[Congressional Record (Bound Edition), Volume 163 (2017), Part 8]
[Senate]
[Pages 10768-10785]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           EXECUTIVE SESSION

                                 F_____
                                 

                           EXECUTIVE CALENDAR

  Mr. McCONNELL. Mr. President, I move to proceed to executive session 
to consider Calendar No. 157.
  The PRESIDING OFFICER. The question is on agreeing to the motion.
  The motion was agreed to.
  The PRESIDING OFFICER. The clerk will report the nomination.
  The bill clerk read the nomination of Patrick M. Shanahan, of 
Washington, to be Deputy Secretary of Defense.


                             Cloture Motion

  Mr. McCONNELL. Mr. President, I send a cloture motion to the desk.
  The PRESIDING OFFICER. The cloture motion having been presented under 
rule XXII, the Chair directs the clerk to read the motion.
  The bill clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the

[[Page 10769]]

     Standing Rules of the Senate, do hereby move to bring to a 
     close debate on the nomination of Patrick M. Shanahan, of 
     Washington, to be Deputy Secretary of Defense.
         Mitch McConnell, Joni Ernst, Tom Cotton, Thom Tillis, 
           Lindsey Graham, Mike Crapo, John Boozman, Roger F. 
           Wicker, Dan Sullivan, John Cornyn, John Thune, Steve 
           Daines, John Barrasso, David Perdue, Mike Rounds, Orrin 
           G. Hatch, John McCain.

  Mr. McCONNELL. Mr. President, I ask unanimous consent that the 
mandatory quorum call be waived.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. FLAKE. Thank you, Mr. President.
  (The remarks of Mr. Flake pertaining to the introduction of S. 1552 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. FLAKE. I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.


                         Healthcare Legislation

  Mr. HATCH. Mr. President, today I wish to make some remarks paying 
tribute to a former staff member of mine for whom I have the highest 
opinion. However, before I begin those remarks, I should take a moment 
to address the elephant in the room.
  Mr. President, today the majority leader revealed a revised 
discussion draft for legislation to repeal and replace ObamaCare. Let 
me say at the outset that this bill isn't perfect. There are some 
things in the bill that, given my preferences, I would do very 
differently. But one thing I have learned in my 40 years in this Senate 
is that people who demand purity and perfection when it comes to 
legislation usually end up disappointed and rarely accomplish anything 
productive. That is particularly true when we are talking about complex 
policy matters.
  The next vote on this legislation will presumably be whether to let 
the Senate proceed to the bill. Regardless of any of the positions of 
my colleagues on this particular draft, if they support the larger 
effort to repeal and replace ObamaCare, they should at the very least 
want to have a debate on this bill. Under the rules, we will have an 
open amendment process. Members will get a chance to make their 
preferences known and to have the Senate vote on them. Taking that 
opportunity is the very least we can do.
  Keep in mind, virtually every Republican in this body has supported 
the effort to repeal and replace ObamaCare more or less since the day 
it was signed into law. We have all made promises to our constituents 
along those lines. This legislation, while far from perfect, would 
fulfill the vast majority of those promises.
  If we pass up this opportunity, we are looking at further collapse of 
our health insurance markets, which means dramatically higher premiums 
and even fewer healthcare options for our constituents. Make no 
mistake, while some are talking about a bipartisan solution to prop up 
markets in the event this bill fails, there is no magic elixir or 
silver bullet that will make that an easy proposition.
  I have to think that at the end of the day, if we fail to take action 
to fulfill the promises we have all made, we will have to answer to the 
American people for the missed opportunity and the chaos that will 
almost certainly follow. I hope all of my colleagues will keep that in 
mind.


                     Tribute to Everett Eissenstat

  Mr. President, I wish to take this time to pay tribute to a very dear 
and noble colleague of mine, Everett Eissenstat. For the past 6 years, 
Everett has served as my chief international trade counsel on the 
Senate Finance Committee--a very important position. He has had a long 
and distinguished career in public service, obtaining and utilizing 
what is really an unparalleled level of knowledge and expertise about 
our Nation's trade policy. In fact, I think it is safe to say that very 
few, if any, individuals have had as great an impact on the current 
state of U.S. trade law as Everett Eissenstat. His public service will 
continue, as he has recently gone on to serve as the Deputy Director of 
the National Economic Council.
  Everett received his juris doctorate at the University of Oklahoma, 
where he graduated cum laude and served as research editor of the 
Oklahoma Law Review. He also holds a master's degree in Latin American 
studies from the University of Texas at Austin and a bachelor's degree 
in political science and Spanish from Oklahoma State University. With 
diverse alma maters like that, some might wonder how Everett decides 
what colors to wear on college football Saturdays. But those of my 
colleagues who know Everett will correctly guess that he has, since his 
undergraduate days, remained a devoted fan of his beloved Cowboys.
  After obtaining his law degree, Everett went to work for Dixon and 
Dixon in Dallas, TX. Later, he worked as Congressman Jim Kolbe's 
legislative director and, shortly thereafter, he became the 
international trade counsel for the Senate Finance Committee for 
Senator Grassley, who was then the lead Republican on the committee.
  Everett was a key staffer in the effort to draft and pass the Trade 
Act of 2002, which renewed trade promotion authority for the first time 
in 8 years. This was a major update to our Nation's trade laws and made 
possible the completion and passage of trade agreements with Chile, 
Singapore, Australia, Morocco, Bahrain, Oman, Peru, Colombia, South 
Korea, Panama, as well as the countries of the CAFTA-DR agreement; 
namely, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and 
the Dominican Republic.
  Everett then helped implement a number of these agreements when he 
served as Assistant U.S. Trade Representative for the Western 
Hemisphere, a position he held from 2006 through 2010.
  After recognizing his fine work, I asked Everett to return to the 
Finance Committee in January of 2011 to once again serve as chief 
international trade counsel, and he continued to distinguish himself as 
one of the most knowledgeable and dedicated trade lawyers in the 
country.
  Very early in his second tenure at the Finance Committee, he helped 
shepherd our free trade agreements with Colombia, Panama, and South 
Korea through the Senate. In 2015, he was the key staffer in the effort 
to draft, introduce, and pass the bipartisan Congressional Trade 
Priorities and Accountability Act, which, among other things, once 
again renewed trade promotion authority after another 8-year gap, and 
updated our Nation's trade negotiating objectives for the 21st century.
  At about the same time, Congress also passed legislation to update 
our customs enforcement and facilitation laws, as well as a bill to 
reauthorize some important trade preferences.
  All of these successes were the culmination of years of hard work and 
represent the most ambitious legislative agenda on trade in recent 
history, and Everett was an indispensable part of it all.
  With his work on passage of those laws in 2015, his work on the prior 
TPA statute in 2002, and his efforts at USTR, Everett has been a key 
player in the development and facilitation of a generation of U.S. 
trade law. That is no small feat. More than anyone I have known, 
Everett is committed both to improving opportunities for Americans 
abroad and to ensuring an increasingly free-trade economy around the 
world. He is a true believer in free trade and the benefits free trade 
brings to our economy.
  I am not the only Senator who will miss Everett's knowledge and 
expertise. Indeed, during his time here, he was an asset to the entire 
Senate. But, more than that, I will miss him personally: his tireless 
work ethic, his calm and thoughtful demeanor, and his cheerful 
disposition, even when he is breaking bad news or telling Senators 
things they may not want to hear.
  While I am sad to see him go, it is comforting to know that Everett 
is continuing to serve our country and will keep advancing pro-growth 
economic policies at the National Economic Council. His expertise and 
wisdom are more important now than ever before, with numerous trade 
possibilities on the immediate horizon.

[[Page 10770]]

  As I have said before, and I imagine I will say many times again, 
Everett is very, very good at what he does. The administration and the 
country are lucky to have such an important asset. I look forward to 
seeing his successes in this new chapter of his career, though it goes 
without saying that he leaves behind some very big shoes to fill. I 
count myself lucky to have been the beneficiary of Everett's knowledge 
and advice for several years.
  I want to wish Everett, his wonderful wife Janet, and their sons 
Jacob and Alex the very best in this and any other future endeavors. 
Everett has a dedicated family, and I understand that they are here 
today; that Everett's wife and his one son were outside here just a 
short time ago. I am quite certain they are just as proud of Everett as 
I am.
  I have worked with a lot of people in the U.S. Senate. I have had a 
lot of staff people, and all of them have been, almost to a person, 
very, very good. I have appreciated all of them, and I know that we 
wouldn't be nearly as good without our staffs whispering in our ears, 
preparing the documents that we put into the Record, working with us to 
help us improve our abilities to put forth our agendas.
  I want my colleagues to know that Everett Eissenstat has been one of 
the all-time great staff people on Capitol Hill. I hesitate to even 
call him a staff person because he has the kind of reputation that goes 
far beyond being a staffer on Capitol Hill. He is one of the great 
leaders in this country, and I just want him to know how much I 
personally appreciate him. I want his wife to know how much I 
appreciate her and him; and his children--I want them to know what a 
great father they have.
  Everett is a great, great man, and I am really happy to have said a 
few nice words about him on the floor. No matter what I say, it is not 
enough to explain what a truly great individual Everett Eissenstat 
really is.
  I hope we can get other good staff people like Everett to help us on 
both sides. We are willing to work with both sides, willing to bring us 
together to do the things we know are important for this country and 
its future. Everett is one of those. I am going to miss him terribly. 
On the other hand, I know that where he is now is very important, and 
he will do the job as well as anybody alive.
  I just want to pay tribute to him and his wife and his son who is 
here today, and tell him how much we all love and appreciate him.
  With that, 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.
  Mrs. SHAHEEN. 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

  Mrs. SHAHEEN. Mr. President, I am pleased to be here with my 
colleagues--Senator Klobuchar, from Minnesota, and Senator Heitkamp, 
from North Dakota--to talk about the most prominent issue facing us 
right now; that is, what happens to healthcare for millions of 
Americans.
  At a town hall in Kentucky last week, Majority Leader McConnell said 
that if he can't secure the votes to repeal the Affordable Care Act, he 
will have no choice but to work in a bipartisan way with Democrats on 
legislation to repair and strengthen the law. Well, I was encouraged to 
hear the majority leader say that because I don't think bipartisanship 
should be a last resort. I think it should be the starting point. It 
should be the beginning of the work we do in this Chamber because that 
is what the American people want and that is the best way to make 
lasting public policy.
  This is especially true with healthcare legislation, which impacts 
families all across America. As we have been hearing--and I have had a 
chance to hear it directly from my constituents in New Hampshire--the 
American people have wanted all along for to take a bipartisan 
approach. It is unfortunate that our colleagues on the other side of 
the aisle have spent months trying to pass a partisan, deeply unpopular 
bill.
  Now, I think we would all agree that there are changes we need to 
make in the Affordable Care Act, something for which I have advocated 
since we passed the law. I have had the opportunity to work with our 
colleague Tim Scott from South Carolina. In 2015, we worked together to 
make modest changes to the law to protect small businesses from 
excessive premium increases. I think that bipartisan approach is 
something with which, if we started today, we could make changes in the 
Affordable Care Act to improve it and to make sure that Americans could 
get better access to healthcare.
  We all understand that there are problems currently in the market in 
terms of premium increases, and we know why these premium increases are 
happening. In their 2018 rate request filings, insurers justified the 
increases because of the uncertainty surrounding the repeal of the ACA 
and because this administration refuses to commit to making what are 
called cost-sharing reduction payments.
  These payments were included as part of the Affordable Care Act to 
address premiums, deductibles, and copayments and to make them more 
affordable for working families, basically, to be able to help people 
afford insurance. The payments have been built into the rates that 
insurers are charging for 2017. But as we look ahead to 2018, there is 
a big problem because, if there is uncertainty around those payments, 
it means premiums will skyrockets, insurers will leave marketplaces, 
and people will lose their health coverage. Now, we could fix this 
today if we were willing to work together, because we know what we need 
to do.
  I think New Hampshire offers a vivid example of what we are seeing 
across the country. Last year, insurance markets were stable, health 
insurance premiums increased an average of just 2 percent in New 
Hampshire--the lowest annual increase in the country and in our State's 
history. Unfortunately, today, because of the uncertainty in the 
market, it is a very different story.
  Insurers in New Hampshire are raising premiums for 2018. The same 
thing is happening across the country. In some cases, insurers are 
filing two different sets of rates--one premised on the 
administration's continuing to make those cost-sharing payments that I 
talked about earlier, and the second set with higher premiums to 
account for continuing uncertainty and the possibility that the Trump 
administration, which is legally charged with implementing the 
Affordable Care Act, is going to renege on making the payments that 
have been promised to insurers and, ultimately, to families so that 
they can get healthcare.
  This uncertainty is completely unnecessary. The instability in the 
ACA marketplaces is a manufactured crisis, and we could put a stop to 
it today. That is why I have introduced the Marketplace Certainty Act, 
a bill to permanently appropriate funds that would expand the cost-
sharing reduction payments and ensure that we can count on those 
payments being made.
  I am pleased to be joined by 25 other Senators who have already 
cosponsored this bill, and we can pass this right now if we had 
agreement with our colleagues on the other side of the aisle.
  The Marketplace Certainty Act is also supported by a broad spectrum 
of provider and patient advocate groups--including the American Cancer 
Society, the American Heart Association, the American Diabetes 
Association, and the National Association of Community Health Centers, 
just to name a few.
  We can end the artificial crisis. We could immediately restore 
certainty and stability to the health insurance markets. In turn, this 
would give us the space we need to come together on a bipartisan basis 
to improve the Affordable Care Act, to strengthen what is working, and 
to fix what is not working. That is what we were sent to Washington to 
do.
  Bipartisanship should be our first choice, not a last resort. The 
American people want us to stop bickering over healthcare, to work 
together, and to make the commonsense improvements to the law that we 
should be making.

