[Pages S224-S260]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         CONCURRENT RESOLUTION ON THE BUDGET, FISCAL YEAR 2017

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of S. Con. Res. 3, which the clerk will report.
  The senior assistant legislative clerk read as follows:

       A concurrent resolution (S. Con. Res. 3) setting forth the 
     congressional budget for the United States Government for 
     fiscal year 2017 and setting forth the appropriate budgetary 
     levels for fiscal years 2018 through 2026.

  The PRESIDING OFFICER. Under the previous order, 3 hours of debate 
remain on the resolution for the majority and 3 hours of debate remain 
on the resolution for the minority.
  Mr. SCHUMER. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. TOOMEY. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                      Tribute to Christopher Gahan

  Mr. TOOMEY. Madam President, I rise this afternoon to bid a very fond 
farewell to a man whom I have come to like very much and respect 
enormously. He is Christopher Gahan. He has been my chief of staff for 
6 years. After 6 years of extraordinary service, he has decided that he 
is going to move on to the private sector. I want to say a few words 
about Christopher's background and his contribution to my office, to 
our country, and the people of Pennsylvania.
  Christopher is actually from New Hampshire. He is a native of Rye 
Beach. After growing up in New Hampshire, he earned his degree in 
biology at Brown University and then went on to get a law degree from 
Harvard. I can assure everyone he has recovered from his educational 
experience to a very extensive degree.
  He went into law and practiced at the law firm of Latham & Watkins in 
Los Angeles and Washington. He had a very successful time there, but he 
decided he wanted to come to Washington and work in government and, 
specifically, work on the Hill. He went to work for Judd Gregg, Senator 
Gregg from New Hampshire, and Christopher Gahan, I understand, had 
almost every job that a Senate office has. He started at the very 
beginning, but because of his enormous talents and his ability and hard 
work, he relatively quickly rose and became chief of staff for Senator 
Gregg.
  When I was elected to the Senate in 2010, I got a call within a 
matter of weeks from Christopher, and he said he wanted to come and 
meet with me and discuss the fact that I needed a chief of staff. He 
drove up to Allentown. We had lunch, and I decided almost immediately 
that this guy would probably do a great job. He clearly had the 
attributes that I was looking for.
  I should also point out some of the things that are perhaps not as 
widely known about Christopher outside of my office. One is that he is 
a tremendous athlete. He has been for a long time. When he was in 
college, he was on the varsity men's water polo team. He was cocaptain 
at Brown, he was All-Ivy League, and to this day, he gets up at 4 or 5 
o'clock every morning and usually goes for a run. He occasionally bangs 
out a marathon and thinks nothing of it. He has quite a diverse range 
of talents.
  He also has a very peculiar taste in certain things. He loves all 
things related to cats, except the animals themselves. I don't 
understand that. Maybe it is an allergy; I am not sure exactly what it 
is. If you look at his desk area, he has funny photos of cats, little 
porcelain cats, little masks of cats, and a calendar of cats. He loves 
all things cats, except the animals themselves. It is quite remarkable.
  Having said all of that about his background, what I really want to 
say is how fortunate Pennsylvania and I have been to have Christopher 
Gahan serving in this capacity. As I said, from the day that I had 
lunch with Christopher, I knew he could do a great job. I knew he had 
that ability. I had very high expectations for what he could do, and he 
has exceeded those expectations every day. It has really been quite 
amazing. He is a very intelligent man, but more importantly, he has 
great judgment and a great ability to work with people.
  The role he has played in my office has been absolutely tremendous. 
For example, he is very knowledgeable about a number of issue areas, 
but he always understood that his role was to help the legislative 
assistants who had responsibilities for those areas. Christopher's role 
was to make sure that they were able to do the work they were assigned 
to do and to really shine and get a chance to excel and to grow 
personally. While he could have inserted himself in that dynamic, he 
never did. He always chose to empower

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the people who worked under him, and he created an environment where 
people loved to come to work every day. They loved to work hard. They 
wanted to do well for a lot of reasons, not the least of which is they 
wanted to continue to earn the respect of Christopher Gahan.
  Needless to say, he is extremely well liked, both within the office 
and on the Hill. I know how often other chiefs, other Members, people 
who come to us with concerns from Pennsylvania--they have praised his 
even-handed, very thoughtful, very hard-working approach. He has truly 
enabled us to have a very successful office for these last 6 years, and 
I am very grateful to him.
  He is moving on to the private sector, and I understand that. He has 
served me and my office, our State and our country very well. He 
deserves the change that he has embraced, and I think he is going to do 
very well. I am sure he will, and I wish him every success. My only 
insistence is that he stay in touch because he has become a very good 
friend and he is just a great source of advice.
  Lastly, he is a great patriot. He loves this country. He has served 
it well, and we are going to miss him.
  Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Madam President, apparently a number of our colleagues 
here are having second thoughts about the strategy on the floor. We 
have before us a budget resolution. It is setting the stage for a 
budget process called reconciliation. To put it in layman's terms, we 
are going to be moving from this budget resolution vote to a vote at a 
time to be announced later, possibly in the next 2 weeks, to repeal 
ObamaCare.
  There has been a lot of speculation about what the impact will be if 
we don't replace the Affordable Care Act, or ObamaCare, with something 
very quickly--for obvious reasons. We have seen 30 million Americans 
who now have health insurance because of the creation of the Affordable 
Care Act.
  We have changed health insurance policies across the United States so 
that if you have someone in your family with a preexisting condition, 
you can't be discriminated against when you buy insurance.
  Back in the old days, before ObamaCare became the law of the land, 
health insurance companies could just refuse to insure your family or 
charge you a premium that was beyond reach. We also eliminated the caps 
that were built in--the limits that were built into these health 
insurance policies. People were buying policies which covered up to 
$100,000 in expenses. Then, God forbid, there is a diagnosis of cancer 
or some serious illness, and $100,000 evaporates over a weekend.
  So those limits are no longer allowed in health insurance policies. 
We said women should be treated the same as men when it comes to 
premiums. We also went on to say that, when it comes to these health 
insurance companies, they have to be focused on keeping premium costs 
in control, and they have to justify any profits that go way beyond the 
reasonable.
  Then we said: If you are a mother or father with a son or daughter 
coming out of college and they are looking for a job, they are doing an 
internship, and they don't have health insurance, they can stay on your 
family policy until age 26.
  That is pretty important for a lot of families. My family has been 
through that with our kids. To know and have peace of mind that your 
daughter or son can continue to be covered by your family plan--these 
things are all built into the Affordable Care Act. Now, simply 
repealing that, even saying it will happen at a later date, throws into 
question, if not chaos, our health care system in America.
  A lot of people are finally thinking about that. It is not just a 
protest vote about a President who is going to be leaving office in 9 
days. It is a life-and-death decision for health care for millions of 
Americans. Now many of my colleagues on the other side of the aisle are 
starting to wake up to that reality.
  Senator Cotton of Arkansas said: ``It would not be the right path for 
us to repeal ObamaCare without laying out a path forward.''
  Yesterday, House Speaker Paul Ryan said that Republicans want to 
repeal ObamaCare ``concurrently'' with a replacement--``concurrently.''
  Senator Lamar Alexander, my friend and colleague from Tennessee, who 
chairs the Health, Education, Labor, and Pensions Committee, responded 
by saying: ``To me, `simultaneously' and `concurrently' mean ObamaCare 
should be finally repealed only when there are concrete, practical 
reforms in place that give Americans access to truly affordable health 
care''--Senator Alexander.
  Newt Gingrich, the former Republican Speaker of the House, said: ``I 
don't think Republicans want to leave 23 million people out there 
worried that they are going to lose their insurance.''
  So you go through the long list of Republican dissenters to this 
notion of repeal and we will get back to you later: Senators Corker, 
Portman, Collins, Cassidy, Murkowski. They have come up with an 
amendment to this budget resolution, and they have said: Let's postpone 
this whole effort until we have had time to put some work into it and 
come up with an alternative to answer some of the basic questions about 
what a new version of the Affordable Care Act would look like.
  But the problem with that approach is that they have had 7 years--7 
years--to prepare something, and they have nothing. So what are we 
going to do in the meantime?
  We did the responsible thing, I hope. Let's find a way to make the 
Affordable Care Act even stronger, better, fairer. Sign me up. Make it 
a bipartisan effort. Don't repeal it. Sit down and rewrite it in a way 
that is fair and makes it stronger and better.
  The basic things we want to make sure of are that people can have the 
same basic protection if they wish it in health insurance. Ensure that 
no one loses their current benefits, whether it is maternity care, 
mental health care, or substance abuse treatment, which is now required 
to be covered by health insurance plans. Ensure that no one's premiums 
or out-of-pocket expenses get out of line. Protect people with 
preexisting conditions and don't just simply shift the cost to States--
my State included--that could not afford to take this on. Keep drug 
prices down for seniors.
  You see, that is a part I did not mention. Medicare is affected by 
the Affordable Care Act. Under Medicare, the 60 million Americans under 
Medicare used to have something called a doughnut hole. It was on odd 
invention when this bill was written into law. It said that Medicare 
for seniors would cover the front end of their prescription costs, if 
they are high, and, then, they have to take the middle part out of 
their savings, and, then, late in the year, Medicare kicked back in.
  It was costing seniors $1,000, $2,000 a year. We eliminated it with 
the Affordable Care Act. Now, if you repeal that, what happens to 
seniors and their prescription drug costs? Those are legitimate 
questions which need to be answered before we go blindly into repealing 
the Affordable Care Act.
  Let's work together--Democrats and Republicans--to make this a better 
law. I have said it before and I will say it again. The only perfect 
law that I am aware of was carried down a mountain by ``Senator Moses'' 
on clay tablets. The rest of the efforts that we put into this are 
always subject to review, amendment, and improvement. The Affordable 
Care Act I would put in that category.
  If there is a good-faith effort on the Republican side to join with 
Democrats, I want to be part of it. I also want to salute my colleague, 
Senator Debbie Stabenow, who will be on the floor in a couple of hours 
to talk about the mental health protections and substance abuse 
treatment protections in the Affordable Care Act. We used to have this 
debate on the Senate floor about whether health insurance policies 
should cover mental illness. We debated that. For the longest time, 
they did not. People with those problems and challenges have long-term 
care, in some cases.
  But because of the bipartisan effort of Mr. Paul Wellstone, the late 
Senator

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from Minnesota, and Mr. Pete Domenici, the retired Senator from New 
Mexico--Democrat and Republican--we have included it in there. Senator 
Stabenow wants to make sure that whatever we write in the future is 
going to cover mental illness and substance abuse treatment.
  Facing mental illness challenges across America, facing an opioid and 
heroin epidemic, we can do no less. Let me tell you a story about Lori 
Myers in Freeport, IL. She sent me a letter. Here is what she said:

       I am writing to ask you to fight to preserve the ACA . . . 
     it has literally saved our daughter Brianne.
       Brianne has been insured through the ACA since its 
     inception. . . . She has multiple health concerns and her 
     prescriptions are insanely expensive without insurance.

  Lori writes:

       It is imperative that she continue to have health coverage 
     in order to remain a functioning and productive adult. . . . 
     She has excellent policies purchased through the 
     Marketplace--with BlueCross BlueShield, and she receives a 
     subsidy to assist with cost.
       The increase in premium this year was offset by an increase 
     in the subsidy. She is actually paying $20-$30 less for her 
     policy this year than she did last year for basically the 
     same coverage.

  Ms. Myers says:

       The election of our incoming President and the Republican-
     controlled Congress has our family in a panic mode. Paul Ryan 
     and company want to take away programs that are assisting 
     people: like Social Security, Medicare, Medicaid, and 
     healthcare.

  She makes this final plea:

       I am asking you, as our elected official, to stand strong 
     against any attempt to dismantle the Affordable Care Act and 
     these other extremely vital programs.

  What does it mean for seniors--the Affordable Care Act?
  Well, the first thing it did was to start to contain the growth in 
health care costs. That had a dramatic impact on Medicare and its 
future. Because of the Affordable Care Act and the changes it includes, 
which give to seniors, for example, free preventive health exams and 
that sort of thing, and because of prescription drugs now being covered 
so it does not come out of pocket for many seniors--because of these 
changes and others--Medicare is now financially solvent through 2028.
  ObamaCare, or the Affordable Care Act, added 10 years of solvency to 
Medicare. That is critically important. What happens when they repeal 
it? Because we slowed the pace of Medicare costs, seniors are now 
paying $700 less each year in premiums and cost sharing, on average. 
Premiums are down, and Medicare solvency is up. We want to repeal that?
  Our health care system now prohibits insurers from charging seniors 
much higher premiums simply because of age. Seniors were often charged 
five times what younger people paid for health insurance--banned by the 
Affordable Care Act. ObamaCare, as I mentioned earlier, closed this 
doughnut hole, saving 11 million seniors an average of $2,127 on their 
prescription drugs. They want to repeal that?
  Thanks to ObamaCare, more than 30 States have expanded their Medicaid 
Program. People often forget that the vast majority of money spent on 
Medicaid is for seniors who are in an institutional or at-home-by-
themselves setting. So when you cut Medicaid--and people say that it 
must be the poor unemployed; it is--but the largest amount of money is 
going to seniors--mothers and fathers, grandmothers and grandfathers.
  The Affordable Care Act has been good for kids across America. 
Between 2013 and 2015 we saw the largest decline of children uninsured 
in our Nation's modern history. Today, more than 95 percent of kids in 
America are insured. We ought to be proud of that. In Illinois, there 
is a 40-percent decline in the number of children uninsured. Under our 
current health care system, children can now stay on their parents' 
plans till age 26, as I mentioned.
  The number of young adults ages 19 to 25 without health insurance has 
declined by over 50 percent since we passed this bill. In Illinois, 
more than 90,000 young people have signed up. Today, insurance 
companies are required to cover important health care for children free 
of charge--vaccinations, vision checks, lead poison screening. Of 
course, we ended the preexisting condition provisions. The Republicans 
want to repeal this. What will they replace that with to protect 
children and seniors?
  When it comes to women, because of ObamaCare, the uninsured rate for 
adult women in America has declined by 44 percent. Today, women can no 
longer be charged more than men simply because of their gender. Our 
health care system now prohibits insurers from discriminating based on 
preexisting conditions. There was a time, literally, when health 
insurance companies said being a woman is a preexisting condition. We 
are going to charge you more.
  Our health care system now ensures that women can get free preventive 
health services. Before ObamaCare, 62 percent of individual health 
plans did not cover maternity or newborn care. Today, it is a 
requirement.
  So when you talk about cutting the cost of health insurance and that 
we will just take off some of these benefits, understand what you are 
doing. If you take the basic maternity care out of a health insurance 
plan, and it is not included and it is needed, that family is going to 
have to bear that expense.
  If they can't pay the bill--some won't be able to--who is going to 
pay for it? The hospital will deliver the baby and send the mother and 
baby home happy and healthy, I hope. But the cost will be passed on to 
everyone else who shows up at that hospital with a health insurance 
plan. That was the old days. Do the Republicans want to return to that?
  In the area of behavioral health, as I mentioned earlier, thanks to 
ObamaCare, health insurance plans now cover mental health and substance 
abuse disorders. The law extended protections under the Mental Health 
Parity and Addiction Equity Act to 60 million Americans in private 
health plans. This means that insurers can no longer discriminate 
against individuals with mental illness or addiction.
  Our health care system now prohibits insurers from discriminating 
based on preexisting conditions, including the 44 million Americans 
with some history of mental illness and 20 million with a substance 
abuse disorder.
  When you repeal this, as the Republicans plan on doing, what will 
they replace it with? What will they say to the families who have 
someone with a mental illness or someone suffering from a drug 
addiction?
  Substance abuse and mental health disorders often present in young 
adulthood, and that is why the provision that families can keep their 
kids on their plan is at the right time and the right place for many 
young people.
  There is a long list of things that were done by the Affordable Care 
Act. It is one thing to campaign and say: We will repeal it. People 
cheer. And then you ask yourselves: What are you going to say, as some 
of the Republican leaders have said, to the people who are going to 
lose this coverage, to the people who want their guarantees built into 
their health insurance plans?
  I can still remember--and I will bet many watching this debate can 
too--the bad old days when you called up that adjuster for the health 
insurance plan that you owned and wondered how long you were going to 
sit on hold for the person on the other end and if the person on the 
other end would even be able to comprehend what you were asking.
  These sorts of things don't need to be returned as evidence that we 
are making progress. If we go back to those bad old days, it is a step 
in the wrong direction for millions of Americans.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Madam President, I am not going to get into a lot of the 
things that Senator Durbin got into about increasing the lifespan of 
Medicare or issues that revolve around folks who get charged more just 
because they are a woman. But I do want to approach this health care 
debate from a standpoint of how it is going to impact rural America 
because it is going to impact rural America in a huge way.
  Before I start my prepared remarks, I just want to say something. For 
the last 6 years, I have listened to folks stand on this floor and talk 
about repealing health care, repealing health care, repealing health 
care. Now the folks on the other side of the aisle can do it if they 
want. But for the last 6 years, I have never seen a plan to replace the 
Affordable Care Act, and I

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still haven't seen a plan. I am going to tell you that if we repeal 
this bill without a plan to replace it, we will have big, big problems 
in this country. And if we repeal this bill without a plan that 
increases accessibility and affordability across this Nation in urban 
and rural and frontier areas, we will have big, big problems.
  I have been visiting for the last--well, it has been over a year but, 
more specifically, since the election, with folks across rural America 
on the impacts of repealing this health care bill. These are folks who 
work to feed our country, farmers and ranchers. These are folks who 
work with their hands to manufacture products that have that ``Made in 
the USA'' stamp on it. These are folks who teach our children, who help 
keep our families safe, who operate retail businesses on Main Street. 
These folks, in my opinion, are the backbone of this country.
  I am proud to be a product of that rural America, hailing from a town 
with a population today of about 600 people, so I am not here talking 
about what is going on in Chicago or L.A. or New York or any of the 
other big cities. I am going to talk to you about communities where you 
know your neighbor; communities where you are driving down the street, 
and you see that pickup, and you know who is in that pickup; folks who, 
when you go down to the local grocery store, you know their first name. 
These are towns where often the hospital is the largest employer and it 
is the only source of health care, that foundation that keeps families 
healthy.
  I am here to talk to you about how this Affordable Care Act has been 
so important to those families in rural areas in States like mine. By 
the way, all of Montana is rural.
  Today, more Montanans have health insurance than ever before. That is 
undeniable. Folks are no longer denied coverage by insurance companies 
because they have preexisting conditions like diabetes nor are they 
forced to pay higher premiums because they have common ailments like 
high blood pressure. Children are able to stay on their parents' 
insurance policies for a time until they finish their college career or 
launch lives of their own. Folks who have life-threatening diseases 
like cancer can now finish the treatments without hitting an arbitrary 
cap and being kicked off their insurance plan. Now they are required to 
be able to stay on it. And seniors can get out of the prescription drug 
doughnut hole faster, which was costing them millions of dollars each 
and every year. In fact, since the ACA was signed into law, Montana 
seniors alone have saved $56 million in prescription drug costs and 
there is enough money in the bank, as I said in my opening, to keep 
Medicare above water through 2028.
  These reforms have made incredible impacts on people in rural 
America. But don't just take my word for it; listen to everyday 
Montanans. I have been traveling across that State, hearing their 
stories, hearing their struggles, hearing their successes.
  Just this weekend, a man stood up at a public forum I was hosting in 
Missoula and talked about how the ACA saved his life. He told me that 
he had a heart attack the previous week. He was home and started having 
some chest pains. He picked up the phone, called his doctor--a doctor 
who he had, thanks to the insurance he received under the ACA.
  Luckily, he survived his heart attack, was able to get the treatment 
he needed, and was able to come to my roundtable that I had in 
Missoula. He told me: I know myself, if I did not have insurance, and I 
could not afford to get it without the ACA, I would not have called the 
doctor, and I would have died. As pointedly as that, he would have 
died.
  I have traveled around Montana. I have found that this story is not 
unique. I can take you to a coffee shop in Havre--population 8 to 
10,000--where seniors have told me that they no longer have to choose 
between prescription drugs and heating their homes.
  I can take you to the grocery store in Great Falls, where a man came 
up to me and said: ``I finally have peace of mind that I won't lose my 
home if I get sick.''
  Or I can introduce you to my best friend growing up in Big Sandy, who 
now lives in Seattle, who no longer can be denied coverage due to the 
fact that he has diabetes, a preexisting condition.
  These are real success stories and real-life impacts across Montana 
and across this country. But rather than build on the successes of the 
ACA and fix the problems with the ACA, there are folks in this body who 
want a full-scale repeal, ignoring any of the progress that we have 
made.
  They want to go back to the old health care system. And here is what 
that would look like in Montana: 152,000 Montanans with preexisting 
conditions will be at risk of losing their health care plans; 61,000 
Montanans enrolled in Medicaid--just in the last year because that is 
when the Medicaid expansion actually went into effect--will lose their 
health care coverage. Montana seniors will lose help paying for their 
prescription drugs. Insurers will be allowed to subject every Montanan 
to lifetime and annual caps on their coverage. And women will lose 
important protections that prevent them from being charged more for 
coverage than men.
  It doesn't stop there, folks. Their plan to repeal health care 
coverage without presenting a replacement doesn't just impact families. 
It will wreak damage on our rural hospitals and clinics too.
  I will tell you that if we lose these hospitals and clinics--and we 
all know how rural America is drying up--it is another nail in the 
coffin of rural America. Folks will not be able to live there if they 
are over the age of 50 because they will have no access to health care.
  The Affordable Care Act has provided rural hospitals and clinics a 
level of certainty that, quite frankly, they have never had before. 
Every day in rural communities, folks rely on their local hospitals and 
clinics for everything from basic checkups to emergency treatments. I 
know. And as folks age, they have the peace of mind to know that they 
can visit their hometown provider without being forced to travel long 
distances.
  But if folks in Congress take us back to the old health care system, 
they put these local hospitals and clinics at extreme risk.
  Take Mineral County in Superior, MT. The county is home to just over 
4,000 people--not a lot by national standards but a lot by Montana 
standards--nurses, schoolteachers, construction workers, all folks who 
want reliable access to affordable care. According to the Mineral 
County Hospital CEO, a repeal of the ACA would mean a real loss to that 
community. The hospital would be probably shutting its doors.
  Without a hospital in that community, folks would be forced to travel 
over 100 miles to deliver their baby or take an expensive air ambulance 
ride, which is a whole other problem, for emergencies that come down 
the pike, like a broken arm. And if I am a new parent or senior, I will 
not be taking that risk. I am going to be moving closer to a hospital. 
But there are a lot of folks who can't afford to leave their homes--in 
some cases, homesteads, where their families have lived for 
generations--to move somewhere closer to medical care.
  I can tell you that in my small community, there are a lot of folks, 
who, when they hit age 65, have to move to a bigger town to be able to 
have access to the kind of specialty care they need. You can move that 
age down to age 50 if we lose these hospitals in these rural areas. 
These rural hospitals not only keep patients alive; they keep 
communities alive too. A repeal of the ACA--I am told by the 
hospitals--would kill those rural hospitals which, as I said before, 
would be another nail in the coffin of rural America.
  Let's take, for example, the Billings Clinic, which is Montana's 
largest health care provider. They are responsible for innovating and 
providing critical resources to rural areas through things like 
telemedicine. But the Billings Clinic will not be able to make this 
large-scale impact anymore if their patients are no longer able to pay 
their medical bills because they lost their access to Medicaid, cost-
free preventive care, or insurance from the marketplace. Repealing the 
ACA will restrict their ability to provide quality care and jeopardize 
their standing as a pillar in Montana.
  It is not just hospitals either. It is community health centers 
serving over

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100,000 Montanans every year, fully one-tenth of our population. They 
are at risk of losing 70 percent of their Federal funding.
  Let me repeat: If health care progress is repealed, the community 
health centers in Montana will be at risk of losing 70 percent of their 
Federal funding. These devastating impacts are not unique to Montana, 
but this is how it is going to play out across this country in rural 
areas with hospitals and clinics--more uncompensated care, more trips 
to the emergency room without insurance, more hospitals facing the grim 
reality of having to close their doors.
  Oftentimes I wonder if it really matters to Congress. It looks as if 
they intend to go through with their plan, which will have devastating 
impacts on the patients, and, by the way, it will have devastating 
impacts on their taxpayers.
  Repealing this health care coverage without a replacement will add an 
additional $350 billion--$350 billion--to the deficit and the debt over 
the next 10 years, and this budget resolution will saddle the next 
generation with an additional $9 trillion in debt over the next decade.
  You know, it is amazing. When I came to this body, there were folks 
talking about the debt all the time. In the last 2 years, I have heard 
little talk about the debt. With the exception of Rand Paul, everyone 
who was supposedly a deficit hawk voted to increase our deficit and 
debt by $9 trillion over the next decade. This would push our total 
national debt to nearly $30 trillion by year 2026. I stand with Rand 
Paul on this one. Hamstringing the next generation with additional debt 
is unacceptable, especially when you are taking away their health care 
coverage to boot.
  As folks try to jam this bill through Congress, I have barely heard a 
peep about this increase to the deficit. Oh, my, how times have 
changed.
  The folks who are normally card-carrying Members of fiscal restraint 
are now swiping the credit card of the next generation. I dare those 
Members to go back home and tell their neighbors that you are going to 
take away their health coverage, and, oh, by the way, you are going to 
add about $9 trillion to the debt too. Try to do that with a straight 
face.
  I will be the first to tell you that the ACA isn't perfect. I have 
heard that also in my travels across Montana. Costs have gone up. 
Premiums are rising. Many hard-working middle-class families cannot 
afford health care. That is unacceptable. So we ought to do something 
about that.
  Let's tackle rising premiums. Let's hold health insurance and drug 
companies accountable. Let's put patients before profits. But I am 
telling you, repealing all the progress we have made will not do that. 
We need to build on the successes we have had in the last few years, 
not tear them down.
  Members of this body, quite frankly, this is not just a debate about 
health care. It is a debate about our economy, our growing deficit, the 
foundation of our rural communities.
  The folks in this Congress who are pushing to repeal without a 
replacement will kick families off their health insurance, close down 
rural hospitals and clinics, and add $9 trillion to the debt if they 
succeed.
  Rather than go down this dangerous path, I have a suggestion. Let's 
roll up our sleeves and work in a bipartisan manner to increase access 
and affordability, to lower the cost of care, to bring down 
prescription drug prices. I will tell you, I am willing to work with 
anyone: Republican, Democrat, Independent, Libertarian, whoever wants 
to have a serious conversation about improving our Nation's health care 
system. But I am not going to allow folks in this body to take us back 
to the old days, the days when our friends and families couldn't afford 
to get sick.

  Members of the Senate, it really is time to listen to what is going 
on, on the ground. We have an opportunity to build on the progress we 
have made, and work towards a bipartisan solution that will work for 
the backbone of this country, the folks in rural America.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Tillis). The Senator from New York.
  Mrs. GILLIBRAND. Mr. President, I rise in favor of amendment No. 82. 
This amendment would make it so anyone in Congress trying to destroy 
the Affordable Care Act would not be allowed to touch women's health 
care services.
  I have been listening to my colleague from Montana and my colleagues 
in this Chamber speak about health care in our country, and after many 
hours, I am worried there is a lack of concern. I am worried there is a 
basic lack of empathy of what is going to actually happen to millions 
of Americans, and I am particularly worried about what will happen to 
women and their children and their families. So I want to spend a 
moment just talking about what the ACA actually provides for women and 
what actually will happen when it is no longer there.
  I am very concerned that we are barely 1 week into the new Congress 
and too many of my colleagues have already made it clear that their 
most urgent priority this year is to take our country back to its 
darker days when women could be denied coverage and charged higher 
health care premiums just because they are women. I am outraged by 
this, and I stand with millions of American women and men, moms and 
dads, sons and daughters who are outraged too. The Affordable Care Act 
uniquely gave women access to health care on a level that was 
unprecedented. In fact, 9.5 million more women now have access to basic 
health care because of that law.
  In my State alone, thanks to the Affordable Care Act, women can now 
have access to contraceptive care, cancer screenings, and mammograms. 
Millions of women who were pregnant or survived diseases like cancer 
are able to keep seeing their doctors without fear that their health 
insurance companies will take it away, but too many people in this 
Chamber don't seem to understand that consequence or seem to care about 
that consequence. After years of talking about it, some of my 
colleagues now seem determined--even entitled--to take away this 
lifesaving health care for millions of women.
  The election in November was not about women's health care. No one 
came to Congress with a mandate to take away women's access to 
mammograms and cancer screenings, but now we are one big step closer to 
once again making it impossible for millions of American women to see a 
doctor when they need to in order to access basic medicine and 
reproductive health care services so they can live healthy, happy, 
productive lives. For some, there is a very real risk that if they do 
get cancer or some other life-threatening disease, they will have to 
declare bankruptcy just to pay for the health care they need. This is 
something we must stand together to stop. It will show the American 
people that we understand what is happening to them. The consequences 
are too real and too dangerous, and for too many families the 
consequences are actually life or death.
  We should never go back to the days when insurance companies can tell 
a woman: You are no longer economic for us. We can't make money 
insuring pregnant women. We cannot go back to the days where insurance 
companies can tell a breast cancer survivor to go elsewhere because 
their insurance costs too much. I don't think we can ever go back to 
the days when insurance companies can simply charge women more for the 
same plan than men. We should not turn back women's basic health care 
rights.
  My amendment makes it very clear that the Senate would be forbidden 
from directing the committees to cut funding for basic women's health 
care services. It would ensure that the women's health care protections 
we put into the Affordable Care Act would stay there and women would 
have access going forward. It protects vital services such as disease 
screenings and comprehensive reproductive care that millions of women 
in my State rely on.
  If my colleagues destroy the Affordable Care Act, it will have real, 
direct, and painful consequences for a lot of women and the families 
who love them. I think it would be what we call the ultimate overreach 
by Congress, and it would take years to fix.
  I urge my colleagues to not let these protections be taken away from 
American women and their families, and I urge my colleagues to join me 
in supporting this very simple amendment.
  I yield the floor.
  The PRESIDING OFFICER. The minority leader.
  Mr. SCHUMER. First, Mr. President, let me thank my dear friend and 
colleague from New York, not only for her

[[Page S229]]

great remarks today and her amendment but for her passion, 
intelligence, and success in fighting for equality for women. I very 
much appreciate those efforts.


