AMERICAN HEALTH CARE ACT OF 2017--Continued; Congressional Record Vol. 163, No. 127
(Senate - July 27, 2017)

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              AMERICAN HEALTH CARE ACT OF 2017--Continued

  The PRESIDING OFFICER (Mr. Young). The Senator from Wyoming.

                 Amendment No. 502 to Amendment No. 267

  Mr. ENZI. Mr. President, I call up amendment No. 502, the Heller 

[[Page S4390]]

  The PRESIDING OFFICER. The clerk will report.
  The senior assistant legislative clerk read as follows:

       The Senator from Wyoming [Mr. Enzi] for Mr. Heller, 
     proposes an amendment numbered 502 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 as follows:

  (Purpose: To strike the sunset of the repeal of the tax on employee 
          health insurance premiums and health plan benefits)

       Strike subsection (c) of section 109.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BLUNT. Mr. President, we are talking today, obviously, as we move 
into the final hours of this debate, about the two mandates in the 
original Affordable Care Act, the individual mandate and the employee 
mandate--certainly, the individual mandate but both of these mandates.
  First, I want to talk about the individual mandate. It was 
unprecedented in Federal law. The idea that the Federal Government 
could tell somebody they had to buy a product, tell them what that 
product had to look like, and have very little input on the price or 
competition is just something the Federal Government had never done 
before. They didn't just set guidelines, they didn't even just set 
subsidies but actually a requirement to buy a product or pay a penalty.
  Now, when this case got to the Supreme Court, the government was 
still arguing it was a penalty and there was nothing wrong with that 
penalty, until apparently they figured out the Court wanted to look at 
this as a tax because a penalty wouldn't have been constitutional.
  Now, we all know this is a penalty. The Supreme Court can call it a 
tax, the Obama lawyers could at that moment decide, well, even though 
we set up the law as a penalty, we really think it must be a tax, and 
that 5-to-4 decision decided that because it was a tax, not a penalty, 
that part of the law was upheld.
  Nobody ever thought this was a tax before that day, nobody has ever 
seriously thought it was a tax after that day. It was a penalty you pay 
if you decide you don't want to do something the Federal Government 
tells you that you have to do.
  There is no constitutional basis that gives the government the 
authority to make that kind of decision, and families and individuals 
have been hurt by that decision.
  There is only one place to go on the individual market, the exchange. 
Remember that? We have almost forgotten the total disaster of the 
exchange. States tried to operate exchanges, almost none of them 
worked. States spent millions and tens of millions, and I think a time 
or two maybe even more than that to put an exchange together. It didn't 
work. That part of the law didn't work so you wind up mostly with one 
big exchange. Even with one big exchange, you have to think about 
whether the policies available in the county you live in--most of the 
debate over the past several years, a lot of the debate has been we 
ought to expand the marketplace, we ought to buy across State lines, we 
should have more choices and more places to go. Somehow we managed to 
define in this law, the law that is currently the law of the land, a 
marketplace that is about as small as it could possibly be.
  In our State, in Missouri, we have counties that have a million 
people. We have a county that has a million people. We have a county 
that has 4,000 people. The county that has 4,000 people has its own 
buying unit when it comes to looking at how the marketplace is set up. 
It just doesn't make sense. The deductibles are so high, the choice is 
so low. Some defenders of the law will say that costs will go up if the 
amendment passes. That is possible, but we know the costs will go up if 
the amendment fails. We know the costs will go up if we stay where we 
  Costs, since 2013, have increased an average of over 100 percent in 
the country--105 percent. This was the law that was going to reduce 
family costs by $2,500 a year. Families are generally relieved if their 
insurance didn't increase by $2,500 a year, let alone fail to reduce by 
$2,100 a year. So a 105-percent increase in 4 years--in Missouri, where 
I live, 145 percent is the increase.
  I think at least three States have had an increase of more than 200 
percent, and even with an increase of more than 200 percent, nobody 
wants to sell insurance there. Not only is there no competition, I 
think about one-third of the counties in America this year don't have 
more than one company that will even offer a product. Some have had no 
companies that would offer a product, and 40 percent is the estimate 
for next year. There are places where no more than one company will 
offer a product. What kind of competitive marketplace is that?
  The government, with the mandate, says you have to buy a product and 
you have to buy it in that marketplace and you have to buy it from that 
one company at whatever rate some other level of government has finally 
approved to keep the company there that probably didn't want to be 
there, but if you don't buy it, you pay a penalty.
  This is not working. Millions of people have chosen to pay the 
current penalty, which was $695, rather than to participate in a system 
that didn't work for them. Families can't continue to pay more and get 
  Remember former President Clinton's observation on this: What a crazy 
system. The costs keep going up and the coverage keeps going down. We 
have forced people to be in a system that according to President 
Clinton, the costs keep going up, the coverage keeps going down, and if 
you don't participate in that, you pay a penalty.
  We have to move in a different direction. Eliminating these mandates 
helps to do that. There are some Congressional Budget Office numbers 
out there that estimate what is about to happen. They certainly totally 
misestimated the current law. I believe, under the current law, there 
would be 25 million people, roughly, or some big number like that on 
the exchange today. There are 10 million instead of 25 million, 22 
million, whatever the projection was for this date in 2017. There are 
about 10 million.
  CBO is notoriously wild with their projections. They projected, for 
instance, that 15 million people would drop out of the individual 
market if one of the many burdens of this bill or these amendments 
passed. There are only 10 million people in the market. How do 15 
million people drop out if there are only 10 million people there?
  They said that 7 million people who get Medicaid and pay nothing for 
it wouldn't take that if the government didn't force them to. There 
must be something wrong with the insurance product and Medicaid both if 
people don't take it even if it is available to them. The current 
system isn't working.
  The other mandate, the employer mandate, is telling employers what 
they have to do. One of the great benefits of health insurance in this 
country since World War II has been insurance at work. It was pretty 
much an accident in 1946. The war was over, and no one wanted to heat 
up the economy too quickly so it was decided to have wage and price 
controls. Somebody asked the price control person: If we add insurance 
at work, does that count toward wages? They wanted to compete for more 
and better employees they could get coming back into that economy from 
the war. So they asked, if we add insurance to work, does that count as 
wages? The wage and price control person said, no, it wouldn't count. 
So they went to the IRS person and said: If it doesn't count toward the 
wage, is it taxable if they get it at work? That person said, no, it 
wouldn't be taxable either. So we have this unique system that 
developed. We need to figure out how more people can get insurance at 
work, more people can get insurance as a part of bigger groups. There 
are things that work and things that don't. The government requiring 
you to do something and thinking there is a constitutional right to do 
that just simply doesn't work.
  In fact, with the employer mandate, there are all kinds of unintended 
consequences. People with 50 employees didn't want to get more than 50 
employees. The 30-hour workweek became a problem. In fact, Ms. Collins, 
the Senator from Maine, from almost day one has said: Why do we want to 
enshrine the 30-hour workweek? Let's have a 40-hour workweek. Her 
amendment was offered and filed over and over again. Companies were 
reluctant to hire new employees. These are the

[[Page S4391]]

unintended consequences of the employer mandate. Too many people have 
two 26-hour jobs now who need a 40-hour job with good benefits instead 
of two 26-hour jobs with no benefits.
  More choices and the kind of access to healthcare people need is 
where we ought to be focused, a solution that provides healthcare and 
not just coverage. It is great to have insurance coverage. It is great 
to have even a government insurance coverage like Medicaid, unless no 
doctor wants to take any new Medicaid patients or if your insurance 
coverage deductible is so high. The averages on the bronze plan is 
$6,000 per individual, $12,000 per family. If your deductible is so 
high you can't go to the doctor, you don't have the kind of access to 
healthcare you need. You only have access to catastrophic sickness 
care. This system needs to change, and I believe one of the fundamental 
flaws in the system from day one was the government believing it could 
force people to purchase a product that didn't meet their needs and 
didn't meet what their family could afford to do.
  I am glad we are having this debate.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. LANKFORD. Mr. President, I would like to tell my colleagues a 
couple of stories. We are going to talk about what is happening in 
healthcare right now. There is the healthcare that is happening here in 
this room in the debate that is ongoing that started months ago, 
continuing to try to figure out the solutions to what we face with the 
Affordable Care Act. Then there are the healthcare issues happening at 
  Sometimes we get caught up in this conversation and think this is 
what the center of the healthcare conversation is about. It is not. The 
center of the healthcare conversation in America is around dinner 
tables. Let me tell my colleagues what that conversation sounds like.
  This comes from one of my constituents who just wrote to me. He said:

       My premium increases from $1,308 per month to $2,489 per 
     month. This is for just my wife and I. We are self-employed 
     small business owners and simply cannot afford to pay nearly 
     $30,000 per year for health insurance. We will have to pay 
     the penalty for not having healthcare, but we have to eat and 
     pay our bills. Sadly, we are both in our late 50s, and we 
     probably need healthcare more now than ever. Mr. Lankford, 
     this is not the America that I grew up in, the America my 
     father fought to preserve in World War II.

  That is the healthcare debate happening in America right now--
individuals who used to be able to afford their healthcare coverage, 
but now they cannot and no longer have healthcare.
  The Affordable Care Act did cover a new group of people who were not 
covered before, but it also pushed out another whole group who used to 
have coverage and now does not.
  This is an extremely personal issue. This is not a political issue. 
These are families and lives and children. These are individuals who 
have cancer and diabetes and a history of genetic diseases in their 
families, and they are very concerned about what happens politically in 
this room because it affects their families and their real lives.
  Congress needs to act on this. What is happening right now with the 
status quo is untenable for families all across the country. Insurance 
carriers have left the market. Rates have gone up dramatically. We have 
fewer choices and more control but less control for families.
  What does that look like in my State? Well, in my State, premiums 
went up last year 76 percent--last year--a 1-year increase. I have 
folks all the time who say to me that their great complaint is about 
the rising cost of college tuition. Let me give my colleagues a 
glimpse. College tuition has increased 76 percent in 15 years. 
Insurance in my State went up 76 percent in 1 year. In fact, since 
ObamaCare fully rolled out in 2013 until now, insurance in my State has 
gone up 201 percent. That is not the Affordable Care Act; that is a 
recipe to be able to push people out of insurance and keep them out.
  ObamaCare was designed to force healthy people to buy insurance to 
increase the risk pools for those insurance companies. But when you 
can't afford the premiums, you are forced to pay this big tax. Now, the 
question is, Who is paying the tax? Originally, ObamaCare said: Well, 
people who didn't buy into the insurance who want to just take the risk 
on their own, these wealthy individuals, they would have to pay the 
extra tax. Really? What did that end up looking like? Again, coming 
back to my State, 96,000 Oklahomans are currently paying the tax to the 
IRS because they don't have healthcare insurance. Who are they? Eighty-
one percent of the people who pay the penalty make less than $50,000 a 
year. These are individuals who cannot afford the insurance, and they 
also can't afford the fine that is coming from the IRS. It is a poverty 
tax that the Affordable Care Act created to try to force these people 
into insurance they cannot afford, and when they can't afford that, 
then they get a big hit on their taxes as well. It is literally a no-
win situation for them.
  One of the major goals of the Affordable Care Act was to provide 
affordable coverage. It was to be able to help people get into 
insurance. It was to be able to help improve the safety net. Those are 
not irrational goals. Those are good goals, but the execution of it was 
terrible, and the implementation has caused more problems than it has 
  In my State, many physicians in rural areas used to be independent. 
Now they have all been forced into working for big hospitals because 
they can't afford the compliance costs to keep their office moving 
anymore. So independent doctors and independent clinics are now part of 
big conglomerate hospital companies. I am glad they are there, or we 
would have no access to care at all.
  My State used to have four insurance carriers in the State. Now it 
has one, and that one is discussing leaving.
  I hear all the time people who are mad at Republicans saying: Why 
haven't you solved this yet? Quite frankly, this is an incredibly 
difficult issue. But I also want to be able to respond back to people: 
Don't gripe at the firefighters fighting the wildfire. They didn't 
start it. We are trying to put it out. Yes, I know the fire line is 
big, and, yes, I know it is difficult to put it out, but we are doing 
our best to resolve a fire we did not start. We will resolve this.
  So what is happening right now with our trying to resolve it? What 
are we trying to accomplish? We are trying to do several specific 
things dealing with the Affordable Care Act. This is not about 
resolving everything in healthcare. There are, quite frankly, lots of 
issues on which we have bipartisan agreement that we should work on in 
the days ahead, things like prescription drugs and so many other things 
we can do to help bring down the cost of healthcare itself, but in the 
meantime, we do have a dispute.
  Our Democratic colleagues have said to us that they want to be able 
to cooperate with us on healthcare, but the parameters are that we have 
to keep the individual mandate--that tax penalty on people in my State 
for people who make $50,000 or less to pay this giant tax; they want to 
keep that. They want to keep the employer mandate, which is 
dramatically driving up the cost of insurance for employers and 
decreasing wages. The initial estimates are that people in my State are 
making about $2,500 a year less now than they would be because of the 
employer mandate that is on them. So we can't negotiate and say ``Let's 
form a bipartisan agreement on this'' if they want to keep the 
individual mandate and the employer mandate. Those things hurt people 
at home.
  So here is what we are trying to do. This is a budget bill. It is 
called reconciliation. We are limited to only budget-related items to 
be able to deal with. So we are working on some of the basics of what 
needs to be repealed in the Affordable Care Act. We do want to get rid 
of the individual mandate. We do want to get rid of the employer 

  We do want to deal with how we can take control of healthcare out of 
Washington, DC, and get it back to the States, where it used to be. 
Prices are much cheaper when there is local control on healthcare than 
when there is Federal, centralized control.
  We would also like to find a way to get some of the bureaucracy out 
of this. You see, when there is a healthcare dollar paid and it first 
has to pay the Federal bureaucracy, then it goes to the State 
bureaucracy, then it

[[Page S4392]]

pays an insurance company bureaucracy, and then it pays a hospital 
bureaucracy, there is not much of that dollar left to finally get to 
patient care at the end. If we can take out one of those bureaucracies, 
we can actually get more dollars to patients rather than having them 
just feeding the bureaucracy of another layer.
  We are simply trying to deal with the mandates that are there, who 
actually makes the healthcare decisions for regulations and policy, 
whether it is the State or the Federal Government, and how we are going 
to balance out coverage for individuals who desperately need it in the 
safety net.
  I have heard a lot of folks talking about CBO scores. I will tell 
you, I am in the middle, and I am very frustrated with CBO right now. 
Every policy we want to float to say this is something we think will be 
very effective to be able to help people in the safety net or to be 
able to help people purchase insurance, CBO responds back to us: That 
sounds like an interesting idea; it will take us about 4 weeks to study 
it. When we are in the legislative process, when we are doing 
amendments, we can't wait 4 weeks between each amendment. We have to be 
able to get answers from them.
  So we are stuck in this spot, so our resolution is--we have a House 
version that has been scored, and we have a Senate version. We have a 
lot of changes we want to make, even to our latest version. The best 
answer we have while we wait on CBO scoring--another month to get us an 
answer--is to be able to get an interim bill, get into a conference 
between the House and the Senate, allow CBO the month that they need to 
score this, and for us to be able to pass a better bill in September. 
So that is where we are stuck right now.
  This is not a final bill that is coming out. This is still an interim 
process that is moving. But we need to be able to keep this process 
moving because there are people at home who are counting on this 
actually getting better for them in the future. Their words to me are: 
This cannot get worse, because I can't afford what we currently have, 
and I can't afford that access I have been given to healthcare.
  In the middle of all of this debate, a lot of people on the outside 
look at it and say: How come the Senate can't move faster?
  I respond back to them: We can't get a score from CBO, so we can't 
move any faster. We are stuck waiting on them.
  They typically will call me and say: Well, just run over CBO.
  We are not going to ignore the law, and we are not going to ignore 
the rules of the Senate, but we are going to work to actually get this 
  In the meantime, I have heard an awful lot of scare tactics coming 
out. It usually circles around, there will be 22 million people who 
will suddenly not have insurance. That is a fascinating number to me 
since only 9 million people have ObamaCare right now. Nine million are 
actually on the exchange. So it seems difficult to me for 22 million 
people to lose what only 9 million people have. But if you are an 
economist, they look at, on the horizon, people who may one day join in 
at some point, and then those people who may have joined in then might 
have lost their insurance. It makes total sense to an economist, but to 
all of us who just look at math, it becomes very difficult.
  CBO also believes that without a Federal mandate and a tax penalty on 
individuals, they will not buy this insurance product. People do not 
want to buy it and will not buy it unless they are made to buy it.
  The problem is, there are 6.5 million people in the country who are 
also required to buy it who are just paying the tax rather than buying 
the insurance.
  We need to allow people to make decisions on their own lives, but we 
need to also make sure there is actually an insurance product they can 
afford. And all the scare tactics about how we are going to throw out 
preexisting conditions and people who have preexisting conditions will 
be on their own--that is not true. Every single one that we have 
debated has included protection for preexisting conditions. We all are 
still honoring things like lifetime caps, annual caps. We have all 
included 26 and under. If you want to stay on your parents' insurance, 
you can still do that.
  There have been all of these scare tactics, like this will throw 
senior adults out on the street, and Medicaid is going to have these 
dramatic cuts. I looked at one of the proposals that was put out by the 
Senate and one of the drafts that we went through, and it said 
``dramatic cuts.'' Here are the ``dramatic cuts'' we had in Medicaid: 
Every year for the next 8 years, Medicaid increased at twice the rate 
of inflation. Every year for 8 years in a row, twice the rate of 
inflation, Medicaid went up. That is twice as fast as Medicare goes 
up--twice as fast as Medicare. So Medicaid was accelerating twice as 
fast as Medicare, and then 8 years from now, Medicaid went back to 
growing at the same speed as Medicare--at the rate of inflation. That 
was the ``dramatic cut'' in Medicaid. Every year going up twice as fast 
as inflation is a cut? Nine years from now, only growing as fast as 
inflation is a cut? But it is being portrayed that people are going to 
be thrown out on the streets and Medicaid is going away.
  I would encourage Americans to understand that the conversation has 
been a lot about political rhetoric. This body really is committed to 
the safety net. This body really is committed to allowing people to 
have choices again that they can actually afford for insurance. We are 
really committed to taking control of healthcare out of Washington, DC, 
and pushing it back to the States and to families so they can control 
healthcare decisions again. That is the real debate that is happening 
here. I know it is boisterous, and I know it is much easier just to 
have bumper sticker comments, but at the end of this, we have to 
realize there really are people who are involved in this, who are 
deeply affected by it.
  A couple more stories. A gentleman recently sent me an email saying 
that he received word that his premiums are rising from $1,229 a month 
to $2,205 a month to cover just him and his wife. His deductible is 
rising to $4,000 a person. His out-of-pocket maximum is rising to 
$13,000. That is under ObamaCare now.
  Another person who wrote me is currently enrolled in ObamaCare now. 
He is 62 years old, and his wife is 61.

       Our monthly health insurance premium increased by 71 
     percent to $2,900 last year. My wife and I are healthy with 
     no major problems, so my health insurance is the size of my 
     mortgage payment.

  That is under ObamaCare now.
  Under ObamaCare now, a lady from my State wrote me and said that for 
her first year, her monthly premium was $1,200. This year, she will pay 
$1,900 a month. She just got a letter from the one insurance company 
left in her State--the one opportunity she has to get insurance--saying 
that her monthly premium next year will be $3,540. That is an increase 
of 84 percent, or $42,000 a year, for insurance under ObamaCare now. 
Her simple statement to me is, How is this possible?

  I speak to some of my colleagues, and they say: Those stories aren't 
  I say: Let me introduce you to some real-life people outside of this 
political debate who are debating around their kitchen table about how 
they are going to make it with the rates that have been put on them.
  What we have now has to be addressed. I know this is a boisterous, 
loud process. But as we walk through the process, the end solutions are 
for these families, so that our noise helps them to actually move back 
to thinking about their kids and what they are going to do next in 
their retirement, and not to say: How in the world am I going to pay 
for my health insurance anymore?
  Let's get this finished. Let's move to the next stage. Let's get to 
conference and try to resolve the differences between the House and the 
Senate. By September, when we finally get a score back from CBO on all 
of our scoring and they finally get us information on the things we 
have asked for, let's get this passed so we can actually get this done.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Mississippi.
  Mr. WICKER. Mr. President, let me congratulate my colleague from 
Oklahoma for a very fine statement, and let me associate myself with 
each and every word and each and every fact he outlined in his very 
fine statement, and also with the remarks of my friend from Missouri 
who went before him. I appreciate their leadership on this issue.

