July 11, 2017 - Issue: Vol. 163, No. 116 — Daily Edition115th Congress (2017 - 2018) - 1st Session

[Pages S3889-S3911]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           EXECUTIVE SESSION

                                 ______
                                 

                           EXECUTIVE CALENDAR

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will proceed to executive session to consider the Nye 
nomination, which the clerk will report.
  The senior assistant legislative clerk read the nomination of David 
C. Nye, of Idaho, to be United States District Judge for the District 
of Idaho.
  The ACTING PRESIDENT pro tempore. The Senator from Iowa.


                         healthcare legislation

  Mr. GRASSLEY. Mr. President, I am going to speak for about 5 minutes. 
Before I begin, I will reference an item that I ask unanimous consent 
be printed in the Record following my speech.
  I rise to share real stories of real hardships from hard-working 
families in my home State of Iowa. Seven years ago, Americans were 
promised that the Affordable Care Act would make health insurance 
cheaper and healthcare more accessible. Well, I will not pretend to 
break any news here. The facts speak for themselves: ObamaCare is not 
living up to its promises. When passing the law, the other side made 
promises they knew could not be kept.
  The irony is, the so-called Affordable Care Act is anything but 
affordable. I have heard from many Iowans who tell me, in no uncertain 
terms, that they cannot afford to buy health insurance because 
ObamaCare is unaffordable. In fact, 72,000 Iowans can't even get help 
from the exchange because there isn't an insurance company to service 
them.
  One Iowan wrote to me:

       I am forced to pay $230 a month for a healthcare plan that 
     covers nothing until I reach $11,000 in deductible. So on top 
     of paying 100 percent of my medical bills anyway, now I also 
     have to pay for insurance I can't use.

  How did we get to this point?
  Seven years ago, I spoke right here on the Senate floor and predicted 
what would happen to the cost of insurance if ObamaCare passed. So 
let's go back to that period of time when I spoke in October of 2009. 
This is my own quote from that speech:

       And while some of the supporters of these partisan bills 
     may not want to tell their constituents, we all know that as 
     national spending on health care insurance increases, 
     American families will bear the burden in the form of higher 
     premiums. So let me be very clear, as a result of the current 
     pending health care proposals, most Americans will pay higher 
     premiums for health insurance.

  That is the end of my quote from a speech in the Senate in October of 
2009.
  Now, I don't have a magic crystal ball, but it was easy to read the 
writing on the wall. I knew that layers of new taxes and burdensome new 
mandates in ObamaCare would lead us to where we find ourselves today: a 
broken healthcare system that is not better off than it was 7 years 
ago, and for millions of Americans--including those 72,000 Iowans--it 
is much worse.
  So where do we go from here? After 7 years of rising premiums, 
soaring deductibles, and climbing copays, Republicans are committed to 
fixing the damage caused by the Affordable Care

[[Page S3890]]

Act. Not only is it unaffordable for too many people, it is 
unsustainable. ObamaCare is unable to fulfill its promises to the 
American people.
  Here is what every lawmaker in Congress ought to agree on: Insurance 
isn't worth having if patients can't afford to use that insurance. The 
facts are clear. A one-size-fits-all, government-run plan from 
Washington, DC, is driving insurers out of the exchanges, driving up 
premiums, driving away customers, and driving up the tab to the tax-
paying public.
  ObamaCare has overregulated, overtaxed, and oversold its promises to 
the American people. ObamaCare has not healed what ails the U.S. 
healthcare system. It is time to move forward.
  Mr. President, I also want to speak about Medicaid for a moment.
  Medicaid, as we know it, is not sustainable. The Federal Government 
and States spent $553 billion on Medicaid in 2016. That amount is very 
close to $593 billion spent on the No. 1 responsibility of the Federal 
Government--our Nation's defense.
  Every decade since Medicaid started, it has grown faster than the 
economy. Medicaid is now unmatched as a driver of the deficit of our 
country. We cannot sit by and leave this kind of debt to our children 
and our grandchildren.
  Dollars are not the only metric by which we measure Medicaid. 
Medicaid is a program that should supply healthcare to diverse 
populations and should have quality measured, but it does not.
  Medicaid dollars should be spent efficiently, but they are not. 
Activists in Washington, DC, are fighting to preserve the status quo 
and, of course, in the process, scaring the daylights out of the 
American people.
  Yet Iowans tell me that there are waiting lists for Medicaid waivers 
to obtain services for children with disabilities. Others tell me that 
medicines that will cure diseases are rationed to be used only with 
those with the most advanced disease. In other words, you have to get 
really sick for Medicaid to cover medical expenses.
  It is a fact that Medicaid is not working the way it should for 
everyone. The time to act to preserve and improve Medicaid as the 
safety net for the most vulnerable citizens is right now.
  I am holding up a letter here because, under a Democratic President, 
proposing to do what we are doing, 46 Democrat Senators wrote to 
President Clinton and expressed their ``strong support'' for Medicaid 
per capita caps. The letter went on to say that it would give States 
the flexibility to achieve savings without cuts to essential services. 
That is what the current proposal aims to do as well.
  We are proposing per capita caps as a way to make sure tax dollars 
are spent wisely on the most vulnerable people in our Nation. Medicaid 
dollars should be spent on a child with cystic fibrosis who needs a 
blockbuster drug. A person with severe mental illness should be able to 
rely on Medicaid for care.
  Medicaid cannot continue to be a limitless credit card for the States 
to spend money without any accountability to the people who need it. I 
urge my colleagues to put aside partisan dogma and work to solve this 
problem for the American people.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                               Washington, DC,

                                                December 13, 1995.
     President William J. Clinton,
     The White House,
     Washington, DC.
       Dear Mr. President: We are writing to express our strong 
     support for the Medicaid per-capita cap structure in your 
     seven-year budget. We have fought against Medicaid block 
     grants and cuts in the Senate, and we are glad you 
     acknowledge the importance of our position.
       We support a balanced budget. We are glad you agree with us 
     that we can balance the budget without undermining the health 
     of children, pregnant women, the disabled, and the elderly.
       The savings level of $54 billion over seven years included 
     in your budget will require rigorous efficiencies and 
     economies in the program. However, after consulting with many 
     Medicaid Directors and service providers across the country, 
     we believe a reduction of this level is possible to achieve 
     without dramatic limits on eligibility or cuts to essential 
     services. States will need flexibility to achieve these 
     savings, and you have taken steps toward granting it in your 
     bill.
       We were encouraged that your Medicaid proposal does not pit 
     Medicaid populations against one another in a fight over a 
     limited pot of federal resources.
       We were further encouraged to hear Chief of Staff Panetta 
     relay your commitment to veto any budget not containing a 
     fundamental guarantee to Medicaid for eligible Americans.
       We commend you on the courage you have exercised in making 
     these commitments to Americans eligible for Medicaid. There 
     is a bottom line when it comes to people's health; do not 
     allow the current Congressional leadership to further reduce 
     our commitment to Medicaid beneficiaries.
       Your current proposal is fair and reasonable, and is 
     consistent with what we have advocated on the Senate floor. 
     We urge you in the strongest possible terms to hold fast to 
     these commitments in further negotiations. We are prepared to 
     offer any assistance you may need in this regard.
           Sincerely,
       Bob Graham; John Breaux; Jay Rockefeller; Herb Kohl; 
     Patrick Leahy; Frank R. Lautenberg; Ted Kennedy; Tom Daschle; 
     Patty Murray; Barbara Boxer; David Pryor; Barbara A. 
     Mikulski; Max Baucus; Paul Simon; Kent Conrad; Wendell Ford; 
     Harry Reid; Paul Wellstone; Richard H. Bryan; Ernest 
     Hollings; Dianne Feinstein; Tom Harkin; Byron L. Dorgan; 
     Chris Dodd; J. Bennett Johnston; Joe Lieberman; Paul 
     Sarbanes; Carol Mosely-Braun; John Glenn; Jeff Bingaman; Carl 
     Levin; Bill Bradley; John F. Kerry; Bob Kerrey; Joe Biden; 
     Daniel K. Akaka; Dale Bumpers; Daniel Inouye; Chuck Robb; J. 
     James Exon; Howell Heflin; Claiborne Pell; Russ Feingold; 
     Daniel P. Moynihan; Sam Nunn; Robert C. Byrd.

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


                   Recognition of the Majority Leader

  The ACTING PRESIDENT pro tempore. The majority leader is recognized.


                        Mississippi Plane Crash

  Mr. McCONNELL. Mr. President, I want to start this afternoon by 
offering deepest condolences to the Marine Corps and to all those who 
lost loved ones in the tragic plane crash yesterday in Mississippi. We 
are still learning details about the incident, but we know that at 
least 16 on board the plane perished as a result of the crash. Our 
hearts break for all those impacted and the many lives cut short in 
this tragedy. We are reminded of the bravery that our voluntary 
servicemembers exhibit, putting their lives on the line, both at home 
and abroad, in order to defend our communities and our freedom. We are 
indebted to them for their courageous, courageous sacrifice.


                         Healthcare Legislation

  Mr. President, on a totally different matter, ObamaCare is a direct 
attack on the middle class. Seven years ago, Democrats imposed it on 
our country. In the years since, Americans have found themselves at the 
mercy of its failures repeatedly. Choice was supposed to go up, but it 
plummeted. Costs were supposed to go down, but they skyrocketed.
  ObamaCare's defenders spent years trying to deny these clear 
realities. When the weight of the evidence became too clear to ignore, 
some appeared to bemoan ObamaCare's harmful impact on our country.
  The Democratic Governor of Minnesota declared that it was ``no longer 
affordable.'' President Clinton branded it ``the craziest thing in the 
world.'' Other Democrats said similar things.
  Such acknowledgements of the obvious seemed to many of us like 
progress, but they turned out to be just rhetoric. In the last 
election, voters delivered Congress the opportunity to finally address 
the ObamaCare status quo. Yet Democrats made clear early on that they 
did not want to work with us in a serious, bipartisan way to actually 
do so.
  I wish they had made a different choice. I wish their sudden calls 
for bipartisanship now were even somewhat serious, but this is the 
reality before us. We must accept it because that is where we are.
  As my Republican colleagues know, this is the charge we must accept 
as well. The American people are looking to us for a better way. That 
is why, despite the headwinds, I chose to keep working toward a better 
solution than ObamaCare. I have seen the pain in the eyes of too many 
of my constituents because of this law. I think they deserve better 
than what ObamaCare has given them. I hope, in the end, that a majority 
of the Senate will agree.
  We have been continuing with ongoing conversations across the 
conference about how to get there. Members shared significant input 
over the State work period. We are going to keep working very hard on 
this. We will continue to focus on the fundamentals that have guided 
the process from the start, like improving the affordability

[[Page S3891]]

of health insurance and stabilizing collapsing insurance markets before 
they leave even more Americans without any options at all.
  We also want to strengthen Medicaid for those who need it most by 
giving States more flexibility while ensuring that those who rely on 
the program don't have the rug pulled out from under them.
  Many States want the ability to reform their Medicaid programs so 
they can actually deliver better care at a lower cost. Under current 
law, States have some ability to do so. Indiana, for example, has 
launched a particularly notable effort, thanks to the leadership of 
now-CMS Director Seema Verma.
  Ms. Verma has also helped States like Kentucky develop their own 
plans, but the process is still too restrictive. It hinders broader 
innovation, and it is very slow. Kentucky's plan, for instance, still 
has not been approved by the Federal Government.
  The Senate's healthcare legislation contains a provision to 
dramatically expand the State's authority to improve its Medicaid 
system. It is an idea that could significantly improve healthcare in 
States across the country. The Wall Street Journal wrote in a recent 
editorial:

       This booster shot of federalism could become the greatest 
     devolution of federal power to the states in the modern era. 
     [It could] launch a burst of state innovation.

  The Journal went on further:

       Introducing many competing health-care models across the 
     country would be healthy. California and South Carolina 
     don't--and shouldn't--have to follow one uniform prototype 
     designed in Washington, and even a state as large as 
     California doesn't have the same needs from region to region 
     [within the State]. If nothing else the repeal and replace 
     debate has shown that liberals, conservatives and centrists 
     have different health-care priorities, and allowing different 
     approaches and experimentation would be politically 
     therapeutic. The more innovative can become examples to those 
     that stay heavily regulated.

  It is clear that we have an important opportunity to achieve positive 
things for our country. It is also clear that, if we let this 
opportunity pass by, the options left are not good ones.
  The Senate Democratic leader acknowledges that ObamaCare isn't 
working the way they promised, but his solution, as he noted in a 
statement last week, is simply more money for insurance companies. The 
solution would be an insurance company bailout--no reforms, no changes, 
just more money to paper over the problems under the current law. It is 
a multibillion-dollar bandaid, not a real solution.
  Senator Sanders acknowledges that ObamaCare isn't working, too, but 
his solution, as he stated in my State over the weekend, is to move to 
the kind of fully government-run single-payer system that was already 
abandoned in his home State of Vermont, that 80 percent of the voters 
recently rejected in Colorado, and that even the California State 
Legislature and its huge Democratic majority is finding rather hard to 
swallow.
  Is it any wonder? The so-called single-payer plan Senator Sanders 
proposed in his Presidential campaign would strip Americans of so many 
facets of decisionmaking over their own healthcare and literally hand 
it over to the government. It would require almost unimaginably high 
tax increases--unimaginably high.
  The cost, according to a recent analysis by the Urban Institute, 
stands at an astonishing--listen to this--$32 trillion. That is 
trillion with a ``t.'' That represents a greater sum than the entire 
economy of the most populous nation on Earth--China. It is more than 
Japan's economy, too--and Germany's, Britain's, and France's. It is the 
same with Italy's, Brazil's, India's, and Canada's.
  In fact, the cost of Senator Sanders' healthcare plan is projected to 
be roughly equal to the size of all nine of those countries' economies 
combined. It would total more than the entire economy of the European 
Union twice over. If you laid out 32 trillion one-dollar bills end to 
end, they would stretch from the Earth to Neptune. It took the Voyager 
2 spacecraft 12 years to reach Neptune.
  That is the government-run single-payer plan put forward by the most 
famous proponent of the idea. Many in the Senate Democratic leadership 
now support single-payer, too, and these days, increasing numbers on 
the left seem to openly comment on the failures of ObamaCare, as if 
they see an opportunity to finally realize their leftwing dream of 
total government dominance of the healthcare system.
  That is the dream of many on the other side in this body. That will 
not happen if we succeed in our charge today. Americans deserve better 
than what we are getting under ObamaCare. They deserve better than what 
they get under an even more government-heavy system than we have now. 
They also deserve better than a bandaid solution.
  The people we represent deserve more affordable health insurance. 
They deserve improved healthcare choice. They deserve a more flexible 
Medicaid system that can help improve outcomes for those truly in need. 
They deserve a more responsive healthcare market that trusts the 
American people to make more of their own choices, not the government.
  That is what we have been fighting for throughout this debate. That 
is what we are going to keep fighting for today.
  Mr. President, on one final matter, believe it or not, the current 
business before the Senate is the consideration of a noncontroversial 
nominee to be a U.S. district judge in Idaho--Idaho.
  How do we know he is noncontroversial? Well, the Judiciary Committee 
reported out his nomination on a voice vote, and, then, every single 
Senate Democrat voted yesterday for cloture on his nomination, thereby 
agreeing that there is no need to continue debate on this 
noncontroversial nomination--a noncontroversial district court judge.
  Why are we still having a debate on a noncontroversial district court 
judge? If they agree that the Senate should bring the debate on the 
nomination to a close, then, why did they insist on dragging out the 30 
hours of postcloture debate time in order to debate a nomination that 
not a single Democrat said needed to have more debate?
  We all know the answer. It is that the unnecessary procedural vote 
yesterday served our colleagues' apparent purpose of wasting--literally 
wasting--more of the Senate's time. Unfortunately, this has become a 
common practice for our friends across the aisle.
  At this point in President Obama's Presidency, we allowed more than 
90 percent of his nominees to clear by simple voice vote. Let me say 
that again. At this point in President Obama's Presidency, we allowed 
more than 90 percent of his nominees to clear by a simple voice vote, 
and we only asked for those procedural votes known as cloture votes 
eight times. At the same point under this current President, President 
Trump, Democrats have allowed voice votes 10 percent of the time. While 
90 percent of Obama's nominees got a voice vote, 10 percent of Trump's 
got a voice vote, and they forced procedural hurdles 30 times.

  These delays have nothing to do with the credentials or whether 
Democrats support the nominee. In many cases, in fact, they do support 
the nominee, like the nominee before us.
  As the Wall Street Journal observed yesterday:

       Democratic obstruction against nominees is nearly total, 
     most notably including a demand for cloture filings for every 
     nominee--no matter how minor the position.

  What does this mean? It means a 2-day waiting period and then another 
30 hours beyond that. It is not about changing the outcome; it is about 
wasting time to make it more difficult for the President to make 
appointments.
  According to the nonpartisan Partnership for Public Service, at this 
point in President Obama's administration, he had 183 of his nominees 
confirmed. While the current President has made 178 nominations--almost 
as many--the Senate has confirmed only 46 of them.
  The Wall Street Journal editorial I mentioned goes on to note that 
the extent of this Democratic obstruction extends far beyond the 
cloture vote issue. I have discussed this issue before, and I urge the 
Democratic minority to think critically about the consequences for the 
Senate and our country if they allow this near-total obstruction to 
continue.