       Senator Booker's Testimony Before the Judiciary Committee

  Right now Senator Booker, my friend from New Jersey, is beginning his 
testimony before the Judiciary Committee. Senator Booker sought to 
testify before this panel, and it was unprecedented. My friend Senator 
Booker is a leading voice, not just in this caucus but in this body, on 
civil rights and so many other issues. He speaks with a passion and 
eloquence and intelligence on these topics and with a knowledge and 
depth from which we all benefit.
  I regret that a sitting U.S. Senator has to fight to earn the right 
to speak at the Judiciary hearing on Thursday, and I regret the manner 
in which he was treated--he and his colleagues from the House--being 
placed on the last panel today. Traditionally, Senators want to speak 
early on. That was the case, and I am glad he is testifying.
  He is speaking right now, and I would urge my colleagues and all of 
America to tune in and watch because what Senator Booker has to say 
will be very important for all of us to hear.
  I thank the Presiding Officer, and I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                             Climate Change

  Mr. WHITEHOUSE. Mr. President, I have crossed through and beyond 150 
``Time to Wake Up'' speeches. People sometimes ask me how I come up 
with the material. It is actually easy, even week after week after 
week, because it only takes reading the news. If we look back at the 
headlines and dubious milestones of 2016, we find plenty to talk about.
  Last year was hot. NASA and NOAA are expected to certify later this 
month that 2016 was the hottest year in recorded history, exceeding the 
previous record set by 2015 and the previous record set by 2014. What 
this means is, 2014, 2015, and 2016 have each succeeded the last as the 
three hottest years on record.
  The United Nations World Meteorological Organization found that the 
world was 1.2 degrees Celsius or over 2 degrees Fahrenheit warmer in 
2016 than it was before the Industrial Revolution and the dawn of wide-
scale fossil fuel use.
  We are careening closer and closer to the 2-degree Celsius mark which 
scientists say brings, to quote Donald Trump in 2009, ``catastrophic'' 
and ``irreversible'' climate effects.
  In 2016, climate change continued to make some places almost 
unrecognizable. Up north in the Arctic things got bizarre. Thermometers 
spiked in mid-November to almost 35 degrees Fahrenheit warmer than 
normal, with a 37-year low in the nearby sea ice. The peaks were about 
50 degrees above normal, and around Christmas it actually rose above 
freezing at the North Pole. Imagine, the snow was actually beginning to 
melt at the North Pole just as Santa was loading his sleigh with 
Christmas gifts.
  In the tropics, undersea forests of once colorful coral stood bone 
white as the Great Barrier Reef experienced the greatest bleaching and 
coral die-off on record. What happens is that the superwarm water 
stressed the corals. That forces them to expel the tiny algae that 
lives symbiotically with the coral, providing them their food, and that 
is what gives coral reefs their beautiful color and their life. When 
the algae go, the coral structures turn ghostly white. They often do 
not recover.
  It is not just the Great Barrier Reef. My clips today included a 
story from Japan, whose biggest coral reef has just been determined to 
be 70 percent dead.
  The researchers in Australia found severe bleaching throughout the 
Great Barrier Reef. The Guardian reported in March that ``93 percent of 
the 3,000 individual reefs [had] been touched by bleaching, and almost 
a quarter . . . [had] been killed by this bleaching event.''
  By November, around two-thirds of the northern portion of the Great 
Barrier Reef had died, with some atolls suffering complete devastation. 
Warming is at the heart of that catastrophe.
  We also know from the physical laws of thermal expansion that as 
ocean water warms, it does something else. It expands. The oceans also 
are taking in melting water from our shrinking glaciers. Together, 
those factors are causing sea levels to rise worldwide. Last year, the 
Proceedings of the National Academy of Sciences predicted that at our 
current pace, over 90 percent of the world's coastal areas will 
experience almost 8 inches of sea level rise by 2040. Year 2040 is not 
that far away. On the Atlantic coast of the United States, it will be 
more than 15 inches. By 2040, a house that you bought on the coast 
today could be literally underwater before you paid off your 30-year 
mortgage. The real estate business is starting to take notice.
  Zillow, the online real estate marketplace, has released a tool for 
users to show how potential sea level rise by 2100 would affect the 
over 100 million U.S. homes in its database. Around 1 in 50 homes in 
the United States, or just under 2 million properties, will find their 
ground floors underwater by 2100 if we don't get ahead of this. Thirty-
six U.S. cities would be considered ``completely lost''--those are 
their words--``completely lost,'' and another 300 cities would lose at 
least half their homes. This doesn't even include commercial or public 
properties.
  Government-backed mortgage giant Freddie Mac is girding for broad 
losses from climate-driven flooding. ``The economic losses and social 
disruption may happen gradually,'' it wrote in an April 2016 report, 
``but they are likely to be greater in total than those experienced in 
the housing crisis and Great Recession.''
  Let me say that again. The economic losses ``are likely to be greater 
in total than those experienced in the housing crisis and Great 
Recession.''
  The report says some of the effects of climate change may not even be 
insurable and, unlike our 2008 housing crash, owners of homes that are 
subsumed by rising seas would have little expectation of their homes' 
values ever returning and, therefore, little incentive to continue to 
make mortgage payments through the crisis, and that, in turn, adds to 
steeper losses for lenders and insurers.
  Remember that Donald Trump signed, along with his children, this 
full-page ad in the New York Times in 2009. Here is what it said, 
speaking as Americans:

       [W]e must embrace the challenge today to ensure that future 
     generations are left with a safe planet and a strong economy. 
     . . .

  He said to the President in this advertisement:

       We support your effort to ensure meaningful and effective 
     measures to control climate change, an immediate challenge 
     facing the United States and the world today.

  It went on:

       Please don't postpone the earth. If we fail to act now, it 
     is scientifically irrefutable--

  Let me repeat his words--

     scientifically irrefutable that there will be catastrophic 
     and irreversible consequences for humanity and our planet.

  That is what Donald Trump and his family said in a 2009 ad, 
``catastrophic and irreversible.''
  We have been warned.
  President-Elect Trump also pledged to ``drain the swamp'' here in 
Washington of corporate insiders and special interests. But we don't 
see that. We see an alligator pack of climate deniers, oil executives, 
and Koch brothers flunkies nominated to fill his Cabinet, his White 
House, and his executive agencies.
  The Koch brothers, Exxon, and other special fossil fuel interests 
stand on one side. On the other side stand our military, our National 
Labs, and NASA.
  Let me put in a little footnote on NASA. They have a rover driving 
around on the planet Mars right now. Do you think their science might 
be OK? And, on the other side, also, I think, is every university in 
the United States of America. That is the choice: The fossil fuel guys, 
led by the Koch brothers and ExxonMobil, and the whole array of phony 
baloney front groups that they have stood up to try to mask their hand, 
or the virtually complete science establishment of the world, every 
Nation, our military, our National Labs, and all of our universities. 
Who are you going to believe?

[[Page S230]]

The ones with the huge conflict of interest or the people who know what 
they are talking about?
  Well, too many people in this room have made the wrong choice, but we 
need to fix it.
  In Rhode Island, some good things happened last year. After over 8 
years of work, we have the Nation's first offshore wind farm. Thirty 
megawatts, five turbines came online in December 2016--the Block Island 
Wind Farm. I am proud of Deepwater Wind for getting it done. I am proud 
of Rhode Island for establishing a process for siting an approval that 
is now a national model. It is part of a transformation that happened, 
emphasized in 2016, and that was jobs in the renewable energy industry 
taking off.
  At the end of 2016, we had 400,000 wind and solar jobs, and by 2020, 
that number is expected to be 600,000. As employment climbs in these 
industries, costs for renewable technologies continues to drop compared 
to fossil fuels.
  Last year we saw new records for electricity generation from 
renewable sources. Texas wind generation hit a record 15 gigawatts in 
December of last year, meeting 45 percent of the State's power needs, 
with 18,000 megawatts installed and another 5,000 megawatts under 
construction.
  In Iowa, MidAmerican Energy is planning to add 2,000 megawatts of new 
wind by 2019. Once installed, 85 percent of the energy MidAmerican 
generates will be renewable.
  We continued to make real progress internationally in 2016 as well. 
Earth Day was the signing ceremony for the historic Paris climate 
agreement. Nearly 200 nations pledged to reduce their greenhouse gas 
emissions. By October, we met the threshold for ratification of that 
agreement, when over 55 countries officially joined, and the agreement 
was fully adopted in November.
  Just this week, over 630 companies and major investment firms, with a 
combined 1.8 million employees and $1.15 trillion in annual revenue, 
called on President-Elect Trump, us in Congress, and global leaders to 
continue to participate in and implement the Paris Agreement to 
``create jobs and boost U.S. competitiveness.''
  This is the business community saying that the Paris Agreement will 
create jobs and boost U.S. competitiveness.
  Signatories included food giants General Mills, Kellogg's, Campbell's 
Soup, and Mars; apparel companies VF Corporation, Nike and Levi's; and 
other corporate heavy weights like Monsanto, DuPont, Intel, and Johnson 
& Johnson.
  Mr. President, I ask unanimous consent that the ``Business Backs Low-
Carbon USA'' letter be printed in the Record at the conclusion of my 
remarks.
  I sure hope President-Elect Trump will heed this call from the 
leaders of the business community.
  Closing word: Secretary of State Kerry, in addition to providing 
great leadership through this, has also started doing something that I 
know is precious to him and that is important to me and many of our 
colleagues; that is, to give oceans the global attention they deserve. 
In September, more than 90 countries convened here in Washington for 
the Our Ocean Conference. Nations, nonprofit organizations, 
foundations, and big corporations all came together pledging over $5 
billion for marine conservation and committing to protect more than 1.5 
million square miles of ocean. Secretary Kerry secured the legacy of 
the Our Ocean Conference by locking in hosts for the conference for the 
next 3 years.
  So 2016 was a year of worsening climate effects but also of 
heartening climate action. The dramatic changes taking place in the 
Earth's climate are now undeniable, but so is the growing spirit of 
action among men and women of good conscience across the United States 
and around the world. One can hope that 2017 will be the year when we 
in this Chamber finally wake up.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     Business Backs Low-Carbon USA

       Dear President-elect Trump, President Obama, Members of the 
     US Congress, and Global Leaders:
       We, the undersigned members in the business and investor 
     community of the United States, reaffirm our deep commitment 
     to addressing climate change through the implementation of 
     the historic Paris Climate Agreement.
       We want the US economy to be energy efficient and powered 
     by low-carbon energy. Cost-effective and innovative solutions 
     can help us achieve these objectives. Failure to build a low-
     carbon economy puts American prosperity at risk. But the 
     right action now will create jobs and boost US 
     competitiveness. We pledge to do our part, in our own 
     operations and beyond, to realize the Paris Agreement's 
     commitment of a global economy that limits global temperature 
     rise to well below 2 degrees Celsius.
       We call on our elected US leaders to strongly support:
       1. Continuation of low-carbon policies to allow the US to 
     meet or exceed our promised national commitment and to 
     increase our nation's future ambition
       2. Investment in the low carbon economy at home and abroad 
     in order to give financial decision-makers clarity and boost 
     the confidence of investors worldwide
       3. Continued US participation in the Paris Agreement, in 
     order to provide the long-term direction needed to keep 
     global temperature rise below 2  deg.C
       Implementing the Paris Agreement will enable and encourage 
     businesses and investors to turn the billions of dollars in 
     existing low-carbon investments into the trillions of dollars 
     the world needs to bring clean energy and prosperity to all.
       We support leaders around the world as they seek to 
     implement the Paris Agreement and leverage this historic 
     opportunity to tackle climate change.
       22 Designs, 3P Partners, 3Sisters Sustainable Management, 
     LLC, 475 High Performance Building Supply, 900 Degrees 
     Neapolitan Pizzeria, Abt Electronics, Abundance Food Coop, 
     Acer America Corporation, Active Minds LLC, Addenda Capital, 
     adidas Group, Adobe, Inc., Aegis Renewable Energy Agrarian 
     Ales, AjO, Akamai Technologies, Inc., Allagash Brewing 
     Company, Allianz, Allumia, AlphaFlow, Inc., Alta Ski Area, 
     Altiz Orchard, Amalgamated Bank, AMD, Ameresco, Inc., 
     American Outdoor Products, Inc., Amherst College, Amicus GBC, 
     LLC, Anchor, Ankcrom Moisan Architects, Annie Card Creative 
     Services, Annie's, Inc. Anthesis Group, Anthropocene 
     Institute, Apricus Inc., Arapahoe Basin, Artemis Water 
     Strategy, As You Sow, Aslan Brewing Company LLC, Aspen 
     Brewing Company, Aspen Skiing Company, Athena Sustainable 
     Materials Institute.
       Athens Impact LLC: Socially Responsible Financial Services, 
     Auralites Inc., Aurental Consulting, Autodesk, Inc., Aveda, 
     Avery Dennison, Azzad Asset Management, Baldwin Brothers 
     Inc., Beautycounter, Belay Technologies, Inc., BELKIS 
     Consulting, LLC, Ben & Jerry's Homemade, Inc., Bent Paddle 
     Brewing Co., Bergsund DeLaney Architecture & Planning, 
     Bespoken Corporate Communications, Big Kid Science, Big Path 
     Capital, Biodico, Biogen, Inc., Biohabitats, Inc, BioJam 
     Industrial Research & Development Global, Inc., Biosynthetic 
     Technologies, BKW III, LLC, Blackthorne S&D Consulting, Blogs 
     for Brands, Blue Cross Blue Shield of Massachusetts, Blue 
     Moon Wellness, Blue Mountain Solar Inc., Boardwalk Capital 
     Management, Bora Architects, Boreal Mountain Resort/Woodward 
     Tahoe/Soda Springs Ski Resort, Borst Engineering & 
     Construction LLC, Boston Common Asset Management, Bowling 
     Green LLC, Box Digital Media, BR+A Consulting Engineers, 
     Breate New Hampshire, Breathe Deep, Brewery Vivant, Brit + 
     Co, Broadside Bookshop, Buglet Solar Electric Installation, 
     Bump'n Grind, Bunk House at ZION Bed & Breakfast, Burton 
     Snowboards, Business Wisdom, C+C, CA Technologies, Califia 
     Farms, California State Teachers Retirement System, Calvert 
     Investments, Calypso Communications LLC.
       Cambridge Energy Advisors, Campbell Soup Company, Carbon 
     Lighthouse, Carolina Biodiesel, LLC Catalyst Paper 
     Corporation, Catalyze Partners, CDI Meters, Inc., CEO Pipe 
     Organs/Golden Ponds Farm, Cerego, CEVG, Charge Across Town, 
     Che Qualita Enterprises, Inc., Cheryl Heinrichs Architecture, 
     ChicoEco, Inc DBA ChicoBag Company, Christopher Reynolds 
     Foundation, City Brewery, Clean Agency, Clean Edge, Inc., 
     Clean Energy Collective, Clean Energy Investment Management, 
     Clean Technology Partners, LLC, Clean Yield Asset Management, 
     CleanCapital, Clear Blue Commercial, Clif Bar & Company, 
     Climate Coach International, LLC, Climate First!, Climate 
     Ready Solutions, Cloudability, Coelius Consulting, Coerver 
     Analytics, LLC, Columbia Green Technologies, Columbia 
     Sportswear Company, Community Capital Management, Inc., 
     Confluence Sustainability, Congregation of Sisters of St. 
     Agnes, Congregration of St. Joseph, Connecticut Retirement 
     Plans and Trust Funds, CONTEMPL8 T-SHIRTS LLC, Cool Energy, 
     Cooper Spur Mountain Resort, Copper Mountain Ski Resort, 
     Copyrose Marketing & Communications, Cornerstone Capital 
     Group, Craft Brew Alliance, Creekwood Energy Partners, 
     Crystal Mountain, CTA Architects Engineers, Curren Media 
     Group, Cyclone Energy Group, Dahlman Ranch, Inc., Dana 
     Investment Advisors, Dannon Company, Inc.
       Daughters of Charity, Province of St. Louise, DBL Partners, 
     Deep Green Inc, Deer Valley Resort, Dehn Bloom Design, 
     Deschutes Brewery, Detour, Dignity Health, Distance Learning 
     Consulting, Do Good Investing, LLC, Domini Social Investments 
     LLC, Dominican Sisters of Mission San Jose, Dominican Sisters 
     of Peace, Dominican Sisters of

[[Page S231]]

     San Rafael, Dominican Sisters of Sparkill, Drew Maran 
     Construction, Inc., DuPont, Durango Compost Company, 
     Eaglecrest Ski Area, Earth Friendly Products (ECOS), 
     EarthKind Energy, Earthshade Natural Window Fashions, Ebates, 
     eBay, Echo Credits, Echo Mountain, Eco-Products, Ecogate, 
     EcoPlum, ecoShuttle, Ecosystems Group, Inc, Eighty2degrees 
     LLC, EILEEN FISHER, Eleek, Inc., Elephants Delicatessen, 
     Ellenzweig, Emerger Strategies, Empowerment Solar LLC, 
     Endosys, Energy Optimizers, USA, Entercom Communications 
     Corp., Environment & Enterprise Strategies, EOS Climate, Epic 
     Capital Wealth Management, Eskew+Dumez+Ripple, Espresso Parts 
     LLC, Essex Timber Co. LLC, Ethical Markets Media Certified B 
     Corp., ETM Solar Works, Eva Realty, LLC, Everence & the 
     Praxis Mutual Funds, Exact Solar, Fairhaven Runners, Inc., 
     Faller Real Estate, Felician Sisters of North America Inc., 
     Leadership Team, Fetzer Vineyards, Fiberactive Organics.
       Filtrine Mfg. Co., First Affirmative, Financial Network, 
     Flink Energy Consulting, FOG Pharmaceuticals, Inc., Four 
     Twenty Seven, Franciscan Sisters of Allegany, NY, Fremont 
     Brewing, Friends Fiduciary Corporation, Future Energy 
     Enterprises, LLC, Gale River Motel, LLC, Gap Inc., Garmentory 
     Inc., Gauthereau Group, GCI General Contractors, Genentech, 
     Inc., General Mills, Inc., Gerding Edlen, Gerding Edlen 
     Development, Gladstein, Neandross & Associates, Globetrans 
     EC, GO Box, Going Beyond Sustainability, Good Company, 
     Good Energy Guild, Goodmeetsworld, Granlibakken Management 
     Company, Green Alliance, Green Century Capital Management, 
     Green Hammer, Green Heron Tools, LLC., Green Pod LLC, 
     Green Star, GreenBeams, LLC, GREENPLAN Inc., Greentown 
     Labs, Hackensack Meridian Health, Hammerschlag & Co. LLC, 
     Hanging Rock Animal Hospital, Inc., Hannon Armstrong, 
     Happyfamily, Hello!Lucky, Hemp Ace International LLC, 
     Hewlett Packard Enterprise, High Plains Architects, PC, 
     Hilton, HJKessler Associates, Holiday Valley Resort, Horse 
     & Dragon Brewing Company, House Kombucha, HP Inc., ICCR 
     (Interfaith Center on Corporate Responsibility), Ideal 
     Energy Inc, IDEAS For Us, IKA North America Services, LLC, 
     Impact Bioenergy, Inc., Impax Asset Management.
       Independence Solar, Indow, Infer Energy, Innovative Power 
     Systems, Inntopia, INTEGRAL GROUP, Intel Corporation, 
     IntelliparkUS, Inc., Interdependent Web LLC, Interface, 
     Intersection, Intex Solutions, Inc., ISOS Group, iSpring, 
     Itty Bitty Inn, Jackson Hole EcoTour Adventures, Jackson Hole 
     Mountain Resort, Jacoby Architects, Jantz Management LLC, JF 
     Pontzer, LLC, JGE Global LLC, Jiminy Peak Mountain Resort, 
     LLC, JJ McNeil Commercial, JLens Investor Network, JLL, JMJ 
     Construction Group, Johnson & Johnson, Jonathan Rose 
     Companies, Joule Energy, JSA Financial Group, JTN Energy, 
     Jupiter Aluminum, Just Business, Justice Commission of the 
     Sisters of the Presentation of the Blessed Virgin Mary, 
     Aberdeen, SD, K2 Sports, Kayak Media, Kellogg Company, 
     KERBspace, Kirksey Architecture, KL Felicitas Foundation, 
     Kleynimals, Kostis Kosmos Inc., Krull & Company, Kuity Corp., 
     L'Oreal USA, Law Office of Nancy D. Israel, Lazarus Financial 
     Planning, LLC, Le Pain Quotidien, Leadership Team Sisters of 
     St. Francis of Tiffin, OH, Levi Strauss & Co., LifeWise 
     Community, Liftopia, Inc., LightWave Solar, Linear City 
     Concepts, LiveNeighborly, Livingston Energy Innovations, 
     Locksley, Inc., Long Wind Farm, Lookout Pass Ski & Recreation 
     Area, Louis Berger U.S., Lutsen Mountains Corporation, Lyft, 
     M.A. Mortenson Company, Mammoth Mountain and, June Mountain, 
     ManpowerGroup, Mars Incorporated, Maryknoll Sisters, Mazzetti 
     + GBA.
       Melina/Hyland design group, Mennonite Education Agency, 
     Mercatus, Inc., Merck Family Fund, Mercury Press 
     International, Mercy Health, Mercy Investment Services, 
     Michael W. Grainey Consulting LLC, Midwest Capuchin 
     Franciscans, Mightybytes, MILLC, Miller/Howard Investments, 
     MindEase Billing, Minerva Consulting, Mission Cheese, Mobile 
     Data Labs, Mondelez International, Monsanto Company, Montanus 
     Energy, Moore Capital Management, MooreBetterFood, Mount 
     Bohemia, Mountain Gear, Inc., Mountain High Resort, Mountain 
     Rider's Alliance, LLC, Mountain Rose Herbs, mphpm design, Mt. 
     Hood Meadows, Mulago Foundation, MyFlightbook, National 
     Foundry, National Ski Areas Association, Natural Habitat 
     Adventures Natural Investments, Neighborhood Sun, Neil Kelly, 
     Nettleton Strategies, New Belgium Brewing, New Horizon 
     Financial Strategies, New York City Comptroller's Office, New 
     York State Common Retirement Fund, NIKE, North Highland 
     Worldwide Consulting, North Ridge Investment Management, 
     North Sound Energy Remodel, LLC, NorthFork Financial, LLC, 
     NorthStar Asset Management, Inc., Northwest Coalition for 
     Responsible Investment, Nurx, Oasis Montana Inc., Octagon 
     Builders, Office of the General Treasurer of Rhode Island, 
     OgreOgress productions.
       OhmConnect, OLAVIE, Old Bust Head Brewing Company, 
     Omnidian, Inc., On Belay Business Advisors Inc, Oregon State 
     Treasurer, Organically Grown Company, Orion Renewable Energy 
     Group, Our Earth Music, Inc., Outdoor Industry Association, 
     Outdoor Project, Outerknown, Owens Business & Cnsltg., Llc., 
     Pacific Gas and Electric Company, Page, Parnassus 
     Investments, Patagonia, Pax World Funds, Payette, PeopleSense 
     Consulting, Pepper Sisters, Inc., Perkins+Will, Pitchfork 
     Communications, Planet Cents, PlanGreen, PLC Repair, 
     Portfolio Advisory Board, Adrian Dominican Sisters, Portland 
     Consulting Group, Presbyterian Church U.S.A., Priests of the 
     Sacred Heart, Prisere, Projector.is, Inc., Proterra, Inc., 
     Pure Strategies, Inc., Quest, Quri, RADAR, Inc., Re-Nuble, 
     Inc., Recreational Equipment, Inc., Region VI Coalition for 
     Responsible Investment and Sisters of the Humilityof Mary, 
     ReGreen Inc., RenewWest, Reynders, McVeigh Capital 
     Management, LLC, Reynolds Foundation, Rivermoor Energy, RL 
     Investments, Rockford Brewing Company, Room & Board INC, 
     Roots Realty, Royal DSM, RPM Bank, Ruffwear, Rune's Furniture 
     and Carpet, Rutherford + Chekene, s2 Sustainability 
     Consultants.
       Salesforce.com, Sarah Mae Brown Consulting LLC, Saris 
     Cycling Group, Sasaki Associates, Saunders Hotel Group, 
     Savenia, Schneider Electric, School Sisters of Notre Dame 
     Cooperative Investment Fund, Scoville Public Relations, SEA 
     Builders LLC, Sealed Air Corporation, Seattle City Light, 
     Sefte Living, Seismic Brewing Company, SEIU Staff Fund, 
     Servants of Mary, Seventh Generation, Seventh Generation CRI, 
     SharePower Responsble Investing, Inc., SheerWind, Sheng Ai 
     International,LLC, Shift Advantage, Sidel Systems USA Inc., 
     Sierra Club Foundation, Sierra Energy, Sierra Nevada Brewing 
     Co., Sierra Real Estate, Sigma Capital, Silicon Ranch 
     Corporation, Sisters of Bon Secours USA, Sisters of Charity 
     of Leavenworth, Sisters of Charity of New York, Sisters of 
     Charity, BVM, Sisters of Saint Francis, Rochester, Minnesota, 
     Sisters of Saint Joseph of Chestnut Hill, Philadelphia, PA, 
     Sisters of St. Dominic of Caldwell, Sisters of St. Dominic, 
     Racine, Wisconsin, Sisters of St. Francis of Philadelphia, 
     Sisters of St. Joseph, Sisters of St. Joseph of Boston, 
     Sisters of the Humility of Mary, Sisters of the Precious 
     Blood, Sisters of the Presentation of the BVM, Sisters of the 
     Sacred Heart of Mary WAP, Skibutlers, Smarter Shift Inc., 
     SMMA, Snake River Brewing Co., SNOCRU LLC, Snow King Mountain 
     Resort.
       Snowbird Resort, Sol Coast Consulting & Design, LLC, 
     SolAire Homebuilders, Solar Concierge, Solar Design 
     Associates, SolarCity, Solberg MFG, Solitude Mountain Resort, 
     Sonen Capital, South Salem Cycleworks, SouthStar Capital LLC, 
     SPEEDILICIOUS LLC, Spruce Finance, Squaw Valley/Alpine 
     Meadows Ski Resort, LLC, Staples, Inc, Starbucks Coffee, 
     Startworks Ventures, LLC, Starvation Alley Farms, State of 
     Maryland Treasurer's Office, Stevens Pass Mountain Resort, 
     Stitch, STOKE Certified, StoneWork Capital, Stonyfield, 
     Strategic Carbon LLC, Strategic Imperatives Inc., Strong 
     Brewing Co., StudentVox, Stumptown Coffee Roasters, 
     Sugarbush, Sundance Mountain Resort, SunEx Solar, Sungevity, 
     Sunsprout Farms, SustainAbility, Sustainability and Impact 
     Investing Group, Rockefeller Asset Management, Sustainability 
     Roundtable Inc., Sustainability Solutions LLC, Sustainable 
     Action Consulting PBC, Sustainable Business Consulting, 
     Sustainable Capital, Sustainable Food Trade Association, 
     Sustainable Health Solutions, Inc.
       Sustainable Insight Capital Management, Sustainable Island 
     Products, Sustainable Manufacturing Consulting, Sustainable 
     North Bay, SustainableBusiness.com, Sustrana, SVT Group, 
     Swift Foundation, Symantec Corporation, Synapse 
     International, T2 Energy, Taos Ski Valley, Inc., Teak Media + 
     Communication, Tech Networks of Bostoon, Terra Alpha 
     Investments LLC, Terrapin Bright Green, TerraShares, Tesla, 
     Tetra Pak, Tevlin Strategic Communication, The Alchemist 
     Brewery, The Brainerd Foundation, The George Gund Foundation, 
     The Green Engineer, Inc., The Green Suits, LLC, The Hartford, 
     The Hivery, The Lion Company, Inc., The McKnight Foundation, 
     The North Face, The Pension Boards--United Church of Christ, 
     Inc., The Pretenders, The Refill Shoppe, Inc., The Ruskin 
     Group, The Spotted Door, The Stella Group, Ltd.The 
     Sustainability Group at Loring, Wolcott & Coolidge, The 
     Tofurky Company, Thinkshift Communications, Third Partners, 
     Thornton Tomasetti, Three Corners Capital, Thriving Solar, 
     Throwback Brewery, Tiffany & Co., Timberland, Toad&Co, 
     TransPower, TransUNImission, Inc, Trap Door Brewing, 
     TreeZero, Tri-State Coalition for Responsible Investment, 
     Trillium Asset Management LLC, Trinity Health, Triple Ethos, 
     TripZero, Triskele Collaborative, Truck Trike, Tsoi/Kobus & 
     Associates, UltraCell Insulation, Unilever, Unitarian 
     Universalist Association, Unitarian Universalist Service 
     Committee (UUSC), United Church Funds, United Natural Foods 
     Inc.
       Urban Fabrick, Inc., US Green Building Council, Vail 
     Resorts, Vans, Velasquez Family Coffee, Verde Brand 
     Communications, Veris Wealth Partners, Veritas Technologies, 
     Vermont Energy Investment Corporation, VF Corporation, Vibes, 
     Vigilent, Violich Farms, Virgin, Virginia Mason Health 
     System, Vision Realty & Management, VISIONS Service 
     Adventures, Visual Stream Productions, Inc., VMware, Vulcan 
     Inc., Walden Asset Management, Walden International, Wall 
     Law, LLC, Watermen Investments, webShine, LLC, Welch Village 
     Ski Area, Inc, Wespath Benefits and Investments, Wetherby 
     Asset Management, Whitney Inc., Wild Joe*s Coffee Spot, Win 
     Before Trial, Windham

[[Page S232]]

     Mountain Resort, Winkler Development Corporation, Wisp 
     Resort, Woodsong Property Renovation Partners. LLC, Workday, 
     WorkTurbo, Worthen Industries, WR Consulting, Inc., Wynkoop 
     Properties, LLC, Xylem Inc., Yodsampa Consulting, Zaurie 
     Zimmerman Associates, Inc., Zero Waste Solutions, Zevin Asset 
     Management, ZipPower.
       Note: Signatories in bold > $100 million annual revenues.