[[Page 10771]]

  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota--North Dakota.
  Ms. HEITKAMP. That is OK. I am from the better Dakota. I just have to 
tell you.
  Mr. President, I am always perplexed when the opposition party, the 
Republican Party, says: We are the party of business. We are the party 
that believes that government should function more like a business. We 
are the party that believes that we have to make the tough decisions, 
we have to do the work that needs to get done, and we have to do it in 
a timely fashion.
  OK, I get that. There is not a corporate board in America confronted 
with the challenge that we have in healthcare that would not shore up 
the cost-saving payments. When you look at those of us who have served 
on corporate boards, those of us who have spent some time in the 
private sector, and, certainly, those of us who have been county 
officials or State officials, where we have actually had to make 
decisions, we look at how you make those decisions. The first thing you 
do is to try to make sure that while you are deliberating and while you 
are making decisions, you don't create market disruption. You don't do 
the things that create more uncertainty. You stabilize what you can, 
triage what you can, and then take a look at what the advantages are 
and what the experience you can bring to bear is to resolve bigger, 
broader, and more systemic issues.
  If we look today at where we are right now with our constituents or 
our customers, if we can put it in a business sense, our customers are 
Americans and American families. Guess what. As for those of us who 
have been in our States and who have spent time looking at healthcare, 
talking to people about healthcare, talking to providers about 
healthcare, I will tell you that there are two emotions they have. They 
are mad, and they are scared. They are probably more scared than mad 
because under the bills that are being deliberated here, the Republican 
healthcare bills, they don't know if they can continue to keep their 
disabled children at home with them. They don't know if they can 
continue to provide for their parents in a nursing home. They don't 
know if their rural hospital is going to be able to survive the kinds 
of reductions in payments that are anticipated under this bill.
  Today in North Dakota, $250 million is the value of Medicaid 
expansion. I have institutions in North Dakota, providers in North 
Dakota that are operating on razor-thin margins. They can't make ends 
meet without making sure that they keep that amount of uncompensated 
care greatly reduced. They need the cash flow.
  If we raise uncompensated care, two things will happen. The first 
thing that will happen under this bill is that they will have a hit to 
their bottom line. The second and obvious consequence of that is that, 
when they negotiate with the private insurance market on what those 
next payments are going to be, they are going to ask for more money to 
put back on the private insurance market the cost of uncompensated 
care.
  Let's also take a look at the growing issue in this country of 
opioids. I have a facility in southwestern North Dakota. Their new 
hospital anticipates that Medicaid is going to be about 14 to 17 
percent of the billings they have. As they are trying to respond--as 
responsible healthcare providers would--to the opioid crisis, they are 
looking at converting the old hospital into a long-term facility, a 
facility where people can go and get healthcare when they are addicted.
  They anticipate that the facility will have to rely on about 60 to 70 
percent Medicaid reimbursement. When people tell you that these issues 
aren't intertwined, that the population that is going to need 
assistance in recovery from addiction is not our Medicaid population, 
they are wrong. Every person who has looked at this has come to the 
same conclusion.
  The other thing I am going to tell you about the people whom I talked 
to is that most of them have never been involved in politics. They are 
not partisans. They don't really even care about politics, but they 
wonder why they are caught up in this tidal wave of political rhetoric 
when people are scaring them about whether they are going to have 
health insurance. They are wondering: What kind of responsible leaders 
would ever do that? What kind of responsible leaders would not do what 
they could today to provide some assurances in the near term that the 
health insurance is going to be available, that their Medicaid is going 
to be available, and that they are going to be able to take care of 
their kids?
  I am telling you that, instead of continuing to release bad bill 
after bad bill, I hope the Republicans will come and honestly take us 
at our word. We stand ready to work with Republicans on a truly 
bipartisan bill that is going to deliver quality healthcare to North 
Dakotans and quality healthcare to the people of this country.
  People think bipartisanship can't happen. That is not true. Yesterday 
I held a press conference on a completely separate issue that involves 
clean coal. Standing side by side when we announced that bill, we had 
Senator Sheldon Whitehouse, one of the most vocal advocates for 
aggressive action on climate, and Senators Barrasso, Capito, and me, 
the most vocal advocates in support of coal. We all stood together 
introducing this bill because we wanted to offer a real solution on 
45Q. We wanted to find out where that lane is where we can all coexist 
and solve the problems of the American people.
  It is not impossible to do this. It is not impossible if we park the 
partisanship, if we park the ideology, and if we start examining what 
the true problems and the true issues with our healthcare system are.
  The answer is usually in the middle. Has Medicaid worked to get more 
people with chronic conditions, to manage care, and to lower costs? The 
answer is yes. Are there too many people on Medicaid? The answer is 
yes.
  We need to grow our economy. We need to help people move them into a 
workplace where they have workplace insurance. Instead of talking about 
how we are going to grow the economy, instead of talking about how we 
are going to raise wages, instead of talking about how we are going to 
help people get set, we are talking about shifting the responsibility 
of the sickest among us, shifting that responsibility to the States and 
back to the patients.
  Just 2 weeks ago, I joined 15 of my colleagues trying to bring some 
commonsense bills forward. I thought we made a great case. We have been 
challenged: You really don't want to work with us.
  That is all facade. That is not true. We are back here again, saying: 
Please, please, work with us. Let's just for a moment do what Senator 
McConnell suggested we do. Let's take care of what is happening with 
the 2018 plan year. Let's remove the uncertainty as we are looking at 
premiums going up and skyrocketing because of that uncertainty. Let's 
remove that uncertainty and solve this problem.
  That is why I am supporting my colleague Senator Shaheen's 
legislation that makes cost-sharing payments permanent and increases 
the eligibility and generosity for that benefit.
  I also cosponsored Senator Carper and Senator Kaine's bill to make 
the reinsurance program for the individual marketplace permanent and to 
devote resources to outreach and enrollment efforts. As a result, it 
would encourage insurance companies to offer more plans in a greater 
number of markets, improving competition, and driving down costs.
  Isn't that what we all want? Everyone can agree that is the 
consequence of this legislation.
  Also, earlier this week I introduced another commonsense bill--the 
Addressing Affordability for More Americans Act. That helps make 
healthcare more affordable for middle-class families. What does that 
mean? We know that right now on the exchanges--when we look at 
subsidization of families on the exchange--we have what we call a cliff 
event. You are either in or you are out, and there is no stepdown. Many 
of

[[Page 10772]]

our middle-class families could experience a joyous event called a pay 
raise, only to find out that the pay raise evaporates because they lose 
some of the tax advantages that they received because they bought 
health insurance on a private exchange.
  Why don't we glide that out? The same is true, actually, for 
Medicaid. Is there an opportunity to take that slide out, or that glide 
out, and moving more people into the workplace who are on Medicaid?
  I share concerns that people have that the subsidization on both 
Medicaid and on the individual marketplace may result in people not 
taking economic opportunities that are available to them because, in 
the long run, it doesn't pencil out, given where they will be with 
healthcare. Let's take that incentive out. Let's work together. Let's 
solve that problem.
  I think our bill is the starting point. If people have a better idea 
on how to address that concern, I stand willing and ready to make that 
work. I want to say that we are here saying: Let's work together. We 
are here saying: We do not believe that, on this side of the aisle, we 
have all the answers.
  Guess what. I don't believe that, on that side of the aisle, they 
have all the answers. I believe we could learn an incredible amount 
from a hearing with a bipartisan group of Governors who are going to be 
responsible. They are going to get this heaped into their lap if this 
passes. That is why you see a bipartisan group of Governors saying: You 
know what, keep it, because that is not a path forward.
  If you want to hear some good ideas, I think we could hear some great 
ideas from the corporate America that has become self-insured--as they 
look at wellness programs, as they look at using big data metrics to 
help keep their population healthier and drive down costs, and as they 
negotiate for better deals with providers.
  There are hundreds of ideas out there. There are hundreds of 
opportunities to learn more before we take this step, but what is the 
process we are in? The process we are in is this: Don't confuse me with 
the facts. Don't confuse me with a new idea. Don't confuse me because, 
politically, we have to do this.
  Do you know what? No one, politically, has to do this. What we have 
been sent here to do is not to fulfill political promises. We have been 
sent here to legislate in the best interest of the American people and 
the people of our States. That is our job--not to represent a partisan 
political idea. Let's do it.
  Let's bring in a whole lot of ideas, and let's park the ideology at 
the door. Everybody, park the ideology at the door. As so many people 
on the other side of the aisle would say, let's start acting in a 
business, yeoman-like manner and start working through these problems.
  We have to do what Senator Shaheen has suggested, and that is to buy 
some time by making sure that we don't disrupt the marketplace today.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Mr. President, I am honored to be here today with 
Senator Heitkamp, from North Dakota--my friend from across the border, 
the prairies--and also Senator Shaheen, from the Granite State. I don't 
think it is a coincidence that the three of us are here today. We have 
worked on a number of bipartisan issues over the years.
  As I was sitting here, I was remembering when Senator Collins stood 
during the government shutdown and asked for people who would be 
interested in working with her on a bipartisan plan to get ourselves 
out of that mess. And all three of us were involved in that effort, 
which was, I note, half women in the group. I think it is time to do 
that again when it comes to healthcare.
  I appreciated it when last week Senator McConnell said it may be time 
to work to strengthen the exchanges and to work across the aisle. Like 
Senator Shaheen, I didn't see it as a last option, I saw it as a first 
option.
  I certainly appreciate the work my colleagues have done to propose 
some smart ideas that could help us improve the Affordable Care Act, 
including the Marketplace Certainty Act. When I talked with our small 
businesses and our citizens in Minnesota, they want that kind of 
certainty to help with cost sharing.
  The idea of doing something more with reinsurance, which we just 
passed on a State basis in Minnesota with a Republican legislature and 
a Democratic Governor--we are awaiting a waiver from Health and Human 
Services here in Washington. We think we should do it in a bigger way 
on a national level, so I also support the Kaine-Carper bill.
  The work that I have been doing on prescription drugs--much of it 
across the aisle with Senator Grassley--to stop this unprecedented 
practice of big pharmaceutical companies paying off generics to keep 
their products off the market--it would save billions of dollars for 
our taxpayers if they stopped that practice.
  Unleash the power of 41 million seniors who are currently barred from 
negotiating for less expensive drug prices. Bring in less expensive 
drugs from Canada--a bill that I have with Senator McCain. There is 
nothing in this new proposal we have seen today that would help in any 
way with prescription drug prices, and that is just wrong.
  That is why we are here to welcome our colleagues to work with us on 
some improvements in a bipartisan way to this bill, because the bill we 
saw this morning would again not do anything--minor tweaks but nothing 
about these major Medicaid cuts that have brought so many people 
together against this bill.
  Minnesota seniors organizations have said that these proposals we are 
seeing that are not bipartisan--it feels like we are pulling the rug 
out from underneath families and seniors. That is why we have seen AARP 
so strongly opposed to a number of the proposals that have been 
circulating around with no Democratic input.
  Many, many people have come up to us across our States. I was in 
northern Minnesota over the Fourth of July and was there among the Lawn 
Chair Brigade in one of my favorite units in the Ely parade and the 
clowns and the Shriners and everything else in the five parades that I 
did. I was so surprised, as I know my colleagues were, at the number of 
people who came up--especially parents of kids with disabilities--in 
front of a whole crowd on the side of the road and said: This is my 
child. He needs Medicaid. He needs help. We need you to stand with us.
  So it is about people like that mom with that child with Down 
syndrome who needs Medicaid. It is about the senior who knows they are 
going to need nursing home help. Thirty-two percent of our seniors use 
Medicaid funding for their nursing home help. A woman told me about her 
mom, who died 2 years ago at 95 after suffering from dementia for more 
than 20 years. She had worked her whole life, but she couldn't afford 
that nursing home and needed that help. It is about our seniors, who 
don't want to see the age tax. It is about our rural hospitals that 
know how important it is to have healthcare not an hour away but 15 
minutes away. That is what we are talking about.
  So we would welcome any efforts to work on these commonsense bills we 
have out there, many of which have had Republican support in the past.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, I thank my colleagues who are here this 
afternoon for their eloquence, their remarks, their passion for making 
sure the people in this country can get healthcare when they need it, 
and for their hard work and legislation to try and make that happen.


