CONCURRENT RESOLUTION ON THE BUDGET, FISCAL YEAR 2017; Congressional Record Vol. 163, No. 3
(Senate - January 05, 2017)

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[Pages S75-S106]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         CONCURRENT RESOLUTION ON THE BUDGET, FISCAL YEAR 2017

  The PRESIDING OFFICER. The clerk will report the concurrent 
resolution.
  The bill clerk read as follows:

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

  The PRESIDING OFFICER. The assistant Democratic leader.
  Mr. DURBIN. Mr. President, the pending business in the U.S. Senate is 
to set the stage procedurally so the Republican majority of 52 to 48 
can repeal ObamaCare, the Affordable Care Act. That is what we are 
about. That is the business of the day, the week, and probably the 
weeks to come. So we are addressing that issue and others related to 
the budget.
  I would like to start by sharing a story that was told to me by a 
family who I represent, Richard and Mary Laidman, who live in 
Naperville, Illinois. They told me a story, and I will recount it to 
you.

       My 13-year-old son Sam was diagnosed with leukemia one day 
     after the ``no pre-existing conditions exclusions for 
     children''

[[Page S76]]

     protection went into effect [under the Affordable Care Act.] 
     The good news is that the form of leukemia has, so far, been 
     effectively controlled by a magic-bullet drug. My son is 
     currently a very robust young man and in otherwise good 
     health (while the drug keeps him alive). The bad news is that 
     the drug, as I understand it, costs [Blue Cross Blue Shield] 
     about $10,000 a MONTH! Without even going into the issue of 
     ``Big Pharma'' pricing--

  They wrote--

     this means that it would take about $6 million to get my son 
     into his 60's. Obviously we are feeling dependent on all the 
     clauses of the [Affordable Care Act] right now--no pre-
     existing conditions exclusions, no caps on benefits, allowing 
     Sam to stay on our health insurance plan till [he reaches] 
     age 26.

  Mr. President, the bottom line according to the Laidman family of 
Naperville, IL, is that the Affordable Care Act is critical to their 
family's health and financial survival. That is what this debate is 
about. It is not about talking about promises made in campaigns or 
slogans one way or the other. It is about families like the Laidman 
family in Naperville who understand that were it not for the provisions 
in the Affordable Care Act, their son might not be here today or they 
may be penniless.
  That is what it was like in the old days. If you had a son with 
leukemia and wanted to buy a family health insurance plan, good luck. 
If they would sell it to you, you probably couldn't afford it. And 
secondly, many policies had limits on how much they would pay. Listen 
to what she tells us: $10,000 a month just for this drug that keeps her 
son alive. There were policies that had $100,000 limits on the amount 
they pay each year. Oh, they were affordable and cheap enough. What 
would the Laidman family have done if that is all they had to turn to?
  Sadly, we know thousands, perhaps millions, of families across 
America face that. That is why the Affordable Care Act made a 
difference. That is why it is inconceivable that the Republicans are 
coming to the floor, saying they want to repeal the Affordable Care Act 
without any replacement.
  They have had 6 years to come up with a better idea, 6 years to come 
up with a list of improvements, and they have failed and failed 
miserably. Why? Because it is hard. It is difficult. We found that when 
we wrote this law.
  Let me concede a point to the Republican leader who was on the floor 
this morning. I am ready to sit down. I think other Democrats are as 
well. If you want to change and improve the Affordable Care Act to make 
sure that American families like the Laidmans of Naperville have a 
chance for these protections in a better situation, I want to be part 
of it, and I have wanted to be part of it for 6 years. But the 
Republican approach has been very simple: All we will propose is 
repeal. We will not come up with an alternative.
  It is catching up with them this week in Washington. Have you 
noticed? Senators on the Republican side of the aisle and even some 
House Republicans are saying publicly: You know, we really ought to 
have a replacement.
  It is not fair for us to say to America: We're going to repeal the 
only protection you have. Trust us. Some day in the future we might 
come up with a better plan.
  The atmospherics have changed--maybe even changed with the President-
elect. Remember a few weeks ago when he said he thought that provision 
about the preexisting conditions was a good idea? Well, he is right, 
and so is the provision to make sure you don't have limits under the 
policy, the provision that allows the Laidmans to keep their son under 
their family health insurance plan until he reaches the age of 26.
  Yesterday, Mrs. Kellyanne Conway, Senior Advisor to President-Elect 
Trump, was on a morning show, and she said: ``We don't want anyone who 
currently has insurance to not have insurance.'' That is a good 
statement. Then, when she was asked about whether the Republicans 
should come up with a replacement, she went on to say: ``That would be 
the ideal situation. Let's see what happens practically.''
  Well, I don't know Mrs. Conway, but her observations square with what 
we feel on this side of the aisle, and more and more Republicans are 
starting to say publicly that it is irresponsible for us to repeal the 
Affordable Care Act without an alternative. It invites chaos. We know 
what is likely to occur. We know that if there is no replacement that 
is as good or better, people are going to lose their health insurance.
  Illinois' uninsured rate has dropped by 49 percent since the 
Affordable Care Act was passed. A million residents in my State now 
have health insurance who didn't have it before the Affordable Care 
Act. Illinois seniors are saving on average $1,000 a piece on their 
prescription drugs because we closed the doughnut hole in the 
Affordable Care Act, which the Republicans now want to repeal. More 
than 90,000 young people in Illinois have been able to stay on their 
parents' health plan until age 26 under our current health care system, 
and 4.7 million Illinoisans, such as the Laidman family, no longer have 
annual or lifetime caps on benefits, and that protects them when there 
is a sick member of their family and they need it the most. Under our 
current health care system, 5.6 million Illinoisans with preexisting 
conditions no longer have to fear denial of coverage or high premiums.
  I am going to close with this brief reference. Remember the first 
thing President-Elect Trump did when he went to visit the State where 
they were going to keep 800 jobs and not transfer them overseas? He 
took justifiable pride in the fact that he had jawboned the company 
into deciding to keep at least some of the jobs in the United States--
800 jobs. That is good. America needs companies to make the decision to 
keep jobs here. We need all the good-paying jobs we can get, 
particularly in manufacturing. But do you know what the repeal of the 
Affordable Care Act means to jobs in Illinois? Well, the Illinois 
Health and Hospital Care Association knows. They told us that it would 
have a devastating impact on hospitals in Illinois. That includes many 
rural downstate hospitals, the major employers in their community. They 
estimate that we would lose between 84,000 and 95,000 jobs with the 
repeal of the Affordable Care Act. We could have a press conference for 
saving 800 jobs at Carrier, but are they going to have a press 
conference and celebrate when they are killing 84,000 jobs in Illinois 
with the repeal of the Affordable Care Act? They shouldn't. They should 
do the responsible thing.
  Let's work together. Let's make the Affordable Care Act better, more 
affordable. We can do it, but the notion of repealing it first and then 
promising to get around to a substitute later invites chaos. That is 
going to make America sick again.
  Mr. President, I yield.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, first I want to thank Senator Durbin for 
his comments about the policy of repealing the Affordable Care Act and 
not knowing what comes next, the impact it is going to have on people 
from Illinois. I am going to talk about people in Maryland. I have 
received similar letters showing that people are going to be adversely 
impacted.
  I want to share with my colleagues the conversation I had with the 
secretary of health from Maryland. Maryland has Governor Hogan, a 
Republican Governor, and his secretary of health met with me several 
weeks ago to express his concerns about the impact on the people of my 
State of Maryland if the Affordable Care Act were repealed. What I 
heard from the secretary of health of Maryland was similar to what I 
heard from many of the health care stakeholders from the hospital 
association to physician groups, to health care advocates, to ordinary 
Marylanders who have contacted me about their concerns about what 
happens if we see a repeal of the Affordable Care Act.
  Let me just give you some examples of how the Affordable Care Act is 
working in my State and, as Senator Durbin indicated, in his State. The 
uninsured rate in Maryland has dropped from 12.9 percent to 6.6 
percent. That is about a 50-percent drop in the uninsured rate. That 
benefits all Marylanders--all Marylanders. Yes, 400,000 Marylanders now 
have health coverage who didn't have health coverage before, and for 
those 400,000, that is a big deal. That means they can see a doctor and 
get a physical examination. If they are ill, they can get treated and 
know there are doctors and hospitals that will want to take care of 
them because they have third-party reimbursement. They

[[Page S77]]

no longer have to show up in emergency rooms because that is the only 
place they could get to. They can now go to a doctor and get a physical 
examination.
  Mr. President, it benefits more than just those 400,000 Marylanders, 
who, thanks to the Affordable Care Act, have health coverage. It 
affects all Marylanders because we no longer have the amount of cost 
shifting of those who have health insurance paying for those who don't 
have health insurance because they use the system and don't pay for it. 
That dislocation has been dramatically changed in my State. So all 
Marylanders are benefiting from having 400,000 Marylanders who now have 
health coverage, but it goes beyond that. Many Marylanders who had 
health insurance didn't have adequate health insurance. They had 
restrictions on preexisting conditions. They had caps on their 
policies. It didn't cover preventive health care. They now have quality 
health coverage.
  All of that is at risk. All of that is at risk because of what we are 
talking about doing, if I understand correctly. Quite frankly, I am 
still trying to figure out what the Republicans are doing to the 
Affordable Care Act, but if I understand it, they are going to repeal 
it, and they are not going to tell us right now how they are going to 
replace it. So everything that is included in the Affordable Care Act 
is at risk.
  I will give you one more example of costs because I think this is an 
important point. Under the Affordable Care Act, if an insurance company 
wants to increase rates more than 10 percent, there are certain 
procedures they have to go through, certain public disclosures. We have 
a much more public process, but the number of claims of those who 
wanted to increase their policies by 10 percent have dropped from 75 
percent before the Affordable Care Act to now 14 percent nationally. We 
have seen one of the lowest growth rates in health care costs in modern 
history. Yes, the Affordable Care Act has helped us do that. Why? 
Because individuals who had insurance now have coverage for preventive 
health care and are saving us money. Those who didn't have health care 
coverage now have health care coverage, and they are seeing doctors, 
and they are saving us money because if they have a disease, it is 
being caught at an earlier stage, being treated in a more aggressive 
way, and they are saving more intensive health care costs. All that is 
benefiting the people of Maryland and our country.
  Senator Durbin mentioned several people in his State--a person in his 
State--and letters. I want to talk about people in Maryland whom I have 
talked to over the last several years about the impact of the 
Affordable Care Act and why they are so concerned about the policy now 
of repealing the Affordable Care Act.
  I want to go back to 2007. That is a date that Marylanders know very 
well. I want to go back to a 12-year-old, Deamonte Driver. Deamonte 
Driver was a 12-year-old who lived about 10 miles from here. His mom 
tried to get him to a dentist, but he had no insurance coverage, and 
she couldn't find a dentist. She couldn't find a dentist who would take 
care of him. Deamonte Driver needed about $80 of oral health care. He 
had an abscessed tooth that needed to be removed. It would have cost 
$80, and he couldn't find care in 2007 in the wealthiest country, in 
America. As a result, his tooth became abscessed and it went into his 
brain. He had thousands of dollars of health care costs, and he lost 
his life. As a result of that incident, I, along with other members of 
Congress, took up the cause of pediatric dental care to make sure every 
child in America has access to pediatric dental care. That is included 
in the Affordable Care Act as an essential health benefit.
  Before the Affordable Care Act, very few health policies included 
pediatric dental; therefore, families were at risk as to whether they 
would actually use dental services because they did not have the money 
to pay for them. That was changed under the Affordable Care Act. That 
is at risk. That is at risk because, if I understand what is being 
suggested here, we are going to repeal the Affordable Care Act and the 
essential health benefits. We can't allow any more tragedies like 
Deamonte Driver in America, and yet we will be putting our children at 
risk if we repeal the Affordable Care Act.
  There was another provision I worked very hard to get into the 
Affordable Care Act that I think is extremely important. We now have a 
National Institute of Minority Health and Health Disparities at the 
National Institutes of Health. We have agencies that deal with minority 
health and health disparities in all of our health care agencies thanks 
to the Affordable Care Act. That means we are now acknowledging that 
historically we have not done right for minority health in America. We 
looked at a lot of the research dollars; they were not spent in areas 
that minorities were impacted by. We see that access to care in certain 
communities is much more challenging because of minority status. We are 
looking at these issues and taking action.
  The Institute sponsored a study in my home city of Baltimore. That 
study showed that depending on what ZIP Code you live in, your life 
expectancy could be as different as 30 years--a generation. Just your 
ZIP Code. We are taking steps to change that in Baltimore thanks to the 
National Institutes and the Institute on Minority Health and Health 
Disparities. Are the Republicans telling us that is not needed anymore, 
that we are going to repeal our efforts to look at minority health and 
health disparities? That is unconscionable. Yet, if I understand 
correctly, that is the course we are going to follow.
  Mental health parity is another area we have talked about at great 
length here. We know we still have not reached that goal to make sure 
mental health receives the same attention as any other health need, but 
in the Affordable Care Act, we did amazing things to expand access to 
coverage for mental health and drug addiction. By expanding the 
Medicaid population, we have 1.6 million Americans who now have 
expanded coverage for mental health and substance abuse.
  We have had great discussions in this body. I am very proud of the 
Cures Act, where we expanded coverage for drug addiction. Now 
Republicans are talking about taking a major step backward by repealing 
Medicaid expansion that allows access to coverage for mental health and 
drug addiction. To me, that is something that is unthinkable. Yet we 
are moving on that path by the legislation that is before us.
  Let me share a letter I received from Lillian from Baltimore. In 2008 
she lost her job. She has a history of abnormal mammograms. She could 
not get coverage. She could not get an insurance company to cover her 
because of the preexisting concerns. She wrote: The Affordable Care Act 
has worked. I have coverage.
  No preexisting conditions. No longer is being a woman considered a 
preexisting condition in America. Are we now going to turn our backs on 
the women of America and allow these discriminatory practices that 
existed before the Affordable Care Act to come back? I will tell you, I 
am going to fight to do everything I can to make sure that does not 
happen, and I would hope my colleagues on both sides of the aisle feel 
the same. But you are marching down a path that puts women at risk, 
that puts Americans at risk.
  We know about the caps that were in the law before the Affordable 
Care Act. What do I mean by caps? That is the maximum amount your 
health insurance policy will pay you. Some 2.25 million Marylanders had 
caps on their policies before the Affordable Care Act--not just the 
400,000 new people who have come into the system, 2.25 million 
Marylanders will be impacted if we eliminate the protection against 
arbitrary caps.
  The tragedy about caps is that when you really need coverage, that is 
when you are impacted. You get insurance to cover you. You discover you 
have cancer. It is extremely expensive to treat cancer in an aggressive 
way. All of a sudden, you are in the middle of treatment and you reach 
your cap. What do you do? What do you do? There are real, live examples 
from before we passed the Affordable Care Act. We are going to go back 
to those days in the United States of America? That is what repealing 
the Affordable Care Act means for 2.25 million Marylanders who are 
being put at risk.
  Rebecca from Baltimore told me about her daughter Eva, who is 18 
months of age and has severe congenital heart defects and has gone

[[Page S78]]

through numerous operations. If caps are in place, she cannot get 
adequate care for her 18-month-old daughter. Those are real, live 
examples of people who are impacted by the Affordable Care Act. She 
also told me: Thank you for the 26-year-old provision where you can 
stay on your parent's policy. At least she knows Eva will be able to 
stay on her policy until she is 26.
  I heard from Nichole, who is a 22-year-old student at Towson 
University. She could not get affordable health coverage and was able 
to stay on her parents' policy. That is an important provision which is 
being repealed by the Affordable Care Act.
  I helped work on the provision in the Affordable Care Act that 
provides preventive care coverage--immunizations, cancer screening, 
contraception, no cost sharing. That saves money. Preventive health 
care saves money. It makes our health care system more cost-effective. 
That is why we decided to put a focus on preventive health care and 
expand it dramatically. Now, 2.95 million Marylanders benefit from the 
preventive health care requirements of the Affordable Care Act that is 
included in every health policy. That will be repealed, if I understand 
correctly what the Republicans are attempting to do on their repeal of 
the Affordable Care Act. We don't have a replacement. We don't know 
what it is going to look like. It is not easy to figure out how to put 
the pieces back together again.
  There is a provision in the Affordable Act that deals with prevention 
and public health funds and that provides dollars to deal with some of 
the real challenges we have out there--obesity, tobacco abuse. My State 
is getting funds so that we can deal with healthy eating that will not 
only provide a better quality of life for those who have weight issues 
but also lead to a more cost-effective health care system. That will be 
gone with the repeal of the Affordable Care Act.
  Let me talk for a moment about health centers because I know we made 
that a priority in the Affordable Care Act. Qualified health centers 
are centers that are located in, in many cases, challenging communities 
where it is hard to get doctors and hospitals to locate. We provide 
access to care for people who have limited means. The Affordable Care 
Act did two things that are extremely important in regard to 
health centers. First, it provided some significant new direct 
resources for those programs. Secondly, because they are in challenging 
neighborhoods, they have a much higher number of people who have no 
health coverage who go into these centers; therefore, their third-party 
reimbursement is much lower than other health centers that are located 
in better neighborhoods or more affluent neighborhoods.

