the ACA gave an opportunity to get insurance for the first time 
for their family.
  Cora and Jim Banks from Portland raised four boys. This is amazing. 
They raised four boys, and every single one was an Eagle Scout. That is 
amazing. I mean, to be an Eagle Scout is a real achievement in this day 
and age. Cora worked at her home. She developed Alzheimer's in her late 
fifties. That is a tragic disease. When Jim could no longer care for 
her safely at home, she went to a nursing home, and Medicaid helped her 
be there. Medicaid helped her be there. If you start taking away 
Medicaid, what will become of Cora? What will become of Jim? He took 
care of her as long as he could. If she has to go home, if she has to 
leave that home, that will be a tragedy for her and for her family.
  Again, as I mentioned before, 70 percent of the residents in nursing 
homes in Maine are on Medicaid. That is the kind of difference it makes 
in real life.
  Here is Dan Humphrey. Dan Humphrey is a young man with autism who 
volunteers at local soup kitchens and delivers Meals on Wheels in 
Lewiston, ME. He depends on a Medicaid waiver to support his 
independent living. If it weren't for Medicaid, Daniel would be in an 
institution, or he would be with his parents. They wouldn't be able to 
work because he would need care 24 hours a day. He does need care and 
support 24 hours a day. Under Medicaid, he is able to lead a real life 
and feel good about it. You can tell he is a great guy; look at his 
smile. Medicaid is a lifeline.
  I talked about Dan 2 or 3 weeks ago, and since then, I have had an 
outpouring from people across the country and especially in Maine, 
people who have children or relatives or friends with disabilities, on 
what this has meant for them and how terrifying it is that anybody 
wants to take three-quarters of a trillion dollars out of Medicaid, 
which is providing an opportunity for Daniel to lead a decent life. Why 
would anybody want to do that? I don't get it. I don't get it.
  Of course it can be made more efficient. Of course the ACA can be 
made more efficient but not three-quarters of a trillion dollars more 
efficient. That is a huge amount--$450 million a year in Maine.
  Daniel waited 8 years, under the current program, for the services he 
gets now. And if we put in caps and block grants--that sounds good in 
Washington: We are going to put in caps. Caps mean Daniel may not get 
his services next year or the year after or another guy like Daniel in 
Peoria or Philadelphia or San Francisco. That is a tragedy. These are 
real people. We are not talking ideology; we are talking real people.

[[Page 10009]]

  Here is Lydia Woofenden. She lives near where I live. She just 
graduated from Mount Ararat High School in Topsham. Two of my boys 
graduated from Mount Ararat. She even has a job she was offered after 
years of volunteering. Everything she has achieved has been 
accomplished with help from her family and dedicated teachers and 
therapists almost exclusively funded through special education in the 
public schools and Medicaid.
  By the way, having a child with disabilities has nothing to do with 
your income. You could be high income, low income, middle income. It 
has to do with the luck of the draw. It has to do with bad fortune, and 
it could hit anybody. So, again, this idea that Medicaid is some kind 
of welfare program is just not true. It is not true.
  So, Mr. President, the reason I am here is because of these people. 
The reason I am here is to stand up for these people because they can't 
be here to do it themselves.
  We can do better. The failure to get the votes to vote on this bill 
this week gives us all a chance to take a deep breath, to step back and 
say: Sure, there are things wrong with the Affordable Care Act. There 
are things we can debate. There are things we can argue about. We can 
have amendments. We can do what we did in the Armed Services Committee 
over the last 2 days and have a real discussion and debate. I know it 
is possible because I sat there and saw it happen. It can be done, and 
we can do it here.
  Let's take a week not to try to browbeat and push and make special 
deals to try to get 51 votes or 50 votes and then the Vice President 
breaks the tie. It goes to the House, and they don't even look at it--
they will pass it. And then we will be embarked on a path that is 
really going to hurt the American people.
  We have to have help. Healthcare is too expensive, and regular people 
in this country can't afford it. We have to have help, and this is the 
place where people are looking to find that help. Let's try to work 
together. I am certainly willing to work with anybody who will listen. 
But if they are starting from a premise of gutting Medicaid and giving 
somebody else a huge tax cut, that doesn't work. Let's talk about the 
real problem. You want to talk about healthcare, let's talk about it. 
Let's talk about how we can lower the cost of healthcare, how we can 
lower the cost of deductibles, how we can lower premiums, and how we 
can provide new options to people in the health insurance system. But 
let's not talk about what we are going to do that is going to have such 
tragic results on individuals and families and on the fabric of our 
society.
  Mr. President, I believe we can do better. I believe we can do 
better, and we have an opportunity to do so. It sort of dropped into 
our laps this week. We have 10 days to work on this, to think about it, 
to try to come up with a solution or at least begin the process of a 
solution. There is no deadline here next week, but let's begin the 
process.
  As we begin, I have this radical idea of referring these bills to 
committees here in the Senate, having hearings, getting expert 
opinions, listening to the country, listening to the hospital 
association that says this is a terrible bill. The American Medical 
Association says this bill violates the basic principle of the medical 
profession: First, do no harm. This bill will do harm.
  There is no group whom I have heard of who is for it--only people who 
have an agenda to cut Medicaid because they don't like Federal support 
or people who have an agenda to change the Affordable Care Act because 
it has Obama's name on it. That is not a good enough reason to strike 
at the heart of our people, our communities, and our society.
  One final point. I have been talking about people; let me talk about 
jobs. In Maine, in 8 of our 16 counties, the hospital is the largest 
employer. I talked to a hospital director an hour ago. They are 
desperate about what is going on down here because it is going to make 
it difficult for them to survive and serve their communities--the rural 
hospitals especially. I have met with them across Maine--in Farmington, 
Bridgton, Skowhegan, Lincoln. Maybe you haven't heard of those towns 
because they are small towns in Maine, but they have a hospital that is 
the heart of the community and the biggest employer in the community. 
They all told me the same thing. This idea of this bill, this approach, 
is going to kill them. It is going to cause them to at least shrink 
their services or close. In Maine, because we are a rural State with 
far-flung communities, that means people are going to be a long way 
from available care--1 hour, 2 hours--and that is a tragedy for our 
communities in terms of economic development, in terms of jobs, but 
mostly, as I keep saying, because of people.
  People say: Why are you so impassioned about this, Angus?
  It is because this is what the people of Maine sent me to do. They 
sent me down here to help them, not hurt them. They sent me down here 
to speak for them, not stifle their voices. They sent me down here to 
do the right thing, to do the ethical thing, to protect them when 
nobody else will. That is why I am here, and I believe that this 
Senate, this Congress, this government, can do better, and I hope we 
will.
  Thank you, Mr. President.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Toomey). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. INHOFE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded
  The PRESIDING OFFICER. Without objection, it is so ordered.


  Congratulating the University of Oklahoma Women's Softball Team on 
  Winning the 2017 Women's College World Series National Championship

  Mr. INHOFE. Mr. President, this is a little out of character. 
Confession is good for the soul. One of my very favorite--maybe my most 
favorite--of spectator sports is, of all things, girls' softball.
  Now, a lot of people don't even know anything about the sport. It is 
pretty incredible. I am pleased to tell you that Oklahoma City is the 
home of a very famous ASA Hall of Fame stadium, which is the world's 
No. 1 softball field. This is where the Big 12 Softball Championship 
and the Women's College World Series are held.
  This past May, the Sooners won the championship game at the Big 12 
softball tournament between Oklahoma and Oklahoma State, which also has 
a great team, at this impressive stadium. The Sooners won.
  Then, on June 6, they became the 2017 Women's College World Series 
national champions in Oklahoma City.
  After facing diversity in the earlier game against North Dakota State 
in the NCAA regionals, the Sooners proceeded to win 11 consecutive 
games--think about that, 11 consecutive games--ultimately achieving a 
5-to-4 victory over the University of Florida Gators.
  In the first game of the championship series, Oklahoma outlasted 
Florida in a recordbreaking--I was here; we were actually in session at 
that time--17 innings. It went until 3 o'clock in the morning. Of 
course, we won. It was the longest game in the history of women's 
college series of all time.
  This win is the women's softball team's second consecutive national 
championship and the third in the last 5 years. This is a big deal. 
These girls come from all over the country and end up playing softball 
there. It is something where they are clearly national champions. It 
makes me very proud to see that they are doing so well.
  I would like to take a moment to congratulate all of the players. 
Their hard work clearly paid off. It is important to thank the coaches 
as well. Thank you for your skills, your tenacity, and your dedication, 
which helped lead these ladies to victory.
  Their remarkable head coach, Patty Gasso, has been with OU since 
1995, and was inducted into the National Fast Pitch Coaches Association 
Hall of Fame in 2012. I bet you didn't even know there was such a 
thing, but there is. She and her staff have worked together over the 
last few decades to build a legacy that has a strong community 
following. These women will

[[Page 10010]]

continue to make Oklahoma proud through their various roles as 
students, athletes, and leaders.
  Just last week, junior pitcher Paige Parker was warming up before she 
threw the ceremonial first pitch of the game between the Kansas City 
Royals and the Boston Red Sox. It was during this warmup that the 
Royals players were able to see firsthand how impressive girls' 
softball pitchers are. The catcher even missed some of them and almost 
fell over.
  I wish the best of luck to these players and the coaches for next 
year's softball season. Enjoy your success, and bring home another 
national championship next year.
  Mr. President, I ask unanimous consent that the team roster of all 
the players and coaches, who made this a great championship victory, be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       The players: Kelsey Arnold, Falepolima Aviu, Caleigh 
     Clifton, Alissa Dalton, Macey Hatfield, Shay Knighten, Mariah 
     Lopez, Paige Lowary, Kylie Lundberg, Nicole Mendes, Melanie 
     Olmos, Paige Parker, Nicole Pendley, Raegan Rogers, Sydney 
     Romero, Hannah Sparks, Vanessa Taukeiaho, and Lea Wodach.
       The coaches: Patty Gasso, Melyssa Lombardi, JT Gasso, 
     Jackie Bishop, Lacey Waldrop, Brittany Williams, and Andrea 
     Gasso.