  Mr. WHITEHOUSE. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. GARDNER. Mr. President, I come to the floor today to discuss the 
continued broken promises of ObamaCare--the Affordable Care Act--that 
passed in the most partisan of fashions several years ago, and to 
discuss the process by which we are putting together a repeal-and-
replace package and the pieces we will be voting on tonight and over 
the next several weeks and months.
  ObamaCare's failures are simple. The promises that have been broken 
are clear. While partisan supporters of the administration's plan 
continue to promote the success of this poorly conceived law, 
Coloradans know far better.
  Time and again, hundreds of thousands of Coloradans have felt the 
consequences of the Affordable Care Act in their pocketbooks, in their 
workplaces, in their doctor's offices, and in the choices they have for 
health care. The past 6 years have been marred by higher costs, fewer 
choices, and less competition in Colorado and across the Nation.
  It is now time that we stand up for the American people to restore 
reliable and stable health care, as well as health care markets and 
insurance markets, and to undo the damage done to our health care by 
the failed law known as ObamaCare.
  Let's just review the broken promises we have seen--not just a broken 
promise that the President himself made to the American people but 
broken promises echoed by the partisan supporters of ObamaCare. 
President Obama assured the American people over 35 times: Don't worry 
about ObamaCare because if you like your plan, then you can keep it, 
period. It is on video. It is on YouTube, and you can probably find it 
on Snapchat. It is available to find, this first broken promise.
  As Coloradans began to receive cancellation notices, they quickly 
learned that this promise was far from the truth. In late 2013, nearly 
335,000 small group and individual policies in Colorado were canceled 
due to requirements in the Affordable Care Act. These cancellations 
also included my family's cancellation, because we had chosen to stay 
in the private market in Colorado. But in August of 2013, we received 
the letter that 335,000 others received in Colorado saying that our 
policy had been canceled thanks to ObamaCare.
  But, unfortunately, those cancellations--those 330,000-plus 
cancellations in August of 2013--were just the beginning, because in 
January of 2014, the Colorado Division of Insurance canceled an 
additional nearly 250,000 plans for the same reason.
  Again in 2015, Coloradans were made abruptly aware of the failures of 
ObamaCare when another 190,000 more plans on the individual and small 
group market were canceled. In total, according to the Congressional 
Research Service, over 750,000 health insurance plans were canceled in 
Colorado between 2013 and 2015.
  The promise that if you like your health care plan, you can keep it 
was so bad--that promise was so broken--that the fact-checking 
organization PolitiFact named it the ``Lie of the Year'' for 
2013. PolitiFact didn't really need to name it the ``Lie of the Year,'' 
because over 750,000 people in Colorado got a letter in the mail 
telling them it was a lie.

  Broken promise No. 2 from ObamaCare: Americans were told that the 
Affordable Care Act would reduce costs for families, businesses, and 
our government. In fact, President Obama said that under his new health 
care law, a typical family would save up to $2,500 a year on premiums 
by the end of his first term. Look it up on video, on YouTube. However, 
hit with the rising costs, Coloradans became acutely aware this too was 
yet another broken promise. Statewide, premiums in Colorado will rise 
by 20.4 percent on average for plan year 2017 on the individual market. 
That number is even higher in some of the more rural areas, like the 
Western Slope of Colorado. Where is the Western Slope? That is what 
most people think of when they think of Colorado, an area with 
mountains, forests, and great beauty. That area has been harder hit 
than many areas across the country with higher premium increases.
  A year prior to this next plan year, in 2016, the Colorado Division 
of Insurance found that premiums on the individual market rose a 
whopping 25 percent on the Western Slope, plus the higher than 20 
percent premium increases.
  One woman living in Colorado on the Western Slope saw her premium 
rise from just a little over $300 a month to $1,828 per month, or 
nearly $22,000 a year. Here is her quote:

       It's actually like another mortgage payment. I have friends 
     who are uninsured right now because they can't afford it. 
     Insurance is hard up here.

  That is the Western Slope of Colorado, where people have seen 
mortgage-payment-size health insurance bills being added to them 
because of a bill that the President promised would lower their health 
care costs.
  An increase of nearly 26 percent is devastating for most families, 
but in 2014 an Americans for Prosperity study showed that nearly 
150,000 Coloradans saw their health insurance become 77 percent more 
expensive. These sharp increases in prices and coverage have left 
Coloradans reeling, and we have a duty--a duty--to make sure we provide 
them with the financial relief they deserve and the health care we know 
we can put together.
  Broken promise No. 3 of the Affordable Care Act was the menu of 
options that was promised--the choices that the Affordable Care Act 
would bring to the marketplace. President Obama promised Americans that 
a greater choice and a menu of options to choose from would be right 
around the corner as a result of the Affordable Care Act, but 
Coloradans again found out that wasn't true. Of the 64 counties in 
Colorado, 14 counties have only one carrier to choose from and 29 
counties have only two plans for the year 2017 on the individual 
market. We can see the plans right here. That is the western part of 
Colorado that I was talking about seeing such high premiums--77 percent 
and a higher percentage next year. Here, we can see counties with only 
two carriers to choose from, and 14 counties only have one to choose 
from.
  So the President's signature health care law failed in this respect 
to create the menu of options, but it did succeed in creating 
monopolies.
  President Obama also insisted that competition would increase through 
consumer-run coops. The Federal Government spent a great deal of money 
to prop up the consumer coops and to make sure they had the marketing 
in place. Over 80,000 Coloradans felt the impacts of this broken 
promise when the Colorado health coop was declared to be insolvent by 
Colorado insurance commissioner Marguerite Salazar. Eighty thousand 
people had their insurance coops declared insolvent because of the poor 
Affordable Care Act law.
  Not only did the failure of this promise leave 80,000 people 
scrambling to find coverage, but it forced the coop to default on its 
Federal startup loan, valued at an estimated $72 million. So 80,000 
people were out of coverage because of the failure of the Affordable 
Care Act, and $72 million went out of the American taxpayers' pockets 
because of the Affordable Care Act--money the American taxpayers will 
never see again. What is more, it cost taxpayers nearly $40 million to 
shut the coop down. Of the 23 original coops, only 6 are remaining and 
17 consumer-run coops as a result have failed. The 23 startup insurers 
received a total of roughly $2.5 billion in loans under the Affordable 
Care Act, and only 6 remain. That means that even more money the 
American people gave to this government to be good stewards of--through 
their hard-earned tax dollars, through their premium taxes--will never 
be seen again. This is an unacceptable and egregious use of taxpayer 
dollars.
  But the careless spending under ObamaCare doesn't just stop there. An 
audit was released 2 weeks ago by the U.S. Department of Health and 
Human Services, Office of Inspector General, and it found that Connect 
for Health Colorado, Colorado's State exchange,

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misspent and mishandled nearly $9.7 million in grants to establish its 
marketplace. The audit concluded by recommending that the marketplace 
be required to repay the $9.7 million identified by the Federal 
Government. The audit found that Connect for Health Colorado did not 
adequately document $4.4 million, improperly transferred costs totaling 
nearly $300,000, and made $164,000 in overpayments to subgrantees 
without identifying a reason.
  Furthermore, Connect for Health Colorado spent more than $211,000 on 
bonuses to executives without providing performance evaluations. The 
kicker on the $211,000 in bonuses--the largest of which was $18,500 for 
the CEO--back in 2013, when the exchange was trying to get started, was 
that the then-CEO of Connect for Health Colorado wanted a raise even 
though the exchange had enrolled far fewer than half the people it was 
supposed to. So we have an executive asking for a raise in an exchange 
that hadn't even met the lowest of the low predictions for what it 
would do. Here we are, with a new audit from the Office of Inspector 
General saying that $9.7 million was fraudulently spent. To quote a 
member of the board at the time:

       Given the poor performance for the first two months of 
     enrollments, I think it's incredibly audacious for the 
     executive director to request a salary increase.
       I think most people would feel like if you're a CEO and you 
     are significantly underperforming the goals you helped set, 
     then you layer on that the money comes from public funds, I 
     think it is highly inappropriate.

  I have heard colleagues in the House and the Senate talk about how 
CEOs are overpaid for the work they do. If the stock prices are low or 
dividends aren't there, then they shouldn't be as highly compensated as 
they are. But here we are, a government-funded program from the 
Colorado health exchange and others around the country using Federal 
dollars to give bonuses to people who haven't even met the basic 
projections they were supposed to. It is an unacceptable use of funds.
  But the problem is that it is not just funds wasted somewhere else. 
It is funds wasted that came from the American people's pockets--hard-
earned dollars that are being misspent.
  The Affordable Care Act has had a negative impact on business owners 
and individuals. Let's talk about some of the effects on businesses. I 
will share a letter given to me, from a small business owner to his 
customers, letting them know how the Affordable Care Act impacted his 
prices.

       Dear Valued Customer,
       There is never a good time to announce a price increase but 
     we have to. Effective February 1, 2017 we will have a 2% 
     across the board increase for a reason beyond our control.
       We've had many challenges over the years but none like 
     this. 100% of this price increase is due to one thing only, 
     the Affordable Care Act.
       The Affordable Care Act has caused our health insurance 
     premiums to skyrocket by 42% and our choices of insurance 
     providers to dwindle down to one.
       Some of you may be faced with a similar challenge. It seems 
     to be a problem all over the U.S.

  So now we have the double whammy on the American consumer. Not only 
are they required by law to buy insurance they can't afford, but they 
then go buy consumer goods whose prices have increased as a result of 
the Affordable Care Act. So they are squeezed at home because they have 
to pay higher insurance premiums--thanks to the broken promises of 
ObamaCare, thanks to the lack of choice they have with ObamaCare. Now 
they have to pay higher prices at the grocery store or the implement 
dealership--wherever it is--because they have had to increase their 
prices--the people who make those goods, the people who manufacture 
those goods, the foundries, the equipment dealers. They have to pay for 
their insurance premiums that they are required, under a broken law, to 
search and find.
  But it is important that we talk more than just about the business 
impact of the Affordable Care Act, because, day after day, I hear 
stories from Coloradans who have felt the brunt of ObamaCare's 
failures. Whether it is letters or emails to the office or whether it 
is town meetings across Colorado, I hear stories, and I wish to take 
this opportunity to share some of these from my constituents that 
demonstrate the impacts of ObamaCare.
  A letter I received from an individual residing in Aurora, CO, said:

       Cory--As a business owner who pays for my own insurance, 
     ObamaCare is not working. Last year, my premium went up 20% 
     for less insurance with a higher deductible and less 
     coverage.
       This year we just got a cancelation notice that our 
     insurance plan will no longer be offered and we must start 
     looking for a new plan yet again.
       I read that more and more insurance companies are pulling 
     out of the Colorado marketplace.
       The system is broken, it has only cost us more and more 
     money for lower quality health care.
       Please--do everything you can to stop this failed program.

  That is from a Coloradan who has struggled under the burdens and 
broken promises of ObamaCare.
  Let's talk about a letter we received from a family living in 
Lafayette, CO.

       I have a ``Bronze'' HSA plan covering myself, my wife and 
     my two daughters.
       I just received my renewal notice from [the] insurer 
     informing me that my premium for 2017 will increase by 38.9%.
       To put that in perspective our family went from $1,200 per 
     month or $14,400 per year to $1,667 or $20,000 per year.
       While the premium is increasing, the benefits are reduced 
     as annual deductibles for individual and family plans are 
     increasing to $5,000 and $10,000 respectively. This is 
     unconscionable!
       The cost of my health insurance coverage has more than 
     doubled in the last three years and benefits have reduced 
     with each successive premium increase.
       The ACA needs to be repealed immediately!

  That is a letter from a family of four who saw a dramatic increase in 
price, both from the amount they pay every month to nearly $20,000 a 
year, to a deductible that has gone from $5,000 to $10,000.
  Here is another story from a young woman residing in Colorado 
Springs, CO:

       This is the third time since 2010 that I will be losing my 
     health insurance plan because of Obamacare.

  This is the third time. Do remember the promise that if you like your 
plan, you can keep your plan?
  This woman from Colorado Springs already has had her plan canceled 
three times.

       Now I am losing the option of being in the plan I want to 
     be in.

  There is the second promise--that if you like your plan, you can keep 
your plan; you get the choice of keeping your doctor--broken promises.

       I must settle for being in an HMO, and still pay 400% what 
     I was paying for premiums in 2010.
       I also just learned that my carrier is raising rates by 25% 
     next year on the individual market.
       My premiums are already four times higher than they were 
     before the Affordable Care Act. My deductible and out of 
     pocket amounts are also much higher.
       Obamacare is nothing but a heavy tax for us. Our income 
     doesn't qualify us for an Obamacare credit.
       Since our premiums have quadrupled I figure we are now 
     paying for the insurance for three or four other families 
     when we pay for our premiums.
       I am very disappointed in Congress for letting this go on 
     and on and on.
       Year after year now my premiums skyrocket and I have fewer 
     choices in plans. Pretty soon there will be no incentive left 
     to work hard and earn money in this country.

  The government will take it from you and give it to people [to spend 
irresponsibly in Washington, DC].
  To this young woman in Colorado Springs, we are doing something--
finally. Last year, we put on the President's desk a repeal of 
ObamaCare, and of course it was vetoed. But this week, we will be able 
to start the process to repeal and replace ObamaCare, signed into law 
by a President who will indeed sign it.
  Another story I would share from a family in Fort Lupton, CO:

       It is impossible to afford health care for us.
       We are right above the Medicaid limit by $400, and my 
     husband has gone without health care for 2 years. They keep 
     taxing him.
       Soon we will be a family of 4 with no health insurance. We 
     will be paying so much to afford health insurance we will 
     struggle to buy food. We need help and we don't know where to 
     find it.

  These stories demonstrate what Americans are experiencing as a result 
of ObamaCare and its broken promises. No family should have to decide 
between purchasing health coverage and putting food on the table. We 
owe it to these struggling families--stories we just heard, about 
anyone who is sick or might get sick--to roll up our sleeves

[[Page S234]]

and provide real solutions and to recognize that the Affordable Care 
Act was a failure, it caused calamity, and it continues to destroy and 
crush our health care market.
  ObamaCare was a poorly designed law that was rushed through Congress 
on the most partisan of votes. Its nearly 20,000 pages of regulations 
have had a devastating impact on many hard-working Americans. That is 
why I will continue to work hard to find solutions that will relieve 
the financial burden this law has imposed on Coloradans and Americans 
throughout the country.

  We need a health care system that promotes competition, increases 
flexibility, encourages innovation, and puts Americans back in control 
of their health care--one that gets ``Dr. Congress'' out of the 
picture, one that safeguards the doctor-patient relationship, preserves 
Medicare for our seniors, and one that protects the most vulnerable 
among us.
  I will continue to fight for all of those in Colorado and across the 
country who are looking for real health care reform, and I look forward 
to working with my colleagues in Congress to do so.
  We have a chance this week to act, and I look forward to replacing 
ObamaCare with something that actually fixes and makes this system work 
again.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Cotton). The majority whip.
  Mr. CORNYN. Mr. President, soon the Senate will vote to repeal 
ObamaCare. This is for at least two reasons. One is that ObamaCare has 
been an abysmal failure when you look at the promises that were made to 
sell it and actually what has been delivered in terms of higher 
premiums, higher deductibles, and more challenges for ordinary 
Americans. Many Americans now find that their deductible is so high 
that they are effectively self-insured.
  I remember like it was yesterday--actually, it was some 6 years ago--
that President Obama said: If you like what you have, you can keep it, 
in terms of your health coverage. He said: If you like your doctor, you 
can keep your doctor. He said: The average family of four would see 
their premiums go down by $2,500.
  None of that has proven to be true. ObamaCare was sold under false 
claims, false promises. We know that many headlines today demonstrate 
that premiums are higher than people can afford. They can't keep the 
insurance plan they had and they liked, and they have to go find 
another doctor, sometimes as often as each year because the insurance 
coverage they have is no longer being written because insurance 
companies simply can't survive in this marketplace. In many instances, 
they end up having to leave rural parts of the country, particularly 
rural parts of places like rural Texas.
  A lot of this has to do with redtape. A lot of this has to do with 
the companies that have been forced to pass along higher costs to 
consumers or leave, and that is exactly the sort of thing that happens 
when the government intervenes in the marketplace, unintended 
consequences occur.
  I mentioned increased rural access to health care. That was actually 
supposed to be one of the selling points of ObamaCare, and now it is 
just another example of how this law has truly failed. Even so, even 
having acknowledged some of the failures of ObamaCare themselves, our 
Senate Democratic colleagues are refusing to acknowledge the 
catastrophe they created because this law was passed on a purely 
partisan basis, without any votes on the other side of the aisle, and 
signed by President Obama into law without any participation by 
Republicans. Now, having created this mess--creating this crisis 
really--they made clear they want no part of fixing the problem. 
Apparently, they would rather ignore the harmful effects brought about 
by ObamaCare and try to then assign blame to those who are trying to 
rescue the American people from the failure known as ObamaCare.
  We are confident the American people know the truth. They know 
President Obama made promise after promise to get ObamaCare passed. 
They know the reality is a lot different, and it is a lot dimmer than 
the picture he painted. In my mind, such widespread public deception 
amounts to nothing more and nothing less than a simple case or, 
actually, I should say a colossal case of consumer fraud.
  In my former job as attorney general of the State of Texas, we had a 
consumer protection bureau that went after scam artists and others who 
deceived the American consumer, Texas consumer, and promised them one 
thing and delivered another. That is nothing more or nothing less than 
what happened here where President Obama promised the American people 
the Moon when it came to health care, and they found out that those 
promises were hollow indeed.
  That is why the American people want ObamaCare to become a thing of 
the past. One recent poll showed that about 8 out of every 10 Americans 
wanted to change the law in significant ways or see it replaced 
altogether. The truth is, ObamaCare is a terrible law that continues to 
hurt many American families trying to get by.
  Americans all around the country are asking for help, asking for 
relief from this terrible law, and demanding a better health care 
system that actually delivers results, not just empty promises. We 
can't get to that replacement until we actually repeal ObamaCare, which 
will start with the budget resolution we will pass this evening or late 
tonight.
  This is not a rushed or hurried response; it is merely the first step 
in a deliberative process that Republicans in both Chambers of Congress 
have been working on for years. The only difference is now we will soon 
have a President in office who understands that people are hurting, 
asking for change, and are in need of promises that are actually 
delivered.
  It is not too late for our Democratic colleagues to work with us to 
get this job done and move forward with a solid plan that helps all 
Americans. I understand the temptation, after creating this 
legislation, this health care debacle known as ObamaCare, to now say it 
is your baby, you deal with it and then try to assign blame if things 
don't work out exactly the way we hope. The fact is, we always do 
better here, and the American people are always better served when we 
try to work together in a bipartisan way, on a step-by-step basis, to 
deliver on the promises we made.
  This budget resolution that we will be voting on tonight is not about 
Medicare. It is not about cutting health care for millions of people. 
Rather, the opposite is true. We are actually going to try to save the 
American consumer from falling through the cracks or finding out that 
the promises that have been made to them are simply not true or that 
they are burdened with health care policies that they simply can't 
afford.
  What we are about is getting rid of a failed policy that now 6 years 
in is still making life harder for millions of Americans. I am eager to 
make sure we keep our promise. That is the second part of this. We 
promised the American people that if they gave us an opportunity by 
electing a new President, by retaining the majorities in the House and 
the Senate, as they have, that we would deliver by repealing and 
replacing ObamaCare. That starts with tonight's vote.


                      Nomination of Rex Tillerson

  Mr. President, this morning I had the honor of introducing Mr. Rex 
Tillerson, President-Elect Trump's nominee to be Secretary of State, at 
his confirmation hearing before the Foreign Relations Committee. I was 
joined by my colleague Senator Cruz from Texas, former Senator Sam 
Nunn, and former Secretary of Defense Mr. Gates. All of us said that 
Mr. Tillerson is an inspired and outstanding appointment by President-
Elect Trump.
  I have come to learn that Mr. Tillerson is a person whom I both 
respect and admire the longer I have gotten to know him. He has proven 
over his decades-long career in the top echelons of a large global 
company that he has what it takes to represent the United States on the 
world stage. True, to this point, his responsibility has been toward 
shareholders of the company he has represented, but I have every 
confidence he can transfer that same sort of diligence, that same sort 
of acumen, and those relationships, from which a large multinational 
corporation has benefited, now to the American people, and the United

[[Page S235]]

States of America can resume its place on the world stage with him as 
our top diplomat.
  I said before that one of my biggest frustrations with the current 
administration is it regularly ignores our allies while intentionally 
propping up or strengthening our adversaries. I have every confidence 
that Mr. Tillerson will flip that narrative, and he will help the 
United States regain our leadership role in the world by 
unapologetically supporting our allies and friends while keeping our 
enemies in check. He is the right man to lead the State Department, and 
I hope we confirm him soon.


                      Nomination of Jeff Sessions

  Mr. President, let me add, today we are engaged in the second day of 
hearings before the Senate Judiciary Committee regarding the nomination 
of Senator Jeff Sessions, our colleague of longstanding, to be U.S. 
Attorney General.
  Some people who haven't had the benefit of working with Senator 
Sessions know him by his record. Frankly, given some of the testimony, 
I don't recognize the person who is being described by those who, for 
various reasons, are opposing his nomination. We know that he has an 
outstanding record of service, both to the people of Alabama, to the 
United States as U.S. attorney, and then in the U.S. Senate for the 
last 20 years.
  It is ironic that we are having a hearing before the Senate Judiciary 
Committee on the qualifications of Senator Sessions to serve as 
Attorney General, a committee on which he has served for 20 years. Our 
colleagues across the aisle don't need to have a hearing to know Jeff 
Sessions because they already know him well. They know him to be a man 
of honor, a man of principle, a man who is true to his word, and who 
believes, above all, that the role of the Attorney General is to 
enforce the law of the land--something we have not seen in the last 8 
years during the Obama administration, where the Justice Department has 
become a political arm of the White House.
  I have every confidence that Senator Sessions, as the next Attorney 
General of the United States, will restore the reputation of the 
Department of Justice and the Office of Attorney General to one that 
respects the rule of law and dispenses equal justice under the law.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, over the past few days, we have been 
listening to the health care horror stories from across the country, 
such as families earning an annual income of $50,000 who opted for 
high-deductible coverage and are facing up to $6,000 or, in one case, 
$10,000 of out-of-pocket costs before their coverage even begins. That 
is not affordable insurance.
  Nearly 7 years after the enactment of ObamaCare and 3 years into 
implementation, one thing is crystal clear: ObamaCare has failed, but 
Republicans are working to fix the damage. Over the past several years, 
it is clear that this law is simply unworkable for millions of hard-
working Americans. Insurance markets are collapsing, premiums are 
soaring, and health care choices are disappearing, but the answer isn't 
to ignore the problem. With ObamaCare getting worse by the day, it is 
time for us to act. The repeal resolution we are debating this week 
promises relief from ObamaCare and provides the tools necessary to 
immediately repeal this failed law while ensuring a stable transition 
period to a patient-centered health care system that gives Americans 
access to quality, affordable care. The resolution includes 
instructions to authorizing committees so that repeal legislation can 
move through a fast track process and can pass with a simple majority 
in the House and Senate. These instructions to committees are provided 
to allow immediate action on repeal with the intent of sending 
legislation to the new President's desk as soon as possible.

  Headlines from across the Nation highlight the urgent call to action. 
The New York Times says: ``Obamacare Premiums Set to Rise Even for 
Savvy Shoppers.'' The Wall Street Journal says: ``Insurers Move to 
Limit Options in Health-Care Exchange Plans.'' The Baltimore Sun says: 
``Marylanders face hefty rate increases for ObamaCare.'' The Omaha 
World Herald says: ``Health insurance rate increases may have some 
Nebraskans in sticker shock.'' The Miami Herald says: ``Florida's 
ObamaCare premiums to rise average 19 percent in 2017, the State 
says.'' And the Bergen County Record says: ``New Jersey left with just 
two ObamaCare health providers for 2017.''
  My own State of Wyoming is down to one insurer in the individual 
market, both on and off the exchange. That is a national scandal. We 
have heard from people who talked about counties where there are no 
insurers. We have heard people talk about the costs they have both for 
the premiums and the deductibles. And just talking about the premiums, 
in New Mexico they had some counties where the average cost of a house 
payment is less than the monthly cost of their health care--much less, 
about 50 percent less in one instance.
  It is also important to look at the facts surrounding ObamaCare. 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. 
Even with insurance, many still can't afford the care due to surging 
deductibles. If you can't afford the deductible, you really don't have 
insurance. If you can't afford the insurance, you don't have insurance. 
And it isn't the insurance that is important; it is the availability of 
providers that can take care of you. Most of the newly insured gained 
coverage only through a flawed Medicaid program that is providing 
inferior quality and threatening to bankrupt States across the Nation.
  According to research from the architect of ObamaCare, Jonathan 
Gruber--he explicitly said that most of the newly enrolled 
beneficiaries were actually eligible for Medicaid before ObamaCare. In 
fact, his research showed that two-thirds of new people signing up for 
Medicaid were brought into the program, not through ObamaCare but by 
increased Medicaid advertising.
  As America soon discovered, the President and congressional Democrats 
focused exclusively on coverage and mandates that were handed down from 
Washington instead of patient-centered reforms. Coverage was the silver 
bullet for them because coverage equaled health care. They forgot a key 
detail though: The cost of the plans that were mandated made it nearly 
impossible for many to pay for the insurance or, if they had coverage, 
to pay for care with the sky-high deductibles. I know that some people 
on my staff had health savings accounts that gave them catastrophic 
coverage. They didn't have to worry about going bankrupt over health 
care. Their deductibles were lower than the ones that we have with this 
health care.
  Focusing on and highlighting the number of people now enrolled in 
ObamaCare doesn't translate into anything more than phantom insurance, 
which, for users plagued by inadequate coverage, is coupled with huge 
out-of-pocket costs. We are seeing families now having to forgo medical 
care, not because they don't have insurance but because it is simply 
too expensive to go to the doctor with their ObamaCare health plan.
  Normally I would say that you get what you pay for. But with 
ObamaCare, you seem to just pay without getting much at all. It is kind 
of like buying a bus ticket, but when you show up for the trip, they 
tell you that to get a seat, you are going to have to spend a little 
bit more, and then you have to chip in for the gas.
  For years, Republicans have pledged to repeal this disastrous law. 
Passing this resolution is just the first step in keeping that promise, 
clearing the way for consideration of repeal legislation that will be 
signed into law by the new President. While providing immediate relief 
from ObamaCare, Republicans will ensure it is a stable transition in 
which those with insurance will not lose access to health care 
coverage. This will allow the Nation to move to a patient-centered 
health care system that gives hard-working Americans access to quality, 
affordable care. The goal is a more modern health care system where 
there is innovation to improve the health of all Americans, where 
insurers are offered new and affordable options, and where families 
have a more direct say over their own health care decisions.