[[Page S4393]]

  Let me, at this point, also give a salute to the First Amendment of 
the Constitution of the United States, to the right of freedom of 
speech, which we have seen exercised in this building and in this 
Nation during the course of this debate, and the freedom granted to 
petition the government for address of grievances. We have seen 
examples of that. They have been on full display in this healthcare 
debate, a phase of which will come to a close I hope this evening.
  Let me give a shout out to our staff members. They have fielded 
thousands, if not tens of thousands, of phone calls, letters, emails, 
and visits from Americans exercising their rights under the First 
Amendment. Americans have come to their Capital City, almost all of 
them in an appropriate and nondisruptive way--sometimes intense, for 
sure--expressing their opinions but also in display of their First 
Amendment rights.
  After all the debate, all the conversation, and all the exhortation 
on this issue, we have seen a lot of things said from the floor and a 
lot of things said on the news media that have amounted to a matter of 
opinion. But here is one thing I know for a fact. For four straight 
elections--2010, 2012, 2014, and 2016--Republicans ran on a promise to 
repeal and replace ObamaCare. We ran on that platform, and for four 
straight elections Republicans prevailed at the ballot box on the 
strength of that platform. I know that for a fact, and this I believe. 
Millions of Americans are at work today or at home or getting home from 
their offices, from their shops, from their factories. They are turning 
on the media. They are checking online. They are turning on the radio. 
They are wondering if a campaign promise is going to be kept by this 
party to which they have given the reins of government in four straight 
  We are close to keeping that promise. We are closer than we have ever 
been, and we can take a big step tonight on making good on that 
promise. That is not just a matter of keeping a promise, but I will say 
to my colleagues that it is important this platform be honored.
  Mr. President, I ask unanimous consent to speak for 10 additional 
minutes if there are no other people on the other side asking for 
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WICKER. So we are keeping a promise, but there is a lot more to 
it, as my friend from Oklahoma outlined, not only in fact but also in 
stories from honest-to-goodness Americans.
  This debate is about keeping Americans from hurting, about relieving 
the pain that this 2009 ACA has caused people to have. They were told 
they could keep their doctors. They wanted to keep their doctors, and 
it turns out they lost their doctors. They were told they could keep 
their healthcare plans. They liked their healthcare plans, and, in 
fact, they were not able to keep their healthcare plans. They were told 
their premiums would go down, and we have seen chapter and verse--as 
the gentleman from Oklahoma so forcefully outlined--of the dramatic, 
drastic, unspeakable increase in premiums that Americans have 
undergone. They were told they would have choice when it came to health 
insurance, and they have not had that choice. They have lost their 
freedom to make their own healthcare decisions, and that has been 
sacrificed in favor of a big government approach. So people are 
hurting, as has been explained on the floor tonight.
  Families in my State who do not have employer-based health insurance 
are paying nearly $3,000 more per year in premiums than they did 4 
years ago. In my State, it is a 116-percent increase in premiums under 
the Affordable Care Act over this short period of time. I guess we 
should be thankful we are not the 201-percent increase in premiums that 
our neighbors from Oklahoma have, or the 223-percent increase in 
healthcare premiums that our neighbors across the line in the State of 
Alabama have. But still, it is pretty bad wherever you go, and they 
were told and this program was sold on a promise of reducing healthcare 
  As has also been pointed out, 6 million independent-minded Americans 
have just said: I will not purchase this required insurance. I will pay 
the penalty, instead. The Supreme Court says it is a tax. We know it is 
a penalty. It comes right out of their pockets. They are doing that 
many times because they are independent-minded but many times because 
it is the only thing they can afford.
  So Americans are hurting. Americans from Missouri, Oklahoma, and 
Mississippi are hurting, and they are hurting all across America. My 
Republican colleagues know this. My Democratic colleagues know this.
  They say: Well, the ACA needs adjustment. It needs some help.
  But what is their solution? I think we are beginning to know, based 
on statements made and based on information coming forward, that our 
Democratic friends really want a single-payer system. That is their 
solution to the failed ObamaCare system we have now--a British-style, 
European-style, government-run insurance-for-all program. I don't think 
we need that in America. I don't think that is what Americans thought 
they were getting.
  My wife and I have never moved our family to Washington, DC. We have 
kept our home on the same street in Tupelo, MS, the whole time. We 
raised our kids in Mississippi. When the last bell rings this weekend, 
I will be on a plane back home to my State, moving around the State, 
talking to Mississippians, speaking to people who gave me this great 
opportunity to serve in this great body and this great system of 
  I want to be able to tell them when I go home after this vote that I 
have taken a big step in keeping the Federal Government out of the 
business of deciding healthcare for their families. I want to be able 
to tell them that they are now going to have more options to choose the 
plan that works for them. I want to tell people back home who put me in 
office that we put more power in the hands of the States, not unelected 
Washington, DC, bureaucrats. I want to be able to tell them we passed a 
bill that, as my friend from Oklahoma says, answers their concerns 
about preexisting conditions and takes care of those people with low 
incomes who need assistance in buying insurance. I want to assure the 
people back in my home State and all across America, as my friend from 
Oklahoma just did so eloquently, that the Medicaid Program will 
continue. As a matter of fact, it will continue to grow, but at a rate 
that is more sustainable, so we can afford it today and so we can 
afford the Medicaid Program in future generations.
  This has taken long hours of give and take. It may take more long 
hours in debates tonight and in a conference with the House, but we can 
get there. I see the solution formulating, and I am as optimistic as I 
have ever been that we will be able to keep this four-election promise 
we made.
  These reforms are now within reach. We should take advantage tonight 
of this opportunity to deliver on what was promised to the American 
people, to relieve Americans who are hurting from the current ObamaCare 
system, and to give them a better opportunity for affordable and 
accessible healthcare.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. TILLIS. Mr. President, I ask unanimous consent that the time 
until 8:30 p.m. be equally divided between the managers or their 
designees and that at 8:30 p.m., the Senate vote in relation to the 
Schumer or designee motion to commit, which is at the desk, followed by 
a vote in relation to the Heller amendment No. 502.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Nevada.

                           Amendment No. 502

  Mr. HELLER. Mr. President, I rise today to talk about my amendment, 
Heller amendment No. 502. It addresses one of the most onerous taxes 
enacted as part of the Affordable Care Act, commonly known as the 
Cadillac tax. The Cadillac tax is a 40-percent excise tax set to take 
effect in 2020 on employer-sponsored health insurance plans.
  In Nevada, 1.3 million workers are covered by an employer-sponsored 
health insurance plan. These are public employees in Carson City and 
service industry workers that work on the Las Vegas Strip. They are 
small business owners, and they are retirees across my State.
  Hardly anyone in Nevada will be shielded from the devastating effects 

[[Page S4394]]

this Cadillac tax. Across America, 54 percent of employers and almost 
151 million workers who currently enjoy employer-sponsored healthcare 
benefits will experience massive changes to their healthcare by the 
year 2020. We are talking about reduced benefits, we are talking about 
increased premiums, and we are also talking about higher deductibles. 
Hard-working Americans will suffer.
  That is why I joined Senator Heinrich from New Mexico in introducing 
what was called the Middle Class Health Benefits Tax Repeal Act earlier 
this year, with the support of over 75 organizations. Some of those 
organizations include unions, chambers of commerce, small business 
owners, State and local government employees, and retirees. They are 
all saying the same thing--that the Cadillac tax needs to be repealed. 
From unions to small businesses, employers are proposing sweeping 
changes to employee benefits today--right now--to avoid this onerous 
tax later.
  First, over 33 million Americans who use flexible spending accounts 
and 13.5 million Americans who use health savings accounts may see 
these accounts vanish in the coming years as companies scramble to 
avoid the law's 40-percent excise tax. HSAs and FSAs are used for 
things like hospital and maternity services, dental care, physical 
therapy, and access to mental health services. Access to these 
lifesaving services could all be gone for millions of Americans if the 
Cadillac tax is not fully repealed.
  Second, I have heard from employers, large and small, from all over 
Nevada, saying that they will inevitably have to eliminate services 
their workers currently enjoy, dramatically increase deductibles and 
premiums, and will have to cut certain doctors out of their networks. 
This goes right at the heart of ObamaCare's broken promise: If you like 
your healthcare, you can keep it; if you like your doctor, you can keep 
your doctor.
  This onerous tax targets Americans who already have high quality 
healthcare, and Nevadans have reached out to tell me how this tax will 
affect them. One of the stories that hit me the hardest was hearing 
from a school teacher in Las Vegas. As the son of a cafeteria worker, I 
know the sacrifices that these educators make each day. Cynthia, who 
works in the Clark County School District, sacrificed a higher paycheck 
to ensure that a quality health plan would be there when she retired. 
The Cadillac tax would place a 40-percent excise tax on her retiree 
benefits and cause her to deplete her savings to cover the loss.
  Seniors have worked their entire lives for these benefits, and the 
Cadillac tax puts at risk the sacrifices they have made for decades to 
have a safe and stable retirement. That is why I am committed to 
repealing this very bad tax. Many are in the service industry, like 
Michael from Las Vegas, who wrote to my office and explained how he is 
worried that the cost of his union-sponsored health insurance premium 
will now skyrocket. He is already seeing his deductibles increase and 
understands that next year there will be more increases to his 
healthcare premiums. Michael also shares his concerns about an imposed 
fine from the Internal Revenue Service, should he not have health 
insurance. He makes a valid point. If he loses his job, then how can he 
be expected to pay for his healthcare?

  Norm, a city employee from Southern Nevada, shared a concern with me 
recently: The last thing a self-insured provider wants to do is reduce 
benefits for his employees.
  Back in 2015, 90 Senators voted on the record in support of repealing 
the Cadillac tax, and I hope all 90 will join me again today. They 
recognize it will hurt middle-class families who, for reasons outside 
of their control, have health plans that already or soon will reach the 
Cadillac tax's cost limits. The tax will force many employers to pay 
steep taxes on their employees' health plans, flexible spending 
accounts, and possibly eliminate some employer-provided health coverage 
plans altogether. Under this tax, deductibles will be higher and 
benefits will be reduced even more, putting a strain on middle-class 
families trying to make ends meet.
  The short-term success of this was pushing the delay through 2020. 
Now it needs to be fully repealed. So I encourage all my colleagues to 
join me today in voting to support Heller amendment No. 502 to fully 
repeal this bad tax and send a message that Congress is serious about 
lowering costs for all Americans.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, time will be charged equally to both sides.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. SCHATZ. Mr. President, you know, late this afternoon, around 5 
o'clock, a number of Republican Senators indicated their unwillingness 
to support the so-called skinny bill, which would rip healthcare from 
16 million people, according to CBO, and increase health insurance 
premiums by 20 percent--and not 20 percent over several years, 20 
percent per year for the next several years, doubling health insurance 
premiums over the next 4 or 5 years. That is the bill we are talking 
about. They said that they don't like this bill, but they are willing 
to vote for it if they are provided assurances that this is just sort 
of a procedural vote.
  We just had a motion to proceed that was procedural in nature, 
according to them. We think it is the vote on healthcare.
  Now, this second vote, which is actually a vote to enact 
legislation--they are saying they are going to vote for it but only on 
the condition that we go to conference committee.
  Something just happened over the last couple of hours that is 
actually pretty astonishing. The House Rules Committee adopted what 
they call martial law. Now, it is not quite as bad as it sounds, but it 
is pretty bad. What that means is it gives total control over the 
procedures to the House majority. The House majority now is in a 
position to enact the skinny bill right away.
  There are a lot of Members of the Senate who want to talk about this, 
but I will just give you my little indicators that they are going to 
enact this into law by Sunday. They are going to enact this into law by 
Sunday. No. 1, the White House already has a name for it, the President 
has indicated a willingness to sign it sight unseen, and Paul Ryan just 
issued a statement that was not at all reassuring. There were lots of 
words, but none of them included ``We will not enact anything that 
comes from the Senate. We will go to conference committee, and if we 
don't have an agreement, we will not enact the Senate version of the 
  They are desperate to enact a bill before the summertime starts, and 
that is why we are all terrified here. There are a lot of people on the 
Republican side who hate the bill that they are going to be asked to 
vote for, and the only reason they are entertaining the possibility is 
that they want to go to conference. But they are not going to end up in 
a conference committee; they are going to end up in a signing ceremony 
over the weekend.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. Mr. President, if I could just pick up on the comments of 
my colleague from Hawaii, we had a comical discussion 2 days ago in the 
Democratic caucus lunch. Comedy isn't that unusual in a caucus with Al 
Franken, but the comic discussion was about how we would describe to 
the American public what a skinny repeal is. It was kind of phraseology 
that we might understand; how do we describe that to the American 
public? We took about half an hour to try to figure out how to do it, 
but about 2 hours ago, one of our Republican colleagues did it in 5 
seconds. He said--and this is the Senator from South Carolina--that the 
skinny repeal is a fraudulent disaster. That is what Senator Graham 
said--the skinny repeal is a fraudulent disaster. He did such a better 
job than we did of describing what the bill is, and it is a fraudulent 
disaster because it hurts people. It takes health insurance away, 
according to the CBO, from 16 million people, and it would jack up 
premiums in a compounding 20 percent this year, then an additional 20 
percent--40 percent the next year. That is why it is a fraudulent 
  But some Members, as was described by my colleague from Hawaii, are 
entertaining that: Even though we call it a fraudulent disaster, we can 
vote on it because, don't worry, the House will

[[Page S4395]]

create an opportunity for us to fix it and make it better. But the 
comments of the Speaker, which had to be clarified a few minutes later 
by his press spokesperson, have made absolutely plain that if this bill 
passes out of the Senate, it is intended to be passed by the House 
ASAP, and the President's spokesperson has said: We like this bill, and 
the pen is in hand--we are ready to sign it.
  So no one in this body should have any illusions: If the skinny 
repeal--otherwise known as the fraudulent disaster--passes, it is not 
to continue a process; it is to take health insurance away from 16 
million people, and it will raise premiums dramatically. And that is 
what the intent of this vote would be.
  With that, Mr. President----
  Mr. WYDEN. Mr. President, will my colleague yield for a question?
  Mr. KAINE. I will yield the floor for a question.
  Mr. WYDEN. Mr. President, just very quickly, the Senator pointed out 
this analysis we have gotten where the premiums go into the 
stratosphere. Senator Murray and I worked a long time on it.
  Wages for working people are going up about as fast as a snail trying 
to climb uphill. I am curious what you think that means for working-
class families in Virginia, because I know in my home State--and 
Senator Merkley and I have talked about this--we have working families 
right now who every single month are walking on an economic tightrope, 
balancing their food bill against the fuel bill, the fuel bill against 
the rent bill.
  Because my colleague was correct with respect to the fact that this 
would start, by the way, in January--this is not some kind of far-
removed thing--people are going to feel the hit of these skyrocketing 
premiums right away. What does my colleague think that is going to mean 
for working-class families in his home State?
  Mr. KAINE. Well, to respond, Mr. President, to my colleague from 
Oregon, one of the things we have seen in the first half year of this 
administration is, whatever job report comes out month to month--comes 
out at the beginning of each month, we are not seeing wage growth. We 
are not seeing wage growth. So imagine that continuing forward--
essentially no wage growth and 20 percent increases in premiums that 
then compound to 40 percent next year, 60 percent the year after that. 
This will be devastating.
  So if you put together the CBO consequences--16 million losing 
insurance, the 20 percent compounding increases in premiums, a likely 
dramatic destabilization of the insurance market, and then other 
features that we hear are in the skinny bill--for example, if you take 
funding away from Planned Parenthood--and 3 million women have decided 
that is their choice, that is where they are going to get healthcare, 
including many working women and women in working-class families--the 
premium effect is going to be absolutely dramatic, and it will be 
devastating to Virginians and Oregonians.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. BLUMENTHAL. Mr. President, we are here at a historic moment, and 
we listened to a historic speech just within the last 48 hours from our 
colleague, Senator John McCain. All of us welcomed him back and were 
inspired and overjoyed by his return and then by his speech asking that 
we go back to the regular order, that we have committee consideration 
of a bill, with hearings and markup and the democratic process really 
  What threatens us tonight is the democratic process being brought to 
new lows.
  If this bill is passed with the assurance that it won't go to 
conference--and there are conservatives, and I could quote them.
  Senator Lindsey Graham said earlier today:

       There's increasing concern on my part and others that what 
     the House will do is take whatever we pass--the so called 
     ``skinny bill''--not take it to conference, go directly to 
     the House floor, vote on it, and that goes to the President's 
     desk with the argument, ``This is better than doing 
     nothing.'' Here's my response. The ``skinny bill'' as policy 
     is a disaster. The ``skinny bill'' as a replacement for 
     Obamacare is a fraud. The ``skinny bill'' is a vehicle to get 
     in conference to find a replacement. It is not a replacement 
     in and of itself. The policy is terrible because you 
     eliminate the individual and employer mandate which we all 
     want eliminated but we actually want to have an overall 
     solution to the problem of Obamacare, so you're going to have 
     increased premiums and most of Obamacare stays in place if 
     the ``skinny bill'' becomes law. Not only do we not replace 
     Obamacare, we politically own the collapse of healthcare. I'd 
     rather get out of the way and let it collapse than have a 
     half-assed approach where it is now our problem.

  Senator John McCain said earlier today:

       I'm not supportive of the legislation as it stands today. I 
     am in close consultation with Arizona governor over the so-
     called ``skinny repeal.''

  Senator Ron Johnson said earlier today:

       Virtually nothing we're doing in these bills and the 
     proposal are addressing the problems and challenges and the 
     damage done to people.

  We will see, in effect, a betrayal of our trust, and I say that very 
  I hope this body will keep faith with our democracy and make sure 
that a bill that is regarded as a bad bill--and rightly so because it 
will eliminate insurance for 16 million people, it will raise premiums 
by 20 percent in less than a year, it will drive up costs, and it will 
bring down the number of people who are insured by catastrophic 
numbers. We owe it to the American people to vote against this so-
called skinny bill, which is really a sham repeal. It is a skeletal 
version of TrumpCare 2.0, 3.0, 5.0, 7.0. We can do that.

  With that, I yield the floor to my distinguished colleague from the 
State of Delaware.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. COONS. Mr. President, I want to speak for a few minutes on the 
floor to answer the calls I am getting into my office, the texts and 
the emails I am getting with people asking: What is going on? What is 
happening in the U.S. Senate? They can't keep track of what it is we 
have moved to.
  We don't know either.
  We are here probably all night waiting for the majority to finally 
produce the bill that they will use to attempt to repeal and maybe 
replace--or not--the Affordable Care Act.
  All we know is, every single proposal that has been brought forward 
in recent days has two features: It reduces coverage, and it raises 
  It may be that 16 million Americans will lose healthcare coverage. It 
might be 20 million, might be 32 million. Those are different scores 
for different proposed bills.
  It may raise costs by 15 percent, 20 percent, or 30 percent. Sometime 
later tonight, we will see the final bill presented on this floor, and 
hopefully we will get some score so we know what we are voting on 
before we finally get there, but what is so scary to families I am 
hearing from, is that after 7 months of majority rule, where the 
Republican Party controls the Senate, House, and White House, we don't 
have a finished bill for us to debate tonight in detail, and we don't 
know yet exactly what we will vote on later tonight. We just know a 
simple theme--every proposal that has been brought forward when scored 
by the CBO, the independent scorekeeper, offers less coverage and 
higher costs.
  Folks, I want to remind you about something because I just ran into a 
family out on the steps of the Capitol, outside the building, not 
inside the building--a family who is raising two typical children and 
one child with Down syndrome, a family where the father of the family 
is Active-Duty U.S. military. They asked me: ``Why can't we be heard?''
  The process that brought us here tonight did not include committee 
hearings, where doctors, nurses, patient advocates, folks who run 
hospitals, or folks who are specialists on insurance were heard.
  In a press conference earlier this evening, four of our colleagues 
said they are going to vote for this bill later tonight so it can go to 
conference and get fixed. They said the current expected skinny repeal 
bill is a fraudulent disaster, to paraphrase a colleague.
  Well, what I really think we should do is heed the advice that 
Senator McCain laid out on the floor a few days ago and go back to 
regular order.
  Just earlier today, there was an inspiring moment when we took up and 
passed by a vote of 97 to 2 the Russia

