[Congressional Record (Bound Edition), Volume 163 (2017), Part 9]
[Senate]
[Pages 12031-12057]
[From the U.S. Government Publishing Office, www.gpo.gov]




              AMERICAN HEALTH CARE ACT OF 2017--Continued

  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Madam President, I want all my colleagues and everyone 
listening right now to be very clear about what Republican leadership 
is planning for today. Faced with defeat after defeat on their plans to 
rip apart our healthcare system--``no'' on a bill that would spike 
families' premiums, gut Medicaid, and deny 22 million people 
healthcare; ``no'' on a bill that would cause chaos and healthcare 
costs to skyrocket and deny 32 million people healthcare--it appears 
the Republican leader has a last-ditch plan waiting in the wings.
  As soon as they have an official score from the CBO--which could be 
hours from now--in the dead of night, Senator McConnell will bring 
forward legislation that Democrats, patients, families, and even many 
Senate Republicans have not seen, and try to pass it before anyone can 
so much as blink.
  Now, we have heard rumors about what could be in this bill, and based 
on what we know, Democrats took it upon ourselves to do the best we 
could to figure out what its impact will be. The CBO scored our best 
guess at what Republicans are talking about doing, and here is what 
they found: Sixteen million people will lose their healthcare coverage 
in the next 10 years under this bill; premiums will increase by 20 
percent every single year for the next 10 years; your premiums will 
increase 20 percent every single year in the next 10 years, all while 
special interests in the healthcare industry are going to get a massive 
tax break.
  Republicans could still play games with the language as they 
negotiate in secret somewhere to try to get a bit ``better'' than this, 
but no matter what they do here, if they jam it through, they will be 
held accountable for the millions of people who lose care and the 
millions and millions more who will see their premiums go up.
  I hope, when my Senate Republican colleagues began their process, 
they were not planning to pass a bill in the dark of night to deny 
millions of people healthcare and hand special interests billions in 
tax breaks, but, right now, that is the path they are careening down--
even as more and more people are speaking up about what the impact of 
this legislation would have.
  In fact, just yesterday, a bipartisan group of 10 Governors wrote a 
letter

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urging Senate Republicans to reject this secret bill, saying it would--
I am quoting 10 bipartisan Governors--``accelerate health plans leaving 
the individual market, increase premiums, and result in fewer Americans 
having access to coverage.''
  I hope every single Senate Republican read that letter.
  I also hope they understand that if they pass this bill tonight, it 
will only get worse from here. If this secret bill--the lowest common 
denominator--goes through and a conference starts with the House, then 
every Senate Republican who voted for it has just bought TrumpCare a 
trip to the White House. The Senate Republicans who so loudly made 
clear they hated the TrumpCare bill when it passed the House could now 
very well find themselves being held responsible for sending that same 
bill straight to President Trump's desk because, let's be honest, 
extreme conservatives aren't going to rest until they have a bill on 
the way to the White House that would spike premiums and out-of-pocket 
costs, gut protections for preexisting conditions, end Medicaid as we 
know it, defund Planned Parenthood, and kick tens of millions of people 
off their coverage--a bill that would, in other words, shatter the 
promises of more responsible Republicans who I know are deeply 
concerned about ways these outcomes would impact the people they serve.
  So, to put it simply, a bill in conference is no excuse to kick 
people off coverage, spike premiums by 20 percent for everyone, and 
give a massive tax break to the wealthy, especially because it will 
simply be an opportunity to hand the keys over to the House Freedom 
Caucus.
  I want to remind any Senate Republican who doesn't want to have 
TrumpCare on their hands--who truly does want to make our healthcare 
system work better for patients and families--there is a better path. 
As Senator McCain said so powerfully earlier this week, we shouldn't 
let the ``bombastic loudmouths'' drive our work. We should get back to 
regular order, and we still can.
  I am saying to every Senate Republican every chance I get: Drop this 
partisan, sham floor process. Drop it. Start over with an open, 
transparent process in which both sides, patients, and families across 
the country have a voice.
  I hope that as big as our differences are, many of my Republican 
colleagues would prefer that bipartisan voice and route. They have said 
as much. Their votes to reject the partisan TrumpCare and full repeal 
bills this week made it even clearer.
  So let's have hearings like Chairman Alexander has proposed to do in 
our HELP Committee. Let's have a public debate. Let's focus on policies 
that lower costs, that expand coverage, and improve quality.
  Democrats are ready. We are at the table. I hope Senate Republicans 
who are ready to work on real solutions will join us, but, first, for 
that to happen, Senate Republicans need to step away from this sham 
process we are on today. Say no. Vote no. Return us to a process we are 
all involved in.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nebraska.


                          Separation of Powers

  Mr. SASSE. Madam President, in the fall of 2015, when I first spoke 
on the Senate floor, I gave Nebraskans and every Member of this body my 
word that I would speak up when a Republican President exceeded his or 
her powers. At that moment, the Democratic President had taken to 
himself powers the Constitution had not given him. My opposition was 
not that President Obama was a Democrat but rather that our brilliant 
Constitution intentionally separates executive and legislative powers.
  I gave my promise then because, despite the lazy, partisan rhetoric 
of this city, not everything is actually a blood feud between 
Republicans and Democrats. That is because American politics at its 
best is acutely aware of the difference between justice and strength. 
That is because when our body is working well in the Senate, we take 
seriously our history, our duties, and our unique place in the 
Constitution's architecture of separate powers, both vertically and 
horizontally.
  In 2014, the U.S. Supreme Court ruled that the Obama administration 
had made unconstitutional appointments when it declared this body to be 
in recess when the U.S. Senate was not, in fact, in recess, and it 
functionally claimed power--that is, the administration functionally 
claimed power--that belonged to the Senate under our Constitution.
  So today I have come to the floor to keep my promise and to offer a 
word of humble advice to the President. If you are thinking of making a 
recess appointment to push out the Attorney General, forget about it. 
The Presidency isn't a bull and this country isn't a china shop. Mr. 
President, you are a public servant, in a system of limited government, 
with a duty to uphold and to defend and to teach to our kids the 
Constitution's system of checks and balances. This--this is the world's 
greatest experiment in self-government. It works only if all of us--
Presidents, Senators, Republicans, Democrats, Independents, and 
judges--if we all keep our faith to the American institutions and to 
the rule of law.
  Our oath is not to popularity, it is not to polls, and it is not to 
political parties. Our oath is to the Constitution and to the rule of 
law. Our duty is to the American people--the men and women who elected 
us, the men and women who came before us, and especially the men and 
women who will come after us in this greatest of experiments in self-
government.
  Madam President, with respect to the healthcare debate that we are 
having in this body, while I obviously look forward to taking seriously 
and considering any and all amendments offered by my colleagues, both 
Republicans and Democrats, the basic trajectory of where we are in 
healthcare has not changed. We should all be disappointed by where we 
are.
  Here is what I mean. It is very likely that in the coming decade, 
basic math is going to force Americans and those who will serve them in 
this and other institutions of government--they are going to be forced 
to choose between two paths. This isn't that hard to see. We are 
ultimately going to choose between single-payer, socialized medicine--
something I think is terrible policy, but it is intellectually 
coherent--or we are going to actively build the innovative, disruptive 
system of consumer-based health insurance that actually goes with 
consumers and patients and Americans and taxpayers across job and 
geographic change. We are ultimately going to make a choice.
  Sadly, this has been a missed opportunity. We are not making the big 
choice now. We are making a choice between a couple of small options. 
We have forks in front of us that are, I think, dissatisfying to 
everyone. I have one constituent at home, who also happens to be my 
wife, who when she checks in on the processes of Washington, she 
regularly says: Both of your political parties are so gross. She is 
dissatisfied, like so many of the constituents who call us and come to 
our offices, with the fact that we are not debating the real stuff 
around here. We are making a choice between two small, pretty crappy 
options, when really the big choice that is in front of us--when we 
have health entitlements which dwarf everything else on the Federal 
budget--the two choices before us aren't really that hard to see. We 
are ultimately going to migrate toward a European-style single-payer 
system, where government will be more effective at controlling costs, 
but it will do it by crowding out lots and lots of the private sector. 
We are either going to have single-payer healthcare or eventually we 
will create a system where you have portable, affordable insurance.
  We have none of those things today. We have no portability today. You 
can't take your insurance policy with you across job and geographic 
change. When I change jobs, I don't lose my life insurance. I don't 
have to cancel my car insurance because I changed jobs. But we are 
still living on a system that launders our insurance, which is really 
mostly the collectivized prepayment of mostly predictable medical 
expenses. We launder it through a tax accident

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from the 1940s. So you have to do that through your large employer 
group. You can't do it in the small market or as an individual. So we 
don't have portability, and we all know we need portability.
  We did this 30 years ago in pensions. We used to also launder through 
a tax accident where, when people were presumed to work at one firm 
through their whole career, they had a defined benefit pension plan. It 
worked when you worked at the same place from high school graduation to 
retirement. It doesn't work when the average duration at a job for 
Americans is now under 4 years. So we did the hard work of reforming a 
pension system from a defined benefit to a defined contribution, tax-
protected, portable 401(k) plan.
  Obviously, we all know that if we are not going to end up in 
socialized medicine, we should have portability in our health insurance 
benefits. We should have farmers and ranchers in the Presiding 
Officer's State or in my State able to keep their insurance that they 
usually have to buy through the individual market, or we need the gig 
economy mobile workers who are going to change jobs even faster than 
every 4 years to not become uninsured for 4 to 6 months every fourth 
year when they change jobs. That is actually the No. 1 driver of 
uninsurance in America today.
  To listen to pundits screaming on TV, you would think that somehow 
there are so many sicker or so many poorer Americans and that is why we 
have had arcing uninsurance since 1990. But that is not true. We don't 
have more poor people and we don't have more sick people. Uninsurance 
went up from 1990 to 2009 because people change jobs more rapidly, and 
every 4 years when they change jobs, if they have a 4- to 6-month 
period of uninsurance, that is when they get the breast cancer 
diagnosis, or probabilistically that might be when they get in the car 
accident, and now they become the preexisting condition population of 5 
and 10 and 15 years from today.
  This isn't rocket science. Uninsurance has grown in America over the 
last 25 years because we change jobs more and we have a stupid, clunky 
system from 60 years ago that we still launder through a tax accident. 
We should have portability. We should have affordability. We should 
have a real debate in this body about why so many--and by the way, I 
have been critical of my party for not having a good plan for replace. 
But I will say to those on the other side of the aisle, the 
``Affordable Care Act'' is an absurdly Orwellian name for a piece of 
legislation that those who were in this body and voted for 7 years ago 
told the American people--you all did a press conference at the White 
House, and you said premiums would fall $2,500 per family of four. They 
have risen $3,200 on average per family of four. So your plus or minus 
sign was off to the tune of $5,700 per American family.
  In my State and in the Presiding Officer's State, we now have a lot 
of farming families in counties where there is only one insurer, where 
premiums are now north of $20,000 a year for the insurance market.
  Stop pretending this is in any way affordable.
  What we have is a system where the assumption is that because the 
system is so broken, the only way anybody could ever get health 
financing--and supposedly, health financing is the means to getting 
access to the health delivery system--is that everybody needs to be on 
welfare. That doesn't work.
  We should have a robust social welfare safety net for the poorest and 
sickest among us, and we all in this body should be accountable for 
passing a piece of legislation that delivers a system where lower 
middle-class and middle-class and upper middle-class Americans can 
afford their own health insurance. Not everybody in America needs to be 
on welfare, and not everybody in America wants to be on welfare.
  So our system is not affordable, it is not portable, and 
fundamentally it is not really insurance.
  We have a system that is mostly about the collectivized prepayment of 
all medical expenses. We don't do this in any other sector of the 
economy. Think how absurd it would be for us to pass a law in this body 
mandating that Allstate and State Farm have to buy all your gas and 
schedule all your Jiffy Lube appointments. That is what we are trying 
to do in healthcare. Guess what. We can guess what it would look like. 
Jiffy Lube would be open at the wrong hours; it would be at the wrong 
locations; we wouldn't know what services they deliver; there wouldn't 
be quality metrics on any of it; and it would probably grow at 2 to 
2\1/2\ times inflationary or GDP growth--just like healthcare.
  We are trying to hyper-regulate and micromanage all of the largest 
sector of the U.S. economy from here by pretending we are talking about 
insurance, when we are not. What this body and what the Congress and 
what Washington, DC, have wanted to do for years is run every decision 
in healthcare but not tell the American people the truth--that it turns 
out it is really expensive.
  Nobody comes to the floor and advocates--maybe Bernie does. Maybe 
Senator Sanders comes to the floor and actually honestly advocates for 
raising taxes to the level of all the micromanagement of the health 
sector that people in this body want to do. But what most people want 
to do--and it isn't just your side of the aisle; it turns out it might 
be a lot of people on my side of the aisle as well--they would like to 
have so much control over the healthcare sector but not admit how 
expensive it is, that we will do it by regulations on the financing 
model so you can hide it under the word ``insurance.'' Most of what is 
happening in American healthcare isn't insurance. Insurance is 
insulating people from catastrophic loss from non-behaviorally-driven, 
unpredictable events.
  Everybody in this body wants every American to have health insurance, 
and everybody in this body should also want a health delivery system 
where the average American family living on middle-class wages could 
afford to buy their healthcare without potentially going broke or 
needing to become a ward of the State in the form of welfare. We should 
be having that debate. We should have a debate about portable 
insurance, about affordable insurance, versus socialized medicine. I am 
against socialized medicine, but people who want to advocate for it 
have an intellectually coherent position. That is the debate we should 
be having. Instead, we are going to kick the can down the road and have 
another small-ball debate. This is a lost opportunity for the American 
people, and it kind of makes a sham of the joke that this is the 
greatest deliberative body on the face of the Earth.
  I live in a little farm town in Nebraska. There are 10 not-for-profit 
boards in my town that deliberate a heck of a lot better than we 
deliberate in this body. We can and should do better.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Madam President, the first three words of our 
Constitution are ``We the People.'' Indeed, our entire system was set 
up to be a government which produces results of, by, and for the 
people, but certainly right now, that is not what we are getting.
  We are getting a secret plan which has not yet been put on this 
floor, with a promise that there will be a debate in the middle of the 
night--no chance for committee hearings on it, no chance to consult 
with experts, no chance for us to go home and talk to our constituents. 
This is about as far away from a deliberative democratic republic as 
you can possibly get.
  It makes us think of 1787, when Ben Franklin came out of the 
Constitutional Convention and was stopped by someone in the crowd and 
asked: What do we have--a monarchy or a republic?
  He answered: A republic, if you can keep it.
  Well, we are not keeping it right now through this secret, middle-of-
the-night, non-consultative process. We are disgracing the notion that 
our Founders fought for the ``we the people'' Republic.
  This is something which touches so many Americans. We are not talking

[[Page 12034]]