  Mr. INHOFE. Mr. President, I yield the floor.
  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. 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.


                         Healthcare Legislation

  Mr. BLUMENTHAL. Mr. President, over the last 10 days, I have 
conducted emergency field hearings, giving my constituents in 
Connecticut an opportunity to be heard, a chance for their voices and 
faces to be part of considering the Republican healthcare or really, 
more accurately, wealth care bill. Indeed, that label or 
characterization of the bill came from one my constituents who said: 
This plan is not healthcare, it is wealth care because it produces a 
massive transfer of wealth from the poor and middle-class Americans, 
whose healthcare would be deeply harmed, to the richest Americans, who 
would enjoy the benefits of hundreds of billions of dollars in tax 
cuts.
  That kind of voice and criticism deserves to be heard here. Yet my 
Republican colleagues and their leadership have gone from total secrecy 
to total chaos. They are in chaos because they have refused to heed the 
voices and faces of ordinary, average working people--middle-class 
people, the most vulnerable people--who would be deeply harmed by this 
proposal.
  One woman at one of my hearings in Connecticut, knowing what would 
happen under this bill, said to me:

       Do the right thing. Save the Affordable Care Act and save 
     our lives.

  She was not exaggerating when she said lives are at stake. She is 
right. This very eloquent woman, Amy Etkind, knows all too well what 
this bill means for Americans like her, and the man she described, 
literally, as the ``love of her life.'' She told me about him during a 
hearing in New Haven Friday afternoon--about how he has struggled with 
addiction, mental health issues, and now diabetes. He is alive today 
because of Medicaid, and he has access to the services he needs. As she 
said, ``If Medicaid were to go away, he would be literally dead in a 
very short period of time.''
  When we say the Republican plan would cost lives--it would kill 
people--it is no hyperbole, no exaggeration. It is plain, simple fact. 
As Ronald Reagan said, ``Facts are stubborn things.'' The fact is, this 
bill would cost the State of Connecticut nearly $3 billion in Federal 
funding over the next 10 years. These cuts, mainly to Medicaid, cannot 
and will not be replaced, as the CBO has predicted. It would leave 
States like Connecticut in an impossible position: either raise taxes 
to pay the difference or cut Medicaid enrollment to insurers, putting 
people like Amy's husband at risk, literally, of death; putting out on 
the streets the senior citizens living in the Monsignor Bojnowski Manor 
in New Britain, where they are enjoying great care--a high-quality 
environment because of Medicaid. Many of them are middle-class folks 
who worked hard, played by the rules, and exhausted their savings. They 
are vulnerable now because of the cost of healthcare and their care, in 
particular. The focus ought to be on them, on the people who are 
affected, not so much the numbers, but we know from the numbers that 
the Republican plan would disastrously raise premiums by 20 percent and 
would cut enrollment impact on the individual market--premiums and 
enrollment, apart from Medicaid, on the individual market. These 
numbers are from the Center on Budget and Policy Priorities. They are 
fact. Facts are stubborn things.
  We know also what the effects would be--what the numbers are for 
people who are middle income. The elimination of the tax credits for 
middle-income people paying their premiums would be nothing short of 
disastrous.
  We focused on Medicaid. I talked to you about Amy and the love of her 
life and what the effects would be of the decimation of Medicaid, but 
here we are talking about the elimination of tax breaks that help 
middle-income people. I don't need to explain this graph. For someone 
with $26,500 in income, their premiums under the Senate plan would jump 
to $6,500 from the present $1,700. For somebody earning in the 
midfifties, the jump is even greater, and it is true even for people 
who are earning $68,200. They will have to pay more, a larger share of 
their income, and receive less. It is not only that the Senate plan is 
disastrous because it is more costly, it is also going to impact the 
quality of care by reducing the standards; eliminating the strict 
requirements on preexisting conditions, the protections on annual and 
lifetime caps for coverage, defunding Planned Parenthood, continuing 
the war on women's healthcare. The long and short of it is that this 
measure is bad for America.
  Tia spoke to me at these hearings about the opioid epidemic. If there 
is one example that breaks our hearts and wrenches our guts, it is the 
effect on people who are trying to recover from opioid addiction and 
abuse. Their recovery would be shredded--maybe stopped--by gutting 
Medicaid coverage.
  Another woman who spoke at my hearing, Donna Sager, called herself 
``the perfect example as to why our healthcare plans must include 
preexisting conditions and not punish people like me with high 
premiums.'' Donna, as she told me, is 63 years old and not yet eligible 
for Medicare. When she was 36, she was diagnosed with a rare form of 
hereditary colon cancer. For 27 years she has been undergoing major 
surgeries, constant screening, doctor visits to make sure she can 
remain as healthy as possible. Then she told me about her husband, a 
man in his seventies, and she said this:

       He would like to retire, but how can he with all my medical 
     expenses? I am frightened what I will do if the Republican 
     healthcare bill gets passed. Changes to preexisting coverage 
     will be extremely damaging to me, how will I pay these costs 
     and high premiums? The republican healthcare plan wants to 
     punish me for having cancer.

  She closed by saying:

       It is as though Washington wants to punish me again for 
     having cancer and being older. . . . I never would have 
     expected that the greatest country in the world would treat 
     me like this.

  There is a path forward, and it requires our Republican colleagues 
very simply to start over, to work with Democrats, to abandon this 
misguided, myopic effort to repeal, repeal, repeal. That mantra simply 
is not a policy for American healthcare.
  What is needed is to build on the Affordable Care Act, to improve it, 
to correct its defects. We can do it if we work together and if we 
focus on the rising costs of medical care and try to bring them down, 
if we focus on the regulatory barriers to entering insurance markets 
and seek to eliminate them, if we focus on the FDA drug approval 
process and seek to responsibly

[[Page 10011]]