[[Page S236]]

  Unwinding partisan gridlock to make these changes will not be easy. 
As I noted in my earlier remarks, our Nation has made great strides in 
improving the quality of life for all Americans, but these transforming 
changes are always forged in the spirit of bipartisan compromise and 
cooperation. We still need health care reform, but it has to be done 
the right way. Passing this resolution will start building a bridge 
from ObamaCare's broken promises to better care for each and every 
American.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CARPER. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CARPER. Mr. President, I come to the floor with a lot of other 
folks to talk about the health care in this country. I think one of the 
goals we all share--and maybe we are not sure how to get there--is how 
to make sure that everybody who needs access to health care has it, 
that it is affordable, and that they get reasonably good quality, 
whoever they are and wherever they come from.
  When I was a naval flight officer, we used to fly a lot of missions 
out of Japan during the Cold War. I have a special interest in Japan, 
and I like the folks there. They are pretty remarkable in what they 
have achieved over the years. One of the things they have achieved over 
the years is providing pretty good health care for a fairly modest 
amount of money.
  We started working on the Affordable Care Act 7 or 8 years ago. One 
of the things I learned about Japan was that they were spending 8 
percent of their gross domestic product for health care in their 
country. We were spending 18 percent. As it turns out, they were 
getting better results. They had lower rates of infant mortality and 
higher rates of longevity. People lived longer. Newborns died less 
frequently than we did. On top of all that, in Japan they covered 
everybody. Everybody was covered for health care. We had about 40 
million people--over 40 million people at the time--whose health care 
coverage was to get into an emergency room of a hospital, try to get in 
line, and get someone's attention.
  I know how smart the Japanese are, but I don't think they can be that 
smart and we can be that dumb. That is sort of where we were 6, 7 years 
ago. So we said: What are we going to do about it?
  I think almost every President--maybe since Truman--had a goal of 
making sure everybody in this country had access to health care. A lot 
of folks talked about it and maybe tried to do something. The first 
time we had a serious effort to do that was during the Clinton 
administration, not led by President Bill Clinton but led by First Lady 
Hillary Clinton. What she came up with and worked on was something 
called HillaryCare.
  The Republicans came up with an alternative to HillaryCare introduced 
by the Republican Senator from Rhode Island, John Chafee--a really good 
guy, a very able guy. I actually served with his son Lincoln in the 
Senate. But in 1993, 1994, when most people focused on HillaryCare, 
John Chafee introduced legislation with 20 or so Republican cosponsors. 
A couple of them are still here, I think. Senator Orrin Hatch was one 
of them, and Senator Chuck Grassley of Iowa was one of them--maybe a 
couple of Democrats, as well. But 20 to 25 Senators, mostly Republican, 
cosponsored the Chafee legislation.
  This chart mentions the Chafee bill and what was included in the 
Chafee legislation. One of the things included was the individual 
mandate--basically, that everybody had to get coverage.
  Second was the employer mandate, which basically said that employers 
had to provide health care coverage for their employees--maybe not for 
everyone, maybe not for the smallest businesses--but getting employers 
to meet what Senator Chafee and other Senators thought were the 
employers' obligations, their responsibilities.
  In the Chafee legislation there was a ban on preexisting conditions.
  In the Chafee legislation there were subsidies for purchasing 
insurance. Purchasing it where? Purchasing it in State exchanges. The 
idea of creating large purchasing pools--there were folks who didn't 
have health care coverage who could get their health care coverage in a 
large purchasing pool. If their income was low or relatively low, they 
would be eligible for tax credits to buy down the cost of their health 
care coverage. They would get theirs from the exchanges and the 
purchasing pools.
  Those were all ideas in Senator Chafee's legislation in 1993. Do you 
know what? I am a Democrat and probably shouldn't say this, but I 
thought they all made sense.
  The legislation didn't go anywhere. In the end, HillaryCare didn't go 
anywhere. But long before we had serious debate on the Affordable Care 
Act, people were talking about the same thing.
  You go over here--RomneyCare in 2006. Individual mandate: Got it. 
Employer mandate: Got it. Ban on preexisting conditions? Yes. Subsidies 
for purchasing insurance? Yes. Establish State purchasing groups? Yes. 
Those are all in RomneyCare.
  I have always given Governor Romney credit for the idea of the 
individual mandate, but apparently that was wrong. It was in Senator 
Chafee's legislation as well. Governor Romney took the handoff, if you 
will, from Senator John Chafee and introduced what they call RomneyCare 
in Massachusetts. It was introduced in 2006.

  When it first was introduced, they had real good success in getting 
people covered. It was successful in terms of getting people covered. 
Where they were not so successful initially was affordability. They had 
to work on affordability. Part of the problem there was it took a while 
for the healthier, younger people who did not think they needed health 
care coverage because they were young and invincible. It took a while 
for them to start.
  They said: The fine keeps going up year after year after year. Maybe 
I should get some health care coverage and not pay the fine. 
Ultimately, I think RomneyCare did a much better job on affordability.
  If you take those five key provisions, the individual mandate, 
employer mandate, ban on preexisting conditions, subsidies for 
purchasing insurance, and establishing the State exchanges--key 
provisions in the Chafee bill--they are in RomneyCare. Believe it or 
not, they are in the Affordable Care Act.
  I know some of our Republican friends think that nobody listened to 
them when we wrote the Affordable Care Act. Actually, these are your 
ideas. These are your ideas. Some of the provisions or aspects of the 
Affordable Care Act that our friends across the aisle have been most 
critical of are things that were originally their idea--originally 
their idea.
  Then we changed this thing. Senator Sanders who has joined us on the 
floor. We added to that. We expanded Medicaid. We said to States--we 
didn't make them expand Medicaid, but we said: If you do, the Federal 
Government will pay the lion's share of the increased costs in 
Medicaid. I think initially maybe 24 States signed up and said: We will 
do that, including the District of Columbia. Later on, another seven or 
so, eight States--I think Indiana is one of those that decided, under 
then-Governor Pence, to expand Medicaid up to about roughly 135 percent 
of poverty from maybe closer to 100 percent of poverty for most States.
  That is a little bit of a good history lesson. I think we have 
another chart we can look at. It is a pie chart. Sylvia Matthews 
Burwell came by--the Secretary of Health and Human Services came by a 
month or two ago and talked to our Democratic Senate caucus. One of the 
things she said to us that I thought was especially informative was she 
talked about this pie chart.
  What she said is: Think of this pie chart. It includes about 300 
million Americans who get health care, at least those who get some kind 
of health care other than emergency room. She told us that roughly half 
of the people, a little bit more than half of the 300 million people 
among the Americans who are getting health care--a little over half, 57 
percent--get their coverage through employer coverage. The employers 
provide that as a condition of employment. Another roughly 22 percent--
that is this area, sort of the brown area--is Medicaid and

[[Page S237]]

the S-CHIP program, the Children's Health Insurance Program, a 
bipartisan idea. Bill Roth worked on that, the Clintons, and others. I 
even worked on it as Governor. About 15 percent--this area right here, 
the green--is Medicare. Then down here you have the individual markets, 
the marketplaces, and so forth.
  There are roughly 5 or 6 percent down here where people are getting 
their coverage. A lot of the attention, a lot of the criticism of the 
delivery of health care in the last 6 or 7 years by our friends on the 
other side has been down here with the marketplaces, the exchanges. 
Those were their ideas.
  One of the nice things the Affordable Care Act has done--not many 
people know this--but the Medicare trust fund, which is in danger of 
running out of money, the life of that trust fund has been extended by 
12 years because of the Affordable Care Act. The Medicaid pieces have 
been--the Secretary of Health and Human Services, Sylvia Matthews 
Burwell, has negotiated with a number of Governors to try to give them 
the opportunity to sort of customize their Medicaid programs.
  I think maybe in Indiana they wanted to have a small copay for the 
people who participated in Medicare. That is what they got. So it is 
not all one size fits all, but there is some differentiation between 
Medicaid. Now we have roughly two-thirds of the States that have signed 
up for Medicaid expansion.
  So that is just a little visual. Do we have another chart here? The 
question is, Who gets hurt by repealing the Affordable Care Act? If we 
just repeal the Affordable Care Act, and we don't replace it at the 
same time we repeal it or change it, a lot of people will get hurt, 
including a lot of people who are in the exchanges and getting health 
care coverage maybe for the first time in a long time, and actually 
folks who are not in the exchanges, people who get their health care 
coverage in all kinds of ways, including employer provided, Medicare, 
and Medicaid, or privately purchased.
  We don't need the kind of uncertainty, the lack of predictability 
that would be created by repeal without having a very clear picture of 
what we are going to replace it with at the same time--not a year from 
now, not 2 years, not 3 years, not 4 years from now but at the same 
time. That is what we ought to do.
  I will close with this. I note one of my colleagues from a big State 
up to the northeast of us has a few things he wants to say. I welcome 
hearing him.
  My dad used to say to my sister and me when we were kids growing up, 
a little younger than our pages--we would do some bone-headed stunt, 
and he would say to my sister and me: Just use some common sense. That 
is what he would say. Just use some common sense. He said it a lot. We 
must not have had much.
  Well, just repealing the Affordable Care Act and not having something 
to replace it with immediately that provides coverage just as good--
affordable, comprehensive coverage--that would not be very good common 
sense. We can do better than that. We can do better.
  I hope our Republican friends, with this rush to judgment to repeal 
and replace 2 or 3 or 4 years down the line, can come around and say: 
No, that does not make much sense. I hope they will listen to some of 
their colleagues and some of the rest of us who say: If we are going to 
repeal the Affordable Care Act, let's know what we are going to replace 
it with, and make sure we do that on day one.
  With that, I am happy to yield the floor to my friend from Vermont.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, I thank my friend from Delaware for 
yielding. When we talk about the health care crisis in this country, it 
is not just health care, it is also the outrageously high cost of 
prescription drugs. I know in my State of Vermont, and in fact 
throughout this country, millions of people today are unable to afford 
the medicine they need.
  In fact, almost one out of five Americans who go to the doctor and 
get a prescription are unable to afford to buy the medicine their 
doctors prescribe. Frankly, that is insane because what happens if you 
don't take the medicine your doctor prescribed, often you are going to 
get sicker. Sometimes you may die. Sometimes you may end up in the 
emergency room. Sometimes you may end up in the hospital. It is 
literally beyond comprehension that almost one out of five Americans 
today are unable to afford the medicine they need.
  Meanwhile, while so many of our people cannot afford the medicine 
they need, the top five drug companies last year made $50 billion in 
profit--$50 billion in profit. The top 10 CEOs in the pharmaceutical 
industry earned over $300 million.
  So what we have is a scenario in which the American people pay the 
highest prices in the world for prescription drugs. Millions cannot 
afford the medicine they desperately need, but at the same time the 
drug companies make out like bandits, and their CEOs earn exorbitant 
compensation packages.
  I happen to live 50 miles away from the Canadian border. A number of 
years ago, I took a busload of Vermonters across the Canadian border, 
not just to do some sightseeing in Montreal, which is a beautiful city, 
but to go there to purchase the same exact medicine that Vermonters, 
many of whom were dealing with breast cancer, were buying but yet 
buying it in Montreal, Canada, for a fraction of the price they were 
paying in the United States.
  In fact, on that particular trip, many of the women who were dealing 
with breast cancer purchased the medicine they needed for one-tenth of 
the price they were paying in Vermont--one-tenth of the price. Let me 
take a moment today to review the costs of some of the exact same drugs 
sold in the United States compared to their costs in Canada.
  Here in the United States, EpiPen, as we all know, costs more than 
$600 a set. That price has skyrocketed in recent years. In Canada, the 
same exact set costs $290, less than half of what we pay in the United 
States.
  Crestor, a popular drug to treat high cholesterol levels, is $730 
here but $160 across the border. We are not talking about generics. We 
are not talking about another drug. We are talking about the same exact 
same drug manufactured by the exact same company.
  I may be mispronouncing it, but I think it is Abilify, a drug for 
depression, is more than $2,600 for a 90-day supply here in the United 
States but only $436 in Canada.
  I can go on and on and on. By the way, let's be clear--
  Mr. President, I ask unanimous consent to have printed in the Record 
a chart of drug prices around the world which will show that prices in 
the United States are not only almost always higher than in Canada but 
higher than in the UK, Spain, and the Netherlands as well.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                    USA--THE HIGHEST DRUG PRICES IN THE WORLD
----------------------------------------------------------------------------------------------------------------
                                      CANADA           U.K.            SPAIN        NETHERLANDS       U.S.A.
----------------------------------------------------------------------------------------------------------------
ENBREL..........................          $1,646          $1,117          $1,386          $1,509          $3,000
CELEBREX........................              51             112             164             112             330
COPAXONE........................           1,400             862           1,191           1,190           3,900
CYMBALTA........................             110              46              71              52             240
GLEEVEC.........................           1,141           2,697           3,348           3,321           8,500
HUMIRA..........................           1,950           1,102           1,498           1,498           3,048
NEXIUM..........................              30              42              58              23             305
----------------------------------------------------------------------------------------------------------------

  Mr. SANDERS. Mr. President, perhaps people then will ask a simple 
question: How does it happen? How does the same exact same medicine 
sold in the United States sell in countries around the world for a 
fraction of

[[Page S238]]

the price that we have to pay? The answer is severalfold. No. 1, we are 
the only major country on Earth, of course, that does not have a 
national health care system guaranteeing health care to all people. We 
are the only major country on Earth not to have that.
  As part of that problem, we are the only major country not to 
negotiate drug prices with the pharmaceutical industry. You can walk 
into a drug store today, and the price could be double or three times 
what you paid a year ago. There is no law to stop them. They can and 
they will raise prices as high as the market will allow. If people die 
as a result of that, not a problem for them. If people get sick, not a 
problem for them.
  Perhaps next to Wall Street, the pharmaceutical industry is the most 
powerful political force in this country. They have spent more than $3 
billion on lobbying since 1998, and they have 1,400 lobbyists on 
Capitol Hill. We have 100 Senators. There are 435 Members of the House. 
Yet the drug companies have 1,400 lobbyists on Capitol Hill. They have 
lobbyists all over the country in every State capital.
  These are no small-time lobbyists. These are former leaders of the 
Democratic Party, leaders of the Republican Party, people who have 
enormous contacts. So the drug companies are able to raise prices to 
any level they want because we as a nation, uniquely among major 
nations, do not negotiate prices with them. The reason we do not 
negotiate prices with them is they got lobbyists and they make very 
hefty campaign contributions to make sure Congress, in fact, does not 
pass legislation which will lower drug prices in this country.
  The pharmaceutical industry is an industry that is not only 
incredibly greedy, but they have a business model which is largely 
based on fraud. Like Wall Street, their business model is largely based 
on fraud. Almost every major drug company, not widely known--but almost 
every major drug company in this country--multi, multibillion-dollar 
corporations--have been fined for illegal activities and for cheating 
consumers in our country and all over the world.
  Since 1991, with lax enforcement--it is not like we have a vigorous 
Attorney General's office that really goes after these guys. With 
relatively lax enforcement policies, drug companies over the years 
since 1991 have paid over $35 billion in fines or reached settlements 
for fraud and misconduct. Imagine that. This is just when they are 
caught, and I suspect that most of the times they cheat, they don't get 
caught--but $35 billion in fines or settlements since 1991 from the 
major drug companies in this country.

  Let me give you just a few examples of some of the settlements and 
fines the major drug companies have made in recent years.
  In 2013, the Justice Department ordered Johnson & Johnson to pay $2.2 
billion in fines because they ``recklessly promote drugs for uses that 
have not been proven to be safe and effective.''
  According to the U.S. attorney handling the case, Johnson & Johnson's 
``promotion of Risperdal for unapproved uses threatened the most 
vulnerable populations of our society--children, the elderly, and those 
with developmental disabilities.''
  In 2010, AstraZeneca Pharmaceuticals paid $520 million to resolve 
allegations that it illegally marketed the antipsychotic drug Seroquel 
for uses not approved as safe and effective by the Food and Drug 
Administration.
  In 2009, Eli Lilly was fined over $1.4 billion for its off-label 
promotion of another antipsychotic product known as Zyprexa. According 
to Federal investigators, Eli Lilly's ``illegal activity increases 
patients' costs, threatens their safety and negatively affects the 
delivery of healthcare services to the more than nine million military 
members, retirees and their families who rely on'' TRICARE.
  Very interestingly--and I am sure many of the Members saw it--
President-Elect Trump had a press conference this morning, and in his 
press conference, he said that pharma is ``getting away with murder.''
  Mr. Trump: Pharma is ``getting away with murder.''
  Do you know what? Mr. Trump is exactly right. Pharma is getting away 
with murder. Pharma has gotten away with murder for many decades.
  The interesting issue is, with a Republican President-elect telling 
the truth, that pharma is getting away with murder, will the 
Republicans, will all the Democrats have the guts finally to stand up 
to the pharmaceutical industry and their lobbyists and their campaign 
contributions and fight for the American consumer and end the disgrace 
of having our country pay, by far, the highest prices in the world for 
prescription drugs?
  The good news is--I say to my fellow Republicans and to Democrats--
the good news is that tonight you are going to have that opportunity 
because as part of the so-called vote-arama, I will be offering a very 
simple amendment which I hope wins strong bipartisan support. In fact, 
there have been a number of Republicans over the years--in the House 
and in the Senate--who have supported the concept of reimportation for 
many years.
  What this amendment will do is allow pharmaceutical distributors and 
pharmacists and those involved in the pharmaceutical industries--those 
people who sell drugs--to import low-cost medicine from Canada and 
other countries which will be FDA-approved. In other words, all over 
this country people ask a very simple question: We can eat fish and 
vegetables that are grown all over the world, but somehow we cannot get 
into this country brand-name prescription drugs manufactured by some of 
the largest drug companies in the world from an advanced country like 
Canada? The reason we can't do that is for one reason and one reason 
alone, and that is the power of the pharmaceutical industry.
  I would hope that tonight, both Democrats and Republicans will stand 
together and demand that this country be able to import safe, low-cost 
medicine from Canada and from other countries.
  I should also mention that I will be introducing legislation with 
Representative Elijah Cummings from Maryland in the coming days on this 
very issue, on the issue of reimportation and also another issue that 
Mr. Trump touched on, I believe, today; and that is, the need for 
Medicare and the government, in general, to negotiate prices with the 
pharmaceutical industry. The VA does it. Clearly, Medicare should be 
doing it as well. I believe we are going to have an amendment on the 
floor tonight. I would hope people support that amendment. I will be 
introducing legislation on that issue as well as reimportation.
  When we talk about the health care crisis in America, one of the 
issues of concern to most Americans is the outrageously high cost of 
prescription drugs. The question is whether the Congress has the guts 
to take on an enormously powerful industry, the pharmaceutical 
industry, with all of their lobbying and all of their campaign 
contributions. I certainly hope we will do the right thing, and tonight 
we can begin that process.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mr. Toomey). The Senator from Louisiana.
  Mr. CASSIDY. Mr. President, as we continue to debate health care, 
there are some things that are kind of being debated that I call monkey 
dust. When two gorillas fight, they try to confuse each other by 
throwing dust up in the air. It has nothing to do with the substance of 
the fight but rather is only meant to distract the other side. That is 
part of what this kerfuffle, if you will--people raise per-beneficiary 
payments as if that is something pernicious, something that should be 
avoided, something which is bad.
  First, we are setting this kind of in the perspective of Medicaid.
  Let me speak about per-beneficiary payments. For those who are in the 
Federal Employees Health Benefits Plan, the Federal Government makes a 
per-beneficiary payment to the insurance company to cover that Federal 
employee. For those States which have a Medicaid managed care company 
contract, the State makes a per-beneficiary payment to the Medicaid 
managed care company. That is a per-beneficiary payment. The reason I 
like this is because, inherently, the dollar follows the patient.
  Now we are speaking about this in the context of a Medicaid reform 
program. Why should Medicaid be reformed? That is the question. Let's 
speak about our current Medicaid system. It is bankrupting States and 
the Federal Government.

[[Page S239]]

  In 2009, for the first time, the amount of money spent by States on 
Medicaid exceeded what they spent on education. Ever since then, 
Medicaid's expenditures are going up, and education expenditures are 
going down. Despite all this money, we get poor outcomes. Medicaid 
typically pays physicians below their cost of seeing a patient.
  I pointed out in my speech yesterday that the week ObamaCare passed 
the House of Representatives, Robert Pear, the New York Times 
journalist, wrote an article in the New York Times following cancer 
patients on Medicaid in Michigan. What Mr. Pear found was an oncologist 
who had so many Medicaid patients she was going bankrupt. Indeed, she 
had to begin to discharge those patients from her practice because she 
could not pay her bills. We tracked down one of those patients who was 
featured, and she died 2 weeks after being discharged from the 
practice.
  Medicaid pays so poorly that physicians cannot afford to see large 
numbers.
  That said, it isn't just an anecdote from this New York Times 
article. There is a study out of MIT for the National Bureau of 
Economic Research, I believe it is, that found that with all the money 
spent on Medicaid, the beneficiary only receives 20 to 40 percent. The 
rest goes to institutions.
  If we speak about a per-beneficiary payment, substantially all of 
that money goes to the patient. Under the current scenario, out of an 
MIT study, only 20 to 40 percent does.
  Go back to the oncologist who couldn't afford to see the patients 
because her reimbursements were so low. What if the rest of that money, 
which was not being attributed to the patient, instead could go to pay 
her doctor, then the patient would have never been discharged.
  By the way, on average, States spend 17 percent of their State 
dollars on Medicaid. In my own State of Louisiana, it is 19 percent, 
and in my State this has increased, nearly doubling from the year 2000.
  Let's go back to the per-beneficiary payment, where the dollar 
follows the patient, as in, by the way, the insurance plans that people 
have under ObamaCare on the exchanges. There is a subsidy that goes to 
the insurance company that then provides for the patient. The dollar 
follows the patient. So the per-beneficiary continues to do that.
  Folks say: Well, there is not enough money in Medicaid; therefore, we 
have to somehow do things differently. The models we use in private 
insurance will not work in the Medicaid population.
  We looked up the SEC report for a Medicaid managed care company, and 
the Medicaid expansion population, they get $6,000 per enrollee. I just 
met today with an insurance company that was discussing the rates they 
are going to give on the exchanges next year. It is going to be roughly 
$5,500 per enrollee will be a year's premium.
  So think about this. Those in the Medicaid expansion population have 
more Federal dollars going to support them than those citizens, those 
fellow Americans who are receiving their insurance on the ObamaCare 
exchanges. Yet we continue to hear from the Medicaid patients that they 
have problems accessing specialists.
  There is more money in Medicaid than in the private insurance market, 
but the Medicaid patient can't see a specialist because the patient's 
specialist is being paid below cost and cannot afford to see the 
patient. There is something incredibly wrong here.
  By the way, I should also point out that in States in which Medicaid 
is expanded, another MIT study found that 60 percent of those who go on 
the Medicaid expansion dropped private insurance--dropped private 
insurance--which means they go from kind of paying their own way to the 
taxpayer paying for them.
  My own State of Louisiana recently expanded Medicaid. It might not 
have been 60 percent of those on the Medicaid expansion dropped their 
insurance, but I am told by the chief insurance company that I think 
about 70 to 80,000 people dropped private insurance to go on Medicaid; 
60 or 70 or 80,000 people stopped paying for themselves and asked 
taxpayers to pay for them.
  That is OK if you are the person going on Medicaid. You no longer 
have a deductible or a copay. I understand ObamaCare exchanges have 
$6,000 deductibles, and maybe that is what they had to do, but if we 
are going to come up with a sustainable system, that is not an answer.
  What I do is encourage that there be a per-beneficiary payment, that 
the money follow the patient. Again, for those who say it is some 
terrible thing to have a per-beneficiary payment, they are ignoring all 
the evidence of how it is good. Think of the Federal Employees Health 
Benefits Program. Probably if somebody is watching on C-SPAN, their 
spouse or their own policy they get through their employer, the 
employer pays the insurance company a certain amount of money per 
employee and per employee family member.
  We could also do what Indiana has done. In their Healthy Indiana Plan 
2.0, they made per-beneficiary payments, if you will, to Medicaid 
enrollees, giving them a health savings account and covering their 
catastrophic expenses. They found that the Hoosiers who enrolled in 
this used 40 percent less charity care than those with traditional 
insurance. These are all Medicaid patients.
  Folks say: Oh, my gosh. Health savings accounts per-beneficiary 
payments can never work for the poor.
  In this case, 70 percent of those enrolled in this program were below 
the Federal poverty level. Yet, nonetheless, they contributed to their 
own HSA. They continued making those contributions and altered their 
behavior to become more cost-conscious, better consumers of health 
care.
  I always say don't underestimate patients. In my own practice, for 30 
years, I worked in a hospital caring for the uninsured, and although 
the uninsured don't have some of the advantages in life that others 
have, they can take care of themselves. They know what is right and 
what is wrong in terms of their own interests.
  So let's make those per-beneficiary payments. Let's not be distracted 
by those who somehow make this a bad thing. Let's believe in the 
American people, that they can handle their own health care and that 
they don't need a Washington bureaucrat to tell them how to live their 
health care lives.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Georgia.
  Mr. ISAKSON. Mr. President, first of all, I want to acknowledge the 
great intellect that the Senator from Louisiana brings to the debate, 
the experience he has in the health care field, how much I personally 
have learned from him on the committee in the work we do, and I thank 
him for the contribution he makes to the Senate.
  I rise to talk a little bit about how we got to where we are today, 
what we are about to do, and where we need to end up. It will be short, 
and it will be sweet, but it will be to the point.
  I was here in 2009 when we passed ObamaCare. In fact, as the 
Presiding Officer will remember, it was at 9 o'clock in the morning on 
Christmas Eve in 2009. I opposed it at that time for a particular 
reason. The reason was that I saw it driving us toward a single-payer 
health care system, which I personally opposed. But the votes were 
there. It passed, and it passed on the promise that if you liked your 
doctor, you could keep him; if you liked your insurance, you could keep 
it. And because everybody is going to be insured, rates will go down 
and everything is going to be wonderful.

  What has happened over the last 8 years has been pretty incredible. 
Rates have gone up tremendously. People have not been able to keep 
their insurance. We find ourselves on the cusp of being forced to a 
government single-payer health care system because the private markets 
are collapsing.
  In my State of Georgia, where we have 159 counties, up until this 
year every county had at least two or more providers providing health 
insurance. Today in 2017, 96 of our 159 counties have one carrier. Next 
year half of them will be down to no carrier, and we will be forced 
into a system that we don't know what it will look like. Prices have 
gone up not just by a little bit, but they have gone up by an awful 
lot. The end-user market in Georgia is approaching the breaking point.
  I will give you a couple of examples. Two parents in Georgia picked 
the least expensive plan available this year to their family of four. 
It comes out to be a $6,500 deductible and $2,400 a month for premium--
unsustainable.