[[Page S3892]]

  Mr. President, I ask unanimous consent that the Wall Street Journal 
editorial I just mentioned be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

             [From the Wall Street Journal, July 10, 2017]

 Running the Schumer Blockade: The GOP Senate Needs To Stop Democratic 
                           Abuse of the Rules

                        (By the Editorial Board)

       The Trump Presidency is well into its seventh month but the 
     Trump Administration still barely exists. Senate Democrats 
     are abusing Senate rules to undermine the executive branch, 
     and Republicans need to restore normal order.
       President Trump got an inexcusably slow start making 
     nominations, but in the past few weeks he's been catching up 
     to his predecessors. According to the Partnership for Public 
     Service, as of June 28 Mr. Trump had nominated 178 appointees 
     but the Senate had confirmed only 46. Barack Obama had 183 
     nominees confirmed by that date in his first term, and George 
     W. Bush 130.
       The White House has understandably begun to make a public 
     issue of the delays, and Minority Leader Chuck Schumer says 
     it ``has only itself to blame.'' But a press release Mr. 
     Schumer sent out Monday made the White House case, showing 
     that the Senate has received 242 nominations but confirmed 
     only 50 through June 30. Democrats are now the problem.
       Among the non-controversial nominees awaiting confirmation: 
     Kevin Hassell to lead the White House Council of Economic 
     Advisers; David Malpass, under secretary at Treasury for 
     international affairs; two nominees needed to review 
     pipelines and other projects at the Federal Energy Regulatory 
     Commission; and Noel Francisco for Solicitor General. Mr. 
     Malpass was nominated in March and voted out of committee in 
     mid-June. Mr. Trump's State Department is barely functioning 
     with only eight confirmed appointees.
       Democratic obstruction against nominees is nearly total, 
     most notably including a demand for cloture filings for every 
     nominee--no matter how minor the position. This means a two-
     day waiting period and then another 30 hours of debate. The 
     30-hour rule means Mr. Trump might not be able to fill all of 
     those 400 positions in four years. The cloture rule also 
     allows the minority to halt other business during the 30-hour 
     debate period, which helps slow the GOP policy and oversight 
     agenda.
       Democrats have also refused to return a single ``blue 
     slip'' to the Judiciary Committee, which has the effect of 
     blocking consideration of judicial nominees from their home 
     states. Senators like Minnesota's Al Franken and Amy 
     Klobuchar are holding hostage the eminently qualified 
     Minnesota Supreme Court Justice David Stras for the Eighth 
     Circuit Court of Appeals for no reason other than politics.
       Minority Leader Chuck Schumer's troops are even invoking an 
     obscure rule that prohibits committees from doing business 
     more than two hours after the Senate opens for the day. 
     Republicans have had to cancel briefings on national security 
     and Russia electoral interference, as well as scrap a markup 
     of two human-trafficking bills.
       Democrat Harry Reid didn't have the cloture headache when 
     he was Majority Leader because in 2013 he cut a deal with 
     Republicans. The GOP traded the ability to offer more 
     amendments to legislation in return for letting Mr. Reid 
     limit post-cloture debate for most nominations to eight 
     hours. This rule let Mr. Reid confirm dozens of judicial and 
     lower-cabinet nominations every week. But the deal expired in 
     early 2015, and good luck getting Mr. Schumer to grant the 
     GOP the same terms.
       Frustrated Republicans may soon begin listening to Oklahoma 
     Senator Jim Lankford, who wants the majority to impose the 
     eight-hour rule unilaterally. Most debate about nominees 
     occurs during vetting and in committees. Eight hours on the 
     floor is enough for all but the most controversial nominees, 
     and the Senate could then get back to other business.
       As for the blue-slip tradition, it was designed to 
     facilitate advice and consent by allowing Senators to use 
     their home-state knowledge about local judges to better 
     inform the White House. But it is a courtesy, not a rule, and 
     Judiciary Chairman Chuck Grassley can ignore Senators who are 
     using their blue slips as ideological vetoes of qualified 
     candidates.
       Mr. Trump has nominated first-rate judges, and Mr. Grassley 
     is justified in suspending blue-slip privileges on a case-by-
     case basis. Majority Leader Mitch McConnell has also been 
     starting the Senate at different times of the day to get 
     around the Democratic sabotage of committee work. But note 
     Mr. Schumer's childishness in forcing a game of Senate hide-
     and-seek.
       Mr. McConnell will be wary of Mr. Lankford's advice to 
     change a Senate rule in the middle of the term, but the 
     Majority Leader rightly did so when Democrats staged a 
     historic filibuster of Supreme Court Justice Neil Gorsuch. 
     Democrats aren't using cloture to raise the level of debate 
     or highlight unqualified nominees. They are using it--and 
     have said as much--to sabotage a Presidency. That isn't what 
     the Founders intended, and Republicans have every right to 
     stop this abuse of process to let the President form a 
     government.

  The ACTING PRESIDENT pro tempore. The Senator from South Dakota.


                         Healthcare Legislation

  Mr. THUNE. Mr. President, as the leader has very ably pointed out, 
the Democratic obstruction when it comes to President Trump's nominees 
is reaching an unprecedented level if you compare it to any past 
administration. He pointed out the number of nominees President Obama 
was able to get in and the way in which Republicans here in the Senate 
cooperated with him on his nominees. This state of affairs here in the 
Senate really is taking the obstructionism when it comes to trying to 
block even getting people into the administration, into their 
positions, to an entirely new level.
  Frankly, about the only thing that probably exceeds the pileup of 
President Trump's nominees who are not getting into his administration 
is the pileup of bad ObamaCare news stories. Just take a look at a few 
of the recent headlines.
  From the Cincinnati Enquirer: ``Another insurer leaves Ohio health 
care exchange.''
  From Bloomberg: ``Anthem's Exit Creates Obamacare `Crisis' for Rural 
Nevadans.''
  From the Washington Free Beacon: ``Recent Obamacare Insurer Exits 
Lead to 2 More Counties With No Choices.''
  This is another headline from the Washington Free Beacon: ``19th 
Obamacare Co-Op Folds, Leaving Only 4 Operating in 2018.''
  Across the United States, the story is the same--huge premium 
increases, fewer choices, and a system that is well on its way to 
complete collapse.
  In late May, the Department of Health and Human Services released a 
report comparing the average individual market insurance premium in 
2013, which was the year most of ObamaCare's regulations and mandates 
were implemented, with the average individual market exchange premium 
in 2017 in the 39 States that use healthcare.gov. This is what they 
found:
  Between 2013 and 2017, the average individual market monthly premium 
in the healthcare.gov States increased by 105 percent. That is in the 
4-year timeframe since ObamaCare was implemented. On average, 
individual market premiums more than doubled in just those few years.
  In my home State of South Dakota, premiums increased by 124 percent, 
or $3,588. That is money South Dakota families had to take from other 
priorities, such as saving for retirement or investing in their 
children's education. Over the past 5 years, the average individual 
market yearly premium has increased by $4,800 in Arizona; $8,364 in 
Alaska; $3,648 in Louisiana; $5,064 in North Carolina; $4,488 in 
Tennessee; and $5,292 in West Virginia.
  Premium hikes aren't over. In fact, in many cases, they are getting 
worse. Here are some of the premium hikes insurers are proposing for 
2018. In Maryland, one insurer has proposed an average premium increase 
of 52 percent. An Iowa insurer is seeking an average 43.5 percent 
premium increase. In North Carolina, an insurer is pursuing an average 
22.9 percent hike. A Virginia insurer is looking for an average rate 
increase of 38 percent. A Delaware insurer is looking for an average 
rate hike of 33.6 percent. A Maine insurer is seeking an average rate 
hike of 40 percent. I could go on. Remember, these are rate hikes for 
just 1 year. The double-digit rate hikes for next year are in addition 
to years upon years of dramatic Obama premium increases, as I already 
pointed out.
  The ObamaCare status quo is not sustainable. This law was fatally 
flawed from the beginning, and it is rapidly imploding. The American 
people need relief. Inaction is not an option.
  My colleagues across the aisle seem to want to do one of two things. 
They either want to do nothing, which would leave Americans even worse 
off than they are now, or they want to double down on ObamaCare's 
failures by giving the government even more control over Americans' 
healthcare and then raising Americans' taxes to pay for it. Neither one 
of those so-called solutions will provide relief to the American 
people.
  Republicans are committed to providing real help to the millions of 
Americans who have been hurt by ObamaCare, and we are working on 
legislation to do just that. My colleagues

[[Page S3893]]

in the House made a good start, and we are working to build on their 
bill here in the Senate.
  We are committed to helping to stabilize the collapsing insurance 
markets that left millions of Americans with no options. We are 
committed to freeing the American people from the onerous ObamaCare 
individual mandate, which requires Americans to purchase insurance that 
they may not want or can't afford. We are committed to improving the 
affordability of health insurance, which keeps getting more expensive 
under ObamaCare. We are committed to preserving access to care for 
Americans with preexisting conditions. We are committed to 
strengthening Medicaid for those who need it most by giving States more 
flexibility while ensuring that those who rely on this program don't 
have the rug pulled out from under them.
  The American people have suffered under ObamaCare for long enough. It 
is time to give them some relief, and that is what we intend to do.


                              North Korea

  Mr. President, I would like to take a few minutes today to discuss 
the serious threat posed by a nuclear-capable North Korea.
  Last week, on the Fourth of July, North Korea leader Kim Jong Un took 
the latest and possibly most alarming step in his unwavering quest for 
a nuclear weapon by successfully testing an intercontinental ballistic 
missile. Estimates suggest that the missile tested had a range of more 
than 4,000 miles, which means it could reach Alaska. North Korea has 
not yet demonstrated the ability to arm these missiles with nuclear 
warheads, but that day may not be far off.
  North Korea's nuclear program has achieved a disturbing number of 
milestones in this year alone. The United States must do everything we 
can to prevent a nuclear-capable North Korea, but we must also be 
prepared should Kim Jong Un put the final pieces together, and that 
starts with maintaining a credible military deterrence.
  This weekend's B-1 bomber flights were but a sliver of the response 
the United States could bring to bear in direct military engagement.
  Gen. Terrence O'Shaughnessy, commander of the Pacific Air Forces, 
said of the exercises:

       Let me be clear, if called upon, we are trained, equipped, 
     and ready to unleash the full, lethal capability of our 
     allied air forces.

  We need to make sure we maintain that lethal capability. Congress has 
a key role to play here by making sure we adequately fund our military 
and pass defense appropriations in a timely manner.
  While Kim Jong Un has not shown much of an inclination toward 
rationality, we need to keep emphatically reminding him that his regime 
would not survive a war on the Korean Peninsula.
  A robust and redundant defense is also an important component of the 
U.S. and allied response to North Korea. A key part of building our 
defenses should be a rigorous test schedule to inform research and 
development of anti-ballistic missile technology.
  It is true that some U.S. missile intercept tests have failed, but 
those setbacks have led to improvements. Some of our best men and women 
are working to keep us ahead of threats. We must repeatedly and 
aggressively test intercept systems to ensure that they are effective.
  Gen. John Hyten, the head of U.S. Strategic Command, has pointed out 
that our testing schedule for intercept systems lags behind the pace of 
North Korea's aggressive missile testing.
  Tuesday's successful THAAD missile defense system test against a 
simulated intermediate-range ballistic missile attack was a timely 
demonstration of this critical defense capability, and I hope we see 
further deployment of this promising system. Placing THAAD or the Aegis 
Shore missile defense system in Japan would bolster frontline defenses 
against future North Korean missile launches.
  We should also increase information sharing and military cooperation 
in the area around the Korean Peninsula to ensure that sanctions are 
enforced. The joint maritime operations conducted by the U.S. Navy and 
Coast Guard and the Japanese Maritime Self-Defense Force are good 
examples of this cooperation.
  We must also examine how we have gotten to this state. For a so-
called hermit kingdom, North Korea has made significant advancements, 
while evading international sanctions. Those advancements, which build 
off a legacy of Soviet support, have been facilitated by North Korea's 
ties with Iran and a passive China providing North Korea with an 
economic lifeline. Not all the blame rests with China, but we know 
President Xi has proved largely unwilling to curtail North Korea's 
agenda.
  Late last month, Treasury Secretary Steve Mnuchin announced sanctions 
on Chinese entities with financial ties to North Korea. This is a 
positive first step, but more can be done to target banking and front 
companies that serve as financial conduits for North Korea. Increased 
transparency in Chinese customs and export reporting, for example, 
would restrict oil and steel exports to North Korea and ensure that 
China is adhering to its ban on coal imports from North Korea.
  The United States should also weigh whether new sanctions, both 
punitive and preventive, could exert additional pressure on China to 
rein in North Korea. I hope the administration will seriously consider 
such sanctions alongside measures to address other problematic Chinese 
actions, such as its continued military buildup on disputed reefs in 
the South China Sea.
  Kim Jong Un is clearly ready and willing to threaten the United 
States and its allies, and we should have no illusions that he is 
planning to reverse course. We need to make sure that we are prepared 
for any threat he or his regime poses.

  I yield the floor.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. NELSON. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Hoeven). Without objection, it is so 
ordered.


                         Healthcare Legislation

  Mr. NELSON. Mr. President, I want to speak on behalf of a group of 
Floridians I have met with who would be tremendously hard-hit by the 
healthcare bill, whether it be the one that has already been published 
by the majority leader or some of the iterations that are being 
discussed.
  I want to talk on behalf of and be the spokesperson for these people 
who have cried out to me. I want to say that people are crying out. It 
is not just the group of four families I assembled in my Tampa office 
last week, but it also includes walking down the street, being in an 
airport, or going into a public building. Constantly, folks are walking 
up to me and saying: Please, don't let them take away my healthcare.
  Just this past week, I was in--it shall remain nameless--a Republican 
Senator's State. It happened in the airport there as my colleague, the 
Republican Senator in that State other than mine--the travelers, the 
constituents of that Senator in the airport as we were waiting for the 
airplane walked up to that Republican Senator and begged: Please don't 
take away my healthcare.
  What we have seen in this Republican bill is that it takes health 
insurance away from millions of Americans. That is not my conclusion; 
that is the conclusion of the Congressional Budget Office. According to 
CBO, it also cuts back some $800 billion out of Medicaid over a decade, 
and it allows insurance companies to hike rates for older Americans.
  Under the bill, 22 million people would lose their insurance by 2026. 
Over 2 million of these folks are in Florida. In fact, the bill would 
increase the uninsured rate in Florida by 62 percent. That is not what 
I want inflicted on the folks in Florida.
  This bill lets insurance companies go back to the days when they had 
annual and lifetime limits on coverage and refused to cover basic 
health benefits, such as prescription drugs, mental health services, 
and even maternity care. This Republican healthcare bill, which has 
been so much the subject in the news and the center of the debate here 
for the past innumerable weeks, really does cut Medicaid. According to 
CBO--again, not my words; CBO's words--funding will be 26 percent lower 
in Medicaid by the year 2026 than under the existing law.

[[Page S3894]]

  My home State of Florida is projected to lose $5.7 billion in Federal 
Medicaid funding from 2020 to 2026 under the bill that is proposed by 
the majority leader. If that is not enough, the Senate bill would 
dramatically increase healthcare costs for Americans between the ages 
of 50 to 64 before they turn that magic age of 65 when they are 
eligible for Medicare. It dramatically increases those costs. That 
dramatic rise in cost is due in large part to a provision that would 
allow insurance companies to charge older Americans up to five times 
what younger people are charged. The current law, the Affordable Care 
Act, has a differential of 3 to 1. This bill as proposed has a 
differential of 5 to 1. So if you are not on Medicare because you 
haven't turned 65 and you are an older American in those ages--which 
increasingly seem very young to me--up to age 64 when the differential 
from what the insurance company charges the young person is five times, 
not three times, as is the current law, this would especially be felt 
among those older individuals making between $42,000 and $48,000 a year 
who, after that point, no longer qualify for the tax credits under the 
Republican bill to make coverage more affordable.

  Remember, in the current law, up to 400 percent of poverty level, you 
are entitled to get tax credits according to what your income is to 
help you buy private health insurance from insurance companies on the 
marketplaces in each State. Even that is going to be reduced.
  This bill also includes a backdoor provision that undermines the 
protections that currently exist for people with preexisting 
conditions. In defending the bill, people will argue that it doesn't do 
that, but look what the bill says. It says that it can be left up to 
the States to determine that. What is a way that the State can lessen 
the cost of insurance premiums? Take away the guarantee that someone 
can get insurance if they have a preexisting condition.
  I have given a number of speeches. I have had some experience in this 
as the former elected insurance commissioner of Florida, when it was an 
elected position. It was also a constitutional position of the State 
treasury. I held that position for 6 years, and I have dealt with 
insurance companies. I have seen some insurance companies say: You have 
a preexisting condition. We are not going to insure you because you 
have asthma. I have even seen an insurance company cite: We are not 
going to insure you because you have a preexisting condition; you had a 
rash.
  Under the current law, an insurance company cannot deny you insurance 
because of whatever your preexisting condition is. Your preexisting 
condition may be that you have a weak heart, and you, of all people, 
would want health insurance. Before, you couldn't get it. Now, under 
the current law, you can.
  I don't want you to hear this plea over and over again from me. I 
want the pleas from several Floridians to reach out across the State 
lines and get to the Senators who are going to be voting on this. I 
want them to hear from some of my constituents. When I met with them 
last week in Tampa, I had many who said that they would be devastated 
if Medicaid were cut.
  I want to share with you how this has personally affected them and 
how apprehensive and plain scared they are right now that the 
healthcare they are getting will cease if this bill proposed by the 
majority leader is to become law.
  Take, for example, Michael Phillips. He is 36 years old, and he has 
spinal muscular atrophy. It is a genetic disorder that affects control 
of his muscle movement. He relies on a tracheotomy, a breathing tube, 
and uses assistive computer technology to be able to talk. The computer 
talks for him.
  Michael was supposed to join us on that day, but he wasn't feeling 
well, and, of course, there is always the added exposure to germs in 
his weakened immune condition. Instead came his two caregivers, his 
single mother Karen and his brother Brian. Michael relies on Medicaid, 
which allows him to live at home with his mom and have a personal care 
assistant. He benefits from the Medicaid home and community-based 
waivers. If the waivers are eliminated because of the whacking of 
billions and billions of dollars from Medicaid, he would ultimately end 
up in a nursing home, away from his mother and his family, being forced 
to compromise his level of care and quality of life.
  You may have seen this fellow and his mom interviewed by the national 
news networks. He is one and the same, Michael Phillips.
  The Senate healthcare bill ends Medicaid as we know it. Whether it is 
a cap on the amount of money going to the State or it is called a block 
grant, the effect is the same. It will put people like Michael at risk 
of losing critical services, and it will certainly take away his 
independence and his quality of life.
  I have already said that the bill certainly takes away the guarantee 
of coverage with a preexisting condition. Let me tell you about another 
Floridian who was in that meeting. Elizabeth Isom is from St. 
Petersburg, and she told me that the Affordable Care Act saved her life 
and allowed her to purchase insurance for the very first time. If it is 
taken away, she doesn't know how she is going to be able to afford 
coverage because of lifetime caps. An insurance company cannot put 
those lifetime caps on what they pay out. For example, in the old days, 
before the existing law, an insurance company would say: I'll pay you 
as long as it doesn't exceed, say, $25,000 or $50,000. That was all 
figured into their insurance payment and their premiums. In the current 
law there are essential health benefits. There are about a dozen of 
them.
  Elizabeth was a social worker before she developed a sinus tumor. She 
went without insurance for 3 years, during which time her health was 
deteriorating. Because she did not have health insurance, she could not 
afford to have that tumor operated on. What I do not know is if she 
knew this at the time--because she hadn't had the operation--or if she 
thought it was cancerous. As it turned out, later, when she was able 
under the Affordable Care Act to get health insurance and to have the 
operation, thank the good Lord it was benign. But her health had 
deteriorated to the point that as this thing started to grow into her 
sinus passages and into her brain cavity, she actually thought she was 
approaching death. She ended up having vital organ damage and reached 
the point of complete disability. The mass in her sinus had extended 
into her skull.
  After the ACA became the law of the land, she purchased insurance 
through healthcare.gov. She says that it is the best insurance she has 
ever had because it covered essential health benefits like preventive 
services. It certainly provided for her to go on and get the operation, 
and it saved her life.
  If this Senate bill passes, services that Elizabeth relies on may no 
longer be covered, and she likely will never be able to afford a decent 
health insurance package again. She obviously has a preexisting 
condition. She would be one of the 22 million people whom the 
Congressional Budget Office estimates would lose their health insurance 
if the bill proposed by the majority leader, Senator McConnell, were to 
become law.
  Let me tell you about another Floridian. Regina Hebert is from Tampa. 
She is a small business owner. She was diagnosed with stage IIB breast 
cancer at the age of 57. She, too, told me that the ACA saved her life. 
Without the ACA, she would not have received health insurance because 
her cancer is considered a preexisting condition--57 years old, 
preexisting condition, stage II breast cancer. She obtained health 
insurance through the ACA. She had two surgeons, months of chemo and 
radiation, and she told me that if her cancer comes back and she 
doesn't have insurance, then she is going to have to choose between 
going bankrupt--not through what she is doing now with her small 
business. She is paying taxes. She is contributing to society.
  What is her other choice? Her other choice is to give up. Take away 
her insurance and those are her choices: bankruptcy or giving up. I 
don't think we want to put Americans in that position. The Senate 
healthcare bill allows States to waive the essential health benefits--
the dozen I talked about that are listed, like those needed if they 
have a preexisting condition.
  There was another lady I met named Olivia Babis. She is from outside 
of

[[Page S3895]]

Tampa, a place called Lutz. She also has a preexisting condition. She 
told me that she uses the essential health benefits guaranteed by the 
existing law. She is scared that insurance companies would take away 
the coverage of treatments for her disability and also reinstate annual 
and lifetime limits on coverage.
  Let me tell you about this young lady. She is just amazing. She was 
born without arms. She uses her feet and her toes to be able to 
function in the place of hands and fingers. She had to have a total 
knee replacement in one leg by the time she turned 30. She works as a 
community organizer. She doesn't qualify for Medicaid in Florida 
because her income is considered too high. She actually has an income. 
Olivia purchased health insurance through healthcare.gov with the help 
of tax credits to help her afford health insurance.