about the weight limit on a highway. We are not talking about what 
kinds of signs to post. We are talking about fundamental access to 
healthcare.
  If the rumors are right, my colleagues plan to bring forward a bill 
that will blow up insurance on the exchange for millions of Americans.
  An insurance pool is a little bit like a swimming pool. You tear a 
hole in the side of a swimming pool, the water drains out and there are 
only a few inches left, and the only people who would bother to go into 
that depleted swimming pool would be those who really, really want to 
swim. It is the same with the healthcare pool. The bill coming out 
tonight, we are told, will rip a big hole in the side of the insurance 
pool, and it will do so in a fashion that only those who have 
preexisting conditions, only those who are sick, only those who are 
old, will truly try to get that insurance. This means the price will be 
driven up, and many of them can't afford it, so they will drop out. So 
it means the pool will have even more people who are sick and older. 
This is the death spiral.
  My colleagues today are planning to put forward a bill tonight, we 
are told, that creates a death spiral insurance. Who pays the price? 
Who pays the price? Our Nation pays the price with an estimated 16 
million people who would lose insurance. We are talking about those who 
have every desire to have the peace of mind that if their loved one 
gets sick, they will get the care they need. We are talking about 
Americans who have every desire to know that if their loved one gets 
injured, they won't end up bankrupt. But all of that is at risk 
tonight.
  A few moments ago, my colleague from Nebraska came to the floor, and 
he started out by saying we need to ensure that the President doesn't 
overstep his powers. Let's talk, too, about this Senate not destroying 
its procedures designed to ensure a ``we the people'' republic, which 
means we should all vote to send whatever bill comes out tonight to 
committee, where it can be duly considered in a bipartisan fashion, 
with experts, with consultation. In fact, my colleague from Arizona, 
who came back and gave a dramatic and beautiful speech just 2 days ago, 
said it should be considered by committee.
  Let's work together to take whatever plan comes out tonight and put 
it where it needs to be--in committee for due deliberation. This issue 
touches too many lives. It is too core to the quality of life of our 
fellow Americans. Let's not allow any bill to pass out of this Chamber 
that would do so much destruction.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Sasse). The Senator from New Mexico.
  Mr. UDALL. Mr. President, the Senate is now in its third day of 
voting on major healthcare legislation, and we still have no idea 
exactly what the Republican leadership wants or what bill they are 
going to put on the floor. The Republican leadership tosses out 
options, bills that would affect the lives of millions of Americans and 
one-sixth of our economy. Not even Republicans know what proposal is 
coming next, and the American public certainly doesn't know what is 
coming, and they are very interested because they have healthcare and 
they want to know if it is going to be taken away from them.
  It is as if the Republicans are playing healthcare roulette. The 
leader spins the roulette wheel, the ball lands arbitrarily on some 
version of the ACA repeal, and the leader quickly calls a quick vote on 
that random version of ACA repeal.
  Soon we are going to vote on a cynical amendment from the Republicans 
offering Medicare for all. My understanding is the Senator offering 
this isn't even going to support his own amendment. If you were in a 
State legislature, you would be prohibited from offering an amendment 
like that. They oppose this Medicare-for-all amendment. They oppose 
Medicare for all. So why are they seeking a vote? To distract from 
their own dangerous bills and reckless process. It is a desperate ploy, 
and everyone sees through it. I support healthcare for all. It should 
be a right in this Nation. But this is a phony and insincere amendment.
  All the while, the President stands to the side, not caring one whit 
what the bill looks like or how many people will be hurt in the rush to 
get a bill out the Senate door.
  On Tuesday, we voted on the leadership's Better Care Reconciliation 
Act 2.0. That would cut 22 million Americans off healthcare. It also 
has been rejected overwhelmingly by Americans.
  Yesterday, we voted on straight ACA repeal, not replacement. That 
bill would throw 32 million Americans off of healthcare. That idea is 
no more popular than the other bills.
  Today, maybe we will vote on a last-ditch version which would repeal 
parts of ObamaCare, the so-called skinny repeal option. That bill is no 
better. It would mean 16 million Americans get thrown off healthcare, 
and the other very important part of this is that it would raise 
premiums 20 percent. We have heard our friend from Nebraska come down 
here on the floor and talk about their concern about healthcare and 
concern about the cost of premiums. They ought to know that this 
proposal is going to raise premiums 20 percent.
  This bill is the Republicans' last hope. It takes away the individual 
mandate to get health insurance and the employer mandate to provide 
health insurance to employees. Like the other schemes the Republicans 
have tried, it would hike premiums for the elderly and for the sick.
  Blue Cross Blue Shield is opposed to this proposal. They say ``strong 
incentives for people to obtain health insurance and keep it year 
round''--that is what they are looking for, that is what is in current 
law, and we have the Republicans wanting to take it out.
  There must be Affordable Care Act cost-sharing provisions for 
consumers. Otherwise, there will be--and this is Blue Cross Blue Shield 
again--``steep premium increases and diminished choices that would make 
coverage unaffordable and inaccessible.''
  Like the other schemes, this won't ensure that more Americans will 
have healthcare; it means many fewer will. It doesn't decrease 
healthcare costs; it increases healthcare costs. Even worse, there have 
been no committee hearings, no public input on this or any of the other 
versions of ACA repeal the Republican roulette ball has landed on.
  To give you a sample of the public feeling on this issue--I am seeing 
it across New Mexico--my office has received 14,500 calls, emails, and 
letters rejecting the Republican plans. It is an unprecedented number 
from the small State of New Mexico.
  I agree with Senator McCain. We must go back to regular order. We 
must stop this gamesmanship. We need to work together on a solution to 
improve the Affordable Care Act by bringing down costs, making it 
easier for small businesses to provide healthcare, and especially 
making prescription drugs more affordable--but not by denying New 
Mexico families and millions more access to quality healthcare.
  The Republicans are playing with people's lives. Making sure severely 
disabled children have healthcare through Medicaid is not a game; 
neither is kicking elderly grandparents out of their Medicaid-funded 
nursing homes or enabling women to get breast and cervical cancer 
screenings from Planned Parenthood.
  It is hard to keep up with the Republican versions 2.0, 3.0, 4.5, 5.0 
of the Affordable Care Act repeal. Every bill is consistent in cutting 
care for millions of Americans.
  The Republicans keep proposing so-called healthcare bills that are 
not actual healthcare bills. The real healthcare bill would protect 
gains made, cover more people, and make health insurance more 
affordable. The Republican bills do none of these things. Their bills 
reverse the gains, cover millions fewer people, and make health 
insurance less affordable, especially for those most vulnerable.
  The American people want everyone to have affordable healthcare. That 
must be our goal. Republicans and Democrats should be working hard 
right now to get us to that national goal.
  I have shared the stories of New Mexicans who have lives that have

[[Page 12035]]

been changed, and even saved, because of the Affordable Care Act--New 
Mexicans like Mike, from Placitas. Mike had an aggressive cancer but 
was diagnosed early, thanks to the Affordable Care Act, and doctors 
saved his life. Alexis, from Albuquerque, had a stroke and brain 
surgeries when she was 28. She had affordable health insurance under 
the ACA, and those subsidies helped her keep health insurance and get 
healthcare coverage. Elena was able to afford a lifesaving mastectomy 
because of Medicaid expansion. These are real people who are now 
jeopardized by the Republican bills and Republican proposals.
  There are thousands more across New Mexico and millions across the 
country who are crying out for the Republican majority to change this 
reckless and dangerous scheme.
  I yield the floor.
  My colleague from New Mexico, Senator Heinrich, is here. He has been 
a real champion in terms of fighting for working families and for their 
healthcare.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. HEINRICH. Mr. President, I ask unanimous consent to speak for up 
to 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HEINRICH. Mr. President, for over 7 years, Republicans in 
Washington have cheered shortcomings in our healthcare system and 
blamed the Affordable Care Act for every problem under the premise that 
they would do so much better if just put in charge.
  Repealing the law made for great bumper stickers and great campaign 
promises, but the trouble is that their opposition to the ACA has 
always been more about politics than it ever was about actual policy 
or, for that matter, plans to do better for the American people.
  The shockingly rushed and secretive effort on display this week in 
the Senate is only further evidence that President Trump and 
Republicans in Congress don't have any real solutions to improve our 
Nation's healthcare system. After months of negotiations behind closed 
doors, when Senate Republicans released their secret TrumpCare bill, 
its contents proved too harmful for passage, even among themselves. 
Stuck without a path forward, their latest idea is to pass a small 
backroom deal before sundown today--which no one has seen yet--and then 
go to conference with the tea party and the Freedom Caucus in the House 
of Representatives.
  While we still don't know what we will be voting on, we know that the 
so-called skinny repeal bill would mean higher premiums and millions of 
Americans losing their healthcare coverage, not to mention deep cuts 
that would dismantle the Medicaid Program as it currently exists and 
throw millions of Americans off their healthcare coverage and put our 
entire healthcare system into chaos--all to give a massive tax break to 
the wealthiest among us. That is awful policy any way you look at it.
  Since January, I have heard from literally thousands of New Mexicans 
who have told me how important their healthcare coverage is to them and 
their families. What answers do President Trump and Republicans in 
Congress have for the grandmother in Santa Fe who wonders where she 
will go when her nursing home closes because of Medicaid cuts or the 
woman in Albuquerque who wrote to me about how scared she is about 
losing access to mental healthcare for her depression and anxiety? What 
are they going to tell the single mother in Rio Rancho who relies on 
Medicaid to cover her children's medical costs or the young man in 
Espanola who needs treatment to get clean from opioid addiction? These 
New Mexicans and millions of other Americans will be harmed if this 
bill becomes law.
  I am not outraged about all of this because I am a Democrat or 
because of what I think of President Trump. I am outraged about this 
bill because of what it will do to my constituents in New Mexico. I 
will do everything I can to oppose this appalling legislation and this 
appalling process and fight to keep quality healthcare accessible and 
affordable for New Mexicans.
  If we can halt this mad rush, we can all work--Republicans and 
Democrats--to get to the things that we agree need fixing in our 
system. There is much work to be done there, no doubt about it.
  As Senator McCain told us all Tuesday: ``We have been spinning our 
wheels on too many important issues because we keep trying to find a 
way to win without help from across the aisle.''
  There is a better way forward. We can come together and work on the 
things that we know need to be fixed in the ACA. People's lives hang in 
the balance. There are real bipartisan solutions if we can get back to 
regular order.
  I want to thank my colleague from New Mexico for his incredible 
leadership in this debate and say how hard we are going to work to make 
sure that we keep fighting for our constituents in New Mexico on this 
healthcare legislation.
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. BENNET. Mr. President, I am aware that the time is at an end. I 
ask unanimous consent for 7 additional minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BENNET. Mr. President, I thank my colleagues from New Mexico, my 
neighbors, for being here.
  I thank the Presiding Officer for his statement. As usual, he is 
pointing the Senate in a direction that we should be headed.
  Whether people in my State support the Affordable Care Act or whether 
they don't, they are dissatisfied with the way our healthcare system 
works. The Affordable Care Act--or ObamaCare or whatever you want to 
call it--is just part of our healthcare system. We have Medicare. We 
have Medicaid. We have hospitals. We have doctors. We have nurses. It 
all adds up, in America in the 21st century, to a system that is really 
hard on people and makes it very hard for them to predict their future. 
It creates situations where they have to make choices that no other 
people in the industrialized world have to make, about raising their 
family, about staying in a job--as the Presiding Officer was talking 
about--that they might not want to stay in for fear they would lose 
their health insurance.
  I thought the Presiding Officer made an excellent point when he said 
that you don't lose your car insurance when you leave your place of 
business for another job. Why should you lose your health insurance? 
Why should you? Why should you have to put up with things in this 
country that nobody else in the industrialized world has to put up 
with?
  It may be that the debate we are going to have is as binary as the 
Presiding Officer was saying. Maybe it is a debate about single payer 
versus what he described as more consumer based. Maybe there is 
something in between. America has a way of trying to figure those kinds 
of things out--or at least we have historically.
  My colleague from Oregon earlier quoted the famous line, which 
somebody yelled out to Ben Franklin: What kind of government are you 
creating, a monarchy or republic? That was the question.
  His answer was, as the Senator of Oregon said: ``A republic, if you 
can keep it''--if you can keep it.
  The Founders had extraordinary vision, and they were creating 
something that had never existed before in the history of humankind--
never existed. You could make an argument about a couple of small 
principalities or places in Switzerland, and there would be some 
argument about ancient Rome, but, really, this exercise in self-
government had sprung from their imagination and their desire as human 
beings to govern themselves, to slough off the monarchy that ruled them 
and ruled others in Europe.
  What Ben Franklin said was so important and so wise because he didn't 
say: ``A republic.'' He said: ``A republic, if you can keep it.''
  When they wrote the Constitution, they were creating a mechanism for 
the American people to resolve their

[[Page 12036]]

disputes. They were not creating a republic where they believed that 
everyone would agree with each other. They had vast disagreements. They 
had disagreements far greater than the ones we have. They had 
geographic disagreements. They had disagreements about big States and 
little States. They had disagreements about slavery.
  They were able to come together and create a mechanism to resolve our 
differences. They didn't believe, as some people seem to on talk radio 
every day, that if you don't agree with the other person that you must 
be a Communist or you must be some rightwinger. That is not what they 
believed.
  They believed there was a public purpose, that there was public 
virtue that underlay the work they were trying to do and that we would 
be able to persist in this Republic only if we kept it--if we kept it.
  That is how self-government works. It is not a king telling you what 
to do. It is not the generation of the Founders telling you what to do. 
It is doing what you need to do, as the Presiding Officer said, for the 
sake of people who did their jobs before us but, more importantly, as 
he said, for the people who are coming after us. Seeing from this 
perspective, this process is a disgrace. This is why we have a 9-
percent approval rating in the U.S. Senate--what has been referred to 
in past generations as the greatest deliberative body in the world. 
Those words are spoken mockingly today.
  The people I represent, and the people the Presiding Officer 
represents, are paying a price for this. It has been a long time since 
I have been in the majority--I am sad to say, but it is true--but there 
was a time when I would preside, as the Presiding Officer is doing 
today. A reporter asked me once: What do you think about when you are 
up there? As John McCain said the other day: We aren't doing anything 
here. He is right. We are not.
  So the reporter said: What are you thinking about?
  Do you know what I told him? I said: What I think about is, What is 
China doing right now, while Democrats and Republicans here had their 
fight that has nothing to do with the people whom we represent?
  We know what China is doing right now. While we don't even have the 
decency to maintain the assets and infrastructure, the roads and 
bridges that our parents and grandparents had the decency to build for 
us--starting on this floor--they are building trains, not just in China 
but all over Asia, to bind them together in an economic union to come 
after the United States. What is China doing?
  What I deeply regret about this debate is that the end product, 
whether we pass this bill or if we don't, is not going to improve 
healthcare for the people I represent. Again, my starting point is that 
there are people who like the Affordable Care Act and there are people 
who don't like the Affordable Care Act, but everybody is deeply 
dissatisfied, as they should be, with the way our healthcare system 
works. What we should do is abandon this process and, instead, go to 
committee. Chairman Alexander--he is a Republican--is perfectly capable 
of running a bipartisan process that could lead us to a place where we 
actually are making things better for people who live on the Eastern 
Plains of Colorado, on the Front Range of Colorado, or on the Western 
Slope of Colorado, who may be Republicans and Democrats, but for whom 
healthcare is not political. It is about their family and about their 
future. That is what we should be keeping in mind, instead of just the 
next election around here. Everybody has lamented that.
  I am running out of time, but I remember when the majority leader was 
not the majority leader. He is a smart person. He came here and said: 
``Major legislation is now routinely drafted, not in committee, but in 
the Majority Leader's conference room and then dropped on the floor 
with little or no opportunity for members to participate in the 
amendment process, virtually guaranteeing a fight.''
  That is what he said. I am telling those of you with whom I was in 
townhall meetings 7 years ago, when people were saying: Read the bill, 
read the bill. The tea party was at the height, bringing pocket 
Constitutions to my meetings, telling me to be faithful to that 
process. I say that we should be saying that right now: Be faithful to 
that constitutional process.
  He knew the process wasn't working as it should. What he said was 
this:

       When Democrats couldn't convince any of us--

  That is, Republicans--

       that [the Affordable Care Act] was worth supporting as 
     written, they decided to do it on their own and pass it on a 
     party line vote.

  He continued:

       It may very well have been the case that on ObamaCare, the 
     will of the country was not to pass the bill at all. That's 
     what I would have concluded if Republicans couldn't get a 
     single Democrat vote for legislation of this magnitude, I'd 
     have thought, maybe this isn't a great idea.

  So I say to the Republicans and Democrats who are here today, maybe 
it isn't a great idea because they can't even get the Republican votes. 
They haven't gotten one Democratic vote. They haven't gotten the 
Republican votes to repeal and replace, even though they have run on 
this for 8 years. They had to bring the Vice President here to cast the 
deciding vote because we were tied. What a shame for the Senate not to 
do its work and to rely on the executive branch to come here and supply 
that vote.
  Every single person in this body knows the President of the United 
States has no idea or interest in what is in this legislation. Every 
single person here knows that. So why are we doing it? We are doing it, 
I guess, to fulfill a campaign promise to repeal ObamaCare. I can 
understand why there is pressure for people to do that, because they 
said that over and over, even though I disagree with their 
characterization of the bill.
  I disagree with the facts they presented. I understand that impulse, 
but I don't understand the impulse of writing a bill in secret--listen 
to this folks--not having a single committee hearing--not one committee 
hearing in the Senate. Talk about ``read the bill.'' How about having a 
bill that is written down on paper so we can read it? Where are my 
brethren in the tea party who wanted to read the other bill? There was 
a bill then. There had been a bill for a year and a half.
  There is no bill. There is no bill because what they are trying to do 
is to figure out what they can eke out across the line here. They are 
calling it a skinny repeal. I don't even know how that satisfies the 
laugh test, when it comes to the campaign promises that were made 
around here, but that is not my issue. But we should just stop. We are 
at 9 percent. This bill, I think, the last time I checked, had a 15-
percent approval rating or a 20-percent approval rating. Don't pass 
that. We have wasted 6 months--not of our time but of the American 
people's time. I have people all over the State of Colorado who would 
love to come here and testify at a committee hearing about how 
healthcare is intersecting with their lives and making their lives 
difficult or how they are benefiting from certain things. I would love 
for them to have a chance to come here and testify, but we haven't set 
up that process. We should. We should stop this.
  The American people would be relieved if we would stop this 
partisanship to get together and work on the committee as we should do 
and pass something on the floor. What we have forgotten about the 
Affordable Care Act--even though it didn't have Republican votes, and 
it should have--is that it had almost 200 Republican amendments adopted 
as part of the process. I agree with what the majority leader said 
then. If the process is lousy, the outcome of the bill is likely to be 
lousy. An important point he made is that it is unlikely to reflect the 
will of the American people, and when it doesn't, what it is going to 
mean is that we are just going to continue to seesaw from one election 
to the next election and we are not going to get a result.
  I am willing to settle for 80 percent of what I want, or 70 percent 
of what I want--I am. I don't think that is an unvirtuous position to 
have. All these

[[Page 12037]]

people here are talking all the time about the principle they are 
standing on. When you scratch at that and look for the content of the 
idea underneath that principle, there is very seldom anything there. 
They are often repeating something they heard last night on FOX or 
MSNBC, but it wouldn't be recognizable to the Founders as a principle. 
For them, a fundamental principle was that you had to unleash the 
imagination of people with different sets of experiences and different 
sets of opinions and from different geographic places in order to do 
the right thing for this country. That is what we should do today.
  I realize the indulgence of the Presiding Officer. I thank him for 
his kindness.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. SULLIVAN. Mr. President, I wanted to weigh in on a debate that 
took place on the floor a couple of hours ago--actually, when I was 
presiding in the chair--between the majority leader and the minority 
leader on what we are going to be doing here in the next couple of days 
on the Senate floor.
  So right now we are having a healthcare debate. We are finally having 
a healthcare debate. Many Members on both sides of the aisle--I say to 
the Presiding Officer, I saw your speech a few hours ago--are talking 
about the importance of healthcare for our country, the importance of, 
from our perspective, repealing, replacing, repairing a healthcare 
system that is not working. It is certainly not working the way in 
which it was promised to Americans. I will not repeat all the promises 
made by the former President and many Senators, but we know those 
haven't come to pass.
  As a matter of fact, a number of us--I certainly believe in my State, 
the State of Alaska, the so-called Affordable Care Act has done a lot 
more damage than good. Here are just a few statistics in Alaska: 
Premiums in the individual market went up over 200 percent since the 
enactment of the Affordable Care Act--200 percent. Alaskans in that 
market--individual Alaskans, for one health insurance plan for one 
individual, pay almost $1,100 a month in premiums for healthcare. That 
is not affordable.
  So we are debating it. It is important. There is an open amendment 
process. We are probably going to be debating all night, and that is 
what we should be doing--the world's greatest deliberative body 
debating a very important topic, but healthcare is not the only issue 
the Senate is focused on.


