AMERICAN HEALTH CARE ACT OF 2017; Congressional Record Vol. 163, No. 125
(Senate - July 25, 2017)

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[Pages S4168-S4184]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    AMERICAN HEALTH CARE ACT OF 2017

  The VICE PRESIDENT. The clerk will report the bill.
  The legislative clerk read as follows:

       A bill (H.R. 1628) to provide for reconciliation pursuant 
     to title II of the concurrent resolution on the budget for 
     fiscal year 2017.

  The VICE PRESIDENT. The senior Senator from Arizona is recognized.


                           Role of the Senate

  Mr. McCAIN. Mr. President, I have stood in this place many times and 
addressed as ``President'' many Presiding Officers. I have been so 
addressed when I have sat in that chair, and that is as close as I will 
ever be to a Presidency. It is an honorific we are almost indifferent 
too; isn't it? In truth, presiding over the Senate can be a nuisance, a 
bit of a ceremonial bore, and it is usually relegated to the more 
junior Members of the majority.
  But as I stand here today--looking a little worse for wear, I am 
sure--I have a refreshed appreciation for the protocols and customs of 
this body and for the other 99 privileged souls who have been elected 
to this Senate.
  I have been a Member of the U.S. Senate for 30 years. I had another 
long, if not as long, career before I arrived here, another profession 
that was profoundly rewarding and in which I had experiences and 
friendships that I revere. Make no mistake, my service here is the most 
important job I have had in my life. I am so grateful to the people of 
Arizona for the privilege--for the honor--of serving here and the 
opportunities it gives me to play a small role in the history of the 
country I love.
  I have known and admired men and women in the Senate who played much 
more than a small role in our history--true statesmen, giants of 
American politics. They came from both parties and from various 
backgrounds. Their ambitions were frequently in conflict. They held 
different views on the issues of the day. They often had very serious 
disagreements about how best to serve the national interest.
  But they knew that however sharp and heartfelt their disputes and 
however keen their ambitions, they had an obligation to work 
collaboratively to ensure the Senate discharged its constitutional 
responsibilities effectively. Our responsibilities are important--
vitally important--to the continued success of our Republic. Our arcane 
rules and customs are deliberatively intended to require broad 
cooperation to function well at all. The most revered Members of this 
institution accepted the necessity of compromise in order to make 
incremental progress on solving America's problems and to defend her 
from her adversaries.
  That principled mindset and the service of our predecessors who 
possessed it come to mind when I hear the Senate referred to as the 
world's greatest deliberative body. I am not sure we can claim that 
distinction with a straight face today. I am sure it wasn't always 
deserved in previous eras either. I am sure there have been times when 
it was, and I was privileged to witness some of those occasions.
  Our deliberations today, not just our debates but the exercise of all 
our responsibilities--authorizing government policies, appropriating 
the funds to implement them, exercising our advice and consent role--
are often lively and interesting. They can be sincere and principled, 
but they are more partisan, more tribal more of the time than at any 
time I can remember. Our deliberations can still be important and 
useful, but I think we would all agree they haven't been overburdened 
by greatness lately. Right now, they aren't producing much for the 
American people.
  Both sides have let this happen. Let's leave the history of who shot 
first to the historians. I suspect they will find we all conspired in 
our decline, either by deliberate actions or neglect. We have all 
played some role in it. Certainly, I have. Sometimes, I have let my 
passion rule my reason. Sometimes I made it harder to find common 
ground because of something harsh I said to a colleague. Sometimes I 
wanted to win more for the sake of winning than to achieve a contested 
policy.
  Incremental progress, compromises that each side criticizes but also 
accepts, and just plain muddling through to chip away at problems and 
to keep

[[Page S4169]]

our enemies from doing their worst aren't glamorous or exciting. It 
doesn't feel like a political triumph. It is usually the most we can 
expect from our system of government, operating in a country as 
diverse, quarrelsome, and free as ours.
  Considering the injustice and cruelties inflicted by autocratic 
governments and how corruptible human nature can be, the problem-
solving our system does make possible, the fitful progress it produces, 
and the liberty and justice it preserves, are a magnificent 
achievement.
  Our system doesn't depend on our nobility. It accounts for our 
imperfections and gives an order to our individual strivings that has 
helped make ours the most powerful and prosperous society on Earth. It 
is our responsibility to preserve that, even when it requires us to do 
something less satisfying than winning, even when we must give a little 
to get a little, even when our efforts managed just 3 yards in a cloud 
of dust, while critics on both sides denounced us for timidity, for our 
failure to triumph.
  I hope we can again rely on humility, on our need to cooperate, on 
our dependence on each other to learn how to trust each other again 
and, by so doing, better serve the people who elected us. Stop 
listening to the bombastic loudmouths on the radio and television and 
the internet. To hell with them. They don't want anything done for the 
public good. Our incapacity is their livelihood.

  Let's trust each other. Let's return to regular order. We have been 
spinning our wheels on too many important issues because we keep trying 
to find a way to win without help from across the aisle. That is an 
approach that has been employed by both sides: mandating legislation 
from the top down, without any support from the other side, with all 
the parliamentary maneuvers it requires. We are getting nothing done, 
my friends. We are getting nothing done.
  All we have really done this year is confirm Neil Gorsuch to the 
Supreme Court. Our healthcare insurance system is a mess. We all know 
it, those who support ObamaCare and those who oppose it. Something has 
to be done. We Republicans have looked for a way to end it and replace 
it with something else without paying a terrible political price. We 
haven't found it yet. I am not sure we will. All we have managed to do 
is make more popular a policy that wasn't very popular when we started 
trying to get rid of it. I voted for the motion to proceed to allow 
debate to continue and amendments to be offered.
  I will not vote for this bill as it is today. It is a shell of a bill 
right now. We all know that. I have changes urged by my State's 
Governor that will have to be included to earn my support for final 
passage of any bill. I know many of you will have to see the bill 
changed substantially for you to support it. We have tried to do this 
by coming up with a proposal behind closed doors in consultation with 
the administration, then springing it on skeptical Members, trying to 
convince them it is better than nothing--that it is better than 
nothing--asking us to swallow our doubts and force it past a unified 
opposition. I don't think that is going to work in the end and probably 
shouldn't.
  The administration and congressional Democrats shouldn't have forced 
through Congress, without any opposition support, a social and economic 
change as massive as ObamaCare, and we shouldn't do the same with ours. 
Why don't we try the old way of legislating in the Senate--the way our 
rules and customs encourage us to act. If this process ends in failure, 
which seems likely, then let's return to regular order. Let the Health, 
Education, Labor, and Pensions Committee, under Chairman Alexander and 
Ranking Member Murray, hold hearings, try to report a bill out of 
committee with contributions from both sides--something that my dear 
friends on the other side of the aisle didn't allow to happen 9 years 
ago. Let's see if we can pass something that will be imperfect, full of 
compromises, and not very pleasing to implacable partisans on either 
side but that might provide workable solutions to problems Americans 
are struggling with today.
  What have we to lose by trying to work together to find those 
solutions? We are not getting much done apart. I don't think any of us 
feels very proud of our incapacity. Merely preventing your political 
opponents from doing what they want isn't the most inspiring work. 
There is greater satisfaction in respecting our differences but not 
letting them prevent agreements that don't require abandonment of core 
principles; agreements made in good faith, that help improve lives and 
protect the American people. The Senate is capable of that. We know 
that. We have seen it before. I have seen it happen many times. And the 
times when I was involved, even in a modest way with working on a 
bipartisan response to a national problem or threat, are the proudest 
moments of my career and by far the most satisfying.
  This place is important. The work we do is important. Our strange 
rules and seemingly eccentric practices that slow our proceedings and 
insist on our cooperation are important. Our Founders envisioned the 
Senate as the more deliberative, careful body that operates at a 
greater distance than the other body from the public passions of the 
hour. We are an important check on the powers of the Executive. Our 
consent is necessary for the President to appoint jurists and powerful 
government officials and, in many respects, to conduct foreign policy. 
Whether or not we are of the same party, we are not the President's 
subordinates, we are his equal.
  As his responsibilities are onerous, many, and powerful, so are ours. 
We play a vital role in shaping and directing the judiciary, the 
military, and the Cabinet; in planning and supporting foreign and 
domestic policies. Our success in meeting all these awesome 
constitutional obligations depends upon cooperation among ourselves.
  The success of the Senate is important to the continued success of 
America. This country--this big, boisterous, brawling, intemperate, 
restless, striving, daring, beautiful, bountiful, brave, good, and 
magnificent country--needs us to help it thrive. That responsibility is 
more important than any of our personal interests or political 
affiliations. We are the servants of a great nation, ``a . . . nation, 
conceived in Liberty, and dedicated to the proposition that all men are 
created equal.'' More people have lived free and prosperous lives here 
than in any other Nation. We have acquired unprecedented wealth and 
power because of our governing principles, and because our government 
defended those principles.
  America has made a greater contribution than any other nation to an 
international order that has liberated more people from tyranny and 
poverty than ever before in history. We have been the greatest example, 
the greatest supporter, and the greatest defender of that order. We 
aren't afraid. We don't covet other people's land and wealth. We don't 
hide behind walls. We breach them. We are a blessing to humanity.
  What greater cause could we hope to serve than helping keep America 
the strong, aspiring, inspirational beacon of liberty and defender of 
dignity of all human beings and their right to freedom and equal 
justice? That is the cause that binds us and is so much more powerful 
and worthy than the small differences that divide us.
  What a great honor and extraordinary opportunity it is to serve in 
this body. It is a privilege to serve with all of you. I mean it. Many 
of you have reached out in the last few days with your concern and your 
prayers. It means a lot to me. It really does. I have had so many 
people say such nice things about me recently that I think some of you 
must have me confused with someone else. I appreciate it, though, every 
word, even if much of it isn't deserved.
  I will be here for a few days--I hope managing the floor debate on 
the Defense authorization bill, which I am proud to say is again a 
product of bipartisan cooperation and trust among the members of the 
Senate Armed Services Committee. After that, I am going home for a 
while to treat my illness. I have every intention of returning here and 
giving many of you cause to regret all the nice things you said about 
me, and I hope to impress on you again that it is an honor to serve the 
American people in your company.
  Thank you, fellow Senators.
  Mr. President, I yield the floor.
  (Applause, Senators rising.)
  The PRESIDING OFFICER (Mr. Hoeven).

[[Page S4170]]

  The majority leader.


                           Amendment No. 267

       (Purpose: Of a perfecting nature.)
  Mr. McCONNELL. Mr. President, I call up amendment No. 267.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Kentucky [Mr. McConnell] proposes an 
     amendment numbered 267.

  Mr. McCONNELL. Mr. President, I ask unanimous consent that the 
reading of the amendment be dispensed with.
  Mrs. MURRAY. Mr. President, I object.
  The PRESIDING OFFICER. Objection is heard.
  The clerk will read the amendment.
  The legislative clerk continued with the reading of the amendment.
  (Disturbance in the Visitors' Galleries.)
  The PRESIDING OFFICER. The Sergeant at Arms will restore order in the 
Gallery.
  (Disturbance in the Visitors' Galleries.)
  The PRESIDING OFFICER (Mr. Strange). The Sergeant at Arms will 
restore order in the Gallery.
  The clerk will continue.
  The legislative clerk continued with the reading of the amendment.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, time will be charged equally.
  The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that, for the 
duration of the Senate's consideration of H.R. 1628, the majority and 
Democratic managers of the bill, while seated or standing at the 
managers' desks, be permitted to deliver floor remarks, retrieve, 
review, and edit documents and send email and other data communications 
from text displayed on wireless personal digital assistant devices and 
tablet devices.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ENZI. Mr. President, I ask unanimous consent that the use of 
calculators be permitted on the floor during the consideration of H.R. 
1628.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ENZI. Mr. President, what is the regular order with respect to 
the pending amendment?
  The PRESIDING OFFICER. It is 2 hours equally divided.
  Mr. ENZI. Thank you, Mr. President.
  I suggest the absence of a quorum and ask unanimous consent that the 
time be equally divided.
  The PRESIDING OFFICER. Is there objection?
  Mrs. MURRAY. Objection.
  The PRESIDING OFFICER. Objection is heard.
  Mr. ENZI. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. NELSON. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                     Welcoming Back Senator McCain