[[Page S4396]]

sanctions bill. We heard the chair and ranking Republican and Democrat 
of the Foreign Relations Committee speak positively of each other and 
positively of the process and they said the outcome is in the best 
interest of our country.
  As we have seen, we don't always follow regular order. Both parties 
have responsibility for moving things over the years without fully 
consulting each other and without going through the committee process. 
I think this is the moment where we should look at what happened 
earlier today on this very floor and follow that process, where the 
committees are included and consulted, and where we find a bipartisan 
resolution to what ails America. I am afraid that is not what is going 
to happen, and later tonight we will be forced to vote for or against a 
bill that raises healthcare costs for Americans and lowers the number 
of Americans who get healthcare coverage. If that is the case, this 
Senator will vote no.
  Thank you.
  With that, I yield the floor to my colleague from Connecticut.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. MURPHY. Thank you, Mr. President.
  We are starting to hear rumors of what is in the so-called skinny 
bill, and it is not skinny. It is humongous. It is filled with all 
sorts of conservative priorities, whether it be--these are rumors--the 
end to the individual mandate, the elimination that insurance companies 
are required to include certain coverages, the denial of funding to 
Planned Parenthood. This is not a bill that is designed to go to 
conference. This is a bill that is designed to become law.
  I just want to put all of the pieces together for folks what we are 
hearing tonight, because you are hearing, if you are following this all 
across America, different pieces of news emerging from different parts 
of this city. Let me try to put it together for you for a minute.
  First, you are seeing this skinny bill get fatter and fatter, which 
all of a sudden looks like a piece of legislation that is not designed 
to go to conference. It looks like a piece of legislation designed to 
become law.
  It is healthcare arson. It sets the insurance markets on fire. It 
immediately takes insurance from 16 million people and drives rates up 
by 20 percent on a compounding basis. This is insanity.
  It is getting bigger and bigger, which makes you wonder, wait a 
second, is this about going to conference or becoming law? Then we got 
another piece of information. The White House doesn't support the 
conference. The White House likes the skinny bill and wants it to 
become law. Then we got another piece of information. The House of 
Representatives tomorrow morning will declare what is called martial 
law. That is a procedural move that will allow the House to pass the 
bill that comes from the Senate as quickly as possible. This isn't 
going to conference, this is becoming law. Then the icing on the cake 
is the most curious piece of news: a statement from the Speaker of the 
House in which he says, not ``we will go to conference,'' he says, ``I 
am willing to go to conference.''
  Why ``I am willing to go to conference'' and not ``we will go to 
conference''? Well, maybe you got the clarification from his spokesman 
who said: ``Conference committee is one option under consideration, and 
something we are taking steps to prepare for should we choose that 
route, after first discussing with the members of our conference.''
  Can you see what is happening here? Can you see what is happening 
here? This is a bill that is being sold as just a procedural step to 
get to conference, but everything else that is happening around it 
suggests this is becoming law. Even if I am not right, let's also be 
clear about the process. Even if there is a conference, how on Earth is 
the conference going to come to a conclusion that the Senate could not? 
Right? You are going to introduce the Freedom Caucus to the U.S. Senate 
and think you are going to get more functionality and not less 
functionality? Even if you get to that conference, it will last for a 
couple days, maybe a couple weeks. They will come to no conclusion, and 
then guess what. The skinny bill, which is not so skinny any longer, is 
there for the U.S. House of Representatives to pass and put into law. 
All the while, the President of the United States is cheering that on. 
That is the signal he gave you. The President of the United States does 
not support a conference. He supports a bill that we are going to have 
unveiled later tonight and passed. He supports that bill going into 
  So even if you get to conference, with the President chiding the 
conference to give us and pass the Senate bill, which is available to 
the House for passage, that is what the outcome will be.
  So for our Senate friends who want assurances that this bill will not 
become law, you are getting exactly the opposite tonight.
  With that, I yield the floor to the Senator from Minnesota.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Mr. President, I thank my colleague from Connecticut 
for that really good and detailed description of how we got to where we 
are because I think it is really hard to explain to Americans at home 
who are watching this what a debate really is. I don't see my friends 
from the other side of the aisle right now, but watch what is happening 
here today because what I have seen in my State the last few months is 
  Families are coming up in the middle of a Fourth of July parade with 
their child with Down syndrome, bringing him over and saying: He is not 
just a preexisting condition. He is our child whom we love.
  This last weekend, I was with a family with two identical twins, 
Mariah and Evelyn. One is the catcher and one is the pitcher on their 
11-year-old softball team. Just in the last few years, one of them 
found out that she has a severe case of juvenile diabetes. The other 
one is perfectly healthy. What the mom told me is that they can hardly 
make it, paying for the cost of the insulin that has gone up 
astronomically over the years, paying for the testing strips and 
everything involved in this.
  Yet, now, instead of seeing a bill which reduces the cost of 
prescription drugs by including some of the provisions I have long 
advocated for--from ending pay for delay, where big pharmaceutical 
companies are paying off generic companies to keep their products off 
the market, or bringing in less expensive drugs from other countries or 
allowing for negotiation under Medicare Part D--instead of doing some 
of those innovative things we need to bring costs down for regular 
Americans, what we see here is going to make it worse.
  When I met with these two girls, I told them and their family that I 
had their back and that I would tell their story on the floor of the 
U.S. Senate. Never once did I think I would be saying it, even this 
last week, when we are facing this kind of onslaught to this family--
because what I would tell these girls now is that this bill, from what 
we have learned--we have not seen it, we don't know exactly what is in 
it--but from what we have heard, what would happen is, according to the 
nonpartisan Congressional Budget Office, it would kick 16 million 
people off of healthcare.
  I would ask those girls: Do you know how many people that is, girls? 
It is 14 States' worth of people. It is the combined population of 14 
States in the United States of America.
  What we have learned about this bill is that it would increase 
premiums by over 20 percent, again, according to the nonpartisan 
Congressional Budget Office. What I would tell them is that is more 
than their school clothes, it is more than their softball clothes, it 
is a good chunk of their college education. This is real money for real 
people and this reduces coverage and it makes it more expensive. We can 
do so much better.
  A few months ago, we went to that baseball game where the Republican 
men's team played the Democratic team. I was there in the stands, and I 
watched at the end this beautiful scene when the Democratic team won 
and they took the trophy and they gave it to the Republicans' team, and 
they said to put it in Representative Scalise's office.
  Why did they do that? Because they were saying we are all on one 
team. That is what this should be.

[[Page S4397]]

  When we are dealing with one-sixth of the American economy, we 
shouldn't be at night passing a bill that one of our most trusted 
colleagues on the other side of the aisle, a Republican, has just 
called ``a fraudulent disaster.'' That is not what we should be doing. 
We should be working on the fixes that so many people have been working 
on for so many years--bringing drug prices down, making the exchanges 
stronger with reinsurance and cost sharing. These are things we 
actually can do together.
  I ask my colleagues to work with us. We have opened the door. We want 
to work together on these changes and not to pass this fraudulent 
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. BENNET. Thank you, Mr. President. I appreciate so much my 
colleagues being out here on the floor.
  We are debating a bill that relates to 16 percent of our gross 
domestic product, almost 20 percent of our economy.
  I wish there were folks on the other side of the aisle who were out 
here tonight having this debate. I thank my colleague from Minnesota 
for the point she made.
  I want to state that I am really discouraged about where we are in 
our political system right now, and part of that is because politicians 
seem to think they can say one thing when they are running for office 
and do another thing when they get here and that somehow there is not a 
  I guess one of the reasons people think there is no consequence is 
that we have begun to treat edited content--journalism--as though 
somehow it is inferior to somebody just shooting their mouth off on the 
internet. We hear the President verbally assaulting journalists who 
have covered terrorism and who have tried to bring the story in Syria 
to the United States. Some have lost their lives. The President says 
they are not covering terrorism; then he attacks them as fake news. He 
goes to places like Youngstown and gets people to attack CNN or the New 
York Times or the Wall Street Journal--anything that is actually edited 
  I think it is because he thinks, A, he will not withstand the 
scrutiny of real journalists, but I think, B, he thinks it will help 
with this anything-goes style of politics, which says you can say one 
thing in the election and do something else.
  The PRESIDING OFFICER (Mr. Kennedy). The time of the Senator has 
  Mr. BENNET. I ask for an additional 3 minutes.
  The PRESIDING OFFICER. The Democratic time has expired.
  Mr. BENNET. I ask unanimous consent for an additional 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BENNET. Mr. President, I just don't think this Republic will work 
very well if we don't have a free press that is respected and if we 
don't hold people accountable for their campaign promises.
  Here is one of the things Donald Trump said during the campaign about 
what he was going to produce for the American people with respect to 
healthcare. He said that it was going to be beautiful, terrific--a 
beautiful and terrific plan to provide such great healthcare at a tiny 
fraction of the cost, and it is going to be so easy.
  That is what he said, in rally after rally across the United States 
of America, and a lot of people believed it. He talked about how much 
he hated the Affordable Care Act, or ObamaCare, whatever you want to 
call it, and all the reasons why; many of the reasons he talked about 
were manufactured.
  But that doesn't really matter anymore. He is the President. The 
Republicans are in the majority of the Senate, and the Republicans have 
a majority of the House. Their characterization--or 
mischaracterization--of the Affordable Care Act is not the issue 
anymore; the issue is what are they going to do for people living in 
the State of Colorado who are dealing with a healthcare system that is 
not supporting them terribly well. My colleagues heard that right. 
People who support the Affordable Care Act or oppose it, in my State, 
are deeply discouraged about the way our healthcare system works. And I 
think that if the President were keeping his promise, we would see 100 
people support the bill because it is actually consistent with what 
people at home want. They want more transparency when it comes to 
healthcare. They want more affordability. They want more 
predictability. That is what they want.
  If I set out to write a bill less responsive to that aspiration of 
the people I represent, who are critics of the Affordable Care Act--
Republicans in my State--I couldn't write a bill less responsive than 
the one the House of Representatives has passed and the one that was 
introduced by the majority leader after he wrote it in secret.
  It is 8:20 on the night we are going to have this vote, and we 
haven't seen the bill. After a year and a half of almost countless 
committee hearings, after adopting almost 200 Republican amendments on 
the Affordable Care Act, and then going to townhall after townhall, 
being accused of being a Bolshevik who hadn't read the bill, my 
question is, Why aren't people being held to that standard tonight? 
Maybe they are not asking us to read the bill because there is no bill 
at 8:20 on the night that we are supposed to take away 16 million 
Americans' healthcare, or 20 million Americans' healthcare--on the 
night we are supposed to vote for a bill that the Congressional Budget 
Office says will jack up insurance rates by 20 percent.
  They wrote the bill in secret. They didn't have a single hearing in 
the Senate--not one hearing in the Senate. Now it is 8:20 at night, and 
there are people in my State who think they are going to lose their 
health insurance because they might be one of those 16 million people 
or they might have a kid or a parent who has a preexisting condition, 
like the thousands of people who have contacted my office. They are 
terrified, and they are not even on the floor, and they can't read the 
bill. Read the bill.
  Now we are told there is going to be a procedural trick that is going 
to allow the House of Representatives to just pass this through over 
the weekend.
  That is a shameful way to run the Senate. It is exactly the opposite 
of what the majority leader promised he would do when he was the 
minority leader in the Senate. He is the one who said: If you can't get 
a vote from the other side--if you can't get one vote from the other 
side--you maybe should acknowledge that the American people aren't 
behind your bill.
  They can't even get all of the Republicans to vote for this. They had 
to have Mike Pence, who is the Vice President, come here to break a 
tie. What a disgrace to ask the executive branch to come here and save 
your bacon because you can't get the votes. And there is not a 
Democratic vote for this bill tonight because it doesn't meet the test 
that the minority leader himself had.
  I see my colleague from Michigan is here. I will yield the floor by 
just saying that we should stop this catastrophe. The only thing we 
know about this catastrophe is if it passes, there will be 16 million 
people who lose their health insurance and a bunch of rates go up. If 
we don't do it, that will not happen.
  I yield the floor.
  The PRESIDING OFFICER. The time of the Democrats has expired.
  Ms. STABENOW. Mr. President, I ask unanimous consent for 5 minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Ms. STABENOW. Mr. President, I want to support what my colleagues 
have been saying on this floor. The reason we haven't seen a bill, the 
reason we have no idea what is coming is that this is a political 
exercise by the Republicans. It is about winning and losing. But for 
people in the country, for people in Michigan, it is personal. This is 
not a political game. This is personal. For everyone who cares about 
their children and wants to make sure they can take them to the doctor; 
if you have a mom with Alzheimer's and you might lose the ability to 
have nursing home care; if you have cancer and know you may not be able 
to get the full treatments that you need, this is personal. And, as has 
been said, every single proposal of theirs is higher costs and less 
  So we voted on what was behind door No. 1, which would gut Medicaid 
healthcare. Three out of five Michigan

[[Page S4398]]

seniors get their nursing home care from Medicaid. Half of the people 
we see with Medicaid healthcare are children. All of the funds in the 
first proposal would go to tax cuts for the wealthy few and 
pharmaceutical companies and destabilize and undermine and raise costs 
for everybody else. So that is door No. 1: higher costs, less coverage.
  Then, when that didn't go forward, it was door No. 2. Door No. 2: 
Repeal everything that was passed under the Affordable Care Act and 
then say to folks somewhere down the road, we will figure out how to 
replace it. That is higher costs and less coverage.
  Now we are at door No. 3, and we don't know what is behind door No. 
3. All we know for sure is that it will be higher costs and less 
  Now, we as Democrats want just the opposite. We want to work together 
with our Republican colleagues to lower costs--by the way, starting 
with the outrageous increases in prescription drug costs. And we want 
to increase coverage options, increase health insurance. That is what 
we are all about. I believe--I know in Michigan--that is what people 
want me to be focused on.
  Are there problems in the current system? Of course, and we should 
fix those, but we don't have to rip away healthcare and raise 
everybody's costs 20 percent a year as is being talked about now in 
order to fix the problems that are there.
  I want to quote Senator McCain, who said that it is time to ``return 
to regular order,'' work to reduce ``out-of-pocket costs,'' and learn 
to ``trust each other'' again.
  It is pretty tough to trust colleagues, to trust the majority, when 
we aren't even given the respect of knowing what we are going to be 
voting on. And it is not just--it is not about us. It is not about us 
as individuals; it is about the fact that every person who is getting 
cancer treatments right now needs to know what the U.S. Senate is going 
to be voting on and have a chance to respond. Every person who cares 
about their child, who cares about their parent in a nursing home, who 
cares about their future has the right to know and to read a bill and 
know what is going on.
  I want to say in conclusion--I want to close with the words of Margo, 
who manages a health clinic in Kent County in the western part of 
Michigan. Margo knows the benefits of increased access to healthcare 
because she sees it every day. She knows it is not political; it is 
personal. There is nothing more personal than being able to take your 
child to the doctor and get the healthcare you need or care for your 
  Margo wrote:

       Seeing working people who have struggled all of their adult 
     lives to manage their chronic health conditions finally have 
     access to regular doctor visits, health education, and 
     prescription medications has been a tremendous relief. It is 
     amazing how different the lives of our patients are today 
     compared to what they were a few years ago.

  She added: ``You can't imagine the sense of dignity the people I see 
  The PRESIDING OFFICER. The Senator's time has expired.
  Ms. STABENOW. It is time to bring back some dignity to the U.S. 
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I heard somebody say that nobody was 
listening. Well, I was listening. I have read a little bit from this 
book before on the floor about healthcare. It is called ``Demystifying 
ObamaCare'' by David G. Brown, who is a doctor. He does a marvelous job 
of going through the history of how we got to where we are.
  He says, maybe we need to answer the question: ``What does ObamaCare 
do? What does ObamaCare purport to do? What does ObamaCare not do?''
  He says that those answers are relatively simple.

       ObamaCare is not a system of healthcare, nor is it a 
     healthcare reform. It is a system of healthcare control.
       ObamaCare was supposed to significantly reduce healthcare 
     costs, but instead it has dramatically increased costs for 
     even those who are not directly within the ObamaCare program.
       ObamaCare was supposed to increase access to care, but 
     instead it can actually reduce access (availability) of care.
       ObamaCare reduces the effectiveness of the safety net 
     program, which is so very important to economically poor 
       The quality of healthcare in America was derided when 
     ObamaCare was passed, but ObamaCare instead reduces the 
     quality of U.S. healthcare by reducing innovation.

  And then he says:

       ObamaCare removes a person's ability to make his own 
     decisions about his healthcare and that of his family. It 
     does so by removing the freedom to make those decisions.

  He continues that what we are trying to do is correct those problems 
and get back to a system of healthcare where the patient and the doctor 
get to make some of the decisions, where we encourage more people to be 
in the system, where we expand the use of HSAs, refundable tax credits, 
where we also allow people to buy insurance across State lines.
  We could put money back into State high-level risk pools. In fact, I 
really like the invisible risk pools that allow people to continue to 
pay what they were paying before, but to get the unique care.
  We could ``pass Medicaid to the States in terms of `block grants' or 
`per capita allotments,' '' and we could ``partially privatize Medicare 
starting in 2024 with the premium support system.''
  That is not in the bill; I am reading suggestions that he gives, 
including ``cap the amount for tax exclusions in higher cost employer-
based plans.''
  Now, you need to know that in the proposals that we have been putting 
out, in spite of what I have been hearing on this side, kids under 26 
still get to be on their parents' insurance. We are not taking that 
off. I keep hearing we are eliminating the preexisting conditions. We 
are not. There hasn't been a proposal to eliminate the preexisting 
conditions. So quit saying that. That is just fearmongering. As to 
eliminating the lifetime caps on insurance, I haven't heard a proposal 
for that. Also, allowing people to continue to be insured even if they 
change jobs--that is what this guy wrote in the book, and I would like 
for everybody to read it.

  He said there are five factors that drive up healthcare costs. One is 
taxes, another is mandates. Another is regulations. Another is lack of 
competition and flexibility within the marketplace. As to the fifth 
one, I don't know of anybody addressing yet, but it is the medical 
liability system that encourages defensive medicine and drives the 
costs up.
  Seniors need to be protected. There needs to be an effective and 
viable safety net system. Nobody is trying to work against that, 
regardless of what you are hearing here.
  I understand my time has expired. I have a lot more of the book I 
would like to share, but I am not sure it is productive, anyway.
  I yield the floor.
  The PRESIDING OFFICER. The Democratic leader.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that before the 
next amendment each side be given 2 minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.

                            Motion to Commit

  Mr. SCHUMER. 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:

       The Senator from New York [Mr. Schumer] moves to commit the 
     bill H.R. 1628 to the Committee on Finance with 
     instructions to report the same back to the Senate within 
     3 days, 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 the subsequent effective date in the repeal of 
     the tax on employee health insurance premiums and health plan 
     benefits, which reinstates the tax in later years.
  The PRESIDING OFFICER. The question is on the Schumer motion to 
  Mr. SCHUMER. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 43, nays 57, as follows:

[[Page S4399]]


                      [Rollcall Vote No. 176 Leg.]


     Cortez Masto
     Van Hollen


  The motion was rejected.

                           Amendment No. 502

  The PRESIDING OFFICER. There is now 2 minutes equally divided prior 
to the vote on the Heller amendment.
  The Senator from Nevada.
  Mr. HELLER. Mr. President, my amendment at the desk, Heller amendment 
No. 502, repeals the Cadillac Tax, plain and simple. No gimmicks. It 
repeals the Cadillac Tax, plain and simple. This is a bipartisan issue 
with bipartisan support. Under these circumstances, it is probably 
appropriate that we have a bipartisan issue that is here in front of 
  I would like to thank Senator Heinrich, my friend from New Mexico, 
for his hard work and effort on behalf of this particular issue. He has 
worked hard.
  This is an issue that is well-endorsed. We have the endorsement of 
organized labor, chambers of commerce, local and State governments, and 
small business organizations. They all supported repealing this very 
bad and onerous tax. Over 83 groups have endorsed full repeal. They are 
saying the same thing--that the Cadillac tax needs to be fully 
repealed, or employees will experience massive changes in their 
  Previously, this Chamber has voted nearly unanimously to support this 
full repeal.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. HELLER. Thank you, Mr. President.
  I would ask support from my colleagues on this Heller amendment.
  Thank you.
  The PRESIDING OFFICER. The Democratic leader.
  Mr. SCHUMER. Mr. President, first on the issue before us, most 
Democrats--the vast majority--are for repeal of the Cadillac tax. We 
are not for many of the other provisions being put forward. This 
requires the two to be tied together. We are for repealing the Cadillac 
tax but not harming the healthcare of millions of Americans.
  I want to make another point, especially to my friends, Senators 
McCain, Graham, Johnson, and Cassidy, who said correctly that the 
skinny bill was totally inadequate and they would require assurances 
from the House.
  Let me first read what Mr. Ryan said: ``If moving forward requires a 
conference committee, that is something the House is willing to do.'' 
That is not worth anything--only if moving forward is required.
  But I make another point that makes the case proof positive that this 
bill could pass and there is no assurance from the House. The House 
Rules Committee. There was a motion to limit the waiver of clause 6(a) 
of rule XIII--
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. SCHUMER. I ask unanimous consent for 30 seconds.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SCHUMER. To limit it just for motions to go to conference; 
rejected 4 to 9.
  If the House was intent on going to conference, they would have voted 
for this rule. It means they want to pass this bill, this skinny 
repeal, and send it to the President.
  I would urge my four colleagues and all the others to vote no until 
they get that assurance.
  I yield the floor.
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  Mr. HELLER. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The bill clerk called the roll.
  The result was announced--yeas 52, nays 48, as follows:

                      [Rollcall Vote No. 177 Leg.]


     Cortez Masto


     Van Hollen
  The amendment (No. 502) was agreed to.
  The PRESIDING OFFICER. The majority leader.

                 Amendment No. 667 to Amendment No. 267

                   (Purpose: Of a perfecting nature.)