                                  NDAA

  As a matter of fact, a number of us on the Armed Services Committee, 
over the last several weeks, have been working on and debating and 
bringing amendments to the National Defense Authorization Act, the 
yearly act that authorizes funding and training and equipment and 
policy for our military and young men and women who serve in our 
military. It is one of the most important things we do in the Senate, 
by far. So we have been doing that as well as healthcare, which is also 
extremely important.
  Three weeks ago, after a lot of debate in committee, after a lot of 
hard work, debate between Republicans and Democrats, the draft NDAA of 
2017, the National Defense Authorization Act--focused on our national 
security, focused on our troops--passed out of the Armed Services 
Committee 27 to 0, a very bipartisan bill, a very important bill, and a 
very important bill for the country to move on after the healthcare 
debate.
  So the majority leader and the chairman of the Armed Services 
Committee had a very simple request of the minority leader this morning 
when I was in the chair presiding, and the request was: Once we are 
done for now--because it is going to continue with the healthcare 
debate, we will not be done for a long time--once we complete the 
business we are undertaking for the next several hours on the 
healthcare debate, that we move forward to debate and pass the NDAA of 
2017. It is a pretty simple request, a very reasonable request.
  This bill, like healthcare, is extremely important for the Nation, 
for our troops, for national security. On a personal note, it is 
particularly important for one of our Members, the chairman of the 
Senate Armed Services Committee, Senator McCain of Arizona. We all know 
him. Americans know him. He has been a mentor to many of us, a leader, 
certainly an American hero who has sacrificed immeasurably for our 
country. In another of a series of heroic acts by the Senator from 
Arizona, he returned to the Senate this week after announcing that he 
is fighting brain cancer. Now, Senator McCain is a fighter. He is going 
to win this fight, but he is going back to Arizona very soon for 
treatment.
  So many of us--but especially the chairman of the Senate Armed 
Services Committee who did more than anyone to move that bill forward 
in such a bipartisan way--want to take up the NDAA after the healthcare 
debate. It is pretty simple, pretty reasonable, and really good for the 
country: finish the healthcare debate for now with this open amendment 
process that we are beginning already on the floor, then turn to the 
NDAA after and debate that. It is good for our troops, good for our 
national security, and it would show a lot of respect to the chairman 
of the committee who has done more for his country and more to advance 
this important bill than anyone else.
  I hope all of my colleagues--this shouldn't be a partisan issue--can 
agree to this, but unfortunately we are hearing rumors that the other 
side is saying: Unless we vote against any healthcare bill to continue 
to move forward, unless we vote against it to move forward, then they 
are not going to take up the NDAA. Now, does that make any sense? We 
are going to debate healthcare. That is really important, but now we 
are hearing the other side saying: If they don't get their way in the 
debate, then forget about it. We are not going to take up the bill that 
authorizes the training and equipping and the policies of the U.S. 
military. Does that make any sense?
  The answer to everybody--everybody in the Senate Chamber, anyone 
watching on TV--it makes no sense. These are not connected. These are 
not connected issues.
  Is playing politics with our troops, tying it to another bill, any 
way to advance the national security and the welfare of the men and 
women serving in our military? The answer is no.
  Unfortunately, we have seen this movie before. Some might remember 
last summer, right around this time, we were working hard on 
appropriations bills. The Appropriations Committee voted different 
appropriations bills out of committee, as they are supposed to do, and 
they voted the Defense appropriations bill out of committee with an 
overwhelming bipartisan vote.
  So what did we do? We brought it to the floor to debate it and try to 
pass it--funding for the troops. That bill was filibustered six times 
by my colleagues on the other side of the aisle, six times. Go home and 
explain that vote, why you filibustered spending for our troops--when 
they are in combat, by the way--six different times. I came down to 
this floor numerous times asking somebody, anybody on the other side to 
come down to the floor and explain why they were filibustering spending 
for our troops on a bill that passed out of the Appropriations 
Committee with overwhelming bipartisan support.
  I am going to ask the same question. The NDAA came out of the Armed 
Services Committee 27 to 0. If the minority leader is going to 
filibuster that, he should come down and explain it. If he is really 
saying we will only take up the NDAA if we get our way on the 
healthcare debate we are having right now, he should come down and 
explain that because it makes no sense. It makes no sense, particularly 
because we all know that right now we are seeing very significant 
national security threats to our country. Pick up the paper--Iran, 
Russia, China, and in particular North Korea.
  There was a report in the paper just the other day--yesterday, front 
page of the Washington Post--saying it is now estimated that North 
Korea is going to have an intercontinental ballistic nuclear missile 
likely by next year that

[[Page 12038]]

could range not only my great State of Alaska but the rest of the 
continental United States. These are serious national security threats. 
One of the provisions in the NDAA that had bipartisan support was to 
significantly enhance our country's missile defense. Is that important? 
Given the North Korean threats that are at our doorstep, do you think 
the American people care about that? It is important. It is important, 
as are the hundreds of other bipartisan provisions in the NDAA that 
will enhance our national security, authorize funding for our military 
forces, increase the numbers in our military end strength--and again 
very bipartisan.
  Mr. President, you and I have the honor of serving on the Armed 
Services Committee. It is a great committee. It is very bipartisan. We 
get a lot of work done, led again by a great U.S. Senator, John McCain. 
It is an honor to serve there.
  I believe right now the Senate is trying to reach a unanimous consent 
agreement that as soon as we are done with healthcare, we will then 
take up this critically important bill. As the chairman wants, as he 
has requested, and as our military needs, we should do that. This is 
not a hard decision by Democrats or Republicans. I hope we can do that.
  I encourage all my colleagues on both sides of the aisle, whatever 
your plans are in the next couple of days, we will get through this 
healthcare debate--very important for the country--and then let's get 
through the NDAA debate and pass that bill as well. What we shouldn't 
be doing is playing politics with our military or somehow tying moving 
forward on an important piece of legislation for them to another issue 
that has nothing whatsoever to do with it. We shouldn't be doing that, 
and if we are, shame on those who are.
  So let's move forward, let's have this healthcare debate, and when it 
is completed, let's immediately move to the NDAA and pass that. It is a 
bipartisan bill. It is going to help our Nation, help our troops, 
enhance our national security in dangerous times. There is no reason 
anyone should block moving forward on that important piece of 
legislation as well.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Perdue). The Senator from Montana.


                     Amendment No. 340, as Modified

  Mr. DAINES. Mr. President, I have listened to some of my colleagues 
from across the aisle decry our desire to repeal and replace ObamaCare. 
Yes, I do want to repeal and replace ObamaCare.
  Why? Why are we doing this?
  Repealing and replacing ObamaCare is a means to an end. This is what 
I have heard from so many Montanans. Here is the end, and I will sum it 
up into three items: No. 1, to lower costs; No. 2, to ensure that we 
save Medicaid--protect Medicaid--for the most vulnerable in our 
society; and, No. 3, to ensure that we protect those with preexisting 
conditions.
  Some of my friends across the aisle want to see more government 
control of families' healthcare decisions--in fact, a complete 
government takeover. I believe that we need less government control, 
not more government control. Their gold standard for healthcare reform 
is really socialized medicine. It is called various things. Some call 
it government-run healthcare. Some call it single-payer healthcare. 
Some call it Medicare for all. But, in essence, it is socialized 
medicine.
  The amendment that I am putting forward today is cut-and-pasted text. 
It is the exact, precise language. It is a carbon copy--down to every 
last comma and period--of Representative John Conyers' bill, who is the 
Representative from Michigan, which has 115 Democratic cosponsors as I 
speak. It is an impressive 60 percent of the Democratic caucus in the 
U.S. House that supports and, in fact, has cosponsored this very bill--
this very amendment--that I am putting on the floor here today.
  In addition to the 115 House Members, who on the Senate side supports 
this bill? Well, moveon.org has circulated a petition in support of the 
Conyers' bill, and the bill has been endorsed by hundreds and hundreds 
of labor groups, medical groups, political groups, and civic 
organizations.
  Let me be clear. I believe that socialized medicine would be a 
disaster for the American people. Last November, the American people 
voted to make America great again, not to make America like England 
again. Yet I believe that Montanans and the American people deserve to 
see us debate different ideas right here on the Senate floor. This is 
referred to as the greatest deliberative body in the world. Well, let's 
deliberate, including the leading idea coming from the other side of 
the aisle, which is why I have offered this amendment.
  Mr. ROBERTS. Will the Senator yield for a question?
  Mr. DAINES. Yes, Mr. Chairman.
  Mr. ROBERTS. Mr. President, I am sorry that I did not catch all of 
the Senator's remarks, but I think he said that this is a vote on a 
bill that was introduced in the House.
  How many cosponsors are on this bill? Is this a legitimate effort 
here?
  Mr. DAINES. For those who are watching and observing, it is H.R. 676. 
There are 115 Democratic cosponsors on that bill as we speak.
  Mr. ROBERTS. So this is a legitimate bill that is up. Well, it is not 
up for consideration now in the House.
  Is this the Conyers' bill?
  Mr. DAINES. It is the Conyers' bill. I did not write this amendment--
this bill--that I am offering. We cut and pasted the precise text and 
are bringing it over here and offering it today.
  Mr. ROBERTS. Is there at least a preamble to this bill or just an 
opening of a couple of paragraphs or something? Would the Senator 
describe it?
  Mr. DAINES. Mr. Chairman, in preparing this and in reading this bill, 
for those who want to see the heart and soul--the vision--of the 
Democrats, they can be found in this first paragraph of the bill. In 
fact, I will read it. ``The bill establishes the Medicare-for-all 
program to provide all individuals residing in the United States free 
healthcare.''
  It goes on to say a couple of paragraphs later: ``Health insurers may 
not sell health insurance that duplicates the benefits provided under 
this bill.''
  If that is not a complete takeover of the healthcare system from the 
government, then you tell me what is.
  Mr. ROBERTS. And that is in the bill?
  Mr. DAINES. It is in the opening paragraphs of the bill, the preamble 
part.
  Mr. ROBERTS. Well, I think we have a very honest choice. There has 
been a lot of talk about single payer. There was a lot of talk about it 
early on in the debate about ObamaCare. I recall in observations made 
by President Obama that this was the first step toward single payer. I 
understand that--well, I know that the former Secretary of Health and 
Human Services, Kathleen Sebelius, had the same plan, that ObamaCare 
was the first step toward single payer. All you are doing is just 
saying, OK, if that is the goal, bring it to a vote.
  Mr. DAINES. Thank you, Mr. Chairman. I agree with you. That is what I 
am planning to do today.
  I ask unanimous consent for an additional 6 minutes of debate equally 
divided between the managers or their designees.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. DAINES. As the chairman, the Senator from Kansas, just mentioned, 
I believe that Montanans and the American people deserve to see us 
debate different ideas. That is why I brought this amendment to the 
floor today.
  Earlier today, a couple of hours ago, my colleague from Vermont, 
Senator Bernie Sanders, was on the Senate floor suggesting that my 
amendment is intended to embarrass Democrats.
  Senator Sanders, my amendment shouldn't embarrass anyone. I am trying 
to show the American people--bring it out here in full light--who is 
supportive of socialized medicine and who is not. If you are supportive 
of that, why be embarrassed?
  The Senator from Vermont announced that he wouldn't support the 
amendment unless I voted for the amendment myself. But let me be

[[Page 12039]]

clear. I don't support socialized medicine. Senator Sanders does. It is 
time to fish or to cut bait. Why are Senators on the other side of the 
aisle running for the hills when they now have the chance to vote on 
the gold standard bill their party supports?
  Senator Sanders and the Democrats who support Representative Conyers' 
bill shouldn't be dependent on my support. Senator Sanders said he 
would vote for it if I voted for it. Guess what. Tell the American 
people what you think. I think we should vote no on this. What say you?
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, the time will be equally divided.
  Mr. DAINES. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SANDERS. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SANDERS. Mr. President, this is an exciting day. After years and 
years, some of my Republican colleagues have begun to understand that 
we cannot continue a dysfunctional healthcare system which allows 28 
million Americans to have no health insurance, which forces us to pay 
the highest prices in the world, by far, for healthcare and even higher 
prices--outrageously high prices--for prescription drugs.
  I understand that Senator Daines has offered a Medicare-for-all, 
single-payer system, and I congratulate him. It sounds to me as though 
the Republicans are beginning to catch on about the need to transform 
our healthcare system and join the rest of the industrialized world.
  So I say to Senator Daines, if he is prepared to vote for this 
legislation and if he can get maybe five, six more Republicans to vote 
for this legislation, I think we can win it, and I think the United 
States can join the rest of the industrialized world and finally 
guarantee healthcare to all people.
  So if Senator Daines and five or six other Republicans vote for this, 
count me in. And we are going to work together, finally, to provide 
healthcare to all people. But if Senator Daines is just playing a 
political trick--I ask unanimous consent for 30 more seconds.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. SANDERS. Mr. President, if Senator Daines is just playing a 
political trick and does not intend to vote for this legislation or 
have any other Republican vote for it, I would suggest that every 
Member in the Senate vote present on this bill.
  The PRESIDING OFFICER. The question is on agreeing to amendment No. 
340, as modified.
  Mr. THUNE. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  Ms. BALDWIN (when her name was called). Present.
  Mr. BENNET (when his name was called). Present.
  Mr. BLUMENTHAL (when his name was called). Present.
  Mr. BOOKER (when his name was called). Present.
  Mr. BROWN (when his name was called). Present.
  Ms. CANTWELL (when her name was called). Present.
  Mr. CARDIN (when his name was called). Present.
  Mr. CARPER (when his name was called). Present.
  Mr. CASEY (when his name was called). Present.
  Mr. COONS (when his name was called). Present.
  Ms. CORTEZ MASTO (when her name was called). Present.
  Ms. DUCKWORTH (when her name was called). Present.
  Mr. DURBIN (when his name was called). Present.
  Mrs. FEINSTEIN (when her name was called). Present.
  Mr. FRANKEN (when his name was called). Present.
  Mrs. GILLIBRAND (when her name was called). Present.
  Ms. HARRIS (when her name was called). Present.
  Ms. HASSAN (when her name was called). Present.
  Mr. HEINRICH (when his name was called). Present.
  Ms. HIRONO (when her name was called). Present.
  Mr. KAINE (when his name was called). Present.
  Ms. KLOBUCHAR (when her name was called). Present.
  Mr. LEAHY (when his name was called). Present.
  Mr. MARKEY (when his name was called). Present.
  Mrs. McCASKILL (when her name was called). Present.
  Mr. MENENDEZ (when his name was called). Present.
  Mr. MERKLEY (when his name was called). Present.
  Mr. MURPHY (when his name was called). Present.
  Mrs. MURRAY (when her name was called). Present.
  Mr. NELSON (when his name was called). Present.
  Mr. PETERS (when his name was called). Present.
  Mr. REED (when his name was called). Present.
  Mr. SANDERS (when his name was called). Present.
  Mr. SCHATZ (when his name was called). Present.
  Mr. SCHUMER (when his name was called). Present.
  Mrs. SHAHEEN (when her name was called). Present.
  Ms. STABENOW (when her name was called). Present.
  Mr. UDALL (when his name was called). Present.
  Mr. VAN HOLLEN (when his name was called). Present.
  Mr. WARNER (when his name was called). Present.
  Ms. WARREN (when her name was called). Present.
  Mr. WHITEHOUSE (when his name was called). Present.
  Mr. WYDEN (when his name was called). Present.
  The PRESIDING OFFICER (Mr. Cassidy). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 0, nays 57, as follows:

                      [Rollcall Vote No. 173 Leg.]

                                NAYS--57

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

                        ANSWERED ``PRESENT''--43

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Hirono
     Kaine
     Klobuchar
     Leahy
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden
  The amendment (No. 340), as modified, was rejected.
  The PRESIDING OFFICER. The Senator from Wyoming.


                 Amendment No. 389 to Amendment No. 267

      (Purpose: To provide for premium assistance for low-income 
                             individuals.)

  Mr. ENZI. Mr. President, I call up amendment No. 389.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Wyoming [Mr. Enzi], for Mr. Strange, 
     proposes an amendment numbered 389 to amendment No. 267.

  Mr. ENZI. Mr. President, I ask unanimous consent that the reading of 
the amendment be dispensed with.