  Mr. NELSON. Mr. President, I am so encouraged by the words of our 
dear friend and fellow Senator, Mr. John McCain.
  First of all, I am so encouraged by seeing that fighting spirit of 
John McCain and so glad to see him back. In the midst of everything he 
is facing, that he would come and insert himself to give us some 
considerable words of wisdom--it was such an enormous, emotional 
experience when John walked in. Then, to have all of us seated here 
because of the vote that was occurring--and not a Senator left after 
the vote was concluded because we wanted to hear from John and did so 
willingly. His eloquent words about how we all need to come together 
and stop being driven apart by partisan reasons were timely, and they 
were well received.
  Mr. President, this Senator never thought we would see a vote to 
advance a bill which, to so many, feels as though it is going to harm 
so many of our fellow Americans. Obviously, we can disagree on 
specifics, but we have seen that particular expression of opinion of 
harm over and over. We have seen it in the coverage of the townhall 
meetings, where people stand up and say: If I didn't have this 
healthcare, I would be dead.
  This Senator has seen it in Florida over and over, as I have had 
people come up to me wherever I am--in a meeting, on the street corner, 
in the airport, wherever--and say: Senator, please don't let them take 
my healthcare away from me.
  Indeed, when people explained their particular circumstances, four 
different families--one family, if they did not have the waiver on 
Medicaid, indeed, that fellow would not only not be alive, but even if 
he were alive, he would be in an institution instead of being able to 
be cared for or three other families who brought forth testimonies 
about how the Affordable Care Act has given them insurance they had 
never been able to get before. It was at a price they could afford and 
involved coverage they never could have had.
  In other cases, people had preexisting conditions. This Senator, as a 
former elected insurance commissioner of Florida, has seen insurance 
companies refuse to insure people because they had a preexisting 
condition. If you had asthma, that was a preexisting condition; if you 
had a bad rash, that was a preexisting condition, and they were not 
going to insure you. Also, insurance policies never had the guarantee 
of lifetime coverage but instead the policy said you had lifetime caps. 
There was a dollar figure which, if you exceeded it, the insurance 
policy was not going to cover any more.
  If we are really serious about wanting to fix the situation, if our 
brothers and sisters on the other side of the aisle are not successful 
in proceeding with what the majority leader is going to be coming forth 
with, if that is voted down, and if we are serious about it, take what 
is left, which is the existing law--the Affordable Care Act--and fix 
it.
  Senator Collins, a former insurance commissioner, appointed in the 
State of Maine, and this Senator, a former elected insurance 
commissioner in the State of Florida, are already working on a 
reinsurance fund which would insure the insurance companies against 
catastrophe. I asked for this to be costed out in the State of Florida. 
This fix would lower premiums 13 percent in the State of Florida.
  In the words of Senator McCain, if we really want to get together and 
fix the problems, we can. Yet, in the midst of hearing from 
constituents all around the country who have shared their personal 
stories about how the existing law has helped, we are in the 
parliamentary position we are in, where we will proceed on trying to 
repeal what is the existing law.
  For some people, they don't care about the politics. As a matter of 
fact, for a lot of people, they don't care about the politics. They 
just want access to healthcare. They want what is genuinely described 
as health insurance--whether it is a Medicaid type of insurance or 
whether it is an actual policy through a private insurance company 
offered on the health exchanges in the States or whether it is the 
guarantees of the coverage in an individual policy that they might buy, 
they just want healthcare. That is the reason you have health insurance 
in the first place.
  Now, I have heard some fixes say: Oh, let's cut back on Medicaid, 
which, remember, is spread over millions and millions of people, just 
like Medicare is spread over millions and millions of people. The 
difference there is age. If you are 65, you are eligible for Medicare.
  There are some people we overlook in the system who depend on 
Medicaid. How about veterans? Veterans' healthcare has been taken care 
of while on Active Duty in the U.S. military. Then their healthcare is 
transferred to the Veterans' Administration, but there are a lot of 
veterans who are not getting their healthcare through the VA. They get 
their healthcare through Medicaid. If you start cutting back on 
Medicaid, which are the versions of the so-called replace bills we have 
seen--if you start cutting back on Medicaid and make a capped program 
or a block grant program, we already know the figures. It has been 
costed out by the CBO. The figures tell us it is close to an $800 
billion cut over a decade. When you start doing that, the people who 
rely on Medicaid at the edges, like some poor people or like seniors in 
nursing homes--by the way, in my

[[Page S4171]]

State, 65 to 70 percent of the seniors in nursing homes are on 
Medicaid, and some of those veterans I told you about are not on VA 
healthcare but Medicaid. How about some of the children's programs on 
Medicaid? If you start cutting that back to the tune of about $800 
billion over a decade, you are going to knock out a lot of these 
people. That is not something we want to do. That is why, when 
explained, you have such low numbers who support what is being 
attempted as a replacement if you repeal the Affordable Care Act. We 
should be focused on working together to improve the Affordable Care 
Act, not to make it worse.
  I pretty much have said it all. The bills we have seen coming forth 
as replacements change the age ratio from the existing law, the 
Affordable Care Act, of 3 to 1 in the healthcare exchanges so you can 
charge an older person three times as much as a young, healthy 
individual--not in the replacement bills we see coming up. It is 5 to 
1. What does that mean? That means for those older Americans, before 
they turn 65 and become eligible for Medicare, they are going to be 
paying more for their insurance premiums. Is that what we want to do? I 
don't think so.

  You cannot ignore these facts. I ask those who come forth with these 
replacements, why in the world do you do this? Why do you support a 
bill that will hurt so many Americans, which has been demonstrated over 
and over? Why do you support a bill that will hurt so many of your 
constituents that your constituents cry out to you, please, don't do 
this? And they give personal testimonies.
  I urge our colleagues, after the emotional appeal of Senator McCain, 
to do things in a bipartisan way. Take a moment, reflect on what your 
constituents have said--not just some of your constituents. Listen to 
all of your constituents and ask yourself, are you doing the right 
thing?
  Let's improve our Nation's healthcare system. Let's not make it 
worse. Let's do it in the spirit of the uplifting words of Senator 
McCain and what he said: Let's do it together in a bipartisan way.
  I yield the floor.
  Mr. HATCH. Mr. President, I rise today to once again remind my Senate 
colleagues what is at stake with the procedural vote that took place 
today.
  The Senate voted on the motion to proceed to the House-passed budget 
reconciliation bill. The Senate will now start working in earnest to 
consider and, hopefully, pass legislation that would repeal and replace 
ObamaCare with a 2-year transition period, or other, specific 
replacement policies.
  That is a complicated undertaking to say the least. However, the 
first vote on the motion to proceed was relatively simple. While 
pundits and talking heads have already analyzed this particular vote to 
death, all of the talk boils down to a single question: Do Republicans 
want to repeal and replace ObamaCare?
  I don't want to belittle or discredit the concerns some of my 
colleagues have raised about the various legislative proposals that are 
out there. However, we won't be voting on any particular policy or 
proposal.
  On the contrary, the vote was simply to determine whether the Senate 
is actually going to consider the budget reconciliation bill. Members 
were not voting for or against any particular healthcare proposal; they 
were simply voting on whether the Senate will actually debate any such 
measure.
  That being the case, the vote was a simple one. Anyone who supports 
the larger effort to repeal and replace ObamaCare should be willing to 
at least debate the various proposals that have been put forward.
  That is the very definition of a no-brainer.
  The final pieces of ObamaCare were signed into law in March 2010, 
more than 7 years ago. Since then, the law has been one of the key 
focal points of legislative and political debate and discourse 
nationwide. Very few topics in our Nation's history have been the 
subject of more public debate and fierce disagreement.
  After all this time, one thing is very clear: ObamaCare has failed 
the American people.
  The vast majority of Americans are dissatisfied with the healthcare 
status quo. These people want answers from Congress that will bring 
down their healthcare costs, reduce their tax burdens, and put them 
back in charge of their own healthcare. For more than 7 years now, 
virtually every Republican in Congress has been promising to provide 
those solutions.
  We have never been closer to making good on those promises than we 
are right now with a Republican President ready to take action to 
support congressional efforts to repeal and replace this unworkable 
law.
  Make no mistake, none of the major proposals that have been put 
forward are perfect. In fact, in my personal view, they are all far 
from perfect. But, at the end of the day, any bill--particularly a bill 
as wide and sweeping as one that addresses a large portion of our 
healthcare system--that is ``perfect'' in the eyes of one Senator is 
likely fatally flawed in the eyes of 99 others.
  Translation: When it comes to legislating successfully, the word 
``perfect'' shouldn't be in anyone's vocabulary.
  Like any aspect of governing, drafting and passing important 
legislation is about compromise and prioritization. It is about 
recognizing which fights need to be fought now and which ones can wait 
for another day.
  I have been here a while. In that time, I have noticed a few things.
  Some who are elected to this Chamber would rather fight the good 
ideological fight for legislative purity than get the majority of what 
they want--but not everything--through compromise. These people tend to 
claim that even the most embarrassing legislative losses are victories, 
so long as they can say that they went down swinging.
  Now, don't get me wrong; speaking in terms of advocating good policy 
I have never been one to back down from a fight. In fact, I have 
battled some of the most revered and admired Senators in our Nation's 
history right here on the Senate floor.
  One reason I think I have developed a reputation as an effective 
legislator is I don't believe that fighting for a cause is an end unto 
itself. Fights are only meaningful if there is an objective in mind. 
While I am no mathematician, I believe getting 60, 70, or 80 percent of 
what you want out of a bill is better than getting nothing, even if, on 
the way to getting nothing, you have fought a valiant fight for that 
perfect--yet ultimately unattainable--outcome.
  The fight to repeal ObamaCare, at least from where I have been 
standing, has always had an objective in mind. That objective, of 
course, has been to actually repeal ObamaCare.
  We have fought for that objective for more than 7 years. Now, we find 
ourselves on the cusp of being able to take major steps toward that 
larger goal.
  No, we don't have a perfect bill to vote on. However, the fact 
remains that we are close to being able to pass legislation that would 
accomplish the majority of our goals and keep most of the promises we 
have all made to repeal and replace ObamaCare.
  Before we can do any of that, we need to at least get a chance to 
consider and debate the matter on the floor. That is what this 
afternoon's vote was to determine: whether we are committed enough to 
this effort to at least take that step.
  I remind my Republican colleagues that, when the ObamaCare 
reconciliation bill was brought up for debate in 2010, all of our 
friends on the other side, who were present at the time, except for one 
Member, voted in favor of the motion to proceed. They supported their 
leader. Leader McConnell is owed the same loyalty.
  Any Senator who has fought with us to undo the damage caused by 
ObamaCare should be willing, at the very, very least, to take that step 
and allow the floor debate to actually happen.
  I hope we all will. Toward that end, I urged my colleagues to vote in 
favor of the motion to proceed to the House-passed reconciliation bill 
to allow the Senate to begin debate on repealing and replacing 
ObamaCare.
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, time will be charged equally to both sides.
  The PRESIDING OFFICER. The assistant Democratic leader.
  Mr. DURBIN. Thank you, Mr. President.
  History was made on the floor of the Senate Chamber today. I don't 
think it

[[Page S4172]]

has ever happened before. Think about this: 50 out of 100 Senators came 
to the floor with the Vice President of the United States and voted to 
begin debate on a bill they have never seen--a bill they have never 
seen--because we don't know what the Republicans are going to offer as 
the alternative to the Affordable Care Act.
  There have been a lot of different versions. Technically, the one 
that is before us now is the version that passed the House of 
Representatives, but I think the Republican leader, Senator McConnell, 
has known from the beginning that has no chance whatsoever. So many 
Republicans have taken a look at what the House passed and said: We 
can't vote for that. You have to give us something different. The 
problem the Senate Republicans ran into is that they couldn't come up 
with anything better.
  They tried. They wrote several different versions, and every time 
they would write a version of the new Affordable Care Act, it got worse 
for the American people, and here is what I mean. Under one proposal 
for the Republicans--not the one before us, but the Senate 
Republicans--1 million people in my home State of Illinois would have 
lost their health insurance. There are 12.5 million people in Illinois, 
and 1 million would have lost their health insurance because of 
dramatic cutbacks in Medicaid and cutbacks in the premium support that 
is given to a lot of working families to buy regular health insurance 
in the health insurance market.
  It was so terrible that every time Republicans came up with a Senate 
proposal, two or two of them would announce: Can't buy it, won't vote 
for it--and ran away from it.
  So Senator McConnell came to the floor today and said: I am begging 
you, just vote to open debate on a bill that I haven't written yet, and 
50 Republican Senators did, and the Vice President broke the tie, the 
50-to-50 tie to move forward, and here we are.
  Let me start by tossing flowers--and this will probably get them in 
trouble--to two Republican Senators, Susan Collins of Maine and Lisa 
Murkowski of Alaska. They were the only two Republican Senators who had 
the courage to stand up and say: This is wrong. We shouldn't do this to 
the American people. They are the only two who are willing to say that 
we should have done this differently.
  There is an interesting thing that happened at the end of this. At 
the very last moment, the very last vote that was cast was cast by 
Senator John McCain. Everybody knows John has been diagnosed with a 
serious form of cancer. He made it back from Arizona here to cast his 
vote, and he asked for 15 minutes after the rollcall to make a speech. 
I don't think many, if any, Senators left the Chamber. Democrats and 
Republicans stuck around to hear his speech after the vote. Can I tell 
you that is unusual in the Senate? Most of us race for the doors and go 
up to our offices and watch on television and may catch a piece of this 
speech and a piece of the other speech, but we sat and listened because 
of our respect for John McCain.
  He is my friend. We came from the House of Representatives together 
many years ago. I served with him in the Senate when we put together a 
bipartisan group to rewrite the immigration laws for America--four 
Democrats, four Republicans. I sat across the table with John for 
months. We went back and forth through all the provisions on 
immigration. John even conceded today that he has an interesting 
temper. There were days when John McCain was Mount Vesuvius, just 
exploding in every direction, and you had to step back. And there were 
days when he smothered you with kindness. That is the way he is. We 
love him for it.
  He came today to give a speech that every American should read if you 
want to understand how a Democratic Senator can stand on the floor and 
give compliments and praise to a Republican Senator, which I am about 
to do. Senator McCain said that we have to do something about this 
country of ours--the political divisions. I will not get the words 
perfectly, but he said to us: Will you please start ignoring these 
radio and TV and internet talking heads who want us to fail and make a 
living by laughing at us? Will you ignore those people? Instead, look 
to what this institution, the U.S. Senate, is all about and what we 
should be doing to solve the problems for the people we represent.
  John McCain went on to say: Why don't we have debates on the floor of 
the Senate anymore?
  Do you know what? He is right. We are 7 months into this year's 
Senate session. We have not had one bill on the floor of the Senate 
that we have debated and amended--not one. This is a first, and it is 
in this kind of convoluted reconciliation process where you speed up 
the amendments.
  Think about this. We are amending your healthcare policy that affects 
you and your family. We are amending how you will buy health insurance 
as an individual and how your company will buy health insurance for 
you. We are amending, basically, whether your insurance policy is going 
to protect your family or not. Listen to how it works.