  Mr. McCONNELL. Mr. President, I call up amendment No. 667.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Kentucky [Mr. McConnell] proposes an 
     amendment numbered 667 to amendment No. 267.
       Strike all after the first word and insert the following:


       This Act may be cited as the ``Health Care Freedom Act of 

                                TITLE I


       (a) In General.--Section 5000A(c) of the Internal Revenue 
     Code of 1986 is amended--
       (1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' 
     and inserting ``Zero percent'', and
       (2) in paragraph (3)--
       (A) by striking ``$695'' in subparagraph (A) and inserting 
     ``$0'', and
       (B) by striking subparagraph (D).
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.


       (a) In General.--
       (1) Paragraph (1) of section 4980H(c) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015, and before 
     January 1, 2025)'' after ``$2,000''.
       (2) Paragraph (1) of section 4980H(b) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015, and before 
     January 1, 2025)'' after ``$3,000''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.


       (a) In General.--Section 4191(c) of the Internal Revenue 
     Code of 1986 is amended by striking ``December 31, 2017'' and 
     inserting ``December 31, 2020''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to sales after December 31, 2017.

                   OUT-OF-POCKET LIMITATION.

       (a) In General.--Subsection (b) of section 223 of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new paragraph:
       ``(9) Increased limitation.--In the case of any month 
     beginning after December 31, 2017, and before January 1, 
       ``(A) paragraph (2)(A) shall be applied by substituting 
     `the amount in effect under subsection (c)(2)(A)(ii)(I)' for 
     `$2,250', and
       ``(B) paragraph (2)(B) shall be applied by substituting 
     `the amount in effect under subsection (c)(2)(A)(ii)(II)' for 
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 

[[Page S4400]]



       (a) In General.--Notwithstanding section 504(a), 
     1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 
     2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 
     1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 1397bb(a)(7), 
     1397ee(a)(1)), or the terms of any Medicaid waiver in effect 
     on the date of enactment of this Act that is approved under 
     section 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n), for the 1-year period beginning on the date of 
     enactment of this Act, no Federal funds provided from a 
     program referred to in this subsection that is considered 
     direct spending for any year may be made available to a State 
     for payments to a prohibited entity, whether made directly to 
     the prohibited entity or through a managed care organization 
     under contract with the State.
       (b) Definitions.--In this section:
       (1) Prohibited entity.--The term ``prohibited entity'' 
     means an entity, including its affiliates, subsidiaries, 
     successors, and clinics--
       (A) that, as of the date of enactment of this Act--
       (i) is an organization described in section 501(c)(3) of 
     the Internal Revenue Code of 1986 and exempt from tax under 
     section 501(a) of such Code;
       (ii) is an essential community provider described in 
     section 156.235 of title 45, Code of Federal Regulations (as 
     in effect on the date of enactment of this Act), that is 
     primarily engaged in family planning services, reproductive 
     health, and related medical care; and
       (iii) provides for abortions, other than an abortion--

       (I) if the pregnancy is the result of an act of rape or 
     incest; or
       (II) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness that would, as 
     certified by a physician, place the woman in danger of death 
     unless an abortion is performed, including a life-endangering 
     physical condition caused by or arising from the pregnancy 
     itself; and

       (B) for which the total amount of Federal and State 
     expenditures under the Medicaid program under title XIX of 
     the Social Security Act in fiscal year 2014 made directly to 
     the entity and to any affiliates, subsidiaries, successors, 
     or clinics of the entity, or made to the entity and to any 
     affiliates, subsidiaries, successors, or clinics of the 
     entity as part of a nationwide health care provider network, 
     exceeded $1,000,000.
       (2) Direct spending.--The term ``direct spending'' has the 
     meaning given that term under section 250(c) of the Balanced 
     Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 

                                TITLE II


       Subsection (b) of section 4002 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 300u-11) is amended--
       (1) in paragraph (3), by striking ``each of fiscal years 
     2018 and 2019'' and inserting ``fiscal year 2018''; and
       (2) by striking paragraphs (4) through (8).


       Effective as if included in the enactment of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10, 129 Stat. 87), paragraph (1) of section 221(a) of such 
     Act is amended by inserting ``, and an additional 
     $422,000,000 for fiscal year 2017'' after ``2017''.


       Section 1332 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18052) is amended--
       (1) in subsection (a)(3)--
       (A) in the first sentence, by inserting ``or would qualify 
     for a reduction in'' after ``would not qualify for'';
       (B) by adding after the second sentence the following: ``A 
     State may request that all of, or any portion of, such 
     aggregate amount of such credits or reductions be paid to the 
     State as described in the first sentence.'';
       (C) in the paragraph heading, by striking ``Pass through of 
     funding'' and inserting ``Funding'';
       (D) by striking ``With respect'' and inserting the 
       ``(A) Pass through of funding.--With respect''; and
       (E) by adding at the end the following:
       ``(B) Additional funding.--There is authorized to be 
     appropriated, and is appropriated, to the Secretary of Health 
     and Human Services, out of monies in the Treasury not 
     otherwise obligated, $2,000,000,000, to remain available 
     until the end of fiscal year 2019. Such amounts shall be used 
     to provide grants to States that request financial assistance 
     for the purpose of--
       ``(i) submitting an application for a waiver granted under 
     this section; or
       ``(ii) implementing the State plan under such waiver.'';
       (2) in subsection (b)(1), in the matter preceding 
     subparagraph (A)--
       (A) by striking ``may'' and inserting ``shall''; and
       (B) by striking ``only'';
       (3) in subsection (d)(1), by striking ``180'' and inserting 
     ``45''; and
       (4) in subsection (e), by striking ``No waiver'' and all 
     that follows through the period at the end and inserting the 
     following: ``A waiver under this section--
       ``(1) shall be in effect for a period of 8 years unless the 
     State requests a shorter duration;
       ``(2) may be renewed for unlimited additional 8-year 
     periods upon application by the State; and
       ``(3) may not be cancelled by the Secretary before the 
     expiration of the 8-year period (including any renewal period 
     under paragraph (2)).''.

  The PRESIDING OFFICER (Mr. Toomey). The majority leader.
  Mr. McCONNELL. Mr. President, the legislation I just laid down is 
called the Health Care Freedom Act, and it restores freedom to 
Americans that ObamaCare took away. It does so in a number of ways.
  First, the Health Care Freedom Act repeals the core pillars of 
ObamaCare. It eliminates the so-called individual mandate that forces 
many Americans to buy ObamaCare insurance they don't want, can't 
afford, or can't use, and taxes those who don't. It also repeals the 
employer mandate that cuts hours, take-home pay, and job opportunities 
for workers.
  Second, the Health Care Freedom Act provides significant new 
flexibility to States. The Health Care Freedom Act gives States just 
the kind of flexibility they need to implement reforms that provide 
more options for consumers to buy the health insurance they actually 
want. These reforms also help make insurance more affordable and 
flexible so it is something Americans actually want to buy.
  Finally, the Health Care Freedom Act frees Americans from ObamaCare 
in several other ways too. It provides 3 years of relief from the 
medical device tax, which increases costs, hurts innovation, and has 
drawn significant criticism from both sides of the aisle. It expands, 
for 3 years, the contribution limits to health savings accounts so 
Americans can better manage their health costs and pay down more of 
their medical expenses like prescriptions with pretax dollars.
  Also, the legislation will prioritize funding for women's health 
through community health centers instead of large abortion providers 
and political organizations.
  The American people have suffered under ObamaCare for too long. It is 
time to end the failed status quo. It is time to send legislation to 
the President which will finally move our country beyond the failures 
of ObamaCare. Passing this legislation will allow us to work with our 
colleagues in the House toward a final bill that could go to the 
President, repeal ObamaCare, and undo its damage.
  I urge everyone to support it.
  Mr. President, I ask unanimous consent that Senator Murray or her 
designee be recognized to offer a motion to commit; further, that the 
remaining time be equally divided between the managers or their 
  The PRESIDING OFFICER (Mr. Kennedy). Is there objection?
  Without objection, it is so ordered.
  The Senator from Washington.

                            Motion to Commit

  Mrs. MURRAY. Mr. President, I move to commit H.R. 1628 to the 
Committee on Health, Education, Labor, and Pensions with instructions 
to report the same back to the Senate within 3 days, not counting any 
day on which the Senate is not in session, with changes that are within 
the jurisdiction of such committee.
  Mr. President, after months of secret negotiations and backroom deals 
and shutting out patients and families and women and Democrats and even 
many Republicans from the process, Republican leaders continue to say 
they are planning to force a vote on this latest TrumpCare bill 
tonight--a bill even Republicans admit would throw our markets into 
turmoil. It is going to kick millions of people off of care, it is 
going to raise premiums for millions of families, it will eliminate 
healthcare for women across the country, and so much more--none of it 
  It does not have to be this way. In fact, Republicans can still 
reverse this course. They can drop this once and for all and join with 
Democrats to get to work to actually improve healthcare, to reduce 
costs, to increase access, and to improve quality. We can start over 
with an open, transparent process, in which both sides--Democrats and 
Republicans--have a voice and one in which patients and families can 
make sure their priorities are being addressed.
  Now, I know many of our Republican colleagues prefer this bipartisan 
route. We have heard them say it. They have said it over and over in 
their votes to reject the partisan TrumpCare bill and

[[Page S4401]]

full repeal bills this week, in their discussions of hearings we should 
be holding, and in their comments even over the past few hours, laying 
out how devastating this bill would be for patients and healthcare 
markets and making it clear they do not trust the House to not simply 
pass whatever moves through the Senate.
  So I call on Republicans now to join us. Let's do what my colleague, 
the senior Senator from Arizona, and so many others have bravely called 
for. With this motion, we will send it back to the committee, where we 
can debate it, where we can work together, where we can do what is 
right for the people we represent.
  I urge my colleagues to support this motion to commit in the way that 
Republicans and Democrats have been talking about. I can personally 
assure every one of you that I will work with you--and I know other 
Democrats will as well--if we reject this process and send it back with 
this motion to commit to do it the right way, the respectful way.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. MURPHY. Mr. President, this process is an embarrassment. This is 
nuclear-grade bonkers what is happening here tonight.
  We are about to reorder one-fifth of the American healthcare system, 
and we are going to have 2 hours to review a bill which, at first 
blush, stands essentially as healthcare system arson.
  This bill is lighting the American healthcare system on fire with 
intentionality. To use the word ``freedom'' at its center--there is 
freedom in this bill. There is the freedom to go bankrupt, there is the 
freedom to get sick and not be able to find a doctor, and there is 
freedom in this bill to die early. That is not hyperbole. That is what 
happens when, overnight, 16 million people lose insurance.
  Don't tell us that is because people all of a sudden will not be 
mandated to buy it. This is a vicious cycle that happens. When you get 
rid of the mandate, every insurance company will tell you that rates 
skyrocket because you are not getting rid of the provision that 
requires insurance companies to price sick people the same as healthy 
people. CBO says that rates go up immediately by 20 percent and then 20 
percent after that and then 20 percent after that. So all of a sudden 
you can't have the individual mandate because nobody can afford to buy 
the product.
  There is a lot of freedom in this bill, it is just not the kind of 
freedom we all thought was at the heart of this reform measure. This is 
real life. It is not a game.
  I know lots of Members on the Republican side are voting for this 
because they have some promise that even though this bill is terrible--
and everybody admits it doesn't solve any problems--it will get to a 
forum in which the problems can be truly solved. That is gamesmanship. 
That is not senatorial. That is not what this place was supposed to be. 
This was supposed to be the great deliberative body where we solved big 
problems, and this bill surrenders to the House of Representatives.
  Let's just be honest about what is going to happen when this bill 
gets to the House. Maybe there will be a conference committee, but it 
will not resolve any of the problems which have been inherent in the 
Republican conference here in the Senate. In fact, those problems will 
get worse because you will inject the Freedom Caucus into a Republican 
conference here that alone wasn't able to come to a conclusion. They 
will argue for a couple weeks, maybe a month, and then the House will 
decide to proceed with a vote on this bill.
  There is nothing in the rules that locks this bill into the 
conference committee once it is there. The House can pick it up out of 
that conference committee and move it to a vote--and they will do that 
because none of the problems that were solved here will be solved 
  We have seen this happen before. Remember the budget stalemate in 
which this hammer of sequestration was created, and the supercommittee 
was supposed to solve all the problems the House and the Senate 
couldn't? They didn't, and now we are stuck with sequestration--
something nobody thought would happen. This is the same thing.
  This will not be a hammer sufficient enough to solve the dysfunction 
which has always been present in this process. Thus, the conference 
will be doomed, and this bill will become law--raising rates for 
everyone, locking millions of people out of the system of insurance, 
with no answer for the parents of those disabled kids who have been 
begging to get into Senators' offices. This isn't a game. This is real 
life. If this bill becomes law, real people will be hurt.
  We are begging our colleagues to vote for the motion to commit. Take 
us at our word. We want to work with you. We acknowledge there are 
still problems that need to be solved, though we maintain there are 
parts of the Affordable Care Act that are working. What if we owned the 
problem and the solution together? What if this wasn't a perpetual 
political football? There is still time for us to work this out 
together if you support us and vote for the motion to commit.
  This process is an embarrassment to the U.S. Senate. This isn't why 
we all came here--and don't delude yourself into thinking that this 
bill you are voting on will not become law. There is a very good chance 
that it will, and the end result will be absolute devastation and 
humanitarian catastrophe visited upon this country.
  It doesn't have to be this way.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Mr. President, it has been an amazing process. I have 
been here a little over 10 years, and I have never seen anything like 
  We voted cloture a few days ago to move to debate. Nothing. Now we 
have a bill here today that as Senator Murphy has already pointed out, 
will rip healthcare away from millions of people, increase premiums by 
20 percent a year, and basically solve none of the problems that are 
out there that need to be solved that affect Americans every day, 
especially rural Americans.
  I must thank the Senator from Washington, Mrs. Murray, for the motion 
to take this back to committee. This is where we should have started. 
We should have started in the committee process like our forefathers 
had designed this place to work, the greatest deliberative body in the 
world, but it didn't. Every bill has been drafted by a select few in a 
backroom, with no input from anybody, especially people from rural 
America. So it is really time, folks, to open this process up.
  As I have gone around the State of Montana--and I have for the last 8 
months--talking to folks about healthcare in rural America, they are 
very nervous. I am going to tell you something. If people cannot pay 
their bills because they don't have health insurance or they don't have 
the money, it is going to put these small hospitals at risk, these 
rural hospitals at risk.
  I will tell you a little bit about the town I grew up in. This is a 
town where my grandparents homesteaded over 100 years ago. From the 
time of the homestead era until the midsixties, they didn't have a 
hospital. Their hospital was the top floor of a place that sold dry 
goods. In the midsixties, they finally scratched up enough money, and 
they built a hospital.
  Big Sandy is not near as big today as it was back then. I am going to 
tell you, the hospital administrators from these small hospitals, the 
folks in the Montana Hospital Association have told me that if charity 
care goes up, they could close and at a bare minimum change their 
method of delivery for healthcare.
  What does that do to a small town? Oftentimes, the hospital is the 
largest employer in that town. They usually fight with the school 
district for that honor. You take the hospital out, you take the heart 
and soul out of that community.
  You want to see a mass exodus from rural America, even bigger than it 
has been over the last 50 years? Pass this bill. Pass this bill.
  This isn't about numbers, and it isn't about words; it is about 
people. Big Sandy is not unique. Every rural town in the State of 
Montana that has a hospital is in that position. It is the same thing 
in Wyoming. It is the same thing in North and South Dakota. It is 
probably the same thing in more urban States that have rural areas, 
where these small hospitals will be put at risk of closure. It is not 

[[Page S4402]]

  I am going to tell you that if we follow the process that should be 
followed in this great body, we would take this healthcare bill and put 
it back in committee, have a debate, listen to ideas from everybody, 
rural and urban alike--farmers and ranchers, businesspeople, healthcare 
professionals, families, doctors, nurses--and we could come up with a 
bill that could work for this country. But that is simply not the case 
here tonight, and we should not be proud of this at all.
  Our forefathers set up a great system that can work, and the majority 
has chosen to ignore that system. It is a disgrace to the Senate.
  I yield the floor.
  The PRESIDING OFFICER. (Mr. Toomey). Who yields time?
  The Senator from Ohio.
  Mr. BROWN. Mr. President, let's look at how all this started. Right 
down this hall, a few months ago, Senator McConnell, a handful of 
Republican Senators, the drug lobbyists, insurance company lobbyists, 
and Wall Street lobbyists met in that office behind closed doors. Most 
Republican Senators didn't know what was happening, no Democratic 
Senators knew what was happening, and the American public didn't know 
what was happening.
  This bill--written by drug companies, insurance companies, and Wall 
Street--was sent to the Senate floor, was discussed, and, alas, it was 
big tax cuts for the drug companies and the insurance companies.
  When you think about this, you have U.S. Senators who get taxpayer-
subsidized insurance, Senators who get insurance provided by taxpayers 
who are going to rip it away from potentially 700-, 800-, 900,000 
  I stand with Governor Kasich. Governor Kasich said: You don't pass 
legislation--you don't meet in the majority's leader's office down the 
hall here, write legislation with drug company and insurance company 
lobbyists, and then take Medicaid away, take insurance away, disrupt 
the insurance markets. You just don't do things that way.
  A professor of healthcare finance at Case Western in Cleveland wrote 
yesterday that millions would lose coverage and that middle-income 
Americans would be ``priced out of the market.''
  If I could talk for a moment about what happens to individuals, 
yesterday I was on the phone with Donna May from Gahanna, OH. She told 

       My mother is 91 years old. She worked hard all her life. 
     I'm 73 years old and still work. Without Medicaid, or even 
     large cuts in Medicaid, I will not be able to care for my 

  Donna and so many others pay into Social Security. They pay into 
Medicare. They pay into unemployment insurance. And then this Congress 
is going to cut their Medicaid. This Congress is going to take money 
away from them when they need it, when they run out of money at the end 
of their lives and they are in nursing homes. Is that what we stand for 
as a country?
  In Toledo, I talked to Kelly Peterson. Her dad is in a nursing home 
and relies on Medicare. She told me:

       My family would be devastated by these proposed cuts to 
     Medicaid. My dad worked in the auto industry and paid into 
     the system 30 years. Now when he needs it most, conservatives 
     in Congress want to take it all away.