[[Page S240]]

  A couple in their sixties had a similar plan but were just outside 
the subsidy limit of $96,000 for their family. So they are paying over 
50 percent of their income for health insurance.
  Hard-working families deserve better. Although President Obama 
promised this law would reduce premiums and make health care more 
available, it has done the opposite. ObamaCare is unsustainable. Now, 
that is the practical answer, and that is exactly what got us to where 
we are today.
  We are in the process of attempting to get the budget reconciliation 
act before us so that we can repeal ObamaCare, but we must also talk 
about what we replace it with because repealing it without a 
replacement is not an acceptable solution. It is not a solution. It is 
a conundrum.
  We must prioritize returning the oversight of individual markets to 
the States and provide them with the flexibility to design their 
Medicaid programs in ways that enable them to cover most people and 
tailor benefits to meet the needs of the unique populations in their 
States.
  We have proven in the past that regulation by the State insurance 
commissioners work. We need to return association health plans to be 
competitive in the United States. We need to allow the sale of 
interstate insurance across State lines and stop the prohibition 
against that. We need to open the opportunity for entrepreneurship in 
the private sector to fill the void that is being filled by the vacuum 
that has been created by the mandates of ObamaCare.
  We need to also preserve those things in ObamaCare that made sense--
preexisting condition, absolutely; insurance coverage up to the age of 
26 while staying at home with a parent, absolutely. Those things can be 
done, and we ought to do them because they were the right thing to do 
when we did them, and they are the right thing to preserve now. But it 
is absolutely essential that we see to it that we return insurance to 
the private sector and regulation to the States. If we fail to do so, 
we will have higher premiums or no premiums at all and no plans at all.
  So as we talk about repealing, we must also end up landing on a 
replacement. It is unsustainable and impractical, and it is wrong for 
us to say we are going to repeal ObamaCare without replacing it with a 
plan that we know works and has the opportunity. Let's address that 
which caused ObamaCare to happen. Let's fix the breaks that have taken 
place. Let's bring back competition, State regulation and authority, 
and let's see to it that health care in America is accessible and is 
affordable. It is important for us to do it. It is essential for us to 
do it, and I plan to commit myself to seeing to it to do my part to 
repeal ObamaCare. We replace it with a sustainable program, we return 
the program to the States, wherever possible, and we see to it that 
Americans have health insurance coverage at a competitive and fair 
price.
  I yield back.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, I want to talk specifically for a few 
minutes about mental health care and about an amendment that I will be 
offering this evening. But I do want to start off by stepping back for 
a moment and indicating that, from my perspective, I know those of us 
on the Democratic side of the aisle understand that we have work to do 
together to continue to bring down costs for health care and, in some 
areas where there is not enough competition, in fact, to create that 
competition. Affordable health care is the goal for all of us. I have 
concerns in looking at my small business community that we continue to 
do things that support them. That is different than what we are being 
asked to vote on here.
  What we are being asked to vote on is a repeal of health reform that 
touches every American and all of the patient protections that we put 
in place that have moved total control from insurance companies to 
people with insurance so that we can't quit a job if we get sick. If 
you have a preexisting condition, are a diabetic, or have heart disease 
or you had some other challenge or your child has, you know that you 
will have confidence that you will continue to be able to find 
insurance and see your doctor. There are all of the provisions that are 
here--young people up to age 26, all of the efforts that we put in 
place to make sure that you have the confidence and the ability to know 
that you have insurance. We need to ensure that if someone has cancer, 
they are not going to be capped with the amount of care they can get.
  Yesterday in the capitol in Lansing, MI, there were physicians and 
pediatricians working with cancer patients, with children and their 
families, who were talking about the fact that, because of the 
Affordable Care Act and taking off the caps on the amount and kinds of 
treatment that children with cancer can get, literally, lives have been 
saved. Parents are now looking at this body and the Congress as a whole 
and the new President and are saying: Why in the world would we want to 
go back to a situation where people can't get the level of care, the 
quality of care, or, in some cases, the care at all for themselves or 
their families?
  So we are proposing that, rather than repealing health reform, which 
unravels the entire health care system because part of it is Medicare, 
part of it is prescription drugs going back up--it weakens the Medicare 
system, and it weakens the Medicaid system, where most of the dollars 
are going to seniors in nursing homes. It creates a situation where 
someone who is working very hard at a minimum-wage job and hasn't been 
able to have insurance because their employer didn't provide it can now 
have the assurance that they can care for themselves and their families 
and see a doctor without using the emergency room for regular 
treatment, which, of course, is the most expensive way to get health 
care and drives the costs up. What is being proposed is that we unravel 
all of it and literally create chaos in the system. We are for 
affordable health care, and we are willing to work with anybody at any 
time. I, certainly, will be ready and willing to do that. But I reject 
the idea that we are going to repeal and unravel the entire health care 
system and create chaos for families, businesses, and communities. 
There are many communities where the hospital system is the major 
employer in the community. Health care is one-sixth of the entire 
economy and is going to be impacted by this.
  I want to specifically speak about the importance of accessible and 
affordable mental health services and what we have been able to achieve 
with protections established by the Affordable Care Act that ensure 
people can receive care. We have come a long way since over 50 years 
ago when President John F. Kennedy signed the Community Mental Health 
Act and put down a marker about the importance of treating health 
issues above the neck as well as below the neck. Comprehensive health 
care should affect every organ, every part of the body, every kind of 
disease. We have made major steps in that direction. We have a long way 
to go to get the comprehensive care we need in the community, but we 
have made major steps forward, including bipartisan efforts here 
related to the Cures Act, as well as the efforts that Senator Roy Blunt 
and I have been working on to make sure the payments for providing 
services in the community are the same for mental health and substance 
abuse services as well as physical health. So we have made steps 
forward, but the reality is that repealing the Affordable Care Act will 
take us backwards in a major way.
  I have introduced, along with colleagues who are also champions on 
this issue--Senators Cardin, Murphy, Durbin, and a number of other 
Democratic colleagues--an amendment that would help to prevent passage 
of any legislation that would reduce or eliminate services and access 
to mental health care. This is an amendment that should not even be 
necessary, particularly given the fact that we have worked in a 
bipartisan way on other pieces of legislation to move forward.
  I don't know why we would ever pass something that reduces or 
eliminates access to mental health or substance abuse services such as 
opioid treatment. Why in the world would this body come together and 
jeopardize work we have already done, essentially ripping it apart? The 
repeal of the Affordable Care Act and the cuts to the Medicaid Program 
do exactly that.
  Why is this important? Well, nearly one in five adults in our country 
has a mental illness. About 4 percent of adults have serious mental 
illness. Unfortunately, even now, with work we have been doing, we 
still have over 60

[[Page S241]]

percent of people who don't receive the full treatment they need. We 
should be working together on that, not taking away the access to 
treatment that people already have.
  This touches all of us in one way or another. I think all of us--our 
families, our friends--know someone. In my case it is very personal. I 
grew up with a loving, wonderful father who became ill when I was in 
elementary school. He was misdiagnosed and mistreated for years, and 
finally was accurately diagnosed as being bipolar, meaning he had a 
chemical imbalance in the brain. So contrary to other people who may 
have a sugar imbalance and they take their insulin because they are 
diabetic or they may have some other chemical change or imbalance where 
they can get treatment that has been covered under health insurance, if 
it is a chemical imbalance in their brain, up until the Affordable Care 
Act, it was not required to be covered under health insurance. It was 
not required, even though we passed policies stating that there should 
be mental health parity. For the first time, in the Affordable Care 
Act, we said in every definition that, when we talked about health 
care, it would include behavioral health, mental health, and substance 
abuse. As a member of the Finance Committee, that was a top priority 
for me. I indicated to the chairman at the time that I would not 
support any health care reform that did not define essential health 
care benefits as including mental health and substance abuse services. 
We know that definitions drive every new system, and we were successful 
in making sure that, in every part of health reform, we defined health 
care in a comprehensive way for the first time.
  Mental health used to be considered a preexisting condition--not any 
more. Health insurance companies can no longer deny you coverage or 
raise your rates because you need mental health treatment. My dad 
struggled with that throughout his life. When he was finally diagnosed 
correctly and got the medications and the help that he needed, he never 
went back into the hospital again. I have seen what happens when 
someone doesn't get the help they need and when they do and the 
challenges to the families as well, and I am committed to making sure 
that services and treatment are available for every family.
  Americans now have coverage for preventive services like depression 
screenings with no cost-share. You can see your doctor to get help 
without breaking the bank. Mental health and substance abuse are also 
now guaranteed benefits, as I mentioned before. They are covered as 
essential health care benefits. Why in the world would we not want to 
do that? Why would we say we want people to have access to health care, 
but it depends on what part of the body your disease is in?
  That makes absolutely no sense. The Affordable Care Act makes sure 
that our law defines comprehensive health care from your head to your 
toes. It is the right thing to do.
  These are all commonsense reforms, and we cannot afford to roll this 
back. A Harvard Medical School and New York University study released 
just this morning shows that if the ACA were repealed, 1.2 million 
Americans with serious mental disorders and 2.8 million Americans with 
substance abuse disorders would lose some or all of their coverage. 
This is 4 million people losing treatment that is allowing them to get 
help, move on with their lives, and be productive citizens as we all 
want to be and as we all want to have available to our family members.
  Think of all the millions more who could again be in a situation of 
not being able to afford insurance once relabeled with a preexisting 
condition. The opioid treatment gap--the gap between the number of 
people who seek services and those who can find or afford--would 
increase by 50 percent if the ACA is repealed. There would be 50 
percent more people unable to find or afford services.
  We just had major debate on the floor and passed grant funding to 
help with this very serious issue. But why in the world should we say 
for a critical part of health care affecting every family, one out of 
five Americans, that it will be only around grants and not a part of 
our comprehensive health care system?
  What happens now? The grant runs out: Gosh, I am so sorry you are 
sick. I am so sorry that you need to see a therapist or that you need 
medications. I am so sorry the grant ran out.
  I don't think we would do that to somebody who had a heart attack: I 
am so sorry you have had a heart attack. You need surgery, but the 
grant ran out.
  But with mental health illness, that is what happens every day. That 
is what happens.
  Frankly, it is outrageous that we don't have a comprehensive health 
care system that is completely treating and responding in every way and 
reimbursing physicians and nurses for all of the different kinds of 
treatments, services, and medical help they provide.
  We have put into law in the ACA that insurance companies cannot 
discriminate, you cannot have larger copays, you cannot have caps on 
services, you cannot have larger premiums--and this is a fundamental 
baseline right that we have placed into law as it relates to access to 
mental health and substance abuse services. To see that ripped away 
from Americans across the country is unbelievable to me. It is totally 
unacceptable.
  The amendment we are offering would create a budget point of order 
against any legislation that comes to this floor that reduces access to 
mental health services for children, for adults, for seniors in this 
country. I would hope that all of us could join together and state 
through our votes that we understand how important these services are 
and what a difference they have made. Right now, repeal of the ACA 
means 4 million people will lose those services, not counting all of 
the others that would be blocked because of future access problems and 
preexisting conditions and caps on services and all of those patient 
protections that go away.
  I hope that we will join together in a bipartisan way, as we have 
done on bills such as the Cures Act and others, to say we understand 
this is the fundamental piece. It starts with mental health parity. To 
me it is incredibly hypocritical to talk about these issues and want to 
provide grant funding when the fundamental question of whether mental 
health and substance abuse services covered under your insurance are 
ripped away, which is what will happen with the repeal of the 
Affordable Care Act.
  I urge my colleagues to support our amendment.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Arkansas.


                        Remembering Stanley Russ

  Mr. COTTON. Mr. President, my home State of Arkansas lost one of its 
great statesmen last week with the passing of former State Senator 
Stanley Russ.
  Stanley was a man of the soil. Born in Conway, he grew up on a dairy 
farm just outside the city. He went through the public school system 
and earned a degree in agriculture from the University of Arkansas. 
Although he spent the bulk of his career in the life insurance 
business, over the years he continued to raise cattle. Even when he was 
an old man, you could find him clearing brush on the road to his house. 
That is how we thought of him--always keeping busy, always working, and 
always in touch with the needs of the land and its people.
  As a veteran, I have to say that one of the things I most admired 
about Stanley Russ was his military service. He served in the Army for 
2 years, completed Officer Candidate School, and became an instructor 
in artillery. After being discharged, he served as a company commander 
in the Arkansas National Guard for several years. In 1995, Stanley was 
inducted into the U.S. Field Artillery OCS Hall of Fame at Ft. Sill, 
OK.
  His true calling in life was public service. Stanley represented 
Conway for 26 years in the Arkansas State Senate. More impressive than 
his lengthy tenure was his unimpeachable integrity. Stanley Russ was 
universally known as good, sturdy stock. The story is often told that 
during his first campaign, one of his opponents had some of his poll 
watchers thrown in jail. But Stanley won the race anyway and went on to 
pass legislation protecting the rights of all poll watchers. He served 
in the senate with distinction, championing quality education for all 
of Arkansas' students and eventually rising to the office of president 
pro tempore.

[[Page S242]]

  Stanley Russ was a model for all of us in public service. I got to 
know Stanley well in my first campaign. He remained a friend and 
trusted source of advice and support until he passed away.
  I have heard Stanley died peacefully, surrounded by his loving family 
as his granddaughter sang the hymn, ``Great is Thy Faithfulness.'' In 
his words, he considered himself ``greatly blessed, highly favored, 
imperfect, but a forgiven child of the King.''
  But perhaps the best summing up was given by the man who now holds 
his seat, State Senator Jason Rapert. As Senator Rapert put it, Stanley 
Russ was ``the kind of man that God made only one time.''
  As I stand on the Senate floor, I wish to say on behalf of our 
grateful State: Stanley Russ, rest in peace.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Mississippi.
  Mr. WICKER. Mr. President, I rise this afternoon to join my 
colleagues in expressing support for S. Con. Res. 3, the budget 
resolution which, as most Americans now know, is the vehicle we will 
use to begin the repeal and replacement of ObamaCare.
  This is a matter of keeping our word to the American people. This is 
a matter of keeping our promises that we have made, not only during the 
last campaign cycle but repeatedly since I voted against this bill some 
8 years ago. It was enacted in January of 2010.
  Republicans on this side of the aisle and many Americans repeatedly 
opposed the ObamaCare expansion of Federal power. We said it wouldn't 
work. We said the President would not be able to keep his promises to 
the American people and when we got a chance to go back into the 
majority, we would repeal that act. On this side of the aisle, this is 
a followup on years and years of determination on our part to right 
this wrong, to keep our promises, and come up with a better plan to 
help Americans have coverage they can afford and a doctor they can 
keep.
  I intend to support the chairman of the Budget Committee in the votes 
we will have today and tonight. We have what some people call the vote-
arama tonight. A number of votes will be taken in rapid succession, and 
we don't know how many will actually be offered by our friends on the 
other side of the aisle. I believe I will be able to vote against all 
of these amendments because I think keeping a clean bill makes it more 
likely we will be able to pass this legislation, send it to over to the 
House of Representatives where it can be tweaked but passed and get 
back to us for final approval, and actually get a bill to President-
elect Trump after he takes office, repealing ObamaCare so we can 
replace it with something that works.
  This is our opportunity to keep our campaign promise. This is our 
opportunity to help the President-elect and the Vice President-elect 
keep their campaign promises and show to the American people that 
elections have consequences and that at least this group of public 
officials intends to keep our word with regard to this piece of 
legislation. It was well intended, no doubt, but it could not possibly 
have worked to do the things that President Obama said it could do.
  In 2009 and 2010, the President told us: If you like your health 
plan, you get to keep it. It turns out that is a promise that was not 
kept because it could not be kept.
  The President said: If you like your doctor, you can keep that 
doctor. Again, this is a promise this administration and our Democratic 
friends on the other side of the aisle were unable to keep. That is why 
so many people around the country are opposed to keeping ObamaCare. 
They want it to be repealed. They want a drastically different approach 
involving market principles to be put in its place so it will work for 
patients and work for the American people.
  ObamaCare is not working. It is not working in my home State of 
Mississippi. It is not working for millions of Americans who lost their 
health insurance. It is it is not working for millions of Americans who 
saw their premiums rise and their deductibles go to unimaginable 
heights.
  Of course, I know the Presiding Officer and I have heard from 
constituents at home, and I am going to take this opportunity to share 
with you some of the views I have heard from people in Mississippi who 
are looking to us in the House and in the Senate to rectify this 
situation with regard to this disastrous piece of legislation.
  A 62-year-old individual from Madison, MS, wrote to me saying:

       Please explain the term ``affordable'' in the Affordable 
     Care Act. . . . I recently went to Healthcare.gov to look at 
     possible health insurance plans. . . . The estimates range 
     from over $18,000 to over $26,000 per year. That is anywhere 
     from 13.5% to 18.6% of our gross salary. So forget about 
     saving for retirement. The system is flawed.

  Another Mississippian wrote to me:

       I have read in many publications about the increases in 
     premiums for ObamaCare, but that is actually a moot point 
     when the only insurance . . . that my doctor and my wife's 
     doctor will take is PULLING out (of the exchange) leaving my 
     wife with no choice but to possibly return to work just for 
     the insurance.

  A third constituent from Saltillo, MS, wrote:

       I just applied at the market place for health insurance. My 
     quote was $415 monthly with a deductible of $6850. I work 
     less than 30 hours a week in retail. There is no way that I 
     can afford that.

  This constituent from Saltillo goes on to say:

       What am I supposed to do? I have a car payment and I need 
     to eat.

  Well, I think help is on the way. The action we are going to take 
this week in sending this resolution over to the House of 
Representatives is a form of keeping our promise and providing 
assistance to this constituent of mine.
  These stories go on and on. For a woman in Gulfport whose husband 
lost his job, the cheapest plan in the ObamaCare exchange was $1,042 
with a $13,000 deductible. This constituent calls ObamaCare ``legalized 
extortion.''
  A 60-year-old constituent was understandably upset when his insurance 
went up by $113 a month. He then noticed that coverage he didn't 
request had been added to his policy without wanting it or needing it. 
Pediatric dentistry and birth control were required on this plan, two 
things neither he nor his wife want to use or want to pay for.
  So I want to remind my colleagues that ObamaCare is hurting 
individuals--individuals who have written to me, and individuals who 
have written to all of my colleagues, but it is also hurting small 
businesses in Mississippi and small businesses in Pennsylvania and 
around the country. I would remind my colleagues that most jobs in the 
United States are created not by large corporations, not by the big-
ticket manufacturing plants that come into our States and districts 
that we like to have, but by small businesses--businesses of under 200 
people.
  A small business owner in South Mississippi wrote to me. Following 
her husband's retirement, she had to find health care through the 
exchange. Her county borders Louisiana, and many Mississippians travel 
across State lines for work. The health care network that she has used 
for 20 years is no longer an option for her because ObamaCare policies 
do not allow beneficiaries to use networks in different States. That is 
also something we need to address when we finally put in place the 
replacement portion of this mechanism.
  The plan for this nonsmoker, with no preexisting conditions, under 
the exchange cost her $900 a month in premiums and she was not able to 
keep her doctor.
  It is not just constituents in my more or less Republican State, 
among my more or less Republican constituents in the State of 
Mississippi who are telling the truth about ObamaCare. I want to quote 
Bill Clinton, speaking on behalf of his wife in Flint, MI, on October 4 
of last year. Former President Bill Clinton said this:

       You've got this crazy system where all of a sudden 25 
     million more people have health care, and then the people who 
     are out there busting it, sometimes 60 hours a week, wind up 
     with their premiums doubled and their coverage cut in half. 
     It is the craziest thing in the world.

  President Bill Clinton said that just last year in Flint, MI.
  I think if we come to grips with this, we will admit that this is a 
crazy system. It was well intended by some of my Democratic friends but 
one that has failed; one that has failed the American people and one 
that has failed to keep the promises that were solidly made when the 
bill was rammed through on a strictly partisan basis. Every Democrat 
was supporting it. No Republicans were supporting it at all.

[[Page S243]]

There was no Republican input, no bipartisan input on overhauling one 
of the most significant systems in our country.
  It is time for us to move forward, and tonight is a step forward. We 
certainly aren't going to get it all done in one fell swoop, and even 
when we get the bill signed into law by our new President Donald Trump, 
it will take a while for it to be put into place. Tonight we show that 
we meant what we said and we said what we meant, and we are going to 
follow through. We are going to pass this resolution tonight and begin 
the process of keeping our promises to the American people to repeal 
ObamaCare and replace it with something that works for the millions and 
hundreds of millions of Americans out there who depend on us for good 
policy.
  Seeing no other Members seeking recognition, I suggest the absence of 
a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mrs. Ernst). Without objection, it is so 
ordered.


                                 Russia

  Mr. DURBIN. Madam President, the most popular dictionary defines an 
act of war as an act of aggression by a country against another with 
which it is nominally at peace. Let me repeat, an act of aggression by 
another country against another with which it is nominally at peace.
  On Friday, America's intelligence community issued a damning, 
detailed assessment concluding that Russian strongman President 
Vladimir Putin ordered an attack on our Nation's electoral system to 
sow mistrust and favor one candidate over another. The evidence was 
sweeping, overwhelming, and troubling.
  The key findings, quoted directly from the public version of this 
report from the intelligence agencies, said as follows:

       Russian efforts to influence the 2016 U.S. presidential 
     election represent the most recent expression of Moscow's 
     longstanding desire to undermine the U.S.-led liberal 
     Democratic order, but these activities demonstrated a 
     significant escalation in directness, level of activity, and 
     scope of effort compared to previous operations.
       We assess Russian President Vladimir Putin ordered an 
     influence campaign in 2016 aimed at the U.S. presidential 
     election. Russia's goals were to undermine public faith in 
     the U.S. Democratic process, denigrate Secretary Clinton, 
     harm her electability and potential presidency. We further 
     assess that Putin and the Russian Government developed a 
     clear preference for President-elect Trump.
       We also assess Putin and the Russian government aspired to 
     help President-elect Trump's election chances when possible 
     by discrediting Secretary Clinton and publicly contrasting 
     her unfavorably to him.

  They go on to talk about the types of influence Moscow inspired.
  I am not going to stand here and argue that if the Russian efforts 
had not taken place, there would have been a different outcome in the 
election. No one will ever know that. And when asked directly, the 
intelligence agencies, despite these strong statements, say there is no 
evidence of direct vote tampering or tampering with election equipment, 
thank goodness. That isn't the point.
  The point is, Vladimir Putin and the Russians did what they could to 
influence our election. Americans should stand up and listen because 
what is at stake is the sovereignty of our Nation and the reliability 
and integrity of our election process.
  What the Russians did was truly staggering and momentous--a foreign 
adversary intentionally manipulating America's democracy and election. 
I don't know if it is an act of war by classic definition. It is an 
attack on our Nation by any definition. It should not go unanswered.
  For those who have been following Vladimir Putin's bullying actions 
over the last several years, this is no surprise. Instead of building a 
modern global economy based on the great talents of the Russian people, 
he and his closest neighbors have created false enemies in the West, 
sadly and dangerously creating a narrative that domestic Russian 
problems are really the result of NATO, the United States, and the 
West.
  He has tried to discredit the West and its Democratic free market 
institutions. He has used manufactured enemies of Russia to rally 
domestic support for his tactics and leadership.
  It is, ultimately, a tired narrative that when combined with domestic 
political repression and manipulation, helps keep Putin in power.
  Let's not be fooled into thinking his actions are merely annoying. 
The threats are real and dangerous, and they go directly not just at 
the United States but many of our strongest allies.
  I have a list which I ask unanimous consent be printed in the Record 
in detail.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       April-May 2007 Estonia: Angered by an Estonian plan to move 
     a Russian World War II memorial and Russian soldiers' graves, 
     Russia disabled Estonia's internet with a particular focus on 
     government offices and financial institutions.
       June 2008 Lithuania: Similarly, when the Lithuanian 
     government banned the display of Soviet symbols, Russian 
     hackers defaced government web pages with hammer-and-sickles 
     and five-pointed stars.
       August 2008 Georgia: After Georgia's pro-Western government 
     sent forces into a breakaway Russian-backed region, Russian 
     hackers shut down the country's internal communications to 
     coincide with a military seizure of Georgian territory.
       January 2009 Kyrgyzstan: As part of an effort to persuade 
     the president of Kyrgyzstan to evict a U.S. military base, 
     Russian hackers shut down two of the country's four internet 
     service providers. Kyrgyzstan in turn removed the base and 
     received $2 billion in Russian aid.
       April 2009 Kazakhstan: After Kazakh media published a 
     statement by the country's president that criticized Russia, 
     a Russian-attributed attack shut down the publication's site.
       August 2009 Georgia: Russian hackers shut down Georgian 
     Twitter and Facebook on the first anniversary of the 2008 
     Russian military invasion.
       May 2014 Ukraine: Three days before Ukraine's presidential 
     election, a Russia-based hacking group attacked and disabled 
     the country's election commission, including its backup 
     system. Ukrainian officials say the arrested hackers were 
     trying to rig the results in favor of the pro-Russian 
     candidate.
       March 2014 Ukraine: As in Georgia, Russian allegedly 
     coordinated military and cyber attacks, disabling the 
     internet in Ukraine while Russian-armed proxies seized 
     control of Crimea.
       May 2015 Germany: German investigators discovered hackers 
     had penetrated the computer network of the German Bundestag, 
     the most significant hack in German history. Security experts 
     said hackers were also trying to penetrate the computers of 
     Chancellor Angela Merkel's Christian Democratic Party.
       December 2015 Ukraine: Hackers believed to be Russian took 
     control of a Ukrainian power station, locking controllers out 
     of their own systems and cutting 235,000 homes from power.
       October 2015 Netherlands: Security experts believe Russia 
     tried to hack into the Dutch government's computers to remove 
     a report about the downed Malaysian airliner over Ukraine. 
     The Dutch Safety Board eventually concluded that the 
     passenger plane was brought down by a Russian-made missile 
     fired from an area held by pro-Russian rebels in eastern 
     Ukraine.
       January 2016 Finland: A security firm announced that it 
     believes Russian hackers were behind attacks on Finland's 
     Foreign Ministry several years before.
       December 2016 Germany: The head of German intelligence 
     warned last month, ``There is growing evidence of attempts to 
     influence the federal election next year,'' specifically 
     citing Russia as the source of the attacks, adding, ``We 
     expect a further increase in cyber-attacks in the run-up to 
     the elections.'' Experts believe Russia wanted to undermine 
     Chancellor Merkel who has supported sanctions against Russia 
     for its actions in Ukraine.

  Mr. DURBIN. Madam President, NBC News compiled a document of activity 
by Russia and Vladimir Putin. It starts in April of 2007 in Estonia, 
where the Russians were disabling their Internet; in June 2008, in 
Lithuania, where the Russian hackers were defacing government Web 
pages; in August 2008, in Georgia, where the Russian hackers shut down 
the country's internal communications system; in January 2009, in 
Kyrgyzstan, as part of an effort to persuade the President there to 
evict a U.S. military base, the Russian hackers shut down two of the 
country's four Internet service providers.
  April of 2009 in Kazakhstan. After Kazakh media published a statement 
by the country's president that criticized Russia, Russian-attributed 
attacks shut down the publication's Web site.

[[Page S244]]

  August 2009 in Georgia, there was similar activity; May 2014 in 
Ukraine; March 2014 in Ukraine; May 2015 in Germany; December 2015 in 
Ukraine; October 2015 in the Netherlands; January 2016 in Finland; 
December 2016 in Germany.
  Of course, there was also the Russian military seizure of sovereign 
territory in the nation of Georgia in 2008 and their invasion of 
Ukraine in 2014. In fact, Russian forces and their proxies still hold 
captured land in Georgia and Ukraine, and from that spot in Ukraine 
separatists shot down a civilian airliner 2 years ago, murdering 283 
innocent passengers, including 8 children.
  This is our adversary. This is the man who is trying to undermine the 
American electoral system. We cannot take it lightly.
  Twenty years ago, when I was elected to the Senate, I was a member of 
the Government Affairs Committee. The first hearing we had was a 
lengthy investigative hearing. What was the basis of it? We had just 
concluded a Presidential campaign, and allegations were made that the 
Chinese Government 20 years ago was trying to insert itself into the 
Presidential campaign of the United States, specifically in support of 
the Clinton-Gore ticket.
  Fred Thompson was chairman of that committee, a pretty well-known man 
who has since passed, but he was a pretty outstanding lawyer in 
addition to being a pretty famous actor. He was my chairman. He spent 
months in public hearings investigating whether the Chinese tried to 
insert themselves in any way, shape, or form in the election of 
Clinton-Gore. They found virtually no evidence, other than a handful of 
Buddhist nuns writing checks to the campaign, which nobody ever really 
explained. But there was no evidence that the Chinese Government was 
involved in this in any specific way. We spent months on that theory in 
open hearings, and then published reports--conflicting reports on 
conclusions from that committee. We took it that seriously 20 years 
ago.
  What are we doing about this? Well, Senator McConnell, the Republican 
leader, said that we will do the regular order; we will let the regular 
committees go about their business and figure out what might have 
happened in the course of that. That is not good enough. Regular order 
may put this investigation in the Intelligence Committee. Do you know 
what that means? It means you are not going to see their hearing. You 
are not going to be able to see their witnesses and listen to their 
testimony, and much of the evidence that is going to be presented will 
never be shared with the public.
  I understand the need to protect classified material. We must do 
that. I insist on that. But at the same time, we need to answer some 
basic questions about what Russia tried to do in this last election and 
to make it clear to them and to the world that the United States is not 
going to be a sucker. We are not going to allow anyone who can hack 
into our systems to try to undermine the electoral system of the United 
States. We are proud Americans. We will handle our own elections, thank 
you. Keep your hackers out of business in the United States.
  Recently, we have had allegations--and I underline the word 
``allegations''--of other involvement of the Russians with the Trump 
campaign and the preparation of certain documents, which have not been 
collaborated as of this date. They may lead to nothing, but they 
certainly deserve investigation so that we know what the facts may be.
  Yesterday at the Senate Judiciary Committee, I asked Senator Jeff 
Sessions of Alabama, a man who is aspiring to be Donald Trump's 
Attorney General, if he could recuse himself from investigations into 
Russian connections with the Trump campaign. He had just said earlier 
he was going to recuse himself from investigations involving Hillary 
Clinton. Senator Sessions said, ``I would review it and try to do the 
right thing as to whether or not it should stay within the jurisdiction 
of the attorney general or not.''
  I hope that Senator Sessions, if he in fact becomes the Attorney 
General, will have some second thoughts. It is far better to consider a 
special counsel in the Department of Justice in light of the political 
circumstances of these allegations.
  Secondly, we need to have a select committee--not the Intelligence 
Committee--of either the House or the Senate that will meet and 
consider this information and investigate it in a responsible way. In 
fact, I think it is of such gravity that we ought to consider a public-
private commission--a commission of elected officials, as well as 
private citizens, whom we respect. I think of the names of General 
Colin Powell and former Supreme Court Justice Sandra Day O'Connor as 
chairs and cochairs of that effort, people of unquestionable integrity 
who will make the right findings for America and not for any political 
reasons, as far as I am concerned.
  Today, I asked Michael Mukasey, former Attorney General under 
President George W. Bush, whether the Attorney General has the 
authority to shut down an FBI investigation, and he answered very 
simply, ``yes.'' So we need more information. We need to make sure that 
this is taken seriously and that we address it in a serious manner 
because it is a serious issue.
  What, in fact, has been the response from the other side of the 
aisle? With a few notable exceptions, that party of Ronald Reagan, the 
40th President--who really understood the old Soviet regime--has 
greeted this information with near silence. That is right. Except for a 
few voices--my colleagues Senators Graham and McCain in particular--
there has been near silence.
  How in the world did an attack ordered by a former Soviet KGB 
official on our Nation become a partisan issue that is largely ignored 
by a majority of one of our Nation's two great political parties? How 
did the Republican Party, which now controls both Chambers of Congress, 
decide that repealing health care insurance for millions of Americans 
was the most urgent, first priority to deal with amid this sweeping 
evidence of a Russian attack on our democracy? Ronald Reagan must be 
rolling in his grave.
  Does anyone remember his clarity about standing up against attacks on 
the West and its allies when the Soviets shot down a civilian Korean 
airliner in 1983? This is what President Reagan said:

       And make no mistake about it, this attack was not just 
     against ourselves or the Republic of Korea. This was the 
     Soviet Union against the world and the moral precepts which 
     guide human relations among people everywhere. It was an act 
     of barbarism born of a society which wantonly disregards 
     individual rights and the value of human life and seeks 
     constantly to expand and dominate other nations.