  People propose an amendment, and then we debate it. Do you know how 
long we debate it? We debate it for 1 minute on both sides. 
Disgraceful. John McCain called us on it today and asked: Why have we 
reached this point when an issue this important is going through a 
process that is totally partisan?
  You see, the Republicans decided early on that they were not going to 
invite us to the party; that they were going to write this healthcare 
bill by themselves, in secret. Senator McConnell picked 13 Republican 
Senators, and they sat for I don't know how long--months, weeks--and 
wrote a bill. One of them I mentioned earlier was ultimately rejected 
by the Republicans themselves. John McCain challenged us and said: For 
goodness' sake. He has been in the Senate--and I have too--during a 
time when it was much different. He really begged us, pleaded, and 
urged us to get back to that time when we worked together on a 
bipartisan basis to solve problems. John McCain was right. I did not 
agree with his vote to put us in this position we are in at this 
moment, but I was encouraged by the way he closed. He turned to Senator 
McConnell, who was sitting right there, and said to him: Do not count 
on my vote on final passage. I want to see what we do in this bill. I 
want to see how we debate this bill.
  One Republican Senator like John McCain can make the difference as to 
whether this process stops and a real bipartisan process starts. Isn't 
that what the American people expect of us?
  Seated in the Chair, the Presiding Officer, is a brandnew Senator 
from the State of Alabama.
  Welcome, Senator Strange.
  He comes here because Senator Sessions went on to become the Attorney 
General. He has seen the Senate for a couple of months or 3 months, 
maybe--5 months now--and I am sure he has his impressions of this body. 
They may be different than what he thought about it before he was 
elected. Yet I can tell him for sure that this is a much different 
Senate than the one Patty Murray was elected to, that it is much 
different than the one I was elected to. Even for Mike Enzi, my friend 
from Wyoming, it is much different than the one he saw.
  I see my colleague here, Senator Schatz, from Hawaii.
  How long have you been here now, Brian?
  Mr. SCHATZ. Four-and-a-half years.
  Mr. DURBIN. Four-and-a-half years.
  He is a newbie, and he has not seen the Senate I am describing.
  Can you believe there was a time in the Senate when we would bring an 
important measure to the floor on many different issues, and Members 
would come to the floor--I am not making this up--and actually hand an 
amendment to the clerk and say: I would like to offer an amendment to 
the bill. Then we would debate it, and then we would vote on it. 
Sometimes you won, sometimes you lost, and you moved on to the next 
amendment. That actually happened on the Senate floor. For the people 
who are new to the Senate, I am sure they do not believe me, but it did 
happen over and over and over. We had a healthy respect for one 
another. The amendments went back and forth, and we ended up seeing 
bills passed that made a difference in America.
  What we are doing now is a disgrace to this institution, and it does 
not honor the Senate, its Members, or our Constitution when what is at 
stake is

[[Page S4173]]

so important. In looking at some of the provisions that have been 
brought before us in the Senate's Republican repeal bills to repeal the 
Affordable Care Act, I do not know how they can do it. I do not know 
how Senators could go home and say in their home States: A million of 
you are going to lose your health insurance because of something I just 
voted for.
  Health insurance means a lot to me personally. I have said it on the 
floor. There was a time in my life when I was a brandnew law student 
and was married. God sent me and my wife this beautiful little baby. 
She had some health issues, and we had no health insurance, as I was a 
law student. We ended up sitting in the charity ward of a local 
hospital here in Washington, hoping our baby girl would have a good, 
talented, capable doctor walk through the door and see her. I was not 
sure because I did not have health insurance. I will never forget that 
as long as I live, and I thought to myself that it will never happen to 
me again. I am going to have health insurance no matter what it takes. 
It meant that much to me, and it means that much to everybody.
  There is not a single one of us who does not want the peace of mind 
of knowing that if we get sick or if someone we love gets sick, he will 
have access to good hospitals and good doctors. That is what health 
insurance is all about. As the Republican proposals eliminate health 
insurance for 60 million, 20 million, 30 million Americans, you ask 
yourself: How can you do that to this country?
  The cuts they make in Medicaid have really educated America about 
Medicaid. People know about Social Security. They know what that is all 
about. We all pay into it and wait to receive our Social Security 
checks when we reach that age. They also know about Medicare. You have 
to be 65 years of age. It is pretty good coverage, isn't it? The ones 
who receive it think it is a pretty good deal to have Medicare coverage 
when they reach the age of 65, but Medicaid was one of those mystery 
programs. People were not sure. What does it do? The Medicaid Program 
in America does the following:
  In Illinois, that program takes care of half of the new mothers and 
their babies. Half of them are paid for by Medicaid--prenatal care to 
make sure the baby is healthy, the delivery of the baby. Afterward, the 
mom and baby are taken care of, paid for by Medicaid. This is one out 
of every two births in Illinois.
  Medicaid also sends provisions--money--to your local school 
districts. I will bet you did not know that. If your local school 
district has a special education program--and virtually all of them 
do--they receive Medicaid to pay for some basics. It pays for 
counselors for special ed students. Sometimes transportation in a local 
school district in downstate Illinois or feeding tubes for some 
severely disabled students are paid for by Medicaid. You may not know 
that for disabled people, Medicaid is their health insurance. Many of 
them have no place else to turn.
  I mentioned on the floor before that a mother in Champaign, IL, with 
an autistic child, said: Senator, if it were not for Medicaid, my son 
would have to go into an institution. I couldn't afford it.
  Medicaid is his health insurance.
  I have not touched the most expensive part of Medicaid of which you 
may not know, which is that two out of three people in nursing homes 
depend on Medicaid to get basic medical care. Medicare is not enough. 
They need the help of Medicaid. So if it is Mom or Dad or Grandma or 
Grandpa who is in a nursing home, two out of three of them depend on 
Medicaid.
  The Republican bill to replace the Affordable Care Act says we are 
going to cut the spending on Medicaid, that 25 to 35 percent will be 
cut. That is why Governors of both political parties have screamed 
bloody murder: You cannot do that. You are cutting the Federal 
contribution to Medicaid in our States. Who is going to pay for that 
baby? Who is going to pay for the mom? Who is going to pay the school 
district? Who is going to pay for the disabled? Who will take care of 
the folks in nursing homes?
  Why did they make that deep of a cut in Medicaid--a program that is 
so important to so many people? There is the tough part. That deep of a 
cut was made in Medicaid so Republicans, in their healthcare proposal, 
could include a tax break for the wealthiest people in America, for 
health insurance companies, and--get this--for pharmaceutical 
companies. To give them tax breaks, they had to cut Medicaid coverage 
for all of the people whom I just described.
  Is it any wonder that many Republicans backed away from this? Senator 
Heller, of Nevada, talked to Governor Sandoval--both Republicans--and 
said he could not support an early version of the bill because of the 
deep cuts in Medicaid.
  If this is supposed to be an improvement over the Affordable Care 
Act, which part of it is an improvement? Is it in cutting Medicaid 
coverage for all of those people, saying that your health insurance 
policy does not have to cover people with preexisting conditions, 
raising the cost of healthcare premiums, particularly for people 
between the ages of 50 and 64, eliminating health insurance for 
millions? Is that an improvement over the current system? It is not. It 
is a disaster.
  The question is, By the end of this debate, after we have gone 
through this crazy process of voting up and down quickly and with very 
little debate, will one more Republican Senator stand up and say 
unacceptable? Two of them have. If one more will join them, then we can 
get down to the real business we should face. The real business is 
being the Senate again with regular order, which means taking the 
measure to the HELP Committee. Senator Murray, of Washington, is the 
ranking Democrat. Senator Lamar Alexander is the chairman from 
Tennessee. I respect him and like him a lot. The two of them ought to 
have hearings on a bill to change the affordable care system and make 
it work better, bring down the cost of premiums, and expand health 
insurance coverage. I think that is what we should be all about.
  Now, there is a basic difference in philosophy here. I will close 
with this, but this is what drives us. Answer the following question, 
and I can tell you how you are going to vote on this bill:
  Do you believe healthcare is a right for every American or do you 
believe it is a privilege; that if you have enough money and you are 
lucky enough, you can get it, and if you don't, you go without.
  If you answer the question that it is a right, that it should be a 
right in America, then you have to reject this approach. You cannot 
take helpless people, some of whom are working hard in two and three 
jobs at a time and who have no healthcare benefits, and say to them: 
Sorry. Our system will not take care of you.
  One last point. The irony of that is that if you do not give people 
health insurance, if you do not give them protection, they still get 
sick, they still go to the hospital, and they still get care. What 
happens to the bills they cannot pay? Everybody else pays them. Before 
the Affordable Care Act, each of us paid $1,000 a year in premiums just 
to cover for the people who could not afford health insurance.
  We think there is a better way. We think Americans should have access 
to affordable health insurance across the board, and we think we can 
achieve that if we work together on a bipartisan basis. So I hope one 
more Republican Senator will join Senators Collins and Murkowski and 
bring us back to what John McCain described on the floor today to the 
Senate--of having a real debate about real issues and really caring 
about the American people.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Mr. President, I ask unanimous consent that after my 
remarks, the senior Senator from Hawaii be recognized.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BROWN. Mr. President, what is happening today on the Senate floor 
is outrageous. I still cannot quite believe my colleagues as their 
staff members stood behind them in the Senate Chamber to my right. All 
of them have health insurance that is paid for by taxpayers. All of 
us--all of them, all of the staff, all of the Senators, all of the 
House Members--have insurance paid for by taxpayers. Yet they would 
come to the Senate floor with their votes entrusted to them and given 
to them by

[[Page S4174]]

the voting public in their districts and their States. All of them have 
health insurance that is paid for by the taxpayers, and they would vote 
to take insurance away from hundreds of thousands of people in my State 
and in Washington and in Wyoming and in Alabama and in Hawaii.
  Millions of people around the country, most of whom have jobs--people 
who are working $8-, $10-, $12-, $15-an-hour jobs--are not as well paid 
as the staff who stand behind us as these floor sessions go on, and 
they would take insurance away from people like them. I am still just 
incredulous that that would have happened. This bill affects all of our 
constituents. It would upend one-fifth of the American economy. Yet the 
people whom we serve have no idea what is in this bill. We really do 
not know what is in it.
  Over the weekend, people said Senator McConnell was going to bring us 
all to the floor on Tuesday to vote on the healthcare law. This is the 
law to repeal the Affordable Care Act. I was part of writing the 
Affordable Care Act as a member of the Health, Education, Labor, and 
Pensions Committee. That bill took months and months and months, dozens 
of hearings, and hundreds of amendments. The committee adopted, and I 
supported, 150 Republican amendments. It was the way we should do 
things here. Instead, Senator McConnell met just down this hall--I know 
the camera does not quite show this. Down this hall in his office, he 
met with lobbyists from Wall Street, with lobbyists from the drug 
companies, and with lobbyists from the insurance companies. I do not 
think the Presiding Officer was part of this--he is, perhaps, too 
junior--but four or five Republican Senators were in there, and they 
wrote a bill that, alas, was good for drug companies, was good for 
insurance companies, and was good for Wall Street. It just left out the 
public.
  Now, we do not really know what is in the bill this time. One of the 
things we do know is, all of the options are bad for my State of Ohio 
and that all of the options are bad for the people who elected us to 
serve here. Let me talk about those options.
  First, behind door No. 1, we have the repeal of the Affordable Care 
Act with no replacement. Again, behind door No. 1, I do not know if 
that is what this bill is. I do know it is one of the options. So 
behind door No. 1 is repeal with no replacement. That means repealing 
the entire Affordable Care Act with no plan to replace it. It creates 
dangerous uncertainty that of course will drive prices up for everyone. 
When insurance companies, when the people who have insurance now have 
no idea what is going to happen, of course it drives prices up. Of 
course, it means insurance companies will pull out of Wyoming and 
Alabama and Washington State and Hawaii and Ohio.
  According to the nonpartisan Congressional Budget Office, 18 million 
Americans will lose their health insurance next year, and premiums will 
go up 20 percent. Professionals hold these jobs. They are people who 
are not Republicans, who are not Democrats, who are just like the 
Parliamentarian, who is not aligned with either party. The 
Congressional Budget Office is just like that.
  Again, think about that. Think of the Members of the Senate. Think of 
the Senate's staff who line up along this wall during floor sessions. 
All of us have insurance. Yet we are going to take it away. According 
to this plan behind door No. 1, we are going to take it away from 18 
million Americans. There would be less coverage, and premiums would go 
up 20 percent--higher costs. By the end of this decade, 32 million 
Americans--that is like 1 out of 10 Americans--who currently have 
insurance would be without health coverage and premiums would double. 
So 32 million people lose their insurance within the decade and 
premiums double.