  Again, these people paid into Social Security. They paid into 
Medicare. Now we are going to take their insurance away from them as 
they grow older. A bunch of Members of Congress who have insurance 
provided by taxpayers think it is morally OK to strip the insurance 
from millions of people in our States.
  Again, I side with Governor Kasich. I am a Democrat. He is a 
Republican. He is as repulsed as I am that down this hall, Senator 
McConnell and Republican leadership, with the drug and insurance 
company lobbyists, wrote this bill.
  I stand with Governor Kasich, who wants to do a simple thing: Stop 
this outrageous attempt tonight. Sit down with Republicans and 
Democrats in both parties. I could sit with Senator Portman. We could 
come up with legislation to fix the Affordable Care Act; to encourage 
more young, healthy people into the insurance pools; to stabilize the 
insurance market; to go after the outrageous cost of prescription 
drugs; maybe even to open up Medicare eligibility for people between 55 
and 64. It is not complicated.
  The special interests have taken over this Chamber. We should be 
ashamed of ourselves. We ought to do this right. I ask my colleagues to 
vote yes on the Murray motion to recommit.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. MANCHIN. Mr. President, I rise in support of the motion to commit 
by my friend from the State of Washington. Let me tell you why.
  We have a problem that most all of you have in your States, which is 
opioids. This opioid addiction that goes on is affecting everybody--not 
just Democrats, not just Republicans. I don't care whether you are poor 
or rich or whether you are conservative or liberal--it has no base at 
all; it is a silent killer.
  For the first time, under the Affordable Care Act, we are able to get 
some treatment. We have not been able to do that before. The only 
treatment people have gotten before--when a parent comes to you and 
says: I just have to hope my child--if my child gets arrested, they can 
go into drug court, and maybe they can get some care, some treatment.
  For the first time, through Medicaid, we can give treatment for 
opioid addiction. We never had this chance before, never had this 
opportunity. It is really lifesaving for these people. It gets them 
back into the workforce, too, and they can clean up their lives. They 
really want this done.
  We are talking about 33,000 Americans who lost their lives in 2015. 
In any other scenario, that would be an epidemic or a pandemic. Here we 
go. We still don't have any adequate treatment centers. We have no way 
that we can go forward and fight this illness. We sit here and talk 
about it.
  Now we are talking about, well, we know 16 million people are going 
to be thrown off. We know that. We know the premiums will go up 20 
  Some one said: You know, you can still have preexisting conditions. 
We are going to take care of them. They can find it. It is available.
  I have said this before: A Rolls Royce is available to me; I just 
can't afford to buy it. That is what we are going to be faced with.
  But this is fixable. What we have said about fixable, we as 
Democrats--there are those of us in this body who will sit down--as 
Senator Murray has said--will sit down tonight. We will start tonight 
if you want to and look at ways we can make this more effective, more 
beneficial for everybody.
  When you think about the reinsurance, we know it has worked in 
Alaska. The Affordable Care Act--the so-called ObamaCare--has been out 
long enough now that we know where the problems are, we know where the 
fixes need to be, and we know how do it. We have seen Alaska do 
something that looks very promising.
  Also, when Vice President Pence was Governor in Indiana, they did a 
Medicaid expansion in Indiana. They are putting in accountability and 
responsibility. It has great effects. My good friend Mitch Daniels was 
the Governor at the time they put this plan into place, and it has 
worked and worked well.
  We are willing to sit and talk. These are good things. We think we 
can make this happen. We have been shut down at every turn. I have 
said: This is not how we were taught in West Virginia. It is not how we 
do business. We sit down and work through it.
  I don't care what side of the aisle you are on--we came here to do 
the right thing for the country. We are all Americans. We all have 
something in common. We are all on the same team, I hope, and that is 
Team America. Let's fix this.
  Let me tell you what will happen if you don't fix it. Let me tell you 
what will happen for the people who lose it. Do you know where they go 
back to? And I don't know why people think there is a savings involved. 
They are going back to the emergency room.
  When I was Governor, every year they came to me and said: Governor 
Manchin, we need $12 million for a rural hospital. We gave all this 
charity care away.
  They are going to go back to that. Do you think that is quality? 
There is no preventive care. There is no planning. There is nothing to 
help these people

[[Page S4403]]

have a better quality of life. We are going to pay again. We are going 
pay dearly for this. We are not going to have any chance to get people 
back in the workforce.
  All we are asking for, please vote for Senator Murray's motion to 
recommit. Give us a chance to do what we were sent here to do. Let's 
work the legislation. Let's sit down and find the commonality that we 
can find as Americans and move forward with a piece of legislation that 
can change people's lives, that can save people's lives and can give 
them hope again for the first time. That is all we are asking for.
  I would ask each and every one of us to search our souls and our 
hearts while we are here, what we are here to do, what our purpose of 
being here is, and give us a chance to fix a healthcare system that 
needs to be fixed but also needs to be available for the people in my 
great State of West Virginia and everyone in this great country.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, this bill is the product of the most 
secretive and partisan process I have seen in my 10 years in the 
Senate. Who did the magicians who came up with this listen to? They 
obviously didn't listen to the doctors. The American Medical 
Association is opposed to this. The American Pediatric Society is 
opposed to this. The American Academy of Family Physicians is opposed 
to this. Certainly the doctors didn't get a chance to get heard in this 
  How about the hospitals? The American Hospital Association is opposed 
to this. Catholic hospitals are opposed to this. Rural hospitals are 
warning that this could end their very existence. Let's have a process 
that gives the hospitals a chance to be listened to.
  The nurses in Rhode Island are opposed to this. I think nurses around 
the country are opposed to this. Why not have an open process that 
gives the nurses a chance to be heard?
  Our community health centers are opposed to this. They have been to 
Washington to say: Please don't do this. You will be hurting real 
people whom we care for.
  Illness advocacy groups--the people they are fighting for are stuck 
in this healthcare system with serious illnesses. Did we listen to the 
American Cancer Society? No. Did we listen to the American Lung 
Association? No. We didn't even listen to the hemophilia group, for 
Pete's sake. Addiction treatment groups are against this.
  We have listened to nobody. We didn't even listen to the Republican 
Governors, let alone the Democratic Governors, like my Governor, who is 
telling me: We are working fine. We having people on Medicaid. Our 
exchanges are working.
  Why fire this torpedo into perfectly working exchanges when we can be 
working on fixing the few where it is not working?
  Why are we here? Who is behind this? Who was telling the little group 
of magicians in their secretive back room what to do? This is what 
happens when a party becomes beholden to a small handful of creepy 
billionaires and stops listening to the people. They are conducting a 
freakish social experiment on other people's health coverage, because 
you can bet those billionaires have all the coverage they need, but 
they have this ideology about taking coverage away from people by the 
millions. And our Republican friends are standing up in lockstep to 
march the billionaire march on a bill that everybody hates and that 
will cause damage in everybody's home State. And it doesn't matter 
because the billionaires have the dark money, the dark money floods our 
politics, and everybody marches to the tune of the anonymous 
  We could be doing great things. We could be solving the known problem 
of end-of-life care and making sure people get their wishes honored at 
that precious time. We could be dealing with opioid and behavioral 
health issues that are bedeviling communities across this country. We 
could be helping doctors with payment reform that lets them treat 
people in a way that keeps them healthier, rather than having to wait 
to be paid until they do stuff to people--running up the cost of 

  We could be dealing with hospital-acquired infections. How many 
people know someone who had a hospital-acquired infection, which brings 
enormous costs into the system as you have to treat it? Do we address 
that? No, because we didn't bother to listen to the hospitals.
  We could do something about pharmaceutical prices. People in America 
are irate about jacked-up pharmaceutical prices, driven up by people 
who aren't even in the drug manufacturing industry but are just 
speculating on their ability to use monopoly pricing to drive up 
prices. But they put money into the system, so they get what they want.
  This bill is a nightmare in and of its own, and it is a colossal 
missed opportunity to do something good for the American people that 
will actually help them. So let's support Senator Murray's motion to 
recommit and just try the regular order that the majority leader has 
proclaimed he was a champion of for year after year, until the creepy 
billionaires said to him: We are giving you the money; this is the bill 
we want. We don't care about those people or those hospitals. Shove it 
through because it suits our ideology.
  This is no way to govern. Give the people, the hospitals, the 
doctors, the nurses, the community health centers, and the people 
suffering from illnesses at least a chance to be heard in some kind of 
open environment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, at last count, I think it was the Gallup 
poll that found 12 percent of the American people had confidence in the 
U.S. Congress. I think we are on our way tonight to single digits 
because in the modern history of this country there has never been a 
process as absurd as what we are seeing right here.
  We are talking about legislation that impacts one-sixth of the 
American economy--over $3 trillion. We are talking about legislation, 
because it is healthcare, that impacts every man, woman, and child in 
this country.
  Mr. President, maybe you can help me. How many public hearings have 
we had dealing with legislation that is of enormous significance to 
tens of millions of people? Well, I will help you with the answer: 
There have been zero hearings.
  What impact will this legislation have on doctors who are trying to 
treat us every day? One might think that we would hear from the doctors 
of the American Medical Association to tell us how this legislation 
would impact their work. We have not had one public hearing to hear 
from one doctor.
  What has the American Hospital Association had to say about how this 
legislation would impact rural hospitals in America, many of which may 
close down? They have not had one moment, one opportunity to say one 
word on this legislation.
  We are proceeding here with major legislation written behind closed 
doors by a handful of Republicans. Most Republicans have not been 
involved in this process, let alone Democrats, let alone the American 
  By the way, when we think of the American people, how do they feel 
about this legislation? Well, the last poll that I saw was USA Today. 
They had 12 percent of the American people thinking that this 
legislation makes sense. Well, maybe the American people got it wrong. 
How do the major healthcare organizations in America feel about this 
legislation--the people who are on the cutting edge, the people who do 
the work every day? Well, guess what. The AMA, the American Medical 
Association, is opposed; the American Hospital Association is opposed; 
AARP, the largest senior group in America, is opposed because they know 
the horrendous impact this will have in raising premiums for older 
workers; the American Cancer Society is opposed; the American Heart 
Association is opposed; the American Academy of Family Physicians is 
opposed; the American Academy of Pediatrics is opposed; the American 
Psychiatric Association is opposed. Virtually every major national 
healthcare organization is opposed to this disastrous legislation.
  So the American people are opposed, and the healthcare organizations 
all across this country are opposed. The bill was written behind closed 
doors. Yet, under those circumstances, they want to bring it to the 
floor for a vote.

[[Page S4404]]

  Now, what most Americans are sitting around and thinking--they are 
saying: Look, the Affordable Care Act has done some good things. Before 
the Affordable Care Act, we had some 50 million people without any 
health insurance. The Affordable Care Act provided insurance for about 
20 million people. That is no small thing.
  In the majority leader's own State of Kentucky, the rate of uninsured 
went from 20 percent down to 7 percent. That is pretty good--not great, 
but it is pretty good. In West Virginia, the rate of uninsured went way 
down. We have seen 20 million people gain insurance. We have dealt with 
the Affordable Care Act under a total obscenity; that is, if somebody 
had a serious illness--breast cancer, diabetes--they could not get 
insurance at an affordable cost because of a preexisting condition. How 
insane is that? The American people said that is nonsense. What is the 
function of insurance if not to cover us when we need it the most for 
those illnesses that we have had? We ended that absurdity. That was a 
good thing. The Affordable Care Act has done other very important 
  Have you heard one Member of this body say that the Affordable Care 
Act is perfect? Have you heard one person here say that the Affordable 
Care Act does not need to be improved? Of course, it does. Right now, 
throughout this country--in my State of Vermont and all over this 
country--deductibles are too high. I have talked to people with $5,000, 
$10,000 deductibles. They can't go to the doctor when they should. We 
have to lower deductibles. Copayments are too high. Premiums are too 
  I will tell you something else. Donald Trump ran for President, and 
he campaigned, and he said: I am going to stand with the working people 
of this country. Prescription drug costs are too high. I am going to 
take on the pharmaceutical industry. We are going to lower prescription 
drug costs in America. Today, if you can believe it, one out of five 
Americans under 65 cannot afford to fill the prescription their doctors 
write. Today, somebody walked into a pharmacy and found that the cost 
of the medicine they have been using for 10 years has doubled, maybe 
tripled, because we have no legislation that stops the drug companies 
from charging us anything they want. And they will charge us anything 
they want. The result is, we have the highest prices in the world for 
prescription drugs.
  Those are the problems that the American people want answers to: 
Deductibles are too high, premiums are too high, copayments are too 
high, and prescription drug costs are too high. We are not doing enough 
good work in primary healthcare. Too many people, even with insurance, 
cannot find the doctors they need. There are many other problems. Those 
are what the American people want us to solve.
  This legislation only makes a very bad situation worse. How do you 
improve healthcare in America when you throw 16 million people off of 
the health insurance they currently have? How do you improve healthcare 
in America when, according to the CBO, premiums are going to go up 20 
percent every year? Let's get that clear: 20 percent on January 1, 
another 20 percent the following year--that is 40 percent--and another 
20 percent the year after. Do you think this is really improving 
healthcare, bringing freedom to the American people? I think not.
  So what is the solution? The solution is--I know this is a radical 
idea--that maybe we should do what the American people want us to do 
and not what special, powerful interests want, not what billionaire 
campaign contributors want--whose rightwing ideology wants to end 
government services for working families all across this country.
  I hope that we will have the common sense and the decency to sit 
down, throw the problems on the table, and then resolve them. I think 
we can do that. That is why we have to end this absurd process. We have 
to go back to regular order, which simply means go back to the 
  I am a member of the Health, Education, Labor, and Pensions 
Committee. Let's have that discussion. Let's hear different ideas. 
Let's solve problems. Let us not make a bad situation worse, and let us 
not make the American people even feel more contemptuous of this 
institution than they currently do.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. I thank my colleague from Vermont.
  Mr. President, in my hand is one of the closely kept secrets in 
Washington, DC. These eight pages have been so carefully guarded that 
for 3 days, we have been on the floor of the U.S. Senate waiting for 
this moment. Within the last hour, the Republicans finally released 
their plan to change healthcare for every American. We have been 
waiting a long time.
  They have been meeting behind closed doors, in secret sessions, 
writing what I have in my hand. You have to think to yourself, why 
would they do it in secret? If this is something that will affect every 
American, family, business, and individual and if they are proud of 
what they have done, why did they wait so long? Well, when you read it, 
you can understand it, because this measure proposed by the Republican 
leadership makes things worse for American families when it comes to 
health insurance.
  It has a great name. I am sure somebody invested time thinking about 
this one: The Health Care Freedom Act. It appears that for 16 million 
Americans, they will be free of health insurance protection; 16 million 
Americans will lose their health insurance protection because of this 
Republican plan. Every other American buying health insurance will be 
free to pay 20 percent more each year for the premiums on their health 
insurance. You don't have to be a math major to figure out compound 
interest at 20 percent a year. By the fourth year, you are knocking on 
a 100-percent increase in your premiums. Your health insurance premiums 
will double in about 4 years under the Republican plan.
  Is that why they started this debate, so they could take health 
insurance away from millions of Americans and raise the cost of health 
insurance for others? Four Senators had a press conference this evening 
at 5 p.m. I watched it carefully. I listened as my colleagues came to 
the floor and those four Senators described this plan. They had seen 
it, this so-called skinny repeal plan. One of the Senators said that 
this plan was a ``fraud,'' it was a ``disaster,'' it would have a 
disastrous impact on the premiums charged to people he represented in 
his State, and it didn't achieve the goal of reforming and repairing 
the Affordable Care Act. I will quickly add--because you will think, 
well, we expect the Democrats to say that--this was a press conference 
of four Republican Senators about 6 hours ago. They had read the 
Republican plan and called it a ``fraud,'' a ``disaster,'' raising 
premiums, and not really bringing reform to healthcare in America.
  It will take only one of those four Senators to stand up and speak up 
and vote no for the right thing to happen--for this proposal to go to 
committee where it should have started and to be considered by the 
experts first, so we know its real impact, and then to have an 
amendment process where better ideas might be offered and debated and 
added to this proposal--benefits voted out of committee. Then bring it 
to the floor of the U.S. Senate for the same thing to happen.
  Do you know who came up with the radical idea that we should go 
through the committee process and both parties participate in writing 
this reform? None other than Senator John McCain. He came to this floor 
a couple of days ago. It was a historic moment. Everyone--both 
political parties--was cheering this man whom we have served with and 
love and respect. And he warned us. He warned us that if we didn't do 
this together--Democrats and Republicans--the results would be 

  Can you afford terrible results when it comes to healthcare for your 
family, for you, for your baby? Of course, you can't. We have to do our 
level best not to win the political debate but to win the confidence of 
the American people that we understand how to make healthcare better 
and more responsive in America.
  I have been through a lot of measures, and I have voted on a lot of 
things over the years. My proudest vote was for the Affordable Care 
Act, because I knew we would extend the reach, protection, and peace of 
mind of health insurance to millions of Americans.

[[Page S4405]]

  I had an experience early in my life. I was newly married and had a 
brand new baby girl with a serious health issue, and I had no health 
insurance--none. I went to the local hospital here, waiting in the 
charity ward, in the hopes that the doctor who walked through that door 
would be the one who would save my baby's life. I thought to myself: I 
will never let that happen again. I will have health insurance, no 
matter what it takes, the rest of my life. I know the feeling, and some 
others do too.
  I don't want American families and individuals to go through this. I 
want them to have the peace of mind and protection of good health 
insurance. That is why this Republican proposal taking health insurance 
away from 16 million Americans is such a travesty. That is why the 
notion of raising health insurance costs beyond the reach of working 
families is so wrong and so disgraceful, and that is why, with the help 
of one more Republican Senator, we can send this measure back to a 
committee where it can be seriously considered, worked on, improved, 
and passed so that we can say to the American people: We did our job as 
Senators. We did what John McCain challenged us to do--to come together 
on a bipartisan basis and to make this a better bill.
  I am glad my colleagues are here this evening. I am glad to see my 
friend from the State of Wyoming who is here. We have worked on many 
issues together. We disagree on this one, but I hope that he will 
realize and the others will, too, that this secret that they have kept 
from the American people is plain wrong. It is a secret that now it has 
been outed. It has to be put to rest. Let's do this the right way. 
Let's do it for the well-being and health of America families across 
this Nation.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. BOOKER. Mr. President, I stand today sort of feeling like a great 
New Jerseyan named Yogi Berra, who has a saying that ``this is deja vu 
all over again.'' The reason why it feels like deja vu all over again 
to me is because I have been watching this process move along. When the 
House first tried to push through a healthcare bill, I was so proud 
that the American public--Republicans and Democrats--were outraged and 
stopped that version 1 in the House. But then version 2 was rushed 
through without a CBO score, and they got it done. We heard Republicans 
in the House literally saying on the record: I so hope that they will 
fix this in the Senate; maybe something will happen in the Senate that 
this will get fixed.
  Well, now I have deja vu all over again, and it is because we see a 
whole bunch of folks--and now we have heard Republican Senators say 
this on the record: Gosh, we know what we are doing is flawed; we know 
what we are doing is wrong; we know the process has been outrageous, 
but our hope is, if we can get it into the conference committee, then 
they will fix it in the conference committee.
  Well, I am proud to be a U.S. Senator. But, dear God, this is not 
what this body is about--to push their responsibilities off, to 
derelict their duties, and to not make legislation happen here that 
puts people first. We all know this process is broken. We all know that 
what we are doing here is not just imperfect. Many of us see this, like 
the CBO, as a serious threat to millions of Americans.
  We are about to do something that is unconscionable to me to be in 
the Senate, where I have seen this place work, I have seen regular 
order, I have seen hearings, I have seen witnesses brought in, and I 
have seen people work hard on crafting actual legislation. So now this 
is just going to be shoved over with the hope in this body that, even 
though the House didn't do their job and the President of the United 
States even criticized what the House did and called it ``mean,'' it 
gets kicked over to the Senate, and the Senate is refusing to do their 
job. They are just passing the buck to something called a conference 
committee, where they are going to hope again.
  So I stand here, and I just have to confess that this has been 2 days 
for me where I haven't just been frustrated and angry like so many 
Americans. I have actually been struggling with being a little sick. I 
started feeling it about 2 days ago. By yesterday my throat was so 
sore, I went to bed. I had a horrible night, got up, and could barely 
even swallow. I had the worry in my head that maybe I had strep throat.
  But guess what. Unlike the thousands of New Jerseyans who have 
reached out to me, for me to worry about an illness, maybe that I have 
strep throat--I went to a doctor today. I had myself tested for strep. 
You see, we, in this body, enjoy health coverage, which right now 
millions of Americans are worried about losing, and many other ones 
worry, as we heard said tonight, about copays and prescription drug 
costs. I wonder where the justice is in that.
  What are the American values that hold us all together? I know we 
pledge allegiance to that flag. We put our hands on our hearts, and we 
swear this oath to liberty and justice for all. Where is the justice in 
this country, where some people who are favored and privileged enough 
and wealthy enough to afford good health coverage can have it, but for 
other folks, a night with a bad sore throat or, worse, with a 
disability or disease--where is their justice in the wealthiest country 
on the planet Earth? We can't even, in this body, come together and do 
what the President said in his campaign that he would do--everyone 
would be covered and have healthcare that--I think the quote was this--
was terrific.
  Well, it brings me back to what our values are as a country, and I 
wonder: For we who believe in life and liberty and the pursuit of 
happiness, how can we have life when we see millions of people about to 
be thrown off their health coverage? We in this Nation hold these 
values so dear. We believe that all are created equal and, in my 
belief, should have equal rights and equal opportunities for the basics 
that are necessary to succeed and to compete, and that is health 

  I wonder how we have gotten to a point as a body on an issue like 
this that is not just one-sixth of our economy, that will not just 
affect millions and millions of lives, but that really goes to the core 
of who we are as a country.
  This great man, Patrick Henry, said: ``Give me liberty or give me 
death.'' Those words have been coming back to me a lot in the last 
months of this debate and this discussion: ``Give me liberty or give me 
  Well, what is the quality of the liberty in this country, where there 
are people who are shackled with preventible disease and conditions 
that could be treated because they don't have access to healthcare? 
What is the quality of liberty in this country, where people are 
chained to poverty, have to sell their cars, have to sell their homes, 
and go into bankruptcy because they can't afford their healthcare 
  ``Give me liberty or give me death.'' What is the quality of the 
liberty when people are imprisoned by fear and worry and stress because 
they have a sick child or they have a parent who is elderly and needs 
care? These are the values of this country, and I don't understand how 
we could be at this moment right now with the ideas that I have heard 
on both sides of the aisle to make healthcare better, to improve upon 
the Affordable Care Act, to extend health coverage to even more people, 
to make this Nation live up to its most powerful and profound values 
that made us a light unto nations, and how we could have gotten to this 
point now after gaining ground, after having more people experience the 
freedom and the liberty that comes from not having to worry about your 
health coverage, from having access to quality healthcare? How can we 
have moved forward and now be about, in a matter of hours, to push this 
Nation back? I don't understand how we could be here where no one can 
justify the process and no one can justify this body having gone 
through such a contorted process that bends our traditions and breaks 
our values. I do not understand how we could have gotten here.
  Who will be hurt? Who will be hurt? I have read lots of studies 
recently about how, when health insurance rates goes down, mortality 
rates go up, and when health insurance rates go down, mortality rates 
go up. It makes me wonder about the duty that we each have to each 
other as Americans. As a man of faith, it makes me wonder about all of 
us who profess our faith and how we could be allowing a process