[[Page 12040]]

  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in the Record of July 26, 2017, under 
``Text of Amendments.'')
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, time will be charged equally to both sides.
  The majority whip.
  Mr. CORNYN. Mr. President, this week we are about the business of 
keeping our promises. For 7 years, we have promised to help the 
millions of Americans who have been let down, not to mention deceived, 
by the promises of ObamaCare. It is absolutely critical that we fulfill 
our commitments.
  This is not just about moving past the failures of ObamaCare but 
laying the groundwork for providing Americans access to better care. We 
said all along that we have four principles:
  One is to help stabilize the insurance markets so people living in 
Iowa, for example, would make sure they have a place where they can 
actually buy health insurance.
  It is about getting premiums lower by eliminating the mandates and 
making it possible for people to choose alternatives that happen to 
suit their needs at a price they can afford.
  Third, we said we are going to continue to do everything in our power 
to protect people with preexisting conditions so they are not afraid 
about changing jobs and being excluded from their new employer's 
insurance coverage because of something we have done here. We protect 
people against the preexisting conditions exclusion.
  Fourth, what we said we want to do is to take Medicaid, an essential 
safety net healthcare program, and make sure we put it on a sustainable 
path. I know there are some in Washington, DC, who think we can just 
continue to spend borrowed money endlessly. Well, we can't. It really 
jeopardizes the very viability of some of our most essential safety net 
programs like Social Security, Medicare, and, yes, Medicaid in this 
instance.
  What we have done, and what we intend to do, working with our 
colleagues in the House, is to put Medicaid on a sustainable path while 
we grow the expenditures to Medicaid each year, over a 10-year period, 
by $71 billion.
  So those who say we are somehow gutting Medicaid or we are cutting 
Medicaid, I think, they simply have to deal with those facts. I haven't 
heard a satisfactory explanation for how you can conclude that somehow 
we are gutting Medicaid or cutting it when we are actually making it 
sustainable in the long run.
  Throughout this process, what I have learned is, Senators have a lot 
of different ideas. Everybody has come to the table to try to help make 
this better. I would say, unfortunately, our Democratic colleagues have 
chosen not to participate in the process. This would be a lot easier--
and the product we come up with would be a lot more durable over the 
long haul--if, in fact, Democrats would work with us.
  The fact is, in this amendment process we are engaged in, and will be 
engaged in this evening, any Senator, Democrat or Republican, majority, 
minority party Member, can offer an amendment and get a vote on it. So 
I don't really understand why our Democratic colleagues are sitting on 
their hands and will not participate in the process.
  I fear what they want is to change nothing about the structure of 
ObamaCare, notwithstanding the failed experiment of the last 7 years. 
Then what they want to do is come back and throw money at the insurance 
companies under these cost-sharing risk pools. We are willing to do 
what we need to do to stabilize the insurance market, but I am not 
going to vote for an insurance company bailout without reform.
  Leader McConnell reiterated yesterday that our constituents are 
counting on us. I can tell you, the 28 million Texans I have the great 
privilege of representing are counting on me and Senator Cruz to do our 
part to come up with a solution. The Texan whose premiums have tripled 
and lost his doctor is counting on us. The ER employee who witnessed 
the emergency room busting at the seams with Medicaid patients--people 
who ostensibly have coverage under Medicaid but who can't find a doctor 
who will accept a new Medicaid patient so they end up going to the 
emergency room--is counting on us. The small business owner who was 
forced to fire employees to avoid a $100,000 fine, that person is 
counting on us too. The young woman coming out of nursing school who 
was forced to change her plan three times, only to end up with a plan 
with coverage options she didn't want, at a price she could barely 
afford, she is counting on us too.
  My constituents in Texas and Americans across the country are 
counting on us. They are sick and tired of the bickering and the lack 
of productivity here in Washington, DC, and I don't blame them one bit. 
They are counting on us to free them from some of ObamaCare's mandates 
that force them to make very tough economic decisions, like the 28 
million people under ObamaCare who either pay a fine--about 6.5 million 
of them--or, the rest, who claim hardship exemptions so they don't have 
to buy insurance. But in Texas alone, there are more than 400,000 
Texans who earn less than $25,000 a year who can't afford to buy the 
insurance. So they pay the fine to the government. So their government 
fines them for not buying a product they can't afford.
  So now is the time to deliver some relief to our constituents. They 
are counting on us to keep the deeply personal choice of healthcare 
plans and doctors in their hands and not the Federal Government's. So 
it is time to deliver, and my goal is to make sure we find a solution 
and get it to the President's desk.
  One of the most offensive parts of the Affordable Care Act--or we 
should have called it the un-Affordable Care Act, since premiums have 
gone up 105 percent since 2013 alone--is that people who were told a 
family of four would see a reduction of $2,500 a year in their premiums 
have seen their premiums go up by more than $3,000. There are a lot of 
stories--I am sure even here in this room, in this Chamber--where 
people simply have seen their premiums go up, up, and up along with 
their deductibles, basically denying them the benefit of their 
insurance. But the individual mandate is a prime example of government 
getting in the way of individual freedom and the right to choose.
  The so-called individual mandate--we really should call this the 
penalty that government imposes on its citizens for failing to purchase 
a product they don't want and, in some cases, don't even need--forces 
them to do so at a cost that was crippling and continues to be 
crippling for many individuals and families.
  Here is a shocking statistic. An estimated 8 million Americans pay 
the fine associated with this mandate each year. Eight million 
Americans are penalized by their own government, forced to pay a fine 
that could be used on coverage that might actually suit their needs. If 
ObamaCare would make it possible that the market could prosper and 
insurance companies offered a variety of products at different prices 
that people could choose from, maybe some of these folks could take the 
money they are paying their own government as a penalty and actually 
buy insurance coverage.
  Then there is the employer mandate. This is one of the most 
pernicious of the mandates. I remember sitting with a friend of mine, 
who happens to own a small architectural firm in San Antonio, back when 
ObamaCare passed, and I explained to him: If you have more than 50 
employees, then you are going to have to buy or provide ObamaCare-
compliant healthcare for your employees.
  He said: Well, I may have to lay off some people because we have 54 
employees. So I am going to have to fire at least four of them to get 
below that 50-person threshold so I can avoid the fine and the 
insurance that I can't afford to provide for my employees.
  So this has literally been a job-killing employer mandate. This is 
not some benign or innocuous requirement. This has been one of the 
reasons why

[[Page 12041]]

the economy has been so anemic even since the great recession of 2008, 
and this is the reason why so many people feel like the economy has not 
really recovered, because it hasn't provided them job opportunities and 
larger wages. So this mandate has stifled business growth, to be sure, 
especially among small businesses, which are the primary job engine of 
our economy. Oftentimes jobs were cut in order to avoid bankrupting the 
business through ObamaCare fines.
  So Americans have been forced by their own government, no less--
government is supposed to serve the people, not the other way around--
to live under mandates, taxes, broken promises, and collapsing markets 
for too long. So this week is about keeping our promises, demonstrating 
that we can govern, even, unfortunately, without the assistance of our 
Democratic colleagues, and paving the way to tackle other important 
issues, like tax reform, infrastructure construction--things we need to 
do to keep the economy growing and moving forward.
  So we will be hearing more about a possible solution and a way 
forward, something I call ``the freedom to choose'' plan, where we free 
the American people from the destructive impact of this so-called 
individual mandate, where we free small employers from the employer 
mandate, letting them hire the employees they need and not having to 
choose between that and bankruptcy.
  And, yes, we are going to push more power out of Washington, DC, and 
back to the States. I know, based on the public opinion polling I have 
seen, that people sure trust their States a lot more than they trust 
Washington, DC, when it comes to healthcare. So we are going to provide 
the flexibility and tools that the States, the Governors, and the 
legislators need, as well as the insurance commissioners, to come up 
with a viable market using resources we are going to provide to them.
  It would be better if we could all come together to find a solution 
to engage in debate--Republicans and Democrats alike--and pass a final 
product and get it to the President's desk. That is, actually, how the 
legislature is supposed to function. But unfortunately we are in 
unusual times, when almost half of the Senate refuses to participate. 
Actually, they will be actively trying to undermine our efforts to come 
to the rescue of the people that are hurting as a result of the 
deception and the failures of ObamaCare. I don't know how you explain 
that. You certainly can't explain it to constituents like I have. I bet 
you a dollar that every single one of the Senators here who is trying 
to blow up this process and undermine the progress we are making has 
constituents back home who are suffering the same way my constituents 
are, but they are turning a deaf ear to them and saying: You know what, 
politics and party and ideology are more important to me than actually 
addressing the needs of my constituents. That is what their actions are 
effectively saying, and it is a shame.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. KENNEDY. Mr. President, I wish I could stand here today and tell 
you that the Affordable Care Act, or so-called ObamaCare, had worked. I 
wish I could sit here and tell you today that the American people were 
better off as a result of the Affordable Care Act, but I can't do that, 
and it gives me no joy in having to make that statement.
  Now, as you know, Mr. President, not a single Republican voted for 
the Affordable Care Act. The Affordable Care Act was passed at 
President Obama's suggestion by the Democratic Members of the House and 
the Senate. They had a majority, and in this body the majority rules. I 
don't want to ascribe to the President or to our Democratic friends any 
ill motives whatsoever. They wanted what was best for the American 
people. It wasn't a question of bad motives. It was just a bad idea. It 
didn't work.
  Let me say this another way. I believe that President Obama and our 
colleagues on the Democratic side of the aisle in the Senate and in the 
House of Representatives passed ObamaCare with the best of intentions. 
But, you know what, Mr. President--I know you also happen to be a 
physician--150 years ago, doctors used to bleed their patients with the 
best of intentions, and they stopped doing that. They did it. They 
didn't have any bad motives in doing it. They did it because they 
thought it would help the patient. It killed many of them. So they 
stopped doing it.
  You know we were told when the Affordable Care Act, so-called 
ObamaCare--I don't mean any disrespect in calling it ObamaCare. 
President Obama himself refers to it as ObamaCare. When the Democrats 
in the Congress passed ObamaCare, I remember well what we were told 
because I wanted to believe it. The President said: If you like your 
insurance plan, you can keep your insurance plan. I think he meant that 
at the time. It wasn't true. It turned out not to be true.
  The President said: If you like your doctor, you can keep your 
doctor. I think that is what he wanted, but you couldn't.
  He said the Affordable Care Act would ``cover every American and cut 
the cost of a typical family's premium by up to $2,500 a year.'' It is 
not even close.
  President Obama said ObamaCare would ``bend the cost curve for 
healthcare'' without adding ``one dime to the deficit.'' None of that 
was true. I think the President meant it at the time. I think he wanted 
it at the time. I know I did. I know you did, Mr. President. But it 
just turned out not to be true.
  Now, the simple fact of the matter is--and I think every reasonable 
person has to conclude--that the Affordable Care Act has not worked for 
the American people.
  Let's talk about the exchanges. As you know, Mr. President, there are 
two parts of the Affordable Care Act. There are the exchanges through 
which people go and buy insurance directly from an insurance company, 
and then there is the Medicaid expansion. I want to talk about the 
exchanges for a moment.
  In 2016, under ObamaCare, we started out with 281 insurance companies 
offering insurance to the American people. That is a good start. The 
problem is that now we have 141, and they are dropping like flies. In 
my State of Louisiana we are down to three. A third of all of the 
counties in America have only one choice--one insurance company that 
will still write insurance--and many of our counties have zero, none, 
nada, zilch. They can't get insurance at all. They have been given a 
bus ticket, but there is no bus.
  As for Louisiana, let me talk just for a moment about my State--our 
State--Mr. President. In Louisiana, premiums have gone up 123 percent 
on the exchanges since 2013. That is an average of a $3,600 increase 
per plan. Nationwide, the average ObamaCare plan now costs 105 percent 
more than when it started. That is $3,000 per person. What is 
particularly incredible to me, Mr. President--you know these statistics 
better than I do--in Louisiana we have 136,000 people who, rather than 
buying insurance off the exchanges, have chosen to pay the fine. Let me 
say that again: 136,000 people in my State have looked at the insurance 
offered to them, with the subsidies, and have said: We would rather pay 
the fine. Of that 136,000 who said they would pick the fine instead of 
the insurance, 84 percent of them make $50,000 or less, 48 percent of 
them, or half, make $25,000 or less. Now, do you know what that tells 
me? That tells me that 136,000 people in my State, most of whom are too 
poor to be sick, looked at the Affordable Care Act plan and said: We 
can't afford it. We would rather pay the fine. We are better off paying 
the fine. So they are out of pocket the money for the fine, and they 
still don't have insurance. No reasonable person would call that a 
success.
  Let me give a couple more examples because we talk around here in 
concepts, and we all know what we are talking about, but average 
Americans who get up every day and go to work, who obey the law and pay 
their taxes, who try to do the right things for their

[[Page 12042]]

kids and try to save money for retirement do not have time to deal in 
concepts. They are too busy earning a living. They just want to know: 
What kind of health insurance do I have, and what is it going to cost? 
So let me give some examples right now from Louisiana. This is brought 
to you by the Affordable Care Act.
  Let's suppose that I am a 60-year-old, nonsmoking male who is living 
in Baton Rouge, LA. I am making $50,000 a year. According to 
healthcare.gov--I did not make this up--the cheapest and most basic 
plan available to me would cost me $689.14 a month, with a $4,500 
deductible, for a grand total of $9,000 a year--deductibles, my out-of-
pocket, plus my premiums. Now, I am 60 years old. I am living in Baton 
Rouge, LA, where the cost of living is not that high, and I am making 
$50,000. The Federal Government has said: We have a great deal for you. 
Give us $9,000, and then we might be able to give you some healthcare.
  For that $9,000, what do I get?
  Suppose I say: OK. Here is my $9,000.
  I don't know where I am going to find it, as I am only making $50,000 
a year, and, of course, the government is taking some of that for 
taxes, but I find $9,000 a year. Do you know what I get? I get four 
doctor visits, I get two lab tests, and I get nine prescription drugs 
and additional medical costs for a grand total of $100. That is not 
insurance; that is giving somebody a bus ticket without a bus.
  All right. Let's suppose that I am a 50-year-old female. I don't 
smoke. I am living in Lafayette, LA, which is to the west of Baton 
Rouge. I am making $50,000 over in Lafayette. The most basic plan in 
Lafayette--once again, I am 50 years old. So I am not 60 now; I am 50 
years old, a female, and I don't smoke. The most basic plan, the 
cheapest plan I could get would cost me $450 a month in premiums, with 
a $4,800 deductible, for a grand total of $6,550. So I have to go into 
my pocket for $6,550 before I can get any kind of health insurance. 
That is not health insurance.
  I would remind the Presiding Officer, as he is a physician who has 
been on the frontlines in caring for people in our charity hospital 
system in Louisiana--and God bless him for that--that the options I 
describe are the cheap ones. They are the most affordable ones. That is 
the best-case scenario.
  Nobody wanted this. I know President Obama did not want it to turn 
out this way. I know our friends on the Democratic side did not. They 
wanted what was best for America. It was not a bad motive; it was just 
a bad idea.
  What do we need? Everybody has his own opinion of that. That is what 
we are going to try to convince each other of over the next few days as 
we vote. I will tell you what I think we need. I think that in the 
healthcare delivery system, we do not need more government.
  I know that some of my friends on the Democratic side think they have 
the solution, and I respect them for all of the time and care they have 
put into this. Some of my friends on the Democratic side say they have 
the solution. Government has failed, they will admit. They do not say 
it very loudly, but they will privately say: We realize the government 
has failed with ObamaCare. Our prescription to fix it is more 
government, so let's go to a single-payer system. Let's have the 
Federal Government be in charge of everybody's healthcare, and let's 
let the Federal Government regulate our doctors and our nurses and our 
hospitals and our health insurance companies and our patients and our 
lab techs like they were utilities.
  I have lived under a system like that. England has a system like 
that. You can not name me a single G20 country--not one--that has a 
single-payer system that is working. It is not the answer.
  Quickly, because I am running out of time, here is what we need.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. KENNEDY. I will conclude then, Mr. President. I thank him for his 
time and attention.
  America needs a healthcare delivery system and deserves it like 
somebody designed the dadgum thing on purpose.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, there has been a lot of talk here on the 
Senate floor about this so-called skinny health package, and if you 
believe the reports, the skinny health package was going to be written 
today at the Senate Republican lunch. On the day that the Senate is 
supposed to vote, the future of American healthcare may have gotten an 
overhaul between the salad course and the entree.
  I would like to talk a little about where things are and really 
contrast these reports about the skinny health package with the process 
that brought together the Affordable Care Act.
  Our colleague, the Presiding Officer, now serves on the Finance 
Committee. There were dozens of hearings in the Finance Committee about 
the Affordable Care Act, and there were dozens of hearings in the HELP 
Committee. Both committees had markups that lasted longer than a week 
and incorporated ideas from both sides. I was a pretty junior member of 
the Finance Committee at that time, and I remember a flock of 
Republican amendments being added, in the Finance Committee, to the 
Affordable Care Act. When the bill came to the floor, the Senate 
debated it for 25 legislative days. It was the second-longest 
consecutive debate in history.
  We are not seeing anything that resembles that today. You have a rush 
job. So I am going to try to spend a few minutes talking about what 
comes out when you have a rush job and about some of the red flags that 
I think my colleagues might want to think about, particularly some on 
the other side of the aisle who are thinking about voting for this 
skinny package.
  Any Senator who believes that Medicaid makes it out of the skinny 
package without taking a hit ought to take a look again. Senator Murray 
and I spent a long time in working with the Congressional Budget Office 
to, in effect, get them to do some analysis of some of the ideas that 
are part of a CBO package. What the Congressional Budget Office said--
and it is the impartial, nonpartisan umpire--is that under this skinny 
package that is not supposed to do any harm to Medicaid--and it is on 
the first page of the CBO report--Medicaid gets hit with a $220 billion 
reduction for over a decade under this so-called skinny proposal.
  So if you are one of our colleagues on the other side of the aisle 
who say they really feel strongly about Medicaid and about seniors--
Medicaid, we all know, picks up the cost of two out of three nursing 
home beds, and it covers a wide variety of community-based services.
  I have loved to watch the development of those community-based 
services. We started them in Oregon back in the days when I was the 
director of the Gray Panthers.
  In this so-called skinny budget, according to the Congressional 
Budget Office, Medicaid would get hit with a $220 billion reduction. I 
think my colleagues on the other side of the aisle who are saying 
``Hey, the skinny package isn't going to have any implications for 
Medicaid'' would want to take a look at it because I think the 
Congressional Budget Office is saying there really are implications for 
vulnerable seniors, for kids with special needs, for the disabled, and 
for all of those Americans who are walking on an economic tightrope 
every single month in balancing their food costs against their fuel 
costs and their fuel costs against their health bills.
  The numbers on skinny repeal show that 16 million Americans will lose 
coverage and that premiums are going to jump by 20 percent immediately 
if it becomes law. Industry experts are saying there is not any way 
this can work. It just causes too much bedlam and uncertainty. It is 
like pouring still more gasoline onto the fires of uncertainty in the 
marketplace. Republican and Democratic Governors have come out against 
the skinny bill.
  By the way, as the ranking Democrat on the Senate Finance Committee--
I guess we have 100 percent of the Senators who are here who serve on 
the Finance Committee. I do not even see Republican Senators making 
much of an attempt to defend the skinny bill on its merits. In fact, in 
the halls, many of