  Let's talk about Barbara. Barbara, whom I met in Toledo just 
recently, is 63. She is not old enough for Medicare; she relies on the 
healthcare exchanges. Repeal with no replacement would create massive 
uncertainty for Ohioans.
  The people in this body who voted yes today--does the Senate staff 
who stands behind here who have insurance from--taxpayers like 
Barbara--do they think about Barbara? Do they think about somebody who 
reads in the paper that the Senate took the first--still reversible but 
barely--step toward taking their insurance away? Do they ever think 
about people like Barbara? Do they, as President Lincoln said, ever get 
out and get their public opinion pass and listen to people like 
Barbara? She is 63 years old, and she doesn't know if she will have 
insurance next month. Imagine that. Do the staff back here, do the 
Senators who get insurance from taxpayers--do they think: Oh, maybe my 
insurance won't exist a few months from now. Do they think about that? 
I am guessing they don't.
  Repeal with no replacement creates massive uncertainty for Ohioans 
like her. We have already seen this year what that uncertainty does to 
Ohio families, with insurance companies that have been forced to pull 
out of the market as Congress and the White House create more and more 
uncertainty. When Aetna pulled out of Dayton and other communities in 
Ohio--in that part of Ohio--they and others left nearly 20 counties in 
Ohio without any insurer next year. When they did that, they announced 
it was because of the uncertainty in this Congress, that nobody really 
quite knows what is happening.
  So that is door No. 1--repeal with no replacement, higher cost, less 
coverage.
  Let's look at door No. 2. Behind door No. 2 is the plan that Mitch 
McConnell negotiated in secret. As I said, straight down this hall, go 
to the right, that is Mitch McConnell's office. That is where the drug 
company lobbyists hung out; that is where the insurance company 
lobbyists hung out; that is where the Wall Street lobbyists hung out 
and a small number of Senators, and then they slammed the door shut. 
That is how they wrote this bill. The Presiding Officer knows this from 
his constituents in Florida. The drug companies wrote the bill. The 
insurance companies wrote the bill. Wall Street wrote the bill. And, 
alas, the bill: tax cuts for insurance companies and tax cuts for the 
drug companies. The 400 richest families in America--many of them 
contribute huge numbers of dollars, with lots of zeroes on them, to my 
Republican colleagues who voted for this bill. The 400 richest families 
in America will get--under this McConnell door No. 2, there are not 
just higher costs with less coverage for the public, but 400 families 
will average a $7 million tax cut for each of the next 10 years. Four 
hundred families will get a $7 million tax cut for each of the next 10 
years.
  The McConnell plan would increase healthcare costs for working 
families. We know that. They would slap on higher costs. They would 
slap an age tax on Ohioans over 50 when they buy insurance. And when it 
comes to healthcare costs, Senator Heller from Nevada said it best: 
There is nothing in this bill that would lower premiums.
  So they give tax cuts to rich people. They give tax breaks to the 
insurance and the drug companies. They cut Medicaid. But there is 
nothing in this bill, according to Senator Heller, a Republican from 
Nevada, that would lower premiums. There are, however, those massive 
tax breaks for drug companies that have been jacking up prices on 
lifesaving medicines like insulin and those drug companies that played 
a role in creating the opioid epidemic that devastates my State. More 
people in my State--as the Presiding Officer, who also represents a 
large State, knows--more people in my State died of opioid overdose 
than any other State in the United States.
  What does this plan do for the opioid epidemic? I have had dozens--
maybe not dozens--I have done at least 15 or 20 roundtables around Ohio 
to talk about the opioid epidemic with doctors and counselors, 
psychologists and therapists and nurses, people who are recovering from 
addiction and their families, and others. One thing they all agree on 
is that the single best tool to help with opioid addiction is, alas, 
Medicaid. The single best tool to combat the opioid epidemic is 
Medicaid. This bill would take away the No. 1 tool we have to fight 
that.
  So 220,000 Ohioans right now struggling with opioid addiction, 
getting treatment for opioid addiction--220,000--they are getting their 
addiction treatment because they have the Affordable Care Act and 
insurance provided by the Affordable Care Act. We are going to take 
that away from them.
  At one of my roundtables in Cincinnati--the Talbot House--a father

[[Page S4175]]

sitting next to his daughter, who I believe was in her early thirties, 
looked at me and said: My daughter would be dead from an opioid 
overdose had it not been for Medicaid expansion. I thank Governor 
Kasich for having the courage to stand up against his President and 
stand up against the Republican leadership in this town and do the 
right thing in expanding Medicaid.
  This plan, door No. 2, has higher costs, less coverage, and would 
kick many of those 220,000 people off their insurance. It would disrupt 
treatment for hundreds of thousands of Ohioans as they fight for their 
lives. It would pull the rug out from under local police and 
communities in the midst of an epidemic.
  A number of police officers told me that when they go to a home--a 
police officer or a firefighter or another first responder--when they 
go to a home where somebody is unconscious because of an opioid 
epidemic, first they give them Narcan to revive them, and the second 
thing they do is sign them up for Medicaid. They sign them up for 
Medicaid so they can get treatment. Otherwise, there is a very good 
chance that person will die.
  The most important tool for fighting opioid addiction is Medicaid. 
Yet this body voted today--2 Republicans stood up and voted against 
this--today, 50 Republicans and the Vice President of the United 
States, who honored us with his presence today with the tie-breaking 
vote, voted essentially to kick those people off their treatment.
  So door No. 2, the insurance company lobbyist plan: higher costs, 
less coverage. The same plan written by lobbyists.
  Let's talk about door No. 3. Behind door No. 3 are higher costs and 
less coverage. It is the same plan written by lobbyists, just with 
taxpayer dollars thrown in to buy off votes. Same result--higher costs 
and less coverage.
  They can't just throw money at this bill and make it better.
  Take opioids. They want to take away Medicaid, which is the No. 1 
tool we have to get people treated, and then they throw in a $45 
billion Federal grant program instead.
  Governor Kasich said that those dollars--taking away Medicaid, taking 
away treatment, taking away insurance from the 700,000 Ohioans in 
Medicaid expansion and hundreds of thousands of Ohioans later--Governor 
Kasich is a Republican, and he and I see this pretty much the same way. 
Governor Kasich said that putting that money in after taking away 
Medicaid is like spitting in the ocean.
  The director of Ohio's Medicaid Program said the Republican Senate 
plan would be devastating for Ohio. For instance, if someone had 
cancer, I don't think the best treatment for cancer is to cut off their 
insurance and then give them a Federal grant to pay their oncologist--
not even a Federal grant to pay their oncologist. You don't treat 
people by a Federal grant, you treat people by insurance and all of the 
wraparound part of insurance that matters.
  It is not just those fighting addiction--I talked a lot about 
opioids--it is kids with special healthcare needs. It is Ohio schools. 
There is a program called Medicaid in Schools that helps young people 
struggling with various kinds of physical and mental illnesses in the 
schools. That is helpful.
  It is rural hospitals. I have been on the phone with literally four 
dozen hospital CEOs in this State--at least four dozen, a number of 
them a number of times--and small hospitals in rural communities know 
that they may close if this bill, the one behind door No. 3, is 
adopted.
  It is seniors in nursing homes, and it is their families who help 
care for them. Few people realize that three in five nursing home 
residents in my State rely on Medicaid to cover the cost of their care. 
That is 60 percent. They are our parents and our grandparents. These 
are middle-class families and working-class families who end up in 
nursing homes. They run out of money at the end of their lives. That is 
Medicaid dollars. Two-thirds of Medicaid dollars don't go to children 
or opioid addiction, they go to nursing homes to take care of our 
parents and grandparents.
  I met with families again in Toledo last week who rely on Medicaid to 
help afford nursing home care.
  Bob's mother Blanche lives at a home in Perrysburg, a suburb of 
Toledo.

       My mother and father worked all their lives. My mother is 
     95 and receives a pension of only $1,500 a month. Medicaid 
     keeps her alive so she is able to spend time with her kids 
     and her grandkids.

  I remember Margaret Mead, the great anthropologist, who said that 
wisdom and knowledge are passed from grandparent to grandchild. A child 
can spend time with her grandparents, as my daughters got to spend time 
with their grandparents, especially my grandmother in her last years. 
It didn't just bring great joy to the grandparents, it imparts wisdom 
and understanding and education to the grandchildren. Medicaid does 
that, too, when people have insurance, when people are taken care of in 
nursing homes and assisted living.
  We talk about people like Blanche who worked hard to build a good 
life for their families. They paid their taxes. They paid their 
insurance premiums. They paid into Medicare and Social Security. So we 
are going to cut their Medicaid in the last years of their lives. They 
shouldn't have to lose everything because they need more intensive care 
in the later years of their lives, and neither should their families, 
who are already squeezed--people in their forties and fifties and early 
sixties--who worry about their children's education on the one hand and 
then worry about paying for nursing home care for their parents on the 
other.
  Another huge portion of the people Medicaid helps are Ohioans who are 
workers, who pay taxes, who have children with a disability or with 
serious special needs. Nearly 500,000 kids in Ohio--20 percent of Ohio 
kids, 2 in 10--have special healthcare needs. Boaz, whom I met in 
Cleveland, was born with several heart defects. He wouldn't be alive 
today without treatment covered by Medicaid. Benjamin Dworning from 
Akron, born with Down syndrome, visited my office recently with his 
parents.
  It is not just kids with special needs who will lose out. Ohio 
schools could lose $12 million a year. Twenty-two percent of rural 
hospitals would be at risk of closing. It goes on and on.
  These are all problems created by this bill behind door No. 3, 
written by lobbyists, written down the hall in Senator McConnell's 
office by drug company and insurance company and Wall Street lobbyists. 
That is the bill--undisclosed, unknown until he regurgitated it on the 
Senate floor and gave us this bill.
  Cleveland.com wrote: ``As for the proposed $200 billion to ease the 
path for ACA funding losses, this too would pale compared with the 
losses themselves.''
  Again, Governor Kasich--he, a Republican; I, a Democrat--said this is 
spitting in the ocean.
  So that is what is behind door No. 3--higher costs, less coverage.
  That brings us to door No. 4. What is behind the last door? We have 
no idea. It is the ultimate mystery plan.
  Remember what Washington uncertainty has already done to Ohio 
families? There are 20 counties with no insurer next year.
  As an editor at the Columbus Dispatch--Ohio's most conservative 
newspaper--said to me about a month and a half ago, uncertainty is like 
carbon monoxide for business, a silent killer.
  Now, the Republican Party, which fashions itself as the party of 
business, seems to have specialized over the last 10 years in injecting 
uncertainty into the economy--uncertainties such as, are we going to 
pass the Export-Import Bank, which Senator Murray worked so hard on, so 
our companies can export American-manufactured, well-made products? Are 
we going to pay our debts or are we not going to meet our obligations 
and shut down the government? Are we going to leave hanging out there 
the Affordable Care Act repeal? All of these things create uncertainty, 
and as a result, business investment freezes. We know what happens. So 
who knows what kind of damage this latest vote will do in the insurance 
market.
  What we know for certain is that this mystery plan behind door No. 4 
will mean higher costs and it will mean less coverage, because nothing 
so far--nothing that has been put on the table--could result in 
anything else. The math doesn't work. How can anyone stand here--again, 
staff standing by the wall here and Members of the Senate, all getting 
insurance provided by taxpayers--how can you stand here and

[[Page S4176]]

threaten to take away the insurance of others and at the same time 
drive up costs?