and safely expedite new drugs coming to market, if we enable Medicare 
to negotiate drug prices as the VA does. Those examples of improving 
the present system are doable. They require leadership, which has been 
lacking and most particularly lacking at the White House.
  Yesterday, we saw a picture that is worth a thousand words: the 
President of the United States sitting with Members of this body, but 
only Members of this body from the other side of the aisle--only 
Republican Senators. It was almost the entire membership on the 
Republican side. Not a single Democrat was invited, not a single 
Democrat consulted, not a single Democrat involved in the continuing 
process now of producing yet another plan behind closed doors in 
secrecy.
  The majority leader announced it just today. The effort is to have 
another version to be submitted to the CBO by Friday, but that process 
simply continues the present fatal flaw in my Republican colleagues' 
thinking, which is that they can do it with only one party. I want to 
give credit to our Republican colleagues who had the courage and 
strength to say no because they saw it was bad for America.
  In closing, I want to say that my Republican colleagues will be going 
home this weekend. They have been looking at themselves in the mirror, 
at their consciences, and they have been seeing something they don't 
like--a moral failing in this bill, not just a political failing or a 
policy defect but a real moral failing.
  Healthcare is a right, and even if my Republican colleagues disagree 
on that point, they have to recognize that taking away healthcare, 
decimating Medicaid, waging war on women's health, depriving children 
of the preventive care they need so they can go to school and learn 
properly, evicting seniors from nursing homes, putting the burden of 
billions of dollars on my State of Connecticut and every State 
represented in this body, and other grotesque, cruel, costly impacts of 
this bill are the wrong ways to go. They know that when they look in 
the mirror, but they will know it even more powerfully when they look 
in the eyes of their constituents this week--if they have the guts and 
courage and heart to do so.
  This wealth care plan is doomed to failure. Even if it passes, it is 
doomed to fail America. It is a moral failing, not just a policy 
failing. The health of our consciences, as well as our physical well-
being, hangs in the balance.
  Thank you.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. UDALL. 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. UDALL. Mr. President, I rise to defend the essential healthcare 
that 300,000 New Mexicans and millions of Americans depend on.
  Leader McConnell calls his TrumpCare bill the Better Care 
Reconciliation Act, but actually the bill will mean worse care for 
seniors, children, the disabled, rural communities, and working 
families all trying to make ends meet. It will mean no care for 22 
million people, according to the latest Congressional Budget Office 
report. The bill cancels health insurance and slashes Medicaid funding, 
all so Republicans can give big tax breaks to the richest Americans.
  President Trump called the original House bill mean. The Senate 
Republicans' healthcare bill isn't just mean; it is cruel. It is cruel 
to take away nursing home care that seniors depend on, cruel to take 
away necessary medical services from disabled children. Make no 
mistake, this bill will cost lives.
  This version of TrumpCare is a massive redistribution of wealth from 
working families, seniors, and the disabled to the wealthy. But the 
Republicans' bill is not Robin Hood in reverse. TrumpCare doesn't just 
take money away from the poor to give to the rich; it takes away 
people's healthcare and robs families of their health and ability to 
work, care for their families, contribute to society, and lead happy 
and healthy lives.
  This bill was drafted in secret. Only a handful of Republicans and 
their lobbyist friends got to see the bill. It is no wonder the 
American people hate what TrumpCare would do to them and to their 
families. TrumpCare is cruel; there is no doubt about it.
  It is good that Leader McConnell decided not to call a vote this week 
on this terrible bill, but I am by no means satisfied. We need to hear 
from the Republican leadership that they are ready to work with 
Democrats to improve the Affordable Care Act, not gut it, and to truly 
improve our healthcare system. This is what the American people are 
demanding, and this is what we in Congress should be working toward on 
a bipartisan basis.
  We created Medicaid in 1965 to serve a critical need. Since then, 
Medicaid has become one of the most successful programs for making sure 
low-income people get the healthcare they need. People get treatment 
for illnesses that once were a death sentence.
  The American people support a government that doesn't leave its most 
vulnerable to suffer and die, but the current Senate bill cuts Medicaid 
by more than $770 billion. Let's be clear, these cuts have nothing to 
do with better healthcare. They are a ruthless tactic to fund tax cuts 
for the wealthy.
  On the campaign trail, the President vowed not to cut Medicaid. He 
said it a number of times. Last week, he tweeted that he is ``very 
supportive'' of the bill. Yesterday, he met with the Republican caucus 
and told them to pass the bill. By supporting this bill, the President 
breaks the promise he made during the campaign.
  Medicaid expansion has allowed millions of Americans and over 265,000 
people in my State to see a doctor. Many of these folks work but don't 
have health insurance through their jobs or can't afford private health 
insurance. Medicaid expansion is literally a lifeline, but TrumpCare 
wipes this out. I can't believe that our Republican friends are doing 
this to New Mexico children and families.
  Take 1\1/2\ year old Rafe--this is Rafe. Rafe is here with his mom 
Jessica and his dad Sam, a veteran. They are from Albuquerque, NM. Rafe 
was born with cortical visual impairment--a kind of legal blindness--
and significant developmental delays. He faced monumental medical 
challenges. But Jessica and Sam have been able to access the intensive 
medical care, early intervention services, medical equipment, and 
therapies he needs through a combination of their military insurance 
and Medicaid.
  Now Rafe's parents are scared he will lose his Medicaid services. 
Their military insurance alone doesn't cover all the services and 
equipment Rafe needs. They need Medicaid. Without it, Rafe's chances 
for a better life are threatened. They worry about--and this is their 
quote--``dealing with insurance, finding healthcare, tracking down 
specialty doctors, keeping up with therapy appointments and doctor's 
appointments.'' They worry whether Rafe will be able to walk, feed 
himself, graduate from high school, and get a job. Now they must worry 
whether he will get the medical care he needs to give him the 
opportunity to do all of those things.
  Let's talk about Carmen and her three children. Carmen is a single 
parent. She serves Native American students as a teacher, a coach, dorm 
parent, and higher education administrator. The small nonprofit 
organization Carmen works for doesn't offer health insurance. For the 
past 4 years, Medicaid has helped pay for the healthcare for her two 
sons.
  Her kids are healthy, but two have nut allergies and need EpiPens at 
school and at home. According to Carmen, ``When I renewed their EpiPen 
prescription for school this past fall, I was astounded that the price 
sky-rocketed to $741 to fill one prescription!''
  Now Carmen is worried; she doesn't know whether her kids will lose 
Medicaid or how she will pay for prescriptions. She asked me: ``Please 
continue to fight for the Affordable Care Act because you are fighting 
for me and my family's well-being.''
  It is cruel to threaten Rafe's chances for a healthier life, cruel 
that Carmen

[[Page 10012]]

might not be able to pay for EpiPens for her kids. TrumpCare threatens 
these two families and millions more.
  TrumpCare will hurt seniors, so it is not surprising that AARP 
strongly opposes it. AARP opposes the TrumpCare age tax that allows 
insurance companies to charge seniors up to five times more for their 
premiums. The age tax, combined with reducing tax credits for premiums, 
will price seniors out of health insurance needed to supplement their 
Medicare. AARP is calling on every Senator to vote no on the Senate 
Republicans' bill.
  Medicaid pays for an astounding 62 percent of all nursing home care. 
By cutting Medicaid, the Republicans threaten our mothers, our fathers, 
and our grandmothers and grandfathers in nursing homes. States can't 
bear the burden of these costs. Republicans want to shift them.
  I know the State of New Mexico can't handle this. This cost-shift 
sets States up to cut reimbursement rates and reduce eligibility for 
services at nursing homes. Medicaid pays 64 percent of nursing home 
care in my State. New Mexico's 74 nursing homes will be impacted by 
these cuts.
  Many of the folks in nursing homes are middle-class Americans who 
worked all their lives, paid taxes, and saved for retirement. They did 
everything right, but because skilled nursing care is so expensive, 
they have outlived their life savings, and now Medicaid pays the cost 
of care at the end of their lives, allowing them to live with dignity.
  Senate Republicans may say that one improvement in their bill over 
the House bill is it protects people with preexisting conditions, but 
the American people shouldn't be fooled. People with preexisting 
conditions are not protected under the Senate bill the way they are now 
protected under the ACA.
  The Senate Republican bill still allows States to waive the essential 
health benefits that all insurance companies must now provide under the 
ACA. These benefits include prescriptions, hospital stays, 
rehabilitative services, and laboratory services. If States waive these 
benefits, people with serious illnesses would have to pay out of pocket 
for these services or buy additional insurance, or if these services 
are covered but are not essential health benefits, insurance companies 
can put annual or lifetime limits on the services, and people with 
serious illnesses could end up with no coverage or be priced out of 
services.
  All this sends us back to the time when people faced not getting care 
or going bankrupt if they got sick. We passed the ACA because the 
American people agreed no one should go broke to pay for lifesaving 
care and that insurance companies shouldn't be able to place limits on 
the care someone could get in their lifetime. Why do Republicans want 
to take us back?
  Finally, the steep cuts to Medicaid would devastate hospitals, 
especially rural hospitals. Make no mistake--rural hospitals are 
already struggling. Medicaid cuts will force some to close their doors 
if TrumpCare becomes law.
  In New Mexico, our rural hospitals are often an economic anchor for 
the community. Hospital administrators in my State are very worried. 
Medicaid has helped the Guadalupe County Hospital cut its uninsured 
payer rate from 14 percent to 4 percent from 2014 to 2016. Its 
uncompensated care decreased 23 percent in the same period. The 
hospital's administrator, Christina Campos, fears what might happen if 
TrumpCare becomes law. She is urging me to protect access to care in 
rural areas.
  I will fight hard to keep residents in our rural areas insured and to 
keep rural hospitals open in New Mexico and across the Nation.
  The President and congressional Republicans want to take us back to 
the days when healthcare was a privilege for those who could afford it. 
The American people do not support the Republicans' cruel plans. 
Congress should listen to the pleas of our constituents. The American 
people reject the framework of TrumpCare. They reject gutting Medicaid 
and the Medicaid expansion. They reject making seniors pay more for 
healthcare. They reject making healthcare inaccessible for those with 
fewer resources.
  The Republicans need to go back to the drawing board and begin to 
work with Democrats. I say to my colleagues across the aisle, do not 
take healthcare and the opportunity to lead a productive and happy life 
away from millions of Americans. Together, we can make affordable 
healthcare a reality for all.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Ms. HEITKAMP. Mr. President, one of the things that the healthcare 
law changes here have demonstrated is that partisanship in Congress has 
reached a new high--or I would say a new low. I am tired of reading 
about who is to blame for what, and I know Americans and North Dakotans 
are too. Most importantly, it certainly doesn't do anything to help 
American families' healthcare get any better.
  We should all want to improve our healthcare system so it works 
better for families and for businesses. It should be a bipartisan 
discussion, not a political exercise. I am here, as are many of my 
colleagues, because that is what we hope to accomplish.
  For years, I have been offering reasonable reforms to make the 
current health reform law work better. I want such reforms to be 
bipartisan. I want to have a larger conversation about healthcare in 
this country. But the Republican Senate bill, the Better Care 
Reconciliation Act, is simply not the way to have those discussions. 
Frankly, this bill is a nonstarter.
  I have heard from so many North Dakota children with disabilities, 
seniors in nursing homes, men and women with preexisting conditions in 
my State, and hospitals, doctors, and nurses, especially in rural 
communities, who are deeply concerned--in fact, I can tell you, deeply 
panicked--about how this bill would make care less available and less 
affordable.
  There are commonsense actions we can and should take right now to 
make sure American families aren't hurt in the near term. That is why 
we are here today.
  Action and uncertainty caused by the administration, as well as House 
Republicans, exacerbated instability in the insurance markets, 
threatening significant cost increases for consumers in 2018. The 
administration has been unwilling to commit funding for cost-sharing 
reduction payments, and some Republicans have been working to dismantle 
the health reform law by not funding critical reinsurance programs. 
These actions make it extraordinarily difficult for insurers to plan 
and make business decisions for 2018--yes, 2018, the year we are 
talking about today. If insurers can't rely on these funds to support 
healthcare programs that make it possible for health insurance costs to 
remain affordable for families, the health insurance premium filings 
for the next term year will reflect that uncertainty. Health insurance 
rates for 2018 that have already been filed in some of our States 
demonstrate that fact.
  Let's talk about the facts. Independent reports from the 
Congressional Budget Office and Standard & Poor's have said that the 
insurance markets were expected to stabilize this year and could 
stabilize this year unless the administration causes disruption. If you 
look at the numbers from last year, you will see that health plans were 
offered in every county in this country.
  Today, we are here to offer a few bills that will make an immediate 
and real difference for families to address health insurance rate 
increases that we expect in 2018. These are commonsense bills that 
should be bipartisan.
  We hope our colleagues across the aisle will work with us in a 
bipartisan way so we can provide immediate relief and guarantee 
stability for the individual market--stability that will enable 
individuals and families in all of our States to avoid serious 
increases in their health insurance rates.
  No family should face bankruptcy to cover their healthcare costs 
because in Washington, DC, we can't implement the bill that we have and 
instead continue to stall and play the game of politics against the 
interests of the American people and, certainly in many