[[Page 12043]]

them seem to be telling folks, including some folks, I believe, in the 
press, that they are kind of worried about its becoming law.
  There are a few directions for this process to take. It is possible 
that, if you pass it, the House could just take up the skinny repeal 
and then they could pass it. My guess is that when people around here 
think about what that means and what those CBO numbers mean, the 
premium hikes and the implications for Medicaid, they will look at 
those CBO numbers and probably get a little heartburn--my Republican 
colleagues in this Chamber who are thinking about being for this.
  The other possibility is that passing the skinny repeal bill leads to 
a conference. I am telling you that if it heads to conference, a skinny 
repeal is sort of a gateway drug to TrumpCare. The fact that a 
conference is going to fix every problem and solve every disagreement 
is just fantasy. If this gets to conference and if suddenly there is a 
new Republican replacement plan that everybody likes--that is about as 
likely to happen as my joining the NBA for the upcoming season.
  Let's take an honest look at how the debate has unfolded.
  Republicans have had 7 years to come up with a replacement to the 
Affordable Care Act that they can all agree to. Obviously, that has not 
worked out. In the Senate, the process flatlined until the majority 
leader began the shell game that has culminated in today's vote. There 
were not 50 votes for TrumpCare here in the Senate. There were not 50 
votes for repeal. That is why a skinny repeal is the only proposal left 
on the table. As I indicated, who knows what was done at the Republican 
lunch today at noon between the salad course and the entree?
  Yet let's be clear about what is likely to happen when the House gets 
involved. The guarantees that Members of this body will get to protect 
their constituents are out the window--kids with disabilities and older 
people--say, a baby boomer. My colleague in the chair, who is a skilled 
physician, understands this. You have a baby boomer who has had a 
stroke, who is in his late fifties, early sixties, and he is in a 
nursing home. He is going to really face some challenges in terms of 
how to be able to afford that care with the kinds of cuts that, on page 
1 of the report to Senator Murray and me, the CBO has said it believes 
will take place in Medicaid.
  We know these rural hospitals are the economic engine of communities. 
I have made eight stops on a rural healthcare listening tour in my home 
State, and what we see is, without rural healthcare, you aren't going 
to have rural life. It is going to be particularly important because 
other efforts could conceivably result in seniors between 55 and 64 
paying five times as much as younger people and getting fewer tax 
credits. Nobody can honestly say that the millions of Americans with 
preexisting conditions will be shielded from discrimination, and what a 
step backward that would be.
  Before the Presiding Officer was here in this body, 14 Senators--7 
Democrats and 7 Republicans--joined me in the 2008, 2009 period. Many 
of them are still here on both sides of the aisle. Republicans were a 
part of the effort and Democrats were a part of the effort. We wrote a 
bipartisan bill that had air-tight, loophole-free protection for those 
who have preexisting conditions. We got it in the Affordable Care Act. 
All of the Senators who joined on that bill ought to feel pretty good 
about taking a big step to move America away from healthcare that is 
just for the healthy and wealthy. Now we are talking about the prospect 
of policies that will walk that back.
  It is my view that the clear choice for my colleagues who don't like 
the risks in skinny repeal and don't like TrumpCare is to reject the 
process. It seems to me the surest way to prevent a bill you don't like 
from becoming law is to vote against it. Quaint idea: Just vote against 
it.
  I want to turn, as well, to another bit of breaking news, which comes 
from our Parliamentarians who do so much good work, and they have an 
extraordinarily stressful job. Another key part of the Republican plan 
has been deemed ineligible in the last few hours to move forward via 
the partisan approach--reconciliation. The decision pertains to a 
proposal that lets States undo the consumer protections built into 
insurance marketplaces under the Affordable Care Act. That proposal 
will not get fast-track privileges or a 50-vote threshold under 
reconciliation here on the Senate floor.
  Here is what that section of the bill was all about. I wrote a 
provision--and, again, our group of 14 bipartisan Senators, seven 
Democrats and seven Republicans, can take credit for this as well--
about an issue that the Presiding Officer and I have talked about a 
number of times: letting the States be the laboratories of democracy, 
taking the lead on creative health solutions.
  So out of our bipartisan bill--14 Senators--we said that we are going 
to give the States the chance to do better. The States would have the 
chance to do better. When we did it, we got some flak from all over the 
political spectrum. But we pushed very hard, and we got it in to the 
final legislation. It was about providing flexibility to States because 
so many on both sides of the aisle--my guess is our friend from 
Pennsylvania, and anyone who is on the Finance Committee, has heard 
again and again that State officials, business leaders, and others have 
said: If you just give us the freedom, we can do better. They don't 
say: Give us the freedom to let us do worse. They say: Give us the 
freedom to let us do better.
  That is what section 1332 was all about. It said that States could 
chart their own course on healthcare as long as they were going to do 
better--better for coverage, better for affordability. They made it 
clear that if you feel you can do better--if the Louisiana Legislature 
says: We have ideas for what works for Louisiana, which may not 
necessarily work for Oregon; give us the freedom to go do our thing--
that is in the Affordable Care Act, the freedom to do better.
  I would be the last person to tell my friend from Louisiana, a 
skilled physician who has a great interest in health policy--I would be 
the last person to say: Hey, I am going to dictate to Louisiana what an 
approach involving a waiver should be all about. It is quite the 
opposite. I am prepared to say to Louisiana, to Pennsylvania, to all of 
our colleagues, if you have ideas that are going to do better by 
people--better coverage, more affordable--God bless you and your 
constituents. That is what 1332 is all about.
  We said that all we are going to say is we have to have some basic 
consumer protection here. You can't just get a waiver and go off and do 
nothing or just spend the money on some pork kind of project; you have 
to do better by people--better coverage, more affordable coverage, 
having basic consumer protections. The Senate TrumpCare bill tried to 
basically throw those consumer protections out the window. States would 
be able to get waivers to opt out of basic consumer protections--basic, 
plain, vanilla consumer protection for coverage and affordability. My 
view was that kind of stuff is a backdoor way to set up junk 
insurance--junk insurance that wouldn't cover much more than gauze 
bandages and aromatherapy.
  Some people may wonder why this is important today, since the Senate 
resoundingly voted down the Better Care Reconciliation Act earlier this 
week.
  The answer is that my colleagues on the other side still seem to be 
trying to shoehorn this scheme for worse coverage--not better 
coverage--under a waiver into the skinny repeal proposal the Senate is 
going to vote on in a matter of hours. But the decision has come down. 
The decision has come down from the Parliamentarian that regulatory 
changes that gut consumer protection, that was right at the heart of 
that waiver in the Affordable Care Act, isn't going to fly. And, 
frankly, I think it calls into question what the Parliamentarian said--
it calls into question whether any of these big anti-consumer schemes 
are going to get 50 votes.
  So this is yet more uncertainty ahead if Senate Republicans pass this 
skinny repeal bill and the debate drags on.

[[Page 12044]]

  Now, at the risk of boring our wonderful pages and the staff who have 
heard me on the floor saying this before, there is a bipartisan 
approach. I think I have shown my bona fides over the years with 
respect to bipartisanship. I mentioned our universal coverage bill--the 
first time Republicans, Democrats came together and said that this is 
something where there is common ground because it is common sense. I 
have worked with colleagues who are perhaps some of the most 
conservative Members of the Congress on initiatives to move healthcare 
forward. That is what I have wanted to dedicate my entire professional 
service to--bipartisanship in health. Ever since those days with the 
Oregon Gray Panthers, that is what I always thought was the most 
important thing because if Senator Toomey, the Presiding Officer, all 
of our colleagues--all the people here--if you don't have your health, 
then pretty much everything else is uphill. So healthcare has always 
been the most important issue--an important issue we have to deal with 
in a bipartisan way.
  I have said--which is why I wanted to alert the pages and the 
professional staff about the prospect of true boredom and just nodding 
off through the afternoon--that there is an alternative. If Republicans 
drop the reconciliation, the our-way-or-the-highway approach, 
colleagues on this side have said that they want to work on a 
bipartisan basis. It doesn't take rocket science to figure out what 
that needs to be.
  The first thing that Democrats and Republicans would do is stabilize 
the private insurance market--the first thing. Everyone over here has 
said that the Affordable Care Act is far from perfect. We have 
colleagues here, including Senator Kaine with his reinsurance proposal, 
Senator Shaheen with her cost-sharing effort, Senator McCaskill to try 
to help areas where there is little or no coverage, and I am certain 
there are Republicans who have ideas that would be part of a good 
bipartisan package if we drop this our-way-or-the-highway partisan 
approach.
  We ought to be working together to bring down prescription drugs 
prices. I have spoken on a number of occasions with the Presiding 
Officer about the fact that literally out of nowhere over the last few 
years we saw a whole industry develop around prescription drugs, where 
a bunch of middlemen are supposed to be getting the consumer a good 
deal on medicine, but nobody knows what they put in their pocket and 
what they put in the consumers' pocket. They are called pharmaceutical 
benefit managers. So I said: How about a little sunlight on that? How 
about a little sunshine, the best disinfectant?
  I sure think people ought to be able to work together on those kinds 
of things. That, colleagues, is not what is on offer right now.
  I urge my colleagues to say: We are getting out of this shell game. 
Nobody has to accept the skinny repeal option or the dictates of the 
other body. If you are unhappy with the option on the table--and I hope 
more people will be unhappy now that I have outlined what some of the 
key considerations are in this Budget Office report Senator Murray and 
I worked hard to get--I hope some people are going to think again, 
especially on the other side of the aisle, about voting it down. Twenty 
percent premium hikes--those go into effect on January 1 of 2018. And I 
expect we will have more information on it, but I think there are going 
to be 20-percent hikes after that. That is real. That is not what some 
interest group made up or some liberal partisan or anybody else who has 
an ax to grind. That is what our impartial umpire found.
  So if you are unhappy with a proposal with those kinds of options, 
you ought to vote it down.
  I want to close by way of echoing a point that so many colleagues on 
this side have said. This is not about saying: Look, we are just 
against what you want to do. Quite the opposite. For all my time in 
public service, I have said what I want to do is try to find common 
ground with people with common sense.
  Let us defeat this skinny, sham, shell game kind of process that 
looks like what we are going to be voting on tonight and then get 
serious about doing what legislators do, which is not take each other's 
crummy ideas, but take good ideas and work on them in a bipartisan way.
  Mr. President, I yield the floor.
  Mr. LEAHY. Mr. President, on Tuesday, the Vice President cast a tie-
breaking vote to move to debate on a healthcare reconciliation bill, 
the contents of which even now remain a mystery to most of us.
  This vote to proceed without a transparent path forward underscores a 
process that has, from the beginning, been politics and policymaking at 
their worst. You would think that, after 7 years of campaigning to 
repeal the Affordable Care Act, the majority would have a plan in place 
to do just that. Instead, a dozen or so male, Republican lawmakers met 
behind closed doors, shielded from public view, to negotiate a grand 
plan to repeal the Affordable Care Act and make devastating cuts to the 
Medicaid Program--no hearings, no debate, no process. This is not the 
path taken when we considered, debated, and approved the Affordable 
Care Act. This is not the way the Senate, the greatest deliberative 
body in the world, should conduct such far-reaching and impactful 
business. This is not the Senate that I know and respect.
  In spite of multiple drafts and a go-it-alone, hyperpartisan 
philosophy, the majority leader was still unable to garner enough 
support within his own Caucus to pass a sweeping healthcare bill. I 
joined with many Democrats to offer motions to get the Senate back to 
regular order and have the appropriate committees study the effects of 
these policies on Medicaid beneficiaries and those with disabilities, 
on women and children, on seniors and the most vulnerable, but 
Republicans voted down those efforts and plowed ahead. During this 
debate, the Senate has also considered multiple amendments to rewrite 
the Affordable Care Act. Each of these amendments would have caused 
tens of millions of Americans to lose insurance and would have made it 
harder for those with preexisting conditions to obtain coverage. When 
those amendments failed, the Republican leadership attempted to fully 
repeal the Affordable Care Act. That did not work either.
  The collapse of these ideas should have resulted in a renewed spirit 
of bipartisanship, where we could work together to stabilize and 
improve the health insurance markets. Instead, the Republican majority 
is so intent on voting on anything, that we are considering voting to 
repeal two or three policies from the Affordable Care Act solely in 
order to get something through the Senate and into conference with the 
House. This is nothing more than legislative malpractice. We are 
presumably considering a bill that will devastate our health insurance 
markets, and the best reason the Republicans can come up with for 
supporting final passage is ``because we said we would.''
  The notion that this majority would reduce themselves--and the 
Senate--to finding the lowest common denominator in order to move ahead 
with a policy of this magnitude is not only absurd, it is dangerous. 
While all the versions of the Republican plans we have seen differ 
slightly, they all have the same, basic structure. Let's call these 
plans what they are: a massive tax cut for the wealthy on the backs of 
pregnant women, children, and the disabled who depend upon Medicaid for 
their health coverage. It is a tax plan in the guise of a health plan. 
We are considering massive entitlement reform bills that the Republican 
majority is trying to sell as fixes to the Affordable Care Act, but we 
know that these bills would fix nothing and would instead create 
tremendous new challenges.
  According to the nonpartisan Congressional Budget Office, CBO, each 
of the various Republican proposals would cause at least 22 million 
people to lose their health insurance. For instance, the CBO projected 
that the Senate Republican's first proposal would result in marketplace 
enrollees paying on average 74 percent more towards their premiums for 
a plan in 2020 than under current law. Another proposal offered

[[Page 12045]]

by the majority would result in higher deductibles, rising from $3,600 
under current law to $6,000. Under this one proposal, Americans would 
be expected to pay more money for less care. And as if the Medicaid 
cuts in the House bill were not deep enough--which caused the President 
to call the bill ``mean''--another Senate Republican proposal would 
double down and even deepen Medicaid cuts beginning in 2025. The 
Senate's proposals have certainly not been less ``mean'' than the House 
bill. If anything, the Senate's bills are meaner.
  In Vermont, the effects of any of these bills would be disastrous. 
Since the passage of the Affordable Care Act, Vermont has made 
exceptional progress to cut the rate of uninsured Vermonters by half. 
The number of uninsured Vermonters is now less than 4 percent. Because 
of the Medicaid Program and the Children's Health Insurance Program, 
known as Dr. Dynasaur in Vermont, 99 percent of children have health 
insurance in our State. TrumpCare, in any version, places Vermont's 
progress at risk.
  Vermont has also worked on new and innovative ways of delivering 
healthcare, which has brought down costs and increased coordination of 
care. One of the most significant ways Vermont has done this is through 
existing flexibility in Medicaid. It is through the Medicaid Program 
that Vermont has offered comprehensive treatment and counseling 
services for those suffering with opioid addition. In Vermont, 68 
percent of those receiving medication-assisted treatment for opioid 
addiction are Medicaid recipients. If hundreds of billions of dollars 
are cut from the Medicaid Program, States will be forced to limit 
coverage, jeopardizing Vermont's ability to overcome this crisis. 
Provisions that cap Medicaid spending do not create ``flexibility'' in 
Medicaid. This policy would instead force States to ration care.
  This spring, I met a Vermont mother who has two young daughters. Both 
of her daughters suffer from cystic fibrosis. Luckily, they have the 
disease mutation that allows them to benefit from new drug therapies, 
but it is because of Medicaid that they have the resources necessary to 
afford the $20,000 per month that it costs to provide medication for 
each of her children. How can we tell this mother that her daughters 
might no longer be able to take this medication because of fiscal 
constraints in Medicaid? How can we tell future children who should 
have access to Medicaid that it was more important to give the 
wealthiest Americans a tax cut?
  I heard from another woman in Norwich who shared this story with me: 
``Five years ago, both on the same day, my husband and I were diagnosed 
with cancer. The fact that we are both alive today is entirely thanks 
to President Obama. My treatment alone involved two hospital 
admissions, four months of chemotherapy, and fourteen surgeries. I 
still take drugs every day. There is no way we could have afforded any 
of this without Obamacare. Before the ACA, our health insurance costs--
both premiums and deductibles--were sky high. My husband and I used to 
avoid going to the doctor, reserving that luxury for our three 
children. Without Obamacare, it's entirely possible that we wouldn't 
have had the check-ups that led to our diagnoses.''
  These TrumpCare proposals are not healthcare bills. A true healthcare 
bill would not kick millions of Americans off health insurance. A true 
healthcare bill would not allow insurance companies to charge people 
more for less coverage. A true healthcare bill would not move us 
backwards to a time when healthcare was unaffordable.
  Instead, we should be working on proposals that improve our existing 
system. Where there are deficiencies, let's fix them. Where we can find 
common ground, let's act. One of the first things we should do is 
stabilize the insurance market by making cost-sharing payments 
permanent. We should also be working to reduce the cost of prescription 
drugs, which is why I have introduced a bill, along with Senator 
Grassley, that would help reduce drug costs by helping generic 
alternatives come to market faster. The American people expect us to 
work on real solutions. We should not be voting on a cobbled together 
plan where the primary goal seems to be to get to 50 votes, rather than 
actually improving our health insurance system. Importantly, no Member 
should vote on a proposal unveiled at the eleventh hour, with no 
debate--a proposal that will impact such a large component of our 
economy and tens of millions of Americans.
  Was the Affordable Care Act absolutely perfect when it was passed? 
No, and we acknowledged the need for continual improvement as the ACA 
would be implemented. Unlike other important social programs that have 
been created over the years--such as Social Security and Medicare--
Republicans have not allowed us the opportunity to improve, strengthen, 
and perfect it over time. Those programs were also not perfect, but 
instead of playing partisan games, Republicans and Democrats came 
together to get something done, time and time again. We did not vote to 
repeal the Social Security Act. No, we came together and we discussed 
what needed to be done to better help the American people, not unravel 
their safety net.
  I hope that we can end this dangerous exercise and move forward in a 
responsible way. Let us act on the best interests of our constituents 
and not resort to cynical, bumper-sticker politicking. At its best, the 
Senate has been able to act as the conscience of the Nation. I hope now 
is such a time and that the Senate will rise to the occasion to defeat 
this harmful bill.
  Mr. BLUMENTHAL. Mr. President, I had previously submitted to the 
Record my intention to submit a motion to H.R. 1628 regarding the 
Prevention and Public Health Fund. That motion was also supported by 
Senator Nelson.
  Mr. FRANKEN. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Franken moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions that 
     would repeal the medical loss ratio and allow insurers to 
     spend less of their revenue from premiums on providing high 
     quality medical care and more on corporate profits and 
     administrative overhead.