  There was a time in this town when national security issues were 
truly bipartisan, when security meant patriotically putting aside 
partisan agendas. Can anyone here imagine for a second--just one 
second--the debate we would be having here now if the situation were 
reversed? The House alone spent millions of dollars on countless and 
ultimately fruitless investigations into the tragic events of Benghazi. 
Here we are, with overwhelming evidence of an actual attack on our 
Nation, and the majority party is largely silent. That is incredible. 
It is quite simply an abdication of political responsibility not to 
address a verified national security threat to our Nation.
  With the release of Friday's report, I urge my colleagues to read 
both the public and classified reports. The classified version contains 
the same damning and sweeping conclusions I mentioned here today from 
the public document, but it goes into detail. As such, I urge this body 
to come up with an appropriate response to this attack. I have joined 
in bipartisan Russian sanctions legislation with Senators Cardin, 
McCain, Menendez, Graham, Shaheen Rubio, Klobuchar, Sasse, and Portman. 
We urge that we quickly advance as an urgent priority Russian sanctions 
to make it clear that what they have done is reprehensible, 
unacceptable, and will not be tolerated.
  This Congress can also do what many tried to do in the past and 
failed--which is certainly timely--and that is pass meaningful cyber 
security legislation.
  We have to maintain our strong NATO Alliance, stand firm against 
Russian meddling or attacks, and tell our friends in the Baltics and 
Poland, in particular, that we stand by their side, that nothing has 
changed, and that our friends in Ukraine can trust that we will be with 
them as they establish democratic sovereignty. We must work with the 
new administration to fully accept and counter this

[[Page S245]]

Russian threat. We must work to undermine any such future attacks at 
home and against our allies. We should get to the bottom of the 
extremely troubling allegations that have been made recently.
  Yes, ultimately we must work with Russia where those efforts serve 
our global interests--and I think there will be some common areas--but 
we must not do so from a position of weakness. We will never be taken 
seriously by Putin or our adversaries otherwise.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from South Carolina.


    Congratulating Clemson on Winning the College Football National 
                              Championship

  Mr. GRAHAM. Madam President, there are a lot of pressing issues going 
on in the country and in the world. These are tough, turbulent times. 
But Senator Scott and I are going to take a moment or two to talk about 
a topic that I think millions of Americans appreciate: college 
football.
  In the South, where Tim and I come from, it is as close to being a 
religion as you can get, and we are here to celebrate Clemson 
University becoming the national champion in college football, beating 
Alabama in the best college football playoff game I have ever witnessed 
in my life.
  To the people of Alabama: You had one heck of a ride, a 26-game 
winning streak, something you should be proud of.
  To the Tigers: You beat the best team in the country, and, to me, the 
way you won is as important as the outcome.
  DeShaun Watson is probably going to go in the very top of the draft 
to the NFL. I would say he is the best college football player in 
America. What DeShaun has won for Clemson is unbelievable. The way he 
has done it is even more unbelievable. He graduated in 3 years. He is 
one of the nicest young men I have ever met in my life. His faith means 
a lot to him.
  He threw the ball to Hunter Renfrow, who was a walk-on--a young man 
from a small town in South Carolina who walked on to the Clemson 
University team. Because of Coach Dabo Swinney, he had a shot at making 
the team and wound up catching the winning pass to win the national 
title.
  How is this possible? It is possible because of leadership at the 
top. President Clements, our new president, has a vision of Clemson 
University as aggressive and bold off the field as Dabo has had on the 
field. I think Dabo Swinney represents the best in college sports. The 
Clemson team is truly a family. If I had a son, I would want him to 
play for Dabo.
  If you are looking for a place to go to school where you would be 
academically challenged, go to Clemson. If you are looking for a place 
to go to school or to be a part of a community, something bigger than 
yourself, go to Clemson. If you are looking for a place to watch sports 
at the highest level possible, go to Clemson.
  So I congratulate the Tigers. Who you beat was impressive, but more 
impressive is how you have conducted yourself over the last couple of 
years.
  The Clemson program is a model for college athletics. Dabo has an 
uncanny ability to take people from different backgrounds and mold them 
into a team. He loves his players and they love him.
  I live 5 miles from Clemson University and went to the University of 
South Carolina, and most of you don't know what that means: the biggest 
rivalry.
  I am proud of Clemson. I grew up in the shadow of the university, 5 
miles from the stadium. I have been around the Clemson Tiger family all 
my life. They conferred an honorary degree upon me a couple of years 
ago. Given the academic standards at Clemson, that is the only way I 
would have ever graduated from Clemson.
  So I want to tell the Tiger Nation that all of us in South Carolina 
are so proud of your victory on the field, but equally proud of the way 
you conduct yourself off the field. Clemson University is in the top 20 
public schools in the country, with no end in sight.
  Next year, if I were an Alabama fan, I would be very optimistic. This 
young freshman quarterback is coming back. He is an incredible talent. 
The people of Alabama should be proud of their football team and their 
coaching staff because you have been on top of the mountain for a very 
long time. I hope you believe that Clemson is a worthy successor.
  Dabo said it best, ``The [tiger] paw is flying on the top of the 
mountain'' of college football, and that is saying a lot.
  Go Tigers.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. SCOTT. Madam President, I ask unanimous consent to display my 
Clemson flag.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. SCOTT. Madam President, I think it is important for us to realize 
and note that while Senator Graham did in fact grow up just a few miles 
from Clemson--which means his affinity for the university is natural--
it is consistent with his upbringing. For me, it is very different. 
When you are born in South Carolina, and you are born on the coast near 
the Atlantic Ocean, the likelihood of your being a Gamecocks fan and 
wearing garnet and black is about 75 percent. So I must concede that I 
still pull for the Gamecocks. That is a controversial position to be in 
when you are talking about the new national champions.

  I would also like to say to Senator Shelby--a man of integrity, 
character, and long service--thank you for making the bet. I am so glad 
you lost.
  I would also say to the Clemson Tigers--the ``Tigers Nation''--we are 
so incredibly proud of what you have accomplished. It is amazing, not 
only the successful season that you have had on the field but the 
character that has been the focus of so much of the conversation off 
the field.
  We have talked specifically about No. 4, Deshaun Watson, and the 
amazing story about his relationship with his mother. I have a special 
relationship with my mom. So I appreciate his focus and determination 
to honor her when he is on the field and to continue to honor her when 
he is off the field. That story is a remarkable story that deserves 
more attention. It really does.
  As to Coach Dabo Swinney, is an amazing coach, without any question, 
but he is also an Alabama alum. Having won the national championship as 
a part of the Alabama football team--I believe it was 1992--you have a 
champion come into Clemson University and making champions by loving 
compassionately, by challenging on the field, and by embracing these 
men and the entire apparatus around the university and college 
athletics. He has done a fabulous job.
  I think of the walk-on receiver that Senator Graham mentioned. In 
every facet of the team--whether you are the so-called water boy, 
whether you are the athletic trainer, whether you are a physical 
therapist--people win because of the team that they are on. There are 
no self-made success stories.
  We should remember that as we focus on these young athletes. I know 
their lives will be meaningful because of the team they played on and 
not simply the victories they celebrated.
  I do want to take a few seconds and mention the president, Jim 
Clements, who is a fantastic guy and one of my dearest friends. Jim and 
I were having a conversation through text before the game, and I 
decided, since we can't use our phones on the floor of Senate--I know 
they frown on that kind of stuff, technology; it is an interesting 
concept here--I decided to print the text. This was a Wednesday evening 
around 10 p.m. I had just predicted that Clemson would win, 27 to 24. 
Jim Clements said:

       Seriously if we play like we did last week then we win! I 
     believe it will happen!! 35-31. Go Tigers.

  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. LEE. Madam President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LEE. Madam President, I rise today to give voice to some of my 
fellow Utahns, including a few of my fellow Utahns who are suffering 
because of the health care law passed by this body nearly 7 years ago. 
These are not stories from wealthy Utahns who have simply had to pay 
higher taxes, nor are these stories from low-income Utahns who already 
have insurance through Medicaid.

[[Page S246]]

  These are letters are from the too often invisible victims of 
ObamaCare--those middle-class families who used to be able to afford 
health care when they needed it but are now forced to pay for it and to 
pay for what amounts to, in some cases, one of their largest payments 
or even their largest payment they make each month for a so-called 
insurance plan that never seems to pay out because of high deductibles.
  Jenica from Davis County, UT, writes as follows:

       I am an ordinary mother raising my kids and striving to 
     live within my means. For the first time, my family is facing 
     a year with no health insurance. Our gross income falls a few 
     hundred dollars per month too high for us to receive help 
     through CHIP or UPP programs, but we cannot afford to 
     purchase health insurance through my husband's work or 
     through the Marketplace. After this year's premium increases, 
     the most inexpensive plan offered to us on the Marketplace is 
     a full quarter of our gross income per month (before taxes), 
     and if we put that into our budget we will not be able to 
     save any money to pay deductibles as healthcare needs arise.
       We face the same problem with my husband's work insurance; 
     it would be even more expensive, and we cannot wisely budget 
     a quarter or more of our income toward health insurance 
     premiums.
       I know this problem is not limited to my family, and I want 
     you to be aware of those of us who are falling in the gap 
     this year. We earn barely too much to receive any assistance, 
     but not enough to actually pay for insurance premiums. It 
     seems the wisest course for us is to withdraw from insurance 
     and save our money to pay for medical expenses in cash, as 
     well as saving to pay the fine on our taxes next year.
       It is a decision I do not make lightly, as I know that the 
     insurance companies need more people, not less, to 
     participate to make the system work. However, my family 
     cannot afford to participate this year.
       I know you will represent us well and take our needs into 
     consideration as you work with the other members of Congress 
     to make our country's healthcare system work for all of us. 
     Thank you for serving our state and our country. May God 
     bless you in your efforts.

  May God bless you, Jenica. May God bless you for having the courage 
to write these things down and to share them with your fellow Utahns 
and your fellow Americans.
  I promised Jenica that I will do everything I can, everything within 
my power, to make sure that you and families like yours are not 
forgotten when we repeal this law and replace it.
  Trevor from St. George, UT, had a similar story. He writes:

       I recently got a new job and I'm trying to get healthcare. 
     None of the 3 plans my employer offers are affordable to me, 
     even though the government claims they are. Even if I were to 
     buy the cheapest plan, I would never be able to use it 
     because of the high deductibles.
       I do not qualify for Medicaid, and earn $1,000 per year too 
     much to qualify for subsidies.
       In a nutshell, I can't afford to buy insurance from 
     anywhere, and by not buying it, I can't afford the penalty 
     levied by the federal government. What is someone in my 
     position supposed to do?
       The ACA is not helping the very people it was designed to 
     help and is in fact throwing a terrible burden upon me and my 
     family. We need a new healthcare system. This one is not 
     working. Please share my story so that others will be aware 
     that people in my position (and there are many of us) are 
     struggling.

  I will share your story, Trevor, and soon we will be one step closer 
to a new type of system, a system that will put patients and doctors 
back in charge of health care decisions rather than having those 
decisions made by government bureaucrats in Washington.
  The last letter I would like to share today comes from Washington 
County, UT. Ron from Washington County writes as follows:

       Today I received a letter from my health insurance carrier 
     indicating that the premium for me and my two kids--yes, only 
     three people--is increasing from $1,020 per month to $1,706 
     per month, an increase of slightly over $8,200 per year. My 
     annual income for 2017 will not be increasing, let alone to 
     cover eight grand.
       Later this afternoon, I am contacting my travel agency (a 
     local small business) and asking Judy to cease her research 
     into my family vacation for the summer of 2017. Why would I 
     cancel my vacation and also take away revenue from a local 
     small business? The answer is ``67.26%.'' That is the 
     percentage increase for my health care insurance.
       I need you to see that this is real. It greatly and 
     negatively impacts my family and it subsequently impacts 
     local businesses as more of my money is drained from the 
     economy. I make roughly $60,000 per year. My medical premium 
     is now one third of my gross income! Plus, I still have to 
     pay out deductibles and copays.
       Even the bronze programs, which are worthless, are designed 
     to bankrupt a family and end up costing more in the long-run, 
     have exceeded the cost of the mortgage I took out on my St. 
     George home in 2014. More than my mortgage! Repeat more than 
     my mortgage. That should send shivers down anyone's spine.
       One of the most important aspects of America's middle class 
     is the ability for a family to purchase a home. Now that 
     insurance premiums have exceeded the mortgage payment of a 
     median priced home in the US, I suspect that the dream is now 
     slipping out of the hands of many Americans.

  Ron, you are absolutely right. Thanks to ObamaCare, the American 
dream is now slipping out of reach for far too many families throughout 
the State of Utah and throughout the entire country. These are not just 
the stories of a few isolated Utahns. These are not just stories from a 
few statistical outliers. There are fewer affordable options for Utahns 
throughout the State.
  In 20 out of Utah's 29 counties, Utahns can only choose a health plan 
from one insurance company. They have just one company to choose from, 
and the options available are not always as robust as they should be. 
Within those options that they have, the costs have risen far too much 
each year. For 2017 plans, insurance rates across Utah increased at 
least 30 percent, on average. This is after multiple years of 
substantial premium increases in the other years leading up to this.
  Fortunately, help is on the way. Thanks to President-Elect Donald 
Trump's victory this November--and thanks to the outcome of House and 
Senate races throughout the country--we now have the opportunity to 
uproot this ill-conceived health care law, root and branch.
  The old system, to be clear, is far from perfect. After we repeal 
ObamaCare, we still have much work to do unbundling health care from 
employer-provided health insurance so doctors, nurses, patients, and 
innovators can do the work of bringing down prices and increasing 
quality. That is what happens when we allow the free market to operate. 
We get competition. When people compete, two things happen that are 
important for consumers: Prices go down and quality goes up.
  That is what the American people have come to expect and basically 
every other sector of our economy. Sadly, we have seen the opposite 
become true with respect to our health care system under ObamaCare 
because we have restricted free market forces, and we have impeded 
competition. As a result, prices have gone up and quality, in some 
cases, has gone tragically down.
  Step one involves repealing this health care law. Trevor, Jenica, and 
Ron, I want you to know that I hear you. I hear you and I hear all 
Utahns who have contacted me to share their experiences with this 
health care law. My colleagues in the Senate have heard you too. We 
will repeal this health care law and we will bring reform and 
competition to our Nation's currently broken health care system.
  Madam President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. DAINES. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Gardner). Without objection, it is so 
ordered.
  Mr. DAINES. Mr. President, today is the day when we will begin to 
repeal and replace ObamaCare. Repealing and replacing this disastrous 
law is one of the top jobs that citizens elected us to get done. In 
many ways, it is why Donald J. Trump will be sworn in next week as the 
45th President of the United States.
  I think what is most helpful is to recap why repealing ObamaCare is 
so important to so many American families. Montanans were promised that 
with this bill you could keep the health plans that you liked. That was 
wrong and millions of Americans lost their plans.
  Montanans were assured that coverage under ObamaCare would be 
affordable. For millions of Americans, for thousands of Montanans, 
nothing could be further from the truth. Montanans were guaranteed that 
ObamaCare would lower health care

[[Page S247]]

costs. We witnessed premiums skyrocket since ObamaCare's 
implementation.
  Finally, Montanans were assured that ObamaCare would create more 
competition in the marketplace, but now Americans in one-third--one-
third--of the counties across our entire country have but one plan to 
choose from. Let's not forget, supporters of ObamaCare paid for these 
failed programs by raiding Medicare of over $700 billion. Seniors and 
people with disabilities in Montana and across our country deserve much 
better.
  Over the past several years, I have heard from countless Montanans 
about how ObamaCare has failed them. Take, for example, Terry from 
Choteau, MT, who wrote:

       We just got a letter from Pacific Source that our premium 
     is going up $260 per month and our deductible is going up to 
     $1000. This is $1025 per month and a $7500 deductible for 2 
     healthy adults [with] (no preexisting conditions). For a 
     ranch family this is a huge hit, especially in these times 
     with low commodity prices. Something needs to change.

  Jeff from Kalispell, MT, said this:

       I am married with 5 children. I live in Kalispell. I bought 
     Blue Cross Blue Shield of MT PPO Gold insurance plan #104 for 
     the 2016 year. My premium was $1,477.28 per month. In early 
     November 2016 [2 months ago] I received notice that my same 
     plan would increase to $2,820.00 per month. That is a 91% 
     increase. . . . If keeping the same rate hikes, my insurance 
     will be $5,500 in 2018, then $10,000 per month in 2019.

  That was from Jeff in Kalispell, MT.
  I have Anthony from Bozeman. That is my hometown. I went to college 
in Bozeman. A fellow Bozemanite writes this to me. He says:

       I have never been able to afford Obamacare insurance. With 
     quotes of over $400 a month for a single healthy male I found 
     it easier to pay the penalty. So now not only can I not 
     afford to have medical insurance but I am getting fined for 
     not making enough money to pay all of my bills and give a 20% 
     tithe to the medical insurance industry.

  Here is another Bozemanite, Kenneth. He writes this:

       For 2014 we had med insurance from Pacific Source for my 
     wife which was adequate and filled our needs. For 2015 
     Pacific Source canceled that policy, citing Obamacare rules, 
     and best alternative was 150 percent more expensive.
       We did it for 6 months and then canceled; it just took too 
     much from our budget. The IRS fined us $584 for missing 
     insurance for 6 months. We are doing without coverage for 
     2016 again because of the outrageous costs for this high-
     deductible policy. Our IRS fine will probably be about $1500.

  The list and the heartfelt stories go on. They all share one common 
theme: ObamaCare is not working. This ObamaCare hardship did not just 
impact Terry, Jeff, Anthony or Kenneth. Montanans, on average, face 
premium increases between 27 and 58 percent just this last year. This 
is year-over-year numbers.
  Last evening, I had a telephone tele-townhall meeting where thousands 
of Montanans joined me, thousands across the entire State. Every corner 
of our State was on the call last night. I asked a simple question. I 
asked: How many of you would want to repeal ObamaCare? An overwhelming 
82 percent said they support the repeal of ObamaCare.
  The reason why is quite simple. They did not get what was promised to 
them on this very floor of this Chamber back in 2010. ObamaCare is 
failing because it is a massive intrusion by the Federal Government. It 
is centered on raising taxes, huge spending increases, and heavy 
regulations from Washington, DC. It is straight from the Big 
Government, Washington-knows-best playbook, and that is what happens 
when Congress doesn't listen to the American people.

  You know, Montanans have very good horse sense. They know when 
somebody from Washington, DC, shows up and says: We have this 2,700-
page bill from Washington, DC, led by Nancy Pelosi, Harry Reid, and 
President Obama--Montanans know better. They know they should run for 
cover.
  And that is exactly what ObamaCare is and what is happening now to 
the American people.
  ObamaCare can't be tweaked. It has to be repealed. It needs to be 
replaced with better reforms. And we need to make sure that we do as 
much as we can as soon as we can so folks aren't having to deal with 
ObamaCare for much longer. People are hurting. It is time to replace 
it.
  I urge my Democratic colleagues to work with us. Don't use scare 
tactics.
  Unlike 2009, we are focused on a path forward that conveys practical 
benefits, not hopeless ideology. I ask them to accept the reality that 
ObamaCare is irreversibly flawed, it must be repealed, and it must be 
replaced with effective policies.
  I know there are comments out there about a plan and what is next. 
Well, for me, it is not that complicated. It is getting the costs down. 
You have heard the stories. The American people are asking for relief.
  For the generation of Americans just now entering the workforce--and 
that would be my kids; they are just entering the workforce--health 
care costs have increased by 77 percent. This is outrageous. It is 
unacceptable. These are supposed to be the easiest people to insure, 
yet ObamaCare seems intent on placing health care out of their reach.
  I believe there are policies that are fundamental to any health care 
system, and it will be working and fighting for provisions that provide 
access to affordable insurance, that protect people with preexisting 
conditions, that allow young adults to stay on their parents' coverage 
until age 26, that return decisionmaking authority back to the States, 
that will eliminate these harmful Washington regulations and mandates, 
that will empower the American people with greater access to health 
savings accounts.
  That was part of the health care system that was actually working 
pre-ObamaCare, and ObamaCare moved in and slashed health care savings 
accounts.
  We need to make it easier to purchase health insurance across State 
lines, encourage and incentivize work among able-bodied Americans, and 
uphold fiscal responsibility by preserving and protecting Medicare for 
our seniors.
  I very much look forward to working with the nominee for the U.S. 
Department of Health and Human Services, Dr. Tom Price. I served with 
Dr. Price in the House. There is not a better leader at this point in 
time in our Nation's history to assume the leadership of the Department 
of Health and Human Services. He is a doctor, has served in Congress, 
and will be able and ready to lead from day one.
  We will work together to find the best solutions, Montana solutions, 
solutions that work for our respective States, for people like Terry, 
for Jeff, for Anthony, for Kenneth, and for the thousands of other 
Montanans who have been harmed by this law.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Lee). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SCHUMER. Mr. President, I wish to speak briefly and pointedly 
about the budget resolution before us which will, at some late hour, 
culminate in a final vote. Whether that vote is tonight or in the dark 
hours of early morning, with it, Republicans are taking their first 
step into a box canyon.
  Now, I hear my Republican colleagues talking more and more about 
doing repeal and replace together, but let me be very clear. This 
budget resolution is not repeal and replace. It is one thing and one 
thing only: the first step of repealing the Affordable Care Act, 
ripping health care away from tens of millions of Americans, and 
throwing our health care system into chaos. It will, as many have 
repeated across the land over the last few weeks, make America sick 
again.
  Over the past few weeks, this fact has made some of my more 
thoughtful colleagues nervous. I understand that. I would be nervous if 
I were them too. My friends, the Senators from Maine, Arkansas, 
Tennessee, and Kentucky, have all quite forcefully voiced their concern 
with repealing health care reform without a scrap of a plan of what to 
do next.
  Now the President-elect has tweeted that they should do repeal and 
replace at the same time. Today he said Republicans would repeal and 
replace the law essentially simultaneously, but that is not what this 
budget resolution would do.
  We are here because the Republicans are flummoxed. It is a bit like 
an

[[Page S248]]

Abbot and Costello show. Republicans in Congress and the President-
elect are pointing at each other, waiting for the other one to come up 
with the plan--``You do it. No, you do it''--because no one can come up 
with a repeal plan that keeps the benefits of ACA.
  This confusion of the Republicans makes sense because the Republicans 
are in a pickle and driving into that box canyon. They promised every 
conservative group and audience in the country for the past 8 years 
that they would repeal health care reform ``root and branch,'' but 
actually it is only their base that wants repeal. Most Americans want 
us to keep the law and work to improve it.
  In a recent Politico/Morning Consult poll, only 28 percent of 
Americans support repealing the law if there is no current plan for 
replacing it--less than one-third. This is the Republican base.
  Two-thirds of Americans support the provisions that prevent insurance 
companies from denying coverage to patients with preexisting 
conditions, 63 percent support letting kids stay on their parents' plan 
until they are 26, and there are similar numbers on the other major 
benefits of health care reform. Those are the key features. Those 
aren't extraneous. Those are the heart and soul of the Affordable Care 
Act. The Republicans are in a pickle. They cannot please their base and 
the broader public at the same time so President-Elect Trump says to 
Congress: You come up with replace.
  The Congress says to the President: You come up with replace.
  Abbot and Costello.
  No replace. We haven't seen one yet, and it has been 6 years.
  From a policy perspective, our Republican friends can't repeal a law 
and keep in place the provisions that are overwhelmingly popular with 
the majority of Americans. That is why they are in such a pickle.
  The Affordable Care Act is not despised by the American people, only 
the hard right of the Republican base, which is fervently anti-
government. It is an ideology. It doesn't matter how much ACA helps 
people. If the government did it, we don't want it. They oppose health 
care because they oppose everything that government does. They oppose 
Medicare, Medicaid, even Social Security.
  If Republicans go forward with this plan, they may mollify their 
base--the base will stop complaining--but they will ostracize and hurt 
the American people and ultimately lose in the court of public opinion.
  There is a much more responsible course of action that I urge my 
friends on the other side of the aisle to consider: abandon repeal.
  We Democrats are willing to work with our Republican colleagues on 
improving the existing law. We will even look at a comprehensive 
replacement plan if they can come up with it. We don't care about 
credit. You can call it McConnellCare or RepubliCare or RyanCare or 
TrumpCare. It doesn't matter so long as it covers as many people as the 
ACA, so long as it helps bring health care costs down, and so long as 
it doesn't move our health care system backward.
  We haven't seen one so far. I am skeptical that we ever will, but we 
will look at one if they can come up with it. Unfortunately, that is 
not the road we are on. The vote tonight is the first step on the road 
to repeal, which leads straight into that box canyon.
  I just want to sincerely urge my Republican colleagues, especially 
those who have rightly expressed concern about the very serious 
consequences of repealing without replacement: Vote against this 
resolution. Put this irresponsible and rushed repeal plan aside. Work 
with us Democrats on a way to improve health care in America, not set 
it back 8 years. Don't make America sick again. Don't put chaos in 
place of affordable care, which is what you will do if you follow 
through on this resolution.
  The consequences of throwing our system into chaos, which the 
Republican plan will do, are enormous: denying 30 million Americans 
health coverage, blowing a $1 trillion hole in our deficit, depriving 
the college graduate from staying on their parent's plan, preventing 
women from getting fair treatment, and telling the family whose 
daughter has a preexisting condition that they can't get coverage, and 
they will have to watch her get sicker.
  That--all of that--falls entirely on the shoulders of my Republican 
colleagues. I think that is a scenario we all would like to avoid. So 
turn back before it is too late because you will regret going forward.
  Thank you, Mr. President.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. 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, tonight is an important night because it 
allows what is very rare here in the Senate--for Members of the body to 
bring forth amendments and ideas that are very important to them, and 
that, unfortunately, don't often get debated or voted upon here on the 
floor.
  I know I speak for virtually all Democrats in saying that we have 
deep concern about the Republican proposal that would repeal the 
Affordable Care Act without having any alternative plan in place. We 
think the idea of throwing some 30 million Americans off of the health 
insurance they have and significantly reducing funding for Medicaid 
will not only be very, very problematic for lower income people but 
also impact middle-class people who depend upon Medicaid to help pay 
for the nursing home care their parents get. We are deeply concerned 
about the possible privatization of Medicare, making Medicare into a 
voucher program. We are concerned about the increase in prescription 
drug costs for seniors that would occur. If the Affordable Care Act 
were repealed, seniors would have to pay far more than they are paying 
right now, at a time when many seniors cannot today afford the high 
cost of prescription drugs. What we find is outrageous is that, in the 
midst of all these attacks on the middle class and working families of 
this country, the Republican repeal of the Affordable Care Act would 
end up providing hundreds and hundreds of billions of dollars in tax 
breaks for the top 2 percent. I believe there are very few people in 
America who think we should devastate the health care programs that 
millions of Americans depend upon and at the same time give huge tax 
breaks to the very, very wealthy.
  Tonight we are going to hear a number of Senators on the Democratic 
side come down to the floor and offer very, very important amendments 
which I hope can receive bipartisan support.
  We are going to hear Senator Manchin talk about the need to protect 
rural health. As a Senator from a rural State, I understand very 
clearly that if the Affordable Care Act is repealed, it will be 
devastating to rural hospitals all across this country.
  Senator Nelson is going to talk about the high cost of prescription 
drugs and what the repeal of the Affordable Care Act would mean in 
raising prescription drug prices. Senator Baldwin will be talking about 
the need to make sure that, as is currently the case, young people 26 
years of age or younger can continue to stay on their parents' health 
insurance. Senator Tester is going to be offering an amendment which 
will oppose limiting veterans' ability to choose.
  I will be offering an amendment making certain the people in our 
country do not have to pay more for medicine than the people in Canada 
and in other countries. Senator Casey is concerned about protecting 
individuals with disabilities and chronic conditions. Senator King is 
concerned about protecting health insurance for people, many of whom 
are working in very dangerous occupations.
  Senator Menendez is concerned about protecting Medicaid expansion. 
Millions of Americans have received health care, in some cases for the 
first time in their lives because we were able to expand Medicaid.
  Senator Gillibrand is concerned about protecting women's health. The 
Affordable Care Act has gone a long way in terms of equity for women, 
in terms of the health care they receive, and I hope nobody wants to 
see that disappear.