  The Affordable Care Act has worked in expanding dramatically the 
capacities of these qualified health centers. We have 18 that are 
located in Maryland. I could talk about all of them, but I have been to 
the Greater Baden Medical Services center several times. It is located 
in Prince George's County. They also have a center in St. Mary's 
County. I have been to them many times. I have seen their new 
facilities thanks to the Affordable Care Act. I have seen the building 
in which they provide mental health services and pediatric dental care 
and actually adult dental care also. They provide those services to the 
community thanks to the Affordable Care Act. They told me that in the 
very first year alone of the Affordable Care Act, they were able to 
reduce their uninsured rates by 20 percent, meaning they get a lot more 
money coming in and they can provide many more services. All of that 
will be gone if the Affordable Care Act is repealed. I can't be silent 
about that. This center is providing incredible services. It is one 
thing to have third-party coverage; it is another thing to have access 
to care. We provided both in the Affordable Care Act. We are not going 
to go back.
  I heard Senator Durbin talk about Medicare. I just want to underscore 
this. This is not just about those under 65. It is about our seniors. 
It is about those on disability who are covered by Medicare.
  We heard about the doughnut hole. We all understood. We were getting 
numerous letters from people who fell into that doughnut hole. Guess 
what. Those letters are tailing off dramatically. Why? Because the 
Affordable Care Act closes the doughnut hole for prescription drug 
coverage. In my own State of Maryland, 80,000 Marylanders benefited in 
2014 from the Affordable Care Act and better coverage for prescription 
drugs, amounting to $82 million, averaging over $1,000 per beneficiary 
benefit. Those over 65 have better coverage for prescription drugs. You 
repeal the Affordable Care Act, and all of a sudden seniors figure out 
they have to pay another thousand dollars a year for prescription 
drugs. In my State, they don't have the money to do that. You are going 
to again hear about prescription drugs left on the counter at the 
pharmacy because of the repeal.
  Guess what. It even does more than that. The Affordable Care Act 
provided greater solvency for the Medicare system. I have heard my 
Republican colleagues say: We are not going to do anything to hurt 
Medicare. Repealing the Affordable Care Act hurts Medicare. It hurts 
the coverage and it hurts the solvency. I don't want to be part of 
that. I would hope my colleagues don't want to be part of that. Yet 
repealing the Affordable Care Act does that.
  Let me talk for a moment about affordability. It is one thing to have 
coverage; it is another thing whether you can afford that coverage. We 
heard all of these stories about the increased premiums, and we know, 
of course, that insurance premiums in America have gone up at a slower 
growth rate than they did before the Affordable Care Act. That is a 
fact. But we do hear about the individual market within the exchanges 
and how that has gone up by a significant amount, mainly because of the 
way it was originally rated. We have heard about that. But perhaps what 
many people don't know is that in my State and around the Nation, 75 
percent of the people who qualify for private health insurance within 
the exchanges are eligible for credits. In other words, we are helping 
them with the affordability of their health care. In my State, that was 
$200 million a year to help Marylanders pay for health insurance. That 
will be gone with the repeal of this Affordable Care Act. That is 
wrong.
  I received many letters from small business owners. One of the proud 
parts of the Affordable Care Act is that it helped our small business 
owners. Why? If you ran a small business, you wanted health insurance 
for your employees because you wanted to keep them well. You were 
discriminated against before the Affordable Care Act. You didn't have a 
big pool. God forbid one of your employees gets really sick during the 
year; your insurance premium goes through the roof. That is what was 
happening before the passage of the Affordable Care Act. Are we going 
to go back to the days where we tell small companies: You really can't 
get health insurance because if someone gets sick, you lose your 
policies basically. That is what we are talking about.
  Annette of Bel Air, MD, wrote to me. She said she has saved 
significant money as a small business owner as a result of the 
Affordable Care Act. Tim from Laurel, MD, told me that in his small 
business, he saved $7,000 a year thanks to the Affordable Care Act. The 
reason is simple: You have broader pools, and you get the same type of 
rates larger companies get now. You will lose that with the repeal of 
the Affordable Care Act.
  Let me tell you about one of the tragedies of this that will happen 
immediately, affecting America's competitiveness and entrepreneur 
spirit. We know that a lot of people who work for big companies have 
great ideas, and they want to start out on their own. I have seen that 
over and over again in the biotech industries of Maryland. I go down 
the 270 corridor, the 95 corridor. I see small entrepreneurs who used 
to work for one of the giant defense contractors, and now they are 
pulling out and coming up with new ideas, doing things in a great way. 
That is what makes America a great nation. That is how we create jobs 
and how we deal with innovation.
  Here is the situation. You are a 30-something-year-old, ready to 
leave that company and go out on your own. Your spouse has cancer. What 
do you do? You are not going to be able to get coverage. You are locked 
into that job. That will be a consequence of the repeal of the 
Affordable Care Act. We are

[[Page S79]]

dealing with real people and real people's lives. It is irresponsible 
to repeal the Affordable Care Act and not tell that young entrepreneur 
what he or she can expect. That is what is at stake.
  There is one last point I want to talk about, and that is the 
Patients' Bill of Rights. I helped draft the Patients' Bill of Rights. 
It was not easy to pass the Patients' Bill of Rights. We were able to 
get it in the Affordable Care Act. We were able to get in the right 
that--you go to an emergency room. Under a prudent layperson standard, 
you did the right thing. You find out you didn't have that heart attack 
even though you had chest pains. Then you wake up the next morning and 
find out your insurance company is not paying the bill because you 
didn't have that heart attack. We changed that in the Affordable Care 
Act.

  Are we going back, eliminating those protections, the right to appeal 
decisions or are we going to repeal that part of the Affordable Care 
Act? Are we going to go back to medical loss ratios, where insurance 
companies can make obscene profits and not rebate those excess profits 
to their policyholders when we have millions of people receiving 
rebates today? All of that is gone with the repeal of the Affordable 
Care Act.
  Mr. President, I could go on and on, but I see my colleague Senator 
Kaine is here and others who want to speak on this issue.
  Let me conclude with this. This is the wrong way to go about this. I 
heard the leader say that for 6 or 7 years--for 6 or 7 years--Democrats 
have been trying to work with Republicans to make the law even better.
  We have never passed a major law that didn't need to be revisited. We 
understand that. We have been working to try to improve the law--not 
repeal it--improve it, build on it, make it better, and we have gotten 
no help from Republicans, not any help whatsoever.
  Republicans have blocked efforts to improve this law. Instead, they 
are stuck on this repeal without knowing what the replacement is going 
to be. That is wrong. We should be working together to improve our 
health care system, but to pass a repeal, to put Americans at risk will 
lead to uncertainty, which will lead to insurance companies abandoning 
the market, giving consumers less choice rather than more choice. To 
hurt millions of Americans is wrong, and I urge my colleagues to reject 
this approach.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.


                            Amendment No. 8

  Mr. KAINE. Mr. President, I call up amendment No. 8, which I send to 
the desk on behalf of Senator Murphy, me, and other Senators as well.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Virginia [Mr. Kaine] proposes an amendment 
     numbered 8.

  Mr. KAINE. Mr. President, 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 prohibit legislation that makes America sick again)

       At the end of title IV, add the following:

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

       (a) In General.--It shall not be in order in the Senate to 
     consider any legislation that makes America sick again, as 
     described in subsection (b).
       (b) Legislation Making America Sick Again.--For purposes of 
     subsection (a), legislation that makes America sick again 
     refers to any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that the 
     Congressional Budget Office determines would--
       (1) reduce the number of Americans enrolled in public or 
     private health insurance coverage, as determined based on the 
     March 2016 updated baseline budget projections by the 
     Congressional Budget Office;
       (2) increase health insurance premiums or total out-of-
     pocket health care costs for Americans with private health 
     insurance; or
       (3) reduce the scope and scale of benefits covered by 
     private health insurance, as compared to the benefits 
     Americans would have received pursuant to the requirements 
     under title I of the Patient Protection and Affordable Care 
     Act (Public Law 111-148; 124 Stat. 130) and the amendments 
     made by that title.
       (c) Waiver and Appeal.--This section may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under this 
     section.

  Mr. KAINE. Mr. President, I rise to offer this amendment, amendment 
No. 8, with Senator Murphy and other Senators, to the budget resolution 
we are currently considering, and the purpose of amendment No. 8 would 
be to create a point of order against considering any legislation that 
would either strip Americans of health insurance coverage, make health 
care more expensive, or reduce the quality of health coverage.
  Our amendment creates a high hurdle to any legislation that would 
make America sick again, and basically that is what we are trying to 
do. If we are going to either strip coverage from people or make health 
insurance more expensive or reduce the quality of health coverage for 
Americans that they currently have, we shouldn't make that easy to do. 
We should have a high hurdle in place so we consider it before we do 
it.
  The point of order is necessary because the entire purpose of this 
budget resolution is not to really address the budgetary matters facing 
the country. I say that as a member of the Budget Committee. In fact, 
the budget process was basically ignored in the last Congress.
  This budget is only before us to set up a pathway to pass a fast-
track repeal of the Nation's most consequential health care program in 
decades, a program that affects millions of people and a repeal being 
fast-tracked that would strip health care from millions of Americans.
  I will come back to the health points in a second, but I want to 
address how we got to where we are on the budget question that was in 
the province of the Budget Committee.
  I think it is a little strange that halfway into Fiscal Year 2017, 
which began in October 2016, we are going to be setting budget levels 
now. A budget resolution is a tool to set forth the guidelines for 
spending in Congress.
  We know, in the history of this body, we are not always successful in 
passing a budget through both Houses of Congress and approving that 
budget through a conference process, but at least some progress is 
usually made; for example, both Houses doing their budget resolutions. 
As you know, that did not happen in 2016. Last year, our GOP 
counterparts in each House decided, for the first time in the modern 
budget era, not to hold a hearing on the President's submitted budget, 
not to have any activity on a budget in the Senate, either in the 
committee or on the floor.
  To begin, I have to ask, if the budget wasn't important enough for us 
to consider last year, why is it now so important for us to be taking 
up a budget? The answer is obvious. We are debating a budget for the 
sole purpose--the sole purpose--of setting in motion a process to 
repeal health care coverage for tens of millions of Americans. This is 
really about an attack on people's health care.
  I and many of my colleagues have said there is a significant need to 
make improvements to the Affordable Care Act and, more generally, to 
our health care system.
  Mr. President, you were a chief executive of a State, just like I 
was. I learned something in my first year as Governor of Virginia, 
which was, when I looked at all the bills that were put on my desk for 
signature, amendment, or veto at the end of my State's legislative 
session, three-quarters of the bills were not new legislation or not 
repeals of legislation; three-quarters of the bills were improvements 
of existing law. That is the work of a legislative body. 
Overwhelmingly, it should be improvements to existing law. The 
Affordable Care Act needs significant improvement, just as other health 
care laws do, just as virtually everything we do needs improvement.
  There is no reason, while we acknowledge the need for improvement, to 
repeal a law outright without having a sense of what the replacement 
will be because, by doing so, what we do is create chaos in the 
economy, chaos in the health insurance market, and especially chaos in 
the most intimate and important area of people's lives, their health.
  Actually, on that subject, there was a wonderful letter that was sent 
on January 3 by the American Medical Association to the congressional 
leadership on

[[Page S80]]

this very point, don't do a repeal that creates chaos for people. I am 
going to read some sections of the letter.
  The AMA supported passage of the Affordable Care Act because it was a 
significant improvement on the status quo at that time.

       We continue to embrace the primary goal of the law to make 
     high-quality, affordable health care coverage accessible to 
     all Americans. We also recognize that the ACA is imperfect, 
     and there are a number of issues that need to be addressed.

  Continuing the quote:

       It is essential that gains in the number of Americans with 
     health insurance coverage be maintained.

  The letter concludes, from the American Medical Association, the 
largest organization representing American physicians:

       Consistent with this core principle, we believe that before 
     any action is taken, through reconciliation or other means, 
     that would potentially alter coverage, policymakers should 
     lay out for the American people, in reasonable detail, what 
     will replace current policies. Patients and other 
     stakeholders should be able to clearly compare current policy 
     to new proposals so they can make informed decisions about 
     whether it represents a step forward in the ongoing process 
     of health reform.

  The amendment Senator Murphy and I propose is designed to accomplish 
exactly the goal, exactly the goal the AMA has specified in the letter 
of January 3.
  We would create a 60-vote point of order against any legislation that 
would, first, reduce the number of Americans who are enrolled in public 
or private health insurance coverage, so there would be a 60-vote point 
of order against any proposal that would reduce coverage for Americans; 
second, the point of order would also lie against any plan that would 
increase health care premiums or total out-of-pocket health care costs 
for Americans with private health insurance; and, third, the point of 
order would lie against any proposed plan on the table that would 
reduce the scope and scale of benefits offered by private health 
insurance because the ACA was not only about affordable care and it was 
not only about coverage, it was also about the quality of care.
  Could your coverage discriminate against you because you are a woman? 
Could your coverage expire once you get diagnosed with an illness and 
now have a preexisting condition?
  These bill of rights protections for patients were an important and 
integral part of the Affordable Care Act, and the budget point of order 
that we would put on the table would establish a 60-vote threshold for 
considering any legislation if it triggered one of those three 
concerns: reduction in coverage, increase in cost, reduction in 
quality.
  The point of order actually goes right to promises that the 
President-elect has made. In September of 2015, President-elect Trump 
said:

       I am going to take care of everybody. I don't care if it 
     costs me votes or not. Everybody is going to be taken care of 
     much better than they are taken care of now.

  He has made a promise to the American public that we will not rush 
into a new health care chapter that reduces coverage, that reduces 
quality, or that increases costs.
  Just 2 days ago, the key spokesperson for the President-elect 
Kellyanne Conway said: We don't want anyone who currently has insurance 
to not have insurance.
  She is not setting a threshold of 1 million people or 100,000 people 
or 10,000 people or 10 people. She is saying the threshold is this: We 
do not want anyone who has insurance to have that insurance jeopardized 
by actions of Congress.
  This is what a repeal of the Affordable Care Act, without a 
replacement plan, will mean. It will have three significant 
consequences, and then I want to finish with some personal stories.
  First, a repeal with no replacement will inflict a significant wound 
on the American economy. Health care is one-sixth of the American 
economy, one-sixth. You cannot inject uncertainty into one-sixth of the 
American economy without having significant negative effects on our 
Nation.
  Congress should be in the business of increasing certainty, not 
increasing uncertainty, and if we go into the biggest sector of the 
American economy with a repeal, without any replacement strategy, it is 
the equivalent of, ``I am now going to jump off a cliff and I will 
figure out how to land once I am in midair.'' This will be economic 
malpractice to affect that many people.
  Second, the effect of the repeal of the Affordable Care Act is sort 
of an under-the-table tax cut for the wealthiest Americans. 
Millionaires, if the Affordable Care Act is repealed--there are two 
taxes on high earners that are part of the financing of the Affordable 
Care Act, and these taxes on high-earning Americans would expire, and 
this is hundreds of billions of dollars over 10 years of a tax cut. 
Millionaires would get 53 percent of the tax cuts from a repeal, which 
is more than double the same group's share of the 2001 and 2003 tax 
cuts that were done during the Bush administration.
  Just to put that in some context, Americans in the top 0.1 percent 
economically would get an average tax cut of $197,000 if the Affordable 
Care Act is repealed. That is one way to sort of look at this repeal 
without a replacement. It is essentially a tax cut for the wealthiest, 
financed by reductions of health care on the people who are most in 
need.
  Third, the impact that is the most significant is the impact on the 
health care of average Americans. The Urban Institute did a study in 
December and said: If there is a repeal with no replacement or a repeal 
with a delayed replacement to something that we know not what it will 
be, there will be 30 million Americans who will lose their health 
insurance. About 20 million will be people who got health insurance 
under the Affordable Care Act, and an additional 10 million will be 
people who will lose their insurance because of the chaos created in 
the insurance market.
  I want to put that number, 30 million, into a context because numbers 
can just sound big and mysterious. Here is what 30 million people is. 
The number of people who would lose health insurance because of an ACA 
repeal is equal to the combined population of 19 States: Wyoming, 
Vermont, North Dakota, Alaska, South Dakota, Delaware, Montana, Rhode 
Island, New Hampshire, Maine, Hawaii, Idaho, Nebraska, West Virginia, 
New Mexico, Nevada, Utah, Kansas, and Arkansas. Nineteen States' 
combined populations, that is 30 million people, and that is who is 
going to lose health care coverage if we go forward with a repeal 
without a replacement.
  Eighty-two percent of these 30 million who would become uninsured are 
working families, 38 percent will be between the ages of 18 and 34, and 
56 percent are non-Hispanic Caucasians. Eighty percent of the adults 
becoming uninsured are people who do not have college degrees. There 
will be 12.9 million fewer people who have Medicaid or CHIP coverage in 
2019 if the repeal goes through. These are some sobering statistics. 
These statistics show that, at a minimum, what we are doing here is 
very, very consequential and very, very important and should not be 
rushed into in a partisan 51-vote budget reconciliation process.
  I want to conclude and tell a couple of stories from Virginians of 
people who are going to be impacted by this. When we essentially 
recessed in the Senate on December 9--between then and now--I went 
around the State and talked to people. I heard a story that I want to 
share, and then I will tell a couple of quick ones.
  I met with Ashley Hawkins, a young mother in Richmond, a mother of 
two kids. We sat around a conference table in a federally chartered 
community health center in Richmond and talked to stakeholders. Ashley 
told her story. She had a preexisting health condition. Before the 
Affordable Care Act, health insurance was unaffordable. After the 
Affordable Care Act passed, she could suddenly get insurance.
  Ashley owns a small business. She runs a nonprofit group that 
provides community arts education that serves others. Because of the 
ACA, she has been able to sign up on exchanges and get health 
insurance. Because of her income, she can receive subsidies to make 
that health insurance affordable. She makes $45,000 a year.
  Without health insurance, the recent hospital bill for the birth of 
her youngest child would have been close to $16,000. With the 
Affordable Care Act, she receives a subsidy, and she is able to access 
high quality health insurance for her and her two kids for $280 a 
month. That is the difference between

[[Page S81]]

not being able to afford to go to a hospital and deliver a child and to 
be able to afford, as a small business owner, a health insurance policy 
that covers her and her two kids for less than $300 a month.
  This is what she said as we sat around the table and talked about 
what it means to have affordable insurance. She said: ``It has to do 
with self esteem and security and well-being.''
  Having health insurance is about security, even when you are not 
sick. Obviously, when you are sick or when you are delivering a child, 
health insurance is needed. But when you are a mother of two children, 
even if you are at the peak of your health and even if your children 
are at the peak of their health, you would go to bed at night--and 
Ashley described this--wondering: What will happen tomorrow if my child 
gets sick? What will happen tomorrow if I am in an accident? Not having 
health insurance for a parent is a continuous agitating voice in your 
mind, an anxiety creator, about what is going to happen to my family if 
we get sick or get in an accident, which is something that happens to 
virtually every family. It has to do with self-esteem, with security, 
and with well-being. Without the protection for people with preexisting 
conditions, without the subsidies in the marketplace, people like 
Ashley will go back to not being able to afford coverage for their 
families.
  After the Affordable Care Act passed, I happened to be in a position 
where I was trying to buy health insurance in the open market without 
an employer subsidy for the first time in my life. When I say I was 
doing this, what I mean is that my wife was doing all the work because 
she is the one who does all the work. She talked to two insurance 
companies who said: Hey, sorry, Anne, we can't afford your entire 
family because of preexisting conditions. One company would not cover 
me. One company would not cover one of my children. My wife said: Hold 
on a second. The Affordable Care Act just passed. You can't turn 
somebody down on a preexisting condition now.
  In each case the insurance company said: I have to talk to my 
supervisor. They had to call back and say: You are right; we are wrong. 
We have to provide insurance for your entire family.
  Can I tell you this? My family is the healthiest family in the United 
States. At the time my wife was making those phone calls, of the five 
of us, the only time any of us had ever been hospitalized was in the 
three occasions my wife went to the hospital to give birth to our kids. 
We are a healthy family, and we were turned down twice because of a 
preexisting condition by insurance companies that had to say: We are 
wrong, and because of the Affordable Care Act, now we can write a 
policy for your entire family.
  I had a woman write me a letter--a Virginian from Williamsburg--a 
couple of years ago who said: My husband and I are self-employed, and 
we could never afford insurance. Because we couldn't afford insurance, 
we decided that we couldn't have children. We couldn't pay a hospital 
bill. This is what the Affordable Care Act has meant to them. We often 
talk about life and death issues in the sense of illnesses, sicknesses, 
cancer diagnoses, and preexisting medical conditions. They can be life 
or death issues, but they can also be life issues, in the sense of this 
couple who wrote and said that because they could now get insurance as 
self-employed individuals with subsidies to make it affordable, they 
are now going to start a family because of the Affordable Care Act. 
They could start a family.