[[Page 10013]]

cases, some of sickest among us and people who have a whole lot of 
healthcare insecurity. This is politics. We cannot continue to play 
politics with people's health.
  Some of the issues we are working to address were included, 
interestingly enough, in the Senate healthcare bill--a clear 
acknowledgment from the Republicans that these changes are necessary 
for the health market to function in 2018.
  Right now, we are standing here because time is of the essence. I 
hope our colleagues will join us in this effort. We want to work with 
them. We hope they will work with us. We hope we can at least at a 
minimum get together and solve the problem for 2018 while we are 
debating the future of healthcare delivery in this country.
  I will call on my friend, the great Senator from New Hampshire, 
Senator Jeanne Shaheen, to offer what I think is a terrific idea and to 
talk about a bill on which I am a cosponsor.
  The PRESIDING OFFICER (Mr. Lee). The Senator from New Hampshire.


                   Unanimous Consent Request--S. 1462

  Mrs. SHAHEEN. Mr. President, I am very pleased to join my colleague 
from North Dakota, Senator Heitkamp, and appreciate all of the efforts 
she is making to try to address the challenges we are facing in the 
healthcare markets across this country. Like her and like so many of my 
colleagues who are going to be here, I have come to the floor this 
afternoon because we want to take urgent steps and we can take steps 
today to address the uncertainty in our health insurance markets. We 
can take steps today that can hold down premiums.
  I have heard Senators on both sides of the aisle who have expressed 
concern about looming premium increases in the Affordable Care Act 
marketplaces. We all need to understand, as Senator Heitkamp pointed 
out, what some of the causes of these premium increases are.
  Insurers regularly cite the Trump administration's refusal to commit 
to making cost-sharing reduction payments, also known as CSRs. These 
CSR payments were included in the Affordable Care Act in order to help 
Americans afford insurance once they had it. The ACA requires insurers 
to reduce deductibles and copayments for working families who are 
buying insurance in the marketplace. Because of the cost-sharing 
reduction payments, the CSRs, patients pay less for their care and the 
government reimburses the insurers.
  These reductions and payments are built into the rates insurers are 
charging for 2017. Yet the Trump administration has refused to commit 
to paying these reimbursements because of a partisan lawsuit that has 
been brought by House Republican leaders.
  Because of the radically uncertain landscape insurers are facing 
right now, many of them are doing one of two things: Some are pulling 
out of the ACA marketplaces altogether, and others are dramatically 
increasing premiums. The end result is fewer choices and higher costs 
for American families.
  Last year in my State of New Hampshire--and Senator Hassan is here. 
We represent New Hampshire, and we have been very concerned about what 
is happening right now. Last year, the insurance markets were stable, 
and health insurance premiums increased an average of just 2 percent--
the lowest annual increase in history. Today is a radically different 
story, in large part because of the uncertainty this administration is 
causing by refusing to guarantee insurers cost-sharing reduction 
payments. What we are seeing is that those insurance companies are 
protecting themselves by raising premiums on patients.
  The same thing is happening in other States. In some cases, insurers 
are filing two different sets of rates--a set that is premised on the 
administration continuing to make cost-sharing reduction payments and 
an alternative set with higher premiums to account for continuing 
uncertainty and the possibility that this administration will stop 
making those payments.
  Unfortunately, the Trump administration continues to send mixed 
signals to insurers, and of course it has threatened to stop paying 
cost-sharing reduction payments altogether. If this were to happen, 
insurers could immediately exit the markets for breach of contract.
  So we are kind of in this perverse limbo situation. The 
administration creates uncertainty by refusing to commit to continuing 
the CSR payments, and the insurers protect themselves by exiting the 
markets or raising rates. And it is the premium holders, the families 
out there, who are hurt by this political football that the 
administration seems to be intent on continuing.
  That is why I have introduced the Marketplace Certainty Act, which is 
a bill to appropriate funding for the cost-sharing reduction payments 
in order to make good on our commitment to help working families with 
their deductibles and cost sharing.
  I believe that the House Republican leaders' lawsuit has no merit but 
that the chaos it has caused by allowing the Trump administration to 
waver on these promised payments requires that we act now.
  I am pleased to be joined in this legislation by Senators Baldwin, 
Blumenthal, Cardin, Carper, Coons, Kaine, Hassan, Heitkamp, Cortez 
Masto, King, Leahy, Markey, Wyden, Stabenow, and I am sure that by 
tomorrow, we will have even more Senators on this bill.
  We could pass it right now. Right now, we could end this manufactured 
crisis. We could immediately restore certainty and stability to the 
health insurance markets for all of our constituents. That would be 
good for the Republicans, and it would be good for the Democrats. 
Mostly, it would be good for the families out there who are 
experiencing this uncertainty.
  We could do this. It would give us the breathing space we need to 
come together on a bipartisan basis to improve the law, to strengthen 
what is working and to fix what is not. In poll after poll, that is 
what the American people want us to do. They want us to stop the 
partisan bickering. They want us to work together. They want us to make 
commonsense improvements so that this law works for every American.
  Mr. President, at this point, I ask unanimous consent that the Senate 
proceed to the immediate consideration of S. 1462, the Marketplace 
Certainty Act; that the bill be considered read a third time and 
passed; and that the motion to reconsider be considered made and laid 
upon the table with no intervening action or debate.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, reserving the right to object, I just 
had an opportunity to read the legislation of the Senator from New 
Hampshire. It appears that the legislation was just filed today. 
Instead of giving the American people time to read the bill, the Senate 
is being asked to pass the legislation now. At a minimum, shouldn't the 
American people have at least a day to read the proposal?
  Putting that aside, this bill seeks to address another major failure 
of ObamaCare. That is what they are trying to do here. As a doctor, I 
want insurance to be affordable for patients all across the country. 
This bill confirms what we all know--that ObamaCare is not affordable.
  The Senator is well aware of the large premium increases in her own 
State. It is not just the premiums that are skyrocketing. This week, I 
spoke to a woman in Wyoming. She told me that the deductible under her 
ObamaCare plan is so high that her husband refuses to go visit the 
doctor. She said that it is $6,500 for her and $6,500 for him and that 
he will not go to a doctor with that kind of a deductible. According to 
supporters of ObamaCare, this person is actually covered under 
ObamaCare, but as a doctor, I see things differently in that healthcare 
must be more affordable for everyone.
  The Senator's proposal seeks to throw more money at a systemic 
problem with ObamaCare. Instead, we should be passing bills that 
actually bring down the cost of care.
  When the Senator mentions the CSRs, I will point out that absolutely 
every payment has been made--every one--all the way up until today.