  This young lady, now in her midthirties, is just amazing. With no 
arms, she uses her feet and her toes, and she is capable of getting 
around in her wheelchair. She is capable of driving a car. She has a 
business. She has an income, and she is paying taxes. She is able to 
function because she has health insurance.
  Now, thanks to the ACA, people like Olivia benefit because there are 
bans on lifetime limits in insurance policies, and, thanks to the ACA, 
she lives an active life. She goes snorkeling, hiking, and even 
skydiving. Her legs are good, except for the knee replacement that she 
had so that she can walk. Then, when she has to do the normal functions 
with hands and arms, she sits down, and she uses her legs, her feet, 
and her toes. She told me that, without the ACA, she is trapped.
  I told you about this unnamed Republican Senator who was in an 
airport in another State--that of the Republican Senator's. What 
happened to that Republican Senator happens to me back in Florida with 
people coming up and begging me: Please do not take away my healthcare.
  We should not continue to waste our time with this healthcare bill 
that only takes away healthcare and charges more for less coverage. We 
have said--so many of us out here on this floor--that we should be 
looking for ways to improve the existing law, the Affordable Care Act, 
not to undo all of the good that it has done. We have Floridians and 
folks across the country who are grateful for it. They want us to fix 
it, not repeal it, and they say that over and over: Why can't you guys 
get together in a bipartisan way and fix it?
  These are the personal stories of Olivia, Michael, Regina, and 
Elizabeth, along with the hundreds of people who have come up to me in 
the street or in the airport and have begged me: Do not take it away. 
They do not want us to get rid of this. As you have heard, several of 
them claim that they would not be alive today without the ACA. 
Alternatively, they would be bankrupt if it were not for Medicaid in 
the ACA.
  In order to truly improve our healthcare system, why don't we work 
together to make it better? We need to look at real solutions. I am 
happy to say that this Senator has been talking to Republican Senators, 
and we have talked about specific things. I told some of these Senators 
about my experiences as the formerly elected insurance commissioner of 
Florida.
  When I had a problem after the monster Hurricane Andrew in the early 
1990s and we had a paralyzed marketplace in which you could not get 
homeowner's insurance in Florida from insurance companies because they 
were scared to death that the next big one was coming and that the 
losses were going to be so great that they would have to price the 
premiums so high, what did we do? We created a reinsurance fund called 
the Florida Hurricane Catastrophe Fund, which builds up the reserves 
that would reinsure the companies if they were to have a catastrophic 
loss.
  The same principle with hurricanes can apply to health insurance, 
which is that of creating a reinsurance fund that will insure the 
health insurance companies against catastrophic loss, which, 
occasionally, they will have. Do you know something? I costed that out 
in Florida, and it would reduce the premiums from the marketplace in 
Florida by 13 percent. Now, that is a real savings, and that is just 
one solution for a fix. We ought to be looking at approaches like this.
  I welcome all of our colleagues on this side and on that side--and I 
have been talking to some on that side--to join together and do 
something productive, like getting behind ideas just like the one that 
I suggested.
  I heard our colleague this morning. One of our favorite colleagues 
out here is Joe Manchin from West Virginia, and I heard him being 
interviewed on one of the morning shows. He was terrific. He said: We 
need to be working together. We should not be divided by party over 
this, and we should not be divided ideologically on this. We ought to 
be openly trying to work together to figure out how to drive down 
healthcare costs and increase coverage for more Americans.
  That is what those folks in Tampa, FL, told me last week with whom I 
met. That is what those hundreds of folks are telling me who come up to 
me in the airport, on the airplane, on the street corner, in the public 
buildings, in the hospitals--wherever I am: Please, get together, and 
work it out. They are asking us to fix what needs fixing. That is what 
the American people are asking us today, and that is what I beg of the 
Senate.
  As the good Lord says: Come. Let us reason together. Let us use some 
of our common sense.
  I yield the floor.


                   Recognition of the Minority Leader

  The PRESIDING OFFICER. The Democratic leader is recognized.


                   Thanking the Senator from Florida

  Mr. SCHUMER. Mr. President, first, I thank my good friend from 
Florida for his inspiring words. He is always trying to work together 
on bipartisan solutions. He represents one of the largest and most 
diverse States in the country--a State that very much depends on having 
good healthcare. I hope my colleagues on the other side of the aisle 
will heed his words.


                        Mississippi Plane Crash

  Mr. President, first, I send my sincere condolences to the Marine 
Corps, which lost 15 of its finest today, as well as 1 Navy corpsman, 
in a plane crash in Mississippi. It was the deadliest crash in the 
Marine Corps family since 2005. According to reports, the aircraft that 
crashed this morning was based at Stewart Air National Guard Base in my 
home State of New York.
  Our hearts break for the families of these sailors and marines. We 
mourn their loss and wish comfort to their families and their loved 
ones in this time of tragedy.
  May they rest in peace.


                         Healthcare Legislation

  Mr. President, on an entirely different matter, the majority leader 
said today that we are going to stay in an extra 2 weeks during the 
August break. We Democrats are willing to stay 2 weeks, 2 months, 2 
years to get a good healthcare bill, but in all due respect to my good 
friend, the majority leader from Kentucky, it is not time that is the 
problem here. Our Republican colleagues for 7 years said: Repeal 
ObamaCare. But they had nothing to put in its place. Then President 
Trump was elected with a Republican majority in the House and the 
Senate. Since January 4, when they deliberately excluded us from all 
discussions by enacting a reconciliation bill, they have been trying to 
put together a healthcare bill. They cannot. It is not because of a 
lack of time. Two weeks is not going to help. The problem is the 
substance of the bill.
  The bill provides massive tax cuts for the wealthy, and, just as bad, 
if not worse, it puts a dagger in the heart of the Medicaid Program, 
which has become a program that affects so many Americans. With kids--
poor kids--is where it started, but now it affects people who have Mom 
and Dad in a nursing home and who might face thousands of dollars of 
expenses, those on opioid treatment, those who have kids with 
disabilities, and many, many, many with preexisting conditions. Those 
are all helped by Medicaid, and our Republican colleagues here want to 
slash it.
  Just like my colleague from Florida, I was in some very conservative 
parts in New York State, places that voted for Trump by over 60 
percent. The revulsion--``revulsion'' is the word--and the fear that 
this healthcare bill has put in the hearts of those folks in Republican 
areas are dramatic.
  So I would say to my good friend the leader that we are willing to 
stay as

[[Page S3896]]

long as he wants, but he is not going to solve his problem until he 
abandons tax cuts on the rich, abandons the decimation of Medicaid, and 
works with us to improve the existing law. His problem and our 
Republican colleagues' problem is not time. It is the substance of the 
bill.
  I will say one more thing. If I were a Republican, I would not want 
to go home either. Every time they go home, they are lambasted because 
the American people have such a negative feeling about the bill. So, of 
course, they would want to stay here, but that is not the answer. The 
answer is to change the bill. Work with us. We have been begging, 
pleading, asking, cajoling for a month or two, when it was clear their 
bill was going to fail. I would say that is very important.
  Mr. President, I heard the majority leader complain about the slow 
pace of nominations.
  Our Republican friends, when they are worried about the slow pace of 
nominations, ought to look in the mirror. This President has nominated 
fewer nominees than has anyone else, and seven of the major nominees 
had to withdraw their nominations. Many of them were brought here to 
the Senate without the necessary documentation--the paperwork, the 
ethics reports, the FBI reports. The chaos in the White House is now 
spreading to the Republican Senate. Our President seems to blame 
somebody else when his administration makes a mess. Let's not do that 
here.
  Again, the number of nominees that this President has submitted is 
lower than that of any President's in recent memory. My colleague 
complained about this nominee from Idaho. He was outraged that he had 
to file cloture. I would remind the majority leader that this district 
judge was nominated by President Obama in the last Congress and that he 
was the majority leader in the last Congress, which was responsible for 
putting nominees on the Senate calendar. The district court judge is 
only one of many nominees who the Republicans failed to move in the 
last Congress--a Congress which confirmed the fewest number of judges 
of any Congress since the Eisenhower administration. That goes to show 
how desperate our Republican leadership is to shift blame and attention 
away from its healthcare bill to hypocritical and preposterous 
complaints on nominations. It is in order to distract from the 
healthcare bill. They can try other tactics.
  On one more point, I would remind my colleagues that it is the 
majority leader who has the power to put nominees on the floor. In the 
Department of Defense, we have been asked about three nominees. Leader 
McConnell has the power to put them on the floor--instead of this judge 
from Idaho, instead of the nominee for OMB, and instead of the 
Ambassador to Japan--tomorrow, if he chose. It is his choice. If he 
puts them on the floor--these Defense nominees--in regular order next 
week, they will be approved.
  So, again, to deflect from healthcare and the mess our poor 
Republican colleagues are in, to point falsely at the nomination 
process, which has been slow-walked by President Trump and many of the 
committees, is not going to succeed.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                         Healthcare Legislation

  Mrs. MURRAY. Mr. President, from the moment President Trump and 
Republicans began trying to jam TrumpCare through Congress, I heard 
from family after family in my home State about the damage their 
efforts to undermine families' healthcare would do, and this last week 
was no different. Again and again, my constituents told me what a 
difference it makes to have affordable insurance, to know that benefits 
like substance abuse treatment are covered, or to worry about how they 
would manage if TrumpCare ever became law.
  I heard some of my Republican colleagues went out of their way to 
avoid those kinds of stories when they were home, so I wanted to make 
sure they heard a few examples now that they are back in town. And I 
appreciate that many of my Democratic colleagues will also be sharing 
stories they heard from their constituents over the past few days.
  Like many of my colleagues on both sides of the aisle, I come from a 
State in which the opioid epidemic has had a devastating impact. It has 
been both heartbreaking and inspiring to talk with patients and 
families who are doing everything they can to fight back. Right now, 
the message I am getting from them loud and clear is that they do not 
want TrumpCare.
  Daniel, one of my constituents, was injured in the military. He was 
given a prescription for painkillers. He was on them for 8 years, and 
he told me that during that time, his three daughters wondered why he 
wouldn't play with them. Eventually, Daniel changed doctors and was 
prescribed Suboxone, which made all the difference for him. He is now 
able to work again. He manages a grocery store. He relies on Medicaid 
for healthcare coverage, which covers the hundreds of dollars a month 
his prescriptions cost. Daniel told me that if he loses Medicaid under 
TrumpCare, he will not be able to make ends meet and all of the 
progress he has made will be threatened.
  I heard from a constituent named Rachel of Seattle who was addicted 
to opioids and living in her car when she found out she was eligible 
for Medicaid. She got connected with Swedish Medical Center in Seattle, 
where she received wraparound health services, including mental 
healthcare and primary healthcare. Now she and her husband are 
successfully in recovery. They are raising a family, and Rachel is 
going to school. But, just like Daniel, they do not know what they will 
do if TrumpCare becomes law and the Medicaid coverage that is keeping 
them going is taken away.
  Those are just two of the countless stories I heard from patients and 
families and doctors in my home State and nationwide. I have heard from 
cancer survivors who have fought back as hard as they can and are 
worried that TrumpCare will allow insurance companies to price them out 
of care because they are now labeled with a preexisting condition. I 
heard from young parents of medically fragile children who stay up at 
night worrying about how to afford care for their toddler if lifetime 
caps on coverage are imposed under TrumpCare. I heard from seniors who 
simply don't have the savings to cover the premium spikes TrumpCare 
would cost. I heard from women and men who are furious, and rightly so, 
that a group of 13 men wrote a bill in secret to defund Planned 
Parenthood--the Nation's largest provider of women's healthcare--
removing a quality, affordable provider from communities in which it is 
now very difficult to get care.
  These stories are powerful. They make it undeniably clear just how 
much TrumpCare would hurt people. So it is no wonder that Senate 
Republicans spent the last week lying low and avoiding defending, 
oddly, the indefensible. Senate Republicans have read the same 
independent Congressional Budget Office analysis as we all have. They 
have heard from countless doctors and nurses and hospitals and nursing 
homes and patient advocates about all of the ways TrumpCare would raise 
families' costs and take away coverage. They know that people across 
the country are completely, resoundingly rejecting TrumpCare. It is the 
least popular bill in three decades, according to one study.
  All in all, TrumpCare shatters every promise President Trump and 
Republicans made about providing insurance to everybody and making sure 
no one is worse off. And, incredibly, the extreme rightwing still 
thinks it leaves too much of the Affordable Care Act intact.
  Even though it seems one would be hard-pressed to find anyone who 
wants to stick up for TrumpCare--including, by the way, President 
Trump--Senate Republican leaders are still doing everything they can to 
jam this through Congress as quickly as they can. They are working on 
backroom deals as we speak and coming up with new ways to sweeten the 
deal for Senate Republicans who are rightly wary of voting for a bill 
that would so clearly do so much harm.
  In particular, this afternoon I wanted to address the ongoing effort 
by extreme conservative Senators to double

[[Page S3897]]

down on pulling the rug out from under patients with preexisting 
conditions. They put together this two-track plan to make middle-class 
workers and families pay more. If they get their way, insurance 
companies would be back in charge and could tell patients with 
preexisting conditions or anyone who happens to get sick in the middle 
of the year ``tough luck,'' and they will do that in a way that even 
conservative experts predict will cause premiums and deductibles to 
skyrocket. Senate Republicans are coming up with other ideas, too, such 
as an opioid fund that a Republican Governor said is like ``spitting in 
the ocean.''
  Let me be clear. There is no ``fixing'' TrumpCare. No tweak around 
the edges is going to turn TrumpCare--which, by the way, is just a tax 
break for special interests and the healthcare industry on the backs of 
patients--into a healthcare bill that actually helps people. There is 
just no way. TrumpCare, as the President said, is mean at its core, and 
unless it is dropped altogether, Senate Republicans are going to have 
to decide whether they stand with their party or the people they came 
here to represent.
  So to everyone out there who has called and written and rallied and 
tweeted, you are having an impact. You are why TrumpCare isn't already 
law. But you cannot give up now, and Democrats here in the Senate won't 
either. We are going to keep doing everything we can to make sure 
Senate Republicans can't hold their noses and vote for TrumpCare just 
to hand big corporations a tax break and President Trump a hollow 
political win, whether it is next week or the weeks into August.
  I also want to remind my Senate Republican colleagues again that we 
have made clear all along the way that there is a better way to do 
this. Democrats are ready. We are willing to work with you on policies 
that make healthcare more affordable and workable for patients and 
families.
  So I am here today to say I hope you all listen to the stories our 
Democratic colleagues are bringing to the floor. Think about how 
devastating TrumpCare would be, and do the right thing. Drop this mean 
bill once and for all so all of us can get to work on real healthcare 
solutions that actually help people afford care, get covered, and stay 
healthy. If you do, you won't have to defend this defenseless bill a 
minute longer.
  Thank you. I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, first of all, I wish to thank Senator 
Murray, a member of our leadership, for taking this time to talk about 
accounts from home, what we have heard from those we have the honor to 
represent, and I think this is exactly what is appropriate at the 
beginning of this work period.
  I just come off of eight open-to-all townhall meetings in my home 
State of Oregon. Five were in counties won by President Trump, three 
were in counties won by Hillary Clinton, and the single unifying issue 
that dominated each one is that TrumpCare is a loser. Across the 
political spectrum--Democrats, Republicans, liberals, and 
conservatives--what I was told is that the Congress ought to set this 
TrumpCare bill aside, that the one Mitch McConnell has been working on 
ought to be dropped, and after it is dropped, Democrats and Republicans 
ought to get together and look for the common ground by trying to show 
some common sense.
  I am going to spend a little time talking about what I heard, what 
people are concerned about, and then briefly talk about, as Senator 
Murray said, what we would like to do if our colleagues on the other 
side of the aisle will drop this ill-advised, ``our way or the 
highway'' approach and do what the Senate has traditionally done when 
we are talking about tackling a big issue, which is find common ground.
  It doesn't get much bigger than healthcare. We are spending $3.2 
trillion each year now on healthcare. It comes to something like 
$10,000 for every man, woman, and child. We are spending enough money; 
the real question is whether we spend it in the right place, and this 
very flawed TrumpCare bill will compound that problem.
  During those eight townhall meetings over the past week, Oregonians 
asked me: When is this flawed TrumpCare bill coming to a vote? How are 
my frail, not physically well, older parents supposed to get by if this 
bill passes and they lose their health care coverage?
  As I have talked about with Senator Murray, we know that Medicaid 
picks up the bill for what amounts to two out of three older people in 
nursing homes. What often is not mentioned is that it also covers home- 
and community-based services for seniors. I remember from my days as 
director of the Oregon Gray Panthers that the whole goal was to create 
this continuum of choices for older people and, as Senator Murray 
touched on, the older people who need nursing homes and nursing home 
benefits. She is absolutely right. We also need to protect the Medicaid 
guarantee for the seniors for whom care is appropriate in other 
settings, such as home- and community-based services.
  At those townhall meetings at community centers and auditoriums, 
folks knew that I am the senior Democrat on the Senate Finance 
Committee.
  We have another talented member from the committee, Senator Bennet, 
here, as well as my knowledgeable colleague from Oregon, Senator 
Merkley.
  I have worked on these issues with respect to taxes and healthcare 
for some time, and I have really dedicated my professional life to 
trying to find that common ground, show common sense in the areas of 
healthcare and taxes. But the fact is, this version of TrumpCare is a 
tax break for some of the most powerful special interests masquerading 
as a health plan, and when Oregonians heard that, whether it was in a 
Trump county or in a Clinton county, everybody started nodding.
  The secret is out. This is not a plan to fix anybody's healthcare or 
hold down the premiums; this is one big handout to the most powerful 
special interests. People heard that Republicans were saying those tax 
cuts were going to create jobs. That is not very likely when they have 
made the tax cuts retroactive. What that means--they made the big one 
retroactive to January 1--is that if you have a capital gain say in 
March, and if this bill is passed in its present form, if that capital 
gain is $1 million, you get a tax break of $38,000. That is not 
creating jobs, it is creating windfalls, and the American people have 
caught on.
  Now that the Senate is back in session, the public is reading about 
the newest proposal on offer. It is a Hail Mary pass from Senator Cruz 
and Republican leaders, trying to put together $50 billion for their 
version of TrumpCare. And we know in the Finance Committee, they have 
billions and billions of dollars that they can use to try to find those 
extra votes.
  I will tell you, this Senator Cruz proposal as it relates to 
healthcare is a prescription for mayhem in the private health insurance 
marketplace. It is going to mean misery for so many Americans dealing 
with illnesses. Forget the talk about bringing costs down. This plan is 
going to send health expenses into the stratosphere.
  The plan tells insurance companies: You are off the hook as it 
relates to basic consumer protections. You get to bring back annual and 
lifetime caps on coverage.
  Think about that. In the State of Alabama and everywhere else in 
America under the Affordable Care Act, the 160 million people who get 
their care through their employer heard about this bill and said: We 
are home free. It really does not affect us. They got a little extra 
bonus. The Affordable Care Act gave them a major catastrophic benefit 
if they had that employer coverage. With this Republican bill, all of 
those folks who thought they were home free with the employer coverage 
should know that once again there would be limits on what insurance 
companies could pay.
  I will tell you, for anyone who is listening to this, if someone gets 
cancer at home, they are going to bust that cap in a hurry. This bill 
means they are not automatically protected. You can forget about 
essential health benefits. You get to flood the market with bargain-
basement insurance plans as long as you offer one comprehensive option, 
and you get to price that plan through the roof.
  If you pass this bill--the Cruz fantasy proposal--it is going to be a 
tale of two health symptoms. The young and healthy will opt for the 
barebones insurance plans that don't cover much of