  The Affordable Care Act is not perfect. Of course, it is not. We have 
work to do. Senator Schumer talked today about it. Sit down with us. We 
would love to work through many of the items and get more young, 
healthy people into the insurance pool, to stabilize the insurance 
market, to go after the high cost of prescription drugs and maybe, even 
to consider Medicare at 55. We were one vote away from opening up 
Medicare in a revenue-neutral way for people between 55 and 64 who 
might have lost their insurance as they get sick or as they get older. 
There are all of those options, but don't start with repeal, throwing 
millions of Americans off of their insurance.
  I agree with Governor Kasich one more time. Yesterday, Governor 
Kasich said: Until Congress can step back from political gamesmanship--
which we saw in spades today, as Senator Johnson and Majority Leader 
McConnell were negotiating the last parts of the bill, and as, more or 
less, 98 of us sat here and watched and wondered what was going on and 
saw that political gamesmanship--and come together with a workable 
bipartisan plan, it is a mistake for the Senate to proceed with the 
vote we just took on Tuesday. He said that yesterday.
  Instead of down the hall Senator McConnell working with insurance 
company and drug company lobbyists, instead of listening to the drug 
companies so that he puts the tax break for drug companies in the bill, 
let's listen to the people of Kentucky, Wyoming, Texas, Louisiana, 
Alabama, North Carolina, Ohio, Hawaii, and Washington. Let's listen to 
the people of the States of my colleagues in this body.
  Let's work on a bipartisan plan to fix what is not working in the 
Affordable Care Act. Let's keep what is working and make healthcare 
work better for the people whom we serve.
  The PRESIDING OFFICER (Mr. Rubio). The Senator from Hawaii.
  Mr. SCHATZ. Mr. President, how much time remains?
  The PRESIDING OFFICER. There is 5\1/2\ minutes.
  Mr. SCHATZ. Mr. President, we just took one of the most reckless 
legislative actions in this body's history. We are blowing up the 
American healthcare system, and we don't even know what comes next.
  I want to be clear. The Senate has never before voted on major 
legislation that would reorder about one-sixth or one-fifth of the 
American economy and impact millions of lives without actually knowing 
what the bill would even do.
  There has been no bipartisanship. There has been talk of it, but 
there have been no real discussions. There have been no public 
hearings. Let me say something about hearings. This is not a technical 
point. This is the way a legislative body does its work. This is the 
way we figure out whether our bill is any good or not.
  This is the way the Senate has always worked. We don't do major 
legislation without hearings. But that is what we are doing today, and 
that is because people don't want to disclose what is in this bill.
  It is true that we don't know exactly what is in the bill, but we can 
be sure of a few things. First, whatever problems there are with the 
ACA, this bill doesn't even bother to take a swing at them. To the 
extent people are worried about high deductibles, it will increase the 
deductibles. To the degree people are worried about the choices on the 
exchanges, it doesn't even try to solve that problem.
  We don't know exactly how much Medicaid will be cut, whether it is 
just rolling back the Medicaid expansion or making these radical 
structural reforms, but we know there will be deep cuts to Medicaid. 
This will hurt people. It will hurt people in nursing homes. It will 
hurt people with drug addiction. Medicaid is a program that works for 
tens of millions of Americans, and it will be slashed massively.
  We don't know whether they are going to get rid of the capital gains 
tax or just other revenue, but we know they are going to reduce many of 
the taxes in the original Affordable Care Act, and they are going to 
pay for it by cutting Medicaid.
  So under the guise of fixing the ACA, they are actually doing nothing 
about ACA. What they are doing is cutting taxes and cutting Medicaid. 
We don't know exactly what is in the bill, but we do know that.
  People are going to be hurt--people with preexisting conditions, 
families with loved ones struggling with opioid abuse, people in 
nursing homes, people who rely on Planned Parenthood, and the tens of 
millions of people who will lose their insurance almost instantly. That 
is why every group--from the American Medical Association to the 
nurses, to the American Cancer Society, to the March of Dimes, to the 
National Physicians Alliance, and the AARP--opposes this bill. There 
are 14 different versions of this bill, but, actually, these 
organizations oppose them all.
  There are some core elements of the vote we took that are going to be 
true no matter what. It will cut Medicaid and cut taxes. It will reduce 
patient protections. It will reduce the number of people who have 
insurance.
  It was all done with no hearings, with no Democrats, with no experts 
on healthcare. This thing is going to be dropped on us without enough 
time to review it and without enough time to interact with our home 
State and figure out the impact.
  Make no mistake, the reason they will not tell you what is going to 
be in the final bill is because the moment they do, this thing will 
come crashing down. What the American people have to do is to make sure 
that this thing comes crashing down anyway. We have to do it for the 
tens of millions of Americans who depend on Medicaid and the ACA. We 
have to do it for our rural hospitals. We have to do it for the people 
with preexisting conditions. We have to do it for the people without 
power, without money, without the ability to walk 200 yards from this 
gilded Chamber and get the best healthcare in the world.
  I will be fine. All the Members of this Chamber will be fine. But our 
job is not to take care of ourselves. Our job is to represent our 
constituents, and this bill has earned the title of most unpopular 
major bill in American history, most unpopular major legislation in 
American history.
  There is still time to walk back from the brink.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. Mr. President, I ask for the yeas and nays with 
respect to amendment No. 267.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. The majority leader.


                 Amendment No. 270 to Amendment No. 267

       (Purpose: Of a perfecting nature.)

  Mr. McCONNELL. Mr. President, I call up amendment No. 270.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Kentucky [Mr. McConnell] proposes an 
     amendment numbered 270 to amendment No. 267.

  Mr. McCONNELL. Mr. President, I ask unanimous consent that the 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Is there objection?
  Mrs. MURRAY. Mr. President, I object.
  The PRESIDING OFFICER. Objection is heard.
  The clerk will read the amendment.
  The senior assistant legislative clerk continued with the reading of 
the amendment.
  (Mr. DAINES assumed the Chair.)
  The bill clerk continued with the reading of the amendment.
  (Mr. ROUNDS assumed the Chair.)
  The legislative clerk continued with the reading of the amendment.
  The senior assistant legislative clerk continued with the reading of 
the amendment.
  The bill clerk continued with the reading of the amendment.
  The assistant bill clerk continued with the reading of the amendment.
  (Mr. DAINES assumed the Chair.)
  The legislative clerk continued with the reading of the amendment.
  The senior assistant legislative clerk continued with the reading of 
the amendment.

[[Page S4177]]

  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that the reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. ENZI. Mr. President, I ask unanimous consent that there be 1 hour 
for debate on amendment No. 270, equally divided between the two 
managers or their designees; that following the use or yielding back of 
time, Senator Murray or her designee be recognized to make a point of 
order against the amendment, and that Senator Enzi or his designee then 
be recognized to make a motion to waive; further, that following the 
vote on the motion to waive, Senator Enzi or his designee be recognized 
to offer a second-degree amendment, No. 271, and that Senator Murray or 
her designee be recognized to offer a motion to commit; finally, that 
the time from 10 a.m. until 12 noon be equally divided between the 
managers or their designees; that at 12 noon tomorrow, Senator Murray 
or her designee be recognized to make points of order, and that Senator 
Enzi or his designee be recognized to make a motion to waive; that 
following the motion to waive, the Senate vote in relation to the 
amendment No. 271; that following disposition of the amendment, the 
time until 2:15 p.m. be equally divided on the Murray motion to commit, 
with a vote on the motion at 2:15 p.m. I further ask that following 
disposition of the Murray motion, Senator Murray or her designee be 
recognized to offer an additional motion to commit.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, the pitch to Republican Senators this 
afternoon before the first vote was that it was nothing but a little 
bit of throat clearing--just a first step to get the conversation 
started.
  Let's be clear, nobody can pretend the stakes aren't real now. In a 
few minutes, the Senate will be voting on yet another version of the 
Senate TrumpCare bill. I call it the BCRA 3.0. It features a special 
gut punch to consumer protection offered by Senator Cruz.
  My view is, the Cruz proposal is a prescription for misery for 
millions of Americans dealing with serious illness and bedlam in the 
private insurance market. Forget, colleagues, all the talk about 
bringing costs down. This bill is going to send health expenses like 
deductibles and copayments into the stratosphere.
  TrumpCare 3.0, BCRA 3.0, tells insurance companies: Look, you are off 
the hook for basic consumer protection. You get to bring back annual 
and lifetime caps on coverage, and those caps would hit people who get 
their healthcare through their employer, as well as those who buy it 
for themselves in the individual market. You can forget about essential 
health benefits. You get to flood the market with bargain-basement 
insurance plans, as long as you offer one, single, comprehensive 
option, the kind of plan that actually works for people with 
preexisting conditions and, by the way, you get to price that through 
the roof.
  Under the Cruz proposal, we will be looking at a tale of two 
healthcare systems in America. The young and healthy are going to opt 
for the bare-bones insurance plans that don't cover much of anything, 
but there are millions of people in this country who cannot get by with 
skimpy Cruz-plan insurance. They are people who have had a cancer scare 
or suffer from diabetes. They are people who get hurt on the ski slopes 
or in a car accident. The only coverage that works for them will come 
with an astronomical pricetag.
  There was no hearing in the Finance Committee, no hearing in the HELP 
Committee. Senators are flying in the dark, and as far as I can tell, 
the proposal is going to be before us without having been scored by the 
CBO.
  Let me close with this. It is not too late for Republican Senators to 
put a stop to this shadowy, unacceptable process. Nobody in this 
Chamber--not one Senator--has to choose between TrumpCare and straight 
repeal or any partisan plan. I hope my colleagues will reject TrumpCare 
3.0, BCRA 3.0 and say it is time to stop this my-way-or-the-highway 
process and say, after rejecting this ill-advised amendment, that they 
would like to return to the regular order, where we look to bipartisan 
approaches.
  I urge my colleagues to oppose and to oppose strongly this first 
amendment that we will vote on tonight, BCRA 3.0. It is a prescription 
for trouble for millions of consumers, and I think it is going to cause 
chaos for the reasons I described in the private insurance market.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. PORTMAN. Mr. President, I rise tonight to talk about the Portman 
amendment and about the broader substitute that repeals and replaces 
the Affordable Care Act, otherwise known as ObamaCare.
  Is this replacement perfect? No. I don't think any replacement is. 
But it is a big improvement over the status quo. The status quo on 
healthcare is simply no longer sustainable.
  It isn't working for Ohio. We heard a lot about the middle-class 
squeeze in Ohio, and it is real. Wages are flat and expenses are up. 
For most folks, the biggest single expense is healthcare costs. It is 
the fastest growing expense because of higher premiums and higher 
deductibles.
  It wasn't supposed to be this way. In fact, when the Affordable Care 
Act--ObamaCare--was enacted in 2010, we heard a lot of promises about 
lower costs. They promised that ObamaCare would bring down premium 
costs by 2,500 bucks for the average family, but we now know that 
families have seen their premiums skyrocket. According to the Ohio 
Department of Insurance, health insurance premiums on the individual 
market in Ohio have nearly doubled since the Affordable Care Act went 
into effect 7 years ago. Small business premiums have gone up 82 
percent. Premiums for this year are up double-digits, and next year we 
all expect the same. No one can afford that.
  To make matters worse, we have seen a sharp increase in deductibles. 
For a lot of people covered by insurance, they feel as though they 
really don't have health care insurance at all because their out-of-
pocket expenses are so high and deductibles are so high, they really 
can't access it.
  These higher premiums and deductibles have already made healthcare 
unaffordable for a lot of hard-working Ohioans. But it is not just 
about costs, it is also about choice. Some people are losing their 
coverage altogether because the policies established in the Affordable 
Care Act were set up for failure.
  Fifteen of the 23 nonprofit insurers set up around the country as co-
ops around the Affordable Care Act have now gone bankrupt. One was in 
Ohio. Last year in my State, 22,000 hard-working Ohioans lost their 
coverage because our co-op declared bankruptcy. Many of them, by the 
way, had already paid their deductibles on that, and they lost that as 
well.
  Worse than that even, right now there are 19 counties in Ohio without 
a single insurance company in the exchange market, the individual 
market--not one insurance company. Another 27 counties in Ohio have 
only 1 insurer. That is not competition. That is not choice. Far too 
many Ohioans--thousands of them--if they want health insurance, are 
told they have to move out of their county to another county.
  Less competition has also meant less choices and higher costs for 
Ohio families and cost shifting on to employer-based plans. As these 
insurance companies have lost money, some of them haven't left Ohio, 
but they shifted their costs to other people. That is why so many 
people's costs have gone up.
  Without competition and choice in the market, we are never going to 
be able to lower healthcare costs for families and small businesses. 
That is one more reason why the status quo on healthcare, the system we 
have now, is not sustainable.
  The Affordable Care Act has failed to meet the promises that were 
made, but we can do better, and we have to do better. It is our job to 
do better, but we should do it in a way that protects low-income 
beneficiaries of Medicaid, that protects the most vulnerable in our 
State. We can do that too.
  At the outset of this debate and consistently throughout the debate, 
I have

[[Page S4178]]

said my goal was to create a more workable healthcare system that 
lowers the cost of coverage and provides access to affordable care 
while protecting the most vulnerable. This most recent version of the 
Better Care Reconciliation Act--as my colleague just called it, 
BCRA.3--is an improvement over the House bill, but it is also an 
improvement over the previous Senate bill. This measure includes 
reforms that will help lower premiums on families and small businesses. 
The No. 1 priority out there should be to lower those costs. This bill 
will help lower those premiums.
  Throughout the process, I have expressed my concerns about how we 
deal with Medicaid, which is a critically important Federal program 
that provides healthcare benefits to about 70 million Americans who 
live below the Federal poverty line. The Affordable Care Act allowed 
States, including Ohio, to expand Medicaid eligibility actually above 
the poverty line, to 138 percent of poverty, and to cover single 
adults.
  With our growing debt and deficits, we know the current Medicaid 
Program is not financially sustainable over the long term, and we have 
to look for innovation and reform to protect and preserve it now so 
that Ohioans can count on this program in the future and so that those 
who need it will have it.
  My point all along has been that these reforms can and should be done 
in a way that doesn't pull the rug out from under people and gives 
States time to adjust. So, in this Senate bill, I have worked to put 
Medicaid expansion on a glidepath for 6 years, with the current law for 
3 years and then a transition for another 3 years. That transition 
would be to a new healthcare system. This is a big improvement over the 
House bill, which had a cliff in 2 years without a glidepath.
  Just as important, in this substitute before us, Governors would have 
new flexibility in this legislation to design innovative Medicaid 
Programs that meet the needs of their States and their expansion 
populations.
  One issue I have focused on a lot in this discussion has been the 
opioid epidemic. In my own State of Ohio, this epidemic has had a 
devastating effect. About 200,000 Ohioans now suffer from drug 
addiction, primarily from heroin and prescription drugs and the new 
synthetic heroins, such as fentanyl. Unbelievably, I will tell you that 
about half of the funds we spend in expanded Medicaid in Ohio go for 
one purpose, and that is mental health and substance abuse treatment, 
primarily driven by addiction to heroin and prescription drugs and 
fentanyl.