  Finally--and I will always remember this because this gives me great 
motivation--as I was getting outside of my native Virginia and 
exploring other States on an interesting 105-day summer vacation as 
part of a national ticket, I went to the Iowa State Fair. I told this 
story once before on the floor, but I am going to tell it again. A 
grandfather came up with a little boy in his arms. I said: What is that 
child's name? Jude. Jude, the patron saint of lost causes. There is St. 
Jude Children's Research Hospital in Memphis, a place where children 
have been able to go to get medical care.
  I knew there must be a story. I said: Hey, Jude, tell me about Jude. 
Jude was a 3\1/2\-year-old who was diagnosed with a congenital heart 
defect and by age 3\1/2\--as his grandfather told me the story, now mom 
and dad were coming around me as well--Jude had to have multiple heart 
operations at the Children's Hospital in Omaha. The grandfather said to 
me that Jude would not have been able to have those operations and Jude 
would be uninsurable for the rest of his life if it were not for the 
Affordable Care Act.
  Then Jude's father put his hand on my shoulders. He was a big guy. He 
said to me: You have to tell me that you will do everything you can to 
make sure that Jude isn't stripped away and consigned again into the 
outer reaches of preexisting conditions and uninsurable, with an 
uncertain future for my son. I made a pledge to him. I said: I am only 
one person. I don't know what, at the end of the day, I can do, but I 
can tell you this. I can stand up to make sure that your child and 
other children--such as Ashley's two kids and the family that wrote me 
about wanting to have children--will not be left high and dry and 
without the security of health insurance in the wealthiest and, to my 
way of thinking, still the most compassionate Nation on the face of 
this planet.
  I encourage every Member of this body to ask their constituents for 
stories like Ashley's, like Jude's, like my family's, and like the 
family in Williamsburg about how an ACA repeal with no plan would 
impact them.
  I will go back to the purpose of the amendment. The ACA is not 
perfect. We ought to be talking about reform. If Republicans want to 
call it replace and we want to call it reform or improvement, I don't 
care what we call it. We should have the AMA, hospitals, patients, and 
Members of Congress from both parties around the table to lay down what 
are our concern, what are our problems, and talk about how to fix them. 
There is so much we can do. There is so much we can improve. But by 
pushing an immediate repeal through a partisan budget process, we won't 
have the opportunity to work together to build on that common ground.
  This is not a game. Sometimes we get into a budget vote-arama, and it 
has a little bit of a game aspect to it. I have been here until 2 a.m. 
or 3 a.m. when amendments are put on the table, there are 1-minute 
presentations of why it is good or bad, and we have a vote. It has a 
little bit of a feeling of a game. This is not a game. This is life and 
death.
  Is there anything more important to someone than their health, 
because their health forms the foundation of their relationship with 
their spouse or their loved ones or their children? Health is what 
keeps a parent up at night worrying about the family. Health is what 
keeps a child worrying about an elderly parent. This is the most 
important thing to any person in this country, regardless of party, 
regardless of State, regardless of political persuasion. The worst 
thing we can do on a value of such importance is to rush and create 
chaos in the lives of millions of people.
  So I conclude by saying that the amendment that Senator Murphy, I, 
and others offer would seek to protect what we have--protect coverage, 
protect costs, protect quality--by making it harder to enact 
legislation that would strip these important items away from tens of 
millions of Americans.
  We should be sitting down at the table to talk about reforms. So many 
of us want to do that. But we should not be rushing into a repeal that 
would jeopardize people's lives.
  I urge my colleagues to please support amendment No. 8.
  Thank you, and I yield the floor.
  The PRESIDING OFFICER (Mr. Rubio). The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that all time be 
considered time on the resolution.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. ENZI. Mr. President, I ask unanimous consent that during the 
periods of a quorum call, the time be equally divided between the two 
sides.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. ENZI. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.

[[Page S82]]

  

  Mr. MURPHY. 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. MURPHY. Mr. President, what is happening on the floor right now 
is absolutely extraordinary. It is absolutely extraordinary that 
Republicans are using the budget process, the reconciliation process, 
in between the swearing in of the new Congress and the swearing in of a 
new President, to rip away from 20 million Americans health care 
insurance, to drive up rates for one-third of consumers in this country 
who have some form of preexisting condition--a sickness that without 
this law would make their rates go higher--and to throw the entire 
health care marketplace into chaos.
  It is absolutely exceptional what is happening right now. No one in 
this body should normalize it. No one outside of this body should 
perceive this to be just politics as usual.
  I was here when the Affordable Care Act passed. I was in the House of 
Representatives. Since then, I have heard my Republican friends say 
over and over and over again that they want to repeal the Affordable 
Care Act and replace it. I can't tell you the hundreds of times I have 
heard that phrase, ``repeal it and replace it.''
  President-Elect Trump talked about that throughout the campaign, and 
then 2 days after he won the election, on Thursday night, he went on 
national television to double down on the promise that there would be 
an immediate replacement. He said: There will not be 2 hours between 
the Affordable Care Act being repealed and it being replaced with 
something better.
  That is the second part of the argument the Republicans have made. 
The Affordable Care Act, in their minds, was deficient, despite the 
fact that there are 20 million people who have insurance today who 
wouldn't have it otherwise and despite the fact that there are hundreds 
of millions of Americans across the country who don't have to worry 
about them and their loved ones having their insurance rates jacked up 
because they are sick, and despite the fact that seniors are paying 
thousands of dollars less in prescription drugs than they were.
  The Affordable Care Act isn't perfect--it never was--but the 
enthusiasm of Republicans to take away from Americans their health 
insurance and to drive rates up for millions more is really 
unthinkable.
  We heard over and over again that the priority was to repeal it and 
replace it. Now we are repealing the Affordable Care Act with no plan 
for what comes next. We are driving forward with a repeal vote with no 
plan for how we keep the health care system together, how we prevent it 
from falling into chaos, how we continue to insure the millions of 
Americans who rely on it.
  There is a cruelty to this enthusiasm for immediate repeal that is a 
little bit hard to understand--it is really hard to understand.
  I think about somebody like Jonathan Miller. He lives in my State. He 
lives in Meriden, CT. He was born with cystic fibrosis. He is insured 
today through the Affordable Care Act. Here is what he said:

       For me, I was able to live a relatively normal life growing 
     up, wonderful family and friends, but health has always been 
     the most important thing in my life. I spend even in a good 
     health year probably one or two hospitalizations each year 
     that require IV antibiotics, I am on a whole suite of 
     medications, each day I take about 15 to 20 medications, some 
     of those are pills, some are breathing treatments, and then 
     there are the shots. Healthcare is the number one priority in 
     my life, it's more important than income, more important than 
     anything else, being able to maintain my health.

  He is insured by the Affordable Care Act today, but he also receives 
the benefit of the insurance protections because Jonathan, without the 
Affordable Care Act, even if he had insurance, would lose it--probably 
a couple of months into the year--because of a practice prior to the 
Affordable Care Act of capping the amount of money you would be covered 
for in a given year or in a lifetime. Jonathan would have blown through 
that in a heartbeat.
  It is not hyperbole when he says: ``Without the Affordable Care Act, 
I'd probably be dead within months.''
  That is the reality for millions of people across this country. 
Without health insurance, they cannot survive. They can't afford their 
medication.
  So this isn't just about politics, this isn't just about the words on 
the page, these are people's lives. This is about life or death, and 
the casualness of throwing out a law without any concept of what comes 
next--I have read so many quotes in the paper over the last few days of 
Republicans admitting they don't know yet what they are going to do in 
its place, but they still feel the need right now, in the lameduck 
session, to begin the process of repealing this law without any concept 
of what comes next.
  Why do it now? Why not take one step back? Why not reach across the 
aisle to Democrats and say: Let's try to work to make this better. 
Let's try to answer the concerns the Republicans have, that President-
Elect Trump has. Let's take some time to work through this, reform it 
in a bipartisan way. No. Instead, we are rushing forward with repeal, 
stealing health care for millions of Americans, plunging the health 
care system into chaos, with no guarantee that there is anything that 
is going to emerge in its place.
  Senator Kaine and I have a very simple budget point of order. Senator 
Kaine has talked about it. It would prohibit the consideration of any 
legislation as part of budget reconciliation that would, No. 1, reduce 
the number of Americans who are enrolled in health insurance; No. 2, 
increase premiums or total out-of-pocket costs for those people with 
private insurance; or, No. 3, reduce the scope and scale of benefits 
that people have.
  I have heard my Republican friends say: We are going to repeal the 
Affordable Care Act, and we are going to replace it with something 
better. We are not even committing you to replacing it with something 
better. We are just saying, if you are going to replace it, let's 
guarantee now that legislation is not going to take anybody's health 
care insurance away who has it now who wants it, it is not going to 
raise costs, and it is not going to reduce benefits.
  I am going to be honest. The replacement isn't coming. It is not 
coming, and even if it comes, it can't meet those three tests. There is 
no way there is a replacement coming that is going to maintain the 20 
million people who have insurance now, that is going to maintain cost 
controls and maintain benefits. It is not happening.
  News flash to the American public: This law is being repealed under a 
budget reconciliation process that shuts out Democrats, and it is not 
going to be replaced by something that is equal in quality or better. 
At the very least, we can all put our names and our votes to a budget 
point of order that commits Republicans to the promise that they have 
made for 6 years, which is that if they repeal this, they will not put 
a piece of legislation before this Congress that doesn't guarantee that 
everybody keeps their health insurance, costs don't go up, and benefits 
don't come down.
  I urge, when this comes up for a vote, a positive vote from my 
colleagues, and I urge my Republican friends to honor the promise they 
have made.
  I thank Senator Kaine and others for joining me in offering it.
  I yield the floor.
  The PRESIDING OFFICER. The majority whip.
  Mr. CORNYN. Mr. President, I would just say, I had the pleasure of 
sitting here listening to the Senator from Connecticut talk about his 
concerns about repealing ObamaCare, and I would say it strikes me that 
their posture is that we sold the American people a lemon, and we 
insist they keep it.
  Our position is that ObamaCare has been a failure. It has been a 
grand--in terms of scale--experiment, a national experiment that has 
failed.
  Yesterday I talked about the fact that my constituents are writing me 
and telling me that their premiums, in many instances, have doubled, 
and their deductible has gotten to the point that they are effectively 
self-insured so their insurance does them virtually no good.
  We will vote to repeal ObamaCare, but obviously we are not going to 
leave people hanging out to dry. We are going to make sure they have 
coverage that they choose and that they can afford. I welcome the 
assistance of our colleagues on both sides of the aisle to try to craft 
a bipartisan reform.

[[Page S83]]

  The biggest failure of ObamaCare was the fact that when our 
Democratic friends had 60 votes in the Senate and they had President 
Obama in the White House and a majority in the House, they jammed it 
down the throats of the American people. That is really why ObamaCare 
is unsustainable--because it was purely a partisan political exercise. 
We need to start over by repealing ObamaCare and then reforming our 
health care system so people can buy the coverage they want at a price 
they can afford. We are going to work very carefully to make sure the 
transition is thought out, methodical, and very carefully done.


                              Nominations

  Soon, Mr. President, we will be considering and confirming men and 
women nominated by the President-elect to fill leadership roles 
throughout the administration. This is crucial to ensuring a smooth 
transition from one President to another, and it is important to make 
sure the next President has the people and resources he needs to help 
lead our country.
  I have had some of the reporters in the hallway say: How in the world 
can you process so many nominees at the same time, so quickly?
  I said: It is the tyranny of the calendar. We are going to have a new 
President on January 20, and wouldn't you want--for example, the 
President's CIA Director choice, the Attorney General, the Secretary of 
Defense, the head of the Department of Homeland Security, the Director 
of National Intelligence--wouldn't you want all of those key national 
security positions filled as soon as possible in case some of our 
adversaries decide to take advantage of this transition to try to 
threaten the United States?
  It makes sense to me that we would work in an orderly sort of way 
with our colleagues across the aisle to make this transition a smooth 
one from President Obama to President Trump. President Obama has said 
that is what he is working to do, and you would think it would make 
sense for us to be a part of the solution and not a part of the 
problem.
  Holding up confirmations just for delay's sake is irresponsible and 
it is dangerous. As I speak, there is a hearing going on on the foreign 
cyber threats in the Senate Armed Services Committee. People are 
justifiably concerned about what our adversaries are doing in cyber 
space. But it is not related to just cyber space, it is related to 
nuclear threats from countries such as North Korea, obviously the 
ongoing humanitarian crisis and civil war going on in Syria and 
elsewhere, the threats from Russia not only in cyber space but also to 
our NATO allies in Europe, and I could go on and on talking about Iran 
and its nuclear aspirations, its ballistic missile capability.
  This is a dangerous world we are living in, and why in the world 
would we want to make it even more dangerous just to let our colleagues 
delay for delay's sake President-Elect Trump getting to fill his 
Cabinet, particularly these important national security offices? The 
truth is, when it comes to wanting what is best for America, we are all 
on the same team. We should all want what is best for our country. It 
doesn't do our Democratic colleagues a bit of good to delay the 
inevitable because, thanks to former Democratic leader Harry Reid and 
the so-called nuclear option that changed the Senate confirmation 
rules, we know that President-Elect Trump's Cabinet members will be 
confirmed. It is going to happen because it takes 51 votes. Just 
delaying for delay's sake out of partisan pique really doesn't do 
anything to accomplish any goal but, rather, makes our country more 
dangerous and denies the President-elect the Cabinet he has chosen.
  When President-Elect Obama was nominated to office, we acted very 
quickly. In fact, on the day he was inaugurated--January 20, 2009--
seven of his Cabinet members were confirmed. We were not happy about 
the outcome of the election on this side of the aisle. We wished a 
different electoral outcome had occurred. But once the voters had 
spoken, we accepted their verdict, and we worked cooperatively to see a 
smooth transition from the Bush administration to the Obama 
administration. I believe it is our duty to do that. Nearly all of 
President Obama's Cabinet-level nominees were confirmed within the span 
of 2 weeks. We came together, understood that the people had spoken, 
and we went to work to cooperate in good faith, not necessarily because 
we were happy about the outcome but because it is our responsibility to 
do so.
  Then there are some of the statements from some of our colleagues 
across the aisle that they now appear to be walking away from. In the 
spring of 2015, Senator Stabenow, the senior Senator from Michigan, 
said: ``When a President wins an election, they have the right to have 
their team.'' She said that on April 20, 2015. I hope that not only the 
Senator from Michigan but her other colleagues remember that position 
they took then and simply reciprocate in good faith during this 
transition.
  Senator Stabenow is right, by the way. No matter which side you are 
on, we know that the voters have spoken. As President-elect, he has the 
authority to surround himself with those he sees fit to advise him and 
help him as he serves our country.
  For some of our colleagues to suggest that keeping the President 
understaffed is somehow in the best interest of the American people is 
palpably false. It is ridiculous. I mentioned the national security 
nominations the President-elect has indicated. One of those first ones 
was Senator Sessions, our colleague here in the Senate, the junior 
Senator from Alabama, to serve as Attorney General of the United 
States. The Attorney General is not only the head of the Department of 
Justice and has an important law enforcement role, the Attorney General 
also has a very important anti-terrorism national security portfolio as 
well. So it is very important that people like Senator Sessions, the 
Attorney General nominee, be put in place on a timely basis for the 
safety of our community.
  Talking about the nomination of Attorney General Loretta Lynch not 
even 2 years ago, the senior Senator from Vermont urged a quick 
confirmation, saying: ``Confirming the top law enforcement position 
should be an urgent priority of the Senate.'' And he is right.
  As the minority party is now considering the political strategy of 
obstruction, delay, and stall tactics, what has changed except that 
your preferred candidate did not win and our preferred candidate did 
win? That is the only thing that has changed.
  Another nominee the Senate will consider is the President-elect's 
choice to fill the Supreme Court vacancy left by the death of Justice 
Scalia. Last year, after the death of Justice Scalia, we promised the 
American people that the next President, whether it was a Republican or 
a Democrat, would nominate the successor to Justice Scalia. We didn't 
say we would only vote to confirm a Republican President's nominees; we 
said that the American people had a right to a voice in who would make 
that choice, recognizing that the next Justice on the Supreme Court 
could serve 25 or 30 years.
  Here we are 15 days before the President-elect is sworn in to the 
White House and the minority leader is already threatening to deny the 
voices and the vote of the American people from last November by 
blocking any nominee indefinitely.
  As shocking as it sounds, on Tuesday night, just hours after the 
115th Congress was sworn in, Senator Schumer, the Democratic leader, 
was asked in an interview on MSNBC if he would ``do his best to keep 
the seat open.'' He answered with one word: ``Absolutely.'' Despite 
months of calling for a full Supreme Court, all nine members, even 
using the hashtag ``We need nine,'' the Democratic leader is now 
threatening indefinite obstruction.
  Republicans were clear with the American people: We would respect 
their voice in whom they wanted to pick the next Supreme Court Justice, 
whether it was a Democrat or Republican in the White House, and we 
would move forward with that nominee in the new Congress.
  I hope our Democratic friends don't slow-walk President-Elect Trump's 
nominees. It is one thing to obstruct, but it becomes an even bigger 
problem when they intentionally try to keep President Trump from doing 
the job the voters have given him the responsibility to do.
  The American people made clear in November that they are done with

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business as usual here in Washington, DC. Frankly, I don't think it was 
a robust endorsement of either one of the political parties. We got an 
unconventional President-elect, and I think the American people expect 
him to shake this place up, and I think he will. We intend to work with 
him to make sure there is a positive outcome for the American people. I 
don't think they are interested in political stunts or delay for 
delay's sake, nor do they want us to return to the dysfunctional do-
nothing Congress of the past. They want results, and they want a path 
forward toward a brighter future for themselves and their families.
  Let's not keep from President Trump the men and women he has chosen 
to work alongside him. That would only make us less safe, our economy 
more fragile, and the government less efficient. After all, we are 
paying the bills as taxpayers. Why would we want a less efficient or 
less effective government? In short, it will not serve the interests of 
the American people well.
  I know we are ready on this side of the aisle to roll up our sleeves 
and get to work. As I have learned through hard experience, the only 
time anything ever gets accomplished in the Senate is when we work 
together. I am not talking about people sacrificing their principles. 
We ought to fight like cats and dogs when it comes to our basic 
principles. There are a lot of things that are outside of the realm of 
principles where we can find common ground and work together and build 
consensus. I think we ought to take advantage of this historic 
opportunity to do just that, starting with confirming the President's 
Cabinet and letting them get to work to help his administration as soon 
as possible.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BLUNT. Mr. President, I am going to talk about the resolution we 
are moving to that will allow us to repeal and begin the replacement 
for the President's health care plan.
  A little over 3 years ago, President Obama hailed the start of the 
ObamaCare exchanges as a life-changing opportunity for Americans. For 
most Americans, it was life-changing, but it didn't turn out to be an 
opportunity. It was a life-changing experience because in many cases 
the insurance they had was no longer affordable, what they thought met 
their family's needs was no longer available, and the cost continues to 
go up.
  When President Obama pushed the health care law through Congress 
without a single Republican vote, he repeatedly assured Americans that 
they would be able to keep the plans they had, that they would be able 
to keep the doctors they had, and that every family would have a 
significant reduction in their health care costs. He continued to make 
every one of those commitments until the plan actually was put in place 
and it was obvious those commitments were not going to be what 
happened. By the end of 2013, at least 4.7 million Americans had their 
plans canceled because they didn't meet the law's mandatory 
requirements. Remember, these were plans that 4.7 million people 
thought met their individual needs, and they could afford those plans. 
That is why they bought them. They might not have been perfect. They 
might have still been a stretch on their budget, but they decided: This 
is insurance I can afford, and it is insurance that meets the needs 
that I can afford to meet with the insurance I can buy.