  Ms. HIRONO. Mr. President, I intend to offer the following motions to 
H.R. 1628, and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Hirono moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill will not result in the loss of 
     health care coverage, increased out-of-pocket health care 
     costs, or increased taxes for any individual in the State of 
     Hawaii, with such changes maintaining the deficit neutrality 
     of the bill over the 10-year budget window.

                   Motion to Commit With Instructions

       Ms. Hirono moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) provide that, for each calendar year that begins after 
     the date of enactment, each State shall provide medical 
     assistance through the State Medicaid program to any 
     individual residing in the State who is between 50 and 64 
     years of age and who demonstrates that the least expensive 
     private health insurance coverage available to such 
     individual would require the individual to pay premiums that 
     would exceed 9.5 percent of such individual's income.

                   Motion to Commit With Instructions

       Ms. Hirono moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--

[[Page 12046]]

       (1) are within the jurisdiction of such committee; and
       (2) provide that, for each calendar year that begins after 
     the date of enactment--
       (A) each State shall provide medical assistance through the 
     State Medicaid program to any individual residing in the 
     State who is between 50 and 64 years of age and who 
     demonstrates that the least expensive private health 
     insurance coverage available to such individual would require 
     the individual to pay premiums that would exceed 9.5 percent 
     of such individual's income; and
       (B) The Federal medical assistance percentage applicable to 
     medical assistance provided by a State under the State 
     Medicaid program to individuals described in paragraph (1) 
     shall be equal to 100 percent.

                   Motion to Commit With Instructions

       Ms. Hirono moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate within 3 days, not 
     counting any day on which the Senate is not in session, with 
     changes that would prohibit tax credits from being used for a 
     qualified health plan which has an annual or lifetime cap on 
     benefits, or any plan which does not cover all necessary 
     treatment for a condition until cured (including 
     rehabilitation or reconstruction procedures).

  Ms. HIRONO. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Hirono moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that any child who is enrolled in a State 
     Medicaid program shall not be disenrolled from such program 
     without proof that the child has alternative insurance 
     coverage that is equally affordable and that provides at 
     least the same level of coverage.

  Ms. DUCKWORTH. Mr. President, I ask unanimous consent that the text 
of these motions to commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure the reduction of infant mortality.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill will not reduce funding for, or 
     otherwise harm, rural telehealth programs.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) strike any provision in the bill that results in 
     decreased access to preventive or primary care services for 
     low-income children.

                   Motion to Commit With Instructions

       Ms. Duckworth moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) strike any provision in the bill that results in 
     decreased access to habilitative or rehabilitative services 
     for children with disabilities or children with medically 
     complex needs.

  Mr. BROWN. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  This motion would commit the bill to the Finance Committee with 
instructions to eliminate all provisions that would increase healthcare 
costs for the middle class and those struggling to get into the middle 
class.
  I am offering this motion because healthcare costs are already too 
high for hard-working Ohioans, and this bill would make them even 
higher. We ought to be working to bring down costs; yet as my colleague 
Senator Heller said, there is nothing in this bill that would lower 
premiums.
  The first test of a bill should be, do no harm so I would hope all my 
colleagues will join me in ensuring that any bill that comes out of 
this body doesn't saddle working families with higher healthcare bills.
  My motion is supported by the following Senators: Baldwin, 
Blumenthal, Whitehouse, Hirono, Feinstein, Leahy, Van Hollen, Harris, 
Franken, Carper, Udall, Coons, Menendez, Duckworth, Durbin, Reed, 
Stabenow, Warren, Booker, Nelson, and Klobuchar.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Brown moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that will increase health costs 
     for the middle class and those struggling to get into the 
     middle class.

  Mr. CARPER. Mr. President, I intend to offer a motion to commit the 
reconciliation bill to the Health, Education, Labor and Pensions, HELP, 
Committee with instructions to ensure the bill does not harm or reduce 
the size of the individual health insurance market risk pool in any 
State.
  I am offering this motion to ensure that the healthcare bill does no 
harm to the States' individual and small business health insurance 
markets by fracturing or reducing insurance market risk pools in ways 
that would drive up health insurance premiums and deductibles for older 
Americans or Americans with preexisting conditions.
  The following Senators support my motion to commit: Senators Coons 
and Shaheen.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Carper moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill does not weaken or reduce the size 
     of the individual market risk pool in any State.

  Mr. CARPER. Mr. President, I intend to offer a motion to commit the 
reconciliation bill to the Finance Committee with instructions to 
ensure the bill includes reforms to our healthcare system that lower 
healthcare costs and improve health outcomes.
  I am offering this motion because the healthcare bills before us make 
devastating changes to our country's healthcare system that endanger 
Americans' access to healthcare and raise healthcare costs for all 
Americans, but contains no commonsense reforms to our healthcare system 
that drive down underlying healthcare costs and improves health 
outcomes. Millions of Americans wrestle with unaffordable healthcare 
costs and our fee-for-service healthcare system remains inefficient and 
wasteful. Instead of passing the buck to States and reducing access to 
healthcare for low- and middle-income Americans, we should be focusing 
on reforms that can improve the healthcare system and lower healthcare 
costs for all Americans.
  The following Senators support my motion to commit: Senators Coons 
and Shaheen. I ask unanimous consent that the full text of my motion to 
commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Carper moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the

[[Page 12047]]

     Senate in 3 days, not counting any day on which the Senate is 
     not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill improves health outcomes and 
     lowers health care costs.

  Mr. MARKEY. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Leahy, Shaheen, Van Hollen, 
and Warren.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Markey moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would reduce the Federal 
     Government's financial commitment to currently active and 
     successful Medicaid waivers under section 1115 of the Social 
     Security Act that are promoting the objectives of title XIX 
     of such Act.

  Mr. COONS. Mr. President, I intend to offer the following motion to 
H.R. 1628 and I ask unanimous consent that it be printed in the Record. 
The motion is supported by Senator Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Coons moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate within 3 
     days, not counting any day on which the Senate is not in 
     session, with changes to prohibit a State through a waiver 
     from allowing annual and lifetime limits to be applied by a 
     health insurance issuer with respect to any essential health 
     benefit defined by the Secretary of Health and Human Services 
     under section 1302(b) of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18022(b)).

  Mr. COONS. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senator Blumenthal.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Coons moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate within 3 
     days, not counting any day on which the Senate is not in 
     session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) require the President to notify in writing any 
     individual who receives a cut in health care benefits, lower 
     quality health insurance, or loses health insurance 
     altogether that these changes are the result of H.R. 1628, 
     the Trumpcare bill.

  Mr. COONS. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Durbin, Blumenthal, 
Baldwin, and Brown.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Coons moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) ensure that States that elect to waive essential health 
     benefits under section 1332 of the Patient Protection and 
     Affordable Care Act provide for new essential health benefits 
     that provide at least a level of coverage that is equal to 
     the essential health benefits coverage of Members of 
     Congress.

  Mr. COONS. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Van Hollen, Baldwin, Brown, 
Leahy, Harris, Franken, Stabenow, Carper, Udall, Hirono, Menendez, 
Reed, Durbin, Warren, Blumenthal, Duckworth, Markey, Feinstein, 
Klobuchar, and Shaheen.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Coons moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill increases the number of Americans 
     with health coverage rather than stripping millions of 
     coverage.

  Mr. COONS. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record. The motion is supported by Senators Blumenthal and Menendez.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Coons moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate within 3 days, not 
     counting any day on which the Senate is not in session, with 
     changes that--
       (1) are within the jurisdiction of such committee; and
       (2) expand the credit for employee health insurance 
     expenses of small employers to include employers with a 
     greater number of employees, to extend the credit period, and 
     to increase other limitations under the credit.
  Mr. MURPHY. Mr. President, I intend to offer the following motions to 
H.R. 1628, and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out-of-pocket costs for individuals with rare 
     diseases.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would destabilize health 
     insurance markets.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out of pocket costs for Americans.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out of pocket costs for Americans with 
     Alzheimer's disease.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out-of-pocket costs for pediatric cancer 
     patients.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out of pocket costs for Americans older than 55 
     years.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--

[[Page 12048]]

       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out-of-pocket costs for disabled veterans.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out-of-pocket costs for individuals with mental 
     health or substance use disorders.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out-of-pocket costs for individuals with breast 
     cancer.

                   Motion to Commit With Instructions

       Mr. Murphy moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) eliminate provisions that would lead to increased 
     premiums and out-of-pocket costs for domestic violence 
     victims.

  Mr. SANDERS. Mr. President, I ask unanimous consent that a motion to 
commit be printed in the Record to instruct the Committee on Health, 
Education, Labor, and Pensions to report back with changes that ensure 
the bill includes a provision establishing a robust public health 
insurance option that is affordable and high quality, that provides 
comprehensive benefits, and that may be offered on the Federal and 
State exchanges.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Sanders moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill includes a provision establishing 
     a robust public health insurance option that is affordable 
     and high-quality, that provides comprehensive benefits, and 
     that may be offered on the Federal and State Exchanges.

  Mr. SANDERS. Mr. President, I ask unanimous consent that a motion to 
commit be printed in the Record to instruct the Committee on Finance to 
report back with changes that ensure that no provision in the bill will 
reduce or eliminate the amount of Medicaid funding provided to schools 
under current law.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Sanders moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that no provision in the bill will reduce or 
     eliminate the amount of Medicaid funding provided to schools 
     under current law.

  Mr. SANDERS. Mr. President, I ask unanimous consent that a motion to 
commit be printed in the Record to instruct the Committee on Finance to 
report back with changes that ensure the bill includes a provision to 
lower the eligibility age for Medicare benefits to age 55.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Sanders moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) ensure that the bill includes a provision to lower the 
     eligibility age for Medicare benefits under title XVIII of 
     the Social Security Act to 55 years of age.

  Ms. HEITKAMP. Mr. President, I intend to offer the following motion 
to H.R. 1628. I ask unanimous consent that it be printed in the Record 
and that the Record acknowledge the support of this motion by Senators 
Udall, Cantwell, Cortez Masto, Heinrich, Franken, Murray, Merkley, 
Schatz, Stabenow, and Tester.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Heitkamp moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee;
       (2) provide that any reduction or limitation of Federal 
     payments to help cover the cost of private health insurance 
     not apply with respect to private health insurance purchased 
     by American Indians or Alaska Natives; and
       (3) provide that any reduction or limitation of Federal 
     payments for spending under the Medicaid program shall not 
     apply with respect to services provided by the Indian Health 
     Service, an Indian Health Program, an Urban Indian 
     Organization, or Indian tribes or other tribal organizations, 
     or with respect to services provided to individuals who are 
     American Indians or Alaska Natives.

  Mr. SANDERS. Mr. President, I ask unanimous consent that a motion to 
commit be printed in the Record to instruct the Committee on Health, 
Education, Labor and Pensions to report back with changes that are 
based on hearings held by the committee.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Sanders moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate within 3 
     days with changes that are within the jurisdiction of such 
     Committee based on hearings held by the Committee.

  Mr. MARKEY. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Markey moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with the following amendment 
     (inserted at the appropriate place):

     SEC. __. REGULAR ORDER.

       Notwithstanding any other provision of law, nothing in this 
     Act, including the amendments made by this Act, shall take 
     effect until the both the Senate and the House of 
     Representatives pass this Act through regular order.

  Mr. MARKEY. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Markey moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with the following amendment 
     (inserted at the appropriate place):

     SEC. __. REQUIREMENT TO HOLD CONFERENCE.

       Notwithstanding any other provision of law, no provision of 
     this Act, including any amendment made by this Act, shall 
     take effect until a bipartisan conference has been convened 
     and produced a conference report with respect to this Act, 
     and such conference report has passed the Senate and the 
     House of Representatives. The conference committee shall hold 
     multiple public meetings and consider the input of 
     stakeholders.

  Ms. HIRONO. Mr. President, I intend to offer the following motion to 
H.R. 1628, and I ask unanimous consent that it be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Ms. Hirono moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--

[[Page 12049]]

       (1) are within the jurisdiction of such committee; and
       (2) would strike any provisions that restrict or prohibit 
     Federal funding to Planned Parenthood health centers or other 
     high quality family planning providers, or discriminate 
     against providers based on the provision of constitutionally 
     protected reproductive health care.

  Mr. MERKLEY. Mr. President, I intend to offer the following motions 
to H.R. 1628, and I ask unanimous consent that they be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with HIV.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Autism.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Asthma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     breast cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     pancreatic cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for children with 
     cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for individuals with 
     pre-existing conditions.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for infants.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for Veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for pregnant women.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Diabetes.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for children ages 3-
     10.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for parents of 
     infants.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for Vietnam War 
     Veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for Veterans of the 
     Wars in Afghanistan.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for Veterans of the 
     Wars in Iraq.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for World War II 
     Veterans.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for Social Security 
     recipients.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for Medicare 
     beneficiaries.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     brain cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Leukemia.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the

[[Page 12050]]

     Senate within 3 days with changes that are within the 
     jurisdiction of such Committee to strike provisions in the 
     Better Care Reconciliation Act of 2017 that could result in 
     the loss of health insurance coverage for people with 
     cervical cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     colorectal cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Lymphoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with Lung 
     cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Melanoma.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     ovarian cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     prostate cancer.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Alzheimer's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Cerebral Palsy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Cystic Fibrosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Crohn's Disease.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     ulcerative colitis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Lupus.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Rheumatoid arthritis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     AIDS.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     multiple sclerosis.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Muscular Dystrophy.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with 
     Parkinson's.

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for people with Lou 
     Gehrig's Disease (ALS).

                   Motion to Commit With Instructions

       Mr. Merkley moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate within 3 days with changes that are within 
     the jurisdiction of such Committee to strike provisions in 
     the Better Care Reconciliation Act of 2017 that could result 
     in the loss of health insurance coverage for Korean War 
     Veterans.

  Mr. CARDIN. Mr. President, I intend to offer a motion to commit the 
reconciliation bill to the Finance Committee with instructions to 
report the bill back to the Senate within 3 days, not counting any day 
on which the Senate is not in session, with changes that would strike 
any provision that would eliminate, limit access to, or reduce the 
affordability of pediatric dental services by repeal all or part of the 
Patient Protection and Affordable Care Act, ACA, or otherwise 
negatively impact children's access to coverage or such services.
  I am offering this motion because the Finance Committee should review 
the implications of depriving millions of children of access to dental 
care. An estimated one of five children aged 5 to 11 years and one of 
seven adolescents aged 12 to 19 years in the U.S. have at least one 
untreated decayed tooth. Consequently, tooth decay has led to 51 
million school hours lost annually, and related dental disease can cost 
billions to our healthcare infrastructure. Early childhood cavities and 
related oral health complications also disproportionately affect low-
income families and minority communities.
  The ACA has expanded access to dental services nationwide by 
designating pediatric dental services as one of the essential health 
benefits. Expanding access to affordable dental benefits is essential 
to securing the health and well-being of our children. Many have heard 
me speak before about the tragic loss of Deamonte Driver, a 12-year-old 
Prince George's County resident, in

[[Page 12051]]

2007. Deamonte's death was particularly heartbreaking because it was 
entirely preventable. What started out as a toothache turned into a 
severe brain infection that could have been prevented by an $80 
extraction.
  We cannot let what happen to Deamonte happen again.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Cardin moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would strike any provision that would--
       (A) eliminate, limit access to, or reduce the affordability 
     of pediatric dental services by repealing all or part of the 
     Patient Protection and Affordable Care Act, or
       (B) otherwise negatively impact children's access to 
     coverage of such services.

  Mr. CARDIN. Mr. President, I intend to offer a motion to commit the 
reconciliation bill to the Finance Committee with instructions to 
report the bill back to the Senate within 3 days, not counting any day 
on which the Senate is not in session, with changes that would 
eliminate or reduce access to affordable preventive services that are 
currently offered without copayment or cost-sharing under the Patient 
Protection and Affordable Care Act, ACA, including blood pressure 
screening, colorectal screening, breast cancer screening, cervical 
cancer screening and domestic and interpersonal violence screening and 
counseling.
  I am offering this motion because the Finance Committee should review 
the implications of reducing access to affordable preventative services 
to millions of Americans. A key provision of the ACA is the requirement 
that private insurance plans cover recommended preventive services 
without any patient cost-sharing. Chronic diseases, such as heart 
disease, cancer, and diabetes, are responsible for 7 of every 10 deaths 
among Americans each year and account for 75 percent of the Nation's 
health spending. Research has shown that evidence-based preventive 
services can save lives and improve health by identifying illnesses 
earlier, managing them more effectively, and treating them before they 
develop into more complicated, debilitating conditions.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Cardin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would strike any provisions that would eliminate or 
     reduce access to affordable preventive services that are 
     currently offered without copayment or cost-sharing under the 
     Patient Protection and Affordable Care Act, including blood 
     pressure screening, colorectal screening, breast cancer 
     screening, cervical cancer screening and domestic and 
     interpersonal violence screening and counseling.

  Mr. CARDIN. Mr. President, I intend to offer a motion to commit the 
reconciliation bill to the Finance Committee with instructions to 
report the bill back to the Senate within 3 days, not counting any day 
on which the Senate is not in session, with changes that would strike 
any provision that would eliminate, limit access to, or reduce the 
affordability of health services for homeless individuals.
  I am offering this motion because the Finance Committee should review 
the implications of depriving millions of children of access to dental 
care. On any single night, over 500,000 people experience homelessness. 
On any single night over 50,000 of these individuals are homeless 
veterans. Many individuals experiencing homelessness have significant 
healthcare needs and may suffer from mental health conditions, 
substance use disorders, and chronic diseases like diabetes, asthma, 
and hypertension. Without access to health services, individuals tend 
to use hospitals and emergency departments at high rates, driving up 
overall healthcare costs. The Patient Protection and Affordable Care 
Act, ACA, has greatly decreased the uninsured rate among homeless 
individuals, leading to better health outcomes, and creating stability 
in the individual's life. Health centers that treat the poor and 
homeless in States that expanded Medicaid report that 80 or 90 percent 
of their patients are now covered by insurance.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Cardin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would strike any provisions that would eliminate or 
     reduce access to health services for homeless individuals.