[[Page 10014]]

  People also talk about the sabotaging of the market. To me, the 
sabotaging of the insurance companies and the insurance market in this 
country has been because of ObamaCare's mandating that people buy 
insurance--buy more than they want, more than they need, and more than 
they can afford in so many cases, and it is insurance that provides 
very hollow opportunities to actually use the insurance.
  Again, I appreciate the acknowledgment that ObamaCare is clearly not 
working; however, our focus should be on policies that make healthcare 
more affordable to all Americans.
  I object.
  The PRESIDING OFFICER. Objection is heard.
  The Democratic leader.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that we get our 
full amount of time and that the time my friend from Wyoming uses be 
from the Republicans' time at some point later.
  The PRESIDING OFFICER. There is no order for divided time.
  Mr. SCHUMER. Oh. So we have as much time as we need?
  The PRESIDING OFFICER. There is no order.
  Mr. SCHUMER. I thank the Presiding Officer.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, while I am disappointed, I am not 
surprised that my colleague from Wyoming has objected to our effort to 
move forward. He is objecting to ending the uncertainty we have 
experienced, which is forcing insurers to raise rates because of the 
uncertainty with which this administration is administering the 
Affordable Care Act. They have been very clear that they want 
marketplaces to implode so that the act does not work for people. 
Senator Barrasso is objecting to a commonsense step to stabilize the 
insurance marketplaces.
  This is not going to be the last word because this is a commitment we 
made to American families. The instability here in Washington is what 
is causing the instability not only in insurance markets but in the 
country at large.
  We are approaching the Fourth of July, which is next week. When our 
Founders declared independence on July 4, 1776, Benjamin Franklin 
warned that we must all hang together or we will all hang separately. 
It is no different today. We all need to come together. We need to work 
across the aisle. We need to improve the healthcare system so that it 
works for all Americans. That is our goal. That is why we are here on 
the floor today, and we need to start by making sure the insurers have 
some certainty so that they can keep rates low for American families. 
We will be back, have no doubts about that.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mrs. McCASKILL. Mr. President, I have to say that there are a lot of 
things my friend from Wyoming could have said in his objection, but to 
lecture us about bringing out a bill that people have not had a chance 
to read or study is rather rich at this moment in our legislative 
journey on healthcare. I do not know if he thought that through before 
he said it, but I can assure you that when it came out of his mouth, 
all of us on this side were saying: You have got to be kidding me. 
Really? It was just a little much.
  I know we are all talking around the obvious, and that is that we 
need to fix the healthcare system in America so that people do not have 
to go into their pockets as often, so that insurance is reliable, and 
so that the markets are more stable. We are going to have a lot of 
opportunity, I hope, to come together and do just that. I hope my 
friend from Wyoming and my other friends on the other side of the aisle 
will be part of that.


                   Unanimous Consent Request--S. 1201

  We have a very simple solution to the bare counties, and I hope 
people will think this through before they just object. I am going to 
have 25 bare counties, mostly as a result of the sabotaging of the 
exchanges by this administration. People in those counties are looking 
to me for an answer, and I do not blame them for being worried. How can 
we solve that problem today? S. 1201, the Health Care Options for All 
Act, which I have introduced, will solve that problem today.
  All we have to do is say to anyone who is in a county in America--and 
I know my colleague from Ohio, Senator Brown, has some counties, and I 
know my colleague from Indiana has some counties--if you do not have an 
insurer in your county, you can come with your subsidy and buy 
insurance from the same places our staffs buy it and most Members of 
Congress buy it. Those are national plans. They are in every State in 
the Union because Members of Congress have staff members in every State 
in the Union. There is no need to attract more plans. There is no need 
to do anything complicated. You just take the subsidies that you are 
entitled to and you buy insurance at the same place Congress buys it.
  We can do that today. If we do not do it today, do you know what we 
are saying to the people who live in Ohio and Indiana and Missouri? We 
are saying that we are entitled to something better than they have and 
that they should not be allowed to buy what we can buy. Now, that takes 
some nerve. If we are not willing to take this simple, basic step, 
people in these counties should be angry and take up pitchforks--
metaphorically, of course.
  The national plans that are out there that my staff uses that are in 
Springfield, Cape Girardeau, Columbia--and I am sure my colleagues 
could talk about their staffs using these plans all over the country--I 
would like to make those available to regular folks in my State who 
want to be able to lay their heads on their pillows tonight and not 
worry about whether they are going to have insurance next year.
  Mr. President, I ask unanimous consent that the Committee on Finance 
be discharged from further consideration of S. 1201, the Health Care 
Options for All Act; that the Senate proceed to its immediate 
consideration; that the bill be considered read a third time and 
passed; and that the motion to reconsider be considered made and laid 
upon the table with no intervening action or debate.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, reserving my right to object, before 
coming to the Senate, I practiced medicine in Wyoming for over 20 
years. That is why I am passionate about improving the quality of care 
and lowering the cost of healthcare. Unfortunately, we know healthcare 
is in a crisis. Premiums and deductibles are skyrocketing, and 
insurance is unaffordable.
  It is interesting to hear the comments when we are talking about the 
sabotaging of the marketplace. It is ObamaCare that has sabotaged the 
marketplace. The Presiding Officer knows fully well, as do I, that when 
you look at the co-ops that were set up all around the country under 
ObamaCare, one after another went bankrupt--belly-up, shut down--and 
left people uncovered. That was before we even knew who the Republican 
nominee for President was going to be in 2016. That is ObamaCare. That 
was at a time when all there was out there was the Obama healthcare 
law. One co-op after another failed, and it cost the taxpayers billions 
of dollars--guaranteed loans that will never be paid back.
  Just like the bill we just discussed, this proposal is an important 
acknowledgment by the Senator from Missouri. It is the acknowledgment 
that ObamaCare's collapsing insurance markets are affecting people all 
around the country. In Missouri, 18,000 people in 25 counties will have 
zero options on the ObamaCare exchanges--zero. They have been promised 
that their preexisting conditions will be covered, and no one is 
selling insurance in those counties in that State. They have basically 
been misled by ObamaCare that they will be covered for preexisting 
conditions. In the Republican plan, what we are doing is covering 
people who have preexisting conditions.
  Let me say again that next year thousands of people in Missouri will 
have no insurance company that will be willing to sell insurance in the 
ObamaCare exchange. It is clear that

[[Page 10015]]

insurance markets in Missouri are collapsing, as they are all around 
the country.
  This bill is not the solution. Instead of giving people more choices 
in Missouri, what does the bill do? It sends people to Washington, DC, 
to buy their health insurance--a typical solution from the other side 
of the aisle. Instead of empowering States with more flexibility and 
the authority at the State level, they think once again that Washington 
knows best. They think that the people they represent would rather call 
a bureaucrat who is hundreds of miles away than talk with local people 
who live and work in their communities.
  The simple fact is that ObamaCare is not providing patients with the 
increased choices they were promised. We need to rescue people in 
Missouri and across the country from ObamaCare. This bill is the wrong 
approach.
  I object.
  The PRESIDING OFFICER. Objection is heard.
  Mrs. McCASKILL. Mr. President, will the Senator yield for a question?
  The PRESIDING OFFICER. The Senator from Wyoming does not have the 
floor.
  The Senator from Missouri.
  Mrs. McCASKILL. Mr. President, the next time I will know, when he is 
giving a speech, before he objects, to start then.
  I am pretty sure that his staff in Wyoming is not coming up to 
Washington to buy their insurance. I am pretty sure that all of our 
staffs--I am pretty sure the Presiding Officer's staff, those who work 
for him in Utah--are not coming to Washington to buy their insurance. I 
am pretty sure Senator Manchin's staff and Senator Patty Murray's staff 
and all of our staffs who live all over this great country are not 
coming to Washington to buy their insurance. They are getting good 
health insurance plans.
  I just think it takes incredible nerve to lecture me about people in 
Missouri having no insurance while the Senator from Wyoming is 
objecting to letting them get the same insurance he has. Really? That 
is what this has come to, this partisan exercise?
  We don't have to fix this permanently this way, but we could do it 
just temporarily to give people peace of mind until we figure out the 
right way forward. But how dare Members of this Chamber tell people in 
my State they are not entitled to buy what we have, when they have no 
other options at this moment.
  Let's move forward together and fix it--all of it. But to get a 
lecture that people in my State don't deserve what my staff has or what 
Senator Barrasso's staff has--no wonder people are upset with 
Washington.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.