  The President's claims about everybody being able to keep their 
policies and keep their doctor were so far from reality that PolitiFact 
rated it as the lie of the year. I don't like to use that language as 
it relates to the President of the United States. I would say it must 
be really easy to become isolated in the Oval Office, and the President 
may get lots of information that sounds to him as if his plan is 
working, but the truth is that the President is not entitled to his own 
facts. He is entitled to his own opinion. He is entitled to his vision 
of what he thinks health care in America should look like, but he is 
not entitled to his own facts. If it is not happening the way he thinks 
it is happening, somebody needs to tell him. But, of course, in just a 
few days there will be a new President, and we have to deal with the 
chaos, frankly, that has been created under the old law.
  President Obama said this law would mean more choice, more 
competition, and lower costs for millions of Americans. Nobody can find 
those Americans. A number of Americans got on Medicaid, another 
government program, who weren't on Medicaid before. But there aren't 
millions of Americans who have more choices, and there aren't millions 
of Americans who have more competition for their business, and there 
aren't millions of Americans who have lower costs. In fact, just the 
opposite would be the case in Missouri, where I live. A number of 
insurers pulled out of the exchange totally. Our neighboring States all 
have the same experience and, in some cases, even worse experience, but 
the competition, the choices, just aren't there because the system 
doesn't work.
  We have 115 counties in our State, and in 97 of them, you have one 
choice; you have one insurer offering insurance. That one insurer may 
offer three different plans, but there is no competition for whatever 
level you are shopping for. There is only one place to get that level. 
This would be as if there is one shoe store in town and none of the 
shoes fit and they all cost too much, but if you didn't buy the shoes 
in that shoe store--and the chairman of the Budget Committee knows a 
lot about shoe stores--you would have to pay a penalty for not buying 
shoes that were available at that one location. Everybody would think: 
Well, that is unacceptable; you ought to at least be able to drive to 
another community and look for shoes. But that is not the case in 97 
places, 97 counties. The vast majority of our State and a couple of 
States have no counties on the individual exchange that have 
competition. We went from several--every county a year ago in Missouri 
had at least two companies offering insurance, so there was at least a 
competitor. Some had more than two companies offering insurance. Now 97 
have one company.
  The promise was to bend the cost curve. The cost curve bent, but it 
bent the wrong way. The cost curve went up; it didn't go down. In our 
State, again, increased premiums have been as high as 40 percent.
  In a number of States, they are in the 70-percent category. In one 
State, there is a 100-percent increase--not from when ObamaCare started 
but from last year--in places where the cost of insurance for 
individuals and families had too often already doubled, and now another 
add-on.
  I was with somebody the other day, and I asked them about their 
insurance. He was a healthy guy in his mid-40s. His wife and two 
daughters were healthy. I said: What are you doing for insurance?
  He said: I am self-employed. In 2009, there were four of us. We had 
insurance we thought met our needs. We were paying $300 a month. Now we 
are paying $1,190 a month, and we have a $7,500 deductible. If two of 
us are sick, we have to submit that deductible twice before we get any 
assistance from the insurance company--a $15,000 deductible if two 
people in the family are sick with a $1,190 monthly premium.
  This is a family that had no health care problems. This is not a 
response to somebody who has a policy that they were using. This is a 
policy that wasn't being used and, of course, with a $7,500 deductible 
unlikely to be used unless that family really has a catastrophic 
situation occur. What I believe that family found out a few months 
after I visited with them was that their policy went up closer to 
$2,000 than $1,190.
  The average deductible for a mid-level plan--there are the gold plan, 
silver plan, the bronze plan. For the silver plan, the average 
deductible in the exchange last year was $3,000. The average deductible 
in the bronze plan was $5,000, and it is higher than that for many 
people.
  To make matters worse, if you aren't able to afford the few options 
available on the exchange, you pay a penalty. So you have no 
competition. You are required to buy the product, and if you don't buy 
the product, there is a penalty. It could have been as much this year 
as $2,045, but if your option is to pay $15,000 or $20,000 for 
insurance that has this high deductible, that is what many people have 
decided to do.
  I have heard a lot of Missourians from the day this was initiated 
through today talking about the individual challenges they have seen. 
For

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example, Dave, a small business owner in Columbia, said that the 
premiums for his employees have doubled. Why would that be the case? 
One, the standards necessary for a policy change and, two, if you're 
losing all this money in the individual marketplace, the insurance 
companies make that up somewhere. So his premiums have doubled. At the 
same time, they have continually had to raise deductibles and seriously 
reduce benefits. The cost goes up and the coverage goes down. I think 
that is what President Clinton said when he said this is a crazy 
system. It is costing more all the time and covering less. That is what 
Dave has found out in his business, and he was told late last year that 
he should expect a 40-percent increase this year. He said: If that 
happens another time, we are no longer in the employee-employer 
provided insurance marketplace.
  Another location that serves our State and happens to be 
headquartered also in Columbia is the Older Americans Transportation 
System, a not-for-profit. They provide critical transportation services 
to older Missourians, and they have it other places in the country--
older Missourians to low-income people, to underserved parts of our 
State that don't have other transportation options. The costs to insure 
their drivers have gone up by half a million dollars. The paperwork to 
comply with the law's requirements, as the executive director told me, 
is so complex and cumbersome, they had to spend additional money to 
hire a consultant to implement a software program to help them keep up 
with the new mandates. It suddenly got even harder to be a not-for-
profit and break even.
  Families and small businesses shouldn't be penalized because the law 
did not live up to its promise: If you like your health care, you can 
keep it. If you like your doctor, you can keep your doctor. Family 
costs will go down by $2,500 after this plan is put in place. Those 
things didn't happen.
  We are in a chaotic situation now, and it is time to move in a new 
direction. We will have a bill before us very shortly that will allow 
us to begin that transition to do things that will prevent Washington 
from getting in between health care providers and their patients. We 
will do things that will break down barriers that artificially restrict 
choice and prevent Americans from picking insurance that meets their 
family's needs that they can still pay for. What a concept that would 
be.
  This is basically the system we had before. It wasn't a perfect 
system, and I will say the biggest straw man put forward in that system 
was that nobody else had any ideas. There were plenty of other ideas, 
ideas that would better serve American families, American job creators, 
American job holders, people--plans that would have allowed small 
businesses to band together and become a bigger group to seek group 
insurance for a number of businesses instead of just one business's 
health savings account, better use of health savings accounts, buying 
across State lines, and things that I proposed specifically on letting 
your family stay on your insurance a little bit longer. Frankly, that 
was a 4-page bill that adds 3 million people to insurance every year so 
you can stay on your family policy until you are 26. There are four 
pages with a lot of white space. This does not have to be that 
complicated. There is no cost to taxpayers. Frankly, you are adding 
young, healthy people, not much cost to anybody but fundamentally no 
cost to taxpayers. It is just an additional way to look at things like 
buying insurance across State lines would be. There are solutions here, 
but we have been prevented from moving to those solutions.
  I urge my colleagues to support the resolution that will allow us to 
move forward. We will begin to eliminate the chaos of ObamaCare and 
restore the focus of health care to patients, people, the doctors they 
want to have, and the places they want to go to get their health care.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Fischer). The Senator from Wyoming.
  Mr. ENZI. Madam President, I ask unanimous consent that at 2:45 p.m. 
today, the Senate vote in relation to amendment No. 8.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ENZI. I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Madam President, I want to begin my remarks this morning 
by taking stock of how the 115th Congress, led by my Republican 
colleagues, seems to be coming out of the gate. Here is what is coming 
if the budget process that began this week plays out: 30 million 
Americans from Portland, OR, to Portland, ME, will be in danger of 
being kicked off their health care plans; sharply rising health care 
costs for everybody else, even those who get their insurance through 
their employer; broken campaign promises about a replacement coming on 
day one. With this resolution, Republicans in the Congress are building 
a Trojan horse of tax cuts for the most fortunate in America.
  I want to discuss each of those issues this morning, but first let us 
recognize the bottom line. What is at stake in this debate is whether 
or not America is going to go back to the dark days when health care 
was reserved for the healthy and wealthy. For nearly 7 years and 
through 4 punishing campaigns, Americans have heard and felt the 
steady, partisan drumbeat of repeal and replace from the other side. 
Dozens and dozens of show votes to repeal the Affordable Care Act have 
been held in either Chamber. There have been countless press 
conferences, speeches, and hearings, even a government shutdown, and 
the message is always the same. The President-elect himself said that 
repeal and replace would happen--his words, not mine--simultaneously.
  The replacement plan was coming. It would be fully written, ready to 
plug in--no gap, no harm relevant to anyone in our country. The same 
words, ``Coming Soon,'' have sat on that marquee for 7 years now. It 
seems to me it is time to admit that the show will not open. This is a 
broken promise, plain and simple. Americans are no longer looking at 
repeal and replace; now it is repeal and run. The consequences will be 
serious and immediate for tens of millions of Americans, both in access 
to health care and the bottom line for family budgets across the 
country. In short, it is a plan that will make America sick again. 
According to independent analysis, nearly 30 million Americans will 
lose their health insurance quickly after repeal. The first act of a 
new Congress: Kicking 30 million people off the insurance rolls--that 
is seven times the population of my home State.

  The overwhelming majority of those 30 million Americans are not 
wealthy people. They are not in a position to be able to afford to go 
out and pick an expensive plan once the insurance companies get back in 
the driver's seat. Millions come from working families who will lose 
tax cuts for health insurance. Millions of others toil, often working 
multiple jobs, but still what they bring home is just barely enough to 
keep them out of poverty.
  For many, signing up for Medicaid brought an end to the years when 
they had to choose between visiting a doctor and putting food on the 
table. If repeal goes forward, Americans all over the country are going 
to face that dilemma once again. I think it is important to remember 
that the danger of repeal does not end with Americans getting kicked 
off their insurance plans.
  Repeal will send costs skyrocketing for everyone across the board, 
even those Americans who get their insurance through work, including a 
lot of folks who say the Affordable Care Act has not touched them at 
all. They are going to get a gut punch, a gut punch with higher 
premiums and higher out-of-pocket costs. When you kick tens of millions 
off the insurance rolls and send the markets into chaos, there is going 
to be a ripple effect. Everyone is going to feel those harmful effects, 
even those who have had the same plan from a particular employer for 
years or decades. Rising costs are going to eat into paychecks, 
crowding out the pay raises that our people need so desperately.
  Colleagues, if you are watching this budget debate at home, I am sure 
you are going to say: Why in the world would any lawmaker go forward 
with this plan? I am going to go back to what I just said. In my view, 
this is a Trojan horse of tax cuts for the wealthy and the most 
fortunate.
  When you look at both sides of the ledger, you see how exceptionally 
unfair this scheme actually is. On one

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side, tens of millions of Americans lose insurance and suffer economic 
pain. That is the typical family. On the other side, there are 
substantial tax breaks for those at the top of the income scale.
  One of the questions I am asked nearly every day in these halls, and 
I am asked this by many in the press and elsewhere, is whether 
Democrats are going to take part in this effort and what ideas 
Democrats would put forward. I want to take just a minute to describe 
why that question is so off the mark. First, you have to look at the 
nature of the reconciliation process itself. Budget reconciliation is 
inherently a partisan exercise. Inherently, it is not a process that 
brings people together. It is a process that drives people apart. It is 
inherently partisan.
  A typical proposal that comes to the Senate floor is subject to 
unlimited debate and unlimited amendments. Usually it takes 60 
Senators, Members from both parties to come together and pass 
legislation. It is very rare that a party builds that kind of 
supermajority on its own, so the two sides have to work together. That 
is the Senate at its best.
  I see my friend, the distinguished chairman of the Budget Committee, 
Senator Enzi. He and I have served on the Finance Committee. At its 
best, that is what the Finance Committee has always been about--trying 
to find common ground, working together to get a proposal that can get 
60 votes.
  Reconciliation throws those unique characteristics of bringing 
Senators together; basically, reconciliation just trashes it, throws it 
out the window. In my view, when you use reconciliation the way it is 
being used here, you are telling the other party you neither need nor 
want their votes. It puts a one-sided proposal on the fast track to 
passage, tight limits on debate and amendments, a bare majority of 
votes required to actually pass it.
  I am very concerned that what is at issue now is a serious misuse of 
the reconciliation process. This is not a simplified procedure to 
address a budget issue; this is an effort to ram through repeal and 
run. Second, this is not your run-of-the-mill congressional debate 
where you have both sides bringing their best ideas forward to tackle a 
policy issue.
  For years, my Democratic colleagues and I have said that we are ready 
to work on a bipartisan basis to solve this country's health care 
challenges. I think I have spent about as much time as anybody in the 
Senate working to try to find bipartisan solutions to the country's big 
health challenges. Back in 2008, 2009, we had a bipartisan proposal: 
seven Democrats, seven Republicans. We had never had that before. I can 
tell you, we Democrats are ready to work on a bipartisan basis to solve 
the country's health care challenges.
  For me, essentially what I have tried to make my top priority for 
public service--health care is one-sixth of the American economy. It 
has always been the issue that Americans care the most about because if 
you and your loved ones don't have health, nothing else much matters. 
So we ought to be working on a bipartisan basis to solve the country's 
health care challenges, finding ways to bring costs down for families, 
making prescription drugs more affordable, upholding the promise of 
Medicare, and strengthening its guaranteed benefits.
  When I was director of the Gray Panthers at home, a senior citizens 
group, we always said that Medicare was a promise. It was a promise of 
guaranteed benefits. We ought to strengthen that promise, particularly 
updating it to incorporate changes in the program that reflect the 
needs of the Americans who face chronic health conditions, which is 
where the vast majority of Medicare dollars are going.
  That is what we ought to be doing, upholding the promise of Medicare, 
working together in a bipartisan way. But that is not what is happening 
here. From the other side, what we have heard again and again is repeal 
and replace, dozens of partisan votes producing legislation that burned 
out in the Senate or met the veto pen.
  Now, with a new administration, the Trump administration coming in, 
the Republicans kick off a procedural scheme that slashes taxes for the 
most fortunate, raises costs for typical Americans, and takes insurance 
coverage away from tens of millions of people. No Democrat is going to 
buy in to that proposition. The reason they won't is that the American 
people are not going to buy into that proposition.
  This scheme is going to bring on a manufactured crisis that does harm 
to millions of Americans across the land, rocks our health care sector, 
our providers, our plans--all of those who make up this health care 
system. One side is pushing it, but the other side is saying: No, let's 
not create this catastrophe.
  That is why, in my view, the questions about Democrats signing on to 
flawed, bad proposals miss the point. Everyone recognizes that the 
strict and immovable strategy adopted by the other side 8 years ago 
paid dividends in elections. But politics is different from governing. 
Politics is different from governing because there are serious life-
and-death consequences to actions that deprive Americans of health 
insurance. Families are going to feel economic pain when premiums and 
deductibles jump.
  I believe Americans are going to speak out. They are going to rally 
against an unfair, unbalanced bill that cuts taxes for the most 
fortunate, while putting insurance companies back again in the driver's 
seat. What is at stake here is pretty simple; it is whether or not 
America is going to turn back the clock and go back to those dark days 
when health care in our Nation was reserved for the healthy and the 
wealthy.
  My colleagues and I say no way. We are going to fight that unfair, 
imbalanced approach in every way we can.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, time will be charged equally to both sides.
  Mr. ENZI. Madam President, today I have been listening to the 
diatribes against the repeal resolution we are working on, and I think 
some things need to be answered.
  The Republicans are not trying to throw 30 million people off of 
their insurance. What we have seen over the time of ObamaCare is that 
there were 30 million people who were uninsured when we started that 
debate, and today there are 30 million people who are uninsured. Now it 
is a different 30 million people. The 30 million people who couldn't 
get insurance have insurance, and we want them to have insurance. And 
the 30 million people who are now off insurance used to have insurance, 
but they can no longer afford it. There has been a huge increase in the 
cost of health care. That is not how it was supposed to be. The prices 
were supposed to come down.
  Yesterday we took the first step in fulfilling the promise of 
repealing ObamaCare, which will pave the way for real health care 
reforms to strengthen the doctor-patient relationships, expand choices, 
lower health care costs, and improve access to quality, affordable, 
innovative health care.
  As I discussed yesterday, while Republicans will start by repealing 
ObamaCare immediately, we will ensure a stable transition in which 
those with insurance will not lose access to health care coverage. This 
will allow us to move step by step to a new set of reforms, listening 
carefully to the advice of millions of Americans affected and making 
sure we proceed wisely, doing no harm.
  There is a common misconception that some of my friends across the 
aisle have promoted. It is the idea that ObamaCare was a success and 
that repeal will be tearing down a functioning program. That is not 
true. ObamaCare has put our health insurance markets on the brink of 
collapse in many parts of the country. And what Republicans face now is 
an imperative to do something that the Democrats couldn't bring 
themselves to do when they had control, and that is to fix the problems 
they created.
  ObamaCare became the epitome of a sacred cow for them, and any 
changes, as you can see, unless done by Executive action, were out of 
the question.
  Interestingly, President Obama recently admitted in October 2016 at 
Miami Dade College that the law has real problems and that, in his 
words, ``There are going to be people who are hurt by premium increases 
or a lack of competition and choice.'' That is the President of the 
United States talking about ObamaCare. In that same speech, he went on 
to call these issues ``growing pains.'' I think that is a troubling

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blind spot about this law that he and many of my Democratic colleagues 
share. Millions are facing impossibly high health insurance premiums 
for plans they may not even want to have. Costs are going up, and they 
can't afford it. Somehow these casualties of ObamaCare don't deserve 
relief, apparently; they are just written off as growing pains by the 
authors of the law.
  My colleagues will recall ObamaCare architect Jonathan Gruber, who 
was paid in a number of different ways, who was famously exposed in 
2014 for stating, amongst other things, that while crafting this bill, 
he believed that ``the lack of transparency is a huge political 
advantage'' and that it ``was written in a tortured way to make sure 
the CBO did not score the mandate as taxes.'' Mr. Gruber may have 
succeeded in masking the consequences of ObamaCare to obtain passage, 
but there is no way to hide the results.
  A recent poll by the Gallup organization showed that more Americans 
continue to disapprove--53 percent--than approve--42 percent--of the 
law and that a majority of Americans want to see the law changed. Let 
me highlight that point again. A majority of Americans want to see 
ObamaCare either changed or replaced altogether. In fact, since passage 
of ObamaCare in 2010, there has never been a majority of Americans 
supporting the law. A quick glance around the Nation quickly explains 
why. For more and more Americans, there is only a single insurer from 
which they can select health plans, a monopoly. In fact, on Federal 
exchanges, one in five consumers will only be able to select plans from 
a single insurer. Many residents across the country only have one 
choice of health insurer. That is including my home State of Wyoming as 
well as the entire State of Alaska.
  What does this lack of competition mean? Prices are surging for hard-
working families who now have to choose between unreasonable insurance 
rates or an unreasonable fine. That doesn't even include the deductible 
problem we have. That doesn't even include the additional taxes and 
prices people are paying as a result of other things that are built 
into the law, which I will go into later--not in this speech.
  The irony of a Democrat-led effort to help resulting in the creation 
of a lose-lose proposition for families ran true to voters in the most 
recent election when they voted for change. In Wyoming, some families 
would be forced to pay more than 30 percent of their total income on 
premiums to obtain health care coverage, which often includes 
deductibles of over $1,000. One family faced premiums of more than 
$1,600 per month. That is one family, $1,600 a month. As an 
alternative, their tax penalty for not carrying coverage was only 
$1,700 for the whole year. So guess what they did. They paid the fine 
because they couldn't afford the insurance premium. They could also see 
no way that they were going to be able to get a benefit from that.
  For those lucky enough to be able to afford insurance, particularly 
in the individual market, under the new health law, premiums are 
expected to increase faster in 2017 than in previous years. Some States 
will see insurance premiums rise by as much as 53 percent. I think that 
makes it truly an emergency.
  After discussing the why, it is important to talk about how we are 
going to do this. Passing the repeal resolution we are currently 
debating today will allow Republicans to use the budget reconciliation 
process to untangle the country from this unworkable, unpopular, and 
unaffordable law. This is the exact same procedure congressional 
Democrats and President Obama used to secure passage of portions of 
ObamaCare. Let me say that again. This is the exact same procedure 
congressional Democrats and President Obama used to secure passage of 
portions of ObamaCare.
  After Congress passes this repeal resolution, it can then move 
forward on reconciliation legislation that will provide for the repeal 
of ObamaCare and pave the way for real health care reforms. I think 
Members are looking forward to an open and serious debate about the 
future of America's health and its health care system and the 
importance of restoring the trust of hard-working taxpayers. I think 
that is something both sides can agree on, and that is what will 
happen.
  This resolution we are debating does two things. It recognizes the 
point in the budget we are at considering the points of order and 
things that happened up to this point in time. We are just recognizing 
that is where this budget is. It still keeps in place the points of 
order to maintain some control over our spending, but the significant 
part is the repeal part. That is where we institute the reconciliation, 
and all that is, is an instruction to two committees on the Senate side 
and two committees on the House side. The two on the Senate side were 
the Finance Committee--they are the ones who deal with all of the taxes 
and the finance and the Medicare and the Medicaid, and they need to 
save $1 billion over 10 years. That is peanuts around here. They will 
do much better than that, I am certain. And then the HELP Committee--
Health, Education, Labor, and Pensions--also has an instruction to save 
$1 billion. That is it.
  This isn't a debate over what the changes are going to be to 
ObamaCare; this is a debate about whether we are going to give two 
committees, which have jurisdiction over this situation, the ability to 
consider it and bring us something. It has to conform with the budget 
requirements, and that is going to save some money. That is why we have 
a very low threshold, each of them saving $1 billion. That is the time 
when we will have the debate on what is happening with health care. If 
somebody wants to raise the threshold of the $1 billion for each of the 
two committees, that would be perhaps acceptable--unnecessary but 
perhaps acceptable. If somebody wants to change the budget, we are 
going to have an actual chance to change the budget right after we 
finish this process because there is a budget for 2018. We are already 
a third of the way through 2017, and there are no spending bills 
approved. That is wrong, but that is what this budget reflects. That is 
where we are at this point in time on our spending. Hopefully, we will 
do well on the new budget and come up with a plan that is going to pull 
the United States out of the hole that we are in on our deficit 
spending, which results in huge debt.