                   Unanimous Consent Request--S. 1462

  Mr. President, in the interest of trying to immediately help to 
stabilize the insurance markets, I ask unanimous consent that the 
Committee on Health, Education, Labor, and Pensions be discharged from 
further consideration of S. 1462; that the Senate proceed to its 
immediate consideration; that the bill be considered read a

[[Page 10773]]

third time and passed and the motion to reconsider be considered made 
and laid upon the table with no intervening action or debate.
  The PRESIDING OFFICER. Is there objection?
  Mr. CORNYN. Mr. President, I reserve the right to object.
  I wonder if the Senator from New Hampshire would allow me to pose a 
question about her request?
  Mrs. SHAHEEN. Absolutely.
  Mr. CORNYN. Is it true that under the so-called Marketplace Certainty 
Act, this would appropriate billions of additional dollars to insurance 
companies?
  Mrs. SHAHEEN. What is true about the Marketplace Certainty Act is 
that it would guarantee the payments that were promised under the 
Affordable Care Act--not to insurance companies but to families who 
need help affording health insurance. That is one of the goals as we 
think about what our challenge is to address the healthcare needs of 
the people of this country, and that, in fact, is what the Marketplace 
Certainty Act would do.
  Mr. CORNYN. Mr. President, I appreciate the response from the Senator 
from New Hampshire. I think I want to explore that a little more. I 
don't think the cost-sharing subsidies go directly to beneficiaries 
but, rather, to insurance companies.
  Nevertheless, this is exactly the kind of proposal that the Senate 
can vote on next week when we proceed to the healthcare bill. As we 
know, unlike traditional legislation, there is an open and unlimited 
amendment process, and Members on both sides will have a chance to 
offer amendments and have the Senate vote on them. So I would encourage 
all of our colleagues who have ideas about how to shape the healthcare 
policy to vote to get on the bill and then to offer amendments.
  It has been 7 years since ObamaCare was passed. It is in meltdown 
mode. We are glad to have our colleagues across the aisle offer 
suggestions on how to improve the current terrible situation for so 
many millions of people, but I must object.
  The PRESIDING OFFICER. Objection is heard.
  Mrs. SHAHEEN. I want to be clear that what we need to do is to 
provide certainty in the marketplace right now. What is happening 
because of the effort by our Republican colleagues to repeal the 
Affordable Care Act--which is providing coverage for literally tens of 
millions of people--what is happening because of this administration's 
refusal to guarantee those payments that would help people with the 
cost of their health insurance is that we are seeing instability in the 
marketplace. But the answer is not the proposal that was released this 
morning, the second or maybe it is the third draft of healthcare 
legislation that was done behind closed doors by our colleagues.
  Earlier today, I had the opportunity to meet with two children from 
New Hampshire: Parker, who is 8, and Sadie, who is 10. These kids were 
here advocating for the children's hospitals that have meant that they 
can continue to live. They are kids who were born with serious health 
challenges. They continue to have those serious health challenges, but 
thanks to Children's Hospital at Dartmouth and Boston Children's 
Hospital, Parker and Sadie are alive today. They are smart, they are 
beautiful, and they are the delight of their families. They have been 
able to get the healthcare they need through CHaD and through Boston 
Children's because they are able to get covered for their healthcare 
under Medicaid. What our colleagues' healthcare legislation would do is 
dramatically cut the Medicaid funding that Parker and Sadie and so many 
children and old people and disabled in this country depend on in order 
to stay alive.
  That is a mean-spirited bill. That is not the answer to the serious 
healthcare challenges we have in this country, and that is not what we 
should be doing to fix what needs to be fixed in the Affordable Care 
Act. What we need to do is work together.
  I am disappointed that my colleagues on the other side of the aisle 
continue to work behind closed doors instead of having an open process. 
If this legislation that was introduced this morning is such a great 
piece of legislation, then let's go through regular order. Let's have a 
hearing. Let's let the people of this country weigh in and then see 
whether this is a healthcare bill we should pass.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Ms. HEITKAMP. Mr. President, I would like to associate myself with 
the comments from the former Governor and now Senator from the great 
State of New Hampshire.
  It is not enough to say the system is failing. It is not enough to 
come here and say: We can fix it if you just agree to vote the way we 
are voting. If you just agree, you can present any amendments you want. 
You can do whatever you want.
  We don't even have a CBO score on this legislation. We don't know 
what is in this legislation. There have been no hearings so that people 
on both sides of the aisle can ask questions and say: What does this 
mean for a family on traditional Medicaid who has to rely on this to 
keep custody of their kids? And by the way, what does it mean if, as a 
result of losing their Medicaid coverage, those children are no longer 
able to stay at home and they become foster children because it is the 
only way they can get healthcare? What does it mean for those families 
about whom we all think we ought to have a real discussion, young 
people, young families who have excellent health, how they might have 
been disadvantaged on the exchange? What do we need to do for them? 
Maybe they were doing better economically than a lot of folks until 
they hit the cliff.
  That is why I want to see my bill debated, because it can, in fact, 
offer opportunity. Every time we talk about this, what we hear about is 
how much it would cost. Well, the bottom line is that if all you do is 
shift the burden of these costs without any discussions with Governors, 
with private payers, with corporate America that is self-insured--if 
all we are doing is shifting costs and saying ``It is now your 
problem,'' we are not doing our job.
  If you look at the Rand Corporation study, 12 percent of the 
population of this country has five or more chronic diseases. As a 
result of those unmanaged--typically unmanaged chronic diseases, what 
you will see is they incur 40 percent of the cost. Is that a problem? 
The answer is yes, that is a problem. We need to figure out how we can 
better manage chronic disease.
  A great friend of mine, a guy named Richie Carmona, who once was the 
Surgeon General of this country, used to say--and I think it is true--
70 percent of all healthcare costs are related to chronic disease, most 
of which is preventible. Where in any of these bills are we talking 
about prevention? Where are we talking about wellness? Where are we 
talking about bending the healthcare curve? We are only dumping and 
running with these bills. We are not doing our job, and as a result, we 
are frightening people in this country. We are frightening the elderly. 
We are frightening people who say: Right now, I can afford my health 
insurance; I am on an exchange. But when we change the ratio from 1-to-
3 to 1-to-5 and reduce the amount of subsidies, then 30, 40, 50 percent 
of their disposable income will be used to pay for health insurance. 
That is the thing you are not hearing here.
  So we have to come together. We have to come together with the 
fundamental questions of what is wrong with not just the Affordable 
Care Act but what is wrong with healthcare and how we fix it and how we 
change outcomes. We can't do that if we don't work together. This is a 
body that is divided 48 to 52. How do you come together if you don't 
come to the middle, if you don't come to the middle to compromise? You 
don't.
  At the end of the day, we have not met our deepest obligation, which 
is to speak for those who are the least fortunate among us. We have not 
met our obligation to govern this country in a way that would make our 
Founding Fathers proud, to make our citizens proud, and that can 
advance this idea

[[Page 10774]]

that the U.S. Congress can get something done in the United States of 
America--instead of partisan rancor.
  We hold out the hope that we will at one point be able to debate 
these ideas that we presented. We hold out the hope that we will, in 
fact, meet somewhere to arrive at a better plan for the delivery of 
healthcare in this country.
  I just want to close with one thought. There is not one organized 
healthcare group or advocacy group in my State that supports the 
Republican healthcare plan, so as we are looking at judgment on that 
plan, don't take my word for it. Take the medical associations' word 
for it, take the hospital associations' word for it, take AARP's word 
for it, take the consortium of large hospitals in my State, which urged 
a ``no'' vote on this legislation, take the disabled children's 
advocacy groups' word for it. This is not a path forward, but we are 
big enough people and good enough leaders that we can forge a path 
forward if we just find the will to do it.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Cassidy). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. PORTMAN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Sex Trafficking

  Mr. PORTMAN. Mr. President, I rise today to speak about an issue that 
Members on both sides of this aisle have a deep concern about, and that 
is human sex trafficking and, specifically, the work we have done to 
try to stop one website called backpage.com from selling people online.
  This morning, I--along with my colleagues Tom Carper and Claire 
McCaskill--announced that we have asked the Department of Justice to 
investigate backpage.com for criminal violations of the law. This is a 
criminal referral, and it is a new development in this case. We believe 
there is sufficient evidence to warrant this criminal review by the 
Justice Department, based on the work that we have done in the 
Permanent Subcommittee on Investigations.
  With estimated revenues of more than $150 million a year, 
backpage.com is a market leader in commercial sex trafficking and has 
been linked to hundreds of reported cases of sex trafficking, including 
trafficking vulnerable women and children. Backpage has claimed that it 
``leads the industry'' in its screening of advertisements for illegal 
activity, including sex ads for children. That is simply not true. In 
fact, we now know that this website has long facilitated sex 
trafficking on its site so that it can increase its profits--profits 
that come at the expense of those being trafficked, including children.
  When victims or State authorities try to bring actions against this 
company, backpage has evaded responsibility by saying that it doesn't 
write the ads for sex; it just publishes. Frankly, as a rule, courts 
have sided with the company, citing the immunity granted by a Federal 
law that is called the Communications Decency Act. The law, in essence, 
says that if a company like backpage publishes an ad someone else gives 
them, they are not liable, even though, again in this case, we know 
that this website has long facilitated sex trafficking and they know 
what they are doing.
  We also now know that backpage has actively edited words and images, 
which makes them cocreators of these ads. We also know from a new 
report in the Washington Post just this week that, despite claims, 
backpage has aggressively solicited and created sex-related ads 
designed to lure customers. It further demonstrates that backpage is 
not merely a passive publisher of third-party content. They are 
involved. The article found that backpage workers were active 
cocreators of many of these sex advertisements, including those that 
seek to traffic women and young, underage girls.
  I believe the legal consequences should be that they should lose 
their immunity under the Communications Decency Act, and that is why we 
have asked the Justice Department today to review this matter.
  Let me be clear about the Communications Decency Act. It has an 
important purpose. It is a well-intentioned law. It was enacted back in 
1996 to protect online publishers, and I support the broader 
legislation, the Communications Decency Act. But the law was not 
intended to protect those who knowingly violate the law and facilitate 
illegal conduct, and it was never intended to protect those who 
knowingly facilitate the sex trafficking of vulnerable women and girls.
  We are actively exploring legislation to fix this issue once and for 
all. I have been working with a bipartisan group of Senators on 
potential legislation, and I am hopeful that will soon be introduced in 
the U.S. Senate. We must protect women and underage girls and hold 
accountable websites that knowingly facilitate these types of criminal 
exploitations.
  A couple of weeks ago, I was at a place in Ohio called the Ranch of 
Opportunity in Washington Court House. The Ranch of Opportunity opened 
its doors in the latter part of 2013. It is on a 22-acre site, a 
tranquil setting, a peaceful, spacious, and healthy environment for 
girls between 13 and 18 to help find healing and recovery during a 
residential program.
  The ranch is a place of hope. As it says in its name, it is a ranch 
of opportunity, and a lot of the girls who spend time at the ranch have 
been victims of human trafficking and child abuse. In fact, I am told 
that the majority--roughly 60 to 80 percent--of the young girls who 
come through this program have been trafficked.
  As I have talked to some of the girls and the staff there, of course, 
backpage.com comes up again and again, as it always does when I talk to 
survivors and victims of human trafficking. These types of crimes--
sexual abuse and trafficking--are horrific, but they are happening. 
They are happening all over the country, and they are happening more 
and more. So in your community, wherever you live, sadly I will tell 
you that this is a problem. Part of it is because of these online 
traffickers. In other words, as many of the survivors of human 
trafficking have told me: Rob, this has moved from the street corner to 
the smartphone, and the smartphone is where backpage.com dominates.
  In touring the State, I have heard over and over again about this 
specific link between drugs and human trafficking. I have talked to 
trafficking survivors who have told me that their trafficker first got 
them hooked on heroin and other drugs. I saw this firsthand in May, 
when I toured the Salvation Army of Greater Cleveland Harbor Light 
Complex. They have been operating in Cleveland for 65 years, providing 
incredibly important services to some of the most vulnerable members of 
society, including women who have been trafficked. It is important to 
know that link is there.
  Both of those issues are so important to address--trafficking and 
what is happening in terms of the increasing heroin and prescription 
drug and fentanyl crisis in this country, which is now at epidemic 
levels. That is why the STOP Act is so important--the Synthetic 
Trafficking and Overdose Prevention Act, which we are trying to get 
passed here, as well as the Prescription Drug Monitoring Act, which is 
so important. There is a connection.
  Human trafficking requires urgent action, and so does the opioid 
epidemic. On human trafficking, including sex trafficking, we are now 
told it is a $150 billion a year industry. Think about that. It is the 
second biggest criminal enterprise in the world behind the drug trade. 
Unfortunately, again, it is happening in all of our States.
  Just last month, a 26-year-old man was indicted on human trafficking 
charges. He used backpage.com to advertise the availability of two 
girls, ages 15 and 17. He advertised them for sex and trafficked them 
out to several hotels in the area. Thankfully, in this case, members of 
the Central Ohio Human Trafficking Task Force rescued both of the 
victims, one in Columbus and one in Toledo.
  Cases like this are alarming, but they are happening all over the 
place.