[[Page S3898]]

anything, but there are millions of people in the country who can't get 
by, can't make it with skimpy insurance that covers nothing but 
stitches and aromatherapy.
  There are people who have had a cancer scare or suffer from diabetes 
or people who get hurt on the ski slopes or slip off a ladder. The only 
coverage that works for them will come with an astronomical price tag.
  By the way, the people between 55 and 64, who can get charged five 
times as much as younger people, get fewer tax credits under this 
Republican proposal. They can't get by with skimpy coverage. A lot of 
them have really serious health problems. Skimpy coverage for them is 
just a prescription for trouble.
  The fact is, this new proposal basically starts marching America back 
to the days when healthcare was reserved for the healthy and wealthy. 
What I will say is that there would be plenty of opportunities for 
Democrats and Republicans to find common ground if this proposal is set 
aside.
  Nobody has said the Affordable Care Act is perfect. What we would do 
is go to work to stabilize the private insurance market. That would be 
business No. 1. We would look at ideas, as Senator Nelson has just 
thoughtfully outlined, like reinsurance. Then a special priority of 
mine is to clamp down on skyrocketing prescription drug prices. I think 
there are a number of ideas that are teed up for both sides to come 
together.
  I recently put in a bill called the SPIKE bill. What it says is that 
these big drug companies should have to justify their big price hikes. 
I don't think that is an extreme position to say they ought to have to 
publicly, justifiably make it part of the public record.
  In the last few years, we have had a whole new industry emerge. They 
represent States and companies and labor unions, and they are supposed 
to be negotiating a good deal for patients. They are called 
pharmaceutical benefit managers, but we don't know what they put in 
their pocket and what they put in our pocket.
  I have said: How about some transparency, folks? Sunlight is the best 
disinfectant.
  Those are the kinds of ideas--reinsurance, stabilizing the private 
insurance market, clamping down on prescription drug prices, 
particularly using the power in the marketplace--that both sides ought 
to be able to get together.
  The recess is over, but the healthcare debate is far from over. What 
I will say is what I told my constituents. I see my friend Senator 
Merkley here. We had rallies at home. I said: Folks, in stopping the 
McConnell bill before the July break, you proved that political change 
in America is not trickle-down; it is bottom-up.
  For weeks before that July break, Americans of all ages and political 
philosophies called and texted and wrote and came to rallies and town 
meetings. They said: This TrumpCare bill is a loser for us. It doesn't 
work. Drop it and move on to approaches that involve common sense. Look 
for common ground that both sides could support. It is absolutely 
vital.
  The events of the last few weeks have shown the power of the 
grassroots. I walked through for my constituents what could have 
happened if 2 weeks ago the Republican leader had brought his bill to 
the floor. It was in the morning. I described how the bill could have 
gotten through the Senate. Maybe the House would have stayed in; maybe 
the House would have passed it; maybe the President would have signed 
it. One of my constituents said that morning: If that had happened and 
we had lost the ACA, even though it is not perfect, that morning we 
would have been in mourning.
  Let us show today that we can tackle this in a way that the Senate 
historically has worked best. Let's block the deeply flawed bill, and 
then let's turn around immediately to show that we can come together, 
find common ground.
  I see one of our colleagues, the distinguished Senator from Virginia, 
who has one of the important reinsurance bills here. We have a variety 
of ideas that we can pursue, that I think would have appeal on both 
sides of the aisle, but there is a step you have to take before you get 
on to those commonsense ideas. You have to stop the flawed bill before 
the U.S. Senate at this point.
  I ask the people of this country to continue what they have done over 
the last few weeks and show political change, bottom-up rather than 
top-down.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Strange). The Senator from Colorado.
  Mr. BENNET. Mr. President, I thank the ranking member of the Finance 
Committee for his leadership not only on this bill but also healthcare 
over the decades. He knows something about the right way of doing it 
and the wrong way of doing it, which is partly what brings me to the 
floor today.
  I want to say something that I think will be uncontroversial to the 
people at home but may be news to some people here, and that is whether 
you support the Affordable Care Act or whether you don't support the 
Affordable Care Act, whether you have been a supporter of ObamaCare or 
whether you are not a supporter of what is called ObamaCare, in 
general, people are pretty dissatisfied with our healthcare system at 
home. In general, people are pretty dissatisfied with the rate their 
insurance goes up. They are pretty dissatisfied with the fact that a 
lot of people are still uncovered in this country. If they are a 
senior, they are pretty dissatisfied not just with the idea but with 
the practice that month after month, people have to cut their medicines 
in half just to get through the month. They are pretty dissatisfied 
with the fact that they call an insurance company to make a claim to 
say ``My child was sick'' and point out that month after month they 
have paid their premiums only to find that on the day they make that 
claim, there is someone at that insurance company who has more time 
than they do to stay on the phone, to keep them on that phone, to deny 
them their claim. They are pretty dissatisfied about that.
  As a whole, I think the American people are dissatisfied by the fact 
that we spend 16 percent of our gross domestic product, our entire 
economy, on healthcare when every other industrialized country in the 
world spends half of that or less than half of that on healthcare and--
this is going to come as news to some people in this Chamber--get 
better results. We are moving in the wrong direction on too many 
dimensions when it comes to our healthcare.
  I have said all of that as a proponent of the Affordable Care Act. I 
spent a year and a half in Colorado, in certain places, being called a 
Bolshevik or a socialist, being accused of advocating for a government 
takeover of our healthcare system. This was at a time when the tea 
party was very active, and people would come and say, quite rightly: 
Read the bill. Read the bill. We need to take our government back.
  We tried to do some things to help in that bill. For the first time 
in the country's history, we tried to say that it wasn't OK to 
discriminate against people who were sick or have what is called a 
preexisting condition when they went to buy health insurance. As the 
Senator from Oregon said, it wasn't OK that if you did get sick when 
you had insurance and you got something like cancer that an insurance 
company could just throw you off their rolls because you hit their cap.
  We said that we thought it wasn't OK that there were millions of 
people, many of them children, who didn't have access to primary care; 
that is, a doctor to be able to give you a checkup and see how you are 
doing so that you weren't getting treated in the emergency room--the 
most expensive, least intentional way of running a healthcare system 
that is imaginable. In fact, I would say that is the Bolshevik way of 
running a healthcare system: When you are sick, you get to show up at 
the emergency room, and somebody is going to take care of you. It gives 
you the results of a Bolshevik system because you are paying more for 
less of an outcome.
  We tried to address some of those things, and that became the 
Affordable Care Act. That became ObamaCare. That became something that 
was politicized for 7 years, as the House of Representatives cynically, 
month after month, voted to repeal the Affordable Care Act. Then the 
majority of the House went home to their districts and said: We 
repealed ObamaCare. We voted to repeal ObamaCare.
  You didn't repeal it.
  No, we voted to repeal it. If you send me back there next week, I 
will do the

[[Page S3899]]

same thing. I will do it the week after that.
  Then at some point, people started to say: Well, you keep having the 
vote on repealing ObamaCare. Why haven't you actually done it?
  They said: Well, we didn't have the Senate.
  They have had the Senate now for two Congresses.
  Well, we didn't have the Presidency.
  Now we have the same party in Presidency, the Senate, and the House 
of Representatives. This terrible bill we are considering is not a bill 
that anybody--that is an exaggeration--virtually anybody in my State 
supports or has asked for. That is what we have in front of us.
  I know somebody else who knew that the American people were 
dissatisfied with their healthcare system, and that was Donald J. Trump 
when he was running for President of the United States.
  I hope, in particular, the people who voted for the President, as a 
way of keeping Washington accountable, will remember that he said he 
was going to provide the American people ``a terrific plan,'' to 
``cover everyone at a fraction of the cost.'' The President, when he 
was running--he still does it--was very fond of talking about--his 
words--how stupid everybody in Washington was and he knew how to make 
deals and he was going to come here and make great deals and he was 
going to cover everybody at a fraction of the price with a terrific 
plan. That is what he promised the American people. That is what he was 
peddling when he was running for President. He said: ``Everybody is 
going to be taken care of much better than you are taken care of now.'' 
That is what he said. This isn't fake news. This isn't CNN or the New 
York Times or the Wall Street Journal or whoever is in the crosshairs. 
This is what the President said on the campaign trail when he was 
running because he detected, quite rightly, that the American people 
are unhappy with the way our healthcare system works--unhappy in the 
richest country of the world to have a healthcare system where people 
have to make decisions about their lives and about their children's 
lives that no one in the industrialized world has to make about their 
lives or their children's lives--and they wonder why.
  I think the diagnosis has a lot to do with what some people have 
said, which is special interests having a grasp on Washington, DC. That 
is what the President said he was going to give to the American people. 
This is what his promise was to the American people. What did we get 
instead? We have a bill passed by the House that was a massive tax cut 
for the richest people in America, which, literally, nobody in my 
townhalls in red or blue parts of my State has ever said is something 
that would help with their healthcare. Not a single person has said 
what they want for healthcare is a massive tax cut for people making 
more than $250,000 a year--not one, not one person.
  There is a 25-percent cut to Medicaid in this bill. That was done in 
the name of, I guess, reforming entitlements. The argument has been 
made that there are a lot of lazy people who are on Medicaid, and if 
you cut Medicaid by 25 percent, they will go to work, and they should 
go to work. Well, there are two issues with that. The first is, it is 
important to understand who is on Medicaid.
  In my State, 50 percent of the people are children. Are they supposed 
to be at work or can they go to school? Then there are a whole bunch of 
people on Medicaid--in fact, it is a very large share of the population 
of Medicaid who have spent their entire life savings down for the 
privilege of being in a nursing home paid for by Medicaid. Are they 
supposed to work? Then there are a lot of people--I am ashamed to say 
this--there are a lot of people in this country who are working one 
job, two jobs and can't make enough money to buy private insurance in 
the United States of America. That is a shame. Do they need to get a 
third or fourth job before we are saying they are not lazy or should we 
fix this healthcare system so it is more affordable, more predictable, 
more transparent for American families? Those were the promises the 
President made. That is the content of the bill with one addition. They 
slipped in--between that tax cut and that 25-percent cut to Medicaid, 
which is paying for that tax cut for the wealthiest Americans--what my 
colleague Rand Paul, a Republican from Kentucky, has described 
accurately as ObamaCare lite. He is absolutely right about that. If you 
hate ObamaCare, you will hate ObamaCare lite. If you are looking in a 
rural part of my State or the country, and you already can't afford 
insurance because there is no market there and you can't get a subsidy 
that will help you because you are making too much money, you are going 
to hate that even more. Wait until they pass the Cruz amendment, which 
he is calling the freedom amendment--freedom to have to endure 
something no one else in the industrialized world has to put up with, 
which is buying lousy insurance that doesn't cover anything. You can 
create the worst product in the world and make it affordable. That is 
not hard to do.
  We have come a long way from Franklin Roosevelt's four freedoms, if 
we are talking about the freedom of insurance companies to be able to 
throw you off if you hit the lifetime cap, freedom not to give you 
insurance if you have a preexisting condition. We have come a long, 
long way.
  Finally, my colleagues are here so I am going to stop. I do want to 
say one word about the process. The majority leader today announced 
that he is going to keep the Senate in for 2 weeks in August because 
they have to finish their work on healthcare or maybe it is 3 weeks in 
August. I don't care if it is a month. I don't care if they cancel 
every recess we have between now and the end of the year. I don't care 
if we work on weekends if it will create a situation where we can 
actually improve healthcare for the American people. I am glad to stay. 
In fact, I think we should stay, but, unfortunately, that is not what 
he is trying to do. What he is trying to do is jam through a bill that 
is incredibly unpopular with the American people. That is why, until 2 
weeks ago, it was a secret. Until two Thursdays ago, it was a secret.
  I have to suspect that one reason they want to keep us in August is 
because they don't want to go home because they were just beaten to 
death over the July 4th recess because people came out in Republican 
and Democratic parts of their States and said: Are you out of your 
minds? This bill has nothing to do with our healthcare. They probably 
don't want to repeat that in August.
  I will close just by saying this, and I said this again to the people 
who came to my townhalls and were highly critical of the Affordable 
Care Act and the process: I want to remind you folks that back then--
the Senator from Oregon will remember this--back then, we spent over a 
year debating that bill here in the Congress. We had countless--
somebody could count them up--but countless committee hearings in the 
Health, Education, Labor, and Pensions Committee and the Finance 
Committee. We had almost 200 amendments that were Republican amendments 
that were adopted as part of that bill. Everybody remembers, no 
Republican voted for it, but there were 200 Republican amendments 
adopted as part of that bill. We have not had a single committee 
hearing in the Senate about this healthcare bill--not one.
  So you can keep us in for 2 weeks or 3 weeks longer in August, but a 
better idea might be to follow the regular order around this place. 
Talk about take our country back, take our government back, make it 
work, have hearings, have witnesses. I can think of 100 Coloradans, off 
the top of my head, who would like to come here and testify. I would 
even say 50 of them can be Republicans and 50 of them can be Democrats. 
Have them come testify what would make healthcare better for them. That 
is what this should be about: families all across this country who are 
struggling because of our healthcare system and who need relief from 
this Congress and who so far aren't getting it.
  I will close just by saying, if the President could submit a proposal 
that actually would meet the criteria he set out when he was running 
for President--instead of having a bill he couldn't pass with even 51 
Republican votes--he would have a bill he could pass with 100 votes 
here in the Senate, and that is what we should strive to do.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, let's revisit recent history. Four weeks 
ago,

[[Page S3900]]

my Republican colleagues were meeting secretly in this building, in a 
hallway that the press was not allowed in because they didn't want to 
have the press see them sneaking in and sneaking out of this completely 
undemocratic process--13 Republican men crafting a healthcare plan to 
destroy healthcare for 22 million Americans. That is where we were 4 
weeks ago.
  We made a big deal out of the fact that is not the way a Congress is 
supposed to operate. You are supposed to have committee hearings. You 
are supposed to have committee debate and invite experts in. You are 
supposed to have time to consult with your constituents back home, but 
none of that was happening. No, we had the Republican zero-zero-zero 
process: Zero committee meetings. How does that compare to more than 
100 committee meetings and roundtables and walkthroughs from 8 years 
ago? Zero committee amendments. How does that compare to more than 400 
amendments that were considered 8 years ago and more than 100 minority 
amendments, Republican amendments, that were adopted in this process? 
Zero exposure of the bill to the folks back home and to the healthcare 
stakeholders.
  Then, 2 weeks ago, we had a draft, and we had a chance to circulate 
that draft and get a few folks from home to weigh in on what it looked 
like. We received a CBO analysis. Yes, it looked a lot like the House 
bill. The House bill was going to eliminate 14 million healthcare 
policies in a year, and the Senate was going to best that by 
eliminating healthcare for 15 million Americans and 22 million 
Americans over a 10-year period.
  The President had called the House bill mean, but we had the even 
meaner Senate bill. Fortunately, we were able to create such a fuss 
that the majority leader canceled the vote--the vote that was going to 
take place with the zero committee hearings and zero amendments and 
that would give my colleagues the opportunity to go home and talk to 
their constituents. But what happened?
  Well, in the course of this entire year, two-thirds of my Republican 
colleagues haven't held a single townhall, and last week, when they had 
a full opportunity to finally take their secret 13 bill--zero-zero-zero 
bill--and ask their constituents what they thought, they didn't hold 
townhalls. By best count, 2 Senators across the aisle held a townhall 
out of 52.
  Why are my colleagues so terrified of their constituents? Is it 
because wiping out health insurance for struggling Americans is a 
travesty? Is it because wiping out healthcare for working Americans is 
a crime--a crime against decency? Is it because their bill proceeds to 
give $33 billion to the richest 400 Americans? No, that is not $33,000 
or $33 million, that is $33 billion to the richest 400 Americans--more 
than several hundred billion dollars to the richest Americans overall. 
You know, the money they want to give to the top 400 richest Americans 
would fund healthcare for more than 700,000 Americans under Medicaid.
  Well, I went home. I went to a lot of places. I went to three cities 
in what you might call blue Oregon. I went to 13 towns in what can 
clearly be called red Oregon--predominantly Republican Oregon. I went 
to towns like Echo and Helix; Adams and Athena; Weston and Sumpter; 
Granite and Greenhorn, with 37 individuals; and Adams, with a 
population of 348. I went to larger towns like North Powder and 
Wallowa; and Baker City, Burns and Nyssa.
  In six of those Republican towns, I held full townhalls, and what did 
I hear? I heard that the top concern was healthcare because 
constituents in red America across this country are terrified of the 
secret 13's bill and all that it involves. What would it do in my home 
State? Well, 400,000 Oregonians under the Oregon Health Plan would lose 
their care. At least another 100,000 would lose their care because of 
the changes in the way the exchange operates. They kind of put their 
minds to work at what the picture looks like from the draft the 
Republicans were willing to circulate after we applied extensive 
pressure. And what did we hear? Well, we heard that they are very 
concerned about extinguishing the expansion of Medicaid. Those are 
folks who are working hard but struggling, often in multiple part-time 
jobs.