  I would like to make that distinction. Deficit is our overspending. 
Debt is the amount that we owe that we have to pay interest on--like 
pouring money down a hole--and that interest rate is going up. We get 
to make decisions on about $1 trillion each year, and the interest rate 
right now spends $200 billion right now by itself--that is at about 1 
percent. If it goes to 5 percent, which is the norm for the United 
States, that would be $1 trillion dollars. That is the amount we get to 
make decisions on. What shape will our country would be in if we have 
to spend $1 trillion dollars on interest and that is all we have to 
make decisions on?
  We have to do something. Health care is affecting more people in this 
country than anything else. So we will start immediately. We normally 
have a recess that would begin from the time we reorganize until the 
time the President is sworn in, but Republicans recognize that this is 
an emergency. This is something that needs to be taken care of. So we 
are going to stay around and get it solved.
  We are going to do the processes we have to do. This is the first of 
the processes. There is another more important step, which has to be 
the actual savings part in order to do the reconciliation, and we are 
going to do that.
  We will hear all kinds of stories of ways that people have been 
helped by health care, and we will hear stories about how people have 
been hurt by this health care. We need to fix it for both of them.
  So I think Members are looking forward to an open and serious 
debate--I hope, a serious debate--about the future of America's health 
care system and the importance of restoring the trust of the 
hardworking taxpayers. I hope that is something we can both agree on.
  Thank you. I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  If no one yields time, time will be charged to both sides.
  The PRESIDING OFFICER (Mrs. Ernst). The Senator from Kansas.
  Mr. MORAN. Madam President, in 2010 the American people were promised 
a number of things, but among

[[Page S88]]

those things was affordable, accessible, and quality health care. They 
were promised that if they liked their health care plans, if they liked 
their insurance, they could keep those insurance policies. They were 
promised a system that could get more folks covered at lower costs.
  Instead, unfortunately, the Affordable Care Act has failed us and has 
failed to keep its promises. Canceled policies, elimination of certain 
plans, difficulties in identifying new plans, massive premium 
increases, sky-high deductibles, and limited options for doctors have 
really become a new standard for many American families.
  At the end of last year, I completed another round of 105 townhall 
meetings in our State. There are 105 counties in Kansas. On occasion--
it is pretty rare but on occasion someone will say: The Affordable Care 
Act was helpful to me and my family. My response to that is: I am glad, 
but surely we can come up with a proposal--a plan--that isn't so 
damaging to so many other people for the benefits that you claim you 
have acquired under the Affordable Care Act. Surely, we can come up 
with a plan that doesn't increase premiums, increase deductibles, 
increase copayments, eliminate plans, reduce the choice of the 
physician you see, and reduce your ability to keep the health care plan 
that you like. Because I am opposed to the Affordable Care Act does not 
mean I am opposed to trying to make sure Americans have better options 
and more affordable care.
  I have also visited all 127 hospitals in our State. I have had 
conversations with the chief financial officer, the CEO, the trustees, 
the doctors, the nurses, and almost without exception the conversation 
is about how bad debt expenses increase, the ability for their 
patients--people who are admitted to the hospital--to pay their bills 
is less, not more, and that is because they can't afford the copayments 
and deductibles.
  Unfortunately, ObamaCare--the Affordable Care Act--has taken away the 
freedom to make health care decisions from Americans, from us as 
individuals, and given way too much authority to the Federal 
Government. Kansans continue to ask me to help them get back to their 
former health care plans, to find a better way to do this, a plan that 
is more affordable with better coverage.
  Over the last 6 years, I have advocated for a number of changes to 
our health care plan to help American families. Even before President 
Obama was President, we were talking about what we ought to do.
  I had ideas of what we could do to improve the chances that people 
across Kansas and around the country would have a better opportunity to 
provide health care insurance for themselves and their family members. 
I am proud of some of the successes we have had in recent time.
  I am a member of the Senate Appropriations Committee and a supporter 
of funding for NIH, or the National Institutes of Health. This is 
research that is essential to saving and improving lives, growing our 
economy, and maintaining America's role as a global leader, but, most 
importantly, it saves lives and improves health care. In addition, it 
saves money--the cost of health care--if we can find the cure and 
treatment for cancer, for diabetes, for Alzheimer's. One of the ways we 
can help reduce the cost of health care and make it more affordable is 
to make certain that we make the necessary investments in finding those 
cures and treatments.
  Last year, I supported, and this Senate and Congress passed, the 21st 
Century Cures Act. This takes us in additional directions in the way of 
finding those cures for life-altering diseases and, in the process, 
helps us to save our families' dollars. We have also worked hard to try 
to maintain the funding for Federal programs and agencies that work 
with universities and medical schools to train and recruit medical 
professionals who then go on to serve particularly in medically 
underserved areas. It is very typical of your State and mine, Madam 
President, in which we are experiencing the constant shortage of the 
necessary professionals to provide the necessary health care.
  While this is progress, with a new Congress, a new year, and a new 
administration, we now have a tremendous opportunity to provide real 
substantive reform to our health care system. I mentioned the 
conversations I have had in townhall meetings. In addition to the 
health care side of the Affordable Care Act and the problems it has 
created for affordable and accessible health care, we have also had the 
challenges on the economic side--the job creation side--that the 
Affordable Care Act has unfortunately caused--the conversation about 
whether or not to expand a business, whether or not to exceed the 50-
employee threshold. Those aspects of the Affordable Care Act are very 
damaging and need to be addressed and cured as well.
  As we as a Senate, we as a Congress, and we as a country look for a 
replacement strategy, for something different--significantly different 
than the Affordable Care Act--we ought to focus on the practical 
reforms that embrace increased flexibility and allow American men and 
women to decide what is right for them and their individual family 
health care needs.
  As we take this matter up in Congress, I wish to again put forth some 
specific ideas I have offered over the years as a blueprint for reform 
that we should try to put in place.
  First, we should maintain preexisting condition protections for those 
with continuous coverage. Individuals with debilitating diseases and 
chronic conditions who have purchased health care should be reassured 
that their coverage will not be stripped in any future health care 
changes to our system.
  Second, we can increase coverage by enabling Americans to shop for 
plans from coast to coast, no matter what State they live in. This will 
lower the premiums by spurring greater competition in the insurance 
market.
  Third, we should extend tax savings to those who purchase health care 
coverage, regardless of their employment. To assist low-income 
Americans, we can offer tax credits to help them obtain the private 
insurance of their choice. We also can expand access to care by 
supporting community health centers and other primary care access 
points.
  Fourth, instead of limiting the choice of plans, let's give small 
businesses and organizations the ability to pool together in order to 
offer health insurance at lower premiums, similar to corporations and 
labor unions. We also need to make it possible for health insurance to 
travel with workers when they move from one job to another job 
throughout their careers.
  Fifth, we ought to increase the incentives available to individuals 
to save now for their future and for long-term care needs by empowering 
them to utilize health savings accounts and other incentive plans. 
Doing so enables individuals to take ownership in their health, and 
that is important as well.
  Sixth, we need not accept the idea that costs for currently available 
medical treatments will inevitably rise. Instead, let's continue to 
support those things that bring down the cost of health care by finding 
cures and treatments, as I mentioned, with the National Institutes of 
Health. Advancing lifesaving medical research and spurring innovation 
can help us accomplish health care savings, reducing the financial 
burden for those with diseases and their family members who care for 
them.
  Seventh, we need to address shortages in our medical workforce by 
promoting education and programs at our universities and our medical 
schools that train physicians, nurses, and other health care officials 
and encourage them to practice in underserved areas through scholarship 
and loan repayment programs. Kansas is an example, as is your State, 
Madam President, where those rural areas and, additionally, those core 
centers of our cities lack so often the necessary health care 
providers.
  Eighth, in order to curb the preventable costs that often occur 
through unnecessary emergency room visits and untreated symptoms of 
disease, we should provide coverage to low-income Americans, despite 
their limited financial means, in a financially sustainable way that 
ends up saving money in the long run. For all of us, the best reduction 
in health care costs is wellness, fitness, diet, and nutrition. That 
also means early preventive care. It means early diagnosis, and we make 
certain that Americans have access to that diagnosis and that early 
treatment. Ensuring access to quality care with a focus on preventive 
health is an effective way to limit high-cost health visits that place 
burdens on hospitals,

[[Page S89]]

physicians, our economy, and our health care system as a whole.
  Lastly, we can reform our medical liability system and reduce 
frivolous lawsuits that result in inflated premiums and the practice of 
defensive medicine, where doctors order every possible test out of fear 
of potential lawsuit. Doing so can save tens of billions of dollars 
each year and make health care more affordable for more people.
  The bureaucracy that goes with the providing of health care needs to 
be simplified. I have often looked behind the desk when I go see my 
family physician and wonder what all the people who are working there 
are doing. So much of it is not about patient care but navigating the 
system by which your health care bill, at least in part, gets paid. 
There is all the variety of insurance forms. I know this in my life--
the ability to understand that insurance document that arrives in the 
mail and sits on our kitchen table waiting for my wife or me to figure 
out what this means. I have seen this with my own parents when they 
were living--the amount of documents, paperwork, and forms and checks 
for $13.19 that arrived in my dad's mailbox and trying to figure out 
with my parents: What does that mean? Why am I getting this?
  So much cost savings and so much anxiety and angst could be 
eliminated if we had a system that was much more uniform in its 
presentation, simplifying the way in which our health care bill gets 
paid by our insurance provider, by Medicare, by Medicaid, or out of our 
own pocket. I would defy most Americans to be able, unfortunately, to 
understand what is the stuff that comes in the mail and what it means 
to them.
  As we move forward with trying to replace and improve access of 
Americans to health care--to affordable health care--I believe there 
are reforms that will provide us with a good blueprint for how to start 
helping Kansans and all Americans across the country who have suffered 
under the deficiencies and the costs and the damage that comes from 
ObamaCare.
  I look forward to working with my colleagues--Republicans and 
Democrats--to find solutions to take advantage of this opportunity that 
we have. The American people--many American people, most American 
people--are hurting under this law, and they have spoken clearly 
numerous times. It is time for us to bring to them the changes that 
improve their lives by improving their health care, by improving their 
health, and by making sure that no American is worried about whether or 
not the necessary health care that they need or their family member 
needs is outside of their reach.
  Mr. CARPER. Will the Senator yield?
  Mr. MORAN. I yield.
  Mr. CARPER. It is great to see my friend from Kansas on the floor and 
looking forward to serving the next 6 years.
  One of the things I focused on as a member of the Finance Committee 
on the Affordable Care Act was the idea that we have doctors, 
hospitals, and nurses who in some cases provide entirely too many tests 
and procedures and so forth that are needed to treat somebody just in 
order to cover--as Naval aviation used to say--our 6 o'clock. You 
didn't want to have somebody come up from behind you to shoot you down. 
So we talked about covering our 6 o'clock. Doctors, hospitals, and 
nurses spend a lot of time covering the 6 o'clock, as my friend knows.
  I am an Ohio State boy. I am going to say something nice about 
Michigan, which is really out of character here. In Michigan, the 
University of Michigan Medical School and hospital came up with a 
policy called Sorry Works. If a doctor, hospital, or nurse made a 
mistake that adversely affected a patient, they apologized. The idea 
was to apologize, make up for it, make them whole, help them get well, 
cover their financial costs and so forth. It is called Sorry Works. It 
is a good idea.
  I met a guy who is a doctor and a lawyer--a Republican--from Illinois 
who took the idea of Sorry Works and he put it on steroids and they 
called it Seven Pillars. It has been a great example of what actually 
works to reduce the incidents of medical mistakes in hospitals and 
nursing homes and also to get better health care outcomes. You reduce 
medical malpractice costs, and you also get more satisfaction from the 
patient side.
  We have taken that idea in Delaware--Seven Pillars--at Christiana 
Care, which is the big health care delivery system in our State. We 
have taken that and have begun to incorporate it in the way they work. 
If I am your doctor and you are my patient and I perform a procedure on 
you, if you are harmed or hurt--not your fault, my fault--the idea is I 
apologize. I meet with you privately--no lawyers--and apologize for 
what has happened and try to make you whole. If you lost wages, if you 
have pain and suffering, they pay your health care costs and make you 
whole. Don't hide it. Don't put it under the rug but take full 
acceptance, responsibility. That is one of the approaches being used to 
try to deal with medical malpractice costs. I think it is a good one. 
It is not the only good one, but it is one.
  I happened to be walking through the Chamber and heard my friend 
speaking, and I thought I would share that with you, with everyone.
  When I was Governor of Delaware, we used to meet with my Cabinet. We 
would be talking about a particular problem or challenge we faced in 
Delaware. I would say to my Cabinet: Some other State or some other 
Governor has actually addressed this issue. They figured out how to 
deal with this this. Our challenge is to find out what works and do 
more of that and to see if it can be transferred to Delaware.
  Sorry Works is a Michigan idea. It morphed into Seven Pillars in 
Illinois, and now it is being incorporated in my own little State in 
our big health care delivery system. It is something that works. I am 
not sorry that it works. I am glad that it works, and I am happy to 
share it with my friend from Kansas and whoever else might be 
interested.
  I yield.
  Mr. MORAN. I thank the Senator from Delaware, and I appreciate his 
comments. He did walk in just as I was talking about that particular 
issue of a series of things that I believe would improve the cost and 
affordability of health care. I thank the Senator for sharing his 
experience in Delaware and elsewhere and use that as an opportunity to 
indicate that the cost savings that comes from that kind of reform is a 
positive, but we also want to make sure those who, through no fault of 
their own, are actually harmed are made whole to the best of our 
ability that this can be accomplished.
  Finally, I would use this as an opportunity to point out that this 
Senate ought to work in a way in which the ideas of all 100 Members are 
considered in a respectful way as we try to find solutions to the 
access and affordability of health care.
  Again, I thank you for the time on the floor.
  Mr. CARPER. Madam President, if I could speak through the Chair.
  I failed to mention one thing about Sorry Works, Seven Pillars, and 
what we are doing in Delaware. If we have that meeting between the 
patient who had been harmed, the physician and provider, and they have 
the need where there is an apology and an offer to try to make the 
patient whole--no attorneys involved--if the patient says no, I am not 
interested in doing that, nothing that is said in that conversation 
between the two of them can be used in a court of law, which I think is 
an interesting approach. We are anxious to see how it works over the 
next couple of years.
  Ironically, I was probably the only Democrat--maybe the only member 
of the Finance Committee--who was trying to get included in the 
Affordable Care Act provisions dealing with medical malpractice. I had 
this idea--not to let a thousand flowers bloom or ideas like that--to 
figure out five or six good ideas and put them on steroids to see if 
they actually work on a larger scale. I could not get a cosponsor on 
the other side of the aisle, which blew my mind. It still does. I could 
never understand that. In the meantime, the ideas are starting to crop 
up and flourish, and, hopefully, we can find out what works and do more 
of that.

  Thank you.
  Mr. MORAN. Madam President, I would welcome a membership on the 
Finance Committee, but I don't have one at this stage or with my time 
in the Senate. Under either circumstance--membership on the Finance 
Committee or here in the entire Senate--I look forward to working with 
my friend and colleague, the diligent Senator from Delaware.

[[Page S90]]

  I yield my time.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. CASSIDY. Madam President, I hear my Democratic colleagues 
praising ObamaCare. I had to smile yesterday. I heard a colleague 
talking about how ObamaCare was addressing high pharmaceutical costs. I 
had to start laughing--and kind of a bitter laugh. Tell that to a 
senior who is paying $6,000 for her medicine, which before ObamaCare 
passed was a fraction of that.
  We hear how great it is that ObamaCare has given so many people 
coverage. Say how great that coverage is to someone who has a $6,000 
deductible--a $6,000 deductible--who does not have $400 in her checking 
account. There is a friend of mine--people don't believe it so I put it 
on my Facebook page. He got his quote for him and his wife. They are 60 
and 61 years of age. Their premium for 1 year was $39,000, each of them 
with $6,000 deductibles. Again, it is on my Facebook page because 
otherwise no one would have believed me.
  So when people speak about the affordable health care act, I have to 
laugh. If this is affordable, what would be unaffordable? We can 
clearly do better than this.
  I begin this speech by calling into question my Democratic 
colleague's defense of ObamaCare, but we can have common ground. I 
applauded and still applaud the goals of those who support the 
Affordable Care Act. They wish to have coverage for all. Now, that is 
important. For over 30 years, I have worked as a physician in a 
hospital for the uninsured. My medical practice has been geared toward 
bringing coverage, to bringing care to those who otherwise would not 
have it.
  As I look at this issue, I have to thank them for their motivation 
but have to recognize that the Affordable Care Act has not achieved 
that in a way which most Americans find affordable. The other thing 
about ObamaCare is that it coerces Americans. It takes power from 
patients and States and gives it to Washington, DC, coercing the 
individual with mandates and penalties, taking away her right to 
choose. That is not where the American people wish to be.
  I would like to believe Republicans and Democrats can find common 
ground. I have introduced a replacement plan that would give States the 
power. I am willing to concede, the minority leader believes that 
ObamaCare is working just fine in his State of New York. In my plan, we 
repeal ObamaCare on a Federal level, but if a State like California or 
New York thinks ObamaCare is working for them, God bless them.
  Under my plan, a State legislature would have the right to stay on 
ObamaCare. So here Congress would pass the legislation giving States 
the choice, and the State would either have the option we advance, 
which I think is superior--but when Republicans say that you can keep 
your health insurance if you wish, and we mean it, we mean it. If a 
State decided they wished to stay on ObamaCare, they could or if a 
State truly decides they want to have nothing at all to do with any of 
this, they can totally opt away from the Medicaid expansion, from any 
help for others in their State to purchase insurance, period.
  I think this recognizes that if the minority leader wants to claim it 
is working in New York, they can keep it, but clearly ObamaCare is not 
working in some other States. We can talk about Arizona, where briefly 
a county did not have a single insurance company providing insurance 
and where premiums increased by as much as 100 percent. We can look at 
Louisiana, my State, where that quote I gave earlier--a fellow and his 
wife, $39,000 for 1 year's premium.
  Clearly, ObamaCare markets are failing there. So let's repeal 
ObamaCare, give the States the power, allowing them to choose the 
system that will work for them. Now, health care cost is important. 
Under our bill, we make health care more affordable by giving the 
patient the choice, the power, if you will, of price transparency. 
Under ObamaCare, we have seen prices rise out of control. A lack of 
price transparency keeps providers from having to compete which takes 
away the consumer's power of choice.
  You can see this power of choice price transparency. Fifteen years 
ago, LASIK surgery cost $1,000 an eye or $875 an eye, with more for 
astigmatism. Now you can drive down the street and you see a 
billboard--a billboard--that says: LASIK surgery $275 an eye. So over a 
period of time, when everything has increased, LASIK surgery has come 
down--the power of price transparency.
  Another example I like to use is of a woman, a physician, went for 
her mammogram. She wanted to pay cash. They talked her out of it. No. 
No. No. We don't even know what to charge you.
  OK. I won't pay cash.
  They billed her insurance company. She later found that if she had 
paid cash for her mammogram, it would have cost her $90. As it turns 
out, they billed the insurance company $500. Her deductible was $100. 
She was actually out $10 because they billed her insurance company. She 
should have known that price going into it.
  One more example. If a doctor orders a CT scan, the cash price, 
according to an LA Times article a few years ago in the Los Angeles 
Basin, varied from $250 to $2,500. Unless you are an investigative 
reporter for the LA Times, able to call up and get that cash price, you 
otherwise would not know. I guess maybe it sometimes helps to have 
another example. Would anyone buy a car if they did not know the price 
of the car beforehand? Yet that is routinely done with health care.
  Under the legislation I and Senator Collins have introduced in the 
Senate, and I and Pete Sessions have introduced in the House of 
Representatives, people will know what the cash price is. I have found, 
working in a hospital for the uninsured, that when you the give the 
patient the information and power they need to know to make the better 
decisions, you get better outcomes.
  By the way, we have been told that Republicans don't have a plan. The 
plans I am speaking of now are drafted in legislative language--
legislative language, again, that would repeal ObamaCare, put in price 
transparency, and return decisionmaking power to the patient. We should 
repeal the individual mandate, repeal the employer mandate, prevent the 
Federal Government, the long arm of the Federal Government from 
reaching into someone's household, forcing them to do something they 
don't wish to do.