[[Page 10775]]

At the National Center for Missing & Exploited Children, experts on 
this issue report an 846-percent increase in reports of suspected child 
sex trafficking from 2010 to 2015. That is an increase of more than 800 
percent in 5 years. The organization found this spike to be ``directly 
correlated to the increased use of the internet to sell children for 
sex.'' Again, it is the dark side of the internet, and trafficking has 
now moved from the street corner to the cell phone.
  To confront this problem, as chairman of the Permanent Subcommittee 
on Investigations, along with my colleague and ranking member, Senator 
Claire McCaskill, now Senator Tom Carper, I opened a bipartisan 
investigation into sex traffickers and their use of the internet. The 
investigation began over 2 years ago. The National Center for Missing & 
Exploited Children now says that nearly three-fourths--73 percent--of 
all suspected child sex trafficking reports it receives from the 
general public are linked to one website, backpage.com.
  According to leading anti-trafficking organizations, including Shared 
Hope International, service providers working with child sex 
trafficking victims have reported that between 80 percent and 100 
percent of their clients have been bought and sold on backpage.com. 
Backpage now operates in 97 countries--934 cities worldwide--and is 
valued at well over one-half billion dollars. According to an industry 
analysis, in 2013, $8 of every $10 spent on online commercial sex 
trafficking advertising in the United States goes to this one website, 
backpage.com.
  As I said earlier, they say that they lead the industry in screening; 
in fact, their top lawyer described their screening process as a key 
tool for disrupting and eventually ending human trafficking. That is 
not true. Despite these boasts, the website and its owners have 
consistently refused to cooperate with our investigations on the 
Permanent Subcommittee on Investigations. With regard to our inquiries, 
despite subpoenas for company documents on how they screen 
advertisements, they have also refused to provide us documents after a 
subpoena. As a result, this body, the U.S. Senate, last year, for the 
first time in more than 20 years, voted to pass a civil contempt 
citation--in other words, holding backpage.com in contempt and 
requiring them to supply these documents and come forward with this 
information or else face a lawsuit and potential criminal violations. 
Finally, last August, after going through the district court, the 
Circuit Court, all the way to the Supreme Court, we were able to get 
their request to appeal it rejected, and we were able to get the 
documents.
  Over 1 million documents were eventually turned over, including 
emails and internal documents. We went through them all, and what we 
found was very troubling, to say the least. After reviewing the 
documents, the subcommittee published a staff report in January that 
conclusively showed that backpage is more deeply complicit in online, 
underage sex trafficking than anyone ever imagined. The report shows 
that backpage has knowingly covered up evidence by systematically 
deleting words and images suggestive of the illegal conduct, including 
child sex trafficking. The editing process sanitized the content of 
millions of advertisements in order to hide important evidence from law 
enforcement. I encourage people to take a look at this report. They can 
look at it on our website and other websites here from myself or 
Senator McCaskill.
  Backpage CEO Carl Ferrer personally directed his employees to create 
an electronic filter to delete hundreds of words indicative of sex 
trafficking or prostitution from ads before they were published. In 
other words, they knew these ads were about selling girls, selling 
women online; yet they published them.
  Again, this filter they used did not reject ads because of the 
obvious illegal activity. They edited the ads only to try to cover up 
the illegal activity. It didn't change what was advertised; it changed 
the way it was advertised. Backpage did nothing to stop this criminal 
activity. They facilitated it, knowingly.
  What did they do? Well, afraid to erode their profits--they were 
afraid because, as Mr. Ferrer said, in his words, it would ``piss off a 
lot'' of customers. They began deleting words. Beginning in 2010, 
backpage automatically deleted words including ``lolita,'' referencing 
a 12-year-old girl in a book sold for sex, ``teenage,'' ``rape,'' 
``young,'' ``little girl,'' ``teen,'' ``fresh,'' ``innocent,'' ``school 
girl,'' even ``amber alert''--and then they published the edited 
versions of those ads on their website. They also systematically 
deleted dozens of words related to prostitution. This filter made these 
deletions before anyone at backpage even looked at the ad.
  When law enforcement officials asked for more information about the 
suspicious ads, backpage had destroyed the original ad posted by the 
trafficker, so the evidence was gone. This notion that they were trying 
to help law enforcement flies in the face of the fact that they 
actually destroyed the evidence that would have helped law enforcement.
  We will never know for sure how many girls and women were victimized 
as a result of this activity. By backpage's own estimate, the company 
was editing 70 to 80 percent of the ads in their adult section by late 
2010. Based on our best estimate, this means that backpage was editing 
more than one-half million ads a year--more than one-half million ads a 
year.
  At a hearing on the report, the backpage CEO and other company 
officials pled the Fifth Amendment, invoking their right against self-
incrimination rather than responding to questions we had about the 
report and its findings.
  We also heard powerful testimony from parents whose children had been 
trafficked on backpage. One mother talked about seeing her missing 
daughter's photograph on backpage. She frantically called the company 
to tell them that it was her daughter--they finally found her--and to 
please take down the ad. Their response: Did you post the ad?
  Her response: Of course I didn't post the ad. That's my daughter. 
Please take down the ad.
  Their response: We can take it down only if you pay for the ad.
  Talk about heartless.
  Based on our report, it is clear that backpage actively facilitated 
sex trafficking taking place on its website in order to increase 
profits at the expense of vulnerable women and children. Then, after 
the fact, they covered up the evidence of these crimes.
  What is happening to these kids is terrible. It is not just tragic. 
To me, it is evil.
  No one is interested in shutting down legitimate commercial activity 
and speech. As I said earlier, the Communication Decency Act plays an 
important role, but we want to stop this criminal activity.
  I see some of my colleagues are here to speak. I appreciate their 
allowing me to finish, but I urge all of my colleagues on both sides of 
the aisle to join me in reforming these laws to be able to protect 
these innocent victims, these children.
  I yield back my time.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Ms. HEITKAMP. Mr. President, before the chair of the Permanent 
Subcommittee on Investigations leaves, I also would like to put into 
the Record that, recently, in a raid that was performed in the 
Philippines, some very interesting documentation was seized about 
backpage, according to news reports, and the FBI was immediately 
called.
  I think there is an opportunity to use that information to advance 
the investigation and to continue to expose the participation of 
backpage, not just as a billboard or as a want ad but as a knowing 
participant in the trafficking of children--not just in our country but 
globally.
  I thank the chairman.


                               FUTURE Act

  Mr. President, today I am joined by my colleagues from West Virginia 
and Rhode Island. We are kind of a motley group. We are talking about 
something that has brought us together with a level of excitement and 
bipartisanship.

[[Page 10776]]

I would like to say that it is not just bipartisanship but really 
coming across the ideological barriers we frequently experience here to 
try and talk about an issue that is near and dear to our hearts, which 
is maintaining an opportunity for our coal miners and our coal industry 
to continue to do what they have done for generations--and that is to 
produce electricity that fuels this economy in the United States of 
America--but also recognizing that regulatory certainty is one of the 
key values we need to establish. In order to provide that certainty, we 
need to address concerns of other Members of our caucus who have in no 
small measure a lot of concern about what is happening with 
CO2 emissions and what those emissions are doing 
environmentally.
  I want to just kind of introduce this concept. Back in 2008, we 
passed something called 45Q, which was a provision that would allow for 
tax credits similar to what we have for wind and solar. Wind credits 
are production tax credits, and solar credits are investment tax 
credits. To provide for tax credits, $10 and $20--$10 if you are 
injecting into a formation or you are enhancing oil recovery, $20 if 
you are injecting into a geographic formation to store the carbons as 
CO2--those credits have proved to be, albeit used, but 
somewhat anemic to jump-start the technology, to jump-start the 
opportunity to see wholesale carbon sequestration.
  We also know that since 2008, we have seen new technologies coming. I 
know my colleague from Rhode Island will talk about carbon utilization. 
We are expanding beyond just carbon sequestration--carbon capture and 
sequestration--to carbon utilization. It is a hugely important part of 
this puzzle. We believe that if we provide these tax incentives to our 
industries, if we provide these tax incentives to our innovators, it 
will drive technology that will have the benefit of guaranteeing that 
we will see a diverse fuel source in America that includes coal and 
includes natural gas. We always want to point that out, wherever we 
represent coal States. I know West Virginia is in proximity to huge 
natural gas fields. We know that we may be faced with a carbon 
challenge in natural gas, and the ability to capture CO2 
behind natural gas-fired power may be an essential ingredient for 
regulatory certainty into the future.
  We are excited about this bill. We have 25 cosponsors who will 
advance and continue to talk about it and continue to grow colleague 
support. We hope this show of bipartisanship, this ability to work 
across the aisle, this ability to come together--maybe not with the 
same motivations but certainly with the same goal--will prove that on 
one of the most contentious issues here, which is climate and coal, we 
can come together and actually get something done that we can all agree 
on.
  With that, I yield the floor, and I defer to my colleague from West 
Virginia.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mrs. CAPITO. Mr. President, I thank the Senator from North Dakota. 
She has been a champion of building this bipartisan coalition. When we 
announced this yesterday, we had a very large board that showed quite a 
broad array of groups from around the country that are very much in 
support of this concept. So, I thank Senator Heitkamp for her great 
leadership.
  It is terrific to be on the floor with Senator Whitehouse. We both 
serve on the EPW Committee together, and many times we are totally 
opposite. Sometimes we feel as if we are on opposite planets, I think, 
but definitely on different sides of this issue. It is great to be on 
the same side of an issue such as this, which really helps fortify not 
just our country but our regions and our beliefs as well.
  As Senator Heitkamp said, we have 25 cosponsors. Some of them are 
utilities, environmental groups, oil and gas companies, Governors, 
labor unions, so it is a great array of the country interested in 
carbon capture utilization and storage. We have done a lot of research 
in this area, but we haven't been able to scale it up to a point where 
it is economically viable, and that is where I think the tax credits 
will be not just welcomed and used, but it will be very important to 
see that scalability--which we have seen coming in small bits and 
pieces--maybe come in much greater amounts.
  We obviously have a very robust coal industry in the State of West 
Virginia. We have lost thousands of jobs. Senator Whitehouse and I have 
talked about his stay in West Virginia. He has great empathy for the 
coal miner and for those families that have lost jobs, but he is very 
concerned, as I think we all are, about what it is doing to our 
environment and how can we improve this.
  That is what this legislation, I think, will help do. It will spur 
domestic investment in the technologies. It will also help us, I think, 
bring energy security because it goes to the baseload fuels, whether it 
is coal or natural gas, that we have to have.
  I mean, in Washington, DC, today, it is hot out there, and I can 
guarantee you there are a lot of air-conditioners that are running at 
maximum speed. If we do not have this baseload power, which is coal and 
natural gas in areas--and I see my fellow Senator from West Virginia. 
We know, in coal country, how important that is and also what smiles on 
people's faces these air-conditioners can bring, as these hot days go, 
because we are running at full capacity.
  We want to make sure that by capturing the carbon stream, we prevent 
any waste emissions and we provide a possible valuable resource for 
industry. I remarked yesterday for industry to extract oil, which is 
very important, obviously, to the Senator from North Dakota and also in 
our Marcellus shale region.
  I believe that with this research and with the spurring of this 
technology, CO2 is going to have another use out there. 
There are all kinds of utilization possibilities, but if we just turn 
our backs on it or try to shut it down and make it unviable financially 
to invest in these technologies, we are never going to find that next 
best use of CO2.
  So we tweaked the bill a little bit. The Senators have had this bill 
out for at least a couple of years. There is a companion bill in the 
House with a lot of cosponsors as well. I think it has, with 25 
cosponsors on the Senate floor, bipartisan but very different 
philosophical beliefs, maybe. Maybe that is not the best way to put it. 
There are very different regional approaches to this, I guess would be 
a better way to state that.
  We have our universities, such as West Virginia University and 
Marshall University, that are working on this. We have the National 
Energy Technology Lab in Morgantown, where Secretary Perry joined both 
Senator Manchin and me to talk about the technologies that are in front 
of us and the challenge for researchers.
  I feel like financing and the economic model is where we are trying 
to go, in order to spur investment, to provide the regulatory certainty 
but also the investment certainty in that this is a keeper; that this 
is something that is here to stay, that it is doable, that it is 
economically feasible, that it is scalable, and it provides us with a 
lot of energy security at the same time. I think its greatest benefit 
of all is to keep our air clean and get it cleaner and meet the 
challenges of the next several decades.
  With that, I turn it over to the Senator from Rhode Island.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, it is a great pleasure for me to be 
here with Senator Heitkamp. We knew each other as attorneys general so 
I have admired the Senator from North Dakota for a long time. From my 
time in West Virginia, I remember Senator Capito's father who is a very 
formidable and renowned political personality in West Virginia. To be 
here with the two of them is a personal pleasure. Senator Manchin is 
also joining us, so I am very happy to be here.
  I thank Senator Heitkamp, Senator Capito, Chairman Barrasso, and my 
friend Senator Graham for leading this bipartisan effort, and I thank 
Senator Manchin for joining us on the floor.

[[Page 10777]]