  We heard about the fact that Medicaid pays for more than two out of 
three individuals on long-term care in rural America. In fact, I went 
to one nursing home and asked: Does Medicaid--Oregon Health Plan--pay 
for two-thirds of your residents?
  They said: No, Senator. Here in Klamath Falls, it is nearly 100 
percent.
  Realize that an individual who is getting paid-for, long-term care 
under Medicaid has to have assets of less than $2,000. So there is no 
backup plan. You wipe out healthcare for those 400,000 individuals who 
are on expanded Medicaid, many of whom are in long-term care, and they 
have no backup plan.
  One woman, Debra, said to me: Senator, I am paid for by Medicaid, and 
if they cut Medicaid, I will be out on the street. That will be a 
problem because I can't walk.
  That is right, Debra, you are in trouble, and so is every other 
individual who is funded through Medicaid for long-term care.
  What about maternity care? One out of three individuals in rural 
Oregon and rural America who is preparing to have a baby is funded 
through Medicaid. Children and the disabled are funded through 
Medicaid.
  What do we get as an alternative now that the Republicans are back, 
having ducked their constituents? They want a new plan to offer? Well, 
they are talking about the Cruz plan. Now, this is interesting. It is a 
plan that says an insurance company can offer policies that cover 
nothing as long as they have at least one policy that covers quite a 
bit, which means the young and the healthy buy the policy that covers 
almost nothing, and then the policy that covers quite a bit that older 
Americans and those with preexisting conditions need becomes incredibly 
expensive because the group in that pool are people with lots of 
healthcare problems, and it creates a death spiral in insurance.
  Well, at the one end of the spectrum, you have a death spiral for 
insurance policies that cover a lot; at the other end of the spectrum, 
you have fake insurance because it covers virtually nothing. Oh, maybe 
it only costs $50 a month. Oh, isn't that wonderful--until you find out 
it doesn't cover a day in the hospital; doesn't cover a trip to the 
emergency room; doesn't cover maternity care; doesn't cover drugs. In 
fact, it doesn't cover anything.
  Why is it that a President who is so concerned about fake news is so 
interested in supporting fake insurance?
  My constituents back home told me a lot of stories. These are stories 
that I hope to share in the next couple of days, but right now, I think 
it is important that we hear from my colleague from Virginia, Senator 
Tim Kaine, because he has also been looking in detail at this bill. He 
also understands what a devastating consequence TrumpCare will have for 
American healthcare.
  Can't we come together with a better vision? Can't we come together 
and make the marketplace work better, restore the reinsurance that has 
ripped apart the ability of insurance companies to go into new markets? 
Can't we restore the cost-sharing payments that buy down the premiums, 
in fact improve them, so there are lower premiums and lower 
deductibles? Can't we come together and do a better job of funding 
opioid treatment? Can't we come together and take on the high costs of 
drugs in general, which is driving costs in the healthcare system? Just 
those four things would be something very positive to make our current 
healthcare system even better.
  Let's work together to make healthcare here in the United States of 
America even better, not tear it down and destroy it, as is being 
proposed by my Republican colleagues.
  Thank you, Mr. President.
  The PRESIDING OFFICER (Mr. Johnson). The Senator from Virginia.
  Mr. KAINE. Mr. President, I also rise to talk about the healthcare 
proposal on the floor, and I thank my colleague from Oregon and all my 
colleagues who have taken the floor on this issue.
  I will just state at the top a punch line: I will vote for any 
healthcare bill that meets President Trump's promises. He said that in 
his replacement, no one would lose coverage, no one would pay more, no 
one would get kicked around because of a preexisting condition, and he 
wouldn't cut Medicaid. And any bill that meets those criteria, I am 
voting for, but I won't

[[Page S3901]]

vote for a bill that shatters all those promises, and that is what this 
current proposal does.
  There is a lot to talk about with the bill, and I just want to talk 
about one thing--the proposed cuts to the Medicaid Program and 
especially the effect of those cuts on children.
  In the current Senate proposal, which is being sort of adjusted and 
modified, there is a slashing of Medicaid by about $770 billion over 10 
years. And if you add to that additional cuts to Medicaid proposed by 
the President's budget, we are now north of $1 trillion of cuts to 
Medicaid in the next 10 years.
  Who receives Medicaid? In Virginia, between 50 and 60 percent of 
those who receive Medicaid are children. In Virginia, 600,000 young 
people are Medicaid recipients.
  If you go to school and you are receiving an individualized education 
plan because you have a designated disability, Medicaid is paying for 
it.
  About 50 percent of childbirths in Virginia are paid for by Medicaid.
  If you are a kid who is doing everything right, but your family is 
dysfunctional and a juvenile court judge has to decide whether to keep 
you with your family or put you in a group home, if the judge decides 
to send a social worker to your house 5 hours a week, Medicaid pays for 
that.
  If you are a child with autism and you are getting services for your 
autism after school so you can succeed in school, Medicaid pays for 
that.
  In Virginia, 600,000 children receive Medicaid.
  We recently had the administration's OMB--Office of Management and 
Budget--Director, Mick Mulvaney, before us, and I asked him about these 
Medicaid cuts. These cuts are catastrophic. How can you say these cuts 
are a good thing? This is his quote:

       We are no longer going to measure compassion by the number 
     of programs or the number of people on programs like 
     Medicaid. We are going to measure compassion . . . by the 
     number of people we get off those programs and back in charge 
     of their own lives.

  So the philosophy that drives this is, we want to get people off 
Medicaid and back in charge of their own lives--600,000 kids.
  I had a roundtable yesterday in Springfield, VA, here in Northern 
Virginia, and I had five families, parents and children, come to talk 
about what Medicaid cuts would mean to them.
  Angie and Anna are from Haymarket, VA. Anna is a little 5-year-old 
and, her mom says, typical in so many ways. She loves to play with her 
brothers, and she loves to play with dolls. But she has cerebral palsy 
and tracheal bronchial malacia and subglottic stenosis and chronic lung 
disease. In 2014, she developed a condition that caused her to have 30 
bone breaks in 18 months.

  Anna is in school. Anna is in school with a wheelchair that Medicaid 
pays for. Anna is in school with some home health that Medicaid pays 
for. Medicaid enables this child who has so many needs to actually go 
to school so she can be all that she can be. Her family has TRICARE 
through the military because the dad is in the military, but they 
couldn't make it without Medicaid.
  Jen and Cailyn are from Sterling, VA, also in Northern Virginia. 
Cailyn is about 9\1/2\. Within a week after she was born, the family 
knew there were some things wrong. She was finally diagnosed at age 
3\1/2\ with a very rare, noninherited genetic anomaly. The family was 
able to get her qualified for a Medicaid waiver when she was about a 
year old. And this is secondary insurance. The family works and they 
have private insurance, but it doesn't cover a wheelchair, a hospital 
bed, and things that she needs to succeed. Again, this little girl who 
is 9\1/2\--and her mother testified that she functions on about the 
range of a 6-month old--she is able to go to school because Medicaid 
can pay for some of the technology she needs.
  Kim and Isaac are from Ashburn, VA, in Loudoun County. Isaac is a 
youngster, a very active kid, but he has a tracheotomy. He is feeding-
tube dependent. His family has private insurance, but they couldn't get 
along without Medicaid. He is in the Loudoun County schools succeeding 
because of Medicaid.
  Dylan is another kid in Loudoun County schools. Corinne is his 
mother. Dylan has a rare neuromuscular disease called spinal muscular 
atrophy with respiratory distress. He has a tracheotomy tube. He relies 
on a ventilator to breathe. Little Dylan was at this meeting. The 
family has private insurance, but they couldn't succeed without 
Medicaid. Dylan is able to go to school because of Medicaid.
  Finally, there is a family from Richmond--Amy is the mom, and the son 
is Declan. Declan is not in school because he is only 18 months old. He 
has cerebral palsy, and his medical needs are intense. With Medicaid, 
he is able to get some home nursing help, and he is able to get some 
machinery at home that helps him succeed.
  These are beautiful parents, one of whom had adopted her child--first 
as a foster care and then adopted knowing the special needs of this 
child. This was Angie and Anna. These parents are the saints of the 
world, and these kids are fighting so hard. They are fighting so hard 
just to try to develop every talent they have, every capacity they 
have, but with Medicaid cuts, they would be in deep, deep jeopardy.
  Why would we vote for a bill that slashes Medicaid to families like 
these when President Trump said we are not going to cut Medicaid? Why 
would we vote for a bill that shatters those promises, that takes 
health insurance away from 20 million people, that increases premiums 
for seniors, that subjects those with preexisting conditions to being 
cast in the shadows yet again? That is what this bill would do.
  I had a conclusion written, but I will tell you, one of my moms 
yesterday gave me a better one. She gave me a better conclusion.
  We had this roundtable with five families. We had some great folks 
from the American Academy of Pediatricians who were there, too, saying 
what a bad bill this would be for kids.
  After the hearing was over, one of the moms looked at me and said: 
You know, they kind of picked the wrong group of people to fight with--
talking about this bill.
  I said: What you do mean by that, wrong group of people to fight 
with?
  She said: Parents of kids with disabilities.
  I said: I don't get where you are going.
  And this is what she said to me: From the moment our children are 
born, all we do is fight. We fight so that our kids can survive. We 
fight so that our kids can have as normal a life as possible. We have 
to fight with hospitals. We have to fight with insurance companies. We 
have to fight with school systems. We have to fight with cultural 
stigmas about people with disabilities. If you are a parent of a child 
with a disability, from the day they are born, all you do is fight. And 
if they think that we are going to pass a bill to cut Medicaid to these 
kids and their families and that we are not going to fight about it, 
that we are not going to stand up and be heard, they have seriously 
underestimated us.
  I think we can do the right thing, as my colleagues have said, if we 
will get together. I am on the HELP Committee, Health, Education, 
Labor, and Pensions, and the only topic that has been taboo on my 
committee this year is health. We have had hearings about nominees. We 
have had hearings about the FDA. We have not been allowed to have a 
hearing about this health proposal--either the House bill or the Senate 
bill.
  Let's have a hearing, listen to patients, listen to parents, listen 
to hospitals, listen to doctors, listen to people who are worried about 
their premium costs, listen to insurance companies, and listen to 
medical innovators. If we listen, we will get this right. But if we 
shut down a process, if we don't allow the public in, don't listen, 
don't have hearings, and rush it through, we will get it wrong.
  This is the biggest sector of the American economy, and it is the 
most important expenditure that anybody ever makes in their life. On 
behalf of the 600,000 children in Virginia and the 30 million children 
in this country who receive Medicaid, let's get this right.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. CRAPO. Mr. President, I rise today with my colleague, Senator 
Risch, to speak on the nomination of Judge David Nye to be a U.S. 
district judge for the Federal district of Idaho.
  First, let me acknowledge the diligent work of Judiciary Committee

[[Page S3902]]

Chairman Grassley and Ranking Member Feinstein in expediting the 
confirmation process for Judge Nye's renomination.
  I also thank both President Obama and President Trump for nominating 
Judge Nye to the Federal bench. It is rare to be nominated by 
Presidents of two different parties, but it is a fitting testament to 
Judge Nye's sterling reputation that he has secured that distinction.
  Finally, I appreciate the majority leader giving Judge Nye the honor 
of being the first U.S. district judge by the 115th Congress.
  Judge Nye is supremely qualified as a candidate for the Federal 
district court seat, having a unanimous ``well qualified'' rating from 
the American Bar Association and having received approval from the 
Senate Judiciary Committee without dissent twice in a little less than 
a year.
  Judge Nye has long been ready to assume this high office. A longtime 
member of Idaho's legal community, Judge Nye has been a law clerk, a 
practicing lawyer, and since 2007 a judge on Idaho's Sixth Judicial 
District Court. This court handles all felony criminal cases, major 
civil cases, and appeals from the magistrate court from six counties 
throughout the southeast portion of Idaho. He also served from 2009 to 
2012 as the administrative district judge for the Idaho Sixth Judicial 
District, elected by his peers on the court for the 3-year term to this 
position.

  He is not just a well-respected jurist in Idaho. Judge Nye is heavily 
involved in the training and orientation of new Idaho judges, and he 
serves on the Idaho Supreme Court's committees on judicial education 
and felony sentencing.
  Action on Judge Nye's nomination is critical and timely. Idaho is one 
of only three States having just two authorized district court 
judgeships. The nonpartisan Judicial Conference of the United States 
has declared a judicial emergency for Idaho and has recommended in 
every one of its reports to Congress since 2003 that Idaho be 
authorized a third district judge position. For the past 2 years, Idaho 
has had a three-judge caseload handled by just one active judge. What 
is even more challenging is that our lone remaining active judge is 
already eligible to take senior status since this past March. Even with 
Judge Nye's confirmation, Idaho still needs another U.S. district court 
judge.
  Confirmation of Judge Nye today or tomorrow is undoubtedly a proud 
day for the entire Nye family, including Judge Nye's wife Katre and 
their eight children. Knowing that a successful public servant draws so 
much strength from the family surrounding him or her, I salute their 
partnership with Judge Nye in making this important occasion possible.
  Again, I strongly endorse Judge Nye's nomination and appreciate the 
Senate's confirmation of him.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. RISCH. Mr. President, I want to associate myself with the remarks 
from my distinguished colleague and close personal friend, Senator 
Crapo, and join him in urging our fellow Senators to quickly confirm 
Judge Nye.
  As pointed out by Senator Crapo, this will be the first district 
judge to be confirmed by this Congress. So it should be an honor for 
Judge Nye, and I am sure he views it that way.
  This has been, literally, years in the making. As Senator Crapo 
pointed out, we have only one active Federal judge right now, and he is 
handling what is essentially a three-judge load. Some time ago, when 
this vacancy occurred, Senator Crapo and I went to work on this. Most 
Americans don't understand how this works, but to become a U.S. 
district judge, it takes essentially the concurrence of three people--
that is, the President of the United States and the two Senators from 
that particular State, be they two Republicans, two Democrats, or one 
of each--because we have what is called a blue slip process, where if 
any one of the three can and do object to a person, then that person 
will not be permitted to go forward.
  In this particular case, we negotiated with the Obama White House for 
literally months and months, and it turned into years. I believe we 
acted in good faith on both sides in trying to find a person who would 
be the right fit for Idaho. Again, we literally vetted well over 50 
individuals for this position, and for one reason or another, we were 
unable to get any of those across the finish line.
  Finally, we settled on Judge Nye. I shouldn't say ``settled'' on him. 
He had not really applied. After going through the 50 being vetted and 
not really getting where we wanted to be, we sought out Judge Nye and 
talked with him about it, and we went forward on that basis. The White 
House came along, and before President Obama left office, he nominated 
Judge Nye, pursuant to my and Senator Crapo's request. Unfortunately, 
that was just about the time that we ran out of time processing judges. 
The election came and went. President Trump was inaugurated, and we 
started all over again. I want to personally thank the White House for 
very quickly renominating Judge Nye for this position, again, at the 
request of myself and Senator Crapo.
  Too many States have a shortage of judges, and there is a movement 
afoot right now to attempt to boost the Federal judgeship load, which 
is in bad need. For instance, in the last seven surveys that the 
Judicial Conference has undertaken, they recommended that Idaho get a 
third judge. Senator Crapo and my predecessor before me and, I think, 
even Senator Crapo's predecessor before him have also been pushing for 
this judge. We continue to do that, and I am seeing some green sprouts 
that perhaps we will be moving somewhere in that direction.
  In any event, yesterday we had the vote on moving forward on his 
nomination, and that vote was 97 to 0, which certainly is a testament 
to Judge Nye himself. I would urge our fellow Senators, when we get to 
this vote, which will either be later today or midday tomorrow, to 
proceed with the same kind of vote. It was a bipartisan vote on 
cloture, and we hope it will remain a bipartisan vote as we move 
forward on this confirmation.
  With that, I want to thank Senator Grassley, who obviously is pressed 
by everyone who has a vacancy, and Senator McConnell, who has lots of 
things on his mind these days and is struggling with challenges that 
come at him from all directions, for choosing Judge Nye at our constant 
and gentle urging over the recent months and years and moving him to 
the front of the line. I want to personally thank Senator McConnell for 
doing that. Of course, I want to thank my distinguished colleague for 
his work on the Judiciary Committee and moving it through the Judiciary 
Committee.
  I think Judge Nye will be a person who will make us all proud. 
Certainly, we are going to be very happy to have this judgeship filled 
in Idaho and, particularly, with someone of the quality of Judge Nye.
  With that, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                         Healthcare Legislation

  Mr. CORNYN. Mr. President, as we move forward in our efforts to 
repeal and replace the failed ObamaCare law, it is worth remembering 
the reasons why this work is so urgent and why it is so important. The 
Affordable Care Act has left many American families paying far more for 
healthcare than they did beforehand, and it has taken away their 
freedom to choose the doctor they want or the health plan they want. 
That is, of course, all contrary to what was promised at the time 
ObamaCare was passed back in 2009 and 2010.
  We all remember what the President said, and none of it has proven to 
be true in terms of your plan, your doctor, or the costs. In fact, as I 
mentioned before, the cost has gone up 105 percent for people in the 
individual market since 2013 alone. So rather than seeing a $2,500 
decrease in the cost to their health coverage, they have seen a $3,000 
increase, and the prices continue to go up. It is actually getting 
worse by the day, which is another reason for the urgency of what we 
are about to do. A report from the Centers for Medicare and Medicaid 
Services, or CMS, released yesterday, found that 40 percent fewer 
insurers have applied to participate in

[[Page S3903]]

the ObamaCare exchanges next year. The reason why that is important is 
because when fewer insurance companies choose to participate, of 
course, consumers have less choice and there is less competition in 
terms of quality of service or the price they charge. The damage goes 
far beyond the damage to the doctor-patient relationship and the damage 
to our pocketbooks, when we are told things will cost us less and they 
cost us more. The damage of the Affordable Care Act has literally 
permeated our entire economy and has led to a lot of people losing 
their jobs along the way.
  ObamaCare consists of a number of mandates, government coercion, and 
punishment if you didn't comply with the mandates that forced many 
Americans to buy a product they would not have bought of their own 
volition and in many instances simply could not afford. But if you 
refused to do it, the government fined you, punished you. That 
represents a radical change in the nature and guiding philosophy of 
this country. This country was founded on the concept of individual 
freedom, not on Big Government coercing you to buy something that you 
don't want and you can't afford. But that is the theory behind 
ObamaCare.
  In addition to that, for small business owners, it included a penalty 
for any business that exceeded more than 50 employees who did not 
provide government-approved health insurance policies. It cost them at 
least an additional $70,000 a year, in addition to other increases in 
healthcare costs.