[[Page S4406]]

to go forward where the most vulnerable among us will face fear and 
deprivation and will see things that will cost life and have them 
surrender liberty. We are better than this. This Nation is greater than 
  This moment casts a shame and a shadow over the soul and the heart of 
America, and I will fight even in these last hours with every breath 
that I have, like the patriots before us, not to allow this to happen 
to my fellow Americans. This is unjust, this is wrong, and we can and 
must in these hours do better.
  Let's send this bill into committees. Let's do this process as this 
institution was designed to have it done. Let's open the doors of the 
Capitol and invite America to come--the American Medical Association, 
the American Cancer Society, hospital associations. Let's invite the 
AARP. Let's have America come down here. Let's join together like our 
forefathers and foremothers have done to expand liberty, to expand 
opportunity, to extend hope. We can do that. All of us collectively 
have that power, and it is what the people want right now. This is not 
what the people want.
  What we are about to vote on has only seen the light of day for a 
matter of minutes now--a matter of minutes.
  This Nation was founded with a proclamation that we the people--this 
idea that all of us together--can do better, that when we join 
together, when we stand together, when we fight together, and when we 
work together, we can create a transcendent reality. That is the story 
of America, and this is not. This is the betrayal of our values. This 
is the betrayal of our history. This is the betrayal of the great body 
in which we all are Members.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Ms. HIRONO. Mr. President, so many of us have spoken so many times 
now against the repeal of the Affordable Care Act, which would hurt 
millions and millions of people in our country and especially the 
sickest, poorest, and oldest among us.
  I would say that I am probably the only Senator here who was not born 
in a hospital. I was born at home in rural Japan. I lost a sister to 
pneumonia when she was only 2 years old in Japan. She died at home, not 
in a hospital, where maybe her life could have been saved.
  It is hard for me to talk about this. I think you can tell. Give me a 
  When I came to this country as an immigrant, my mother brought me and 
my brothers to this country so we could have a chance at a better life. 
We came here with nothing. She had low-paying jobs. There was no health 
coverage. Growing up as a young girl in Hawaii, my greatest fear was 
that my mother would get sick and, if she got sick, how were we going 
to pay for her care, and how would she go to work? If she didn't go to 
work, there would be no pay, there would be no money. I know what it is 
like to run out of money at the end of the month. That was my life as 
an immigrant here.
  Now, here I am, a U.S. Senator. I am fighting kidney cancer, and I am 
just so grateful that I had health insurance so that I could 
concentrate on the care that I needed rather than how the heck I was 
going to afford the care that is going to probably save my life.
  Guess what. When I was diagnosed with kidney cancer and facing my 
first surgery, I heard from so many of my colleagues, including so many 
of my colleagues on the other side of the aisle, who wrote to me 
wonderful notes sharing with me their own experience with major illness 
in their families or with their loved ones.
  You showed me your care. You showed me your compassion. Where is that 
  I can't believe that a single Senator in this body has not faced an 
illness or whose family member or loved one has not faced illness who 
was not so grateful that they had healthcare. I cannot believe there is 
a single Senator who has not experienced that in their family or their 
  I know how important healthcare is. What is in here? Why doesn't 
every single Senator know that? Why are we here tonight voting on a 
bill that has not had a single hearing? Why are we here tonight voting 
on a bill that would eliminate healthcare coverage that could save 
lives for 16 million people? Why are we here voting on a bill that 
would probably mean that people like me, millions in this country, who 
are now in the ranks of those receiving care with preexisting 
conditions will not get the healthcare we need? Why are we here 
tonight? Where is your compassion? Where is the care you showed me when 
I was diagnosed with my illness?
  I find it hard to believe that we can sit here and vote on a bill 
that is going to hurt millions and millions of people in our country. 
We are better than that.
  I listened to John McCain calling on us to have hearings and to do 
the right thing, and I am so saddened he was unable to move us in that 
direction. I would call on him tonight to vote his conscience, to vote 
for us who say we are going to stand for the millions of people in our 
country who will be hurt by what we are contemplating tonight.
  Mr. President, I will yield the floor by asking my friends to show 
the compassion to everybody in this country that you showed me. We all 
should be voting to send this bill to committee.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Sasse). The Senator from Virginia.
  Mr. KAINE. Mr. President, I also rise with my colleagues, 
tremendously moved by the powerful words of my friend from Hawaii: Why 
can't you show compassion to others that you showed to me? That is a 
haunting question, and I hope people will hear that not just with their 
ears but with their hearts.
  I also support the motion to do what we should have done in January--
to commit this important topic to the committee that has jurisdiction 
over it.
  A few years ago, there was a popular thing to do, and that was to 
wear a button or bracelet with the letters WWJD. That button and 
bracelet stood for ``What would Jesus do.'' I was on the floor the 
other night, and I don't think that is a very hard question because in 
Matthew 25, he basically tells us: I was sick and you cared for me. In 
different translations: I was sick and you looked after me. I was sick 
and you visited me. I was sick and you took care of me. I think the 
answer to WWJD is pretty straightforward tonight.
  I am going to talk about a different John McCain. John McCain, based 
on the tremendously moving presentation he made on the floor the other 
day, one that led us to a standing ovation because he talked about how 
this body should work, he said that things weren't working here as they 
should for the American public. He said we needed to fix the Senate and 
be an example for the public. We needed to restore confidence, and the 
way to do that would be to return to operate as the Senate should 
operate, with putting bills in committees and having hearings and 
listening to the public and, most importantly, listening to each other.
  That is the process John McCain's committee just used, the Armed 
Services Committee, to get a unanimous defense authorizing bill to the 
floor, which I hope we will take up in the next few days.
  I just want to spend a few minutes talking about if that is what we 
should do. If those words led us to leap to our feet in a standing 
ovation, why are we standing here 2 days later preparing to break every 
suggestion and recommendation he made to us?
  When should we start the process of listening to each other and 
listening to the American public? Should we start on an inconsequential 
issue that doesn't matter? I think now is the time to start. I think we 
all know it is the time to start. If we didn't believe in our heart 
that now was the time to start fixing this place, we wouldn't have 
leapt to our feet and given Senator McCain a standing ovation. This is 
the time, and this is the issue to start fixing this place and doing 
what we do with the spirit that is worthy of the American people who 
sent us here.
  Why is now the right time? First, because this issue is so important 
to people. You heard moving--moving--words from our friend from Hawaii 
and our friend from New Jersey. We have all spent months going from 
town to town in our States having people come plead with us for 
solutions. I shared stories about being in the medical clinic in

[[Page S4407]]

Appalachia a week ago tomorrow and seeing the tremendous need in this 
richest and most compassionate Nation on Earth.
  There is nothing about a person's life that is more important than 
their health. There is no expenditure that a human being ever makes 
that is as important as an expenditure they make for their health. This 
is the right issue to start fixing this place because it is important 
to people.
  It is important to the economy. This is the largest sector of the 
American economy. We are proposing to reorient one-sixth of the 
American economy on a snap vote, in the middle of the night, without 
having a single hearing or listening to a single expert.
  It is an important issue because we definitely need to hear from the 
public. You know, committee hearings sound kind of wonky. We haven't 
had a committee hearing. What does that mean? What it means is, we 
haven't had a witness table where a patient or a doctor or the American 
Cancer Society or others could stand up and share their points of view. 
We need to listen, and if we don't listen, we will not get this right.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. KAINE. I ask unanimous consent for 2 minutes to close, Mr. 
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. KAINE. The time is right because the consequences are so severe: 
16 million people lose insurance, 20 percent premiums compounding over 
the years, insurance markets skyrocketing and unstable, and Planned 
Parenthood defunded--the healthcare provider of choice for 3 million 
  The final reason we should do this the right way, not the wrong way, 
is what was said by Senator Graham just a few hours ago. He described 
the bill that is now on the floor, the skinny repeal, the skinny bill, 
as a policy is a disaster as a replacement for ObamaCare. It is a 
  Is ``fraudulent disaster'' the best that the United States Senate can 
do now? Is that now the bar we have to get over? If we can say 
something is a fraudulent disaster, it is suddenly good enough to vote 
for? That is salt in the wound of a family that is worried about their 
sick child. That is salt in the wound of anybody who is worried about 
what would happen to their family tomorrow. Will they lose insurance? 
Will they pay more? Will they be blocked from going to Planned 
Parenthood? If this body passes a bill that even Members who vote for 
it claim is a fraudulent disaster, how do you think the American public 
will view this body? How will they view the degree of care and concern 
we exhibit to them?
  This is not the best the Senate can do. We can do much better than 
this, we must do much better than this, and I ask my colleagues to send 
this to committee where we can listen to one another and get this 
  Thank you, Mr. President.
  I yield the floor.
  Ms. COLLINS. Mr. President, few issues are as important or personal 
to the American people as healthcare, which is why this debate has been 
so fervent and ignites such passion.
  On the one hand, the Affordable Care Act, ACA, has allowed millions 
of individuals and families to obtain health insurance for the first 
time. It has also brought important patient protections like those for 
people with preexisting conditions and prohibitions on annual and 
lifetime limits on insurance payments for needed care.
  On the other hand, too many Americans face skyrocketing premiums and 
unaffordable deductibles coupled with mandates that give them few, if 
any, choices. Some insurance plans have become so restrictive that 
families find they can no longer go to the doctor or hospital of their 
choice. In addition, the ACA's employer mandate discourages businesses 
from creating jobs or giving their workers more hours, while its tax 
credits and subsidies are designed so poorly as to cause ``wage 
lock''--``where working harder to get ahead can instead make some 
Americans fall further behind.''
  Despite President Obama's campaign promise that his health plan 
``would save the average family $2,500 on their premiums'' per year, 
the opposite has happened as premiums are increasing in nearly every 
State, with an average increase of 25 percent nationally last year. 
Today, despite the implementation of the ACA, 28 million Americans 
remain uninsured.
  These problems require a bipartisan solution. The Democrats made a 
big mistake when they passed the ACA without a single Republican vote. 
I don't want to see Republicans make the same mistake.
  Earlier this week, I voted against proceeding to healthcare reform 
legislation--the American Health Care Act of 2017--that passed the 
House of Representatives last May without a single Democratic vote. For 
many Americans, this bill could actually make the situation worse. 
Among other things, the bill would make sweeping changes to the 
Medicaid Program--an important safety net that for more than 50 years 
has helped poor and disabled individuals, including children and low-
income seniors, receive health care. The nonpartisan Congressional 
Budget Office, CBO, projects that the number of uninsured Americans 
would climb by 23 million under this bill.
  Senate leaders, recognizing that the House bill did not have 
sufficient support, advanced their own substitute proposal that would 
make similar structural changes to the Medicaid program, as well as 
many other changes. CBO estimates that this plan would reduce the 
number of people with insurance by 22 million, cause premiums and other 
out-of-pocket costs to soar for Americans nearing retirement, and shift 
billions of dollars of costs to State governments. It also would 
undermine the financial stability of rural hospitals and long-term care 
facilities and likely lead to the loss of important consumer 
protections for many Americans, while doing virtually nothing to 
address the underlying problem of escalating healthcare costs. Earlier 
this week, this body struck down that proposal by a vote of 43 to 57.
  A separate proposal that would simply repeal the ACA without a 
replacement also failed, by a vote of 45 to 55. That legislation, 
according to CBO, would result in 32 million people losing their 
insurance, bringing the total number of uninsured Americans to 60 
million a decade from now. Clearly, that is going in the wrong 
  In a final effort to reach consensus, Republican leaders have pieced 
together a plan that would repeal key portions of the ACA while punting 
on many of the more difficult questions. While I support many of the 
components of this plan, this approach will not provide the market 
stability and premium relief that is needed. In fact, a bipartisan 
group of Governors wrote Senate leaders this week, urging rejection of 
this so-called skinny plan, which they say ``is expected to accelerate 
health plans leaving the individual market, increase premiums, and 
result in fewer Americans having access to coverage.''
  I ask unanimous consent that the letter be printed in the Record 
following my remarks.
  Also included in all of these plans is a misguided proposal that 
would block Federal funds, including Medicaid reimbursements, from 
going to Planned Parenthood. Millions of women across the country rely 
on Planned Parenthood for family planning, cancer screening, and basic 
preventive healthcare services. Denying women access to Planned 
Parenthood not only runs contrary to our goal of letting patients 
choose the healthcare provider who best fits their needs, but it also 
could impede timely access to care.
  If Planned Parenthood were defunded, other family planning clinics in 
Maine, including community health centers, would see a 63 percent 
increase in their patient load. Some patients would need to drive 
greater distances to receive care, while others would have to wait 
longer for an appointment,
  Let me be clear that this is not about abortion. Federal law already 
prohibits the use of Federal funds to pay for abortion except in cases 
of rape, incest, or when the life of the mother is at risk.
  This is about interfering with the ability of a woman to choose the 
healthcare provider who is right for her. This harmful provision should 
have no place in legislation that purports to be about restoring 
patient choices and freedom.
  We need to reconsider our approach. The ACA is flawed and in portions 
of the country is near collapse. Rather

[[Page S4408]]

than engaging in partisan exercises, Republicans and Democrats should 
work together to address these very serious problems. In their letter 
to Senate leaders, the bipartisan group of Governors correctly notes 
that, ``True, lasting reforms can only be achieved in an open, 
bipartisan fashion.''
  Healthcare is extraordinarily complex, and we must work together 
systematically in order to ``do no harm'' and improve our healthcare 
system. In developing legislation, our focus should be on the impact on 
people, premiums, and providers.
  We are dealing with an issue that affects millions of Americans and 
one sixth of our economy, and we need to approach reforms in a very 
careful way. That means going through the regular process of committee 
hearings; receiving input from expert witnesses such as actuaries, 
Governors, advocacy groups, and healthcare providers; and vetting 
proposals with our colleagues on both sides of the aisle. It needs to 
be a much more deliberative process, and I am pleased that Chairman 
Alexander has expressed a willingness to begin hearings in the Senate 
Health Committee.
  Neither party has a monopoly on good ideas, and we must work together 
to put together a bipartisan bill that fixes the flaws in the ACA and 
works for all Americans.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                    July 26, 2017.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Charles E. Schumer,
     Minority Leader, U.S. Senate,
     Washington, DC.
       Dear Majority Leader McConnell and Minority Leader Schumer: 
     As the Senate debates the House-passed American Health Care 
     Act (H.R. 1628), we urge you to set aside this flawed bill 
     and work with governors, both Democrats and Republicans, on 
     solutions that will make health care more available and 
     affordable for every American. True, lasting reforms can only 
     be achieved in an open, bipartisan fashion.
       We agree with Senator John McCain that the Senate should 
     ``return to regular order,'' working across the aisle to 
     ``provide workable solutions to problems Americans are 
     struggling with today.''
       Congress should be working to make health insurance more 
     affordable while stabilizing the health insurance market, but 
     this bill and similar proposals won't accomplish these goals. 
     The bill still threatens coverage for millions of 
     hardworking, middle class Americans. The bill's Medicaid 
     provisions shift costs to states and fail to provide the 
     necessary resources to ensure that no one is left out, 
     including the working poor or those suffering from mental 
     illness or addiction. The Senate should also reject efforts 
     to amend the bill into a ``skinny repeal,'' which is expected 
     to accelerate health plans leaving the individual market, 
     increase premiums, and result in fewer Americans having 
     access to coverage.
       Instead, we ask senators to work with governors on 
     solutions to problems we can all agree on: fixing our 
     unstable insurance markets. Improvements should be based on a 
     set of guiding principles, which include controlling costs 
     and stabilizing the market, that will positively impact the 
     coverage and care of millions of Americans, including many 
     who are dealing with mental illness, chronic health problems, 
     and drug addiction.
       The next best step is for senators and governors of both 
     parties to come together to work to improve our health care 
     system. We stand ready to work with lawmakers in an open, 
     bipartisan way to provide better insurance for all Americans.
         John W. Hickenlooper, Governor of Colorado;
         Steve Bullock, Governor of Montana;
         Brian Sandoval, Governor of Nevada;
         Larry Hogan, Governor of Maryland;
         Tom Wolf, Governor of Pennsylvania;
         John Bel Edwards, Governor of Louisiana;
         Terence R. McAuliffe, Governor of Virginia;
         Charles D. Baker, Governor of Massachusetts;
         John R. Kasich, Governor of Ohio;
         Phil Scott, Governor of Vermont.

  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, for 2\1/2\ days I have been listening to the 
same rhetoric. It sounds like deja vu. For 2\1/2\ days I have been 
listening to this. I have been giving extra time to the other side to 
speak. I have been hoping out of that I would get one constructive 
suggestion for what could be done with healthcare.
  It has all been criticism. It has been criticism against all cuts. 
Even tonight, after the bill was read here on the floor, I heard that 
we were changing Social Security. We are not changing Social Security. 
We can't change Social Security under the budget.
  I heard we were changing Medicare. We are not changing Medicare. I am 
not going to allow other time for that side. I will suggest that side 
of the aisle go and read the bill. I think it would be a worthwhile 
  There isn't even Medicaid in there. You have threatened about what 
was going to be done about Medicaid. You talked about what was going to 
be done with Medicaid, but it is not based on fact. So take a look at 
the bill.
  Another way that this is deja vu is I remember being here on 
Christmas Eve when technical corrections were accepted from the other 
side, but you went ahead and passed the bill. We mentioned things that 
needed to be changed in the meantime, and we were told: No, no, that 
doesn't have to be done. It just needs more time.
  Well, we had more time, and there does need to be corrections. You 
keep talking about how the Republicans have ruined the insurance 
market. No, last October, the high rates came out for States across 
this country that pointed out that healthcare was going down the tubes. 
So something needed to be done. Something needed to be done, but 
without getting constructive suggestions from the other side--just 
criticism, saying ObamaCare is perfect, until this debate started, and 
then I started hearing: It is not perfect. It is not perfect.
  Well, where are the suggestions for making it as near perfect as 
possible? We put up a lot of----
  Ms. HEITKAMP addressed the Chair.
  Mr. ENZI. I am not asking that as a rhetorical question. Think about 
it for a little while, come up with constructive suggestions.
  The PRESIDING OFFICER. The Senator from Wyoming has the floor.
  Ms. HEITKAMP. Would the Senator yield for a question?
  Mr. ENZI. No, I will not yield for a question.
  When I feel like there is something constructive that is going to be 
done around here--I remember that one of the Senators on the other side 
of the aisle said: If you just take Medicaid out, I will be for it. 
Well, Medicaid is not in this version so that ought to be some kind of 
a commitment on it.
  I keep referring to this book, which goes back to a lot of the 
history that we have experienced around here. Here is what has 
happened, and all of this is footnoted. I was reading at first the 
footnotes. I didn't check out all the footnotes, but I did look to see 
if they were footnoted.
  Under the bill that we are trying to make some changes to, there have 
been costs from new taxes. There are 21 taxes that have been included 
in ObamaCare, but the most enormous one is the increased taxes on 
healthcare companies that are then passed on to the public as higher 
costs for insurance and pharmaceuticals.
  I have heard that word ``pharmaceuticals'' thrown out a lot, and I 
agree there are things that need to be changed there. I do remember the 
pharmaceuticals joining in on the process of getting ObamaCare passed 
because they did this little thing with the pharmaceutical Part D, 
where there was this doughnut hole, and through the doughnut hole we 
were hoping that people would switch to generic, but the pharmaceutical 
companies said: No, no, no. If you will stick with the brand name, we 
will cover you through the doughnut hole. Do you know why? Because 
people, as they go through the doughnut hole, go beyond the doughnut 
hole, and beyond the doughnut hole the Federal Government picks up the 
cost of the name brands--the name brand pharmaceuticals. My insurance 
commissioner was by to visit with me, and he mentioned that I have 
twins in Wyoming, and they have a rare disease. There is a prescription 
for it, and the prescription is costing $30,000 a year each. Well, that 
is quite a bit of money, and the insurance company is picking that up. 
Then the name brand pharmaceutical company bought out the generic one. 
This was generics they were getting.
  So now they have to have name brand because the generic isn't on the 
market now. The cost? It is $1.6 million for each kid, each year.
  That is why the companies, why the insurance companies are dropping 

[[Page S4409]]

of the market. I mean, Wyoming is the least populated State in the 
Nation, and an insurance company that is limited to Wyoming is going to 
have to bear that $3.2 million worth of cost. So they are going to be 
saying: We are the only ones covering Wyoming; maybe we shouldn't 
provide insurance in Wyoming either. We lost the other two companies 
already, and we are down to just one, but we have one, and they cover 
all of the counties, unlike--it kind of surprised me that the rules 
allow companies to just do some counties in some States.
  Also, under ObamaCare, the insurance plans have to cover more.

       This includes plans for the patient who may not want a 
     particular coverage but has to have this. [It comes under 
     the] essential health benefits, which are required through 
     HHS. This led to 5 million Americans losing their insurance 
     in the individual market.
       Reduction of lower cost plans. High deductible [health 
     savings accounts] are very important in reducing costs for 
     individuals, families, and businesses. A RAND study in 2011 
     found that an HSA/high deductible plan (with a deductible of 
     at least $1,000) would reduce healthcare spending an average 
     of 14%. That savings incurred not only for patients but also 
     for employers and for total healthcare expenditures. These 
     more effective plans have been reduced under ObamaCare.