  There should be an alternative. Under both the World's Greatest 
Health Care Plan--the bill I introduced with Pete Sessions--or the 
Patient Freedom Act that I have Susan Collins as a cosponsor, we take 
all of the money a State would receive had they done the Medicaid 
expansion and those eligible to be signed up for the ObamaCare 
exchanges, and we give that money to the State to allow them to give 
tax credits to those who are eligible.
  These tax credits could only be used for health insurance. If the 
patient did nothing, she would have a health savings account, 
catastrophic policy with a pharmacy benefit. She could use the health 
savings account as first-dollar coverage.
  Now, under ObamaCare, $6,000 deductible. Under our plan, the patient 
has first-dollar coverage, so if her daughter has an earache and she 
takes her daughter to the urgent care center, she can cover that visit 
with a health savings account that would be funded with this credit. 
They also have catastrophic major medical coverage, so if they get in 
that car wreck, take them to the emergency room, sky-high pricing, they 
are protected from medical bankruptcy.
  Under our replacement plan, we also give States the option to say 
that if someone in our State is eligible, they are automatically 
enrolled. I smile when I say that covers two populations, the person 
who may live under a park bench and does not have his life together to 
otherwise do it, and the other population would be my 22-year-old son 
and those like him, those young folks who never think they are going to 
get ill so they never sign up for insurance. Without them being in the 
pool, we end up with a sicker pool. That is what has happened with 
ObamaCare.
  By the way, it would be easy to imagine you could end up with 95 
percent enrollment of those eligible should the State decide to go this 
way. The timeframe for our replacement would be simple. In year one, 
say 2017 Congress

[[Page S91]]

passes the enabling legislation, which in year 2018 allows the State to 
choose between these three options; in 2019, the State would implement 
the option it chooses; and by the end of 2019, we have made the 
transition from repeal to replace, to implementation.
  Folks ask: Would I lose my coverage? I am a physician. I am going to 
give my perspective: a patient I might see who has breast cancer. She 
does not like ObamaCare. She voted for Donald Trump, but she is on the 
bubble financially. She is not sure she can afford coverage, but she 
has breast cancer. As bad as ObamaCare is, at least she is getting some 
care.
  Now she is having to put out all this money first, but still she is 
getting some care. If we keep her in the prism through which we look at 
this problem so that in the transition from ObamaCare to better 
coverage she continues to have her therapy, so at the end of this, not 
only does she have better coverage, but she has health and recovery 
from breast cancer, we have done our job. That is our Republican goal, 
to keep our prism as that woman who is vulnerable from a sickness she 
has now. In our transition, she does not lose coverage; she merely 
moves to better coverage.
  I introduced the Patient Freedom Act with 12 Senate cosponsors in 
2015 and then again teamed up with Representative Pete Sessions in 2016 
to introduce the World's Greatest Health Care Plan. That is truly its 
name. Tom Price, our soon-to-be HHS Secretary, first introduced his 
Empowering Patients First Act to the House of Representatives in 2014. 
Speaker Paul Ryan, Representative Fred Upton, Senators Richard Burr, 
and Orrin Hatch have also outlined plans for comprehensive health care 
reform.
  All of these plans create a new system that returns power of choice 
to patients and to States. Simple provisions as I have described such 
as health savings accounts, instituting free market values, if we put 
them into a replacement plan now, we will quickly have an effect upon 
millions. Republicans have worked hard to lay the groundwork to repeal 
and replace ObamaCare.
  President-elect Trump has said he wants repeal and replace to happen 
at the same time. He promised both. We should fulfill both promises. 
Our majority leader has said we can do a better job as Republicans 
covering more people. We have the principles, the ideas, and the plans 
ready to go so let's put them to use. We owe it to the American people 
to carry out that replacement now with a smooth transition so the 
insured population can grow without anyone losing coverage in the 
process.
  Republicans are committed to creating and passing effective health 
care legislation to replace ObamaCare and to bring real coverage to all 
Americans. Now is the time to do so.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Madam President, I rise today in support of S. Con. Res. 3 
and the ongoing effort to repeal the most harmful elements of the so-
called Affordable Care Act.
  While our friends on the other side of the aisle have been trying to 
convince the American people that there is nothing to see here and that 
this poorly named law is working according to plan, the vast majority 
of our citizens know the truth: ObamaCare just doesn't work.
  According to the results of a recent Gallup poll, 80 percent of 
Americans want Congress to either change the Affordable Care Act 
significantly or repeal and replace it altogether. Let me repeat that. 
Eight out of every 10 people in this country agree that the status quo 
is unacceptable and that we need a major change in what is going on 
around here.
  We need a major course correction in our health care system. It is 
not hard to see why this is the case. After all, under ObamaCare, the 
cost of health insurance has increased dramatically and will continue 
to do so well into the future. Under ObamaCare, individuals and 
families are being left with fewer and fewer choices when it comes to 
buying health insurance. Under ObamaCare, patients have fewer options 
and reduced access to health care providers. Under ObamaCare, the 
American people have been hit with steep taxes, burdensome mandates, 
and a health care system that simply does not meet their needs.
  This year alone, premiums in the benchmark plan for the ObamaCare 
exchanges have gone up by an average of 25 percent, and in some parts 
of the country, the increases have been significantly larger than that. 
In addition, over the past 2 years, insurance plans have been dropping 
out of markets all over the country. As a result, it is estimated that 
more than half of the counties in the United States will have two or 
fewer available health insurance plans on the exchanges--and that is 
this year--and about a third of them have only one available option.
  I am quite certain that every single Member of this Chamber has heard 
from a number of their constituents about these problems, about the 
problems they have faced as the Affordable Care Act has been 
implemented. I know I have. A number of Utahns have written to me to 
express their concerns about the increases in their insurance premiums. 
For example, last month, Austin from Provo, UT, told me that due to the 
growing cost of his insurance plan, ``I'm going to have to drop the 
insurance and face the penalty next year. I'm worried because, as a 
young husband and father, I'm barely making ends meet, and I'm not sure 
I can afford to pay the penalty for not having insurance.'' Similarly, 
Eryn from Spanish Fork, UT, noted that because her family's previous 
insurer dropped out of the Utah marketplace, the remaining plan that 
best met her family's needs was ``a plan with a small list of in-
network providers and no coverage for out-of-network providers.'' She 
continued, saying that under this new plan, ``We will have a higher 
deductible ($13,000 for the family), we will have to pay the full cost 
of any visit to the doctor . . . and we will not be able to save as 
much money in our Health Savings Account each month because of the high 
premiums, which add up to $11,000 a year. . . . The premium is 
basically another mortgage payment for us, only we have no property to 
show for it. This is too much.''
  No family should have to choose between paying their mortgage and 
paying for their health insurance. Yet, with all of ObamaCare's 
failures and broken promises, families throughout the country are 
currently having to make those kinds of choices.
  Unfortunately, it does not get any better from here, not without a 
major change to the status quo. In fact, I think it is safe to say that 
if we fail to act, the worst is yet to come. Therefore, it is only 
fitting that we begin this new Congress by repealing ObamaCare and 
setting the stage for workable reforms that will actually bring down 
costs, provide more options, and let the American people--and not 
Washington bureaucrats--make their own health care choices. The budget 
resolution before us is the first step in this effort.
  As we all know, the resolution contains reconciliation instructions 
to the relevant committees, including the Senate Finance Committee, 
which I chair, to draft legislation to repeal ObamaCare. So after 
approving this resolution, the next step will be for the Finance 
Committee, the HELP Committee, as well as the Ways and Means and Energy 
and Commerce Committees over in the House, to get to work on putting 
together a repeal package. This process will be more difficult than it 
sounds. We don't want to be reckless, and we don't want to inflict more 
harm on the American people or our health care system; therefore, in 
addition to repealing ObamaCare, the legislation we draft pursuant to 
this budget resolution will have to include a stable transition period 
to give us the time and space we need to provide more sensible reforms.
  Under the budget resolution, the legislation to repeal ObamaCare and 
provide that transition period will need to be reported to the Budget 
Committee by January 27. Then both the House and Senate will debate the 
legislation, hopefully passing it by simple majority votes and sending 
it to the desk of the incoming President. Once we pass this repeal 
legislation, we will come to the most important step in the process: 
replacing ObamaCare with a health care system worthy of the American 
people.
  This will not be a simple endeavor. It is going to take a great deal 
of work, and it will almost certainly require the efforts of people 
from both parties. The Finance Committee is going to have a

[[Page S92]]

major role to play throughout this process of repealing ObamaCare, 
providing for a secure transition, and replacing the law with more 
effective reforms. Our committee has jurisdiction over all the major 
Federal health programs, including Medicare and Medicaid. In addition, 
we will have jurisdiction over the tax provisions, which include all of 
ObamaCare's harmful taxes as well as the premium tax credits provided 
to purchase plans in the ObamaCare exchanges.
  I have spoken at length to my Republican colleagues on the Finance 
Committee about these issues, and all of them are ready and willing to 
do whatever is necessary to put our Nation's health care system on a 
more responsible path. We are going to get it done. In that I have no 
doubts.
  To be sure, the first few steps in this effort are going to happen 
quickly. Once again, the plan is to produce repeal legislation before 
the end of this month. This, of course, is how it has to be. The 
American people don't have the time for us to wait around on these 
issues, and we don't have the luxury of sitting back and watching the 
problems get worse over time. The problems facing our health care 
system are growing by the day. We need to take the swiftest possible 
action.
  We intend to act quickly and methodically to begin providing relief 
for the millions of Americans who are currently suffering as a result 
of ObamaCare and the unworkable system it has created. As I noted, if 
that effort is going to be successful, it should be bipartisan. Both 
Congress and the incoming administration will need to work together.


                          Cabinet Nominations

  On that point, Madam President, I do want to note that my friends on 
the other side of the aisle have as recently as this morning made a 
number of statements and issued several demands with regard to the 
process for considering and confirming the President-elect's Cabinet 
nominees. According to my colleagues' statements, they want multiple 
rounds of hearings on every nominee, which, by the way, is 
unprecedented. This morning, they even went further, issuing demands 
that certain preconditions be met before hearings could even be held on 
a particular nomination. These tactics are, to put it bluntly, 
preposterous. My colleagues are certainly free to oppose any nominee 
and to try to convince others to do the same. It is unfortunate that 
they have decided to go further by politicizing the process by which we 
consider nominations.
  Speaking for the Senate Finance Committee, I have to say that we have 
an established set of vetting procedures for all executive branch 
nominees. Republicans and Democrats alike have those particular 
procedures. That process has been in place for decades and has 
traditionally been bipartisan.
  By all accounts, the Finance Committee's longstanding vetting process 
is exceptionally thorough and fair, and it is deeply regrettable that 
some of our colleagues would try to undermine that process and not 
provide the incoming Trump administration's nominees the same respect 
and regard our committee has provided for nominees in the Obama 
administration and prior administrations as well. As chairman, I take 
this process very seriously. I have made no efforts to abbreviate or 
short-circuit our procedures for any nominee and have no intention of 
doing so in the future. I am certain all of our chairmen here in the 
Senate can say the same thing.
  My hope is that my colleagues will stop politicizing this process at 
every step and allow the Senate to function as it has under both 
Republican and Democratic administrations. My friends on the other side 
may not like the results of the recent election, but their 
disappointment of the outcome is no justification for reinventing the 
way we do business here in the Senate.
  I hope we will all take this into consideration and we will start 
cooperating with each other and get this government moving again and 
that we will support and sustain these people who are qualified and 
good people who are being chosen by the Trump-elect administration. I 
think it is important that we do these things and do them carefully and 
that we treat each other with the respect that is well deserved in this 
body. I hope that the petty, cheap politics will be discontinued.
  Mr. President, with that, I yield the floor.
  The PRESIDING OFFICER (Mr. Hoeven). The Senator from Ohio.
  Mr. PORTMAN. Mr. President, I enjoyed listening to the comments of my 
colleague from Utah about the Affordable Care Act, and I wanted to 
expand on that a little if I could. I know we are having a discussion 
right now about whether to repeal and replace the Affordable Care Act, 
and we are focused a lot on what the timeframe might be and what the 
replacement might be, which is appropriate, but we also have to remind 
ourselves as to how we got here.
  We got here because the Affordable Care Act has not met its promises 
and has let down the people of Ohio and people around the country. 
Millions of these families have already had a tough time experiencing 
really a middle-class squeeze of flat wages, even declining wages, on 
average, over the last decade or so, and now higher costs. That squeeze 
is accelerated by the cost of health care which has gone up 
dramatically.
  In my own State of Ohio, the Ohio Department of Insurance has 
reported a 91-percent increase in the individual market in Ohio in the 
last 6 years, an 80-percent increase for small businesses that are 
purchasing Affordable Care Act-compliant plans. This is since the 
Affordable Care Act went into effect. Think about that. There has been 
almost a doubling of health care premium costs. Who can afford that? 
People certainly can't afford that as their wages are flat or even 
declining.
  According to the Kaiser Family Health Foundation, average family 
premiums since the Affordable Care Act was put into place have 
increased by more than $4,700. Recall that one of the promises of the 
Affordable Care Act was that costs would go down, on average, $2,500 
per family. Exactly the opposite has happened. In fact, there has been 
an almost doubling, with a $4,700 increase. I don't think families got 
that kind of pay increase to be able to afford that. They certainly 
haven't in Ohio.
  So this is a huge problem. To make matters worse, we think these cost 
increases are continuing to escalate in our State and around the 
country. In Ohio, premiums grew this year in 2017--on average, 13 
percent higher than in 2016. So there have been double-digit increases 
in 1 year. With two plans in particular, premiums went up by 39 percent 
in Ohio. So for some families it was much worse than that. We have had 
good leadership in Ohio with Governor Kasich and Lt. Gov. Mary Taylor, 
who is also the insurance commissioner in our State, and because of 
that we have done a better job of trying to control these costs, but in 
many parts of the country, the situation is getting even worse.
  Nationally, premiums are increasing by 25 percent just this year. In 
Arizona, they are doubling. In Tennessee, they are rising 63 percent. 
In Pennsylvania, right next door to Ohio, they are rising 32 percent. I 
can go on and on. I am sure North Dakota has had similar problems, as 
the Presiding Officer can tell us about. Some people might be able to 
afford these higher premiums, but I think we just can't afford it.
  I heard Senator Hatch talk about having to make a choice between 
paying your rent or being able to pay your premium. That is what I hear 
in Ohio as I talk to people who are struggling and are now being hit 
with these huge expenses. Unless we take action, there is no light at 
the end of the tunnel.
  The Congressional Budget Office, which is a nonpartisan group in 
Congress, and also the Joint Committee on Taxation projected that 
unless we do something to change the status quo, premiums will continue 
to skyrocket. They say they will grow by at least 5 percent per year 
over the next decade. By the way, that is far faster than they assume 
wages are going to grow so the squeeze will continue.
  The law was advertised as something that would ``bend the cost 
curve,'' meaning we would begin to see a reduction in the costs of 
health care, but health care costs have gone up, not down, and on top 
of that, American people had to pay hundreds of billions of dollars 
every year in taxes for this new law. There are 19 tax increases in the 
Affordable Care Act. Some of these, like the Cadillac tax, are very 
unpopular, even among Democrats and Republicans. So we are hoping we 
can deal

[[Page S93]]

with that with any kind of repeal effort immediately.

  Another goal of this law, we were supposed to be increasing access to 
health care. Let's talk about that for a second. We heard different 
things on the floor about that. About 6 million people lost health 
insurance they liked as a direct result of this law going into effect. 
About 6 million Americans were told their coverage is no longer 
adequate because it didn't meet the mandates so they will lose their 
coverage. President Obama told the American people, I am told, 37 
different times that if they liked their doctor, they could keep their 
doctor. Of course, that turned out not to be true. When you lose your 
health care plan and lose your doctor, you don't feel like those 
promises have been kept.
  The outside fact checker called PolitiFact rated that as the Lie of 
the Year for 2013. That is the outside group that looks at what we 
elected officials say is going to happen and then compares it to what 
actually happens. By the way, it still is not true. One in five 
ObamaCare customers were forced to find a new insurance company for 
this year.
  So the Congressional Budget Office that I mentioned and the Joint 
Committee on Taxation, these nonpartisan groups, now project that 27 
million Americans are still uninsured today. Under the status quo, if 
we don't take action, they say that will be the case for the next 
decade. So this notion that everybody is going to get covered just 
hasn't happened. By the way, that is about 1 in 10 people in our 
workforce, even after hundreds of billions of dollars of taxpayer 
dollars have been spent on the Affordable Care Act, including these 19 
new tax increases.
  A lot of people have told me: Rob, I have health insurance, but I 
really don't because my deductible is so high. So, forgetting the 
premiums for a second, to pay for health care, just the annual 
deductible has gone out of sight. There are some plans where a 
deductible for a family might be $8, $9, $10,000 a year. That is not 
really health care because you end up paying all that money out of 
pocket. The average deductible for a midlevel plan for ObamaCare, 
according to the Kaiser Family Foundation, went up to $2,500 the year 
before last, 2015, to more than $3,000 last year, an increase of about 
25 percent in just 1 year. You see that in increases in deductibles and 
copays, not just in the premiums.
  National insurers have lost billions of dollars on the Affordable 
Care Act exchanges, and a lot of them pulled their plans from the 
States. This is a real problem because if you don't have competition or 
choice out there, you will not get the costs down. I see in my own 
State of Ohio we lost one-third of the companies on the exchanges just 
this year. We have gone from 17 companies offering insurance on the 
exchanges in 2016, last year, to this year having just 11--so 17 
companies going down to 11 companies. We now have 20 of our counties--
there are 88 counties in Ohio--20 of our counties have only 1 insurer. 
This is also true nationally. About one-third of the counties around 
the United States only have one insurer. Again, this leads to higher 
costs, less choice, less competition. Quality also goes down because 
you don't have competition for the beneficiaries. It also affects the 
issue of premiums going up, deductibles going up, copays going up, and 
the middle-class squeezed.
  So the President's health care law certainly failed at its own goals 
that were laid out in the promises that were made. It was supposed to 
create jobs, too, which is a different issue. What is the economic 
effect of this? Having more people covered is a good thing. We all want 
that. But what is the economic impact on the way the Affordable Care 
Act was put into place? We are looking at the weakest recovery in the 
history of our country from a recession still. Unfortunately, we 
haven't seen the strong economic growth we hoped for and had 
anticipated after a deep recession. Some of the reason for that, in my 
view, is health care. Health care costs went up dramatically. People 
are paying a lot more for health care, not being able to get ahead, 
small businesses having higher and higher costs.
  If you look at the latest jobs report, it is interesting. The Bureau 
of Labor Statistics tells us that 5.7 million Americans now are stuck 
in part-time work who want full-time work. These are people who are 
looking for a full-time job but only have a part-time job. Why is that? 
The economy is not working as it should. It is not generating enough 
growth to create job opportunities full-time, but it is also because of 
these mandates under the Affordable Care Act. I can tell you, 
economists may differ on the impact of this, but go talk to people 
about it.
  I was in Chillicothe, OH, and someone came up to me and asked: Can 
you help me; because my employer is saying I can only work 28 hours a 
week. I figured out what it was about. She was a fast-food employee. I 
asked her: What did they say? And she said it was because of health 
care. What does that mean? It means that under ObamaCare, if you work 
under 30 hours a week, you are not covered by the mandates and the new 
costs, so some employers are going to say we are keeping you under 30 
hours a week. That has led to more part-time work.
  In this particular case, the woman said: I have to find another part-
time job and I have kids at home and this is tough. And I said: Well, 
the answer to this, in part, is to change the health care law; that is, 
to take out some of the mandates and requirements and make it more pro-
growth and pro-job rather than the current situation.
  There are tens of thousands of new pages of regulations in this new 
law. It forces small businesses--and I am a small business person. I 
can tell you that I have burned a lot of time and effort to try to 
figure it out. You can go to consultants and pay them a bunch of money, 
and they will tell you they are not sure what it means either. This is 
one of the big issues that doesn't get talked about much with the 
Affordable Care Act; that it is really hard for businesses to figure 
out what they are supposed to do, particularly small businesses that 
don't have that kind of expertise inhouse. Those costs could go toward 
having more employees, they could go into reinvesting in business, 
plants and equipment, but they are going into trying to figure this 
thing out.