  We have to deal with this issue in a smart way. In this latest 
version of the substitute, that is why I fought to provide not only 
that transition for those on expanded Medicaid but also an additional 
and unprecedented $45 billion in new resources for States to address 
the opioid epidemic. I am pleased to say that in the legislation we are 
going to vote on tonight, it is included. We want those receiving 
opioid treatment under Medicaid expansion to maintain access to 
treatment as they work to get back on their feet. This new funding is 
critical to help with regard to that treatment and longer term 
recovery.
  An additional issue I have been working on is to ensure that those on 
expanded Medicaid are able to find affordable healthcare options under 
a new system, whether it is under the new Medicaid structure or 
affordable healthcare options in the private sector on the private 
market. Over the past few weeks, I have worked with the President, the 
Vice President, administration officials, and many of my colleagues on 
ways to improve this bill further in this regard, to help out low-
income Ohioans and others who are trying to find affordable coverage. 
That is why this proposal before us, the Portman amendment, is so 
important.
  By the way, it is called the Portman amendment, but it is the result 
of the work of a lot of different Senators, some of whom I saw on the 
floor earlier and one I see here tonight. Senator Capito, who has been 
a leader on this, and Senators Hoeven, Gardner, Sullivan, Cassidy, 
Young, Boozman, Heller, Murkowski, and others, have worked on this 
proposal.
  I am pleased that we have received a commitment that the Senate will 
vote tonight on this approach to help those on Medicaid expansion and 
other low-income Americans get access to affordable healthcare in the 
private market.
  This plan has two parts. First, it provides an additional $100 
billion to the long-term stability fund in the Better Care 
Reconciliation Act to help people with out-of-pocket expenses, such as 
deductibles and copays, thus ensuring that those who transition from 
Medicaid expansion into private insurance under a new system not only 
have the tax credit to help them, which is part of the underlying bill, 
but also have this additional help for affordable coverage options.
  Second, it is a Medicaid wraparound that allows States to provide 
cost-sharing assistance to low-income individuals who transition from 
Medicaid to private insurance and receive a tax credit on the exchange. 
The States could use this flexibility in combination with this long-
term stability fund increase--the additional dollars I am talking 
about--to assist individuals with their deductibles, out-of-pocket 
expenses, and copays.
  It would also allow the States to capture Federal Medicaid matched 
dollars to supplement the tax credits under the Better Care Act without 
having to seek and renew existing waiver authority.
  This Medicaid wraparound is already available through a waiver, but 
we think it is critically important to put it in a statute so that 
other administrators and the current ones--Seema Verma has said she 
supports this waiver being granted--but others will grant it, and you 
don't have to renew this waiver or beg for a waiver. It is a 
commonsense way to help get people who are going into private plans the 
help they need to be able to afford the premiums, deductibles, and 
copays.
  This is a commonsense approach to help ensure that these low-income 
Americans have access to affordable care, and I urge my colleagues to 
support it.
  We must do better than the Affordable Care Act. I have heard from 
people across Ohio on both sides of this debate. Trust me, I have heard 
a lot. There is a lot of passion. I understand that. But it is 
interesting, the common denominator in many of these discussions is 
that doing nothing is not sustainable. Pretty much everybody 
acknowledges that the status quo is not working. Ohioans deserve 
action.
  In my view, to throw in the towel and give up on finding a better 
alternative is to give up on Ohio's families, give up on Ohio's small 
businesses, and I am not willing to do that.
  We all know the Affordable Care Act has not lived up to its promises 
to the American people. Today, after 7 years of consistently calling 
for repeal and replace, I am supporting a sensible plan to do just 
that. Is it perfect? No. I don't think any substitute is. Replacement 
is hard. But it is an improvement on the unsustainable status quo, and 
it does help keep our promise to the American people to do better.
  I urge my colleagues to support the legislation before us.
  I yield back my time.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. MARKEY. Thank you, Mr. President.
  Mr. President, earlier today the Senate voted on a bill to dismantle 
this country's healthcare--a cruel bill that would affect every single 
American and one-sixth of our economy; a heartless bill that was 
crafted in secret, without public debate and without input from the 
families who will be impacted; an inhumane bill that would make health 
insurance unaffordable for millions of Americans and leave millions 
more with no access at all.
  Despite this legislative malpractice, despite numerous independent 
analyses and nonpartisan Congressional Budget Office findings that 
millions of Americans will lose coverage and face increased costs, 
despite Americans from across the country pleading with Republicans not 
to rip away their coverage or take a machete to Medicaid, despite all 
that, President Trump and Republican leadership put politics ahead of 
people and voted to repeal the Affordable Care Act. That is a travesty.
  I have often said that the proudest vote of my career was the one I 
cast in favor of the Affordable Care Act. The second proudest vote is 
today, voting no on this cruel, heartless, inhumane bill.

[[Page S4179]]

  To all of my constituents in Massachusetts, please know that I vote 
no with you in mind.
  Massachusetts is the home of universal healthcare. We have a model 
for the Affordable Care Act. Because of our belief that healthcare is a 
right and not just a privilege, 98 percent of Massachusetts residents 
have healthcare coverage. That was a dream of the great Teddy Kennedy, 
the lion of this Chamber, and it is a reality in Massachusetts.
  We cast this historic vote today to proceed to debate on healthcare 
legislation, but rest assured, the fight to protect the Affordable Care 
Act is far from over.
  It is a testament to how divided the Republican Party is over how to 
replace the healthcare law that we still don't know which version of 
TrumpCare we will proceed to vote on for final passage. It is not 
because Republicans haven't had time--they have had 7 years to craft a 
plan to repeal the Affordable Care Act. Rather, the chaos we have seen 
so far from Senate Republicans is because millions of Americans are 
finally benefiting from insurance coverage, many for the first time, 
and they don't want these protections taken away.
  In many ways, it doesn't matter which bill they bring up for a vote 
because all versions of the Republican healthcare bill are terrible. 
Republicans still have no idea how they will go about protecting those 
with preexisting conditions and ensure that millions aren't kicked off 
their current insurance plan.
  Senate Republicans have so far proposed three bills that would each 
devastate the healthcare sector, take a machete to Medicaid, and make 
the poorest in our country pay for tax breaks for the wealthiest. These 
bills are the bad, the worse, and the ugly.

  First, the bad.
  Senate Republicans proposed legislation at the end of June--just a 
month ago--that would rip away health insurance from 22 million 
Americans and give the top 400 wealthiest people in our country a tax 
break worth $33 billion.
  Then the worse.
  They introduced yet another bill that would also kick 22 million 
Americans off of their health insurance and cut Medicaid by $750 
billion. They tried to buy Republican votes with a separate opioid 
fund, but that craven, political Hail Mary was not fooling anyone.
  Then the ugly.
  When Republican leadership realized that they did not have the votes 
for either of these cruel replacement bills, they decided to just 
repeal the healthcare law without any kind of replacement. This 
proposal would take coverage away from 32 million Americans and double 
premiums over the next decade.
  That is the slate of Republican healthcare bills--the bad, the worse, 
and the ugly. All of these healthcare proposals have one thing in 
common: heartlessness. They all reduce coverage. They all increase 
costs for Americans. They all eviscerate Medicaid, causing irreparable 
damage to a program that provides coverage for 70 million Americans, 
and they all hand over billions in tax breaks to the wealthiest in our 
country, who do not need them or deserve them. Even in Massachusetts, 
the Republican proposals would mean more than 260,000 people would lose 
coverage, often the lowest income residents in the State. It would cost 
the State more than $8 billion by the year 2025.
  There are no changes, no so-called fixes, no modifications to make 
any of these bills less cruel. Each of the Republican proposals will 
just exacerbate the most devastating public health crisis facing the 
country--the battle against opioid overdose deaths.
  Leader McConnell said today that he would be thinking about the 
families who are hurting in Kentucky when he casts his vote to kick at 
least 20 million Americans off of their health insurance coverage. Yet 
do you know who will really be hurting? It will be the families of the 
nearly 1,000 people who died of an opioid overdose in Kentucky last 
year.
  In a blatantly craven attempt to make TrumpCare more palatable, 
moderate Republicans from States that have been ravaged by the opioid 
crisis included a paltry opioid fund in the most recent version of the 
GOP replacement fund. Those are crumbs compared to the amount that the 
Affordable Care Act would likely spend on covering opioid use disorder 
treatments if we would just leave the law alone to work as intended. 
This opioid fund is not a fix; it is a falsehood. It is a false promise 
to the people who are suffering from opioid addiction. It is a false 
future that will not include critical Medicaid funding for treatment 
and recovery services, and it is a false bargain that Republicans will 
make at the expense of families who are desperate for opioid addiction 
treatment.
  The American people will not be fooled. They realize that opioid 
funding in this proposal is nothing more than a public health 
pittance--a wholly inadequate response to our Nation's preeminent 
public health crisis. No amount of money in an opioid fund can 
replicate the access to treatment that is provided through the 
comprehensive health insurance program that the Affordable Care Act 
represents. Families of those who suffer from substance abuse disorders 
have been shouting from the rooftops that cutting Medicaid and 
hamstringing access to health insurance coverage will only make a 
difficult situation worse.
  We should be making health coverage and treatment access more robust, 
not weaker. Today, only 1 in 10 people with substance addiction 
receives treatment, and it has been estimated that 2 million people who 
live with opioid use disorders are not receiving any treatment for 
their disorders. It should not be a surprise to anyone that the 
epidemic of opioid abuse will only worsen as long as we have a system 
that makes it easier to abuse drugs than to get help.
  These Republican proposals will be a death sentence for millions of 
people with substance use disorders. A vision without funding is a 
hallucination. They are cutting the funding for substance abuse. 
Republicans are turning their backs on their vow to combat the opioid 
epidemic, and President Trump is beginning to break his own promise 
from the campaign trail to ``expand treatment for those who have become 
so badly addicted.'' Instead, they are moving forward with a proposal 
that threatens insurance coverage for 2.8 million Americans with a 
substance use disorder--all to give hundreds of billions in tax breaks 
to billionaires and big corporations--and slashing funding for our 
Nation's preeminent public health crisis is just part of it.
  Creating a separate fund for opioid use disorders just further 
stigmatizes the disease and pushes it back into the shadows. This is 
not how we treat chronic health conditions in this country, and it is 
insulting to those 33,000 Americans who lost their lives just last year 
from opioid overdoses.
  This latest political maneuver proves yet again that TrumpCare has 
never been about creating health. It has always been and still is about 
concentrating wealth--tax breaks for the rich coming from the cuts in 
healthcare coverage for those who need it the most in our country. They 
are abandoning hard-working families so that they must fend for 
themselves while they bestow those gifts of billions in tax breaks to 
the wealthy. That is shameful.
  The GOP replacement plan also imposes an age tax on older Americans, 
allowing insurance companies to charge older Americans five times more 
than younger Americans for the same coverage. That is unconscionable.
  The GOP plan reduces access to care for those with preexisting 
conditions--Americans with cancer, diabetes, women who have had 
children. They want to force them to pay for a Cadillac, but they then 
hand over to them a tricycle. That is just plain wrong.
  On this floor, it is going to be a battle to the very end on this 
bill, and I am going to keep speaking and keep fighting until my 
Republican colleagues understand how important these issues are to 
every single family in our country.
  The American people who believe in quality, affordable healthcare 
will not be silenced by today's vote. Instead, we will be invigorated 
to call out the callousness in any of these bills that would threaten 
the economic security for low-income and working families in order to 
fill the already overflowing bank accounts of the 1 percent. Oh, no. 
This fight is just beginning out here on the Senate floor because the 
lives of all