                         Healthcare Legislation

  Ms. KLOBUCHAR. Mr. President, I thank the Senator from Missouri for 
her good idea and for her passion for this issue and for her correct 
statement that when people sign up for these exchanges, they don't have 
to go by train, plane, or automobile to Washington, DC, to get their 
insurance.
  I heard, when I was home this weekend, over and over, concern from 
people whom I was surprised to see come up to me. Several people in 
Winona, MN, came up to me and said: We are Republicans, but we don't 
think it is fair if seniors have to pay more when tax cuts are going to 
the wealthiest.
  I heard from people in Lanesboro, MN, small business owners who were 
worried about what was happening with the proposal from the other side. 
In Northfield, MN, the town of ``Cows, Colleges and Contentment,'' I 
can tell you that they were not very content at the Northfield Hospital 
as they saw the devastating impact this bill would have on rural 
hospitals.
  So that is why I so appreciate my colleague from North Dakota, 
Senator Heitkamp, bringing people together today to talk about the fact 
that there is another way forward.
  There is another way forward, and the people in this Chamber have 
done this before. Senator McConnell negotiated with Senator Boxer on a 
major transportation bill. The last time we had an issue with doctors' 
fees, we were able to get that done on a bipartisan basis. So what we 
are simply asking our colleagues to do is to start afresh and to look 
at what we could do together to help the people of this country without 
sabotaging the current healthcare delivery system and without taking 
this out on the most vulnerable through Medicaid cuts.
  Here are some ideas. As to prescription drug prices, why would we not 
allow the 41 million seniors in this country to use their bargaining 
power--to harness their bargaining power--as my friend Senator Nelson 
from Florida understands because he knows there are a lot of seniors in 
Florida--to harness that bargaining power to negotiate for lower costs 
on prescription drugs. The current law bans us from doing that. So all 
we want to do is to lift that ban and let our seniors negotiate. That 
is not in this bill we are considering from the Republican side. This 
is something we can come together and work on.
  We can get less expensive drugs in the form of generic drugs. Yet, 
right now, we have a situation where major prescription drug companies 
are paying generic companies to keep their products off the market. It 
is called pay for delay. Senator Grassley and I have a bill to 
eliminate that. We can bring in less expensive drugs from other 
countries if, in fact, we have a situation where the prices have 
ballooned, as they have for the top 10 selling drugs in America. Four 
of them have gone up over 100 percent.
  The exchanges are another area where we have agreement. Senator 
Collins has been working on this. Senator Kaine and Senator Carper have 
a bill on this, and Senator Shaheen is working on the cost-sharing 
issue. We can work together to make insurance more affordable for 
people who are in the exchange.
  As to our small business rates, we must work on that.
  I truly believe we can come together.
  I will end with this. I got to be at that baseball game in the crowd 
with the 25,000 people who were watching the two teams play each other. 
Senator Donnelly of Indiana was on the field. At the end of the game, 
after the Democratic team won, they didn't keep the trophy. They handed 
the trophy to the Republican team and asked them to place that trophy 
in Congressman Scalise's office.
  We are not two teams. We are one team, and that is for our country, 
for America. So let's work together on this bill.
  Thank you very much, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, I love what the Senator from Minnesota 
just said. I am a retired Navy captain. For years we had healthy 
competition among the different branches of our services. I salute the 
folks in the Army, the Marines, the Air Force, and Coast Guard. I 
always say: The Navy salutes you. Then I also say: a different uniform, 
the same team. To the extent that we wear different uniforms, we really 
are on the same team, and I think the American people are anxious for 
us to start acting that way.
  What I hope we will do is to hit the pause button right now on the 
legislation that the Republicans have pulled off the floor and that we 
will use this time as an opportunity not to go to our separate corners 
and figure out how to do the other team in when we return here in 10 
days. I hope we will, as some of our colleagues have suggested, explore 
some ideas where we can work together.
  Some have talked about how to make the marketplaces work. It is not a 
Democratic idea. It is a Republican idea. There are the tax credits for 
the exchange, which is a Republican idea. The individual mandate and 
the idea that there cannot be prohibitions on insurers denying coverage 
are Republican ideas too. Those are all ideas from 1993, taken from 
Mitt Romney, who put them in RomneyCare in Massachusetts, and we put 
them in the Affordable Care Act.
  We didn't just do this and shut out the Republicans. We had 80 days 
where we worked on the legislation. I was on

[[Page 10016]]

the Finance Committee with Senator Schumer and others, and we had, I 
think, a dozen or more hearings and dozens of amendments--over 300 
amendments in all. Some 160 Republican amendments were included in the 
bill. To somehow say that they were being shut out is nonsense. That is 
a reinvention of history.
  Let's do it the right way. At the end of the day, we will do what 
President Trump has been calling for, for the last 5, 6, 7, 8 months, 
as I recall. He said: Why don't we cover everybody, why don't we 
provide better coverage, and why don't we do it in a more affordable 
way.
  Unfortunately, what Republicans have offered and what they pulled off 
the floor doesn't do that. It provides less coverage for more money. It 
says to people--the least well off in our society: We are going to 
provide you less coverage in order to give folks who make a lot of 
money, and really don't need a tax break, a tax break.
  That is not consistent with the Golden Rule. The Presiding Officer 
knows it well. We are supposed to treat other people the way we want to 
be treated. That is an example of a failure with respect to the Golden 
Rule.
  I didn't come here to waste my time and other people's time. I came 
here to get things done. We tried hard to involve the Republicans 8 
years ago. They may not acknowledge that. The people in this country 
still want us to really bear down and work together, and we can do 
that. At the end of the day, we will be better as a party, we will be 
better as a body, and we will be better as a country.
  I want to thank Senator Warner for letting me speak before him. Thank 
you so much. I will say to Senator Kaine: Thank you for allowing me to 
be your partner on a great reinsurance plan that will help stabilize 
the exchanges. I am delighted to be your wingman. Thank you.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. WARNER. Mr. President, I urge my friend, the Senator from 
Delaware, to get to the train station.
  First of all, I wish to thank Senator Heitkamp for bringing this 
group together. There has been a lot of talk about what ideas can fix 
the Affordable Care Act, and here we are hearing some of the ideas that 
we will offer.
  Senator Kaine has had to hear this story before, but before I was in 
politics, I had a pretty long career in venture capital and invested in 
a lot of businesses. Some of those businesses managed to eke out a 
living, but the thing that was remarkable about the companies is that 
the companies that were the most successful weren't the ones that had 
the perfect business plan. They weren't the ones that had the newest 
ideas. The companies that were the most successful were the ones that 
were able to adapt and change. I never, ever invested in a business 
that ever met its business plan. Every one had to change in some way--
alter.
  The truth of the matter is, as to the Affordable Care Act, for all 
its good things, there were things we got wrong. I will be the first to 
acknowledge that. There have been a lot of us in this body who over the 
last couple of years--again, I thank the Senator from North Dakota, who 
has been a part of these efforts--have said that maybe we need to do a 
little less bureaucracy in the ACA in terms of reporting requirements. 
Maybe we ought to have a cheaper option. We have gold and silver and 
bronze. I remember working with the former Senator from Alaska on this. 
Maybe we ought to have a copper plan, as well, to try to get those 
young people invested in buying that first plan.
  We said that maybe we ought to take an idea that came from the other 
side of the aisle, and, as long as we have appropriate consumer 
protections, go ahead and let insurance products get sold across State 
lines so there is more competition. Then, we saw more problems arise. 
Unfortunately, problems arose with the ACA, as we have seen this 
administration and others try to knock out some of the building blocks 
that built up the ACA--risk corridors, cost sharing, or more recently 
the administration saying that we may just ignore part of the bill that 
says there is an individual mandate. Consequently, that means the 
insurance company had to charge a heck of a lot more money because they 
weren't sure whether the law was going to be in force.
  We have had people like the Senator from New Hampshire say: Well, I 
had an idea on cost sharing that might fix it. My dear friends, the 
other Senator from Virginia and the Senator from Delaware said: Let's 
go out and do that reinsurance plan, so that if there are 
extraordinarily high-cost plans, maybe that will be a secondary 
backdrop so premiums will not have to be so high. I am proud to support 
and be a cosponsor on both of those pieces of legislation.
  Then, as only the Senator from Missouri can do, she came up with the 
most obvious of, at least, a short-term solution that says: My gosh, if 
for some reason, because there have been efforts to sabotage the ACA, 
we don't have enough offerings for at least some stopgap period, we 
ought to allow all the folks in our States, if they don't have any 
coverage, to at least get the same kind of coverage we get. That is 
kind of Harry Truman basic common sense--Missouri common sense.
  So I hope our colleagues, after they get out of one more secret 
meeting in one more basement or secret location, will come back and 
start talking about these solutions--solutions that don't start with 
the premise that we are going to give folks like me a tax cut or that 
we are going to take a meat ax to Medicaid or that we are going to come 
up with a proposal that will take 22 million Americans off of health 
insurance.
  The ACA didn't get it entirely right. There is a lot of room for 
improvement. We have asked our friends on the other side to meet us 
halfway and to try to bring the kind of bipartisan spirit we all talk 
about on this issue that affects each and every American and one-sixth 
of our economy. We can do it. We can do it right, but it is going to 
take the kind of cooperation and the kinds of good ideas that are being 
offered by my colleagues on the floor.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON. Mr. President, all of the Florida people walk up to me 
and say: Bill, what is going on? Why can't Congress get together? Why 
can't we work together? We do in our committees. We usually work 
together. We certainly do with Senator Thune, who is the chairman of 
the Commerce Committee. This Senator is the ranking member. We get a 
lot of things out. We are going to mark up the FAA bill tomorrow. There 
are a lot of controversial issues. We are going to get that out. Why 
can't we do it with healthcare?
  So, last night, I had a telephone townhall meeting in my State of 
Florida and 6,000 people joined. They asked questions for an hour. 
Often, they would get through asking their question and they would say: 
I wish you guys could work together. So that is what we have been 
hearing in all of these speeches.
  Well, let me give one suggestion that would lower premiums in the 
existing law, the Affordable Care Act, 13 percent. I had it costed out 
in Florida. Every now and then, you are going to have a catastrophic 
loss. It is kind of like when I was the elected insurance commissioner 
of Florida, and I inherited the mess after the monster hurricane. 
Hurricane Andrew was such a monster hurricane that it took down a 
number of insurance companies because the losses were so big. So we had 
to try to get insurance companies to come back into Florida. We created 
a reinsurance fund. We called it the Florida Hurricane Catastrophic 
Fund, which would reinsure, or insure, the insurance companies against 
catastrophic loss.
  That is what we can do right here. We could be like my poor 
constituent, Megan, who fought cancer for 2 years, with two 
transplants, and ultimately lost the battle, but the bill was $8 
million. That is hard for any insurance company to swallow, but those 
are going to be limited, isolated cases.