  We have more than 20 other cosponsors so this is a bill that has 
broad bipartisan support and has a great coalition behind it. It has 
everything from my great friends at the Natural Resources Defense 
Council, many of our friends in the AFL-CIO, to nonprofits like the 
Clean Air Task Force, to moderating groups like Third Way and the 
Center for Climate and Energy Solutions, which are trying to pick their 
way through the divide, industry groups like Wyoming's Cloud Peak 
Energy coal company and West Virginia's Peabody, a coal company, and 
the ethanol industry. So we have really good, broad support. It is an 
unusual coalition, and I am excited by it.
  There are ways to remove carbon dioxide from the air and from 
emissions, and we are seeing a lot of it. I went with Lindsey Graham up 
to Saskatchewan to see the Boundary Dam facility, where they basically 
put the output of the coal-burning powerplant through a cloud of amino 
droplets that strip out the carbon dioxide and pump it to a nearby 
oilfield where they can use the carbon dioxide to pressurize the 
oilfield and facilitate the extraction of oil. That is made possible 
because they have an oilfield nearby that will pay for that carbon 
dioxide to use in order to extract the oil. If I remember correctly, 
they were getting close to $30 per ton. That is a pretty real revenue 
stream, but a lot of our American coal facilities do not have the 
luxury of being next to an oilfield that will pay for the carbon so you 
have to look elsewhere for revenues to make it worth your while. What 
we have in America is a market failure in which there is nobody who 
will pay you for removing carbon pollution. The way our market is 
structured it just does not work.
  The simplest approach, of course, would be to put a proper price on 
carbon and let the whole economy go to work in solving the problem of 
carbon pollution. Short of that, this bill takes an important step by 
putting a value on reducing carbon emissions by paying facilities with 
a tax credit for every ton of carbon emissions they can keep out of the 
atmosphere. If we can get this passed and if we can get this into the 
Tax Code so it is lasting, then investors can look at it and say: Hey, 
we can finally put some money behind these technologies, and we can get 
them going, not just in the power sector.
  This reaches into industrial carbon capture, into technologies like 
carbon utilization, and into really exciting new technologies like 
direct air capture. Now, most of these are happening elsewhere. To look 
for the models, you have to go to Saskatchewan, like I did and like 
Senator Heitkamp has done, or you have to go to Iceland, where they are 
pumping carbon dioxide down into geological structures where it reacts 
and becomes stone, or you have to go to Switzerland, where they are 
taking direct air carbon capture technologies, because, there, their 
market is not broken so there actually is a return on this.
  We are seeing good work at our National Labs, I will say, which is 
funded by Congress and people like Dr. Julio Friedmann, whom Senator 
Heitkamp and I know and work with. We are doing exciting stuff. Yet to 
take it to a marketable level, there has to be a business strategy. You 
have to be able to make a business case to investors if you are going 
to put money behind building what could be a multi-hundred-million-
dollar carbon capture plant. This will begin to do that, and it makes 
me very excited.
  In particular, I thank my cosponsors for making sure we are not 
talking about CCS any longer and that we are talking about CCUS. It is 
not carbon capture and storage. It is carbon capture, utilization, and 
sequestration.
  I have also been to Shenandoah, IA. Shenandoah, IA, has a big ethanol 
plant, and there is a company, called bioprocessH2O, that is in the 
exhaust stream of that ethanol plant. They pipe out their waste heat, 
their waste energy, their waste CO2, their wastewater all 
into a plant that grows algae, and the algae eats up the 
CO2. They take about 15 percent of it out of the stream, and 
it turns it into a product. They use it for feed, for cattle, for fish. 
They use it for makeup and other products. They use it for a whole 
variety of purposes. It is a new form of agriculture that is going to 
be very valuable, and the fact that you can make it efficient to strip 
carbon dioxide out of a plant's exhaust is a great thing.
  This is a good way we can work together. It may be the first time I 
can think of that Senator McConnell and I have ever been on a bill 
together. He is not on it now in this particular iteration because 
neither he nor the Speaker want to get onto a bill that is a tax bill 
while they are looking at tax reform. Yet, clearly, we know where their 
hearts are from the fact that they were on it the last time. So there 
is a lot of welcomed political news around this, and I think it has the 
chance of really revving up American industry so it is not the 
Canadians and the Icelanders and the Swiss who are cleaning our clocks 
because we have not bothered to get our economic structure in order to 
make this a profitable undertaking. It is a great first step, and I am 
proud to be a part of it.
  I yield to my friend, the Senator from West Virginia, Joe Manchin.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. MANCHIN. Mr. President, I thank my good friend from Rhode Island. 
I have been to his State, and we have gone to the algae farms. It has a 
lot of potential. I agree with the Senator 100 percent.
  I applaud Senator Heitkamp and Senator Capito for leading the effort 
to update and improve this tax credit for carbon capture, utilization, 
and sequestration. We have the support of 25 Democrats and 
Republicans--totally bipartisan--and when you have Senator Whitehouse 
and Senator Barrasso on a bill, you know you have a real bill. It can 
happen. So that is very encouraging.
  Senator Capito and I come from West Virginia, and Senator Heitkamp 
comes from the energy-producing State of North Dakota. Coal was one of 
the most abundant energy sources in the world. It is lying on most 
continents, and most countries have it, and they are going to use it. 
It is a very efficient way of producing energy because it is plentiful.
  Mr. WHITEHOUSE. Will the Senator yield for a question?
  Mr. MANCHIN. Yes, sir.
  Mr. WHITEHOUSE. Does the Senator know that, in Cumberland, RI, there 
used to be coal mining? In fact, there are still coal mines underground 
in New Cumberland, WV. Every once in a while, one collapses, so we have 
been there.
  Mr. MANCHIN. I am so encouraged that you remember the history of your 
great State in not forgetting those coal mines.
  We have to face the facts and the realization that there are 8 
billion tons of coal being burned in the world on an annual basis. We 
burn less than 1 billion in the United States of America, and we are 
the country that has done more to clean up the environment than any 
other country. They all talk about doing different things, but we have 
taken the SOX and the NOX and the mercury out and 
the particulates. We have done more in the last two decades than has 
ever been done, and there is more that can be done.
  I have to be very honest with you. The last 8 years was very 
challenging and difficult for us. No one wanted to make the effort. 
They talked a good game, but no one would put the investment into the 
technology that was needed. Now we have this bill--it is bipartisan 
that everybody is working hard on--that has a chance to really put us 
in the forefront of how we utilize this carbon capture and 
sequestration.
  West Virginia has one of the first powerplants, the Mountaineer Power 
Plant, that shows it can be done commercially. We did a commercial test 
there. We know it can be done. We know it is expensive. At the time, 
President Obama said to go ahead and build a coal plant, and we will 
break you. He knew it was not financially feasible, and that is where 
that statement came from.
  First of all, coal was a baseload fuel. There are only two baseload 
fuels in

[[Page 10778]]

the world today. Baseload is 24/7 uninterrupted power. That is coal and 
nuclear. Gas has now replaced coal in the United States of America in 
its being more plentiful for the production of energy, which we depend 
on, but it still can be interruptible because the gas pipelines could 
be sabotaged. They could break, and weather conditions could change 
that.
  So you have to make sure everything is working for the people of the 
United States of America who have always been used to and been 
dependent upon turning the switch on or their heat and their power or 
opening their fridge, and everything is working. It comes because you 
have baseload that is dependable, reliable, and affordable. You are 
going to have that.
  I think, maybe in my grandchildren's lifetimes, they are going to 
see, maybe, commercial hydrogen, which will be water vapor. I think 
that is coming. It is just not here yet. So we are going to use what we 
have and what we need and make sure we do it in the cleanest fashion. 
The United States should be and will be the leader of this. This is 
what helps us do it, and it gives us incentive to move forward on it.
  When we were doing scrubbers back in the eighties, the Clean Air Act, 
I will never forget, at the time, to do scrubbers that take sulfur out, 
you have to inject, basically, limestone. This crushed limestone, 
basically, clings to the sulfur, and the sulfur drops out in the form 
of the ash. What are you going to do with all of this byproduct of this 
ash? Can it be detrimental? Is it hazardous? Guess what. A lot of the 
drywall you are using today is made out of the ash that came out of the 
new scrubbers from which we did not know we were going to have a 
byproduct.
  So there is value. I still believe in my heart, with this piece of 
legislation, that we are going to find a valuable use of this waste. 
Can it be solidified? We know we can take clear stream CO2 
off. Can we solidify this CO2? It would not just be 
sequestering it. We are doing it in liquid form now and pressuring it 
into the ground. If you have oil or some other energy that is valuable 
to return back, then you can offset the cost, but in a lot of parts of 
the country, we do not have that oil so we are not able to have a value 
returned. It is pure cost, and the cost is about one-third of the 
production. A perfect example: If you have a 900-megawatt powerplant 
and you have carbon capture sequestration, but you have no value in 
return, you lose 300 megawatts by pushing it into the ground. It makes 
it nonfeasible financially, and that is when the statement came, ``You 
build it, and we will break it.'' That is how they break it. You cannot 
do it. So if we don't have to sequester it and pressure it in the 
ground when we solidify this clear stream carbon from liquids to 
solids, can we use the spent fuel of a solid carbon, CO2?
  This is what we should be working on. These are the things we should 
be doing. We missed 8 years. We had a hiatus for 8 years. Let's catch 
up. This piece of legislation puts us on the path to make something 
happen, to truly make us unique in the world of what we do and how we 
do it. The rest of the world counts on us. All the other countries are 
talking about all the things they are doing in climate; trust me, they 
are not. They are talking about it; they are not doing it. Even our 
NATO allies aren't using what we have already developed and perfected. 
They are not using scrubbers, and they are not using baghouses for 
mercury.
  It is not CO2 killing people in Beijing; it is basically 
particulates. It is particulates that we have taken out of the air. We 
can do this, but we need to work together. We can't be fighting each 
other. There is not a West Virginian I know who wants to breathe dirty 
air or drink dirty water--or an American--and they are not going to. We 
have improved and will continue to improve. But we can't be pitting one 
environmental group against another manufacturing or production group, 
and that is what we have done. We are just tearing each other apart 
because we are picking sides: Are you for the environment or are you 
for the economy? I am for both. I am for the environment, and I am for 
the economy, and I think there is a balance between the two.
  If we do the technology and the manufacturers or the producers of 
electricity refuse to use the technology that is proven, then they 
should be shut down. They get a certain period of time to retrofit. If 
they will not do it, then shut them down.
  We haven't gotten there yet on this, and that is why this piece of 
legislation is so important. All of the working groups and 
environmental groups--everybody should be behind this. We have an array 
of Senators who have come together, unlike most bills. We don't often 
have this happen. I am proud of what the Presiding Officer has done. I 
am proud of my good friend from North Dakota. I am proud of my friend 
from Rhode Island. I am proud of my friend from Wyoming. I am proud of 
everyone coming together and saying: If we are going to use it, let's 
do it better.
  With that I say thank you--thank you to all of us for working 
together on this and for continuing to move the United States of 
America forward. West Virginia will do its part, I can assure my 
colleagues of that.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mrs. Capito). The Senator from North Dakota.
  Ms. HEITKAMP. Madam President, one thing I want to talk about, as we 
are talking about carbon utilization--and Joe did a great job of 
talking about new technologies. Frequently when I talk about this topic 
people say: There is no such thing as clean coal. Coal cannot be a 
clean energy source. And I say: That is not true. I tell them about my 
personal experience with the largest carbon sequestration storage 
program in the country, up until some of the new developments, and that 
was Dakota Gas. I served on the board of directors of Dakota Gas, and, 
ironically, the carbon capture and transmission into an oil field was 
not done to respond to concerns globally about carbon; it was done to 
produce a salable and lucrative byproduct--CO2--which can be 
used in the oil fields.
  The one point I want to make is that a lot of the new development in 
exploration and in production of oil is done in tight formations, shale 
formations. This is not a technology, CO2 flooding isn't a 
technology that has been widely used in tight formations because we 
haven't figured out how to do it.
  I want to acknowledge one of those great American corporations, 
Occidental Petroleum, for doing something they call huff and puff, 
where they inject the CO2. They basically let that sit in 
the well and then eventually recharge the well. They are seeing 
excellent results in using this as an enhanced oil recovery method.
  We are very excited about the bipartisan group. We are very excited 
that we can take one of the most contentious issues--one of the most 
contentious issues here on the floor--an issue for which, time after 
time, no one could find a path forward, and we have met with great 
success in getting good people to come together.
  Finally, I want to say that it has been a joy to work with the junior 
Senator from West Virginia. I spend a lot of time with the senior 
Senator from West Virginia. The junior Senator from West Virginia, from 
my experience, is always looking for solutions to problems--not adding 
to the rancor, but looking for solutions to real problems. We have had 
a great partnership, and I look forward to our continued partnership in 
promoting and moving this issue forward.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.


                         Healthcare Legislation

  Mr. SANDERS. Madam President, I wanted to say a few words about the 
new Republican healthcare plan that was just announced a few hours ago. 
While there are some modest changes in it, the truth of the matter is 
that this plan remains a disaster. It remains an embarrassment. I think 
the indication that it is an embarrassment is that with legislation 
that would impact about one-sixth of the American economy of over $3 
trillion a year--legislation that, because it is healthcare, impacts 
virtually everybody--there has

[[Page 10779]]