[[Page S4180]]

Americans who would be hurt by the Senate's vote today to begin debate 
on repealing the Affordable Care Act are simply too important for us to 
stop fighting.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. CRUZ. Mr. President, today is an important step in a very long 
journey. Some 7 years ago, ObamaCare passed into law, and in the 7 
years that ObamaCare has been on the books, we have seen the results of 
this catastrophic law. We have seen the devastation that has resulted. 
ObamaCare is the biggest job killer in this country.
  You and I and the Senators who have listened to their constituents 
across the country have heard over and over again from small businesses 
that have been hammered by ObamaCare. As I have listened to small 
businesses in the State of Texas over and over again, they have 
described ObamaCare as the single biggest challenge they face.
  Indeed, thanks to ObamaCare, we have discovered two new categories of 
people who have been hurt by the Federal Government--the so-called 
49ers and the so-called 29ers. The 49ers are the millions of small 
businesses that have 47, 48, 49 employees and yet do not grow to 50 
because at 50, they would be subject to ObamaCare, and in being subject 
to ObamaCare, they would go out of business. There are literally 
millions of new jobs that are waiting to happen, waiting to grow, small 
businesses ready to expand that ObamaCare penalizes so punitively that 
they do not expand.
  By the way, those jobs that would be the 50th and 51st and 52nd are 
typically low-income jobs. They are jobs for people who are just 
starting out in their careers. They are jobs for people who are 
minorities, who are African Americans, who are Hispanics. They are jobs 
for people like my father in 1957--washing dishes, making 50 cents an 
hour, but he was glad to have freedom in this new country.
  Then there are the 29ers, the people all across this country who are 
forcibly put into part-time work at 28, 29 hours a week because 
ObamaCare defines a ``full-time employee'' as 30 hours a week. People 
all over the country are being hurt. Single moms who are trying to feed 
their kids are being hurt because they have been forced into part-time 
work so that they end up working two or three part-time jobs at 28, 29 
hours a piece, and none of them provide healthcare. The burden on them 
has been enormous.
  It hasn't just been jobs, although that is a big part of it; it has 
also been the millions of Americans who have had their health insurance 
canceled because of ObamaCare. We all know President Obama looked at 
the TV cameras and said: If you like your health insurance plan, you 
can keep your health insurance plan, and if you like your doctor, you 
can keep your doctor.
  PolitiFact--that left-leaning news site--labeled Obama's promise as 
2013's Lie of the Year, and it was. It was a deliberate lie, as 
Jonathan Gruber, the architect of ObamaCare, said that they were 
banking on what they called the stupidity of the American people--
selling it based on a lie.
  Then there is the impact on premiums. President Obama promised the 
American people that under ObamaCare the average family's premiums 
would drop $2,500 a year. That wasn't just a little bit wrong; it was 
wildly and dramatically wrong. In fact, the average family's premiums 
have risen over $5,000 a year.
  People are hurting because health insurance is unaffordable. I hear 
from Texans over and over and over again: I cannot afford health 
insurance anymore.
  I will say that the harms from ObamaCare--the people suffering under 
this failed law--have been mounting and mounting and mounting, and for 
7 years, the Democrats have been content to do nothing. Barack Obama as 
President and Democrats having majorities in the Senate did nothing for 
the 49ers who could not get new jobs; nothing for the 29ers, the single 
moms forced to work part time; nothing for the millions of people who 
had the insurance plans that they liked canceled; nothing for the 
millions of people who could not go see their own doctors anymore; 
nothing for the millions of people whose premiums had skyrocketed.
  After 7 years of stonewalling and blockading and saying ``We do not 
hear you'' to the American people, now our friends on the Democratic 
aisle are suddenly insisting that they want to do something. Today, we 
had a vote to take the first step in doing something--in honoring the 
promise every Republican made to repeal this disaster.
  The bill before the Senate is not perfect. No one would expect it to 
be perfect. Bismarck's comments about sausage-making are certainly true 
in this process here today. Yet I will say that in the bill before the 
Senate, which is not likely to pass tonight--but I believe, at the end 
of the process, the contours within it are likely to be what we enact, 
at least the general outlines--there are at least four positive 
elements that are significant.
  No. 1, it repeals the individual mandate.
  The IRS fines about 6.5 million people a year because they do not 
have enough money to buy insurance. Think about that for a second. You 
are struggling to make ends meet, and you do not have the money to buy 
health insurance. Not only do you not have insurance, but the IRS slaps 
you with a fine--millions of dollars of fines. In the State of Texas, 
there are roughly a million people who are getting fined by the IRS, 
roughly half of whom make $25,000 a year or less and nearly 80 percent 
of whom make $50,000 a year or less. The Democratic solution is, if you 
do not have the money for healthcare, the IRS is going to fine you on 
top of it, and you still do not get healthcare. That is a terrible 
outcome.
  This bill will repeal the individual mandate, repeal the IRS fines on 
6.5 million Americans and the job-killing fines of the individual 
mandate.
  It also repeals the employer mandate, which is the driver of the 
29ers and 49ers. For 7 years, the Democrats had no answer to the single 
mom forced to work part time. Repealing the employer mandate provides 
relief to everyone who finds himself in those camps.
  No. 3, this bill has a major reform that allows people to use health 
savings accounts--pretax money--to pay for insurance premiums. That 
means, for millions of Americans, their effective premium rates 
instantly drop 20 to 30 percent by using pretax money. That is a major 
reform for empowering you, the consumer, to choose the healthcare for 
your family.
  No. 4, the bill before the Senate includes the consumer freedom 
amendment--an amendment that I have introduced like the health savings 
account amendment. It is an amendment that says you, the consumer, 
should have the freedom to choose the healthcare that is best for your 
family. You should have the freedom. You shouldn't have to buy what the 
Federal Government mandates that you must buy; you should choose what 
meets the needs for you and your family.
  The consumer freedom amendment was designed to bring together and 
serve as a compromise for those who support the mandates in title I. 
The consumer freedom amendment says that insurance companies, if they 
offer plans that meet those title I mandates--all the protections for 
preexisting conditions--they can also sell any other plan that 
consumers desire. So it takes away nothing. If you like your ObamaCare 
plans, those are still there. It just adds new options and lets you 
decide: Do you want the ObamaCare option or do you want something else 
that is affordable? So rather than getting fined by the IRS, you can 
actually purchase something you and your family can afford.
  Now, our friends on the Democratic aisle have been unwilling to look 
at any option expanding consumer freedom; they just say it won't work. 
What we know won't work is ObamaCare. We know premiums have risen over 
$5,000 a year. What happens with the consumer freedom amendment? And 
this is critical. Over the past 2 weeks, the Department of Health and 
Human Services conducted a study on the impact of the consumer freedom 
amendment. They concluded, No. 1, it would expand insurance coverage by 
2.2 million people. Our friends on the Democratic aisle are constantly 
alleging that repealing ObamaCare will reduce coverage. Well, HHS found 
the consumer freedom amendment expands it by 2.2 million people.

[[Page S4181]]

  But what does it do to premiums? This is powerful. HHS found that it 
will reduce premiums by over $7,000 a year. If you are a single mom, if 
you are a school teacher, if you are a truckdriver, $7,000 a year is a 
lot of money. It is the difference between making ends meet and not, 
perhaps. HHS found specifically that for those choosing freedom plans--
the less expensive options--premiums would drop $7,260 a year.
  But what about those on the exchanges? What about those purchasing 
plans subject to all of the mandates? HHS found those plans would also 
drop, they projected by $5,580 a year. So consumers benefit across the 
board with lower premiums.
  This has been a process. At the end of this process, it is not clear 
what the Senate is going to pass, what is going to bring together and 
unite the Republican conference because, sadly, the Democrats are not 
willing to help us provide more consumer freedom, to help us lower 
premiums, to help us provide relief to the 49ers and 29ers who have 
been hammered by this bill. But I believe the key to getting this 
done--and I believe we can and will get to yes. We are not likely to 
get to yes tonight, but we can and will get to yes. I think the key to 
it is the consumer freedom amendment, if we are lowering premiums. If 
Texans, if Montanans, if people across this country are going home and 
seeing premiums $5,000 a year cheaper with protections for preexisting 
conditions or $7,000 cheaper if you want a catastrophic plan on a 
freedom plan, that is a win for everyone. It is a win for 
conservatives. It is a win for moderates. It should be a win for 
Democrats. If Democrats were not engaged in this partisan fight, 
Democrats ought to be saying that lowering premiums $5,000 or $7,000 is 
a win for our citizens. That, I believe, will be the key to getting 
this done.
  Let me finally say that there is rhetoric about insurance companies. 
Do you know who loves ObamaCare? It is insurance companies. Under 
ObamaCare, the profits of the top 10 insurance companies have doubled. 
When you have the IRS fining people to force them to purchase their 
product and driving up premiums so they are unaffordable, ObamaCare 
effectively sets up a cartel for the large insurance companies.
  Consumer freedom puts you, the consumer, in charge of your choices. 
Instead of the giant insurance companies, instead of the Federal 
Government, it puts you in charge. Freedom is the key to unifying our 
conference, and lowering premiums is the key, and I believe we can and 
will get this done.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, we are now considering the Cruz 
amendment, which he titles consumer freedom, but there could not be a 
more misnamed amendment to come to the floor.
  Americans know this as the fake insurance amendment. This is the 
amendment that says: Hey, insurance companies, we are going to do you a 
big favor and let you sell these policies that aren't worth the paper 
they are written on. And, Hey, isn't this wonderful, says my colleague 
from Texas, because, you know what, people will only have to pay a few 
dollars per month for those worthless policies, and that is freedom.
  Well, I will tell you that if my colleague had been out talking to 
people in rural America, as I have been, if he had been out there 
talking to people in red America, as I have been, he would be hearing 
that people are terrified about this effort to annihilate health 
insurance.
  One out of three people in Oregon have been able to be on the Oregon 
Health Plan because of ObamaCare. It has had an incredible impact on 
our rural healthcare centers. Many of them have doubled their number of 
employees. About 20,000 employees across the State have been added. Oh, 
we just heard a speech about it being a job killer, but, in fact, it 
has employed thousands and thousands more people in the healthcare 
industry across America. Little communities that didn't have folks 
being able to take on mental health can now take on mental health 
issues. Rural communities that didn't have a drug treatment program now 
have a drug treatment program. Rural hospitals that were going out of 
business now have a strong financial foundation. And that is just the 
beginning.
  Entrepreneurs across this Nation were tied up in their companies, 
afraid to leave and pursue their vision because they couldn't get 
healthcare by themselves. Now, they can, so they are starting one 
business after another after another after another, and what we have 
seen is month after month after month of growth in employment in this 
Nation.
  Oh, we can tell you about the amendment that my colleague from Texas 
is putting forward and what it does in terms of offering these fake 
policies, but that is only the beginning of it because what it is 
designed to do is carve off those who are young, carve off those who 
are healthy, and put them into one pool, and then those with 
preexisting conditions, those who are sick, those who are older, have 
to go to another pool in which the rates go way up and create a death 
spiral. So whether we call this fake insurance for the young and 
healthy or a death spiral insurance for the old and those with health 
problems or preexisting conditions, it is really blowing up the 
insurance market at both ends.
  Don't take my word for it; take the experts' word for it. We have a 
Republican Senator who said that there is a real feeling that there is 
subterfuge to get around the preexisting conditions, referring to this 
amendment. And then we have a staffer for a Republican who says: ``And 
outside health policy folks have said this would set up a death spiral 
for the markets.''
  OK, but let's turn to the American Enterprise Institute, an extremely 
conservative organization. What does their scholar say? He says, ``This 
means that people with those kinds of illnesses will end up paying 
more.'' And then he goes on to say, ``The people who don't know 
something will happen and come down with something, those are the ones 
at issue.''
  Or let's turn to the American Action Forum Deputy Director Tara 
O'Neill Hayes, who says: ``I think that really would be the definition 
of a death spiral.''
  Or we can turn to the former CBO Director, Douglas Holtz-Eakin, who 
says ``What that will do is allow insurers to offer cheap policies to 
young invincibles. And on the exchange you're going to get all the sick 
people.''
  He continues and says: ``That's a recipe for meltdown. You've split 
the risk pool into two exchanges.''
  And he says: ``I think it would end up being bad politics.''
  I am not concerned about bad politics, but I am concerned about those 
folks whom I have been meeting out in rural America, out in red 
America, because they are coming to my townhalls and they are saying: 
Stop this diabolical plan. The Cruz amendment only makes it a lot worse 
by creating the fake policies for the young and healthy--the young 
invincibles--and the death spiral insurance for everyone else.
  So someone can stand up here and speak glibly about how this is going 
to fix job creation in America, but what it really says is healthcare 
for the wealthy--not healthcare, but wealth care.
  It is so interesting to see this whole coalition of individuals who 
want to pass a bill that not only demolishes healthcare for 22 million, 
but gives hundreds of billions of dollars to the very richest in 
America. My colleague mentioned a moment ago that the richest 400 
families would get $33 billion. No, not $33,000 apiece or $33 million--
$33 billion. They feel it is so important to rip healthcare from 
ordinary working families to deliver benefits to the wealthiest 
Americans. That is the opposite--opposite--of what we should be doing 
in America.
  Franklin Roosevelt said that the test of our progress is not whether 
we add more abundance to those who have much; it is whether we do 
enough for those who have too little. What that translates to is 
whether we provide a foundation of affordable healthcare so that every 
family in America has a foundation to thrive. That is what we are 
fighting for.
  This amendment is absolutely a bomb going off in healthcare on both 
ends of the spectrum, with the young and with the old, with the healthy 
and