  Most of the young people on my staff were getting HSAs, and the 
reason they did is because they did a little bit of a calculation. They 
did a little bit of financial literacy. They looked to see what the 
plan was for the full coverage, and then they looked to see what an HSA 
would cost, and they said: Well, gee, if I take the difference in the 
cost between the regular insurance and the HSAs and I put that in one 
of these savings accounts that can grow tax-free, in a maximum of 3 
years, I will cover any deductible that I might have.
  So they considered that to be good insurance and they got to make a 
lot of their decisions.
  But I don't think we want individuals making their decisions; that 
appears to be how ObamaCare is constructed.
  Then there is an increase in mandates, which is item No. 4.

       Mandates existed before ObamaCare but have dramatically 
     increased with ObamaCare. It added mandates ``guaranteed 
     issue and community ratings.'' Both have been previously 
     tried in the states. Such mandates distort the marketplace 
     and drive up the cost of care. Policies within states that 
     had more mandates could actually have doubled the cost of 
     [their] premiums.
       5. Increased costs by constricting hospitals and physician 
     systems. There has been consolidation with increased hospital 
     mergers by 50% compared with 2009. There has also been 
     movement of doctor's practices to connect with hospital 
     systems and both the contractures within the hospital system 
     and then physician's systems increased costs to the patients. 
     For example, group practice charges increased costs 18% to 
     20% and specialty care charges increased costs even more, 34% 
     after connecting the care with hospital systems. These 
     changes in care i.e. changing from private practice systems 
     into hospital-based systems have significantly driven up the 
     cost of care for the patients.
       6. Medical legal liability reform has not been a part of 
     ObamaCare but is a significant driver of healthcare costs.

  That is not considered in it, and it is considered to be about a 10 
to 25 percent increase in total costs.
  Mrs. MURRAY. Mr. President, may I respectfully ask the chairman a 
  The PRESIDING OFFICER. Does the Senator yield for a question?
  Mr. ENZI. I think this is under my time.
  Mrs. MURRAY. It is, and I just----
  The PRESIDING OFFICER. Does the Senator yield for a question?
  Mrs. MURRAY. Regarding time, I just have a question so that Members 
can know how to manage their time between now and the 45 minutes when 
we have the vote.
  The PRESIDING OFFICER. The Republicans have 46 minutes remaining; the 
Democrats have zero.
  Mrs. MURRAY. If I could just respectfully ask the chairman, since we 
have only had this bill for an hour, we have, as you can see, a number 
of Senators who want to speak. I would just respectfully ask if there 
is any time we will have between now and the vote to make any comments, 
since we have just had, for a very short amount of time, the bill that 
we will be voting on, which will obviously impact millions of 
  Mr. ENZI. I think the answer that I gave was perhaps your time might 
be better spent taking a look at the bill because the conversations I 
have heard here didn't necessarily speak to the bill.
  Mrs. MURRAY. Mr. Chairman, I----
  Mr. ENZI. They speak to the process, and I think we have already 
covered that in 3 days.
  Mrs. McCASKILL addressed the Chair.
  The PRESIDING OFFICER. The Senator from Wyoming has the floor.
  Mrs. McCASKILL. Mr. President, will he yield for a question about the 
bill? He clearly knows more about it than we do because he has seen it 
for much longer than we have.
  The PRESIDING OFFICER. The Senator from Wyoming has the floor.
  Mrs. McCASKILL. He will not yield for a question?
  Mr. ENZI. I want to continue on with why we are trying to change 
  The Galen Institute--Grace-Marie Turner wrote about 70 changes to 
ObamaCare that occurred after it went into effect. And those changes 
include the ``employer mandate delay, individual mandate delay, 
preserved benefits to the military and VA, and reduction of funding to 
agencies used for implementation of ObamaCare including IPAB, CO-OP's, 
and IRS.''
  Co-ops are an interesting thing. I was suggesting during the time 
that ObamaCare was being considered that small business health plans 
might make a real difference in costs for small businesses. Now, the 
only thing I can see on small businesses in here is that if you are a 
small business and you have over 50 employees, you have a problem.
  I have people in Wyoming who come to me and say: I have this 
business. It is working really well, and in the next town over--and 
most of the towns aren't big enough to hold two of the same kind of 
store--so in the next town over, I would like to put in the same kind 
of shop.
  My question to them is: How many employees do you have?
  Most of them have said: Well, I have about 48 employees.
  I said: How many will you need in the other store?
  They said: Well, I hope to need the same amount of people.
  I said: Well, the way this works, you are going to come under much 
increased healthcare costs, and you better take a look at that before 
you make your expansion.
  So it has cost jobs that way.
  Now, with small business insurance, with the small business health 
  Ms. WARREN addressed the Chair.
  The PRESIDING OFFICER. The Senate will be in order.
  The Senator from Wyoming has the floor.
  Mr. ROUNDS. Regular order.
  Ms. WARREN. Will the Senator from Wyoming yield for a question about 
the new study on the impact of ObamaCare on jobs?
  The PRESIDING OFFICER. The Senator from Wyoming has the floor.
  Ms. WARREN. Will he yield?
  Mr. ENZI. I will not yield. I would appreciate the same courtesy from 
that side that I gave to you when you were doing your expositions about 
healthcare, which included the things that I have mentioned that aren't 
even in the bill. Our side has some time, and I would like to use some 
of that time.
  As I have been through this process for a long time now--I have been 
on the Health, Education, Labor, and Pensions Committee for the whole 
time that I have been here, which is 20 years. Of course, it wasn't 
Health, Education, Labor, and Pensions when I first got here, but we 
thought that that was a clever acronym: We are from the Federal 
Government, and we are here to help you. There are a lot of people back 
home who don't think we really help out much.
  But, at any rate, the small business health plans, after three of us 
who were in the Gang of 6 got thrown under the train or under the bus 
or whatever it was, small business health plans were changed to co-ops, 
and they were given a significant amount of money to work with, and 
they haven't fared very well.
  I will find the information about the co-ops here. Again, this isn't 
stuff that I wrote; this is stuff somebody else wrote and footnoted and 
sent to all of us. Again, the name of the book is ``Demystifying 
ObamaCare: How to Achieve Healthcare Reform.'' It gives some good 
  He does point out that ``ObamaCare is not a system of healthcare, nor 
is it

[[Page S4410]]

healthcare reform. It is a system of healthcare control.''
  People are told what they are going to do.

       ObamaCare was supposed to significantly reduce healthcare 
     costs, but instead it has dramatically increased costs for 
     even those who are not directly within the ObamaCare program. 
     ObamaCare was supposed to increase access to care, but 
     instead it actually reduced access to the availability to 
     care. ObamaCare reduces the effectiveness of the safety net 
     program, which is so very important economically for 

  Under an amendment that I would like to see is one that would have 
covered the people who make a living of under $11,000--because with 
$11,000, you can't get insurance. They don't get subsidies; they are 
just left out in the cold. It is one of the corrections that should 
have been made and wasn't made. ObamaCare does reduce the effectiveness 
of the safety net program, which is important to economically poor 
  There are a lot of people out there in the States, several thousand 
in my State, who can't get insurance under that.

       The quality of healthcare in America was derided when 
     ObamaCare was passed, but ObamaCare instead reduces the 
     quality of U.S. healthcare by reducing innovation, and it 
     removes a person's ability to make his own decisions about 
     his healthcare and that of his family, and it does so by 
     removing the freedom to make those decisions by putting so 
     many qualifications on it.

  Again, I repeat that we haven't done anything to take people off of 
their policy if they are under their parents' policy if they are under 
the age of 26.
  We haven't done anything to deny patients who have preexisting 
conditions. I have heard that for 3 days.
  We haven't eliminated the lifetime caps on insurance. I have heard 
that for weeks.
  So there are things that need to be done. They could be done. We have 
tried to do it in this bill, again, without constructive suggestions 
from the other side. For any recognition that there was any problem 
that ought to be solved, we have gone ahead. It is not my choice for 
the mechanism that would be used; it is the mechanism that was chosen 
by leadership and it falls to them. One of the things that makes this 
difficult is it is a budget reconciliation, so there are things that 
have to be written in a budget form in order to comply. That limits 
some of the things that I would have liked to have done that I think 
would have made quite a difference. And I think there would have been 
some things the other side might have joined on and been excited about 
too. But, again, we are limited by the mechanism that we have here, and 
there is no indication that----
  Mr. MURPHY. Mr. President, will the Senator yield for a question?
  The PRESIDING OFFICER. The Senate will be in order.
  The Senator from Wyoming has the floor.
  Mr. ENZI. Mr. President, I have heard so many times that the other 
side would love to be cooperative, but I have yet to see cooperation. I 
am not going to take questions; I am going to--I really would 
appreciate it if you would just take some time to look at the bill. I 
have heard the rhetoric.
  The PRESIDING OFFICER. The Senate will be in order.
  Mr. MURPHY. Maybe this time would be better used if you allowed us to 
ask you some questions about the bill.
  The PRESIDING OFFICER. The Senate will be in order.
  The Senator from Wyoming has the floor.
  Mr. ENZI. Yes, and I have an hour, whether I use it or not. As I 
said, for the past few days I have been yielding time to the other 
side. I haven't gotten much satisfaction out of that. I have listened 
for the last hour, and I didn't get any satisfaction out of that 
either. I did sit through all of it. I did listen to it. Again, it is 
complaints about the process, but not constructive suggestions on what 
could be done.
  There are taxes, mandates, regulations, lack of competition in the 
marketplace, increasing costs. When I travel across Wyoming, I have 
people who have come up to me and they say: My insurance premium is 
bigger than my house payment, and it is growing.
  And they said: If something happens to us, my deductible is bigger 
than my year's premium. That shouldn't happen in America, but that is 
where we are. Those aren't isolated cases; those are a lot of cases. 
That is the situation we find ourselves in. We are not trying to hurt 
anybody; we are trying to fix some of these things.
  As I said, for 8 years, every time there has been a waiver--that is 
part of that thing that I mentioned about the 70 changes to ObamaCare 
so far--a lot of those were in the way of waivers.
  Every time there was a waiver, I said: Why are we waiving this? Why 
don't we just fix it?
  I was told: It is not broke; it just needs more time.
  Well, it has had more time. Last year--this was before the election, 
so you can't blame us. We had no idea who was going to be the 
President. We had no idea who was going to be in the majority. Last 
October, people started pulling out of insurance markets, and rates 
increased dramatically. You can't put that blame on us.
  Mrs. MURRAY. Mr. President, parliamentary inquiry.
  The PRESIDING OFFICER. Does the Senator yield for a parliamentary 
  Mr. ENZI. No.
  The PRESIDING OFFICER. The Senator from Wyoming has the floor.
  Mr. MURRAY. Mr. President, I just wanted to ask how much time is left 
on a bill that we haven't had much time to look at much in the last 
hour that we are going to vote on.
  The PRESIDING OFFICER. The Senator from Wyoming has 34 minutes 
remaining, and the Senator has the floor.
  Mr. ENZI. Mr. President, I think what we have is a motion to commit 
and the right for the other side to do other amendments. I would hope 
that some of them would be constructive, but I am not expecting that. 
As I said, I have been listening for 3 days and actually listening a 
lot longer before that time.
  I could talk about some of the things we can learn from ObamaCare, 
because we should. We can learn that decisions have to be made by the 
patients and not by the bureaucrats for the government. There are some 
key examples of when the government starts making those decisions. I 
don't have to pick on ObamaCare for it necessarily; the VA has had a 
few problems, and I am sure all of you have been working casework on 
what the VA has been doing. That is where the government and the 
bureaucrats are making decisions. We have been through some enormous 
times on that. That is why we did the Choice Act. And the Choice Act 
had a lot of problems. That is government healthcare.
  People say: Well, Choice got to go outside of the government.
  That is not quite true. I think the folks with the VA picked the 
companies you have to go through for healthcare, and when they did, 
they didn't want it to be efficient. They wanted as much of it as 
possible to come back to the VA. I am sure all of us, as we travel 
across our States, are running into people who are having problems with 
providers not getting paid or not being able to get their appointments. 
If you check with the providers, you find out what kind of a terrible 
process they have to go through to get paid. That is government 
  In my State, I provide the VA with a list every week of the new cases 
I have of people who are not getting care. That shouldn't happen. But 
they told me when I first inquired: Well, there are only two doctors 
who haven't been paid.
  I said: That is impossible. There are more than two doctors in my own 
town who haven't been paid, and there are a lot of towns in Wyoming--
when I go to them, I hear that they are not paid.
  They said: One was not paid for 30 days, and one wasn't paid for 45 
  I said: Well, I don't know why either one wasn't paid before those 
kinds of deadlines.
  But I can tell you there are a lot more problems than that.
  So if we are thinking about going to a Federal healthcare--and I 
guess we are not because we had that vote a little bit earlier on 
whether we would have a single-payer system. I was amazed at the number 
of people who chose not to vote on that. At any rate, I don't think 
that is where America wants to go. I have had some people ask me about 
that. I have given them some suggestions on where to check to see what 
kind of care they would get under that, and they have come back

[[Page S4411]]

to me and said: I don't think that is where we want to go.
  I know the other side of the aisle has wanted to go that way for a 
long time. When I first got here, Phil Gramm was one of my mentors, and 
I really appreciated all of his advice in so many areas. One of the 
things he said to me was, you have to watch out for healthcare because 
where the Democrats want to go is to single-payer healthcare. In other 
words, they don't care who drives the train as long as it wrecks.
  So I look back on ObamaCare and I say: Man, this was 18, 19, 20 years 
ago that he told me this. Is that where ObamaCare is supposed to go, to 
wreck the train so we can go to single-payer? I don't think so, but I 
think we are on the way to a train wreck, and I am not hearing a lot of 
disagreement about the train wreck. I am hearing some disagreement 
about the amount of calamity in the train wreck but not on whether 
there is going to be a train wreck.
  There are a number of things we could do to take care of the costs 
that have gone up under this. That can be confronted within a free 
market as opposed to the government-run, government-controlled market 
we are under now. One of them is to reduce the tax burden. I did notice 
that I have a lot of people in Wyoming--again, we are one of the 
smallest or least populated in the Nation. We are big in land mass, but 
we are small in population--In Wyoming, $5.6 million was collected from 
people for fines for not having the adequate healthcare.
  Those were people who said: Wait a minute, I have to spend so much on 
my healthcare and then a high deductible that I am never going to get 
anything out of it. So when I calculate the annual cost, the $1,700 
that I have to pay as the fine--or $1,500, somewhere in that range--is 
cheaper than paying for all those premiums and then a deductible if 
anything ever happens to me.
  These are real people I am talking about.
  Mr. SCHATZ. Mr. President, would the Senator yield for a question?
  The PRESIDING OFFICER. The Senator from Wyoming has the floor.
  Mr. ENZI. I allowed the other side to have their hour. I expect to 
have this hour, even if some of it is in silence.
  I mentioned reducing the tax burden.
  We could also eliminate some regulations. We really need to take a 
look at some of those regulations within the essential health benefits 
and see if everybody needs all of them or if there are some they would 
opt out of, given the opportunity, because they know they will never 
need them. There are a lot of examples of that.
  We could eliminate the mandates from the Federal and State. We have 
the elimination of the Federal mandates in this bill, both the 
individual mandate and the employer mandate.
  We could also increase competition within the marketplace by 
increasing flexibility. Some of these things we can't do, particularly 
to the level we would like to do them, but we could have more 
competition if we could increase the number of insurance companies. 
Competition makes a difference.
  I have had a number of people, though, who have suggested to me that 
the biggest thing we could do would be to pass the medical liability 
reform because doctors are practicing defensive medicine, which drives 
up the cost, so that if they are ever in a lawsuit, they can prove they 
did every possible thing that they could ever imagine or that anybody 
could raise as an issue. There is a cost to doing that. One of the 
  Mr. HEINRICH. Mr. President, I would ask if the Senator would yield.
  The PRESIDING OFFICER. The Senate will be in order.
  The Senator from Wyoming has the floor.
  Mr. HEINRICH. Will the Senator from Wyoming yield for a question?
  Mr. ENZI. I will not.
  The PRESIDING OFFICER. The Senator declines to yield.
  Mr. ENZI. It has been suggested that the government could have an 
appropriate role in healthcare by maybe using advanceable, refundable 
credits to prevent any lapse in coverage. One of the problems we have 
right now is that people can wait until they have something terrible 
happen to them, and they can sign up for insurance on the way to the 
hospital--you can't pay when you are in the ambulance, and you can't 
pay when you are getting treatment, and you can't pay when you are 
getting rehab--and when they are done, they drop out of it. It is hard 
for an insurance company to figure in the cost of something they are 
not going to get paid for at all.
  There have been a number of suggestions. I don't know whether they 
are any good. I could throw them out. One of them is that if you don't 
keep continuous coverage, you should have to pick up your own expenses 
for the first 6 months. That would encourage people to have continuous 
coverage. It is just one possible suggestion.
  There is a role for government within this setting, and that is 
requiring some transparency within the system, encouraging the 
development of new healthcare competition, prevention of collusion 
between healthcare companies, and having prices posted.
  I remember a hearing we had once--
  Ms. WARREN. Mr. President, will the Senator yield for a question?
  Mr. ENZI. I will not. You got your hour; it is my hour.
  The PRESIDING OFFICER. The Senate will be in order.
  The Senator declines to yield.
  The Senator from Wyoming has the floor.
  Mr. ENZI. When I was chairman or when Senator Kennedy was chairman of 
the Health, Education, Labor, and Pensions Committee, we switched from 
doing hearings to doing roundtables. That was an interesting experience 
too. Instead of having all of the witnesses except one picked by the 
majority and the other one picked by the minority and then everybody 
coming up to beat up on the person who was in the opposite field, we 
went to roundtables.
  What you do with a roundtable is you pick 2 or 6 or 8 or 10 people 
who are actually knowledgeable in that field, who have actually done 
something, who have had their hands on what we were talking about.
  I remember the first one. One of the questions at the end was by 
Senator Kennedy, and he asked the witnesses that he and I had selected. 
This wasn't me selecting; this was a joint effort selecting them. He 
said: What do you think about single-payer insurance? As they went 
around, there was only one out of 10 people who said: Well, it might be 
a good idea, but we probably ought to take a look at it. The rest of 
them said: It won't work in America. We are already used to something 
  When the hearing was over, Senator Kennedy said to me: You know, I 
think these roundtables are a good idea. I think it is a good thing to 
kind of hear about what the people are actually experiencing out there 
before we write the bill.
  Well, we did a lot of healthcare roundtables. One of the witnesses 
was from Safeway. Safeway had been able to hold their costs level and 
started to bring them down. Of course, we were interested in anybody 
who could hold healthcare costs level or bring them down. The way they 
had done that was to find out what the costs of different procedures 
were in the area where they had stores. After they knew what the cost 
of the procedure was, they could take the median price for whatever it 
was, and if the people in their store would take the median price, it 
didn't cost them anything. If they went above the median price, they 
had to pay the difference. If they went below the median price, they 
got the difference. So they were actually paying attention, using some 
financial literacy in any of the treatments they needed to get, and 
they appreciated that their company had done this research for them in 
advance so they could have some kind of an idea of what the market 
held. He estimated that if they were able to increase the flexibility 
they had with this, they could bring down their costs by about 5 to 7 
percent a year.
  I worked on a 10-step plan--in conjunction with Senator Kennedy on a 
lot of it--and talked about it across the country and particularly 
across Wyoming. It would have been 10 steps to get healthcare for 
everyone without mandates but with incentives.
  Mr. VAN HOLLEN addressed the Chair.
  The PRESIDING OFFICER. The Senate will be in order.
  Mr. VAN HOLLEN. I wonder if the Senator would yield for a question.
  The PRESIDING OFFICER. The Senate will be in order.

[[Page S4412]]


  Mr. VAN HOLLEN. Will the Senator yield for a question?
  Mr. ENZI. The Senator will not yield.
  The PRESIDING OFFICER. The Senator declines to yield.
  The Senator from Wyoming has the floor.
  Mr. ENZI. Earlier I mentioned the CO-OPS. I would have preferred the 
small business health plans. I didn't think the CO-OPS would work.

       CO-OPS were included in ACA.
       These plans were meant to provide competition with existing 
     health insurance companies.

  It was an opportunity to set up insurance companies that actually 
were funded.

       The CO-OPS were given $2.4 billion in ``federal loans.''
       The CO-OPS were prohibited from having former healthcare 
     executives with managerial or accrual experience.
       The CO-OPS were conceived to drive down the premiums by 
     providing competition and underselling the cost for policies.
       More than half the 23 CO-OPS went out of business in 2015, 
     but 8 of the remaining 11 CO-OPS were in financial trouble.
       The number of CO-OPS is now down to 7 (4 of the prior CO-
     OPS went bankrupt in 2016).
       Examples of how the CO-OPS that have failed and have cost 
     the taxpayers. In 2015 alone, there was a huge amount of 
     money lost and also cost the enrollees in the CO-OPS their 
       New York Health Republic, 23,000 policies lost, $57 million 
     dollars lost in the first half of 2015.
       Iowan and Nebraska CO-Opportunity Health, 120,000 policies 
     canceled, $146 million dollars lost. Arizona CO-OP, 59,000 
     enrollees lost their insurance, $90 million dollars lost. 
     Colorado CO-OP, 89,000 enrollees insurance canceled, $72 
     million dollars lost.