  Mr. CARDIN. Mr. President, I intend to offer a motion to commit the 
reconciliation bill to the Finance Committee with instructions to 
report the bill back to the Senate within 3 days, not counting any day 
on which the Senate is not in session, with changes that would strike 
any provisions that would eliminate or reduce access to mental health 
services and substance abuse treatments.
  I am offering this motion because the Finance Committee should review 
the implications of reducing access to mental health services and 
substance use treatment to millions of Americans. An estimated 43.6 
million Americans ages 18 and up experience some form of mental health 
condition, and over 20 million adults have a substance use disorder. Of 
these, over 8 million have both a mental health condition and a 
substance use disorder. That Patient Protection and Affordable Care 
Act, ACA, has been vital to giving these individuals access to 
affordable treatment options where they had none before.
  I ask unanimous consent that the full text of my motion to commit be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Motion to Commit With Instructions

       Mr. Cardin moves to commit the bill H.R. 1628 to the 
     Committee on Health, Education, Labor, and Pensions with 
     instructions to report the same back to the Senate in 3 days, 
     not counting any day on which the Senate is not in session, 
     with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would strike any provisions that would eliminate or 
     reduce access to mental health services and substance abuse 
     treatments.

  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. TOOMEY. Mr. President, I ask unanimous consent to speak on the 
healthcare topic for 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. TOOMEY. Mr. President, I am going to speak mostly about some 
Medicaid reforms that were proposed in the BCRA, but in the course of 
the discussion, I am going to touch on some of the issues that our 
colleague who just finished raised.
  As we know, the BCRA bill is not going to be the vehicle we will take 
to a conference committee with the House, but I hope we will get to a 
conference committee with the House, and I hope the result of that, 
among other things, is that we will address the need to make important 
reforms to Medicaid because they are long overdue.
  I will start with a chart which illustrates our Federal deficits and 
what exactly is driving our Federal deficits. The fact is--I think we 
all know here--we have two big categories of Federal spending. One is 
the discretionary spending which Congress approves at Congress's 
discretion every year. The other category is the programs on 
autopilot--programs where spending is driven by a person's eligibility 
for the program without Congress acting in any way.

[[Page 12052]]

  That latter category we call mandatory spending. In 1980, that was 
only 50 percent of the Federal budget. By 1995, it was 64 percent. Last 
year, it was 70 percent of our entire budget, and we are on a path to 
have these mandatory spending--the blue line. We can see the growth in 
mandatory spending. We can see the relative lack of growth in the other 
categories of spending, be it defense or nondefense discretionary 
spending.
  The budgetary problem we have is mandatory spending. This is not 
breaking news. This is nothing that is controversial. Anybody who has 
taken an honest look at the numbers can come to no other conclusion. 
The discretionary portion of the budget, which used to be the lion's 
share of the budget, has been relatively flat. Actually, it has even 
declined in recent years. The mandatory spending has been going through 
the roof.
  Of course, there are multiple problems with this, not the least of 
which is--at this kind of growth in mandatory spending--the first thing 
it does is it squeezes out all other categories of spending. We are 
already living through that, as the discretionary spending--including 
on our Nation's defense--has been declining because you can't do so 
much of both, but in time you could zero out all the discretionary 
spending, and there still will not be enough for all the mandatory 
spending which is coming our way if we stay on the path we are on.
  Where is all this mandatory spending coming from? The next chart 
shows that pretty clearly. The bulk of mandatory spending, especially 
in recent years, is from Medicaid. The reason I say that is, Social 
Security is a big program, but Social Security has a dedicated revenue 
stream. The payroll tax historically used to cover all of it. For a 
while there, it covered more than the ongoing payments for Social 
Security. While that fluctuated when we suspended the payroll tax, by 
and large, the payroll tax pays most of the Social Security costs that 
we have day-to-day.
  Medicare also has a revenue stream that is dedicated from payroll 
taxes, but it doesn't cover nearly as large a percentage of the 
Medicare costs as Social Security so we see the green line generally is 
higher than the blue line.
  The line which is higher than all by far is the Medicaid line because 
there is no dedicated revenue stream to Medicaid, and the net expense, 
therefore, is by far the biggest of all our entitlement programs.
  Medicaid has been growing at a really shocking rate for years. In 
1980, Medicaid spending was only 2.4 percent of our budget, a half a 
percent of our economy; by 1995, it was almost 6 percent of our budget; 
and today it is 10 percent of our whole budget, 17 percent of all 
healthcare spending. So this is happening because Medicaid is growing 
much faster than our economy is growing.
  The fact is, no Federal program can grow faster than the economy 
indefinitely because the economy has to fund the entire Federal 
Government. Hopefully, funding the government is only a portion of what 
our economy is doing. The main purpose of our economy is to provide a 
livelihood for the people who create it, but Medicaid, as we can see, 
is growing at a staggering rate compared to our economy as measured by 
GDP.
  This picture right here summarizes, really, for me the very 
definition of an unsustainable Federal program because as it continues 
to grow at a rate that is much greater than our economy, it necessarily 
is consuming an ever greater percentage, an ever greater portion of our 
economy and our Federal budget. Nothing can grow faster than our 
economy indefinitely. It is just arithmetic. Eventually, it would 
become bigger than the economy, which is obviously an impossibility, 
and long before that happened, it would cause a fiscal crisis. This is 
the very essence of what is unsustainable.
  You don't have to take my word for it, and I am certainly not the 
first person to observe this. We could take the words of Democratic 
President Bill Clinton, who told us this very thing. Back in 1995, 
President William Jefferson Clinton said:

       We all now, looking ahead, know that our number one 
     entitlement problem is Medicare and Medicaid. They are 
     growing much more rapidly than the rate of inflation plus 
     population.

  Now, President Bill Clinton wasn't making this point because he is 
some kind of ideologue who wants to get rid of Medicaid. I don't think 
he has ever been accused of that. It is not because he has some 
passionate ideological commitment to reducing the size of government. I 
don't think he has ever been accused of that. I think Bill Clinton was 
making this point because he knew this program was unsustainable, and 
he wanted to reform it so it would be sustainable, so our Federal 
budget would be sustainable, so Medicaid would be there for the next 
generation. I think that was Bill Clinton's motivation at the time.
  So what was his solution? What was it that Bill Clinton thought we 
ought to do about this program that was unsustainable?
  President Bill Clinton suggested the Federal Government put caps on 
the amount of money it would contribute to the States based on the 
number of individuals enrolled. In other words, it was a per 
beneficiary limit on the Federal contribution. That was what Bill 
Clinton proposed in 1995. He wanted to maintain the eligibility of 
individuals to participate in the program, but he wanted to put limits 
on what the Federal Government's share would be. He wanted to have it 
grow at about the rate the economy would grow so you wouldn't continue 
to have this wildly accelerating line relative to this modest growth 
line but that the two lines would converge, because then, as Bill 
Clinton knew, the program would be sustainable over time. We would be 
able to afford it.
  One might wonder, what did Congress think of this idea at the time. 
This is 1995. Bill Clinton came along and said: Let's establish per 
beneficiary caps on Medicaid expenditures by the Federal Government, 
and let's limit the growth of those caps to about the growth of the 
economy. That was Bill Clinton's idea.
  Helpfully, the Democrats, who controlled the Senate, decided to weigh 
in on the matter, and on December 13, 1995, Senator Patty Murray--who 
serves with us today--submitted a letter to the Congressional Record. I 
am going to read a very brief comment she made when she submitted this 
for the Record. The senior Senator from Washington, Patty Murray, said:

       Mr. President, I hold in my hand today a letter to 
     President Clinton that is signed by all 46 members of the 
     Democratic Caucus. This letter urges him to hold firm to our 
     commitment to basic health care for children, pregnant women, 
     the elderly, and the disabled in this country. This letter 
     supports a per capita cap approach to finding savings in the 
     Medicaid program.

  It was signed by every single Democratic Senator. They expressed 
their strong support for the Medicaid per capita cap structure.
  I want to be very specific about this because as they developed the 
particulars, they decided the cap should not grow at an index that was 
tied to healthcare spending. They wanted it to be tied to an index 
which would grow at the rate of the economy overall, and they proposed 
it would go into effect the very next year. They didn't want to wait. 
They didn't want to have a transition. They didn't want it to be 
gradual. They wanted it to go into effect the next year. They proposed 
implementing the changes for the very next fiscal year.
  So you can imagine that some of us are a little bit surprised by the 
shrill, over-the-top attacks we have been hearing from the other side. 
We Republicans have been accused of launching a war on Medicaid. We 
have been accused of draconian cuts. We have been accused of wanting to 
decimate healthcare for the most vulnerable. We could go on. As you and 
I both know, all across this country, on this floor, in every form 
imaginable, our Democratic colleagues have attacked Republicans for the 
proposal in the BCRA bill we have been considering.
  What is really so outrageous about this is, we proposed the 
Democratic solution. What we proposed was Bill Clinton's idea, as 
ratified by every single

[[Page 12053]]

Democrat serving in the Senate at the time, including several who are 
still with us today. We proposed that we take Medicaid and restructure 
it the way the Federal Government reimburses States for their expenses 
so that we would put caps on the amount the Federal Government would 
contribute per beneficiary. We would allow the caps to grow, but just 
as President Clinton and all the Democrats in the Senate suggested, we 
would make sure that growth eventually converged to the growth of our 
economy so we would have a sustainable program.
  There are two big differences between what the Democrats proposed in 
the mid-1990s and what many of us have proposed these last few weeks:
  One, we proposed that the change occur more gradually. We suggested 
that we would implement these changes, but we do it over time, not 
suddenly, the way they had proposed it.
  The other big difference, I would suggest, is they proposed this 
structural change to Medicaid before ObamaCare came along and made an 
unsustainable program worse. We are proposing it in the aftermath of 
that huge problem.
  I get our Democratic colleagues have done a 180 reversal. I get they 
no longer acknowledge that this is unsustainable. I get that they don't 
want to do anything about entitlements. I understand all that. You are 
entitled to change your opinion, you are entitled to decide you want to 
ignore this issue, but it is a little bit over the top to attack our 
motives, our integrity, when we are proposing exactly what they 
themselves proposed just a few years ago under President Clinton.
  I wish we could have a substantive discussion about the policy 
without the character attacks.
  Let me get into a little bit more about these changes to Medicaid.
  As the Presiding Officer very well knows, traditionally, Medicaid was 
available, from the time the program was launched, to four categories 
of Americans--four categories of people who were of very low income and 
were deemed to be unable to purchase healthcare for themselves. Those 
are the elderly poor, disabled, blind and disabled children, and adults 
with dependents. So the program set up a partnership with the States--a 
generous partnership. The Federal Government has always paid a majority 
of the costs, ranging anywhere in some States as high as 75 percent of 
the costs and no State less than 50 percent--on average, 57 percent.
  ObamaCare came along and created a new category of eligibility. Under 
President Obama, for the first time--under ObamaCare--a new category 
was created; that is, adults, working-aged, able-bodied people with no 
dependents, would now be eligible for Medicaid if their income was 
below 138 percent of the poverty line. The Federal Government would pay 
all of the costs initially, and then after a short period of time, it 
would go to 90 percent. Then the Federal Government would pay 90 
percent in perpetuity.
  Well, there are a few problems with this design. The most fundamental 
and obvious is the Federal Government couldn't afford this. We were not 
on a sustainable path before, and now we have created this whole new 
liability which can only make it worse and bring a fiscal crisis closer 
to the present.
  The second thing is, when States have no skin in the game, we find 
out they behave as though they have no skin in the game. When States 
have to contribute only 10 percent of the cost--think about it. Every 
dollar a State spends in this category gets matched with nine Federal 
dollars, nine free dollars. That is a huge incentive to spend a lot, 
and guess what. That is exactly what they have done. Medicaid spending 
in this category has ended up being over 50 percent more than what was 
expected.
  So what did the Senate propose in our legislation? We proposed not 
that we would disallow this coverage, not that we would eliminate this 
category of eligibility, not that we would throw a single person off 
Medicaid--we have said, in fact, we will codify the expansion. We will 
make it permanent. No one loses eligibility, no one gets thrown off.
  What we will do is gradually, over 7 years, we will ask States to pay 
their fair share for this new category--this expansion category, the 
able-bodied adults with no dependents. We will ask the States to pay 
the same amount for these folks that they pay for the traditional four 
categories of eligibility. That is the first category.
  The second reform we proposed is what I alluded to earlier, the Bill 
Clinton-Democratic Senate proposal of establishing per beneficiary 
caps. That was in our legislation. What the underlying Senate bill did 
was allow the spending to grow very rapidly on those caps. Only in the 
eighth year did we ask that the growth rate slow down slightly so we 
would have a reasonable chance so the growth in the program would be 
about the same as the economy. That is what we proposed. That is what 
was in the bill. That is what we have been hearing about--all of these 
draconian cuts.
  Let's get to the discussion about these cuts. We have another chart 
that illustrates this because it has been a favorite theme for some of 
my colleagues on the other side to talk about all of these cuts.
  If you look at the CBO score--again, this is the Senate BCRA, the 
legislation on which we didn't get enough votes this week to pass, but 
I hope we will revisit it--the largest of the so-called cuts in 
Medicaid spending comes from CBO's assumption that if you repeal the 
individual mandate--the statute that says you must buy insurance, you 
must have insurance--millions of people on Medicaid, millions of people 
who did get free health insurance, will decide: Oh, I don't want free 
health insurance anymore. If I am not being forced to buy it, I am not 
going to take free healthcare. Why would I do that?
  I don't know about you, but that is a little counterintuitive to me. 
To my friend from Oregon who is attacking the so-called skinny bill, 
100 percent of the so-called Medicaid cuts in that bill come from 
exactly this source. The assumption is that, if people are not forced 
by the government to have insurance, they will not want Medicaid. You 
can decide how much credibility you want to put in that assumption. It 
strikes me as ridiculous, but that is the truth. That is the reality of 
the so-called CBO cuts in Medicaid.
  In the BCRA, that was only the lion's share of the so-called cuts. 
Another category of so-called cuts to Medicaid in the CBO analysis of 
the BCRA are their assumptions about expansion. They decide that under 
current law, if nothing else happens, a whole lot of States will choose 
to become Medicaid expansion States.
  They haven't made that choice yet. They can't point to which ones. It 
is a political decision in the various States. They don't know who is 
going to be leading those States. They have no idea about how that 
would happen, but yet they predict States that have chosen thus far not 
to be Medicaid expansion States would adopt the expansion under current 
law. If we passed the law that was proposed earlier, those States would 
not make that decision. Furthermore, some States that have expanded 
will rescind the decision to expand.
  Any honest person, including the folks at the CBO, have to 
acknowledge that this is entirely speculative. They can't name a single 
State that will expand under the current law but hasn't yet. They can't 
name a single State that would rescind its expansion having already 
done so. They are just speculating that could happen.
  That, my friends, is the lion's share of the CBO's headline numbers 
about all these cuts in Medicaid.
  Let me go to chart 5. Despite that, even if you accept the CBO's 
unbelievable assumptions that people only participate in Medicaid if 
they are forced to and that these mysterious States will expand and 
others will not--these are the draconian cuts--each and every year, 
under the BCRA, Federal spending on Medicaid grows. It grows every 
year--every single year. It is only in Washington that spending can 
increase every year, and it is a draconian cut.
  No, the truth of the matter is that what we do under that legislation 
is