[[Page S4182]]

with the sick, and with those with preexisting conditions.
  So let's defeat this amendment and make sure we don't make a really 
terrible bill a lot worse.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. CRUZ. Mr. President, unfortunately, there is far too much 
scaremongering that occurs in the political world. But as John Adams 
famously said: ``Facts are stubborn things.''
  My friend from Oregon just described the consumer freedom amendment 
as ``a bomb going off in healthcare.'' That is interesting rhetoric, 
but it is disconnected from the actual facts.
  Let's talk about what my friend from Oregon neglected to mention or 
respond to in any way, shape, or form. He said not a single word about 
HHS finding that the consumer freedom amendment would expand insurance 
coverage by 2.2 million people. He had not a word to say in response to 
that. What he did say is that those who might choose freedom plans 
would be choosing what he called junk insurance.
  Well, it is very nice that ObamaCare mandates that every person must 
buy a full-fledged Cadillac plan with all the coverage in the world. 
The problem is, there are millions of people who can't afford it. Not 
only can they not afford it, they get fined by the IRS because they 
can't afford it. My friend from Oregon said not a word about the 6.5 
million people being fined by the IRS, roughly 50 percent of whom make 
$25,000 a year or less.
  It is interesting that Democrats are advocating fining people who 
make $25,000 a year or less because they can't afford insurance. And 
what they say is: Look, we are going to fine you until you can afford 
to buy the full Cadillac plan. Well, you know what, if you are a young 
woman, you are 28 years old, you are just starting your career, you are 
making $30,000 a year, you may not be able to afford the full Cadillac 
plan, but you might like some coverage. You might like catastrophic 
coverage. So if you get a cold, you break your arm, you cover that out 
of your health savings account perhaps. But if, God forbid, you get 
some terrible disease or hit by a truck, you would like to have an 
insurance policy.
  Sadly, our friends the Democrats say that you are out of luck. If you 
can't pay for the full-fledged Cadillac, you get nothing. They think 
your choices are junk insurance.
  Remember when Barack Obama said that if you like your insurance plan, 
you can keep it? Well, listen to how the Democrats have moved today. If 
they don't like your insurance plan, you can't keep it. If they think 
your plan is junk, you can't keep it, and they are going to fine you 
through the IRS. I think you know better what your family wants.
  The consumer freedom amendment doesn't take away a single choice. If 
you like the ObamaCare plans, they are still on the market with all of 
those mandates. But the Democrats are terrified of freedom. They are 
terrified that if people actually had the choice, they might not choose 
the full Cadillac; they might make a different choice.
  But then in the world of scaremongering, my friend from Oregon also 
said: Well, those on the ObamaCare exchanges would go into a death 
spiral, would see their premiums spike.
  Remember that John Adams quote about facts being stubborn things? 
Here is something else my friend from Oregon ignored, said nothing 
about. HHS found that for those on the exchanges, with all the title I 
mandates, including preexisting conditions, their premiums would drop 
by over $5,500 a year.
  So the question is, Who is more trustworthy, the experts at HHS 
analyzing what would occur with competition and choices in the 
marketplace or the rhetoric and scaremongering that sadly is being 
offered from the other side?
  It would be one thing if they were confronting facts, if they were 
actually addressing real facts; instead, it is nothing but angry 
rhetoric.
  My friend from Oregon described repealing ObamaCare and empowering 
consumers and lowering premiums as ``wealth care.'' Well, there is an 
irony in that; in that, No. 1, roughly half of the people paying the 
IRS fines are making less than $25,000 a year. It is the Democrats who 
are fining low-income people.
  No. 2, do you know who agrees with the Democrats on this? The 
insurance companies. Indeed, my friend from Oregon was reading from the 
insurance companies. Why have the top 10 insurance companies had their 
profits double? Because of the Democrats' mandate you have to buy their 
products. Do you know where the Democrats and the insurance companies 
agree? None of them want premiums to lower.
  Of course, the insurance companies don't want more competition, more 
options, and your premiums going down. They want to stick it to you as 
much as they can. Sadly, I don't understand why, but the Democrats are 
standing arm in arm with the insurance companies, saying their profits 
need to increase even more. I don't know, maybe they cynically believe 
eventually it will push it to single-payer socialized medicine. I don't 
know why they do it, but what is wealth care is ObamaCare fattening the 
insurance companies at the expense of working men and women.
  Facts matter, and if our friends on the Democratic side of the aisle 
want to raise accusations, they need to stay in the realm of reality 
and deal with actual facts: You want lower premiums, you want more 
choices, more options, more competition. You want higher premiums, you 
want fewer choices, less options, less competition. That is what 
ObamaCare does, and it is why millions of people are hurting and 
frustrated. It is why today is an important day.
  I yield back the remainder of my time.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, of course my colleague from Texas made 
this big rant a little while ago about how ObamaCare is a job killer. 
When I pointed out it has created jobs all over our country in 
healthcare, no response. When I pointed out it has created the 
opportunity for entrepreneurs to create jobs and healthcare jobs, no 
response. When I pointed out it creates fake insurance that doesn't 
cover anything when you get sick, no response. All he has to say is 
that it makes insurance a little cheaper.
  Yes, it is worth the paper it is printed on. Well, not even that, 
actually, because you pay $40 or $50 a month, you go to the hospital, 
not covered. If you get in an accident and you need an MRI, not 
covered. You and your spouse have the opportunity and have a child, not 
covered. Not covered, not covered, not covered. Fake insurance.
  It is the experts who say it throws it into a death spiral. It is the 
experts who say it in conservative think tanks and in liberal think 
tanks. So what does he have to say? We have something from the Trump 
team that says it is OK--not a CBO score because he is afraid it will 
show it makes it worse than the existing bill.
  So let's talk about real facts. Next time, don't bring in a political 
statistic from the Trump team. Let's get a CBO score on this. Then 
let's have that debate. You had plenty of time to get it and you didn't 
get it.
  This is a terrible amendment. We must defeat it.
  Mr. CRUZ. Will the Senator from Oregon yield for a question?
  Mr. MERKLEY. I believe my colleague has the remainder of the time.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, despite all Senate Republican leaders' 
efforts to keep this mean bill hidden from public view, patients and 
families know the truth.
  This legislation would cause families' healthcare costs to spike. It 
will gut Medicaid, and it will deny tens of millions of people their 
healthcare coverage. It will defund Planned Parenthood and take away 
critical healthcare services that women and men rely on, especially in 
our rural areas where it is already hard enough to get the care you 
need. TrumpCare would also completely pull the rug out from under 
patients with preexisting conditions. I could go on.
  I hope every one of my colleagues joins me in voting against this 
awful legislation, but this vote is far from the last time Senate 
Republicans need to reject TrumpCare, if they are really serious about 
protecting patients and families from the damage it would do, because 
if any version of this awful bill leaves the Senate, extreme 
Republicans in the House are going to do everything they can to make it 
even

[[Page S4183]]

more damaging--and anyone who believes differently is refusing to see 
the writing on the wall.
  I urge my Democratic and Republican colleagues to vote against this 
bill and every other version of it that we are going to see in the 
coming hours and days.
  Mr. President, I yield back all of our time.
  The PRESIDING OFFICER. Is all time yielded back?
  The Senator from Washington.
  Mrs. MURRAY. Mr. President, I raise a point of order that the pending 
amendment violates section 311(a)(2)(B) of the Congressional Budget Act 
of 1974.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. CRUZ. Mr. President, pursuant to section 904 of the Congressional 
Budget Act of 1974 and the waiver provisions of applicable budget 
resolutions, I move to waive all applicable sections of that act and 
applicable budget resolutions for purposes of amendment No. 270 and, if 
adopted, for the provisions of the adopted amendment included in any 
subsequent amendment to H.R. 1628 and any amendment between Houses or 
conference report thereon, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The legislative clerk called the roll.
  The yeas and nays resulted--yeas 43, nays 57, as follows:

                      [Rollcall Vote No. 168 Leg.]

                                YEAS--43

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

                                NAYS--57

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Coons
     Corker
     Cortez Masto
     Cotton
     Donnelly
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Graham
     Harris
     Hassan
     Heinrich
     Heitkamp
     Heller
     Hirono
     Kaine
     King
     Klobuchar
     Leahy
     Lee
     Manchin
     Markey
     McCaskill
     Menendez
     Merkley
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Paul
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden
  The PRESIDING OFFICER (Mr. Young). On this vote, the yeas are 43, the 
nays are 57.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The point of order is sustained and the amendment falls.
  The PRESIDING OFFICER. The Senator from Wyoming.


                 Amendment No. 271 to Amendment No. 267

       (Purpose: Of a perfecting nature.)

  Mr. ENZI. Mr. President, I call up the Paul amendment No. 271.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Wyoming [Mr. Enzi], for Mr. Paul, proposes 
     an amendment numbered 271 to amendment No. 267.

  Mr. ENZI. I ask unanimous consent that the reading of the amendment 
be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The PRESIDING OFFICER. The Senator from Indiana.


                            Motion to Commit

  Mr. DONNELLY. Mr. President, I have a motion to commit at the desk.
  The PRESIDING OFFICER. The clerk will report the motion.
  The senior assistant legislative clerk read as follows:

                   Motion to Commit With Instructions

       The Senator from Indiana [Mr. Donnelly] moves to commit the 
     bill H.R. 1628 to the Committee on Finance with instructions 
     to report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--
       (1) are within the jurisdiction of such committee; and
       (2) strike provisions that will--
       (A) reduce or eliminate benefits or coverage for 
     individuals who are currently eligible for Medicaid;
       (B) prevent or discourage a State from expanding its 
     Medicaid program to include groups of individuals or types of 
     services that are optional under current law; or
       (C) shift costs to States to cover this care.

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

                   Motion to Commit With Instructions

       Ms. Klobuchar moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--
       (1) are within the jurisdiction of such committee; and
       (2) provide a tax credit to individuals who do not qualify 
     for the credit under section 36B of the Internal Revenue Code 
     of 1986 equal to 25 percent of the premiums for health 
     insurance paid by such individuals during the taxable year.

                   Motion to Commit With Instructions

       Ms. Klobuchar moves to commit the bill H.R. 1628 to the 
     Committee on Finance of the Senate with instructions to 
     report the same back to the Senate in 3 days, not counting 
     any day on which the Senate is not in session, with changes 
     that--
       (1) are within the jurisdiction of such committee; and
       (2) provide a tax credit to small businesses for each 
     employee enrolled in their health plan who is 50 years of age 
     or older.

                   Motion to Commit With Instructions

       Ms. Klobuchar moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) would help rural hospitals stay open, maintain 
     emergency room care, and provide access to outpatient 
     services.

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

       Ms. Klobuchar moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such committee; and
       (2) repeal the noninterference clause under the Medicare 
     part D prescription drug program in order to allow the 
     Secretary of Health and Human Services to negotiate for the 
     best possible price for prescription drugs.

  Mr. PETERS. Mr. President, I intend to move to commit the bill H.R. 
1628 to the Committee on Finance with instructions to report the same 
back to the Senate in 3 days, not counting any day on which the Senate 
is not in session, with changes that,
  No. 1, are within the jurisdiction of such committee; and, No. 2, 
would ensure that the bill does not increase costs, reduce benefits, or 
eliminate health coverage for any veteran or dependent of a veteran 
enrolled in traditional Medicaid, expanded Medicaid, or a qualified 
health plan offered through an exchange.
  I am offering this motion because the legislation as written could 
harm millions of veterans and their dependents currently enrolled in 
traditional Medicaid, expanded Medicaid, and ACA exchange plans. The 
following Senators support my motion to commit: Duckworth, Stabenow, 
Carper, Whitehouse, Shaheen, Blumenthal, Hirono, Reed, Durbin and 
Baldwin. I ask unanimous consent that the full text of my motion to 
commit be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       Mr. Peters moves to commit the bill H.R. 1628 to the 
     Committee on Finance with instructions to report the same 
     back to the Senate in 3 days, not counting any day on which 
     the Senate is not in session, with changes that--
       (1) are within the jurisdiction of such Committee; and
       (2) would ensure that the bill does not increase costs, 
     reduce benefits, or eliminate health coverage for any veteran 
     or dependent of a veteran enrolled in traditional Medicaid, 
     expanded Medicaid, or a qualified health plan offered through 
     an Exchange.


[[Page S4184]]


  The PRESIDING OFFICER. The Senator from Wyoming.

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