  Let's say you are a small business of 50 or so employees. You are 
sure not going to hire over the cap and subject yourself to the 
additional $70,000 a year in costs. What you are likely to do is to 
hire fewer than 50 employees in order to protect yourself from that 
expense, and that is exactly what happened.
  I still remember, after the Affordable Care Act passed, having lunch 
in San Antonio, TX, with a friend of mine who was an architect at the 
particular time. When I described to him the nature of the employer 
mandate and its effect, he made it clear to me that he would rather lay 
off some of his employees in order to avoid that additional expense 
under the employer mandate. In fact, that is just what he did.
  This is just another bit of evidence about the pernicious impact of 
the Affordable Care Act. It is not just about premiums. It is not just 
about deductibles. It is not just about freedom of choice. Literally, 
it has been a wet blanket on our economy.
  This damage reaches across many different sorts of industries. 
According to a recent study by the Mercatus Center, an estimated 
250,000 jobs nationwide were lost due to this mandate. That strikes me, 
frankly, as too small a number, but that is the number they projected. 
A quarter of a million people lost their jobs because of this mandate 
because small employers were motivated to keep their numbers under the 
cap in order to avoid the extra expense. This does not even take into 
account the consideration of businesses that were forced to shut their 
doors altogether.
  In other words, ObamaCare was, in part, premised on this idea that 
businesses could endlessly absorb additional taxes and new costs and 
mandates and somehow continue to keep their doors open and do business 
as usual, but that is not the real world.
  It also does not take into consideration the many businesses that 
choose to cut the hours their employees can work instead of firing 
them. This is another one of those stealth characteristics of 
ObamaCare, in which employers are judged on the number of full-time 
employees they have.
  I remember talking to a restaurant owner in East Texas--in Tyler, 
TX--who told me he had to lay off a single mother who was working as a 
waitress in his restaurant. He could not afford to have her work full 
time. He had to put her on part time in order to avoid the penalties 
that are associated with ObamaCare. What that meant for this single mom 
is that she essentially had to go out and get two jobs in order to fill 
the gap that was left by her going from full-time work to part-time 
work. That is not the only story I can tell you.
  A small business owner in Donna, TX, epitomizes this reality in a 
letter that was written to me a few weeks ago. This gentleman said he 
and his wife are both on Medicare. Of course, they are unaffected 
directly by ObamaCare because Medicare covers people who are 65 years 
and older while ObamaCare covers people who are younger than that. 
While they were left unaffected personally by ObamaCare's changes, on 
behalf of his 54 employees, he wrote that after ObamaCare went into 
effect, he was faced with a choice, either he could buy his employees 
expensive health insurance that his business could not afford or he 
could pay fines totaling more than $100,000. Instead, he made the 
painful choice to lay off six of his employees in order to remain under 
the ObamaCare-imposed threshold. As he pointed out, this meant more 
than just simply laying off six people; it also meant risking the well-
being of each of those families represented by those six people.
  Small business owners should not be forced to choose between growing 
their businesses and providing jobs or risking the financial 
livelihoods of their entire companies and their employees just to 
satisfy the demands of Big Government. Even beyond causing layoffs, 
ObamaCare has effectively ensured that many businesses cannot grow and 
that existing businesses will not hire any more employees.
  ObamaCare did not just lead to a new form of healthcare coverage, as 
some have claimed, as two-thirds of the small businesses that were 
surveyed by the Mercatus Center report already offered insurance. Two-
thirds of the businesses affected by ObamaCare already had healthcare 
coverage, but that was effectively displaced and replaced by 
government-approved healthcare, which proved to be far more expensive.
  Instead of having the choice to shop around for the insurance that 
best meets their needs and the needs of their employees, these 
businesses have been forced to either pay the penalty or to pay the 
piper--that is the Federal Government--when it comes to these mandates 
and these demands.
  It ought to be clear by now--7 years into the implementation of 
ObamaCare--that this kind of one-size-fits-all mandate should not be 
applied to a country of 320 million people, especially when it comes to 
something as personal as healthcare. Each of us is a unique human 
being. Each of our families has its own unique needs and desires. 
Frankly, we ought to be able to choose the sort of healthcare coverage 
that best suits our needs as well as our incomes and our desires to buy 
health insurance. Some people want policies that provide purely for 
catastrophic coverage when they go to the hospital. Maybe they prefer 
to have savings accounts that use pretax dollars under health savings 
accounts in order to save money so as to pay for their doctors' visits, 
and they combine that with a high deductible health insurance plan. You 
literally cannot do that under ObamaCare, but you will be able to do 
that under the Better Care Act, which we will be voting on next week.
  What we have tried to do is to look at the meltdown of ObamaCare and 
say that we need some emergency measures to take place because of the 
phenomenon I mentioned earlier in which insurance companies are pulling 
out, people's premiums are going through the roof, or deductibles are 
so high that they are effectively being denied the benefit of their 
health insurance. We need to do something quickly and urgently.

  What we are going to do is take measures to stabilize the insurance 
markets because if insurance companies continue to pull out of the 
insurance markets and deny people a choice or competition or even 
access to a qualifying policy at all, that is going to put people in an 
impossible situation. So the first thing we are going to do is to 
stabilize the marketplace.
  The second thing we are going to do is to repeal the mandates that 
have made health insurance so unaffordable and restore the freedom to 
choose the sorts of policies and create a marketplace in which people 
can choose the policies that best suit their needs and at prices they 
can afford. It will literally bring down the cost of what people are 
charged in order to buy healthcare coverage.
  Because we understand the importance of protecting families against 
preexisting condition exclusions, we are going to make sure the current 
law

[[Page S3904]]

remains in effect that protects people from exclusions when they change 
jobs or lose jobs based upon preexisting conditions.
  The fourth thing we are going to do in the Better Care Act is put 
Medicaid on a sustainable growth rate. Medicaid is an important 
program. It provides the healthcare safety net for the Nation, but 
unfortunately it is unsustainable at the current rate of spending. Over 
the next 10 years, we propose to spend $71 billion more than we do 
today on Medicaid. In other words, it is going to continue to grow but 
at a more controlled and fiscally responsible rate.
  We are also going to provide people with tax credits who have an 
income between zero and 350 percent, including those people who are 
left out in the event that the Medicaid expansion is not embraced by 
their States and States like Texas--people who are now at 100 percent 
of the Federal poverty level up to 138 percent who were left out 
because of the fact that Texas did not expand Medicaid to able-bodied 
adults. They are going to be able to use that tax credit to buy private 
insurance. Private insurance provides much better access to coverage 
because, right now, Medicaid pays doctors and hospitals about 50 cents 
on the dollar when it reimburses them. Private insurance pays them much 
better so it improves the range of choices available to consumers.
  Our bill continues to be a work in progress. We have done our best to 
try to work with everybody who has been willing to work with us and to 
use their ideas. What we have tried to build is a consensus bill, but 
the fact is, our friends on the other side of the aisle have simply 
refused to participate in the process, thus leaving it up to us to save 
people and help people who are currently being hurt by the status quo. 
We are going to do our duty. We are going to fulfill our responsibility 
to our constituents the best we can under these circumstances. In 
recognizing that no bill is ever going to be perfect, certainly, we 
have to do what we can in order to help the people who are being hurt 
now under the status quo.
  Let me just close by saying that I have heard my friend the Senator 
from New York--the Democratic leader--talk about this bill. If we are 
unsuccessful in getting this bill passed next week, he wants to engage 
in a bipartisan negotiation in order to address healthcare. Yet what I 
predict is this: What he is really talking about is a massive, 
multibillion-dollar bailout of insurance companies without there being 
any reform. To me, that is an exercise that, frankly, I am not willing 
to participate in. I will never support a multibillion-dollar bailout 
of insurance companies and not be able to reform the system that 
created the problem in the first place.
  I urge all of our colleagues to work together with us. Bring us your 
best ideas. Work with us. Try to figure out a way to be constructive in 
this process and help us to achieve a result. It is not going to be the 
final result. We will have other opportunities, for example, in the 
Children's Health Insurance Program, which is a bipartisan program that 
expires by the end of September. We will have another opportunity to 
come back--hopefully, then on a bipartisan basis--to do additional 
things that we were unable to do because of the constraints of the 
budget reconciliation process and the fact that our Democratic 
colleagues simply refuse to participate in saving the people who are 
being hurt today by ObamaCare.
  I encourage my colleagues not to be lured by the seductive message of 
our friends across the aisle about doing something bipartisan after 
this bill is unsuccessful. They are not interested in changing anything 
about the structural defects in ObamaCare. If all we are going to do is 
propose to pay insurance companies billions of dollars more in order to 
bail them out--in order to support the same flawed structural program 
known as the Affordable Care Act--you can count me out.
  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. CARDIN. 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. CARDIN. Mr. President, I take this time to share with my 
colleagues the experiences I had in the State of Maryland during our 
most recent work period and shortly before that, when I took the 
opportunity to meet with different groups with regard to the healthcare 
debate.
  I had a townhall meeting this past week at Atrium Village, which is a 
senior living place in Baltimore County. We had a robust discussion 
primarily with seniors, but not just seniors, about their concerns as 
to whether the changes in the healthcare law would affect their ability 
in the Medicare system as well as relating to long-term care and 
Medicaid.
  A little bit earlier than that, I had a townhall meeting at one of 
our local hospitals where we had a chance to talk with lots of people. 
It was an open townhall meeting, and a lot of people from the community 
showed up. They expressed their concerns about what would happen under 
the changes being suggested in healthcare on coverage and quality of 
coverage, and we had a very robust discussion.
  I also had a chance to meet with leaders of the faith community as we 
talked about our responsibility to make sure healthcare is a right and 
not a privilege in the United States.
  I met with the leaders of the community health centers in Park West, 
in Baltimore City, to talk about the impact on the viability of health 
centers if the Medicaid Programs were cut.
  I had a chance to visit with Mosaic Behavioral Health Center, which 
deals with behavioral health in Baltimore, and their concern is, if we 
eliminate the essential health benefits of mental health and addiction, 
what impact that would have on access to care.
  There was a consistent message from each of the places I met with, 
with regard to whether we would be able to maintain coverage--under the 
Affordable Care Act, we expanded coverage by tens of millions--and 
whether that coverage would be compromised under the legislation being 
considered in the Senate.
  We also had a chance to talk about whether there would be a weakness 
in what benefits would be covered. I already mentioned mental health 
and addiction. There were also concerns expressed about reductions of 
benefits regarding obstetrics and how it would affect women, and 
pediatric dental care, which is a particular concern in Maryland after 
the tragic death of Deamonte Driver.
  They also raised many issues concerning discrimination in healthcare 
that was present before the Affordable Care Act and whether these 
conditions would be returning. A young father told me a story about how 
his daughter was born prematurely and, as a result, the baby was in the 
neonatal intensive care unit for 4 months. When his daughter was 4 
months old, she had reached her lifetime limit of what the insurer 
would pay for healthcare if we returned to lifetime limits. Whether we 
would be returning to the predatory-type practices of the insurance 
companies that were present before the Affordable Care Act and whether 
we would be returning to preexisting conditions or doing that 
indirectly through what benefits would be covered--that was expressed 
at several of my healthcare meetings.
  I already mentioned the concerns that the elderly expressed, 
including the discrimination of the near elderly, if we go to a 5-to-1 
ratio on health premiums, so that those who are 60 or 62 years of age 
paying five times higher premiums than younger people are paying. All 
of that was brought out during my townhall meetings.
  The one message I just wanted to leave with my colleagues is that 
there was a strong interest that we work together--Democrats and 
Republicans--because we all acknowledge that the Affordable Care Act 
can be made better. We don't want to repeal it. We want to improve it.
  Before we left for the July 4th break, I introduced legislation that 
deals with some of these issues. The legislation would improve 
competition by putting the so-called public option in the exchanges so 
that we know there would be at least one governmental option without 
subsidies, without any additional breaks over private insurance 
companies, to guarantee more competition in the marketplace.

[[Page S3905]]

  I also included in my legislation a solution to deal with the two 
major problems that we have under the Affordable Care Act. For some 
people, the insurance premiums are too high. Why? Well, I asked 
CareFirst, which is the major health insurer in Maryland, about the 
uncertainty as to whether President Trump is going to fund the cost-
sharing issues. My legislation makes it clear that those funds will be 
made available, as was anticipated under the Affordable Care Act.
  I also provide predictable subsidies for lower income families, up to 
400 percent of poverty, so that we can help bring down the cost of 
premiums in that marketplace, and we reimpose the reinsurance program 
so that we can spread the risk so the insurance companies know that 
they have a more predictable risk when they set their premiums.
  All of this would make a big difference. CareFirst said that, in the 
individual marketplace in Maryland, if you do that and endorse the 
individual mandate, we could reduce our premium increases by 50 
percent.
  So I am trying to work, I hope with Democrats and Republicans, to 
deal with the problems that have been brought to our attention on 
higher premiums and then to deal with healthcare costs generally.
  More and more people talk to me about bringing down the costs of 
prescription drugs. It is outrageous that Americans pay twice what our 
friends in Canada pay for the same medicines that are manufactured here 
in the United States. So why don't we have a more competitive 
marketplace? Why don't we have the rebates that we have in the Medicaid 
and the Medicare systems, and why don't we allow for more collective 
bargaining for prices in the pharmaceutical industry? My legislation 
would do that, and I know there is bipartisan support for that.
  Lastly, we deal with more integrated care. I mentioned Mosaic, a 
behavioral health facility in Baltimore City. They have an integrated 
care model. If you come into their community health center, they will 
treat whatever your problems are. They are not going to say: Well, come 
in one day and we will deal with diabetes, and the next day we will 
deal with high blood pressure. Let's deal with the whole patient in a 
coordinated and integrated care model, and that would help save on 
costs.
  My bottom line is this. No, I am not going to support weakening the 
Affordable Care Act. I am not going to support legislation that would 
diminish those who currently have coverage or the quality of their 
coverage. Let's work together--Democrats and Republicans--to deal with 
the real problems of bringing down costs in our healthcare system--
everybody benefits from that--and to make sure there is more 
competition in our exchanges and to make sure there is better premium 
support for those who cannot afford their premiums. If we do that, 
then, I really think we would be carrying out what the people of 
Maryland were asking me to do during the recess; that is, not to go 
back on the progress we have made under the Affordable Care Act. Let's 
build on that. Let's make healthcare more affordable, and let's deal 
with more competition on the premium costs.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.


                               Venezuela

  Mr. RUBIO. Mr. President, I have, since the year 2014, come to the 
Senate floor on numerous occasions, perhaps more than I hoped to, to 
discuss the developing situation in the nation of Venezuela.
  The reason why I have taken such an interest in this issue is because 
of the impact it has, first and foremost, on my home State of Florida. 
We are blessed in Florida, particularly in my hometown of Miami and in 
South Florida, to have a vibrant and diverse community with people from 
across the world and, particularly, from the Western Hemisphere. That, 
of course, includes a very substantial number of people from Venezuela, 
some who live in Florida for part of the year and some who have made it 
their permanent home. They have contributed greatly to our economy, to 
our culture, and to our lives.
  It is through their eyes that I have witnessed the tragedy that has 
unfolded in that nation over the last 5 years. I use the word 
``tragedy,'' but I don't use it lightly. Venezuela is one of the 
richest countries in the world, blessed with natural resources that God 
has blessed that nation with and the largest crude oil reserves on the 
planet--certainly, more than the United States and Canada combined, as 
an example. They have highly educated and capable people and a long 
tradition of democracy. Venezuela has one of the oldest traditions of 
democracy in the Western Hemisphere. As much as anything else, not only 
is it a tragedy for the people of Venezuela--what has happened--but it 
is a tragedy for the hemisphere and, ultimately, for the world. We look 
at some of the great causes that the world is confronting and think 
what a democratic and prosperous Venezuela could be contributing, what 
its extraordinary people could be contributing. But the last 5 to 10 
years--particularly the last 5--have largely been taken up by internal 
strife.
  At the end of the day, my interest on the issue of Venezuela has 
never been the removal of anyone from power. It has been about the 
restoration of the democratic order so that the people of Venezuela can 
choose their path forward. We look at the history of our hemisphere, 
here in the Western Hemisphere, and we see that up until about 25 years 
ago, most of the nations in the Western Hemisphere were governed by 
dictators and strongmen on both the left and the right, and few, if 
any, people in our hemisphere had a role to play in choosing their 
leaders. Today, but for the exception of a handful of places--
predominantly, Cuba and the Caribbean and some others--almost all of 
the people of the region get to choose their leaders, and that has been 
the story of Venezuela up until very recently. Sometimes they choose 
leaders who agree with America, and sometimes they do not. But they 
choose their leaders.
  In the end, we know that democracies very rarely start wars because 
their peoples do not tolerate it. Democracies always seek stability and 
prosperity because their peoples demand it, and they get rid of leaders 
who don't deliver.
  So our goal from the beginning--my goal, in particular--has 
consistently been the restoration of the democratic order and, through 
that, the respect for basic rights and dignity of all people, 
particularly in Venezuela. It is sad to see what has happened because I 
think it is fair to say that the situation today in Venezuela is worse 
than it has been at any point since 2014.
  We saw about a week ago the horrifying images of armed thugs storming 
the National Assembly--the democratically elected National Assembly--
and attacking members of that assembly. It would be the equivalent of 
protestors storming the Capitol doors and attacking Senators and 
Congressmen. We saw images of uniformed personnel, some of whom, 
basically, are the equivalent of our Capitol Police, roughing up the 
very members of that assembly whom they are supposed to be protecting. 
We have seen the images of protests in the streets, of national guard 
troops firing on people with tear gas and rubber bullets and, in some 
instances, with guns.
  We have seen these irregular groups called ``colectivos'' going after 
people in the streets. By the way, in fairness, we have seen violence 
on both sides of it, although the vast majority of people in the 
opposition--the enormous majority--seek a peaceful resolution to this. 
Anytime you put hundreds of thousands of people in the street, chaos 
happens.
  You think not just of the protestors, but you think of their family 
members on the other side of it. We forget that these national guard 
troops, holding up their shields and wearing the uniforms, have sisters 
and brothers and husbands and wives and loved ones on the other side of 
that barricade, deeply dividing this proud nation with an incredible 
history of contributions that it has made.
  The situation has now reached what I believe is the tipping point. 
Later this month, the Government of Venezuela--I should say the 
executive branch, under its current President--has scheduled an 
unconstitutional assembly. They call it a constituent assembly. It 
violates the very Constitution of the country, not to mention that the 
supreme court has already kind of canceled the democratic order and 
this adds to that. I just say this with deep

[[Page S3906]]

sadness. If that goes forward, I think it fundamentally changes the 
situation permanently.
  I had an occasion early this morning to speak to the President on 
this topic for a few minutes, as I know he is headed overseas. He 
expressed his continued dissatisfaction with the course of events. I 
think it should be abundantly clear to everyone that this government in 
the United States is prepared to take additional significant measures 
if, in fact, that constituent assembly moves forward at the end of this 
month--basically, all but admitting to the world what we already know; 
that is, that the democratic order in Venezuela has ended.
  I do believe that there is still a path forward--a path forward that 
doesn't involve vengeance, that involves reconciliation; a path forward 
designed to restore the democratic order. I believe deeply that all of 
my colleagues here in the Senate and in the Congress and the President 
of the United States are prepared to play whatever role they can to 
help facilitate that. I think that, obviously, ultimately, it would 
involve restoring democracy. It would involve respecting its own 
Constitution. It would involve holding free and fair elections, 
internationally supervised, not by the United States but by the United 
Nations or by neighboring countries. I just left a meeting a few 
minutes ago with the Foreign Minister of Mexico, a nation that has 
shown that it is willing to step forward and be constructive and 
productive in this endeavor.
  That is the goal. The goal is to restore peace and order and to 
restore democracy and to grant amnesty and freedom to those who have 
been imprisoned because of their political views. Within that space, 
there are those within the government who themselves perhaps seek the 
same thing but feel trapped by the circumstances before the nation 
today.
  So I do believe there is a path forward, but I also think it would be 
unfair if I didn't make clear that the time for that path is running 
out and the door will permanently close if, at the end of this month, 
the Maduro government moves forward with this assembly, which is 
illegal and unconstitutional. At that point, it would be clear for all 
that they have no interest and no intent of restoring democracy. I fear 
the consequences of that, not simply because of what the U.S. 
Government and the Trump administration might do but what it would mean 
to those in the streets who are already desperate as it is.