[[Page 12054]]

that we slow down the rate of growth. We slow the rate at which the 
program grows to a rate that is sustainable, so that this program is 
viable, so that we are diminishing the certainty of a fiscal crisis. 
That is what we do.
  If somebody has a better idea for how we put Medicaid on a 
sustainable path, I am all ears. I would love to hear it. In the 1990s, 
our Democratic colleagues proposed exactly what we are proposing now. 
That was a very constructive idea. Unfortunately, there wasn't a 
consensus to do it, and that is a shame.
  I urge my Democratic colleagues to go back to their notes, to go back 
to the discussion, to go back to the arguments they were making 
together with President Bill Clinton on the floor of this Senate and 
around the country about Medicaid, because we are making those 
arguments now. You would think we might be able to find some common 
ground.
  The fact is that Medicaid is a very, very important program. The most 
vulnerable Americans depend on Medicaid to a very significant degree. 
The fact is that, in its current form, it is unsustainable. Our 
Democratic colleagues in the past used to recognize this. They used to 
acknowledge this, and they used to want to do something about it. I 
urge them to return to that attitude so that we can work together and 
get something done.
  The sooner we act on this, the sooner we can have gradual, sensible, 
thoughtful reforms that make the program sustainable and allow our 
States to plan for these changes and allow for a transition. If we wait 
too long, the fiscal crisis that will hit us will force sudden and 
draconian changes.
  We are not going to vote on this provision today. This was embedded 
in the BCRA. That is behind us this week, but it is my hope that we 
will pass a version of ObamaCare repeal that will enable to us to go to 
conference and that we will be able to begin to repair the enormous 
damage to the individual markets that ObamaCare has done, that we will 
be able to stabilize them, that we will be able to move in the 
direction of consumers actually having control of their own healthcare 
once again, and that we will put Medicaid on a sustainable path, 
because the time is overdue.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, how much time remains on our side?
  The PRESIDING OFFICER. The Senator has 3 minutes remaining.
  Mr. WYDEN. Mr. President, I will be very brief.
  To respond to my friend from Pennsylvania, No. 1, none of what he has 
discussed has come up in the Senate Finance Committee. What I can tell 
you about past debates is that our side was always interested in 
reform-minded ideas, for example, bringing the private sector into the 
delivery system of Medicaid. That is No. 1. No. 2, we still have not 
seen the skinny bill.
  I said earlier: Who knows what happened at the Republican Senate 
lunch between one course and another. We would like to see the skinny 
bill. I think, once again, we have heard from the other side that they 
disagree with the umpire. They disagree with the impartial CBO, and I 
think that is unfortunate.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, I ask unanimous consent to speak for 17 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. It is my understanding that if the managers need time 
to break into my speech, I will be glad to accommodate that.
  I rise today to inject a dose of badly needed reality into this very 
important debate. Healthcare is a profoundly personal issue that 
matters to every single American. In fact, every single Senator in this 
body ought to agree on this point. Healthcare hits home for each and 
every constituent we represent from our home States. From standard 
wellness checks to lifesaving cancer treatments, each of us wants the 
best, most effective and affordable medical care for the people we love 
and for ourselves.
  As policymakers, it is our job to solve problems. It goes without 
saying that we are facing a big problem right now. Access to affordable 
healthcare is out of touch for millions of Americans. That is despite 
the promises made over and over. Remember that ObamaCare was rammed 
through on a last-ditch Christmas Eve party-line vote.
  Look at what that got us. Health insurance markets are collapsing 
around the country. Since 2013, the average premium increase on the 
individual market has jumped 105 percent.
  Remember when President Obama promised affordable healthcare for all? 
He promised we could keep our doctor. He promised that Americans could 
keep their healthcare plan, and he promised all Americans that their 
premiums would go down by $2,500.
  We all know ObamaCare did not uphold these promises. Instead, we got 
higher taxes, costly penalties, double-digit premium increases, 
unaffordable copays, job-crushing and wage-crushing employer mandates, 
and thickets of Federal regulations.
  Now ObamaCare is collapsing. No one on the other side of the aisle 
has made an attempt to legislate remedies to the law despite its grave 
condition.
  At this very moment, 72,000 Iowans in my home State are gripped with 
uncertainty. Two insurance carriers have dropped out of the exchanges, 
leaving only one to offer individual plans starting in January. The 
policies offered by that insurance company will go up over 40 percent 
next year, on top of huge increases this year, making it still 
unaffordable.
  ObamaCare is unsustainable, unaffordable, and unacceptable. This 
brings me to the reality check that I mentioned when I started. As I 
listen to some of my colleagues on the other side of the aisle, I am, 
frankly, astounded that they can deliver their talking points with a 
straight face.
  They would like the American people to believe that Republicans are 
dead set on ripping healthcare away from children, the elderly, and the 
disabled. Despite their red hot rhetoric, we have neither horns nor 
tails, but we are dead set on working out the devilish details to get 
to yes.
  Democrats' hyperbole and fearmongering are standing in the way of 
getting the job done for the American people. Fear is easy to achieve. 
Legislating in good faith is hard work. ObamaCare defenders would 
rather disparage than engage. They would rather obstruct a path forward 
than to construct a path forward. They are standing in the way of 
solving problems.
  In the process, they are scaring the living daylights out of hard-
working Americans who aren't able to stretch their paychecks to afford 
health insurance for their families. If there is one job the defenders 
of the big government have mastered, it is the role of Chicken Little. 
They squawk, cluck, and crow at every opportunity to grow the size, 
scope, and reach of government into our daily lives. To their way of 
thinking, ObamaCare was a step toward single payer.
  They will say and do whatever it takes to secure sweeping, universal 
government control of the healthcare system, no matter how much it 
costs the taxpaying public, the toll it takes on the U.S. economy, or 
the loss of personal freedom.
  Their message is dead wrong. Our reform efforts are not making the 
sky fall. The Democrats' rhetoric reminds me of a similar situation. 
The debate 20-some years ago was to reform welfare by reining in 
runaway Federal spending and increasing the independence of 
individuals. Just like now, that debate was full of dire predictions.
  Some of my colleagues will remember the late Daniel Patrick Moynihan 
of New York, then-chairman of the Senate Finance Committee. He strongly 
opposed efforts to reform the welfare system. He predicted that the 
bipartisan proposals would result in an apocalypse and said:

       If, in 10 years' time, we find children sleeping on grates, 
     picked up in the morning frozen, and ask, why are they here, 
     scavenging, awful to themselves, awful to one another, will 
     anyone remember how it began? It will

[[Page 12055]]

     have begun on the House floor this spring and the Senate 
     chamber this autumn.

  That is the end of the quote from Senator Moynihan 20 years ago. The 
facts will show that welfare reform was, in fact, not ``legislative 
child abuse,'' as the former Senator of Massachusetts Ted Kennedy 
predicted. Quite the contrary.
  In the two decades since historic, bipartisan welfare reform was 
enacted, reality shatters this doomsday prophesy of 20 years ago. The 
reality is that the number of African-American children living in 
poverty has fallen to the lowest level in history. The problem still 
exists and deserves our attention, of course, but 1.5 million fewer 
children are in poverty today, and 3.4 million more families are 
independent from assistance.
  At the time of welfare reform, the Chicken Littles forecasted 
homelessness, poverty, and despair. Senator Moynihan also said that 
requiring welfare recipients to work and limiting the length of time 
that they could collect benefits added up to ``the most brutal act of 
social policy since Reconstruction. Those involved will take this 
disgrace to their graves.''
  With all due respect to the memories of my former colleagues, their 
rhetoric simply does not square with reality. The 1996 welfare reform 
law lifted millions out of generational poverty, replacing lifelong 
impoverishment and lifestyles of dependency with livelihoods restored 
with hope and opportunity. These facts separate Democratic rhetoric 
from reality.
  In the absence of a credible reason to continue with ObamaCare's 
failure, the only defense tactic left to the Democrats is fear. In a 
vein similar to that of her predecessor from New York, former Senator 
and Democratic Presidential nominee Hillary Clinton said: ``If 
Republicans pass this bill, they're the death party.''
  In another vein similar to her predecessor, another Senator from 
Massachusetts said that ``I've read the Republican `health care' bill. 
This is blood money. They're paying for tax cuts with American lives.''
  They are not alone in their obstructionism. The minority leader has 
said that Republican-led efforts to reform ObamaCare are ``heartless. 
It is a wolf in sheep's clothing. It brings shame on the body of the 
Senate.''
  Another Democrat chimed in that the Senate bill is ``downright 
diabolical'' and would be ``one of the blackest marks on our national 
history.''
  Still another Democrat said his constituents are ``scared for their 
children, they are scared for their spouses, they are scared for their 
aging parents. . . . And . . . scared . . . for their own health and 
well-being.''
  Another one chimed in that ``our emergency rooms would be 
overwhelmed. They would be unable to deal with the scope of that kind 
of humanitarian need.''
  Not surprisingly, the law's champion-in-chief, President Obama, has 
fueled the fear factor, saying that the Republican efforts to reform 
the healthcare law would put pregnant mothers, addicts, children with 
disabilities, and poor adults in harm's way.
  Such overheated rhetoric shows Democrats have abandoned rhyme, 
reason, and reality. Too often, the arguments from the other side are 
based on what Medicare was supposed to do, not what it actually did, 
which fell far short of projections from the experts. Defenders of 
ObamaCare are relying on a phantom rather than the reality of the law.
  Democrats are refusing to work with us toward a better solution that 
truly works. After years of neglecting consequential problems with a 
partisan-passed law now on the books, they say that they have a better 
deal. Let me tell you, thousands of Iowa families and small business 
owners have contacted me with their personal stories of hardships. To 
them, ObamaCare has been nothing but a raw deal, rather than a better 
deal. What good is having insurance, they say, if it is too expensive 
to use?
  After more than 7 years of ObamaCare, the chickens have come home to 
roost. And in less than 10 years, look what happens when government 
gets in the way of the free market and consumer choice. Well, it is 
obvious: higher premiums, bigger copays, fewer choices, less freedom. 
Health insurance that costs too much to use is just not working for 
hard-working American families.
  I will end my speech today with an appeal from an Iowan from Avoca, 
IA. She has contacted me many times about the hardships her family has 
experienced since ObamaCare was enacted. She pays more than $25,000 a 
year to insure her family on the individual market. If that sounds like 
chicken feed to some of ObamaCare's defenders, I urge you with all 
sincerity to get your heads out of the clouds and join us to fix this 
flawed law. Republicans and Democrats can work together for the greater 
good of the country.
  It is said that when there is a will, there is a way. Many of us 
recognize that ObamaCare isn't working as promised. Half of us voted 
this week to move ahead to fix this problem. The other half is blocking 
any effort put forward to reform the broken law. They are digging in 
their heels and pulling out all stops of any solution and stopping it 
dead in its tracks. Again, it reminds me of those who fought tooth and 
nail to stop welfare reform 20 years ago. I quoted those people from 20 
years ago. At the time, they predicted the most dire consequences would 
befall our most vulnerable citizens. Thank goodness, the pessimists 
back then did not prevail in their obstruction against welfare reform. 
While welfare reform has not been perfect, it has restored hope and 
opportunity to millions of Americans.
  We can't afford to let the pessimists and obstructionists prevail 
today against healthcare reform, and they seem to be acting like the 
very same people that opposed welfare reform 20 years ago. The American 
people deserve high-quality, affordable healthcare. ObamaCare has not 
lived up to its promises, so it is time for elected leaders to live up 
to the promise we made to the American people. Let's worry less about 
who wins and worry more about who will lose when Congress fails to 
restore the collapsing Federal law.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that the time until 
5 p.m. be equally divided between the managers or their designees; that 
at 5 p.m., the Senate vote in relation to the Strange amendment No. 
389; further, that following disposition of the Strange amendment, the 
Senate proceed to the consideration of H.R. 3364, which was received 
from the House; that there be 20 minutes of debate, equally divided 
between the leaders or their designees; that following the use or 
yielding back of that time, the bill be read a third time and the 
Senate vote on passage of H.R. 3364; finally, that following 
disposition of H.R. 3364, the Senate resume consideration of H.R. 1628.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Who yields time? If no one yields time, time will be charged equally 
to both sides.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, I yield myself such time as I need, up to 
the limit that we have. This week, we have been debating why it is so 
urgent for Congress to act on rescuing Americans from the collapsing 
ObamaCare healthcare law.
  We have heard from our colleagues across the aisle, questioning our 
motives and our actions. Congress literally has millions upon millions 
of reasons to replace and repeal this law. Hard-working American 
families are begging us to provide them with some relief. These are 
families who are forced to purchase high-deductible coverage insurance 
and are facing thousands of dollars of out-of-pocket costs before their 
coverage even begins. For them, the status quo--doing nothing--is not 
an option.
  For Senate Republicans, rescuing the American people from this law is 
our only option. But the defenders of this law don't seem to grasp--or 
are unwilling to admit--that ObamaCare is not

[[Page 12056]]

affordable insurance and has been a crisis-inducing failure. This is 
why Republicans are working to fix the damage. Insurance markets are 
collapsing, premiums are soaring, and healthcare choices are 
disappearing.
  Americans expect the Congress and the President to address the 
problem. With ObamaCare getting worse by the day, the time to act is 
now. Just look at my home State of Wyoming, which is down to one 
insurer in the individual market, both on and off the exchange. This 
should be treated as the national scandal it is.
  Some on the other side of the aisle like to focus on how many people 
are insured under the law, but let's look at how many are not insured. 
Almost 28 million Americans remain without insurance under ObamaCare 
because they cannot afford insurance or no longer have access to it due 
to ObamaCare's collapsing markets in their State or county. But 
coverage numbers can be misleading because, even with insurance, many 
hard-working families still cannot afford the care due to surging 
deductibles. Insurance with sky-high deductibles is coverage in name 
only.
  When it comes to Medicaid coverage, what most news stories will not 
tell you is that the newly insured gained coverage only through a 
flawed Medicaid Program that is providing inferior quality and 
threatening to bankrupt States across the Nation.
  The Democratic leader, Nancy Pelosi, famously said that Congress 
would have to pass the bill to find out what's in it. Well, Americans 
soon discovered that President Obama and congressional Democrats 
focused almost exclusively on coverage numbers boosted by government 
mandates handed down from Washington, instead of true healthcare 
reforms that might have actually provided better care, provided 
affordable care. Obama's alleged coverage numbers are only on paper. 
Coverage was their sacred cow, worshipped above all others, because for 
President Obama, Nancy Pelosi, and Harry Reid, coverage equaled 
healthcare.
  Large coverage numbers touted by the Obama administration and 
congressional Democrats have proved to have the healthcare utility of a 
pet rock. Do you remember the pet rock? Millions of people purchased a 
rock. It was very nicely packaged in a box. They would bring it home 
and open it up and find a rock. Pet or not, it served no purpose other 
than its name: a pet rock.
  This is essentially how ObamaCare has worked, except people were 
forced to purchase this marketing gimmick. Americans have purchased 
insurance through ObamaCare exchanges with the promise of accessible 
coverage. What they actually received, however, is coverage in name 
only. It serves no healthcare purpose, and it doesn't work--merely 
packaging a pet rock, if you will--and millions of Americans soon found 
out. The high cost of insurance plans they forced people to buy made it 
nearly impossible for them to pay for the coverage they signed up for, 
or if they could afford coverage, they realized the care they were 
paying for came with sky-high deductibles.
  Congressional Democrats and President Obama focused almost 
exclusively on the numbers of people now enrolled in ObamaCare and 
relentlessly highlighted this information, which showed this law was 
used mainly for public relations purposes at a large cost, as opposed 
to an actual policy accomplishment. Instead, the reality is that 
Americans who were able to get insurance were often plagued with 
inadequate coverage, joined with enormous out-of-pocket costs. Senators 
from across the country this week have been sharing stories about 
families in their States who have had to forgo medical care, not 
because they don't have insurance but because it was simply too 
expensive to go to the doctor under the ObamaCare health plan.
  For years, Republicans have pledged to repeal this disastrous law, 
and this week we are working to address the broken promises of 
ObamaCare to help ensure better care for each and every American. We 
are doing this by working to stabilize collapsing insurance markets 
that have left millions of Americans with no options, which will help 
improve the affordability of health insurance and therefore healthcare. 
Our goal is to preserve access to care for Americans with preexisting 
conditions and to safeguard Medicaid for those who need it most by 
giving States more flexibility, while ensuring that those who rely on 
this program won't have the rug pulled out from under them. Most 
importantly, Republicans hope to free the American people from onerous 
ObamaCare mandates that require them to purchase insurance they don't 
want or can't afford.
  The President and Republicans in Congress last fall promised to 
rescue the millions of American families suffering under ObamaCare, 
which is what this bill will do.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BLUNT. Mr. President, may I inquire, what is the remaining 
Republican time?
  The PRESIDING OFFICER. Three minutes.
  Mr. BLUNT. Mr. President, the majority time is 3 minutes?
  The PRESIDING OFFICER. Yes.
  Mr. BLUNT. Senator Strange is coming, and I will take my time later.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, we have loaned time before to the other side 
of the aisle. If they would loan us some time so that the person 
propounding this amendment could have a moment to explain his 
amendment--they have agreed. So I yield time to the Senator from 
Alabama.
  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. STRANGE. Mr. President, I ask unanimous consent to speak for up 
to 2 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. STRANGE. Thank you.


                           Amendment No. 389

  Mr. President, I rise today in support of an amendment that will 
relieve millions of Americans of a moral conflict. For too many, access 
to healthcare coverage comes only with the restriction of deeply held 
personal convictions about the sanctity of human life.
  The amendment before us offers the opportunity to end the flow of 
taxpayer dollars to abortion procedures once and for all. It allows 
Hyde protections to be extended to all funds appropriated through the 
healthcare legislation we are considering today.
  Let me provide some context. Premium tax credits implemented under 
ObamaCare currently provide over $8.7 billion in annual subsidies for 
nearly 1,000 different insurance plans that cover elective abortion on 
the State exchanges. This provision stands in violation of the 
fundamental principle of the Hyde amendment and the long-held 
understanding that the U.S. Government has no role in funding 
abortions.
  In recent weeks, the Senate has debated countless nuances of 
healthcare policy, and we have taken several crucial votes on efforts 
to rescue the American people from a failed social experiment, bringing 
us to this moment. Under our current procedural circumstances, in order 
to ensure that both the spirit and the letter of the Hyde amendment's 
provision against taxpayer-funded abortion is upheld, we need a new 
solution.
  My amendment would establish a matching arrangement between stability 
funds and premium tax credits, delivering an arrangement that complies 
with the Byrd rule. Starting in 2019, the value of premium tax credits 
that continue to subsidize elective abortions would drop to 10 percent, 
with the remaining 90 percent being made available as Hyde-protected 
monthly payments to insurers to benefit the same people who relied on 
those tax credits.
  Let me be clear. This amendment does not reduce the amount of tax 
credit dollars available to low-income Americans. It does not result in 
their losing coverage. It certainly does not create or expand an 
entitlement program.
  When hard-working Americans pay their taxes, they do so with the 
understanding that the rights granted to

[[Page 12057]]

them by the Constitution are not checked at the door. For the people of 
my State, the right to life is foremost among these, codified by the 
Hyde amendment and engrained in the conscience of a majority of 
Americans. The amendment before us allows for a clear conscience. It 
allows for a concise, conservative solution to a problem that has 
dogged this Chamber for the 44 years since Roe v. Wade changed the 
landscape of American society.
  On behalf of the unborn and the conscience rights of millions of 
Americans, I am proud to offer this amendment, and I urge my colleagues 
to join me in this effort.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Blunt). The Senator from Hawaii.
  Mr. SCHATZ. Mr. President, I make a point of order that the pending 
amendment violates section 302(f) of the Congressional Budget Act of 
1974.
  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. STRANGE. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974 and the waiver provisions of 
applicable budget resolutions, I move to waive all applicable sections 
of that act and applicable budget resolutions for purposes of amendment 
No. 389 and, if adopted, for the provisions of the adopted amendment 
included in any subsequent amendment to H.R. 1628 and any amendment 
between Houses or conference report thereon, and I ask for the yeas and 
nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  The yeas and nays resulted--yeas 50, nays 50, as follows:

                      [Rollcall Vote No. 174 Leg.]

                                YEAS--50

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

                                NAYS--50

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murkowski
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden
  The PRESIDING OFFICER. On this vote, the yeas are 50, the nays are 
50.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The point of order is sustained and the amendment falls.

                          ____________________