[[Page S249]]

  Senator Manchin will address a very important issue about the opiate 
epidemic that exists in West Virginia and all across this country.
  Senator Stabenow will be speaking about the need to protect mental 
health services. We have a major crisis in mental health care in this 
country. We need to do a lot more than we are currently doing, and we 
certainly do not need to do less.
  Senators Cantwell and Carper will be talking about the need to 
protect delivery system reform. Senator Brown will be talking about the 
need to protect the Children's Health Insurance Program. Senator Coons 
will be talking about the need to make sure there are no limits on the 
health insurance people with serious illnesses receive.
  So there are a lot of very, very important amendments that will be 
offered, and I look forward to an interesting evening of discussion.
  I would just conclude my remarks to say that I find it beyond 
comprehension that at a time when we are the only major country on 
Earth not to guarantee health care to all of our people--we are the 
only one--that at a time when we pay significantly more per capita for 
health care than do the people of any other nation, that at a time when 
we pay by far the highest prices in the world for prescription drugs--
what we need is to have a health care system that protects the needs of 
the middle class and working families of our country, not just the 
insurance companies and not just the drug companies. In fact, the votes 
tonight are really about whether we are prepared to stand up for 
ordinary Americans or whether we are going to continue to kowtow to the 
insurance industry and the pharmaceutical industry.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, while we are waiting for the unanimous 
consent agreement that will kick off the evening, I feel compelled to 
make a couple of comments.
  I don't want people to be confused as the evening goes on. This is 
not the bill that repeals ObamaCare. This is the bill that sets up the 
process that will repeal ObamaCare. This is a preliminary step that is 
necessary in order to do what everybody is claiming will be done 
tonight, and that is not accurate.
  So we will hear a bunch of things that people are concerned about, 
but this bill in it has budget numbers. The budget numbers reflect 
where we are--not where we would like to be and not where we have been. 
They are just the numbers of where we are. Then, in the resolution, 
there is a requirement that the Finance Committee save $1 billion, and 
the Health, Education, Labor, and Pensions Committee save $1 billion, 
and they get to do that with some privileged legislation, as long as we 
keep it privileged. There will be a number of attempts tonight to see 
if they can get rid of the privilege by using corrosive or nongermane 
amendments. Consequently, we will have to vote down some of those 
amendments. It might sound logical, and it is because they are not in 
the bill.

  I guess we are still waiting for the unanimous consent agreement so 
at this point I will yield the floor.
  The PRESIDING OFFICER (Mr. Tillis). The Senator from Wyoming.
  Mr. ENZI. Mr. President, for some additional information of what is 
happening, we are organizing lists of what tranche the votes will be 
in. Just because they are not listed in this first group, doesn't mean 
they are not going to be considered. In fact, under a budget 
resolution, we have what is called a vote-arama. Actually, any 
amendment can be turned in until we finish voting. Unlike other 
activity that we usually have where we know what votes there will be 
well in advance, this is a special exercise and it is handled a little 
differently and it is a lot more confusing.
  We will begin in a while. We will begin processing these amendments 
one at a time. For debate, just so people know for sure which amendment 
we are on, the proponent for the amendment will get 1 minute and the 
opponent for that amendment will get 1 minute. At the end of those 2 
minutes, we will vote. The first vote is supposed to take 15 minutes. 
The Senate is seldom held to 15 minutes. After that, we often go to 10-
minute votes, which in the Senate usually only takes about 30 minutes.
  That is the way we do it here. We make sure everybody gets their 
chance to vote. We hope people will be around so they can get here 
punctually and cast their vote. We think the amount of time from 10 
minutes can be reduced if people are interested in reducing the amount 
of time to do them.
  I got the signal that we now have the final list.
  Mr. President, I ask unanimous consent that it be in order to call up 
the following amendments and have them reported en bloc: Manchin, No. 
64; Nelson, No. 13; Baldwin, No. 81; Tester, No. 104; Klobuchar, No. 
172; Casey, No. 61; King, No. 60; Menendez, No. 83; Gillibrand, No. 82; 
Manchin, No. 63; and Stabenow, No. 94.
  You will see, in spite of that listing, we are going to have some 
additional consent needed here.
  I ask unanimous consent that those be on the list for now.
  I further ask unanimous consent that at 6:15 p.m., all time be 
yielded back and the Senate vote on the amendments in the order listed, 
except for the following amendments, which will be voted on first: 
Nelson, No. 13; King, No. 60; a Barrasso side-by-side amendment, the 
text of which is at the desk; Manchin, No. 64; that there be no second-
degree amendments in order to these four amendments prior to the votes; 
finally, that there be 2 minutes, equally divided between the managers 
or their designees, prior to each vote and that all votes after the 
first in this series be 10 minutes in length.
  The PRESIDING OFFICER. Is there objection?
  Mr. SANDERS. Reserving the right to object--and I will not object--I 
have one mild correction.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Amendment No. 172 is Klobuchar-Sanders.
  Mr. ENZI. Klobuchar, No. 172?
  Mr. SANDERS. Yes. Klobuchar-Sanders. I know that because I am 
Sanders.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


  Amendments Nos. 64, 13, 81, 104, 172, 61, 60, 83, 82, 63, and 94 en 
                                  bloc

  Mr. SANDERS. Mr. President, I ask that the amendments be called up as 
under the previous order.
  The PRESIDING OFFICER. The clerk will report the amendments en bloc.
  The bill clerk read as follows:

       The Senator from Vermont [Mr. Sanders], for others, 
     proposes amendments numbered 64, 13, 81, 104, 172, 61, 60, 
     83, 82, 63, and 94 en bloc.

  The amendments are as follows:


                            amendment no. 64

  (Purpose: To create a point of order against legislation that would 
            harm rural hospitals and health care providers)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   FINANCIALLY HARM RURAL HOSPITALS AND HEALTH 
                   CARE PROVIDERS BY REDUCING THE NUMBER OF PEOPLE 
                   IN RURAL COMMUNITIES WITH ACCESS TO HEALTH 
                   INSURANCE.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report if the 
     Congressional Budget Office has determined that it would--
       (1) cause an increase in the rate of uninsured individuals 
     and families in rural communities by an amount sufficient to 
     substantially weaken the financial viability of rural 
     hospitals (including small hospitals), clinics (including 
     community health centers), or other health care providers; or
       (2) reduce Federal funds upon which rural hospitals and 
     community health centers rely.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                            amendment no. 13

  (Purpose: To create a point of order against legislation that would 
 repeal health reforms that closed the prescription drug coverage gap 
                            under Medicare)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   REPEAL THE HEALTH REFORMS THAT CLOSED THE 
                   PRESCRIPTION DRUG COVERAGE GAP UNDER MEDICARE.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment,

[[Page S250]]

     amendment between the Houses, or conference report that would 
     repeal health reform legislation that closed the coverage gap 
     in the Medicare prescription drug program under part D of 
     title XVIII of the Social Security Act (42 U.S.C. 1395w-101 
     et seq.).
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                            amendment no. 81

  (Purpose: To create a point of order against legislation that makes 
                        young people sick again)

       At the end of title IV, add the following:

     SEC. 4__. DON'T MAKE YOUNG PEOPLE SICK AGAIN.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     make young people sick again.
       (b) Legislation That Makes Young People Sick Again.--For 
     the purposes of subsection (a), the term ``would make young 
     people sick again'' with respect to legislation refers to any 
     provision of a bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report, that 
     would--
       (1) reduce the number of young Americans enrolled in public 
     or private health insurance coverage, as determined based on 
     the March 2016 updated baseline budget projections by the 
     Congressional Budget Office;
       (2) weaken dependent coverage of children to continue until 
     the child turns 26 years of age as afforded to them under 
     Patient Protection and Affordable Care Act (Public Law 111-
     148);
       (3) weaken access to care by increasing premiums or total 
     out of pocket costs for young Americans with private 
     insurance.
       (c) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                           amendment no. 104

  (Purpose: To create a point of order against legislation that would 
           limit veterans' ability to choose VA health care)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   WEAKEN THE ABILITY OF THE DEPARTMENT OF 
                   VETERANS AFFAIRS TO DIRECTLY FURNISH HEALTH 
                   CARE TO VETERANS.

       It shall not be in order in the Senate to consider any 
     bill, joint resolution, motion, amendment, amendment between 
     the Houses, or conference report that authorizes funding for 
     non-Department of Veterans Affairs-provided care, funded by 
     the Department of Veterans Affairs, which would reduce the 
     availability of services directly provided by the Department 
     of Veterans Affairs, including primary health care, mental 
     health care, rural health care, and prosthetic care.


                           amendment no. 172

   (Purpose: To establish a deficit-neutral reserve fund relating to 
lowering prescription drug prices for Americans by importing drugs from 
                      Canada and other countries)

       At the end of title III, add the following:

     SEC. 3___. DEFICIT-NEUTRAL RESERVE FUND RELATING TO LOWERING 
                   PRESCRIPTION DRUG PRICES FOR AMERICANS BY 
                   IMPORTING DRUGS FROM CANADA AND OTHER 
                   COUNTRIES.

       The Chairman of the Committee on the Budget of the Senate 
     may revise the allocations of a committee or committees, 
     aggregates, and other appropriate levels in this resolution 
     for one or more bills, joint resolutions, amendments, 
     amendments between the Houses, motions, or conference reports 
     relating to lowering prescription drug prices, including 
     through the importation of safe and affordable prescription 
     drugs by American pharmacists, wholesalers, and individuals 
     with a valid prescription from a provider licensed to 
     practice in the United States, by the amounts provided in 
     such legislation for those purposes, provided that such 
     legislation would not increase the deficit over either the 
     period of the total of fiscal years 2017 through 2021 or the 
     period of the total of fiscal years 2017 through 2026.


                            amendment No. 61

  (Purpose: To create a point of order against legislation that would 
    make people with disabilities and chronic conditions sick again)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD MAKE 
                   PEOPLE WITH DISABILITIES AND CHRONIC CONDITIONS 
                   SICK AGAIN.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that 
     would--
       (1) limit, reduce, or eliminate access to care for anyone 
     with a pre-existing condition, such as a disability or 
     chronic condition, as provided under section 2704 of the 
     Public Health Service Act (42 U.S.C. 300gg-3), as amended by 
     the Patient Protection and Affordable Care Act (Public Law 
     111-148);
       (2) place a lifetime or annual cap on health insurance 
     coverage for an individual with a disability or a chronic 
     condition, as provided under section 2711 of the Public 
     Health Service Act (42 U.S.C. 300gg-11), as amended by the 
     Patient Protection and Affordable Care Act; or
       (3) allow a health plan or a provider to discriminate on 
     the basis of an applicant's physical health, mental health, 
     or disability status to increase the cost of care, provide 
     for fewer benefits, or in any way decrease access to health 
     care as afforded under title I of the Patient Protection and 
     Affordable Care Act.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                            amendment no. 60

  (Purpose: To create a point of order against legislation that would 
reduce health insurance access and affordability for individuals based 
                          on their occupation)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   REDUCE HEALTH INSURANCE ACCESS AND 
                   AFFORDABILITY FOR INDIVIDUALS BASED ON THEIR 
                   OCCUPATION.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     reduce health insurance access and affordability for 
     individuals based on their occupation, unless legislation is 
     enacted to provide comparable benefits and protections for 
     such individuals.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                            amendment no. 83

  (Purpose: To create a point of order against legislation that would 
   eliminate or reduce Federal funding to States under the Medicaid 
                               expansion)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST ELIMINATING OR REDUCING 
                   FEDERAL FUNDING TO STATES UNDER THE MEDICAID 
                   EXPANSION.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     eliminate or reduce funding to States available under law in 
     effect on the date of the adoption of this section to provide 
     comprehensive, affordable health care to low-income Americans 
     by eliminating or reducing the availability of Federal 
     financial assistance to States available under section 
     1905(y)(1) or 1905(z)(2) of the Social Security Act (42 
     U.S.C. 1396d(y)(1), 1396d(z)(2)) or other means, unless the 
     Director of the Congressional Budget Office certifies that 
     the legislation would not--
       (1) increase the number of uninsured Americans;
       (2) decrease Medicaid enrollment in States that have opted 
     to expand eligibility for medical assistance under that 
     program for low-income, non-elderly individuals under the 
     eligibility option established by the Affordable Care Act 
     under section 1902(a)(10)(A)(i)(VIII) of the Social Security 
     Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII));
       (3) reduce the likelihood that any State that, as of the 
     date of the adoption of this section, has not opted to expand 
     Medicaid under the eligibility option established by the 
     Affordable Care Act under section 1902(a)(10)(A)(i)(VIII) of 
     the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) 
     would opt to use that eligibility option to expand 
     eligibility for medical assistance under that program for 
     low-income, non-elderly individuals; and
       (4) increase the State share of Medicaid spending under 
     that eligibility option.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                            amendment no. 82

  (Purpose: To create a point of order against legislation that makes 
                           women sick again)

       At the end of title IV, add the following:

     SEC. 4__. DON'T MAKE WOMEN SICK AGAIN.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that makes 
     women sick again by eliminating or reducing access to women's 
     health care, including decreases in access to, or coverage 
     of, reproductive health care services including contraceptive 
     counseling, birth control, and maternity care, and primary 
     and preventive health care as

[[Page S251]]

     afforded to them under the Patient Protection and Affordable 
     Care Act (Public Law 111-148).
       (b) Legislation That Makes Women Sick Again.--For the 
     purposes of subsection (a), the term ``makes women sick 
     again'' with respect to legislation refers to any provision 
     of a bill, joint resolution, motion, amendment, amendment 
     between the Houses, or conference report, that would--
       (1) allow insurance companies to discriminate against women 
     by--
       (A) charging women higher premiums for health care based on 
     their gender;
       (B) allowing pregnancy to be used as a pre-existing 
     condition by which to deny women coverage;
       (C) permitting discrimination against providers who provide 
     reproductive health care benefits or services to women; or
       (D) otherwise discriminating against women based on their 
     gender;
       (2) reduce the number of women enrolled in health insurance 
     coverage, as certified by the Congressional Budget Office; or
       (3) eliminate, or reduce the scope or scale of, the 
     benefits women would have received pursuant to the 
     requirements under title I of the Patient Protection and 
     Affordable Care Act (Public Law 111-148) and the amendments 
     made to that title.
       (c) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                            amendment no. 63

  (Purpose: To create a point of order against legislation that would 
reduce access to substance use disorder treatment and worsen the opioid 
                            abuse epidemic)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   REDUCE ACCESS TO SUBSTANCE USE DISORDER 
                   PREVENTION, TREATMENT, AND RECOVERY SERVICES 
                   AND WORSEN THE OPIOID EPIDEMIC.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     reduce the expansion of access to substance use disorder 
     prevention, treatment, and recovery services established 
     through the expansion of the Medicaid program under section 
     XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and 
     the consumer protections in the health insurance market, 
     including protections for individuals with pre-existing 
     conditions, the establishment of mental health and substance 
     use disorder services as essential health benefits, the 
     requirement that preventive services such as substance use 
     disorder screenings be covered without cost-sharing at the 
     point of service, and the expansion of mental health parity 
     and addiction equity law to cover health plans in the 
     individual market, and in so doing, worsen the opioid 
     epidemic.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                            amendment no. 94

  (Purpose: To create a point of order against legislation that would 
           reduce or eliminate access to mental health care)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST REDUCING OR ELIMINATING 
                   ACCESS TO MENTAL HEALTH CARE.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that the 
     Director of the Congressional Budget Office determines would 
     reduce access to mental health care and services or reduce 
     the number of individuals with mental illness enrolled in 
     insurance coverage, relative to the Congressional Budget 
     Office's March 2016 updated baseline, by means such as--
       (1) eliminating or reducing Federal financial assistance 
     currently available to States under section 1905(y)(1) or 
     1905(z)(2) of the Social Security Act (42 U.S.C. 1396d(y)(1), 
     1396d(z)(2)) or otherwise eliminating or reducing mental 
     health protections established by the Affordable Care Act, 
     including the addition of mental health services to the list 
     of services covered under section 1937(b)(5) of the Social 
     Security Act (42 U.S.C. 1396u-7(b)(5)); or
       (2) reducing the affordability of coverage established by 
     the Affordable Care Act's consumer protections, including--
       (A) the expansion of mental health parity and addiction 
     equity law to individual health insurance coverage;
       (B) the prohibition on discriminating against enrollees 
     with pre-existing conditions such as mental illness;
       (C) coverage of preventive services like depression 
     screenings without cost-sharing; and
       (D) the establishment of mental health services as an 
     essential health benefit.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).

  The PRESIDING OFFICER. The Senator from Wyoming.


                           Amendment No. 173

  Mr. ENZI. Mr. President, I call up amendment No. 173 and ask 
unanimous consent that it be reported by number.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report the amendment by number.
  The legislative clerk read as follows:

       The Senator from Wyoming [Mr. Enzi], for Mr. Barrasso, 
     proposes an amendment numbered 173.

  The amendment is as follows:

(Purpose: To establish a deficit-neutral reserve fund relating to rural 
             health and repealing and replacing Obamacare)

       At the end of title III, add the following:

     SEC. 3___. DEFICIT-NEUTRAL RESERVE FUND RELATING TO RURAL 
                   HEALTH AND REPEALING AND REPLACING OBAMACARE.

       The Chairman of the Committee on the Budget of the Senate 
     may revise the allocations of a committee or committees, 
     aggregates, and other appropriate levels in this resolution 
     for one or more bills, joint resolutions, amendments, 
     amendments between the Houses, motions, or conference reports 
     relating to strengthening Social Security and repealing and 
     replacing Obamacare, which may include step-by-step reforms 
     providing access to quality, affordable coverage for all 
     Americans, maintaining access to critical rural health care 
     services, and safeguarding consumer protections, without 
     raising new revenue, by the amounts provided in such 
     legislation for those purposes, provided that such 
     legislation would not increase the deficit over either the 
     period of the total of fiscal years 2017 through 2021 or the 
     period of the total of fiscal years 2017 through 2026.

  Mr. ENZI. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ENZI. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Amendment No. 13

  There is now 2 minutes of debate on Nelson amendment No. 13.
  The Senator from Florida.
  Mr. NELSON. Ladies and gentlemen of the Senate, if you really want to 
rile up the senior citizens of this country, then you start taking away 
their prescription drugs. If that is what you want to do, then you 
better vote against my amendment. If you take away the ACA, they are 
going to end up paying $1,000 per year, out of pocket per senior 
citizen, on their prescription drug benefits. So if you want to support 
the seniors, you better support this amendment.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, this amendment is corrosive to the privilege 
of the budget resolution. That means that it is outside the scope of 
what is appropriate for this budget resolution. Any inappropriate 
amendment could be fatal to the privilege of this resolution, which 
would destroy our efforts to repeal ObamaCare. In other words, a vote 
in favor of this amendment is a vote against repealing ObamaCare.
  In addition, this amendment is not germane to this budget resolution. 
This budget resolution is much more focused than a typical budget 
resolution. The Congressional Budget Act requires that amendments to a 
budget resolution be germane. Since this amendment does not meet that 
standard required by budget law, a point of order would lie; as such, I 
raise a point of order under section 305(b)(2) of the Congressional 
Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974, I move to waive section 305(b) of 
that act for purposes of the pending amendment, and I ask for the yeas 
and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.

[[Page S252]]

  The question is on agreeing to the motion to waive.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 47, nays 51, as follows:

                       [Rollcall Vote No. 7 Leg.]

                                YEAS--47

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--49

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     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
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                             NOT VOTING--2

     Feinstein
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 47, the nays are 
51.
  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.


                            Amendment No. 60

  There is now 2 minutes of debate prior to a vote on King amendment 
No. 60.
  The Senator from Maine.
  Mr. KING. Mr. President, I call this the Protect Workers in Rural 
America amendment. One of the lesser known provisions of the Affordable 
Care Act is that it doesn't allow insurance companies to discriminate 
against people because of their occupations.
  Before the Affordable Care Act, if you were a logger or a farmer, a 
fisherman, a miner, you could get exorbitant rates decided by some 
bureaucrat at an insurance company somewhere, and this is wrong.
  So what I am trying to do is prohibit discrimination by occupation. 
We are trying to save an important part of this law. My distinguished 
chairman said this isn't germane. I don't see how it cannot be germane 
since the stated purpose of this bill is to begin the process of 
repealing the Affordable Care Act.
  I ask my colleagues to vote with me. This is protecting workers in 
rural America.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, this amendment is outside of the scope of 
what is appropriate for this budget resolution. It is corrosive to the 
privilege of the budget. Any inappropriate amendment could be fatal to 
the privilege of this resolution, which would destroy our efforts to 
repeal ObamaCare. In other words, a vote in favor of this amendment is 
a vote against repealing ObamaCare.
  In addition, this amendment is not germane to this budget resolution. 
This budget resolution is much more focused than a typical budget 
resolution.
  The Congressional Budget Act requires that amendments to a budget 
resolution be germane. Since this amendment does not meet the standard 
required by law, a point of order would lie; as such, I raise a point 
of order under section 305(b)(2) of the Congressional Budget Act of 
1974.
  Mr. KING. Mr. President, pursuant to section 904 of the Congressional 
Budget Act of 1974, I move to waive section 305(b) of that act for 
purposes of the pending amendment, 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 to waive.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER (Mr. Perdue). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 48, nays 50, as follows:

                       [Rollcall Vote No. 8 Leg.]

                                YEAS--48

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--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
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                             NOT VOTING--2

     Feinstein
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 48, 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.


                           Amendment No. 173

  There will now be 2 minutes of debate prior to the vote on Barrasso 
amendment No. 173.
  The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, this is a side-by-side amendment to the 
Manchin amendment. As a doctor, I understand how ObamaCare has been a 
disaster for patients and for health care providers. Because of this 
law, Americans have been left with higher premiums and fewer choices. 
This budget is an important first step in giving Americans better and 
more affordable health care.
  I am especially aware of the importance of helping folks in rural 
America, people who have been especially hard hit by the policies of 
the Obama administration. Since 2010, more than 70 rural hospitals have 
closed across the United States and Ezekiel Emanuel, who is the 
architect of Obamacare, wrote a book, and he said that 1,000 hospitals 
have to close in the United States. That is what he called for, 1,000. 
We are talking about rural hospitals all around this country.
  So for people in small towns all across the Nation, the closures we 
have already experienced, these 70 closures, have had a devastating 
impact. My amendment says that Congress is ready to help all Americans 
but especially those living in rural America who have been hurt by 
ObamaCare.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, I urge a strong ``no'' vote on the 
Barrasso amendment. The language calls for strengthening Social 
Security, but we all know what strengthening Social Security means. It 
means cutting Social Security. It means cutting Medicare. It means 
cutting Medicaid. We are into Orwellian language. ``Strengthening'' is 
not cutting programs, it is not throwing 20 million Americans off 
health insurance, it is not privatizing Medicare, it is not raising 
prescription drug costs for senior citizens. I urge a ``no'' vote on 
the Barrasso amendment.

[[Page S253]]

  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. MANCHIN. Mr. President, I am rising because I oppose this 
amendment because this is not the way this body should work. The 
politics of the people spoke loud and clear. Politics is not going to 
be accepted. I have an amendment with a point of order, and this 
amendment was pushed in in front of this vote so it would be a 
Republican vote and not a Democratic, and I can tell you, I am sick and 
tired of it, and the people of America are too.
  The PRESIDING OFFICER. The Senator's time has expired.
  The question is on the Barrasso amendment.
  Mr. MANCHIN. Mr. President, I raise a point of order that the pending 
amendment is not germane to the underlying resolution and therefore 
violates section 305(b)(2) of the Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. 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. 173, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a second?
  There is a sufficient second.
  The question is on agreeing to the motion to waive.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 51, nays 47, as follows:

                       [Rollcall Vote No. 9 Leg.]

                                YEAS--51

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     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
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                                NAYS--47

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--2

     Feinstein
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 51, the nays are 
47.
  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.
  The Senator from Vermont.


                Amendments Nos. 143, 86, and 126 En Bloc

  Mr. SANDERS. Mr. President, I ask unanimous consent that the 
following amendments be called up en bloc and reported by number, and 
that they be considered following disposition of the Stabenow amendment 
No. 94: Cantwell amendment No. 143; Brown amendment No. 86; and Coons 
amendment No. 126.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The clerk will report the amendments by number.
  The senior assistant legislative clerk read as follows:

       The Senator from Vermont [Mr. Sanders], for others, 
     proposes amendments numbered 143, 86, and 126 en bloc.

  The amendments are as follows:


                           amendment no. 143

    (Purpose: To create a point of order against any changes to the 
  Medicare program, the Medicaid program, or the number of Americans 
 enrolled in private health insurance coverage, in a manner that would 
   result in reduced revenue to hospitals, health care centers, and 
  physicians and other health care providers, thereby reducing their 
investments in health care delivery system reforms that improve patient 
                   health outcomes and reduce costs)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST ANY CHANGES TO THE MEDICARE 
                   PROGRAM, THE MEDICAID PROGRAM, OR THE NUMBER OF 
                   AMERICANS ENROLLED IN PRIVATE HEALTH INSURANCE 
                   COVERAGE, IN A MANNER THAT WOULD RESULT IN 
                   REDUCED REVENUE TO HOSPITALS, HEALTH CARE 
                   CENTERS, AND PHYSICIANS AND OTHER HEALTH CARE 
                   PROVIDERS, THEREBY REDUCING THEIR INVESTMENTS 
                   IN HEALTH CARE DELIVERY SYSTEM REFORMS THAT 
                   IMPROVE PATIENT HEALTH OUTCOMES AND REDUCE 
                   COSTS.

       (a) Findings.--The Senate finds the following:
       (1) The Affordable Care Act is moving the health care 
     system of the United States from a fee-for-service system 
     that frequently incentivizes the overutilization of health 
     care services and wasteful health care spending to a value- 
     and performance-based health care system that promotes 
     patient-centered and team-based care to keep Americans as 
     healthy as possible, improve health outcomes, and lower 
     health care costs.
       (2) Because of the investments in health care delivery 
     system reforms made by the Affordable Care Act, a third of 
     Medicare payments to health care providers are now based on 
     the overall quality of patient care and health outcomes 
     achieved by such providers.
       (b) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     change the Medicare program, the Medicaid program, or the 
     number of Americans enrolled in private health insurance 
     coverage, in a manner that would result in reduced revenue to 
     hospitals, health care centers, and physicians and other 
     health care providers, thereby reducing their investments in 
     health care delivery system reforms that improve patient 
     health outcomes and reduce costs.
       (c) Waiver and Appeal.--Subsection (b) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (b).


                            amendment no. 86

  (Purpose: To create a point of order against legislation that would 
  undermine the historic coverage gains the United States has made in 
children's health, which have resulted in the lowest uninsured rate for 
                   children in the Nation's history)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   UNDERMINE ACCESS TO COMPREHENSIVE, AFFORDABLE 
                   HEALTH COVERAGE FOR AMERICA'S CHILDREN.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that makes 
     changes to the Medicaid program under title XIX of the Social 
     Security Act (42 U.S.C. et seq.), the Children's Health 
     Insurance Program under title XXI (42 U.S.C. 1397aa et seq.), 
     or Federal requirements for private health insurance coverage 
     unless the Congressional Budget Office certifies that such 
     changes would not result in lower coverage rates, reduced 
     benefits, or decreased affordability for children receiving 
     coverage through the Medicaid Program, the Children's Health 
     Insurance Program, or the private insurance markets 
     established under the Patient Protection and Affordable Care 
     Act.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).


                           amendment no. 126

  (Purpose: To create a point of order against legislation that would 
            permit lifetime limits on health care coverage)

       At the end of title IV, add the following:

     SEC. 4__. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   PERMIT LIFETIME LIMITS ON HEALTH CARE COVERAGE.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     permit lifetime limits on health care coverage.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).
  The PRESIDING OFFICER. The Senator from Wyoming.

[[Page S254]]

  



                  Amendments Nos. 167 and 176 En Bloc

  Mr. ENZI. Mr. President, I ask unanimous consent that following 
disposition of the Manchin amendment No. 64, the Senate vote in 
relation to the following amendments in the order listed, with all 
other provisions of the previous order remaining in effect; further, 
that there be no second-degree amendments in order to the amendments 
listed; and, finally, that the Heller amendment No. 167 and the Flake 
amendment No. 176 be called up and reported by number en bloc.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The clerk will report the amendments by number.
  The bill clerk read as follows:

       The Senator from Wyoming [Mr. Enzi], for others, proposes 
     amendments numbered 167 and 176 en bloc.