  Ms. HASSAN addressed the Chair.
  The PRESIDING OFFICER. The Senate will be in order.
  The Senator from Wyoming has the floor.
  Ms. HASSAN. Mr. President, I wonder if the Senator from Wyoming will 
yield for a question.
  The PRESIDING OFFICER. Does the Senator from Wyoming yield for a 
  Mr. ENZI. No.
  The PRESIDING OFFICER. The Senator does not yield.
  The Senator from Wyoming has the floor.
  Mr. ENZI. Continuing:

       The [Health and Human Services] and administration 
     officials knew that the CO-OPS were at risk even before they 
     received their first ``loan'' in 2014. Senator Rob Portman, 
     Chairman of the Senate Permanent Subcommittee on 
     Investigations, said that the HHS knew of serious problems 
     concerning the failed CO-OPS enrollment strategies, pricing 
     and financial management before the department ever approved 
     their initial loans.
       Dr. Mandy Cohen, the director of the CMS, testified before 
     a House subcommittee that 8 of the 11 remaining CO-OP 
     companies were in serious financial difficulty and receiving 
     ``enhanced oversight'' and ``corrective action.'' Dr. Cohen 
     did not explain what that ``corrective action'' or ``enhanced 
     oversight'' consisted of nor could she indicate the 
     enrollment figures and the possibility of financial survival 
     for the CO-OPS that were being monitored.
       Also, 4 more CO-OPS have failed over the first half of 
     2016, leaving only 7 remaining.

  I am not sure what today's number is.

       The HHS continued to make these federal loans though they 
     knew the CO-OPS were failing.

  Under the small business health plans, there is no requirement to 
have the Federal Government fund it unless we want to fund more 
oversight. I am not opposed to that either.

       So What are the American People Think of This?
       There has been greater than $1 billion dollar loss of 
     taxpayer money to CO-OPS that have gone bankrupt.
       Only 7 of the initial 23 CO-OPS remain in business.
       The CO-OPS were constructed as a way of providing 
     competition against existing companies, however in order to 
     do that they underpriced their products. No company can 
     survive if they take in less than what they put out in 
     services and understandably, the majority of CO-OPS have gone 
     out of business.

  That could be something to do with their being prohibited from having 
former healthcare executives with managerial and accrual experience.

       This was known by the HHS before the first ``federal 
     loans'' had ever been approved.
       Over 800,000 people have lost their insurance because the 
     CO-OPS have gone out of business and there are more to come.
       It speaks to the fact that the HHS and ObamaCare 
     Administration had very little regard for the American 
     taxpayer and the American people.
       The disturbing question is whether any of the taxpayer's 
     money will be returned.

  I did say those were loans, and there aren't many left that can pay 
back the loans, which is a little bit of a difficulty.
  Of course we did hear that ObamaCare was supposed to bend the cost 
curve down. I ought to point out some facts on that as well.

       From 2009 to 2012 healthcare, spending grew less than 4 
     percent, as spending started increasing dramatically in the 
     first quarter of 2014. This was the start of the 
     implementation of the legislation. Subsequent healthcare 
     spending from 2015 showed a 6.8% rise. In 2016, it is 
     estimated to increase to 6.5% spending growth.

  We know from last year, which isn't included in this, that it started 
doubling at that point.

       Deductibles both inside and outside ObamaCare exchanges 
     have increased enormously and will continue to increase. 
     Healthcare costs are now increasing more than inflation.
       Why has spending increased? There has been increased 
     utilization services. The increased healthcare spending thus 
     led to higher insurance costs. A particular cause of 
     increased spending related to ObamaCare is a marked increase 
     in deductibles and health insurance premiums in the ObamaCare 
     exchanges. Additionally, because of the increased number of 
     patients with Medicaid expansion there have been increased 
     costs. Healthcare costs [will] continue to rise.
       The total healthcare spending for 2016 is to increase to 
     over $3 trillion dollars.

  I will get some updated numbers on that.

       Total healthcare spending . . . rate of spending increase.
       Medicaid increased: 11%
       Medicare increased: 5.5%
       Private insurance spending increased: 4.4%.

  If I would have known that Medicare was going to be mentioned, even 
though it is not in the bill, I would have shown the little chart that 
I have, which shows how much revenue we get for different mandatory 
spending that we have.

       All of those mandatory spendings are in a little bit of 
     trouble because the revenue streams to take care of them are 
     not sufficient. At one point, they were sufficient in some of 
     them, and the federal government doesn't have any place to 
     park cash. The federal government puts bonds in a drawer and 
     spends the cash. That is kind of double dipping because there 
     is nothing there for later. There is a Social Security trust 

  I have learned from trust funds that you have to find money to put in 
before you can take money out. I never saw a trust fund that operated 
that way until I got here. We have some crises that are coming up. We 
are going to compound healthcare because for Federal pensions, we 
really don't put any money away for them. We require businesses to put 
it away, and we have had some other suggestions. I have some small 
pension plans I would like people to look at, some pooling for that, 
which I think would encourage more people to have pension plans in 
small business.

       But the cost of administration is extremely high unless 
     they can share in that. All of them would require that there 
     be money put away to be able to cover with reasonable growth 
     in the interest of the fund so that what was promised could 
     be taken care of.

  In 2006, Senator Kennedy and I worked on saving some pension plans, 
trying to make sure that promises that were made could be met. We did a 
pension bill that needs to be redone again, particularly for some 
sectors of the pension.

       The private sector is required to put away money. When the 
     market goes down, it increases dramatically the amount of 
     money that they need to put in and creates some problems for 

  The point I am making is that the Federal Government doesn't do that 
with any excess funds we get. I don't care if it is in healthcare or 
Social Security or where it is, those excess funds are allowed to be 
spent with bonds put in a drawer, with the promise that the full faith 
and credit of the Federal Government will cover them. I don't know how 
many people at home believe that, but that is what it is.
  How has the battle for the quality of healthcare fared? This gets 
covered in this book too.
  Here is a little bit on the quality of healthcare and outcomes.

       The infant mortality rate . . . has been used by 
     politicians and others in political debate to describe the 
     inferiority of the U.S. healthcare [system]. U.S. ranked only 
     30th in the world (and the neonatal mortality below that). 
     When you look at this data, however, you find a very 
     different picture. The United States followed the World 
     Health Organization definition that a live birth is any 

[[Page S4413]]

     that shows any sign of life, i.e. a baby that takes a single 
     breath or has a heartbeat. . . . Other countries however 
     including both developed and underdeveloped countries use 
     different standards. The definition of ``live births'' varies 
     between different countries. For example, in Switzerland a 
     newborn has to be 30 cm. long to be considered a live birth. 
     In Belgium and France, infants have to be at least 26 weeks 
     to be considered as live births. Infants less than 24 weeks 
     gestational age are excluded from registries of live birth in 
     multiple other countries including Japan and Hong Kong. In 
     Canada, Germany, and Austria, the newborns weighing less than 
     500 grams are not considered viable and are excluded from the 
     infant mortality rates.

  What I am saying is, there are games that can be done with that, with 
the performance ratings, with the life expectancy data, with the 
Commonwealth Fund. All of these things are issues that we are 
embarrassed about and things we ought to be working on, things we ought 
to improve, things we ought to help with our country.
  We need to be looking at all of those outcomes--the cancer outcomes, 
the cardiac disease outcomes, the stroke outcomes, the chronic illness 
outcomes, the hypertension outcomes, the diabetes and cholesterol 

       We know that the earlier and more effective there is 
     treatment of the disease, the better treatment of the disease 
     for chronic disease, the better the results are. The more 
     accessible and better technology there is, the more access to 
     specialty care for early diagnosis and treatment, better 
     preventive screening, and the inventiveness of the American 

  I think it was today--my days blend together these days with this 
healthcare that we are working on. I was visited by a couple of young 
people from Wyoming who have diabetes. We have put some additional 
money into research. We, as a Senate, don't say exactly where that 
money has to go because we shouldn't be kicking the tires on the 
different diseases and figuring that out. I worry about where we might 
put the money, if that were the case, because we are affected 
differently than what our constituents are.
  Both of these young people were on a pump, and I have gotten to meet 
Dean Kamen who invented the pump. It is kind of an interesting story. 
Of course, that wasn't his first medical invention. His first medical 
invention was actually when he was a junior in high school and his 
brother was doing a residency in a hospital that handled transplants 
for infants. They were mentioning some devices similar to a needle in 
which medicine can evidently go through. This was needed for transplant 
of a kidney. He was lamenting they didn't have that capability. He went 
down to the basement and figured out how to make one of those. That was 
his first patent. You probably know him more for the patents of the 

  After he made some money, he got to experiment with some different 
things. One of them is that mobile thing that police use and shopping 
centers use and tourists use where you ride around on a Segway. He 
built that for a specific medical purpose, which was to figure out a 
way to have a wheelchair that could climb stairs. Instead of building a 
ramp and being limited where there wasn't a ramp, he figured out a 
wheelchair that could climb stairs. It could do a number of other 
things too. For instance, if the person in a wheelchair went to a 
cocktail party, they could rotate the wheels up so they were at 
standing level to everybody else.
  He had a lot of problems getting it through FDA. He finally got it 
through FDA, then was told there are other wheelchairs that are less 
expensive so we are not going to pay for that. I think another company 
is coming back in to do that. It is an outstanding experience to sit in 
a wheelchair and go downstairs with it.
  He worked on this diabetic pump. It is interesting how he got into 
the diabetic pump. He was told pregnant women who are on insulin, if 
they take the insulin doses, they wind up often with babies that have a 
bigger head, which makes the delivery a bit more difficult. Everything 
changes so the head becomes normal after a period of time, but it is a 
problem at childbirth. He thought, what if we gave them a dose of 
insulin over a longer period of time; would that have an effect on the 
infant? So he invented a machine which started out being a fairly good-
sized machine, but it worked. If they got their insulin over a slow 
period of time, but sufficient insulin, the baby didn't have the larger 
  Well, this man is a businessman. He said: That is good. That will 
provide part of a market, but there ought to be a bigger market for it. 
He said: I wonder if men would have any benefit from having a diabetic 
pump? So he was able to have a trial and found out that also worked. He 
worked it down to be smaller and smaller and is working on other kinds 
of inventions that will do better things.
  We need to keep putting things into innovation. I said a lot of 
times: If there is a problem in America and we put on a small 
incentive, there will be somebody who will figure out how to turn that 
into something very useful.
  Mr. President, I think I have been requested by Senator Schumer to 
have 2 minutes, and to have 5 more minutes by UC perhaps for others, 
but I would ask that at the end, Senator Cornyn be allowed 2 minutes 
before the vote.
  The PRESIDING OFFICER. The Democratic leader.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that Mr. Cornyn 
can conclude, but I be given 5 minutes and the Senator from Oregon be 
given 5 minutes.
  Mr. ENZI. I was wrong. I need 5 for Senator Cornyn.
  Mr. SCHUMER. Senator Cornyn is to speak after us.
  The PRESIDING OFFICER. Is there objection to 5 minutes for both 
  Mr. SCHUMER. No. I ask 5 minutes for the Senator from New York, 5 for 
the Senator from Oregon, and 5, finally--or however much time the 
Senator from Texas wants.
  The PRESIDING OFFICER. The majority whip.
  Mr. CORNYN. Mr. President, I reserve the right to object. I think it 
is only fair that each side gets 5 minutes to speak. Everybody is ready 
to vote. We had 2 hours of debate. So I would ask to amend the 
unanimous consent request that each side be given 5 minutes to close, 
divided up any way you want.
  I ask unanimous consent that each side be given 5 minutes to speak.
  Mr. SCHUMER. I would simply say to my friend, this is a huge bill. We 
have not had a huge amount of time to debate it. We have just seen it 
for 2 hours. To ask for another 5 minutes on our side for the ranking 
member of Finance, in addition to mine, is not too much to ask.
  Mr. CORNYN. Mr. President, I object.
  Mr. SCHUMER. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that there be 
given 5 minutes to the Senator from Oregon, 5 minutes to myself, and, 
in conclusion, 5 minutes to the Senator from Texas.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Oregon.
  Mr. WYDEN. Thank you, Mr. President.
  I thank my leader, Senator Schumer.
  Colleagues, before morning, millions of Americans could be on their 
way to lives filled with healthcare misery, eye-popping cost increases, 
hollowed-out coverage, and gutted consumer protections.
  Colleagues, there are already stories of Americans hoarding pills and 
clamoring for screenings because they fear what the future is going to 
bring. These are the Americans who took deep breaths of relief 7 years 
ago when the Affordable Care Act became law. Women were no longer 
penalized for their gender. Cancer survivors no longer had to worry 
about busting a limit on coverage and facing personal bankruptcy. 
Entrepreneurs with a big idea had the freedom to set out on their own, 
no longer tied to their employer insurance because they had a 
preexisting condition. Now all of them are looking at lives on hold.
  The skinny repeal package makes a mockery out of the President's 
promise to lower premiums. He made that promise repeatedly to the 
American people: no reductions in coverage, no increases in premiums. 
This bill makes a mockery out of that Presidential

[[Page S4414]]

pledge. Don't take my word for it. The Congressional Budget Office--the 
independent umpires--have told us the premiums are going to jump 20 
percent next year as a result of this bill. That goes into effect, 
colleagues, January 1 of this year. Some happy New Year: Your premiums 
have jumped through the roof.
  Colleagues, vote for this and try to explain it to the people you 
represent and have them tell you that there is not going to be anything 
they can sacrifice to pay for that rate hike. Their wages are flat, 
they are on an economic tightrope, and they are going to have to have 
premium hikes with a 20-percent hit.
  The Finance Committee is accountable for funds that are critical for 
women's health. This measure begins the effort to take away the right 
of women to go to the provider they choose. That, too, will be hard to 
explain to millions of Americans who simply want what we have: the 
right to make your own healthcare choices.
  Colleagues, the damage may get worse. Skinny repeal could be the 
gateway drug to TrumpCare. We still don't know what is going to happen 
with Medicaid so seniors are worried, kids with special needs, disabled 
folks. If the Senate and the House head to a conference--that is a big 
``if''--this body is going to face a radical set of demands from a very 
stubborn extreme on the other side of the Capitol.
  My time has expired. I appreciate Leader Schumer getting me this 
time. The promises Senators have gotten to protect their constituents, 
those promises could well be in the trash can within 48 hours.
  I urge my colleagues to think about what it is going to be like to go 
home and explain to their constituents how this misery--how this 
healthcare misery came to be a part of their lives every single day. I 
don't think they are going to be able to make the case.
  I urge my colleagues to support Senator Murray on this motion to 
  I yield back.
  The PRESIDING OFFICER. The Democratic leader.
  Mr. SCHUMER. Mr. President, let me thank my colleagues on the other 
side of the aisle for yielding us time.
  This august body has been around for over 220 years. It has rules. It 
has traditions we are very proud of. In recent years--both parties to 
blame--many of those traditions have been eroded. What happens when you 
erode the traditions--the bipartisanship, the ability to work through 
the regular order--is very simply that the product that emerges is not 
very good. There is a reason this body has been the greatest 
deliberative body in the world, and it is because it had those 
traditions. Now we don't have them.
  We have a bill that we have seen for 2 hours. It affects the 
healthcare, perhaps the lives--almost certainly the lives--of millions. 
It affects the daily lives of men and women and children. We haven't 
even had a chance to explore all the ramifications. There is a lot of 
anger on the other side at the ACA. I understand that, but you are 
repeating what you claim are the same mistakes.
  Just as maybe ObamaCare could have been made better if it were a 
bipartisan proposal, this one certainly would have been made better. 
This skinny repeal, CBO tells us, will kick 15 million people--16 
million people--off care. This skinny bill, after all the cries of 
reducing premiums as the major reason that ObamaCare needed changes, 
will raise premiums 20 percent a year, ad infinitum. The average 
working family is going to struggle to get healthcare even more than 
they have now.
  Why is this being rushed through this way? Why is this being done in 
the dark of night? I can't believe my colleagues are proud of it. If 
they were, there would be brass bands down the streets of smalltown 
America celebrating this bill. That is not what is happening. It is 
midnight. Debate is curtailed. We can't amend it in the open. We can't 
do what is needed.

  So I would plead once more with my colleagues, let's start over. We 
are the first to admit that the present law needs some changes. We are 
the first to want--maybe having learned our own lessons--that it should 
be done in a bipartisan and sharing way. Let's start over.
  We can do better. We can do better for all those people who are going 
to be hurt. We can do better for the traditions of this great 
institution. We can do better as Americans who love our country and 
love our democracy and love our process. It is not too late to turn 
back from this proposal ideologically driven and do better because we 
all are not proud of this product. I don't think there is hardly anyone 
in this body who is proud of this product.
  Let's make this a turning point, not just on healthcare but in how we 
function together. We plead with you, let us commit this bill. Let us 
vote against skinny repeal, and let's work together to improve our 
healthcare system in the way our Founding Fathers intended us to 
improve it.
  I yield the floor
  The PRESIDING OFFICER. The majority whip.
  Mr. CORNYN. Mr. President, it is important to remember how we got 
here. I still remember voting on the Affordable Care Act at 7:30 in the 
morning on Christmas Eve. Because this bill--the 2,700-page bill that 
our Democratic friends did not read and which Ms. Pelosi said we have 
to pass it before we know what is in it--that bill was passed on a 
party-line vote and signed into law by President Obama without any 
participation of Republicans. So it is a little hard on the ears to 
hear my friend, the Democratic leader, plead for bipartisan solutions 
  I agree with him, it is not too late because this is an open 
amendment process. Our Democratic friends, rather than trying to kill 
the bill, can help us make this bill better.
  I suspect that based on their comments, that they really need--we 
need to have some sort of remedial legislation 101 because this is not 
the end of the process. But in order for the House and the Senate to 
work together to come up with a bill we both agree to, there is a 
conference committee, which Members of both parties can appoint Members 
to the conference committee to work out differences. I don't believe my 
friend, the Democratic leader, is really interested in working on a 
bipartisan basis to fix the structural defects in ObamaCare.
  We know the individual market is in meltdown. Premiums are 
skyrocketing, contrary to the promises made by the President when the 
bill was sold. We know deductibles are so high that people are 
basically denied the benefit of their coverage and, yes, insurance 
companies are fleeing because they are bleeding red ink, and they can't 
economically sell insurance on the exchanges anymore.
  So we all know something needs to be done, but we are not interested 
in just throwing more money at insurance companies, bailing out 
insurance companies, which is what I have heard from our friends on the 
other side. Well, it is not true. It is not the only thing we have 
heard. We have also heard the Senator from Vermont, for example, 
advocate for a single-payer system.
  What this bill does do is it repeals the individual mandate, which to 
us is an unacceptable government coercion of American citizens forcing 
them to buy a product they don't want and they can't afford, because 
currently 28 million people are uninsured under ObamaCare. I thought it 
was supposed to provide coverage for everybody, but in my State, about 
450,000 Texans who earn less than $25,000 a year are paying the penalty 
because they can't afford the insurance, so they pay the penalty, and 
it is not working.
  We are doing everything we can, given the fact that our friends on 
the other side of the aisle are simply sitting on their hands and not 
participating in the process, other than to try to undermine it.
  We intend to pass a bill and go to conference with the House to make 
this bill better because our goal is to stabilize the markets, to bring 
down premiums, to protect people with preexisting conditions, and to 
put Medicaid, the safety net for low-income Americans, on a sustainable 
path. You would think those would be things that our colleagues across 
the aisle would want to join us in and participate in but apparently 
  We need to move on. We can't let the fact that our Democratic friends 
are unwilling to participate keep us from doing our duty the best we 
can under the circumstances, and that is what this bill represents. It 
is not perfect,

[[Page S4415]]

but it is better than the status quo, and we intend to do our duty.
  Mr. President, I yield back.
  The PRESIDING OFFICER. All time has expired.

                        VOTE ON MOTION TO COMMIT

  The question is on agreeing to the Murray motion to commit.
  Mr. SCHUMER. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  The result was announced--yeas 48, nays 52, as follows:

                      [Rollcall Vote No. 178 Leg.]


     Cortez Masto
     Van Hollen


  The motion was rejected.

                       Vote on Amendment No. 667

  The PRESIDING OFFICER (Mr. Perdue). The question is on agreeing to 
amendment No. 667.
  Mr. ENZI. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  The result was announced--yeas 49, nays 51, as follows:

                      [Rollcall Vote No. 179 Leg.]




     Cortez Masto
     Van Hollen
  The amendment (No. 667) was rejected.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that H.R. 1628 
be returned to the calendar.
  The PRESIDING OFFICER. Without objection, it is so ordered.