[[Page 10017]]

  Why don't we create a reinsurance fund for the marketplace in the 
Affordable Care Act to help the insurance companies with catastrophic 
loss? I asked: If we did that in Florida, with the Florida marketplace, 
what would it mean? It would reduce the insurance premiums under the 
marketplace in Florida by 13 percent. That is just one suggestion.
  Every one of us has a suggestion. Put all of these suggestions 
together, and we are talking about really fixing the current law, 
instead of this roadway we see our friends on the other side of the 
aisle going down--a solution that is going to take coverage away from 
22 million people and is going to cut $800 billion out of Medicaid and 
eviscerate Medicaid or that is going to charge older Americans over 
younger Americans five times as much as the younger. We don't have to 
do that. Let's come up with a creative idea to fix the existing law.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. Mr. President, I also rise with my colleagues to speak in 
favor of commonsense solutions. I think the GOP leadership made a wise 
decision--and I thank them for it--to pull the vote on their healthcare 
bill this week when the CBO came out and said that 22 million people 
would lose health insurance, 15 million in the first year, and Medicaid 
cuts would be significant. Obviously, the public was very concerned, 
and I am glad the GOP has taken a step back. I think we now have a 
chance to get this right.
  I want to tell a personal story about my own involvement in this in 
the last few months. The story, to me, exemplifies an important 
principle, and that is a bad process will produce a bad product. This 
bill was the subject of a very bad process.
  The bill that was put on the floor was a bill that ignored and shut 
out all Democrats from participating. More importantly, it shut out the 
committees from participating. Most importantly, it shut out the public 
from participating. That led to a bill that was destined to be bad. So 
we ought to fix it.
  Our Democratic leader is just exiting the Chamber. He asked me after 
I came back from the national ticket--as a consolation prize, I guess--
can you be on the HELP Committee? This is the committee I have wanted 
to be on since I came to the Senate--Health, Education, Labor, and 
Pensions.
  I have been a mayor, and I have been a Governor. I have been in local 
and State government for 60 years. Education is the biggest line item, 
and health is the second biggest line item. This is what I actually 
know something about. I was so thrilled to join the committee. But, 
boy, was I naive. I assumed that being on the HELP Committee meant we 
would get to have a hearing about a healthcare bill.
  I got on the committee on the 3rd of January. On the 5th of January, 
with many of my colleagues, we wrote a letter to the Republican leader 
and to the Republican chair of Health and Finance--13 of us; we had 
been on the committee for 2 days--and said: If you want to talk about 
improving healthcare, we have ideas. We want to sit down with you right 
now and talk about improvements to healthcare.
  I guess I am a naive 58-year-old. I thought, now I am on the 
committee. Now I am where things will happen, and we will get to 
actually fix healthcare. But instead, since I have been on the 
committee--and I have committee colleagues here who will attest to 
this--we have had hearings on higher ed, we have had hearings on 
Cabinet nominees, we have had hearings on FDA reform issues. But the 
one taboo topic on our committee is that we are not allowed to have a 
hearing about the healthcare bill.
  We asked for one after the House passed their bill; we couldn't have 
a hearing. The Senate bill has been put on the floor; we haven't had a 
hearing, and as far as we know, there will be no hearing. So those of 
us who are focused on this issue have no opportunity, but, more 
important--it is not about committee Members. For those watching this 
and wondering what a hearing is about, a hearing is about hearing from 
the public. You have a witness table. You get a patient and a doctor 
and a nurse. You get an insurance executive and a pharmaceutical 
executive. You get a small business having a hard time buying health 
insurance. You get them all to sit there and tell you what they like, 
what they don't like, and what can be fixed. All of that--all of that--
has been shunted aside in this process, so the public isn't heard and 
the committees can't do their work.
  Our ranking member on this committee, the Senator from Washington--I 
had watched her as the Budget chair when I was a Budget Committee 
member work out a great bipartisan budget deal in December of 2013, 
with then-House Budget chair, now-House Speaker Paul Ryan. We worked it 
out. It was bipartisan.
  I watched our ranking Democrat on the HELP Committee work with the 
chair on the HELP Committee, Lamar Alexander, 2 years ago to do 
something most people thought was impossible: have hearings and rewrite 
No Child Left Behind into the Every Student Succeeds Act. It was 7 
years past the reauthorization date because it was too controversial. 
But I watched them use the committee process, entertain ideas from both 
sides, hear from the public, rewrite the bill, then conference with the 
House, and then get it to the President for signature.
  Why is healthcare taboo on the HELP Committee? Let the committees do 
their work. Let the greatest deliberative body in the world deliberate. 
Let the Senate be the Senate, and let us work together.
  My colleagues have mentioned that I put an idea on the table. It is 
not a fix-everything idea, but it is a particular idea with a lot of 
bipartisan cred, and it is the notion, as some of my colleagues have 
said, of reinsurance. Senator Carper and I have introduced the 
Individual Health Insurance Marketplace Improvement Act, and it is 
going to a very particular problem that I think Democrats and 
Republicans recognize as a significant challenge in the current 
healthcare law.
  President Trump, from the beginning of his administration, has 
injected uncertainty: We are not going to continue enrolling people--or 
we will reduce the market for enrollment. We are not sure we are going 
to pay the cost sharing. Maybe we should let ObamaCare crash and burn--
a tweet that he did recently. Because this has happened, the individual 
market has become very unstable, and many insurers pulling out of the 
market are citing this unpredictability as contributing to an 
instability in the individual market.
  Here is what Senator Carper and I proposed, and we have numerous 
cosponsors: We take the tool that Senator Nelson was describing, 
reinsurance, a tool that provides a backstop against very high-cost 
claims, and we put it into the Affordable Care Act as it was for the 
first 3 years of the Affordable Care Act. The Affordable Care Act in 
its first 3 years had a reinsurance mechanism to backstop high-cost 
claims. If an insurance company knows there is a backstop, they can 
actually set premiums at a lower and more affordable level for 
everybody. Having that backstop also gives some certainty, so you can 
actually write a plan in a market where, if you don't have certainty, 
you might choose not to write it.
  In the first 3 years of the Affordable Care Act, this reinsurance 
provision worked out very well, held premiums down, and kept insurers 
in the marketplace. It expired. But we actually know reinsurance works 
because it is part of a great bill that was passed during a Republican 
Presidency with overwhelming Republican support. Medicare Part D was 
passed during the administration of President George W. Bush. 
Reinsurance was made a permanent part of that bill to do exactly the 
same thing: to cover high-cost claims, seniors who had multiple high-
cost medications. Because reinsurance was included in that bill--it was 
put in the original bill, authored by Republicans--it enables pricing 
to be more affordable for our seniors who are on Medicare, and it 
enables pricing actually to be more affordable for the public treasury.
  Reinsurance is just one of a number of ideas that are out there, but 
it is an