not been one public hearing on this legislation. It has all been done 
behind closed doors. Honestly, no matter what one's view may be on 
where we as a Nation should go with healthcare, whether you like this 
bill or you don't like this bill, I just don't know how someone can 
seriously say that we don't have to hear from physicians about the 
impact of this legislation on their ability to treat their patients. I 
just don't know how you do that--or that we don't have to hear from 
hospitals.
  I come from a rural State. What will the impact of this legislation 
and the massive $800 billion cuts on Medicaid do to rural hospitals all 
over the United States? There is some belief that many rural hospitals 
in areas where they are desperately needed will be forced to shut down. 
Is that the truth? That is what I hear, but I can't tell you 
definitively because there hasn't been a hearing on that issue. So I 
don't know how we go forward with legislation without having 
administrators from rural hospitals coming before the committee--I am 
on the Health, Education, Labor, and Pensions Committee--or the Finance 
Committee to answer that question.
  The Presiding Officer comes from a State and I come from a State 
where we have a major opioid crisis. It is devastating the entire 
country. What will this bill do to our ability to prevent and treat the 
opioid crisis, which is decimating this country from one end of America 
to the other? What happens if you cut $800 billion in Medicaid? How 
will people get the treatment they need today--which is inadequate? In 
my State, it is inadequate. I don't think there is a State in the 
country that today is providing the necessary treatment or prevention 
capabilities to deal with this opioid and heroin crisis, which is 
ravaging America. What impact will an $800 billion cut have on that? I 
understand there is some additional money going into opioid treatment, 
but how do you do that without the framework of allowing people the 
access to get healthcare? If you get thrown off of healthcare, what 
will the additional opioid money mean? I think not a whole lot.
  In this bill, there are still hundreds of billions of dollars--
several hundred billion dollars--in tax breaks to large health 
insurance companies, to drug companies, to medical device companies, 
and to tanning salons. As a nation, are we really interested in giving 
significant tax breaks to large insurance companies and then throwing 
children who have disabilities off of the Medicaid they currently 
receive? Is that what the American people want? I don't think they do.
  I have to tell my colleagues that this Republican legislation, as the 
Presiding Officer knows, has been opposed by almost every major 
national healthcare organization in the country, including the American 
Medical Association, the American Hospital Association, the AARP, which 
is the largest senior group in America, the American Psychiatric 
Association, the American pediatrics association. Virtually all of the 
major healthcare groups are saying that this legislation would be a 
disaster for the people they serve.
  Just last night we had a teleconference townhall in Vermont and we 
had some 15,000, 16,000 people on the phone. The calls that were coming 
in were very painful calls. I almost didn't want to be honest in 
answering the calls. A woman calls up and she says: My son has a very 
serious medical illness, and we spend a fortune on prescription drugs. 
What is going to happen if this bill passes? What was I going to tell 
her, that perhaps her son would die? It is just not something I feel 
comfortable even talking about.
  The truth is--and this is not Bernie Sanders talking, this is study 
after study after study that says that if you do as they did in the 
House, which is throw 23 million people off of health insurance, 
including people who are struggling with cancer, people who are 
struggling with heart disease, people who are struggling with diabetes, 
what does common sense tell us? If you are struggling with cancer and 
you lose your health insurance, what do you think is going to happen to 
you?
  What study after study has shown is that thousands of people will 
die. It is not that any Republican here wants to see anyone die, but 
that is the consequence of what happens when you throw, as the House 
bill did, 23 million people off of health insurance. We should not be 
giving tax breaks to insurance companies and then throwing disabled 
children, or people with terrible illnesses who are fighting for their 
lives, off of health insurance.
  The AARP is very strongly opposed to this legislation. The reason is 
pretty clear. What every person in America should understand, and I am 
not sure that many do, is that Medicaid now pays for over two-thirds of 
all nursing home care--two-thirds. What happens to the seniors and 
persons with disabilities who have their nursing home coverage paid for 
by Medicaid today? What is going to happen to those people?
  What happens if your mom is in a nursing home? You don't have a lot 
of money, and your mom is in a nursing home paid for by Medicaid. What 
happens if Medicaid is slashed? What is going to happen to your mom? Is 
she going to be thrown out on the street or end up in the basement of 
your house? Are you going to have to make the choice about whether you 
take care of her or put away a few bucks to send your kid to college? 
If suddenly a daughter or a son is going to have to care for a mom or a 
dad thrown out of a nursing home, how do they go to work to earn the 
money their families need?
  These are legitimate questions, and it would have been nice to have a 
hearing or two in order to answer those questions.
  The bottom line is that we have legislation before us that is widely 
rejected by the American people. The last poll that I saw, which was 
done by USA Today, suggested that 12 percent of the American people 
supported this legislation--12 percent. Virtually every major 
healthcare organization in America opposes this legislation. There is 
nothing I have seen today--none of the tweaks that have been put into 
this make this legislation in any way, shape, or form acceptable.
  It is no great secret that the Affordable Care Act is far from 
perfect. I don't think you hear anybody here say: Hey, the ACA is 
great; it doesn't need any changes. It does need changes. Deductibles 
are far too high in Vermont. Premiums are too high. Copayments are too 
high. And the cost of prescription drugs in Vermont and all over this 
country is off the charts.
  I was in West Virginia, and I talked to a woman for a moment after I 
spoke, and she said that she is taking care of her older brother. Her 
brother has seizures. The medicine her brother was using went up by 900 
percent over the last few years. Why? Because that is what the drug 
companies can get away with. Tomorrow it may be 1,000 percent. Does 
anybody in America think that makes sense? Is anybody happy in America? 
Are people in Missouri happy, are people in West Virginia and people in 
Vermont happy that we are paying by far the highest prices in the world 
for prescription drugs? I don't think so. There are ideas out there 
about how we can significantly lower the costs of prescription drugs in 
this country, how we can lower deductibles, how we can lower 
copayments.
  Now, as I have said many, many times, I happen to believe that while 
it is important that we improve the Affordable Care Act, at the end of 
the day, this country must do what every other major country on Earth 
does, and that is to understand that healthcare is a right, not a 
privilege.
  Right now, we have 28 million people who have zero health insurance. 
If this bill in the House were to go through, there would be another 23 
million on top of the 28--over 50 million people--without any health 
insurance. Does that make any sense to anybody?
  Our job is to join the rest of the industrialized world and make sure 
that every man, woman, and child has healthcare as a right, no matter 
what your income is. When you get sick, you go to the doctor. When you 
have to go to the hospital, you don't go bankrupt. That is what a 
civilized democracy is about. That is what they do in Canada. That is 
what they do in the UK, France, Germany, Scandinavia, and Holland. 
Every major country on Earth

[[Page 10780]]

guarantees healthcare to all people. That is where I want to see our 
country go, and I will be introducing legislation to make sure that 
happens.
  More and more people all over this country want to move us in that 
direction. But right now, our job is to make sure that millions of 
people do not lose their health insurance in order to give tax breaks 
to insurance companies. Our job is to make sure that disabled children 
continue to get the care they need and older folks aren't thrown out of 
nursing homes. That is what we have to do.
  So I urge in the strongest possible way the defeat of this 
legislation. Then, let's go forward to improve the Affordable Care Act, 
not destroy it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.


                              Nominations

  Mr. BLUNT. Madam President, it has been nearly 7 months since 
President Trump took office. He was sworn in on the steps of the 
Capitol on January 20.
  Our colleagues across the aisle have had, frankly, more than enough 
time to come to terms with the election results. Unfortunately, they 
seem to be channeling their disappointment through the confirmation 
process by engaging in an unprecedented level of obstruction.
  We spent all this week when the Senate could do no other business on 
the executive calendar than to confirm three nominees--three nominees 
of about 500 that need to be appointed by the President. They are there 
only because the President would want them there. They come and go as 
Presidents come and go. Many of them have gone. The problem is that 
their replacements haven't been there.
  If there is any doubt as to just how unprecedented this drawn-out 
confirmation process has been, let's look at how it stacks up against 
the previous administration. We are only a couple of weeks away from 
August, and Senate Democrats have only allowed us to confirm 52 of 
President Trump's 216 nominees. That is 24 percent. By the August 
recess of President Obama's first term, the Senate had confirmed 313 of 
his 454 nominations, or 69 percent.
  So we start out with an incredibly slow start, where previous 
administrations--both the Bush administration and the Obama 
administration--by the end of the first week, or often by the end of 
the first day, had most of their Cabinet confirmed.
  Getting a Cabinet confirmed is a process that took every minute of 
time that the Senate rules could possibly be stretched to allow.
  Then, we look at nominations. The President, as I said, has nominated 
216 people. Less than one out of four of them have been confirmed. In 
President Obama's term, even though he had more nominees by this time, 
he had a lot more confirmations. The Senate confirmed 69 percent of the 
Obama nominees.
  There are currently more than 150 nominations waiting for 
confirmation, many of them are already out of committee. They are ready 
to come to the floor, but Senate Democrats have caused this backlog by 
using every procedural tactic to needlessly delay nominees. But, when 
they delay the nominees, they also delay our ability to get to the 
other work.
  So there are two questions here. Are you going to let the President 
take over the government, which the Constitution and the Senate have 
been an active part of? Are you going to get the other work done? If 
you don't let the President take over the government, how do you 
effectively get the other work done? It is really a plan that works 
really well if what you want to do is slow down any changes of where 
the government was on January 20.
  A Wall Street Journal editorial earlier this week said:

       Democratic obstruction against nominees is nearly total, 
     most notably including a demand for cloture filings for every 
     nominee--no matter how minor the position. This means a two-
     day waiting period, and then another 30 hours of debate. The 
     30-hour rule means Mr. Trump might not be able to fill all of 
     those 400 positions in four years.

  In fact, at the rate we are going, it will take more than 11 years to 
fill all the jobs that the President is supposed to be able to fill. I 
guess that would put us in the third term of the Trump Presidency 
before he ever got every job filled the first time, which the President 
is expected to fill under the laws that have been there, most of them 
for a long time.
  The Wall Street Journal editorial talks about these difficult terms, 
like cloture. What does that mean? That means that you have to get a 
vote to move forward with the nomination--normally, not done where 
nominations are concerned.
  There is a rule that allows you to have vigorous debate on any 
nominee who really is a problem, but that rule has clearly been abused. 
Now the cloture vote only takes 51 votes. This is no odd Senate 
majority or anything like that. A majority of the Senators can vote to 
move forward with the nominee. But then, if you will not consent to 
waive any of the other rules, you have to wait 2 days before you can 
get to that. You can't do anything else during those 2 days. Then you 
have to have 30 hours of debate.
  That has happened over and over. As a matter of fact, this happened 
30 times. That sounded like about 5 days to me, certainly 3\1/2\ days. 
That whole process has happened 30 times, only to have many of these 
nominees get 90 or more votes, to have no debate on the floor about the 
nominee for whom you are supposed to be insisting on 30 hours of debate 
and to come to the floor and talk about whatever else you want to talk 
about. But if you go back and view the tape on whatever has happened 
during these confirmations, you will find very little discussion of the 
30 times that 30 hours of debate was supposedly required before we 
could get to a final vote. Then, often, in the final vote, in a 
bipartisan effort to find nominees who are willing to serve, they get 
more than 90 votes. That just has never happened before.
  By the first August recess in his administration, President Obama 
only had eight cloture votes. So what has happened here 30 times under 
President Trump happened 8 times under President Obama. Three percent 
of the nominees confirmed under President Obama had a cloture vote 
between swearing in and August, but 60 percent of the nominees from 
President Trump have had a cloture vote, but about the same amount of 
real debate. If we look back at what happened in 2009, the hours of 
actual debate on nominees were about the same, but the use of the 
maximum abuse of the rules is different.
  Let me say this. The rules of the Senate were designed to protect the 
minority, and that is a good thing. This is a unique body in a 
democratic country, where the minority has been traditionally 
protected, and that protection lasts until the minority begins to abuse 
it. There will be a point here pretty quickly where I think Senators 
are going to have to wonder if this rule is any longer a rule that 
should be sustained.
  We cannot continue to do what we are doing. We don't have 11 years 
and 4 months to confirm the Trump nominees. Nobody would want the 
President to have--well, maybe not anybody--an 11-year and 4-month 
term. But our friends on the other side are acting like that is how 
long he has to get just this rudimentary part of this job done that 
largely should have been done in the first 6 months.
  Only 10 percent of the President's nominees' confirmations have been 
done by a voice vote. That is another alternative--just bring the 
nominee, nobody objects to waiving the rules, and you have a voice 
vote.
  Ten percent of President Trump's confirmations have been done by 
voice vote while more than 90 percent of President Obama's 
confirmations were done by a voice vote. So we have the same 
percentages there, just totally turned around--10 percent for Trump and 
90 percent for President Obama. The contrast is striking. It is not 
just simply math. It is, again, about the key positions of government 
that aren't filled.
  As a member of the Intelligence Committee, I hear all the time that 
our country faces more threats from more directions than at any time in 
our history. But we have only been allowed by

[[Page 10781]]

this strung-out process, insisted on by Senate Democrats, to confirm 6 
of the President's 22 nominees for the Department of Defense. The 
Department of Defense has 22 nominees already made, and only 6 of them 
are over there doing the jobs, of which the President says: Here are 
the 22 people I would like to have, and there will be more names to 
follow.
  The positions that haven't been confirmed are the Deputy Secretary of 
Defense, the next job in the Defense Department and the principal 
deputy under the Secretary of Defense; and the Assistant Secretary of 
Defense.
  I don't know about everybody else. I was a little confused by how 
long these titles are. But if you look at what each of these people do, 
these are critical to the mission of defending the country and they 
haven't been filled. These are positions that need to be filled.
  The President continues to work to improve the safety of our 
communities and enforce our Nation's laws. We have seen obstruction 
when it comes to the Justice Department and the 19 people who have been 
willing to serve--all of whom I think are out of committee or about to 
be out of committee.
  If one of them is out of committee, that would be enough. But the 
President has nominated 19 people to fill these vacancies, and only 3 
nominees have been confirmed. Two of the nominees who have been 
reported out of the committee received votes of 20 to 0 and 19 to 1. We 
would think that is somebody who could come to the floor with a likely 
voice vote.
  My bet is that when they do get voted on, 98 Senators will vote for 
them. But if we continue to do what we are doing now, only 2 days after 
a cloture vote, 2 days after the vote, and then almost a day and a half 
of debate after that, it is a disservice to the people that elected us 
to do these jobs and even a greater disservice to the people who 
elected the President to do his job.
  Once again, these are key positions in Justice--the Solicitor General 
of the United States, the principal person who argues in court for the 
United States of America--and it is the middle of July.
  My colleagues from across the aisle have clearly decided that it is 
in their best political interests to stand in the way of the 
President's nominees, but, maybe, more importantly, to stand in the way 
of the Senate's ability to get its job done.
  When I talked to Missourians, they want to know what we are doing and 
why we can't get the work done that they sent us here to do. They also 
want to know why we can't let the President do the job he was sent here 
to do.
  We need to be working on the failures of the current healthcare 
system, how we make college more affordable, and what we can do to 
improve our infrastructure. Those are things we need to get to, and we 
need to allow the President to put his government in place for that to 
happen.
  He was sworn in 7 months ago. He has every right to put the 
government in place. It is time for our friends across the aisle to 
stop grandstanding, to stop standing in the way. It is time to stop 
debating the Presidential election, and it is time to start debating 
the issues of how to run the government and to let the President put 
his people in those jobs so that process can begin.
  Mr. President, I see my friend from Wisconsin is here. I will 
conclude my remarks.
  The PRESIDING OFFICER. The Senator from Wisconsin.
  (The remarks of Mr. Johnson pertaining to the introduction of S. 1553 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. JOHNSON. Madam President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SULLIVAN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Blunt). Without objection, it is so 
ordered.