  I don't doubt the good intentions of my colleagues on the other side 
of the aisle who support this legislation. We all want to see more 
coverage and see health care costs go down, but that is not what is 
happening.
  Before the Affordable Care Act went into effect, the CBO estimated 
that 26 million Americans would be enrolled in a plan in 2016. That is 
what they estimated. The Congressional Budget Office said 26 million 
would be enrolled in a plan in 2016. The actual number was 12.7 
million, less than half. So, again, it hasn't met its own promises and 
projections.
  The co-ops are another failure. There was a debate on the floor just 
before I got elected about should there be a public option so everybody 
would have an option to get into an exchange. We said let's put 
together these co-ops. They will be nonprofit. They will work great. We 
will set up co-ops around the country. There were 23 co-ops set up, 
including 1 in Ohio. We now see that 15 of the 23 co-ops have gone 
insolvent.
  I will tell you that last spring, when 22,000 Ohioans lost their 
health care because the co-op went belly up, it was tough because they 
had to scramble and find a new health care plan quickly. More than 
860,000 Americans--people who were encouraged by this law to sign up 
for these co-op plans--had to scramble to find new coverage because of 
a failed co-op. It is tough on these families.
  It is also tough on the taxpayer. We did an investigation of this 
under the Permanent Subcommittee on Investigations, and we looked at 
what was happening to these families and we also looked at what was 
happening to the taxpayer. At that time, when only about half of the 
co-ops had gone under, rather than two-thirds, $1.2 billion of taxpayer 
money had already been spent on these co-ops. That money isn't coming 
back to the Treasury, meaning this is money that will probably never be 
repaid. Again, part of the problem with our deficit is that ObamaCare 
and the Affordable Care Act is so expensive, and the co-ops in 
particular just wasted money. Among the surviving co-ops, 3 have not 
yet enrolled 25,000 members. In other words, they are not enrolling 
enough members even if they are surviving. So the nonpartisan 
Government Accountability

[[Page S94]]

Office, GAO, issued a report in March which confirmed the results of 
our investigation, and it indicates that this money, the $1.2 billion, 
has now increased substantially because more of the co-ops have gone 
under.
  Many of those 22,000 Ohio families who were in the co-op had already 
paid deductibles in the plans they thought they could count on. Think 
about it. They paid hundreds of thousands of dollars in health care 
costs to get up to their deductible, and then all of a sudden they 
found out that they had to go to a new plan and they had to start all 
over again. So it is adding insult to injury. They lost their plan and 
they had to scramble to find one and then they found out they have all 
these out-of-pocket expenses again because although they met their 
deductible under the old plan, they have to start again in the new 
plan. This is not the way it ought to be. It is just not fair. These 
families did nothing wrong. All they did was what they were told to do, 
to sign up for these co-ops.
  I think these are just symptoms of the problem. The diagnosis is 
clear. The Affordable Care Act is a bad law, bad economics, and bad 
health care policy. It hasn't worked. I think it is difficult to make 
the other argument. The President's health care law hasn't worked, not 
because it didn't have good intentions but because it tried to achieve 
those good intentions by forcing millions of people to buy a product 
they didn't want after losing a product they did want, including a $2 
billion taxpayer-funded Web site that didn't work. If you recall, they 
had problems with the Affordable Care Act Web site and unfortunately 
potentially exposed a lot of personal information of many of these 
individuals to hackers.
  As I talked about, even those who have insurance often have limited 
access to providers because the deductible is so high that they can't 
afford their health care.
  With higher costs and fewer choices, the American people, by and 
large, are dissatisfied with the plan, the Affordable Care Act, just as 
they were when it was enacted. A CBS poll last month has shown that 
more people disapprove of the law then approve of it. A Gallup poll in 
November found that 8 in 10 Americans want the law repealed or 
significantly changed--8 in 10 Americans. Why? Because they have seen 
it.
  By the way, most Americans were not in the exchanges, but they still 
felt it. Think about this. When a company is involved in the exchanges 
and losing money, and many of these companies are losing hundreds of 
billions of dollars a year, what they are doing is they are cost-
shifting onto private plans, onto employer-based plans, and raising the 
costs for other Americans. This is part of the reason health care costs 
have gone up generally, not just in the exchanges but overall.

  I have certainly seen this firsthand in Ohio. Constituents have been 
contacting me for the last 6 years to tell me how this health care law 
has affected them. There is a father of five who wrote to me after the 
cost of the family's insurance doubled. Another man saw his $100 
deductible soar to $4,000 while his premiums hit $1,000 a month.
  I still remember the letter I received from Dean from Sandusky. He 
lost his job in 2009 as so many other Americans did during the 
recession. Because he lost his job, he had to go on the individual 
market to buy health insurance. He picked out a plan that worked for 
him and his family. He liked it and he bought it. Once the President's 
health care law went into effect, that plan was discontinued because it 
didn't meet the mandates and requirements of the new law. He found 
himself high and dry. He, too, had to buy another plan that was twice 
as expensive, and it cost him more than half of his pension--because 
that is his income. It is his pension. So not only did he lose his job, 
but then he was saddled with a plan he couldn't afford and a much more 
expensive cost of living. He didn't do anything wrong, but because of a 
failed, mistaken approach that Congress took to health care reform, he 
has now had to struggle to make ends meet.
  Susan from Batavia also wrote to me. She is a single mom. She lost 
the plan she liked because of the President's health care plan. She 
wrote and said: I stay in shape. I watch my diet. I exercise regularly. 
I do all the right things. I had a high-deductible, low-cost plan, but 
under the President's new health care law, I had to change my plan.
  Her coverage, by the way, was for double the price of the premium. A 
single mom; tough to afford it.
  Another, Susan from Columbus, OH, wrote to me and told me that she 
works for a small business of 12 employees. When the health care law 
went into effect, their rates went up nearly 30 percent in 1 year. 
Small businesses and new businesses cannot afford that. I cannot tell 
you how many small businesses I have been to where I asked them: What 
have your premiums done over the last several years, and they tell me: 
Double digit, Rob. Double digit. If we get an increase in the low 
double digit, that is a good thing. Again, there is no place for that 
to come from except for wages and benefits and cutting back on 
employees--in some cases, again, not expanding a plan that they 
otherwise would have because of this health care law.
  It doesn't have to be this way. We can enact real health care reform 
that uses the market forces that help to increase competition, that 
requires insurance companies to compete for our business, that allows 
people to get the plan they want, looking all around the country for 
what works best for them. This burdensome health care law is standing 
in the way of real reforms right now. It is hurting families in Ohio 
and across the country.
  The health care market was far from perfect before this law so I am 
not arguing that the status quo is acceptable. I think we have to do 
things not just to repeal ObamaCare but to replace the Affordable Care 
Act with reforms that make better sense. We had issues before, but it 
has gone to worse, not better. It accelerated the problems.
  I hope that over the next couple of months, as we talk about this, we 
will be able to come up with a replacement plan that makes sense. 
Republicans and Democrats alike need to come to the table on this 
because, again, I have listed today all the reasons the current law is 
not working. The status quo is not acceptable. I think it is very hard 
to argue that it is. That means all of us have a responsibility to say: 
OK. How do we fix this? How do we come together, Republicans and 
Democrats alike--not on a partisan basis as was done last time--to 
figure out a way to do it together? We need to come together to make 
sure the people we represent have the chance to get the health care 
they want for them and their families, that fits them, where they can 
have costs that are affordable, where they can have quality health care 
that is good for them and their families, where it can be patient-
centered, and we can give people the affordable care they deserve.
  I thank the Chair, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I ask unanimous consent that at 2:45 p.m. 
there be 2 minutes of debate, equally divided in the usual form, prior 
to the vote in relation to Kaine amendment No. 8.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. ENZI. I yield the floor.


                            Amendment No. 8

  The PRESIDING OFFICER. There will now be 2 minutes of debate equally 
divided prior to a vote in relation to amendment No. 8, offered by the 
Senator from Virginia, Mr. Kaine.
  The Senator from Virginia.
  Mr. KAINE. Mr. President, I have spoken about this previously. The 
budget that is on the floor really isn't a budget; it is more of a 
focused attack on health care for millions of Americans. Amendment No. 
8, which I have offered with Senator Murphy and others, is an attempt 
to stop the majority from passing a health care repeal through a fast-
track process. The amendment does one thing: It creates a budget point 
of order against any legislation that would either reduce the number of 
Americans enrolled in public or private health insurance, increase 
health insurance premiums, or reduce the scope and quality of benefits 
provided.
  I ask for the yeas and nays on the amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The yeas and nays were ordered.

[[Page S95]]

  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, this amendment is corrosive to the privilege 
of the budget resolution, meaning that it is outside the scope of what 
is appropriate for a budget resolution. Any inappropriate amendment 
could be fatal to the privilege of this resolution, which would destroy 
our efforts to repeal ObamaCare. In other words, a vote in favor of 
this amendment is a vote against repealing ObamaCare.
  In addition, this amendment is not germane to this budget resolution. 
This budget resolution is much more focused than a typical budget 
resolution. The Congressional Budget Act requires that the amendment to 
a budget resolution be germane. Since this amendment does not meet the 
standard required by budget law, a point of order would lie. As such, I 
raise a point of order under section 305(b)(2) of the Congressional 
Budget Act of 1974.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. Mr. President, pursuant to section 904 of the 
Congressional Budget Act of 1974, I move to waive section 305(b) of 
that act for purposes of the pending amendment, and I ask for the yeas 
and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The senior assistant legislative clerk called the roll.
  The yeas and nays resulted--yeas 48, nays 52, as follows:

                       [Rollcall Vote No. 2 Leg.]

                                YEAS--48

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

                                NAYS--52

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heller
     Hoeven
     Inhofe
     Isakson
     Johnson
     Kennedy
     Lankford
     Lee
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Sessions
     Shelby
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young
  The PRESIDING OFFICER (Mr. Cassidy). On this vote, the yeas are 48, 
the nays are 52.
  Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  The point of order is sustained and the amendment falls.
  Who yields time?
  If no one yields time, the time will be charged equally to both 
sides.
  The PRESIDING OFFICER. The Senator from Texas.


                  United Nations Resolution on Israel

  Mr. CRUZ. Mr. President, in the final days of the Obama 
administration's second term, with all eyes focused on the President-
elect, the temptation to try to take a dramatic action to seal a 
cherished policy legacy must have been almost irresistible. So it 
proved for President Obama on December 23, 2016, when he betrayed 
decades of robust bipartisan American support for Israel at the United 
Nations by abstaining from a completely biased resolution that condemns 
our close friend and ally Israel and condemns all the so-called 
settlement activity, defined as any construction in any territory won 
by Israel in the Six-Day War.
  U.S. policy for decades has been to stand up for Israel at the United 
Nations, a hot bed of anti-Semitism that discriminately condemns Israel 
more than any country in the world, particularly when resolutions are 
being offered up that are outrageously biased, that attempt to 
predetermine the outcome of negotiations, that prejudge the basis for 
negotiations, or that try to dictate terms to Israel.
  We have seen this pattern of appealing to the United Nations from the 
Obama administration over and over with disastrous deals--the nuclear 
deal with the Islamic Republic of Iran, as well as the U.N. Convention 
on Climate Change, two international agreements that significantly 
threaten the security and prosperity of the United States. Both of them 
should have been submitted to this body, the Senate, as treaties.
  But the President chose instead to try to impose them through the 
United Nations because he knew that they would never be ratified by the 
Senate, even when this Senate had a Democratic majority. So the Obama 
administration's strategy, instead, has been to curb American power by 
subjugating our national interests to the globalist agenda of the U.N., 
a policy that he is now attempting to extend to Israel.
  Here are some of the main problems with UNSC Resolution 2334. First, 
it is an attack on Israeli sovereignty, as it falsely defines as 
illegal under international law building activity within Israel's own 
borders, which should be an internal Israeli issue. The historical 
connection of the Jewish people to the land of Israel did not begin in 
1967.
  Let us not forget that the Six-Day War was a defensive war fought 
almost 50 years ago by the Jewish state against the Palestinians and 
their Arab enablers, who were gathering in a concerted effort to wipe 
Israel off the map. Against all odds, Israel won quickly and decisively 
and the map was redrawn to ensure that Israel was not endangered by its 
own borders, the weakness of which Israel's enemies had attempted to 
exploit.
  Of course, the defeated party, the Palestinians, have not accepted 
this outcome. Israel has time and again invited them to negotiate a 
resolution--just one that involves Israel's continued existence as a 
Jewish state, something that the Palestinian Authority has over and 
over refused to acknowledge or accept.
  Therein lies the bottom line for Israeli security. The pre-1967 lines 
proved indefensible. So rather than, as the Obama administration, treat 
them as some sort of gold standard, Israel's security interest has 
deemed them intolerable and any resolution to this issue should not be 
dictated by the United States or the United Nations but rather should 
be negotiated and decided upon directly by the sovereign nation of 
Israel and by the Palestinians.
  Secondly, the resolution falsely claims that Israel's sovereignty 
over the eastern part of Jerusalem and areas that it controls after the 
Six-Day War, including Judea and Samaria, are supposedly ``occupied 
Palestinian territory''. This is nothing short of absurd. What that 
means is that, under the terms of the United Nations resolution that 
the Obama administration acquiesced to--indeed, there are considerable 
reports that the Obama administration, President Obama, and John Kerry 
actively encouraged and facilitated it--the Jewish Quarter, the Old 
City of Jerusalem, is illegal and illegitimate and not justifiably a 
part of Israel. Under the terms of that resolution, the location of 
holy sites for the Jewish people, including the most important holy 
site, the Temple Mount, is illegal and illegitimate to be a part of 
Israel. Under the terms of the resolution, the Western Wall, where Jews 
from all over the world go to pray, is deemed ``occupied Palestinian 
territory,'' illegal and illegitimate.
  It is more than a little ironic that President Obama went to the 
Western Wall to place a yarmulke there, pretending to show respect to 
Israel, and yet his administration, in an outgoing act of contempt, 
declares the Western Wall not part of the nation of Israel.
  This couldn't be further from the truth. It was also an affront to 
Jews around the world that the resolution was adopted on the eve of 
Hanukkah. For 8 days, Jews lit candles all over the world to remember 
the miracle that happened there, and to commemorate the heroic battle 
fought by the Maccabees that liberated Jerusalem and restored their 
right to worship freely and the rededication of the Temple in 
Jerusalem. How ironic it is that on the eve of a celebration liberating 
Jerusalem and rededicating the Temple in Jerusalem, the Obama 
administration and the United Nations would declare that Jerusalem and 
the Temple are not legitimately part of Israel.

[[Page S96]]