[[Page 10018]]

idea that has bipartisan bona fides. It has been demonstrated to work. 
You are not going to put reinsurance in this bill and have an 
unintended consequence that you didn't think would happen. We know how 
reinsurance works, and we know how it will work here.
  I would just conclude and say that I hope we will take a bad process, 
which produced a bad product, set that aside, and engage in a good 
process to find a good product on the most important expenditure anyone 
ever makes in their life--on their health--a good product in the 
largest sector of the American economy; one-sixth of our economy is 
health.
  The right process is this: When the Republicans get to the point that 
they think this bill is all they would want it to be, why not just put 
it in the Finance Committee, put it in the HELP Committee, and let's be 
the U.S. Senate. Let those of us who are on the committees do what we 
want to do. We have good committee chairs in these committees: Senator 
Hatch and Senator Wyden, the chair and ranking on Finance; Senator 
Alexander and Senator Murray on HELP. Put it in the committees; let's 
hear from the public about what works, what doesn't, and what can be 
fixed. Then let's dialogue and listen to one another and come up with 
solutions--just as in that budget deal, just as in the rewrite of No 
Child Left Behind.
  The Presiding Officer knows the next thing I am going to say, I bet. 
I am in the minority on those committees. I have some amendments like 
reinsurance that I want to put up, but I can't get them accepted unless 
I can convince some in the Republican majority that it is a good idea. 
I have to convince Republicans it is a good idea for my amendment to be 
accepted. Shouldn't I have that opportunity? Why would anybody be 
afraid of being open to an idea that might actually improve the bill?
  Just this morning, I came out of a markup that the Presiding Officer 
is very familiar with, the markup of the NDAA. We finished it this 
morning on Armed Services. We went back and forth across the table, 27 
Democrats and Republicans. We traded amendments, we voted some up, and 
we voted some down. We had Senator McCain and Senator Reed leading us 
in that. We got to the end of the day, and we had a committee vote. 
After that discussion and listening to one another across the table, 
back and forth, the committee vote was 27 to 0--27 to 0. We got all the 
Dems on board.
  I will not be naive enough to think healthcare is going to be simple 
and noncontroversial. I am sure we will have some tough discussions. I 
am sure I will offer an amendment that will be turned down. Maybe I 
will offer one that will be accepted. But we are much more likely to 
produce a good product and help people's healthcare if we actually will 
sit down in the committees that have jurisdiction and dialogue and 
amend before we bring this thing to the floor. It is just not worth 
rushing, because it is life and death.
  We have a chance to get it right. The step-back this week enables us 
to take that chance, and we should seize it and work together.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Ms. HEITKAMP. Mr. President, I wish to make some concluding remarks.
  No. 1, I share the concerns that Senator Barrasso expressed. I hear 
from ranch families and I hear from farm families about the 
unaffordability of their healthcare premiums. I hear about high 
deductibles. I hear about how what has happened in the health insurance 
market has made it more difficult for them to cover their families. I 
hear that.
  We have solutions we have been talking about that could lower those 
costs. I would include dealing with people with chronic conditions. 
Reports from the RAND Commission tell us that 12 percent of the people 
in this country who have five or more chronic conditions cost the 
healthcare system over 40 percent. Some of those people are on the 
exchanges, and when they are on the exchanges, that drives the 
healthcare costs up.
  But I have a question. I have a question for people who are advancing 
the Republican healthcare bill: Why do you have to give the richest 
Americans in this country a tremendous tax break to solve that problem? 
How does giving the top 0.1 percent of taxpayers in this country over a 
$250,000 a year tax break--how does that fix the problem for my 
ranchers? How does that fix the problem for my farm families? You know 
the honest answer: It doesn't.
  I need to understand how taking billions of dollars out of the 
Medicaid system, driving sicker, older people who tend to be in the 
Medicaid population onto the exchanges into the individual 
marketplace--how does that help that farm family we talk about almost 
every week on the floor of the Senate, that farm family, that 
individual who is paying excess premiums? It does nothing for them.
  This is all some smoke-and-mirrors deal. What we have done today--
almost 15 of us have come to the floor, and what we are saying is: 
Let's fix the problems. We can all acknowledge that we have a 
healthcare system where really sick people have a hard time finding 
affordability. When you put really sick people into an insurance pool, 
it drives up the cost for everyone. How do we manage that? The 
insurance industry tells me the average time on the individual exchange 
is 10 months. How do you take someone with five chronic conditions and 
manage them in a 10-month plan? You know what, you don't. So they hop 
from plan to plan, costing more and more.
  If you want to reduce costs, you have to figure out how we can better 
treat the sickest among us. Until we do that, we will not achieve the 
common goal, which is reducing and bending the costs of healthcare in 
this country. We cannot achieve that goal. When all we are doing is 
saying: No, we don't want to pay, we are going to make the States pay 
or we are going to make people on the individual exchange pay or we are 
going to make people do what they have done before, which is not have 
coverage and put them into uncompensated care, that will not solve the 
problem.
  We have some great examples here for the immediate concern that we 
have about the premiums that are going to be expressed. In some ways, 
this reflects concerns about the increased costs of healthcare and what 
is happening in that individual market, but it is being driven by the 
failure to fulfill the statutory obligation--reinsurance, cost sharing.
  I do have to point out that I found it interesting that the objection 
to Senator Shaheen's bill was that, oh, we haven't had time to take a 
look at it, haven't had time to even considering this cost-sharing 
issue. Really?
  This is the last page of the Republican bill, page 145, stating in 
section 208, ``Funding for Cost-Sharing Payments.'' I will give you, it 
is a different schedule, different formula in the Shaheen bill, but 
this is not a new concept. If we wanted today to give the insurance 
industry the certainty they needed that would make sure that the 
premium increases reflected not uncertainty but reflected actual costs, 
we would do this: We would take up Jeanne's bill. The very bill that 
the Republicans have advanced says, ``There is appropriated to the 
Secretary of Health and Human Services, out of any money in the 
Treasury not otherwise appropriated, such sums that may be necessary 
for payments for cost-sharing reductions authorized by the Patient 
Protection and Affordable Care Act (including adjustments to any prior 
obligations).''
  The same provision was in the House bill. How can it be objectionable 
to have a debate about a provision that has been advanced in both 
Republican bills? How can that be objectionable when so much is riding 
on that, when the healthcare and availability of insurance to our 
families is riding on making sure we at least have some kind of stopgap 
measures in the exchanges that will guarantee a stability that will 
make insurance available.
  If we don't know what is going to happen with those counties--we know 
we have huge counties that don't even

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have uninsured in them. Senator McCaskill offered an opportunity. Guess 
what. How about they get their insurance where our staff get our 
insurance or some among us get our insurance? That is objected to 
because it is some kind of Washington solution.
  What is ironic about that is that provision that made Senate staff in 
our home States get their health insurance on the DC exchange came from 
Senator Grassley during the debate on the Patient Protection and 
Affordable Care Act, not a Democratic idea. It was a Republican idea 
and certainly something that bears at least a discussion, certainly 
something that ought to be talked about here.
  Let's not pretend there has been an outreach to people on the 
Democratic side. Today the Democratic leader offered to go to Blair 
House, offered to bring people together at Blair House, have a sitdown 
on healthcare, offered to go to the Senate--the Old Senate Chamber, no 
cameras, let's talk about healthcare. What we get is: You are not 
serious.
  I want you to know I am dead serious about sitting down and trying to 
fashion a healthcare plan that actually fixes the problems we have 
right now in affordability of health insurance.
  When someone says, well, you have to accept tax breaks as part of 
that for the richest Americans, think about this: 400 Americans will 
get a tax break under the Republican bill--400. Just 400 Americans will 
get a tax break under the Republican bill, equal to what it would cost 
for Medicaid expansion in four States.
  Make no mistake, this is not healthcare reform we are talking about. 
That bill is not healthcare reform. It is entitlement reform in 
Medicaid, shifting costs to States and patients. It is tax reform, 
making sure the wealthiest among us get a tax break.
  If we want to talk about healthcare reform, if we want to talk about 
fixing the ACA, let's not throw out what is working. Let's make sure we 
are fixing and addressing the problems that we here express every day 
that come in our mail and that we know we have to address in order to 
make the system fair; that is, younger, healthier people need a break. 
They need to find an affordable product.
  How are we going to do that? We have seen ideas here today, ideas 
that could take care of--even if we just made them temporary, even if 
we said this is only going to be there until 2019, we could stabilize 
all of this today and begin that today, but yet it is objected to.
  I think the message we want to send is we stand ready to fix the 
healthcare system. We stand ready to work with the other side of the 
aisle. We stand ready to address the concerns we hear from our 
constituents about the healthcare system.
  If we really want to respond to the concerns the American public has 
about the U.S. Congress, we better start working together. We better 
start finding a path forward to solve problems, real problems, not 
pretend problems but real problems in this country. That way we will, 
in fact, enrich and enhance our democracy. Until we do that, we 
continue to struggle to get credibility with the American public, and 
that is not, ladies and gentlemen and Members of the Senate, a formula 
for success for our democracy.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mr. Tillis). The majority leader.

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