                        Remembering Gene Zerkel

  Mr. SULLIVAN. Mr. President, as you know, for months now, I have been 
coming to the floor to recognize a special Alaskan, somebody who makes 
my great State a better place for all of us to live, someone we call 
the Alaskan of the Week, usually an unsung hero who has done great 
things but doesn't want anyone to tell you about it because they are 
humble people. Some of these people have been very well known 
throughout the State, and others, as I mentioned, are doing their jobs 
in different communities throughout the State, but they are all 
considered our Alaskans of the Week. Unsung, well known--they all share 
a love for Alaska for good reason: There is so much to love about our 
great State.
  I know most of the people in this room and watching on TV and in the 
Gallery think of Alaska as a majestic place, majestic landscape. It is 
true. It is majestic, but it is truly the people of Alaska who make it 
such a special place, kind and generous people, patriots and pioneers 
who pave the way for the rest of us and leave a very indelible and 
important mark on my State and, in many cases, our country.
  Today, I would like to recognize one of these very special Alaskans, 
a trailblazer, someone whose work has touched nearly every corner of 
the State, someone whom we recently lost, unfortunately, just this 
week, but his memory will last forever. I am talking about Gene Zerkel, 
who was a member of the ``greatest generation'' and an aviation legend 
in the great State of Alaska.
  I don't have to remind you, but many others throughout our country 
don't know just how important aviation is to Alaska. In my State, our 
skies are the highways and the roads. We have about 8,000 general 
aviation pilots in Alaska, which is more than any other State per 
capita by far, and with good reason: There are no roads and ferry 
services to over 100 communities in Alaska, including regional centers 
like Bethel, Nome, Barrow, and Kotzebue. That means everything from 
mail services to baby diapers has to be flown in by plane, and if 
someone gets sick and needs to go to a hospital, the only way they get 
to see a doctor is by a plane.
  Our pilots and our airline industry are essential to serving the 
people of Alaska, and Gene Zerkel has been a part of that service, a 
legendary part of Alaska aviation, for decades.
  Let me tell you a little bit about Gene. He lived life on his own 
terms and defined it through love of God, family, country, and 
aviation. The latter--his passion for aviation--took hold when he was 
just 3 years old, then living in Indiana when he took his first 
airplane ride with a barnstormer. He was so taken with it, when he grew 
up, he continued to do some of those kinds of flights, traveling in 
airshows.
  Like so many in the ``greatest generation'' in our Nation, he 
enlisted in the Army Air Corps during World War II and later joined the 
U.S. Air Force. He continued his passion for aviation after he left the 
military. Some of his favorite adventures were flying during the 
construction of the DEWLine throughout Alaska and Canada in the 1950s.
  In 1973, he fulfilled a lifelong dream so many people in America 
have, which was to come to Alaska and start a family. He started to fly 
in the great skies above Alaska. We are a better State and a safer 
State for it.
  In Alaska, he owned and operated Great Northern Airlines and became 
senior VP of operations and maintenance for the legendary MarkAir. He 
also started Alaska Aircraft Sales and Maintenance, which still 
operates to this day on Lake Hood in Anchorage, AK.
  He was an innovator. He transformed the de Havilland DHC-2 Beaver 
into what was known as the Alaska Magnum Beaver, and he was known for 
always putting safety first.
  In 2007, Gene was awarded the Wright Brothers Master Pilot Award from 
the U.S. Department of Transportation and the FAA in recognition of his 
more than 50 years--half a century--of promoting aviation safety within 
the aviation industry, particularly in Alaska.
  Gene lived for 90 years. He saw so much and did so much for many of 
us. His name is written above the skies of

[[Page 10782]]

Alaska. But most importantly, he was a devoted husband of 48 years to 
his wife Joyce and the faithful father of nine children.
  I had the good fortune of calling Gene a friend and was able to visit 
with him a few weeks ago. At 90 years old, he was still full of life 
and spark and energy and passion and optimism. I have also been in 
touch recently with one of his sons, a young Alaskan hero, Keenan, who 
has his father's passion for serving our country, with many deployments 
to Afghanistan as part of the 210th Rescue Squadron of the Alaska Air 
National Guard. He is literally a true hero in my State. Keenan carries 
on his father's passion for aviation, Alaska, and serving in the 
military.
  Gene's love of country, family, and aviation will always be with us. 
My wife Julie and I pray for his family and his friends during this 
time.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CASSIDY. 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. CASSIDY. Mr. President, I rise to speak to the repeal and replace 
effort that is before us, and the challenge has been how to do so. 
Senator McConnell has recently introduced a bill, and as we pore over 
it, there is much to like, but quite likely, there will be some 
Senators who will still express reservations as to whether this 
amendment adequately fulfills President Trump's campaign pledges--those 
pledges specifically to continue coverage, care for those with 
preexisting conditions, eliminate mandates, and lower premiums.
  If more is required, Senator Lindsey Graham and I have actually come 
up with an amendment that we will add to the bill being offered. It 
doesn't replace it but, rather, it adds to it. In it, we return to 
conservative solutions that devolve power back to States and rely upon 
the States to, in turn, devolve power to the patient.
  So what does this bill do? What we do basically is take the dollars 
that the Federal Government would give to a State under ObamaCare and 
we give those same dollars in the form of a block grant. We allow the 
State to then administer the money in its best way to, one, give 
patients the power, and two, fulfill President Trump's pledges.
  We think this works. It is a 10th Amendment solution in which that 
which is not specifically given to the Federal Government is, in turn, 
given to the State. Let the States decide what they want to do. Some 
object. They say: Oh my gosh. A conservative State may do something 
that we don't think--whoever is speaking--it should be allowed to do. 
Another might say: Well, I don't think a liberal State should be 
allowed to do that. Under our bill, we devolve to the State, so a blue 
State can do a blue thing and a red State can do a red thing. Let's let 
our States be the laboratories of democracy that teach each other the 
best way in which to insure others. But we say it will be the State 
that has the power and not the Federal Government.
  If you oppose this approach, it means you would trust a Washington 
bureaucrat more to address the needs of your State than you would trust 
the people of your own State.
  We would still have those protections which would allow folks to get 
the adequate coverage they need. There would still be--for example, 
preexisting conditions will be covered, fulfilling President Trump's 
pledge to that end. We would fulfill what I call the Jimmy Kimmel 
test--that everybody who is ill or has a loved one who is ill would 
have adequate resources to have that person's illness addressed.
  We have a precedent as to how this is done. Congress, I am told, when 
it addressed the Temporary Assistance for Needy Families Program, gave 
the dollars necessary, with flexibility to the States. Although at the 
time the solution was criticized as giving too much money to the 
States, since, the Federal Government has not had to put in more money. 
Because of the flexibility, the States have been able to use the 
dollars allocated in such a way as to meet the needs of the population.
  So what could a State do with these dollars?
  It could help those patients who are at higher risk or higher cost 
purchase the coverage they need, perhaps in a reinsurance or in an 
invisible high-risk pool that would allow premiums to be lowered for 
those individuals and for all.
  It could maintain status quo. Those folks getting tax credits instead 
could have these dollars fund their purchase of insurance. It could be 
used together with Senator Cruz's amendment, which would allow a health 
savings account to be used to purchase health insurance. The individual 
could set up such an account, the State could fund it, and then these 
dollars could then be used to purchase insurance. I like that, 
personally. That particular provision was in the Cassidy-Collins bill, 
the Patient Freedom Act, and it dovetails very nicely with block-
granting these dollars back to the States to care for someone.
  It could directly contract with providers to provide assistance to a 
specific population. So imagine you have an Indian reservation--or if 
not an Indian reservation, which might be covered under another source 
of funding, another fairly isolated population that does not have 
access to healthcare, the State could say: OK, we are going to come in 
and provide providers specifically for that population.
  Alaska may adopt this because they have 700,000 people stretched over 
a land mass almost as big as the lower 48, and that might be a solution 
Alaska comes up with, but the point being, the solution would be 
specific for that State. Unlike ObamaCare, in which, out of Washington, 
DC, Washington bureaucrats dictate that the same approach be taken 
across the Nation no matter how different the States are, in this, the 
money is given to the State, and the State is asked to provide for 
their citizens in a way specific for the needs of that State.
  We think the Graham-Cassidy amendment returning power to States and 
to patients is a conservative solution which ultimately gives the 
patient more power. I will repeat. This does not replace that bill 
which is being offered by Senator McConnell. It would be an amendment 
to that. And if it turns out that some Senators feel as if that 
particular bill is not adequate to fulfill President Trump's campaign 
promises, we think this amendment could take the bill the rest of the 
way.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Ms. CANTWELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. CANTWELL. Thank you, Mr. President.
  I know my Republican colleagues are working on versions of the 
healthcare bill they have been talking about today, and I know my 
colleagues are going to try to say they are protecting the sickest of 
Americans, and they are saying they do want to ensure that people with 
preexisting conditions don't have to pay through the nose when they 
need care. I think the President called the House version of this 
attempt a mean bill, and I think the original Senate bill was just as 
mean, if not meaner, with the number of people who would be cut off of 
Medicaid over a period of time and left without access to care.
  Today's bill also includes an amendment or a package of ideas by my 
colleagues from Texas and Utah--a provision that allows insurers to 
sell junk insurance on the individual health insurance market. As long 
as they offer at least one plan that is real insurance, insurers could 
offer a bunch of plans that, as CBO has said, are not really insurance; 
that is, they just cover one or two things. Yes, they would be cheaper,

[[Page 10783]]

but if CBO doesn't consider these types of plans insurance, how are 
they insurance?
  I think the whole notion of junk insurance being invested into this 
bill is very problematic. Under junk insurance plans, they can limit or 
deny coverage of essential benefits, including hospitalization, 
maternity care, preventive care, prescription drugs, laboratory care, 
and substance abuse treatment. That is what they can limit. We wouldn't 
want those limited. This is why CBO says that if you can't go to the 
hospital and get care, then it is not really insurance. I have to agree 
with them on that.
  These plans could charge people more or simply deny them based on 
preexisting conditions, and these plans could pay out less than 60 
percent of the healthcare expenses, leaving the beneficiary with 
unbelievable, insurmountable deductibles that would be hard to pay. 
These plans could also impose an annual or lifetime cap on insurance.
  I had a young woman come to my office today who was treated at 
Seattle Children's Hospital in our State. This family actually lives in 
a neighboring State, but Seattle Children's Hospital is such a regional 
entity in the State of Washington, in Seattle, and we are so proud of 
that. They told me about the debilitating disease this young child was 
born with and how many surgeries she has had. Literally, with the brain 
treatments she has had to receive, she and her mother told me that if 
there had ever been any lifetime caps, they would have exhausted them 
in the first few years. I am so proud that she came to see us today and 
is continuing to talk about why capping healthcare plans would be so 
devastating to somebody like her.
  We don't want to create two markets of insurance. We don't want the 
one that is the real plan, real insurance, and the one where everybody 
goes and buys insurance that even CBO says is not real insurance.
  I know that probably in the last few days of discussion, people have 
said: Ok, we will put a bunch of money in to help the real, or 
regulated market. I talked to my insurance commissioner in the State of 
Washington, and he said: Listen, when you don't spread out risk, you 
are not going to have a market and you are going to create problems.
  So the notion that you think that catastrophic out-of-pocket costs 
won't be borne by these individual patients, I think, is wrong or that 
these higher premiums and deductibles could be paid by these 
individuals. It turns out that these junk plans, as I said, do not even 
count as insurance, and everybody who is in the real insurance market 
would then end up having to pay more.
  The bill explicitly states that non-compliant plans will not count as 
creditable coverage for the purpose of individuals demonstrating that 
they have insurance.
  I am checking with my staff.
  Is that right? Is that what is in the proposal?
  Yes. The bill explicitly states that noncompliance plans will not 
count as credible coverage for the purpose of individuals demonstrating 
that they have insurance.
  Under this bill, if someone gets one of those junk plans--if somehow 
you see that marketed and you buy into it because you think it is cheap 
and you think it is the greatest thing ever--and then you try to enroll 
in a comprehensive plan, there is a good chance that you will get a 
lockout period of 6 months before you can get coverage.
  Why am I here talking about this? Because the State of Washington 
tried this. We tried this approach in the 1990s. After our State had 
passed a major healthcare reform bill in the 1990s, a group of State 
legislators allowed these junk plans to be sold along with compliant 
plans. Guess what happened? Nearly all of the insurers in our State 
pulled out of the individual insurance market, and a death spiral 
ensued. Why? Because the cost then of that individual market was so 
high and so great that they could not service it.
  They said: Oh my gosh, if I have to offer a compliant plan along with 
this junk insurance, I cannot make the compliant plan work because it 
costs so much. We are not staying.
  This very important experience taught us that that is not the way for 
us to spread risk.
  I am concerned--and I have heard from a number of patient advocacy 
groups, not just the young woman from Seattle Children's Hospital who 
came to see me today but consumer groups and health insurers 
themselves, like America's Health Insurance Plans, Blue Cross Blue 
Shield Association, AARP, American Cancer Society's Cancer Action 
Network, American Diabetes Association, American Heart and Lung 
Association, Cystic Fibrosis Foundation, March of Dimes, National MS 
Society, National Health Council, and the National Coalition for Women 
with Heart Disease. All of these organizations do not like this idea of 
junk insurance, of saying you can have a compliant plan that is real 
insurance and a marketplace in which there are things that are not 
really insurance, because then people are going to go buy a bunch of 
things that are not really insurance and then not have the ability to 
get cost and care and run up uncompensated care. Then you are going to 
make the real market unsustainable and unsupportive, and the rates are 
going to go so high that people are just going to pull out.
  A group of 10 of those leading patient advocacy groups wrote:

       Under the amendment, insurance companies would be allowed 
     to charge higher premiums to people based on their health 
     status--in addition to opting out of other patient 
     protections in current law, such as the guarantee of 
     essential health benefits--

  Those are the things I was going over a few minutes ago--

     and the prohibition on annual and lifetime coverage caps.

  They go on to write:

       Separating healthy enrollees from those with preexisting 
     conditions will also lead to severe instability of the 
     insurance market. This is unacceptable for our patients.

  Yesterday, America's Health Insurance Plans wrote:

       Allowing health insurance products governed by different 
     rules and standards would further destabilize the individual 
     market and increase costs for those with preexisting 
     conditions.

  That is the largest health insurance group in the country, and they 
are writing this.
  If they are telling us in advance that this is going to really 
destabilize the market and cause problems, we should listen because 
right now what we have had is an expansion of Medicaid and covering 
more people, raising the GDP and helping areas of our States and 
country and creating more stability.
  We have had some challenges in the individual market. We should fix 
that. We should definitely drive down the cost of the delivery system 
by continuing to improve it. But the notion that this is the fix for 
the individual market when the providers are telling us it is going to 
destabilize the market and drive us out--we should understand what the 
result of that is going to be.
  Yesterday, the Blue Cross Blue Shield Association wrote:

       The result (of Cruz/Lee) would be higher premiums, 
     increased Federal tax credit costs for coverage available on 
     the exchanges, and insurers exiting the market or pricing 
     coverage out of reach of consumers.