  I do think that path is there. I do believe that opportunity is still 
available, but it will not be around forever. My hope is that cooler 
heads will prevail. My hope is that patriots in Venezuela--no matter 
what side of this debate they have been on up to this point--realize it 
is time to step up and further this process of reconciliation, not with 
a goal of vengeance or punishment but with a goal of freeing those who 
have been imprisoned unjustly, with the goal of having free and 
democratic elections, with the goal of living up to constitutional 
principles, with the goal of restoring democracy to a great people and 
a great nation.
  I know that I, for one, despite all of my criticisms and all of the 
speeches I have given and all of the measures we have taken, am 
prepared to do all I can to be helpful in that endeavor, to help the 
people of Venezuela take control of their destiny once again and 
restore the democratic order, the constitutional order in a way that 
unites the country, not one that further fragments and divides it.
  I know the President has expressed a willingness to be involved in 
that process in whatever capacity is appropriate, knowing that other 
nations in the region are prepared to lead as well.
  I thought it was important on this 11th day of July, as we get closer 
to that measure--which I think will do irreparable harm to this 
possibility--that I come here to the Senate floor and express this. In 
the end, I think all of us in this hemisphere and, ultimately, the 
world would benefit greatly from a Venezuela that fulfills its 
potential--the potential of its people, the potential of its economy, 
the potential of its proud history of democracy. Whatever we can do to 
be helpful in that endeavor, I know that this Nation is prepared to do 
in whatever capacity is appropriate in the eyes of the people of 
Venezuela.
  Ultimately, the future of Venezuela belongs to the people of 
Venezuela, and that is what we stand for. We hope that we can be 
helpful in a process that brings them together--and not further divides 
them--and restores what they once had and deserve to have again: a 
proud democracy, a vibrant economy, and a people with extraordinary and 
unlimited potential to achieve great things on behalf of their nation, 
their countrymen, and the world.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.


                          Welcoming the Pages

  Mr. CARPER. Mr. President, I want to welcome our new pages. They have 
been here all of 24 hours or so. I talked to some of them earlier 
today. They come from all over this country, and we welcome each of 
them.
  I understand they are with us for 3 weeks, and we wish it could be 
longer. Who knows? Maybe it will be. We will see.


                         Healthcare Legislation

  Mr. President, I am here today to talk about healthcare. That is a 
subject we have talked a lot about, not just on this floor this week, 
this month, and this year but for years. A lot of times, when we talk 
about it, we seem to forget that this involves real people, people who 
live in our home States. They are moms and dads; they are parents. They 
are children. They are grandparents, aunts, and uncles. They are young, 
and they are old. They are people from different walks of life. They 
are real people.
  I want to talk today about one of them. Delaware is a little State. I 
like to kid my colleagues that a lot of days in the week I visit all 
the counties in Delaware. We have only three. Yesterday I got to go to 
all three of them.
  In the southern part of our State is Sussex County, which is the 
third largest county in America. I think there are 3,000 counties in 
America. The third largest is Sussex County, DE. The county seat for 
Sussex County is called Georgetown.
  Before I came over here yesterday afternoon to be here for the 
convening of the Senate, I stopped off and hosted a roundtable. There 
were about 20 patient advocates from organizations across the State of 
Delaware. We were in Georgetown at a place called the CHEER Community 
Center, which is a gathering place for seniors in the southern part of 
our State. A lot of good activities happen there for seniors from all 
over Southern Delaware.
  Some of the organizations on the frontlines of our healthcare system 
were there. I am going to mention a couple of them. They include the 
Mental Health Association, the National Alliance on Mental Illness in 
Delaware, the Leukemia & Lymphoma Society, Autism Delaware, the 
American Heart Association, the Juvenile Diabetes Research Foundation, 
the Alzheimer's Association, and atTAcK addiction. The folks at the 
roundtable explained to me and to others how the new plan that was 
presented several weeks ago would dramatically diminish their ability 
to care for the Delawareans they serve.
  During our roundtable, we heard directly from representatives of 
these organizations, and we heard directly from patients. These 
Delawareans shared with us just how devastating a repeal of the 
Affordable Care Act would be for them and for their families.
  One person's story stood out to me. She is a woman I have met before. 
Her name is Jan White. She is pictured here with her husband Mike. They 
live in Newark, which is at the other end of the State. If you drive up 
I-95 from Washington through Baltimore, on up to the Delaware line, the 
first town you come to in Delaware is Newark. That is where the 
University of Delaware is located. That is where they live.
  Jan and her husband were college sweethearts. This October they are 
going to celebrate their 30th wedding anniversary. They run a 
successful small business in Delaware. It involves setting up meetings, 
running them, organizing and running special events.
  Together they have one child, a son named Ethan. This September, 
Ethan will start his senior year at the University of Delaware, which 
is one of my alma maters. I went to graduate school there after the end 
of the Vietnam war on the GI bill. It is a wonderful school. He will be 
a senior there this fall.
  Jan, depicted here with her husband, was doing everything she was 
supposed

[[Page S3907]]

to do to stay healthy. She ate right. She exercised. In fact, she was 
studying martial arts.
  I eat right too. I exercise almost every day of my life and have 
since I headed to Pensacola, FL, as a newly minted ensign in the Navy. 
I still work out, just like Jan. One thing she has done that I 
haven't--she has studied martial arts and achieved her third-degree 
black belt. She did it a couple of years ago, in April of 2015.
  Jan also worked hard at their business and helped to raise Ethan. 
Jan, Mike, and their son Ethan were living the American dream, but 
their lives were irreparably changed in April of 2016--a year after she 
earned her third-degree black belt.
  Something happened. What happened was that Jan was diagnosed with 
aggressive stage IV non-Hodgkin lymphoma. It had invaded her chest and 
her spine. She went from teaching kickboxing and studying for her 
fourth-degree black belt to relying on a walker.
  Jan underwent over 5 months of intense chemotherapy. I am told it was 
102 continuous hours every 3 weeks. Think about that: 102 continuous 
hours of intense chemotherapy every 3 weeks. She had two injections 
into something called--I think it is a cavity in our brain--the Ommaya. 
She had two injections every 3 weeks for her spinal tumor, a high 
dosage of inpatient chemotherapy, and a month of radiation.
  Jan was pronounced in remission earlier this year. Thank God. She 
desperately hopes to stay there, and our prayer is that she will.
  When Jan was sick, she and her husband Mike kept working. There was 
no quit on that team. They kept working at their business, although it 
certainly wasn't possible to keep up with everything. That business had 
its usual pace that they followed.
  As Jan has said, the bills don't stop just because you have cancer. 
That is true. Today she continues physical therapy repair damage from 
spinal cord compression from the tumor and the chemotherapy for the 
spinal tumor. She continues this therapy, even though her insurance-
approved visits ran out a long time ago.
  Jan monitors daily for relapse, hoping and praying it will not 
happen. She and Mike have worked hard to keep their business doors open 
and to try to put their lives back together.
  The current debate in Washington over the Affordable Care Act makes 
Jan and Mike wonder if they will be able to afford the premiums that 
they face. Their current premiums now--not including deductibles, out-
of-pocket expenses, or denials--are double their mortgage payments.
  Jan told me that they wonder if they will have to forgo Jan's medical 
care. They wonder if they will have to choose to pay for care and maybe 
put their family in bankruptcy. What if the treatments don't work?
  Most of us know that cancer is a hard battle. In my own family, we 
know that my grandfather, his wife, and others who have fought cancer 
ultimately succumbed to it. It is a hard battle. Jan shouldn't have to 
fight for the chance to fight and survive. That is what she is doing.
  We are encouraged that she has had better than a fighting chance. Jan 
and her family hope that those of us in this body--in the Senate--and 
our friends in the House of Representatives will do the right thing. 
That is why she is now involved with the Leukemia & Lymphoma Society as 
a patient advocate.
  It is up to those of us in Washington to do the right thing by Jan--
not only to do the right thing by her but by the 1.2 million people who 
have blood cancer, including roughly 400 Delawareans and the 50,000 
cancer survivors who live in my State.
  I will close by saying this: Last week we had the Fourth of July 
recess. The place was closed, and most of us were in our States. I 
covered the State of Delaware almost every day. I saw thousands--
probably tens of thousands--of people during the course of that time. I 
am amazed at how many people talked to me about healthcare legislation. 
They called on us to do the right thing.
  The other thing they called on us to do was to work together. Any 
number of people said to me: This shouldn't be all Republicans trying 
to solve this; this shouldn't be all Democrats trying to solve this. 
This should be everyone working together.
  I couldn't agree more. I think we have a great opportunity right now 
to hit the pause button and not retreat to our different corners around 
here but to figure out how we can engage and do three things with 
respect to the Affordable Care Act: Figure out what in the Affordable 
Care Act needs to be fixed and let's fix it; figure out what in the 
Affordable Care Act needs to be preserved and let's preserve it; and if 
there are provisions in it that should be dropped, let's figure out how 
to drop them.
  I talked with one of my colleagues, a former Navy guy from Arizona on 
the other side of the aisle. We came to Congress together in 1982. We 
served in the Navy together before that. We were talking yesterday 
about a path forward for us. We both said almost at the same time: What 
we should do is regular order.
  I don't know if our new pages have heard that term, ``regular 
order.'' What it means is pretty much this: If someone has a good 
idea--or maybe a not-so-good idea--on an important issue, introduce it 
as a bill. It gets assigned a committee, and the committee chair, 
ranking member, senior Republican, senior Democrat talk about 
scheduling a hearing. They hold a hearing--maybe not just one hearing 
but maybe a series of bipartisan hearings. Sometimes they actually 
schedule some roundtables in addition to hearings, which are more of an 
informal discussion, which are sometimes helpful in working out 
consensus around the very difficult issues like healthcare.

  The regular order is that after there has been a lot of testimony, a 
lot back-and-forth, a lot of questioning, they have a markup in the 
committee on jurisdiction. The markup is to vote on the bill before we 
vote on the bill. We have the opportunity for members--Democrats and 
Republicans have the opportunity to offer amendments to the 
legislation, amendments for and against, amendments that would change 
and hopefully improve the underlying bill.
  After the amendments are offered, there would be a vote on the 
underlying bill, to keep it in committee or report it out. In regular 
order, if it is reported out, then it competes for time on the floor. 
That is something our leaders, Senator McConnell and Senator Schumer, 
would need to work out amongst themselves.
  If the bill makes its way to the floor, in regular order, we would 
have time for debate, especially for something this important. As I 
recall, when we debated the Affordable Care Act in committees, 
hearings, and roundtables, I think we spent 80 days. All told, I think 
over 300 amendments were offered. There were 160 Republican-sponsored 
amendments adopted to the Affordable Care Act. Is it perfect? No. 
Anything that big, that complex, should have been even more bipartisan 
than it was. This is something we need to get right.
  I will close with this thought: If you go back 8 or 9 years ago, we 
had a new administration. I was a brandnew member of the Finance 
Committee, which has jurisdiction over Medicaid and Medicare. We share 
jurisdiction in the Senate on healthcare legislation; the other 
committee is the Health, Education, Labor, and Pensions Committee, 
which is led by Senator Lamar Alexander of Tennessee and Senator Patty 
Murray of Washington State, two very able people and leaders. I would 
suggest that they are the kind of leaders who can help us actually 
figure out what is the right thing to do.
  I don't know that either party is smart enough to figure it out by 
themselves, but if you ask a lot of people around this country, 
including people like Jan and her family or folks who are providers, 
such as doctors, hospitals, and nurses, and folks who work in 
pharmaceuticals, health economists--if you ask a lot of people ``What 
do you think?'' there is a much better chance to ultimately get this 
right.
  I will add a P.S. as a former Governor of Delaware, as some of my 
colleagues know. I call myself a recovering Governor. We have a new 
page here from Ohio. One of the guys from Ohio is now a pharmacist. 
John Kasich, my old colleague from the House, is now Governor of Ohio. 
He has been a strong voice in favor of just what I am talking

[[Page S3908]]

about doing, and that is to hit the pause button and figure out how we 
can do this together, and we need to.
  In closing, I will paraphrase something Mark Twain used to say. Mark 
Twain used to say: ``When it doubt, tell the truth. It will confound 
your enemies and astound your friends.'' Think about that.
  In this case, maybe we should paraphrase Mark Twain: When in doubt, 
try regular order. When in doubt, try working together. When in doubt, 
try a bipartisan approach that is focused on getting this country and 
our healthcare delivery system a lot closer to where it needs to be.
  Every President since Harry Truman said as President that we need to 
change our healthcare delivery system so that everybody in this country 
has access to healthcare. By the time we took up the Affordable Care 
Act in the Finance Committee and the Senate, we were spending, as a 
nation, 18 percent of the gross domestic product on healthcare in this 
country. I have a friend, and if you ask him how he is doing, he says: 
Compared to what? We are spending 18 percent GDP. What were they 
spending 8 years ago in Japan? They were spending 8 percent of GDP for 
healthcare in Japan. Did they get worse results? No. They got better 
results--higher rates of longevity, lower rates of infant mortality. In 
Japan they covered everybody. They still do. They are getting better 
results for less money.
  Frankly, what we did in writing the Affordable Care Act was we looked 
around the world, including Japan, and we looked around this country, 
including at places like Mayo, the Cleveland Clinic, and others, to see 
what they are doing to get better results. We tried to put a lot of 
that in the legislation, in the law. Wonder of wonders, some is 
actually delivering good results--better value, better results for less 
money. That is part of the Affordable Care Act we want to maintain and 
preserve.
  I have probably stood here long enough talking about this today. This 
is an important issue. It is one-sixth of our economy, and healthcare 
eventually affects us all. People who get sick will eventually get 
care. For too long, the care they have gotten has been in the emergency 
room of a hospital. By the time they get sick enough to go there, 
sometimes they are very sick. It is very expensive. They don't spend an 
hour or two in the emergency room of a hospital; they may spend a week 
or two in the hospital and really run up the tab. That is a hugely 
expensive way to provide healthcare. Who pays for it? The rest of us. 
We have to be smarter than that.
  I am hoping that in the days ahead, particularly as our Governors 
gather up in Providence, RI, later this week to discuss, among other 
things, providing healthcare for their constituents in 50 different 
States, my hope is that some of what I said here today will be on their 
minds: Hit the pause button. Fix the things in the Affordable Care Act 
that need to be fixed. Preserve the aspects that need to be preserved. 
Let's do it together.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Rubio). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Mr. President, I represented the congressional district 
of Springfield, IL, for 14 years, and this is my 21st year in the 
Senate. It is a big State with 102 counties. We are proud of our 
diversity in our State, which runs from the great city of Chicago, to 
deep, deep Southern Illinois, to a town of Cairo, IL, which is 
literally south of Richmond, VA, by latitude. They grow cotton down 
there in the State. So it is a very big and diverse State. I am proud 
to represent it.
  I have spent some time doing my best to understand the challenges 
that businesses, individuals, and families face and to measure their 
sentiments on issues over the years.
  For the last several months, I have spent my time visiting every 
corner of downstate Illinois, which is the more rural, smalltown area 
of our State outside of Chicago. It is more conservative politically. 
President Trump ran well in some parts of downstate Illinois. And I 
have been in this area--representing it, growing up in it--to measure 
what I consider to be the topic and issue of the day, and that is the 
issue of healthcare in America. It is an issue which each of us takes 
very seriously and personally because each of us is called on in a 
variety of different ways in our lives to have healthcare for ourselves 
and our family--the people we love--at critical moments.
  We are now engaged in a national debate about the future of 
healthcare in America. The Republicans control the House, the Senate, 
and the White House, and have been from the beginning opposed to the 
Affordable Care Act, which was passed under President Obama. I voted 
for it. I think it was the right vote. I think it has achieved a great 
many things. I hope we can build on it to make an even better 
healthcare system for our Nation. It is not perfect. There are areas 
that need to be changed, improved, and areas that I think need to be 
strengthened over the long haul to make sure America has more fairness 
when it comes to healthcare for our people.
  Last week, I visited about a half dozen healthcare facilities in 
Illinois. I jokingly said to my staff that I have come to know hospital 
administrators in my State far better today than I ever have.
  Here is what they told me. They told me the healthcare bill that 
Senator McConnell has proposed in the U.S. Senate would be devastating 
to the families, the patients, the employees, and the healthcare 
facilities in our State. They told me that nearly $800 billion in 
Medicaid cuts would cripple rural hospitals and health clinics. Not 
only would this harm patients in rural communities, but 35 percent cuts 
in the Medicaid Program would also cost jobs in Illinois. The Illinois 
Hospital Association in my State estimates that the Republican bill, 
which passed the House and now is being considered in the Senate, would 
cost us 60,000 healthcare jobs.
  I went to Granite City, IL, which is near the St. Louis area. I met a 
young woman named Sam, who has Down syndrome and her mother Missy. They 
are worried about the Republican plan to cap Medicaid spending. Sam's 
health needs can't always be anticipated. There are not some that can 
be capped in terms of future needs, and the amount of care can hardly 
be determined in advance for this young woman who is doing her best to 
lead an active and involved life facing this disability, which she 
does. This is so true for so many people nationwide.
  Some of my Republican colleagues in Illinois have said: We just don't 
understand why Medicaid as a program has grown so much. Well, it may be 
hard to understand until you look inside the program and realize what 
it does. Medicaid may have started as a small idea, but it has really 
grown into a major provider of healthcare in America. In my State of 
Illinois, it is responsible for paying for the prenatal care, birth, 
and care of mothers and their children after they have been born for 
more than 50 percent of the kids.
  It is an important provider of healthcare resources to our school 
districts in Illinois, which count on Medicaid to help them take care 
of special needs students--counselors, psychologists, transportation, 
even feeding tubes for those who are severely disabled. It is a 
critical program as well for the disabled community, like Sam and young 
men and women who are victims of autism or Down syndrome who want to 
lead a full life but need health insurance. Medicaid is their health 
insurance.
  One woman said to me in Champaign, IL, my 23-year-old son is 
autistic. He counts on Medicaid, and, Senator, if I don't have 
Medicaid, my only recourse is an institutional program that would cost 
us over $300,000 a year. It is impossible for us to even consider that.
  So those who would cut back on Medicaid spending in the name of 
flexibility and saving money or generating enough to pay for a tax cut 
for wealthy people would leave people just like those I have described 
in a terrible circumstance.
  I haven't described the largest cost of Medicaid. The largest cost in 
Illinois and across our Nation is the Medicaid services and benefits 
provided to those who are older--mothers, grandmothers in nursing 
facilities and care facilities