  The amendments are as follows:


                           Amendment no. 167

   (Purpose: To establish a deficit-neutral reserve fund relating to 
   strengthening Social Security and repealing Obamacare, which has 
  increased health care costs, raised taxes on middle-class families, 
 reduced access to high quality care, created disincentives for work, 
and caused tens of thousands of Americans to lose coverage they had and 
  liked, and replacing it with patient-centered, step-by-step health 
reforms that provide access to quality, affordable private health care 
     coverage for all American's and their families by increasing 
competition, State flexibility and individual choice, and safeguarding 
              consumer protections that Americans support)

       At the end of title III, add the following:

     SEC. 3___. DEFICIT-NEUTRAL RESERVE FUND RELATING TO 
                   STRENGTHENING SOCIAL SECURITY OR REPEALING AND 
                   REPLACING OBAMACARE.

       The Chairman of the Committee on the Budget of the Senate 
     may revise the allocations of a committee or committees, 
     aggregates, and other appropriate levels in this resolution 
     for one or more bills, joint resolutions, amendments, 
     amendments between the Houses, motions, or conference reports 
     relating to strengthening Social Security or repealing and 
     replacing Obamacare, which may include step-by-step health 
     reforms providing access to quality, affordable coverage for 
     all Americans, safeguarding consumer protections, 
     strengthening Medicare, and improving Medicaid, without 
     raising new revenue, by the amounts provided in such 
     legislation for those purposes, provided that such 
     legislation would not increase the deficit over either the 
     period of the total of fiscal years 2017 through 2021 or the 
     period of the total of fiscal years 2017 through 2026.


                           amendment no. 176

   (Purpose: To establish a deficit-neutral reserve fund relating to 
enhancing health care and housing for veterans and their dependents by 
    repealing Obamacare, facilitating medical facility leases, and 
     prohibiting the Secretary of Veterans Affairs from employing 
 individuals who have been convicted of a felony and medical personnel 
  who have ever had their medical licenses or credentials revoked or 
                               suspended)

       At the end of title III, add the following:

     SEC. 3___. DEFICIT-NEUTRAL RESERVE FUND RELATING TO ENHANCING 
                   VETERANS HEALTH CARE, HOUSING, AND THE 
                   WORKFORCE OF THE DEPARTMENT OF VETERANS 
                   AFFAIRS.

       The Chairman of the Committee on the Budget of the Senate 
     may revise the allocations of a committee or committees, 
     aggregates, and other appropriate levels in this resolution 
     for one or more bills, joint resolutions, amendments, 
     amendments between the Houses, motions, or conference reports 
     relating to improving veterans' housing and health care for 
     veterans and their dependents, which may include repealing 
     Obamacare, facilitating medical facility leases, reforming 
     veterans housing programs, and prohibiting the Secretary of 
     Veterans Affairs from employing individuals who have been 
     convicted of a felony and medical personnel who have ever had 
     their medical licenses or credentials revoked or suspended, 
     by the amounts provided in such legislation for those 
     purposes, provided that such legislation would not increase 
     the deficit over either the period of the total of fiscal 
     years 2017 through 2021 or the period of the total of fiscal 
     years 2017 through 2026.


                            Amendment No. 64

  The PRESIDING OFFICER. There is now 2 minutes of debate prior to a 
vote on Manchin amendment No. 64.
  The Senator from West Virginia.
  Mr. MANCHIN. Mr. President, basically, if you are concerned about 
your rural hospital or health care system centers, this is the 
amendment that will save them. This is the amendment that will protect 
them. You can go home and say, basically, that we have made sure that 
no matter what happens with the Affordable Care Act, we are going to 
make sure we protect our rural hospitals and rural clinics. That being 
said, all of us have rural areas in our States. I urge the adoption of 
this amendment and the support of this amendment. It has the teeth of 
the budget point of order.
  So I urge everybody: If you care about your health care providers--
the economic engine, the protection of your people in your areas that 
have very poor health care coverage right now--make sure you vote in 
support of this amendment.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, this amendment is not germane to this budget 
resolution. This budget resolution is focused on defeating ObamaCare. 
So anything other than that is outside of the scope of the repeal 
resolution.
  The Congressional Budget Act requires that amendments to a budget 
resolution be germane. Since this amendment doesn't meet the standard 
required by budget law, a point of order would lie.
  So I am compelled as chairman of the Senate Budget Committee to raise 
a point of order against the amendment under section 305(b)(2) of the 
Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. MANCHIN. Mr. President, pursuant to section 904----
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, making a clarification that the numbers of 
the amendments done in the unanimous consent are Heller amendment No. 
167, Baldwin amendment No. 81, Flake amendment No. 176, and Tester 
amendment No. 104.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from West Virginia.
  Mr. MANCHIN. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974, I move to waive section 305(b)(2) of 
that act for purposes of the pending amendment, 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 to waive.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 51, nays 47, as follows:

                      [Rollcall Vote No. 10 Leg.]

                                YEAS--51

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Collins
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Heller
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Portman
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--47

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

                             NOT VOTING--2

     Feinstein
     Sessions
       
  The PRESIDING OFFICER. On this vote, the yeas are 51, the nays are 
47.
  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.


                           Amendment No. 167

  The PRESIDING OFFICER. There is now 2 minutes of debate prior to a 
vote on Heller amendment No. 167.
  The Senator from Nevada.
  Mr. HELLER. Mr. President, amendment No. 167 is a side-by-side. This 
amendment makes good on two promises to the American people. One is to

[[Page S255]]

repeal ObamaCare, which has increased costs, limited health care 
choices, and has raised $1.1 trillion in taxes on the American people 
in the middle class.
  It also makes good on a second promise; that is, Congress will 
replace ObamaCare with health care reforms that provide access to 
quality, affordable health care coverage, not just to dependents under 
the age of 26 but to all Americans--women, children, seniors, and 
disabled. We shouldn't be choosing winners and losers.
  A vote against this amendment is a vote against affordable, quality 
health care for all, and I urge my colleagues to support it.
  The PRESIDING OFFICER. The Senator from Wisconsin.
  Ms. BALDWIN. Mr. President, I would like to divide the time, claim 30 
seconds, and then yield to Senator Sanders.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. BALDWIN. Mr. President, if Members of this body care about 
insurance coverage for young people, young adults up to age 26, then 
they should vote no on the Heller side-by-side and take the opportunity 
to support my amendment that we will vote on immediately following the 
disposal of this amendment.
  In this Nation, we had an uninsurance crisis among young people 
before the Affordable Care Act was passed--one of the most uninsured 
demographics in America, and we have an opportunity to protect those 
young people through my amendment later this evening, but I urge a 
``no'' vote on an amendment that would do nothing to protect these 
young people.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, this amendment should be aptly called the 
Orwellian amendment because it says one thing and does something very 
much the opposite. It talks about strengthening Social Security, 
affordable coverage for all Americans. What is really going on is a 
desire to cut Social Security benefits and throw 20 million Americans 
off of health insurance.
  I urge the defeat of this amendment.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. HELLER. 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 the purposes of my 
amendment, and I ask for the yeas and nays.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, I raise a point of order that the pending 
amendment is not germane to the underlying resolution and therefore 
violates section 305(b)(2)of the Congressional Budget Act of 1974.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion to waive.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 51, nays 47, as follows:

                      [Rollcall Vote No. 11 Leg.]

                                YEAS--51

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     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
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                                NAYS--47

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--2

     Feinstein
     Sessions
       
  The PRESIDING OFFICER. On this vote, the yeas are 51, the nays are 
47.
  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.


                            Amendment No. 81

  Under the previous order, there will be 2 minutes of debate equally 
divided prior to a vote on Baldwin amendment No. 81.
  The Senator from Wisconsin.
  Ms. BALDWIN. Mr. President, my amendment protects the Affordable Care 
Act benefits for young people, including the provision that allows 
young adults to remain on their parents' health plan until age 26. It 
will safeguard our future generations by blocking Republican efforts 
that would weaken dependent coverage, increase premiums or out-of-
pocket costs, including the premium tax credits, or reduce the number 
of young adults who are currently insured.
  As someone who didn't have access to quality health insurance until I 
was in my 20s, I championed the provision that allows young people to 
stay on their parents' health insurance during my time in the House of 
Representatives. Before we passed health care reform, I heard from 
countless young adults and college-age students in Wisconsin who are 
just starting out in the workforce, many of them in jobs that had no 
health care.
  The PRESIDING OFFICER. The Senator's time has expired.
  Ms. BALDWIN. I urge my colleagues to stand with me and vote in 
support of this amendment to protect our future generations with health 
care coverage.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, this amendment is not germane to this budget 
resolution. The Congressional Budget Act requires that amendments to a 
budget resolution be germane. Since this amendment does not meet the 
standard required by budget law, a point of order would lie against it.
  I am compelled as chairman of the Committee on the Budget to raise a 
point of order against this amendment under section 305(b)(2) of the 
Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Wisconsin.
  Ms. BALDWIN. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974, I move to waive section 305(b)(2) of 
that act for the purposes of the pending amendment, and I ask for the 
yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to the motion to waive.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER (Mr. Gardner). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 48, nays 50, as follows:

                      [Rollcall Vote No. 12 Leg.]

                                YEAS--48

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--50

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi

[[Page S256]]


     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heller
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kennedy
     Lankford
     Lee
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                             NOT VOTING--2

     Feinstein
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 48, 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.


                           Amendment No. 176

  There is now 2 minutes of debate prior to the vote on Flake amendment 
No. 176.
  The Senator from Arizona.
  Mr. FLAKE. Mr. President, I rise in favor of Flake amendment No. 176.
  We have had problems, obviously, with the VA. Phoenix, AZ, has been 
kind of ground zero for that. Part of the problem is that the VA has no 
strong prohibition against hiring felons, and we have had example after 
example around the country of their continuing to hire felons or those 
who have been disciplined by the profession. So this would simply 
require that they fire felons who are on their rolls.
  I urge support and yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Mr. President, the Flake amendment is going to really 
result in less access for veterans across this country.
  The VA already has some hiring challenges due to a severe national 
shortage of medical personnel. This amendment is going to set the VA 
back even further.
  I will tell you why. It is going to prohibit the VA from hiring any 
medical professional who has ever had their license or credentials 
suspended. That means if it was done by administrative error, with that 
suspension, they wouldn't be able to be hired. If it got lost in the 
mail, they wouldn't be able to be hired. If they moved States and 
forgot to fill out the paperwork, those medical professionals wouldn't 
be able to be hired.
  It is really going to undermine the VA's ability to attract some of 
the most topnotch medical professionals and take care of our veterans.
  We have a medical workforce shortage in Montana. I am sure they do in 
Arizona. Why would we make the VA a less attractive place to work? Why 
would we want to do this? I would encourage a ``no'' vote.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, I raise a point of order that the pending 
amendment is not germane to the underlying resolution and, therefore, 
violates section 305(b)(2) of the Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. FLAKE. 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 the act and applicable budget resolutions for purposes of amendment 
No. 176, 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 to waive.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 50, nays 48, as follows:

                      [Rollcall Vote No. 13 Leg.]

                                YEAS--50

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     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
     Murkowski
     Paul
     Perdue
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                                NAYS--48

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Portman
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--2

     Feinstein
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 50, the nays are 
48.
  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.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that following the 
disposition of the Tester amendment No. 104, the Senate vote in 
relation to the Casey amendment No. 61 with all of the provisions of 
the previous order remaining in effect; further, that there be no 
second-degree amendments in order to the amendment.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


                           Amendment No. 104

  There will now be 2 minutes of debate prior to the vote on Tester 
amendment No. 104.
  The Senator from Montana.
  Mr. TESTER. Mr. President, today I offer an amendment on behalf of 
the Nation's more than 21 million veterans and the more than 100,000 
veterans who reside in the State of Montana. As I travel across my 
State, I hear from veterans who say: We don't want the VA privatized. 
As I talk to my friends on both sides of the aisle, they talk about the 
fact that we do not want the VA privatized.
  Here is an amendment you can vote for; in fact, it should pass by 
unanimous consent. What it does is bring a budget point of order 
against any provision that would limit the veterans' ability to choose 
VA health care. It is as simple as that. It needs to happen so we don't 
privatize the VA. The veterans I talk to, once they get through the 
door, love the care the VA provides them. I would encourage a ``yes'' 
vote on this amendment.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I am hoping we can do something for the 
veterans in a bipartisan way under a bill that Senator Isakson worked 
on for a long time, but on this amendment, the Congressional Budget Act 
requires that amendments to a budget resolution be germane. Since this 
amendment doesn't meet the standard required by budget law, a point of 
order would lie, so I would raise a point of order against this 
amendment under section 305(b)(2) of the Congressional Budget Act of 
1974.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Mr. President, I would contend that it is germane, but I 
will not debate that now. Pursuant to section 904 of the Congressional 
Budget Act of 1974, I move to waive section 305(b)(2) of that act for 
purposes of the pending amendment, 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 to waive.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER (Mr. Scott). Are there any other Senators in 
the Chamber desiring to vote?

[[Page S257]]

  The yeas and nays resulted--yeas 48, nays 50, as follows:

                      [Rollcall Vote No. 14 Leg.]

                                YEAS--48

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Heller
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--50

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

                             NOT VOTING--2

     Feinstein
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 48, the nays 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.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, after the Casey vote, we expect that the 
next three votes that we are still working to lock in after this vote 
will be Barrasso No. 181, Hatch No. 179, and Menendez No. 83. We are 
not asking for a unanimous consent agreement at this point. We just 
want people to be aware of the paperwork that is being done so that 
they can be ready for votes on those when we do lock them in.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, reserving the right to object, and I 
won't, I would appreciate it if we could add to the end of that tranche 
the Klobuchar-Sanders amendment. Would that be all right?
  Mr. ENZI. I didn't ask unanimous consent. I was just announcing, and 
I assume you are just announcing as well.
  Mr. SANDERS. OK. If we could add Klobuchar-Sanders as the fourth 
amendment of that tranche--it is all right. OK. Thank you.


                            Amendment No. 61

  The PRESIDING OFFICER. There is now 2 minutes of debate prior to a 
vote on Casey amendment No. 61.
  The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, this amendment deals with three basic 
issues. The first is the issue of preexisting conditions, the second is 
the issue with regard to discrimination as it relates to health status, 
and the third issue is with regard to caps on coverage.
  The first issue is we want to make sure no action is taken in the 
Senate that would have the effect of limiting access to care for those 
individuals with preexisting conditions. That is No. 1.
  No. 2, we want to make sure we don't place any lifetime caps on 
health insurance coverage for individuals with a disability or with a 
chronic condition.
  No. 3, we want to make sure health plans will not discriminate on the 
basis of either the individual's physical health, their mental health, 
or their disability status.
  This is the right thing to do for health care, and I urge an 
affirmative vote on this amendment.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, the Congressional Budget Act requires that 
amendments to a budget resolution be germane. Since this amendment does 
not meet the standard raised by budget law, a point of order would lie. 
As such, I raise a point of order against this amendment under section 
305(b)(2) of the Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974, I move to waive section 305(b)(2) of 
that act for purposes of the pending amendment, 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 to waive.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 49, nays 49, as follows:

                      [Rollcall Vote No. 15 Leg.]

                                YEAS--49

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Heller
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--49

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

                             NOT VOTING--2

     Feinstein
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 49, the nays are 
49.
  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.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that following the 
disposition of the Casey amendment No. 61, the Senate vote in relation 
to the following amendments in the order listed, with all other 
provisions of the previous order remaining in effect; further, that 
there be no second-degree amendments in order to the amendments listed. 
That would be Barrasso No. 181, Hatch No. 179, and Menendez No. 83.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. ENZI. Mr. President, I also ask unanimous consent that Senator 
Corker be recognized to offer amendment No. 106 and that the amendment 
be reported by number. I further ask that there then be 2 minutes of 
debate on the amendment to be controlled by Senator Corker or his 
designee, and following the use or yielding back of time, the amendment 
be withdrawn.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Tennessee.


                           Amendment No. 106

  Mr. CORKER. Mr. President, we have had a number of discussions about 
how to go about repealing and replacing the health care bill that is 
now law in our country. We have had a number of very thoughtful 
discussions on our side. I know a date has been put in this 
reconciliation of January 27, and we realize that is not a real date. 
That is a placeholder. That is the earliest they can come back.
  In talking with leadership and working through this, we understand 
that everyone here understands the importance of doing it right, giving 
Tom Price, the new HHS person, the time to weigh in and help us make 
this work in the appropriate way. For that reason, we plan to withdraw 
this amendment and place our faith in the fact that we are going to do 
this in a manner that works well for the American people.
  I yield to Senator Portman.

[[Page S258]]

  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. PORTMAN. Mr. President, our amendment was about ensuring that the 
second step in improving the health care system for our constituents 
was done in a thoughtful way. We now have assurances from leadership 
that certainly is their intent and that this date is not a date that is 
set in stone. In fact, it is the earliest we could do it, but it could 
take longer. We believe that it might.
  With that, we would like to withdraw the amendment, with assurances 
that we will have this time to be able to put together something that 
will, in fact, ensure that our constituents can better deal with the 
broken health care system.
  Mr. CORKER. Mr. President, if there is any time, I would like to also 
say there have been a lot of concerns about the fiscal nature of this--
making sure that we do it in a manner that does not waste taxpayer 
resources. There has been another concern--obviously, making sure that 
these health care plans stay in place during transition. Both 
discussions have been very thoughtful, very helpful, and I think that 
everyone understands what is at stake in this process, and hopefully we 
will move through it in a way that will reflect the fact that we want 
this to work for the American people.
  I yield the floor.
  Ms. COLLINS. Mr. President, one of my top priorities as a Senator has 
been to expand access to affordable health care for all Americans. I 
have always believed that the key to achieving this goal is to bring 
down the cost of health care, so more Americans can afford to purchase 
the health insurance that they need. During debate over the Affordable 
Care Act, I raised the concern that the bill's cumbersome ``one size 
fits all'' approach would do more harm than good and would result in an 
even more expensive, broken, and unsustainable health care system.
  Unfortunately, my fears are now reality. According to the Kaiser 
Family Foundation, premiums for employer-sponsored family health plans 
now top $18,000 per year, up nearly $5000 since 2009. Deductibles have 
also been rising: in 2009, only one in five workers enrolled in single-
coverage employer plans faced a deductible over $1000. Today more than 
half do.
  In Maine, premiums on the Exchange will rise an average of 22 percent 
this year, and many States are seeing even higher premium hikes. 
Meanwhile, fewer insurers are willing to write policies, leaving few 
choices for consumers who are looking for insurance.
  Some of the ACA's provisions--especially its consumer protections--
enjoy bipartisan support and should be retained; however, its 
Washington-centric approach must be changed if we are ever to truly 
reform our broken health care system. Nevertheless, this task must be 
undertaken with care.
  There is growing understanding that we cannot simply repeal the 
Affordable Care Act now and then wait 2 or 3 years to put reforms in 
place. Doing that would risk harming consumers who rely upon the 
current system for their insurance and would exacerbate the turmoil in 
the insurance markets. If we want a smooth transition from a broken and 
unaffordable system to a system that finally delivers on the promise of 
reform, we must carefully plan how we intend to get from where we are 
today, to where we need to be tomorrow.
  Thus, we are called to act quickly, but not in haste. That is why I 
joined Senators Corker, Portman, Cassidy, and Murkowski in offering an 
amendment that would change the reporting date for the bill reported 
pursuant to the budget resolution's reconciliation instructions from 
January 27 to March 3. While I continue to much prefer the later date, 
I have received assurances from Senate leaders that the January 27th 
date is not binding and that there is a shared commitment that we will 
take the time necessary to proceed thoughtfully with legislative 
reforms to replace and reform Obamacare.
  Few issues are as important to the American people as fixing our 
broken health care system. As we move to repair the ACA, I look forward 
to continuing to work with my colleagues on responsible alternatives 
that can put us on a path to a health care system that is truly 
sustainable and affordable.
  The PRESIDING OFFICER. The clerk will report the amendment by number.
  The legislative clerk read as follows:

       The Senator from Tennessee [Mr. Corker] proposes an 
     amendment numbered 106.

  The amendment is as follows:

      (Purpose: To set an appropriate date for the reporting of a 
                   reconciliation bill in the Senate)

       On page 45, line 15, strike ``January 27'' and insert 
     ``March 3''.


                      Amendment No. 106 Withdrawn

  Mr. CORKER. Mr. President, I withdraw the amendment.
  The PRESIDING OFFICER. The amendment is withdrawn.
  The Senator from Wyoming.


                  Amendments Nos. 181 and 179 En Bloc

  Mr. ENZI. Mr. President, I call up Barrasso No. 181 and Hatch No. 179 
and ask unanimous consent that they be reported by number.
  The PRESIDING OFFICER. Without objection, the clerk will report the 
amendments by number.
  The legislative clerk read as follows:

       The Senator from Wyoming [Mr. Enzi], for others, proposes 
     amendments numbered 181 and 179 en bloc.

  The amendments are as follows:


                           amendment no. 181

   (Purpose: To establish a deficit-neutral reserve fund relating to 
   strengthening Social Security and repealing Obamacare, which has 
  increased health care costs, raised taxes on middle class families, 
 reduced access to high-quality care, created disincentives for work, 
and caused tens of thousands of Americans to lose coverage they had and 
  liked, and replacing Obamacare with patient-centered, step-by-step 
   health reforms that provide access to quality, affordable private 
     health care coverage for all Americans, including people with 
disabilities and chronic conditions, and their families, by increasing 
competition, State flexibility, and individual choice, and safeguarding 
consumer protections, such as a ban on lifetime limits, that Americans 
                                support)

       At the end of title III, add the following:

     SEC. 3___. DEFICIT-NEUTRAL RESERVE FUND RELATING TO 
                   STRENGTHENING SOCIAL SECURITY AND REPEALING 
                   OBAMACARE.

       The Chairman of the Committee on the Budget of the Senate 
     may revise the allocations of a committee or committees, 
     aggregates, and other appropriate levels in this resolution 
     for one or more bills, joint resolutions, amendments, 
     amendments between the Houses, motions, or conference 
     reports, relating to strengthening Social Security and 
     repealing and replacing Obamacare, which may include step-by-
     step reforms providing access to quality, affordable coverage 
     for all Americans, including people with disabilities and 
     chronic conditions, and safeguarding consumer protections 
     such as a ban on lifetime limits, by the amounts provided in 
     such legislation for those purposes, provided that such 
     legislation would not increase the deficit over either the 
     period of the total of fiscal years 2017 through 2021 or the 
     period of the total of fiscal years 2017 through 2026.


                           amendment no. 179

   (Purpose: To establish a deficit-neutral reserve fund relating to 
reforming housing and Medicaid without prioritizing able-bodied adults 
 over the disabled or raiding the Medicare Trust Funds to pay for new 
  government programs, like Obamacare, which has failed Americans by 
    increasing premiums and reducing affordable health care options)

       At the end of title III, add the following:

     SEC. 3___. DEFICIT-NEUTRAL RESERVE FUND RELATING TO 
                   PROTECTIONS FOR THE ELDERLY AND DISABLED.

       The Chairman of the Committee on the Budget of the Senate 
     may revise the allocations of a committee or committees, 
     aggregates, and other appropriate levels in this resolution 
     for one or more bills, joint resolutions, amendments, 
     amendments between the Houses, motions, or conference reports 
     relating to reforming housing and Medicaid, which may include 
     returning State regulation of health insurance markets to the 
     States, without raising new revenue, by the amounts provided 
     in such legislation for those purposes, provided that such 
     legislation would not increase the deficit over either the 
     period of the total of fiscal years 2017 through 2021 or the 
     period of the total of fiscal years 2017 through 2026.

  The PRESIDING OFFICER. The Senator from Wyoming.


                           Amendment No. 181

  Mr. BARRASSO. Mr. President, this is a side-by-side amendment to 
Casey amendment No. 61, which was just defeated.
  As many in this body know, my wife Bobbi is a breast cancer survivor. 
I understand the importance of ensuring

[[Page S259]]

that everyone has access to health care. This is especially true for 
patients with ongoing medical conditions.
  Also, I spent 25 years practicing medicine, working every single day 
to ensure all patients received high quality care. That is why I am 
passionate about enacting health care reform to put patients first, 
unlike the Obama health care law, which put government ahead of 
patients and health care providers.
  As I travel around the State of Wyoming, I hear from many hard-
working folks who have lost their insurance coverage that they liked 
and that worked for them and their families. We are going to help those 
who have been hurt by ObamaCare. We will also ensure that people with 
serious medical conditions receive the care they need.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  The Senator from Vermont.
  Mr. SANDERS. Mr. President, the repeal of the Affordable Care Act 
will throw perhaps up to 30 million people off of health insurance.
  I would yield to my friends if they will tell me now what the 
replacement is. How many of those 30 million people are going to die? 
What is your plan to cover them, plus the other 28 million people who 
have no health insurance? How are you going to end the international 
embarrassment of the United States being the only major country on 
Earth not to guarantee health care to all people?
  They don't have a plan. I understand Senator Corker wants more time. 
Maybe they will develop a plan. Right now what they are talking about 
is repealing legislation which has brought millions of people health 
care, and they have no substitute.
  I would urge the defeat of the Barrasso amendment.
  Madam President, I raise a point of order on Barrasso amendment No. 
181, that the pending amendment is not germane to the underlying 
resolution and therefore violates section 305(b)(2) of the 
Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. 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 the purposes of 
Barrasso amendment No. 181, 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 to waive.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER (Ms. Murkowski). Are there any other Senators 
in the Chamber desiring to vote?
  The yeas and nays resulted--yeas 47, nays 51, as follows:

                      [Rollcall Vote No. 16 Leg.]

                                YEAS--47

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

                                NAYS--51

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Cruz
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Lee
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Paul
     Peters
     Reed
     Sanders
     Sasse
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--2

     Feinstein
     Sessions
       
  The PRESIDING OFFICER. On this vote, the yeas are 47, the nays are 
51.
  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.


                           Amendment No. 179

  The PRESIDING OFFICER. The Senator from Utah
  Mr. HATCH. Madam President, ObamaCare exacerbated financial pressures 
on the Medicaid Program at a time when many States were already facing 
difficult choices. Even before ObamaCare, Medicaid was plagued by 
quality issues and the law did nothing to address these problems. 
Instead, under ObamaCare, able-bodied adults not previously eligible, 
including some prisoners, are now covered by Medicaid which has 
strained already limited resources at the State level.
  Republicans are committed to working with States, stakeholders, and 
the American public to improve the quality of the Medicaid Program, 
ensuring its long-term sustainability. That is reflected in my 
amendment. My amendment would create a reserve fund to allow for 
reforms to Medicaid and ensure the program has the right priorities.
  I urge my colleagues to vote for my amendment and against the 
Menendez amendment, which is simply designed to prevent the repeal of 
ObamaCare and enshrine its flawed approach to Medicaid in a budget 
point of order.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. MENENDEZ. Madam President, this is not an amendment to protect 
the elderly and disabled. It guts Medicaid's opportunity by going into 
a block grant or per capita cut that would sharply cut Federal funding 
over time and eliminate the States' flexibility to innovate.
  Instead, this proposal only gives States flexibility to make 
draconian cuts, leaving millions of seniors and individuals with 
disabilities who rely on Medicaid without the access to needed health 
care. Instead of the State-Federal partnership that gives States broad 
flexibility to run their programs but do so with Federal minimum 
standards that are important consumer protections like mental health 
parity, early and periodic screening, diagnosis, and testing for 
children, and network adequacy protection will go to block grants.
  Do you know what happens when there is no more entitlement and you go 
to a block grant? You cut the block grant, and before you know it, you 
have no Medicaid.
  This is not protecting seniors, children, and the disabled. I urge a 
``no'' vote on the amendment.
  I raise a point of order that the pending amendment is not germane to 
the underlying resolution and therefore violates Section 305(b)(2) of 
the Congressional Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Madam President, I move to waive the applicable provisions 
of the Budget Act with respect to my amendment, 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 to waive.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  Mr. DURBIN. I announce that the Senator from California (Mrs. 
Feinstein) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 51, nays 47, as follows:

                      [Rollcall Vote No. 17 Leg.]

                                YEAS--51

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heller
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kennedy
     Lankford
     Lee
     McCain
     McConnell

[[Page S260]]


     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                                NAYS--47

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Donnelly
     Duckworth
     Durbin
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Heitkamp
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--2

     Feinstein
     Sessions
       
  The PRESIDING OFFICER. On this vote, the yeas are 51, the nays are 
47.
  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.
  The Senator from Wyoming.
  Mr. ENZI. Madam President, I ask unanimous consent that following the 
disposition of the Menendez amendment No. 83, the Senate vote in 
relation to the following amendments in the order listed, with all 
other provisions of the previous order remaining in effect; further, 
that there be no second-degree amendments in order to the amendments 
listed: Alexander amendment No. 174, Klobuchar amendment No. 178, Wyden 
amendment No. 188; finally, I ask unanimous consent that the Klobuchar 
amendment No. 172 be withdrawn.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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