  I believe our goals should be trying to drive down the cost of 
insurance. We have lots of ideas about that, and I want to work with 
our colleagues on that, but I am very concerned that this approach to 
try to get people supporting a Senate proposal is the wrong approach 
and will drive people out of the market.
  I think the bill is still a war on Medicaid. The bill still 
permanently cuts and caps the Medicaid Program. I have said numerous 
times that we saved $2 billion in the State of Washington by 
rebalancing people off of nursing home care and on to community-based 
care. It is a great concept. Look, we have a lot of people who are 
going to live longer. We have baby boomers who are reaching retirement. 
The number of people who are going to demand services, whether from 
Medicaid or Medicare, is going to be increased just because of the 
population bubble. We should be doing things to drive down the costs of 
care.
  There are great ideas, and I was able to get some of those in the 
bill. We

[[Page 10784]]

ended up passing those things, and some States are actually working on 
that. More than 15 States are actually working on that concept of 
rebalancing to community-based care and making long-term care more 
affordable under this provision. I guarantee you that we have to do 
that, but if you permanently cap or cut Medicaid, you are going to have 
veterans who use access to Medicaid for care who are not going to get 
care. You are going to get people who need opioid treatment.
  I find it interesting that we would have this program over here. I 
see that my colleague from Michigan is on the floor. We call it the 
Saginaw Health Clinic.
  One would say: OK, Saginaw Health Clinic, there is a bunch of money 
in this bill. Apply for opioid help.
  They would say: OK. We are going to get $10 million.
  When you walk in the door of the opioid Saginaw Health Clinic, the 
first thing they will ask is if you are on Medicaid. If you are not on 
Medicaid, you are not going to get any opioid help.
  So the notion that we would cut people off of Medicaid but put more 
money in the opioid problem is not what we need to do to solve our 
challenge. What we need to do is make sure we are delivering the most 
cost-effective care as possible and make sure people are getting access 
to care.
  That is why I have been all over the State of Washington. I have met 
so many people. I have met people at healthcare facilities who have 
told me that some of their highest costs were from a patient who 
continually came to see them in the emergency room, maybe 30 times a 
year, because he did not have coverage, so he drove up the cost for 
everybody. They said they finally got this person on the Medicaid 
expansion. Guess what. They do not have those costs anymore in their 
hospitals and facilities. It has driven down the costs.
  I do not want to see people kicked off of Medicaid. I do not want to 
see it cut in a declining budget. I want us to improve Medicaid and 
make it more cost-effective and more utilized and supported.
  Estimates by the CBO of the original Senate bill are that the 
Medicaid cut would be $772 billion over the next decade and that the 
Federal investment would be cut by 35 percent within the next two 
decades, relative to current law projections. That is a lot of 
consequence for the Medicaid population. I think that is why we have so 
many groups and organizations here that are anxious about this proposal 
and where we go. We definitely want to talk to our colleagues.
  One former CBO Director said, the junk insurance idea is ``a recipe 
for a meltdown.'' This is someone who served in past Republican 
administrations, and I take his word seriously.
  I think what we need to do is work together to make sure we get a 
program that addresses our most fundamental issues--the challenges in 
the individual market, keep addressing how we keep and stabilize a 
population on the most affordable rates there are, and keep the things 
we know have worked very well, like the Medicaid expansion. It has 
worked. It has supported people, and it has helped us stabilize the 
market.
  I will remind my colleagues, too, that the State of New York took one 
provision of the Affordable Care Act and has 650,000 people in New York 
on a very, very affordable insurance plan. We think that if you are an 
individual in the individual market, you should be able to get the same 
clout as somebody who works for a large employer. You should be able to 
go in and buy in bulk as a class, as a group of people, and when you 
buy in bulk, you should get a discount. That is what we think will help 
us in the individual market to drive down these costs for what is about 
7 percent of the marketplace.
  I urge my colleagues to reject this latest proposal. Let's get 
serious about fixing the things that we know we can fix and improve 
upon, but for the over 22 million Americans who are very nervous about 
this proposal because they know they are going to get cut off of care, 
let's not do that to them. Let's improve where we need to go in 
affordability in the healthcare arena and not think that a junk 
insurance program or cutting people off is the solution for the future.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, first, I want to thank my friend from 
Washington State, who has been such a leader on healthcare.
  In looking at her chart, at the junk insurance amendment and all of 
the groups opposing it, it reminds me of the calls I used to get prior 
to the Affordable Care Act from someone who was healthy and young and 
had a policy for years that was only $50 a month. He thought it was 
great. Then, all of a sudden, he got sick or his child got sick.
  He called me up and said: I paid into insurance all of these years, 
and they only covered 1 day in the hospital.
  I remember having that conversation with somebody--or no days in the 
hospital. That is what you call a junk insurance plan.
  This latest version of the healthcare bill would allow that to come 
back so that somebody will have the false confidence in paying $30, 
$40, $50 a month and thinking he has insurance. Then, if something 
happens, he will find out it is just a bunch of junk and that it does 
not cover anything. That is going to be legal again. Right now, it is 
not legal to do that. With health reform, we stopped that. But that 
would be legal again under this proposal, and I am deeply concerned 
about that.
  I am obviously rising to talk about the Republican healthcare bill. I 
do not believe it is a healthcare bill, but that is what we are 
debating, is healthcare or whether healthcare will be taken away. What 
I would rather be doing is working with my friend who is in the chair 
on lowering the cost of prescription drugs. We have worked on many 
things together--mental health and addiction services. I would rather 
be doing that than debating what we are debating. I would rather be 
focused on how we lower the cost of prescription drugs, which is the 
cost I hear about the most from my constituents, or about other out-of-
pocket costs for people who are in the private insurance system, the 
individual insurance market.
  We do have situations in which copays and deductibles are too high in 
the private insurance market. Gutting Medicaid will do nothing about 
that--nothing. It will just take away healthcare from tens of millions 
of people. It will not change the private insurance market at all, 
which is where I believe we need to focus, and I am anxious to do that 
and work across the aisle in order to do that.
  I want to make sure we are talking about building on healthcare 
coverage, lowering costs, and tackling prescription drug costs. 
Instead, this bill would take away healthcare from millions of 
Americans. We know that from the nonpartisan Congressional Budget 
Office. We don't know yet how many millions under the current version, 
but we know that at some point, we will get a score on that from the 
Budget Office. We know it will be a lot of people who are going to lose 
their insurance, and they don't need to lose their insurance in order 
to tackle bringing down the cost of insurance.
  So what do we know about this proposal? The versions keep changing, 
but it is the same old song over and over again--a little bit of 
change, a little bit of different refrain, but it is the same old song 
in the end. What we know is that doctors don't like it and nurses don't 
like it, hospitals don't like it, insurance companies don't like it.
  People in Michigan don't like it. They have called and written and 
told me in person, people approaching me in Fourth of July parades. 
People are scared. They are concerned. A woman's mom is in a nursing 
home who has Alzheimer's disease, and she is panicked. Three out of 
five seniors in nursing homes in Michigan are there with the help of 
Medicaid health insurance. Others are deeply concerned about their 
family members, their children, themselves.
  This is called the Better Care Act, but there is nothing better about 
it.

[[Page 10785]]

Democrats have ideas to actually make our healthcare system better, by 
stabilizing our insurance markets and making premiums more affordable. 
My friend Senator Shaheen of New Hampshire introduced the Marketplace 
Certainty Act. It would ensure cost-sharing payments that were part of 
healthcare reform, that they would actually remain in a stabilizing way 
so they could be counted on. This would offer peace of mind to families 
and stability to the market.
  Senators Carper, Kaine, Nelson, and Shaheen introduced the Individual 
Health Insurance Marketplace Improvement Act, which would create a 
permanent reinsurance program, which we had before--before it was 
changed 2 years ago--to stabilize the market and bring down premiums.
  There have been things that would happen to destabilize the markets. 
Two years ago, there was an action, and now with a new administration 
we need to stop that and reverse it and stabilize the markets.
  Senator Heitkamp has a proposal that helps more families afford 
health insurance by smoothing out the individual market tax credit 
cliff that is there--the tax credits that help low-income, moderate-
income people be able to afford insurance--to fix that in a way that is 
more beneficial to families.
  Senator McCaskill's Health Care Options for All Act would allow 
people who live in a county without an insurer on the exchange--they 
don't have anybody in the private individual marketplace exchange, no 
insurance company--to sign up for the same exchange plans we have. 
There are people being covered. We hear a lot about Iowa, for instance. 
Even though there may be no private insurance companies doing a private 
marketplace option, Senators, Representatives, our staffs who are 
required to be in, as they say, ObamaCare or the Affordable Care Act, 
have an exchange. So to help people immediately, we could allow the 
people of Iowa to get the same option that their Members of Congress in 
Iowa have and that their staffs have. That would be possible, as a way 
to address this issue in the short run and to help people. I don't know 
why somebody who is in Iowa or Michigan or anyplace else shouldn't be 
able to get the exact same coverage a Member of Congress can get.
  Here is what we do know in terms of the ideas in the bill. Our 
Republican colleagues know how unpopular the bill is. A new poll found 
that only 12 percent--12 percent--of Americans support this bill. It is 
so unpopular they have been trying to rewrite it and get enough votes 
to pass it. We keep hearing about changes, but unfortunately none of 
these amendments make it better. In some cases, like the junk insurance 
policies that will be allowed, they actually make it worse.
  Now, the proposal that would provide $45 million to tackle the opioid 
epidemic, even Republican Ohio Gov. John Kasich said it would be like 
spitting in the ocean. It is not enough, he said. I appreciate the 
focus on that. It is a horrible epidemic. It is an epidemic in Michigan 
and across the country, but it is certainly not enough to make up for 
the huge cuts to Medicaid insurance--healthcare insurance, as the 
Senator from Washington State indicated.
  The other proposal that we understand is in the new bill, as I 
mentioned before, would give insurers the freedom to once again refuse 
to cover basic health services like maternity care or addiction 
treatment, as long as one plan they offer, among many, would include 
essential health benefits. So everything else could be junk, and there 
would be one high-cost plan that would actually cover things families 
need.
  Insurance companies themselves know this is a terrible idea. In a 
letter to Senator Cruz and Senator Lee, Scott Serota, president and CEO 
of Blue Cross Blue Shield Association, wrote that their plan ``is 
unworkable as it would undermine pre-existing condition protections, 
increase premiums and destabilize the market.'' That is what is viewed 
as this great new provision in the bill.
  He added: ``The result would be higher premiums, increased federal 
tax credit costs for coverage available on exchanges, and insurers 
exiting the market or pricing coverage out of reach of consumers.''
  In other words, premiums would skyrocket for older people, people who 
take prescription drug medications, people with chronic conditions. 
Everyone else would be left with the junk insurance policy that doesn't 
cover really anything, and they feel OK unless they get sick. We would 
all be stuck with a fragmented, destabilized insurance market.
  Remember preexisting conditions? This would bring them right back.
  This bill is wrong for many, many people, but let me mention Felicia. 
In 2011, she was an AmeriCorps member serving in Lansing who didn't 
have health insurance. When she started feeling tired all the time and 
losing weight, she went to the Center for Family Health in Jackson.
  Felicia was diagnosed with stage IV Hodgkin's lymphoma. The Center 
for Family Health helped her get coverage through Medicaid and care at 
the University of Michigan, including chemotherapy and later a stem 
cell transplant.
  Felicia writes:

       Now I am feeling awesome. I am cancer-free, and I am 
     working part time while I am finishing up college. I feel 
     that I owe my life to the Center for Family Health.

  Felicia knows the importance of comprehensive health coverage. It 
saved her life.
  Nick and Chelsey know it too. They and their three young children are 
covered by Healthy Michigan, our State's Medicaid expansion. Nick and 
Chelsey are both employed full time. Chelsey also attends college full 
time.
  During a routine visit, doctors discovered that her oldest son was 
born with an obstructed kidney, which had lost one-third of its 
function by the time he was 5 years old. Thanks to the Medicaid 
expansion, he was able to have surgery before his kidney lost all 
function. Without the Medicaid expansion, which ends under the 
Republican bill, these working parents and their three children 
couldn't afford healthcare coverage, let alone surgery.
  Margo knows this because she sees it every day. She manages a clinic 
in Kent County on the west side of the State. She said the lives of 
patients are much different today than they were a few years ago. Margo 
wrote:

       Seeing working people who have struggled all of their adult 
     lives to manage their chronic health conditions finally have 
     access to regular doctor visits, health education, and 
     prescription medications has been a tremendous relief. You 
     cannot imagine the sense of dignity our patients feel.

  She added:

       Please see it in your heart to care about the people of 
     Michigan who work but do not get insurance through their 
     employer.

  So, finally, let me just say, doctors know this is a bad bill. Nurses 
know this is a bad bill. Hospitals know this is a bad bill. Insurance 
companies know this is a bad bill. I know that even many of my 
Republican friends know this is a bad bill. Their amendments haven't 
changed that. Costs go up and care goes down. Preexisting conditions 
come back. Millions lose their coverage.
  What we should be doing is working together to stabilize the 
marketplace, reduce out-of-pocket costs, and lower the outrageous costs 
of prescription drugs--by the way, not giving a tax cut to prescription 
drug companies, as is in this bill, and other companies as well.
  Felicia, Nick, Chelsey, and millions more like them in Michigan and 
across this country deserve that much.
  I sincerely hope that when it comes time to vote on whether to 
proceed to this bill, that the majority of the Members in the Senate 
will say no.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The majority leader.

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