[[Page S3909]]

who count on Medicaid along with Medicare and Social Security for the 
basics in life.
  I heard from Kevin. He is a worker from Urbana, IL, who is worried 
that the Senate Republican bill is going to increase his out-of-pocket 
expenses by thousands of dollars. He is worried because he fits into an 
age category which would see premiums go up dramatically in costs under 
the Republican bill. The Affordable Care Act, which we passed under 
President Obama, set limits on the increases in premium costs so no 
premium paid would be more than three times the cost of the lowest 
premium that is paid for health insurance in our country. Well, 
Republicans have changed that. In both the House and Senate, they have 
raised that to five times. So it means for people, particularly between 
the ages of 50 and 64, they are going to see a substantial increase in 
their premiums because of that Republican provision. People are 
following this closely enough to know that when premium costs go up for 
many of them, it becomes impossible to buy the coverage they need.
  As I returned to Washington, I once again face the reality of what 
this Republican healthcare plan would mean. The nonpartisan 
Congressional Budget Office told us the bill would cost 22 million 
Americans health insurance coverage--cutbacks in Medicaid as well as 
cutbacks in private insurance. Think of that. I don't know how the 
Republicans in our State can go home and explain why a million people 
in Illinois are about to lose their health insurance in the name of 
healthcare reform.
  I can tell you the notion of repealing the Affordable Care Act may 
have had some surface political appeal until you realize you might be 1 
of the 1 million people in my State who ends up with no health 
insurance when it is all over. It would cut Medicaid dramatically, as I 
have mentioned, and then keep cutting--a 35-percent cut over the next 
20 years--with devastating impacts on hospitals, clinics, and many 
other facilities.
  By 2020, average premiums in the individual market would increase by 
76 percent under the Republican plan. Costs would skyrocket even higher 
for seniors, rural communities, and those with medical needs.
  What happens to people with preexisting conditions under the 
Republican repeal bill? One out of three Americans has a preexisting 
condition. In the old days, they couldn't buy insurance or, if they 
could, couldn't afford it because they had a history of cancer in their 
family, diabetes, heart disease. Well, this Republican plan would take 
away the protections of the Affordable Care Act. It would allow States 
to waive essential healthcare benefits, like maternity care, mental 
health treatment, substance abuse treatment. People in need of these 
services would be left to fend for themselves.
  The Congressional Budget Office analyzed the Republican bill, and it 
said: ``People who used services no longer included in the Essential 
Health Benefits would experience substantial increases in out-of-pocket 
spending on health care, or would choose to forgo the services. 
Moreover, the ACA's ban on annual and lifetime limits . . . would no 
longer apply.''
  With this scathing analysis from the Congressional Budget Office, 
what did the Republican leadership decide to do? Instead of addressing 
these challenges straight on, they retreated. They shut themselves off 
behind closed doors and tried to cut a deal within the 52 Republican 
Senate Members here to pass this measure, as bad as it is. There was 
not one hearing on this bill--on the Republican healthcare bill--no 
markups, no amendments, and no support from medical advocates in any 
part of our Nation. There was no input in the Senate from any Member 
outside the Republican caucus.
  They want to call this bill right away, and it is understandable. The 
longer it sits out there and the longer people get to know it, the less 
they support it. You know we still haven't seen the final language. 
Why? Because Republicans continue to work in secret on a bill that 
literally impacts one-sixth of the American people and every single 
person in our country.
  This measure affects everybody. Even if you get your insurance 
through your employer or Medicare, this bill would make Medicare go 
insolvent sooner and allow employers to, once again, impose annual or 
lifetime limits on care under their health insurance plans.
  Now, the latest we have heard is that the Republicans are meeting in 
secret, making some changes to this bill. They may be throwing some 
money at the opioid crisis facing America, but that will not make up 
for kicking 15 million people off of Medicaid. The amount of money they 
are talking about to deal with the opioid crisis is literally 
inadequate to deal with the seriousness of that issue or to provide the 
substance abuse treatment people currently receive from Medicaid who 
will be cut off under the Republican plan.
  Cutting Medicaid, our best tool to fight the opioid epidemic, and 
offering a coupon for drug treatment is a cruel step backward. If it 
ends up buying a vote on the Republican side, shame on my colleagues 
for selling out so cheaply.
  Republican Gov. John Kasich of Ohio is not fooled. He called this 
idea of a special opioid fund to win some votes on the Republican side 
``like spitting in the ocean.'' I called Governor Kasich this last 
week. He and I came to Washington together many years ago. I have known 
him, and I like him. We disagree on some political issues, but he is 
very forthright and frank. He has warned us that what is going to 
happen to Ohio is going to happen to the Nation, if the Republicans 
have their way with their healthcare bill.
  We have also heard the Republicans are considering adding provisions 
that allow insurers to offer bare-bones plans. I have just heard some 
more about this today, and I believe the author of this idea is the 
junior Senator from Texas, Mr. Cruz.
  Here is what he says: If your State offers a health insurance plan 
that complies with the requirements of the Affordable Care Act, then 
you may offer it to other consumers in the State insurance plans that 
do not. He says it gives consumers choice. Well, it sure does, but look 
at the choice it gives them because if he is aiming for lowering 
premium costs by offering health insurance plans that are junk plans, 
health insurance plans that are fake insurance, the net result is going 
to be people paying a lot more in copays and deductibles and a lot less 
coverage when they definitely need it.
  There are a couple other things it will do. Because these younger 
healthier people will buy the cheaper plans believing they are 
invincible, it will end up raising the cost of premiums for those who 
buy other insurance. The discrimination, in terms of premium costs, 
will be dramatic, and that, in and of itself, could be damaging to 
people all across the United States.
  So Senator Cruz believes that offering junk insurance plans and 
telling the consumers we are giving you a choice is going to answer the 
needs across America. It will not. It will raise premiums on everyone 
else. It will provide inadequate coverage for those who buy these 
plans, and sadly many of them are going to be facing deductibles and 
copays they just can't handle. That is no answer. It may be a political 
answer to get his vote, but it is certainly not a credible answer.
  We have had this before the Affordable Care Act, and do you remember 
what it was like? People got sick and found out their insurance didn't 
cover what they needed. Women who were pregnant found out their plans 
didn't cover maternity or newborn care. People who were diagnosed with 
a mental health condition found out their insurance covered no 
treatment for mental illness. So what good is insurance if it doesn't 
care for the most basic and essential needs of Americans?
  Thanks to the Affordable Care Act, we changed it. We required that 
policies provide real insurance for real families. Do you know what 
happened, in addition to providing more care for people across America? 
The number of bankruptcies, personal bankruptcies, have been cut in 
half since the Affordable Care Act passed. Why? The No. 1 driver of 
personal bankruptcy and family bankruptcy in America was medical 
bills--medical bills that were beyond the payment of an ordinary 
person. There are fewer of those today because of the Affordable Care 
Act.
  Senator Cruz's plan for selling fake insurance or junk insurance 
plans that will not be there when you need them,

[[Page S3910]]

I can just tell you it means more business for the bankruptcy court. It 
would banish those with preexisting conditions to the world of sky-high 
premiums, all in the name of Senator Cruz's freedom of choice. Well, 
freedom isn't free when it comes to relegating so many Americans to 
such a precarious state when it comes to health insurance. No matter 
how much the Republican Senators tinker around the edges, they are 
dealing with a flawed, unfixable bill.
  The American people oppose any bill that rips health insurance away 
from millions of individuals and families, they oppose any bill that 
causes nearly 1 million people nationwide to lose their jobs, and they 
are also opposed to a Republican health insurance plan that would cost 
coverage for half a million American veterans.
  The American people oppose any bill that hurts those with preexisting 
conditions. They oppose a bill that throws millions of people off 
Medicaid and slashes billions in Federal funding to hospitals, 
healthcare clinics, and schools.
  The American people oppose any bill that is rejected by every major 
medical and patient group. The Republican bill is opposed by the 
American Hospital Association, the American Medical Association, 
nurses, pediatricians, AARP, heart, diabetes, and lung associations. 
How can you write a bill that draws that much opposition? They did it. 
They did it behind closed doors, and they don't want you to see what 
they are doing with it now.
  Finally, the American people oppose any bill that takes away nearly a 
trillion dollars in healthcare in order to provide hundreds of billions 
of dollars in tax breaks to the wealthiest Americans and large 
corporations. Case in point: Of the 145 pages of the Senate repeal 
bill, 94 pages are devoted to slashing Medicaid and providing tax 
breaks to the wealthiest Americans and pharmaceutical companies.

  Last week, one conservative writer penned an article which said that 
it gives conservatism a bad name when we are giving tax breaks to the 
wealthiest people in order to cut and eliminate health insurance for 
the poorest people in America. That is exactly what this bill does.
  I am glad the Senate Republicans have delayed their vote on this 
repeal, but many have not given up. In all of my townhall discussions, 
the plea from Illinois people has been clear: Improve the Affordable 
Care Act; don't repeal it.
  So where do we go from here?
  First, Republicans need to take repeal off the table. We need 3 
Republicans out of the 53 to say this is the wrong way to go about it.
  Second, President Trump must stop undermining the stability of the 
marketplaces with his uncertainty and sabotage.
  Third, we need to work together on a bipartisan basis to strengthen 
our current system. We need to address the price of pharmaceutical 
drugs. The current bill and law does not. That is the biggest driver, 
according to Blue Cross in Illinois, of premium increases--the cost of 
pharmaceutical bills. We need to build competition through a Medicare-
like public option available to everyone who chooses it across the 
United States.
  Some Republicans, including Senator McConnell, have said that the 
Republicans have to do this by themselves because the Democrats refuse 
to work with them. That is simply not true. We are here. We have been 
here all along, and we want to have a hearing. Bring in some experts. 
Let's just have a meeting. That would be a breakthrough.
  Democrats have asked the Republicans to join us. Let's sit down 
together, informally, like grown-ups, and address this issue in a 
responsible fashion. We are ready and willing to work on legislation to 
improve the individual market for the 6 percent of the people who 
purchase their insurance there. I fail to see how gutting Medicaid and 
throwing 22 million Americans off of health insurance in order to 
provide tax breaks for rich people does anything to help that 6 
percent.
  This is a critical moment when it comes to healthcare across America. 
It is unfortunate that we are now considering a bill that was revealed 
only 2 weeks ago, a bill that has never been subject to a hearing 
before any committee, a bill that has never been amended in an open 
process.
  When it came to the Affordable Care Act, over 140 Republican 
amendments were adopted. The Republicans haven't offered us an 
opportunity to offer one amendment to their proposal--not one. It is a 
take-it-or-leave-it, closed-door deal. That is not the way the Senate 
was designed to work. It is not the way the American people want us to 
work. They expect us to work in a constructive fashion on a bipartisan 
basis to solve the problems facing our Nation. The biggest single 
problem is giving peace of mind to Americans and American families 
across the Nation that they have healthcare they can count on and 
afford.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Ms. CANTWELL. Mr. President, I have joined my colleague in coming to 
the floor to talk about how we need to make progress on healthcare and 
make sure that we don't pull healthcare out from millions of Americans. 
I thank the Senator from Illinois for talking about his constituents. 
Like the Senator from Illinois, I was at home this past July recess 
talking to my constituents, and I heard many of them talk about their 
individual healthcare needs and their concerns about what is happening 
in Washington.
  I met a young woman who told me about her daughter who was born 
prematurely and weighed less than 2 pounds. Her daughter required 
specialized, expensive treatment as a newborn. She was concerned that 
if we keep moving ahead with the repeal of the Affordable Care Act, she 
and her husband would be overwhelmed with crushing hospital debt if, in 
fact, we hadn't covered preexisting conditions. She is one of millions 
of Americans who are scared that they are going to lose their health 
insurance under the proposal that is being talked about, that has been 
talked about for the last several weeks, and from what we can tell--
because, obviously, there is a lot of secrecy--may still include 
details about reducing coverage for those who have access to care 
through Medicaid.
  I have come to the floor tonight to talk about the latest idea 
because I think one of the things that is clear--and probably why the 
Senate majority leader said that he wanted, basically, to cancel the 
first 2 weeks of the August recess--is that my colleagues don't want to 
go home and talk about the proposal that was brought before them. In 
fact, they are now trying to bring up a new proposal, thinking that, 
again, with a very limited time period, without floor discussion, 
without committee debate, without an amendment process, somehow our 
colleagues on the other side of the aisle will fall prey to the notion 
that there is a silver bullet, a magic solution. I have come to the 
floor knowing that an amendment or a discussion piece or the new 
behind-closed-doors discussion proposal being advanced by my colleagues 
from Texas and Utah is basically to allow junk insurance into the 
marketplace.
  What do I mean by junk insurance? I mean a proposal that basically 
offers less than the essential benefits, such as hospitalization, 
prescription drug benefits, lab costs, and all of those things; that, 
basically, by offering a market where you can get junk insurance, you 
can say: Oh, well, you have to have one offering of insurance that does 
cover all the basics and essentials, but then you can have junk 
insurance.
  I say ``junk insurance'' because this is the wrong idea for the 
marketplace. It is basically mixing good and bad and not having 
adequate risk spread across--so basically it means that you don't have 
to have compliant plans for the market. I know this firsthand because 
we had this in Washington. We had this same experiment in Washington in 
the 1990s, and people tried to do the exact same thing--basically, have 
a compliant plan, and then say that you have a bunch of less-than-
adequate proposals for insurance in the market that really aren't 
giving individuals coverage. What happened? It drove up the cost of the 
compliant plans that covered most of healthcare and basically drove the 
insurers out of the market. That was the experience in Washington 
State. This same idea was tried, and it failed because basically it ran 
up the price, and insurers didn't stay around to offer options. They

[[Page S3911]]

couldn't make the mandate of the required plan work because it 
basically took the risk out of the system.
  The notion that somehow this new idea by my colleagues is going to be 
the silver bullet is, in my opinion, not an answer at all. People who 
would be the ones who could get that kind of coverage for a short 
period of time would then end up leaving the rest of the people without 
adequate coverage. As I said, what happens is, the costs then just go 
up, and then the market has to adjust. I would say that in our State--
because a lot of people are talking about leaving the individual 
markets over the proposals that we are talking about today because they 
are concerned about the costs and who is going to be covered--you would 
see a very rapid collapse of the individual market exacerbated by what 
my colleagues from Texas and Utah are proposing.
  There are numerous nonpartisan health experts who seem to be saying 
the same thing. There is the American Academy of Actuaries, where one 
individual said:

       People who are healthy now would tend to choose 
     noncompliant plans with really basic benefits. People who 
     want or need more comprehensive coverage could find it out of 
     their reach, because it could become unaffordable.

  Another individual from the American Enterprise Institute wrote that 
``the main effect of the Cruz-Lee amendment would be to shift costs 
from healthy consumers to less healthy consumers and households with 
lower incomes.''
  Douglas Holtz-Eakin, a Republican and former Director of the 
Congressional Budget Office called the amendment by my colleagues from 
Texas and Utah ``a recipe for a meltdown.''
  Larry Levitt, senior vice president at the Kaiser Family Foundation, 
summed it up best when he called the amendment ``a recipe for 
instability and discrimination.''
  So you can see that many people already understand the idea of junk 
insurance is not a market solution at all. It is not really even 
healthcare coverage. In its May 24 score of the House proposal, the CBO 
provided a definition of health insurance, saying that they would 
``broadly define health insurance coverage as consisting of a 
comprehensive major medical policy that, at a minimum, covers high-cost 
medical events and various services, including those provided by 
physicians and hospitals.''
  To me it seems pretty clear that the types of plans that could be 
sold under this proposal don't meet that definition.
  What are essential benefits that we expect to be covered in a plan? 
Obviously, hospitalization, emergency services, ambulatory services, 
mental health, prescription drugs, rehabilitation, if needed, 
laboratory services, like lab tests, and we have moved toward some 
preventive, health, and wellness measures. Those are the essential 
benefits that are supposed to be in a plan, and I want my colleagues to 
know that this experiment was tried. It failed. It drove insurers out 
of the marketplace because it just made the plans that were covering 
essential benefits so costly by distorting--really tearing the market 
apart.
  The second point about the proposal we are hearing about is that it 
is still a war on Medicaid. In my opinion there are cost-effective ways 
for us to continue access to healthcare. I have brought them up on the 
Senate floor. One would be looking at rebalancing from nursing home 
care to community-based care or, as I have mentioned, a basic health 
plan that bundles up a population and serves them up to get a discount 
so that individuals would have as much clout as a large employer would 
have in the marketplace.
  I hope that my colleagues will stop the focus on capping, cutting 
Medicare--because it would throw so many people off of the system--and 
focus on rebalancing people to the type of healthcare that will help us 
save costs, keep people in their homes, and give consumers the ability 
to compete cost effectively in the individual market.
  These are the problems I still see with this proposal. To think, 
basically, that junk insurance will be the way for us to get a proposal 
and to see that Medicaid is still the target in a war on Medicaid, to 
me, is not the proposal to move forward on. I hope our colleagues will 
realize that both of these have severe faults and will sit down and 
talk about the proposals that will help us in establishing a more 
robust individual market.
  I thank the Presiding Officer.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.

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