  How disgraceful--the United States should be not be facilitating the 
adoption of a resolution that at its core attempts to distort and 
rewrite recent history as well as the historical connection of the 
Jewish people to the land of Israel that goes back thousands of years.
  Third, the resolution will also help fuel the Palestinian diplomatic, 
economic, and legal warfare campaign against Israel, particularly 
because of its provision that calls on states to make a distinction in 
their dealings with Israel between pre-1967 Israel and Israel beyond 
the 1967 lines, encouraging boycotts, divestments, and sanctions 
against Israel and potentially leading to Israelis and Americans being 
brought in front of the International Criminal Court.
  Palestinian leaders are already promising to use this resolution to 
push the International Criminal Court to launch a formal investigation 
against Israel.
  That was not an unintended consequence of this action. That was 
precisely the intent of the United Nations and the Obama 
administration--to facilitate assaults on the nation of Israel.
  Yet even after this disgraceful United Nations resolution, it was 
clear that the administration was not yet done, with Secretary of State 
John Kerry delivering just days later a truly shameful speech attacking 
Israel. His speech, very much like Kerry's 2014 remarks likening Israel 
to an apartheid state, will only enflame rising anti-Semitism in 
Europe. It will encourage the mullahs, who hate Israel and hate 
America, and it will further facilitate ``lawfare,'' the growing 
assaults on Israel through transnational legal fora.
  President Obama and John Kerry's actions were designed to secure a 
legacy, and in that, they have succeeded. History will record and the 
world will note that Barack Obama and John Kerry are relentless enemies 
of Israel.
  Kerry's speech drew a stunning moral equivalence between our great 
friend and ally Israel and the Palestinian Authority, which is 
currently formed by a ``unity'' government with the vicious terrorists 
of Hamas.
  Secretary Kerry declared the Hamas regime and Gaza ``radical'' in the 
same way that he declared the duly elected Government of Israel 
``extreme.'' That moral equivalence is false, and it is a lie.
  The IDF, defending the people of Israel, protecting people, and 
keeping them safe, is not the same moral equivalent of terrorists who 
strap bombs to their bodies and seek to murder innocent women and 
children.
  Kerry declared the vicious terrorism sponsored by Hamas equal to the 
Israeli settlements in the West Bank, and he equated Israel's 
celebration of its birth with the Palestinian description of this event 
as the ``disaster.''
  Unlike Barack Obama and John Kerry, I do not consider the existence 
and creation of Israel to be a disaster, and the Government of the 
United States should not be suggesting such a thing.
  Kerry's speech attempted to lay out a historic and seismic shift 
toward the delegitimization of our ally Israel. It is a sign of their 
radicalism and refusal to defend American interests that Obama and 
Kerry chose to attack the only inclusive democracy in the Middle East--
a strong, steadfast ally of America--while simultaneously turning a 
blind eye to the Islamic terrorism that grows daily.
  Unfortunately, President Obama still has 2 weeks left in his 
Presidency, and he may not yet be done betraying Israel.
  Next week, on Sunday, January 15, France is convening a conference 
with 70 other nations designed to serve as an extension of the U.N. 
resolution and the Kerry speech--an all-out assault on Israel. I am 
deeply concerned that what is decided at this conference will be used 
to try to further impose parameters or even audaciously to recognize a 
so-called independent Palestinian state through another Security 
Council resolution. The Security Council is scheduled to meet on 
January 17--conveniently, 3 days before Obama and Kerry leave office.
  Let me speak a moment to our friends and allies across the globe.
  When the President of the United States, when the administration of 
the United States attempts to encourage you to support their positions 
in the United Nations, that can be highly persuasive. It has been an 
arena, a forum that Barack Obama has flourished in, even as he has 
shown condescension and contempt for the Congress of the United States 
and the people of the United States.
  But to our friends and allies, let me remind you: The Obama 
administration is coming to an end on January 20. If you desire to 
continue being a friend to America, if you desire a continued close 
working relationship with America, then I call upon our allies: Do not 
join in attacking Israel on January 15 in France or on January 17 at 
the Security Council.
  The new administration--President-Elect Trump--has loudly condemned 
the U.N. resolution and the Obama administration's complicity in its 
passage.
  I would encourage our friends and allies not even to attend the 
January 15 conference, or, if they do choose to attend, to oppose and 
stand up and speak out against any further attempts to attack or 
undermine or delegitimize America or Israel.
  I want to commend my colleagues on both sides of the aisle for 
offering resolutions to repudiate this administration for their actions 
of the last few weeks. It says something when you see Republicans and 
Democrats in Congress coming together, united to say: This action by 
the Obama administration is beyond the pale.
  Let me underscore again to our friends and allies, to our 
Ambassadors, to heads of state, to friendships and relationships that 
we value so much: Listen to the bipartisan consensus of Congress, and 
do not go along with the bitter, clinging radicalism of the Obama 
administration, attempting to lash out and strike out at Israel with 
their last breath in office.
  As commendable as these resolutions are, I believe the Senate and the 
Congress need to go further--that we need to take concrete steps so 
that there will be repercussions and consequences for the United 
Nations and the Palestinians for their behavior. That is why I am 
working with my colleague Senator Lindsey Graham on introducing 
legislation, along with other Members of this body, designed to cut the 
funding to the United Nations--designed to cut U.S. taxpayer funding 
going to the U.N.--unless and until they repeal this disgraceful anti-
Israel resolution.
  We know, previously, that one way to get the U.N.'s attention is to 
cut off their money. We know from the failure of other U.N. 
organizations to recognize so-called Palestine as a member-state after 
American tax dollars were withheld from UNESCO for doing so in 2011 
that the U.N. over and over values its pocketbook over its leftist 
values.
  However unintentionally, President Obama's misguided foreign policy 
has led to an unprecedented rapprochement between Israel and America's 
Arab allies, such as Egypt, Jordan, and the UAE. We have also seen 
hopeful signs of shifting positions at the United Nations, as countries 
such as Brazil, Mexico, Italy, and Australia have recently signaled 
that they may no longer vote reflexively in favor of the Palestinians.
  Great Britain, although it voted for the resolution, has recently 
demonstrated an unprecedented degree of support for the Jewish state.
  These changes represent a significant opportunity for the United 
States to bolster one of our most important allies, an opportunity we 
can preserve for the President-elect by not letting Mr. Obama squander 
it on the way out the door.
  America should be leading the charge at the United Nations and around 
the world to rally burgeoning support for Israel, not trying to stab 
the Jewish state in the back.
  Just over a week ago, I spoke with Israeli Prime Minister Netanyahu. 
I told the Prime Minister that, despite the disgraceful actions of the 
United Nations, America stands resolutely with the nation of Israel, 
that the American people stand with Israel, and that I believe there is 
a very real possibility that the extreme and radical actions of Obama 
and Kerry will, in fact, backfire.
  It is not accidental that they waited until after the election to do 
this. They could have tried to do that this summer, but Obama and Kerry 
knew well that the American people do not support their attempting to 
attack Israel. So they waited until after the election.

[[Page S97]]

They waited until they were on their way out the door.
  Kerry, in his speech, said Israel cannot be both democratic and 
Jewish--one or the other, but not both.
  This is an inanity that is deemed profound only in Marxist faculty 
lounges.
  Israel is Jewish, it is democratic, and it is and should remain both. 
I believe that by revealing just how extreme they are, by removing the 
fake mask of support for Israel that Obama and Kerry have chosen to do 
in the last several weeks, it will help to galvanize support in this 
body and across the world for our friend and ally, the nation of 
Israel.
  Israel is not only our friend and ally, but it is a partner of the 
United States. That alliance benefits the vital national security 
interest of America. Israel's military benefits the national security 
of the United States of America. The Israeli intelligence services 
benefit the United States of America. Israel's steadfastness against 
radical Islamic terrorism, which has declared war on both Israel and 
America, benefits the national security interests of this country.
  It is Israel--the thriving, one and only Jewish state--that stands on 
the frontlines for America and, more broadly, Western civilization 
against the global threats we face. Our commitment to Israel must be 
restored and strengthened. I look forward to taking action with my 
colleagues--I hope on both sides of the aisle--in the near future to 
repudiate Obama's shameful attack on Israel, to repudiate the United 
Nations' efforts to undermine Israel, and to reaffirm America's strong 
and unshakable friendship and support for the nation of Israel.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.


                            Amendment No. 1

                (Purpose: In the nature of a substitute)

  Mr. ENZI. Mr. President, I call up amendment No. 1 and ask unanimous 
consent that it be reported by number.
  The PRESIDING OFFICER. Without objection, the clerk will report the 
amendment by number.
  The legislative clerk read as follows:

       The Senator from Wyoming [Mr. Enzi], for Mr. Paul, proposes 
     an amendment numbered 1.

  (The amendment is printed in the Record of January 4, 2017, under 
``Text of Amendments.'')
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, with the permission of the chairman, I 
would like to ask unanimous consent to speak as in morning business for 
up to 20 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ENZI. Mr. President, would the Senator mind if it comes off of 
the resolution time?
  Mr. WHITEHOUSE. I have no objection to that.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                             Climate Change

  Mr. WHITEHOUSE. Mr. President, this is the 152nd time I have come to 
the floor for my ``Time to Wake Up'' speech, warning about the perilous 
effects of climate change. I am going to continue this in the new 
Congress, continuing to present the latest and most compelling 
scientific evidence of the changes that are coming our way driven by 
carbon pollution.
  Nobody should take my word for it. I urge my colleagues to listen to 
their own home State's climatologists, their own home State's 
university researchers, their own home State's public health officials, 
and their own constituents who are out there fighting to protect their 
communities from the changes that are already happening right before 
their eyes.
  In Rhode Island, we have a lot of fishermen, just as Louisiana has, 
Mr. President. The president of the Rhode Island Commercial Fishermen's 
Association is Chris Brown. Just this past week, he was the subject of 
a New York Times article. ``Climate change is going to make it hard on 
some of those species that are not particularly fond of warm or warming 
waters,'' he told the Times. ``We used to come right here''--where he 
was on his boat, The Proud Mary--``and catch two, three, four thousand 
pounds a day, sometimes 10.'' But the whiting, the fish he was after, 
have moved north to cooler waters.
  The Times reports that two-thirds of marine species off the northeast 
coast have moved from their traditional ranges into deeper and cooler 
water.
  John Manderson is a biologist at NOAA's northeast fisheries science 
center, and he told the Times in that article that public policy needs 
to keep pace with the rapidly changing oceans, where species are 
shifting northward in response to warming 10 times as quickly as they 
do on the land. ``Our ideas of property rights and laws are purely 
land-based,'' he said, ``but the ocean is all about flux and turbulence 
and movement.''
  In Rhode Island, fishermen are getting clobbered by that flux.
  Captain Dave Monti is a member of the Rhode Island Marine Fisheries 
Council. He wrote in the Providence Journal this week:

       I often think about the fish and how important it is to 
     grow them to abundance so there are more fish for all to 
     catch and eat. . . . In 2017 we need a fish-first agenda, or 
     someday there may be no fish left to catch. Climate change, 
     acidification, overfishing by world nations, and changing 
     federal strategies could make it the worst of times for fish 
     in 2017. . . . We need to make an effort to understand what 
     is happening to the environment and the fish, and then take 
     that second step of communicating it to others to affect 
     policy.

  That is what I am being asked.
  The Providence Journal also recently wrote about how in Rhode Island 
the sea is moving higher and farther inland, as it is in Louisiana, 
which is the State losing ground fastest to the ocean of all the 50. 
They reported on StormTools, a program developed by Rhode Island's 
Coastal Resources Management Council director Grover Fugate and 
University of Rhode Island emeritus professor of ocean engineering 
Malcolm Spaulding. StormTools provides 3D maps of the potential 
flooding damage along Rhode Island's coast. The Journal described the 
project as ``one of the most sophisticated models developed anywhere to 
project future damage from storm surges and sea level rise.'' And we 
are taking the results seriously.
  The Journal quoted William DePasquale, who is the director of 
planning in one of our cities, Warwick, RI. He said, ``When I saw some 
of those scenarios, my jaw hit the ground.'' That is what we are 
looking at, and Warwick is now using those maps to prepare for the 
future.
  The Providence Journal has also recently written about Matunuck Beach 
in South Kingstown. Town manager Stephen Alfred warns that if the sea 
takes out Matunuck Beach Road, 240 homes will be totally cut off, 
without a water supply or access to emergency services.
  The article features Kevin Finnegan, who owns the Ocean Mist, a 
renowned local establishment. The Journal said:

       The Ocean Mist has occupied the same spot under different 
     names since Prohibition ended in 1933. But the ocean has 
     moved. Where once beach bathers had to plan a trek across 
     sand to reach the water from the Mist, waves now flood the 
     supports holding up the tavern's deck.

  Finnegan and the town of North Kingstown are scrambling to build 
seawalls. Engineer Bill Ladd, who works for Finnegan and who the 
Providence Journal reports had his first beer at the Ocean Mist back 
when the drinking age was 18, estimates that the two walls may only buy 
Matunuck Beach 20 or 30 more years against the oncoming ocean. That is 
because, as The Independent--a local newspaper in the southern part of 
Rhode Island--reported in December, about 4 feet of Matunuck Beach is 
eroding every year. According to Director Fugate of the CRMC, that 
erosion will more than double by the end of the century. Rhode Island 
is not a big State. We cannot afford to have this much reclaimed by the 
ocean.
  The Independent article quotes North Kingstown Town Council president 
Kerry McKay, who says that climate change threatens the property values 
of his community's coastal homes, which is a significant portion of the 
town's revenue base.

       He said historical values ``will have to change'' as 
     coastal concerns rise, and residents ``have to be more 
     receptive'' to redoing building infrastructure, such as 
     through elevating houses.

  He also said that homes ``may not be there'' in 20 years, resulting 
in a ``major revenue loss.''
  Another Providence Journal article last week featured Tanner Steeves, 
a

[[Page S98]]

wildlife biologist with the Rhode Island Department of Environmental 
Management, which has to tear up roads and parking lots along the 
Sakonnet River as the seas rise. The Journal writes:

       As the barrier beach just south of Sapowet Point has 
     narrowed--losing nearly 100 feet since 1939--the salt marsh 
     on the other side has become more susceptible to flooding.

  The Independent made Rhode Island's case for climate action in a 
December editorial. They said:

       The signs are clear, if not immediately visible to most.
       There are the well-documented, widely publicized shifts 
     with global import, such as the loss of polar ice and the 
     growing frequency of extreme weather events. Locally, there 
     are changes in the ecology of Narragansett Bay, and locations 
     at which the effects of a rising sea level--sometimes subtle, 
     sometimes less so--may be plainly seen. . . . But we 
     encourage all Rhode Islanders, from coastal communities and 
     beyond, to remain attuned to the situation--in terms of both 
     what the sea is telling us and what is being proposed to 
     prepare for coming changes. The stakes are enormously high, 
     and the broadest possible effort is required to meet the 
     challenge.

  That is the message to me from Rhode Island. That is why I give these 
speeches.
  As I continue to push for honest debate on this issue in Congress, I 
also tour around the country to see folks on the ground in other 
States. I have now been to 15 States. In the closing months of 2016, I 
hit Texas and Pennsylvania.
  In Texas, I joined Representative Elliott Naishtat, the advocacy 
group Public Citizen Texas, and Texas environmental advocates at a 
public event in Austin to call out Congressman Lamar Smith, Republican 
chairman of the House Science, Space, and Technology Committee, for his 
abuse of congressional power to harass public officials and climate 
scientists, including subpoenas demanding that States attorneys general 
divulge their investigative materials relating to their inquiries into 
ExxonMobil's potentially fraudulent climate misinformation. The 
committee is also harassing the Union of Concerned Scientists, 350.org, 
Greenpeace, and various university scientists because they are exposing 
Exxon for years of misleading the public on its understanding of 
climate change. Texans are taking notice. The San Antonio Express-News, 
which had previously always endorsed Congressman Smith for reelection, 
decided not to endorse him in this latest election cycle. The paper 
cited his ``bullying on the issue of climate change'' as behavior that 
``should concern all Americans.''
  I joined a panel discussion with leading scientists from Texas 
universities to discuss their research into climate change in Texas. 
The panel included Dr. John Anderson from Rice University, Dr. Andrew 
Dessler from Texas A&M University, Drs. Charles Jackson and Kerry Cook 
from the University of Texas at Austin, and Dr. Katherine Hayhoe from 
Texas Tech University. They had a unified voice on the dangers of 
climate change.
  Dr. Hayhoe said Texans are seeing changes all around them.

       We get hit by drought. We get hit by heat. We get hit by 
     storms. We get hit by sea level rise. And we're starting to 
     see those impacts today. . . . Texas is really at the 
     forefront of this problem.

  Dr. Anderson of Rice agreed that the Texas climate is already 
changing. He said:

       Accelerated sea-level rise is real, not a prediction. Its 
     causes are known--thermal expansion of the oceans and melting 
     of glaciers and ice sheets--and it is causing unprecedented 
     change along the Texas coast.

  Dr. Dessler from Texas A&M laid out what he called ``the fundamental 
and rock-solid aspects of climate science: humans are loading the 
atmosphere with carbon, this is warming the climate, and this future 
warming is a huge risk to our society and the environment. We should 
insist that our elected representatives rely on this sound science when 
formulating policy.''
  I returned to Austin in November to speak to the Association of 
Public and Land-grant Universities. President David Dooley of the 
University of Rhode Island had invited me to join a panel that he 
moderated with, among others, Dr. John Nielsen-Gammon, Texas State 
climatologist and professor at Texas A&M University.
  The bottom line was simple: Climate change is real, and the 
scientists at our universities will be increasingly forced to defend 
good science, academic freedom, and climate action. University 
leadership will have to defend their scientists against the onslaught 
of FOIA requests and personal attacks that are the modus operandi for 
climate deniers and against the phony science fronts propped up by the 
fossil fuel industry to spread calculated misinformation. The American 
scientific community faces a real threat from that operation.
  On to Pennsylvania, I had the opportunity to spend a day traveling 
with my friend and colleague Bob Casey around southeastern Pennsylvania 
getting a firsthand look at the effects of climate change and hearing 
about the work Pennsylvanians are doing to address it. At the 
University of Pennsylvania's Morris Arboretum, leaders from Children's 
Hospital of Philadelphia's Community Asthma Prevention Program, Moms 
Clean Air Force, Physicians for Social Responsibility, and other groups 
talked about kids with asthma and other conditions that worsen when 
temperatures and pollution levels are high.
  In Malvern, we toured the LEED platinum North American headquarters 
of Saint-Gobain, the world's largest building materials company. The 
company is demonstrating that green building materials and technologies 
can be married with stylish design to produce stunning results. With 
operations in Rhode Island, Pennsylvania, and around the globe, Saint-
Gobain is developing innovative technologies to reduce pollution, 
generate clean energy, and improve air quality for millions of people.
  From there, we visited the John Heinz National Wildlife Refuge, which 
is the Nation's first urban wildlife refuge and Pennsylvania's largest 
freshwater tidal wetland. Lamar Gore, the refuge manager, showed us how 
the refuge is at risk from the saltwater pushed in by rising sea 
levels. The refuge is adjacent to the Philadelphia International 
Airport, along the Delaware River.
  As you can see from these graphics reproduced from the New York 
Times, at 5 feet of sea level rise, some of the city goes underwater 
and the refuge is in real trouble. Water encroaches upon the 
Philadelphia airport. At 12 feet of sea level rise, 6 percent of the 
city--including the refuge, airport, and parts of downtown Philly--is 
underwater. Projections that parts of Philadelphia will one day be 
uninhabitable due to sea level rise are one of the major drivers for 
forward-looking climate mitigation and adaptation policies of 
Philadelphia's Office of Sustainability. Senator Casey and I met with 
them too.
  Being in Pennsylvania gave me a chance to connect with Dr. Robert 
Brulle of Drexel University. He is the scholar who documented the 
intricate propaganda web of fossil fuel industry-funded climate denial, 
connecting over 100 organizations, from trade associations, to 
conservative think tanks, to plain old phony front groups. The purpose 
of this climate denial apparatus is, to quote Dr. Brulle, ``a 
deliberate and organized effort to misdirect the public discussion and 
distort the public's understanding of climate.''
  I will wrap up with a special thank-you to one of the folks who 
helped organize my Texas trip: Tom Smith, who has been director of 
Public Citizen of Texas for more than 30 years. Known by his friends 
and colleagues as Smitty and known for his signature straw hat, over 
his career he has testified more than 1,000 times before the Texas 
Legislature and Congress--Mr. Uphill Struggle indeed. He was 
successful, though, and central in creating the Texas Emissions 
Reduction Program, which led to wide-scale deployment of solar and wind 
across Texas. A true environmental champion, Smitty retires this year.
  I ask unanimous consent to have printed in the Record a recent 
tribute from the Texas Tribune entitled: ``Analysis: `Smitty,' a Texas 
Lobbyist for the Small Fry, Retiring after 31 years.''
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                [From the Texas Tribune, Sept. 21, 2016]

  Analysis: ``Smitty,'' a Texas Lobbyist for the Small Fry, Retiring 
                             After 31 Years

                            (By Ross Ramsey)

       Tom ``Smitty'' Smith, a colorful lobbyist and liberal 
     activist who turned Public Citizen Texas into a strong voice 
     on environmental, utility, consumer and ethics issues, is 
     hanging up his spurs after 31 years.

[[Page S99]]

       In the early 90s--the heyday of consumer rights legislation 
     and regulation in Texas--Robert Cullick, then a reporter at 
     the Houston Chronicle, gave Tom ``Smitty'' Smith of Public 
     Citizen Texas an unofficial title: Everybody's Third 
     Paragraph.
       Smith, 66, announced his retirement Tuesday from his 
     official post after 31 years, ending a long run of organizing 
     and lobbying on behalf of consumers and citizens on a range 
     of issues like utilities, insurance and political ethics. He 
     was often the voice of the opposition in legislative fights 
     and in the media, which earned him that reporter's epithet.
       He's from that part of the Austin lobby that doesn't wear 
     fancy suits, doesn't drive the latest luxury cars and doesn't 
     spend its time fawning over and feeding elected officials. 
     Smitty has a beard, an omnipresent straw hat and, often, a 
     colorful sheaf of flyers making his points on whatever cause 
     he's pushing at the time.
       Smitty has been a leading voice for government intervention 
     and regulation of big industries and interests in the capital 
     of a state with conservative, business-friendly politicians 
     from both parties who pride themselves on light regulation, 
     low taxes and a Wild West approach to money in politics.
       For the most part, Smith seems to have disagreed strongly, 
     vociferously, but agreeably. He doesn't wear his wins or his 
     losses on his sleeve.
       ``The thing that I learned time after time, story after 
     story, is that people standing up does make a difference,'' 
     Smith says. ``It does change policy.''
       ``Citizen activism does matter, and it's the only known 
     antidote to organized political corruption and political 
     money,'' he says.
       His causes over the years have included food security, 
     decommissioning costs of the nuclear reactors owned by 
     various Texas utilities, insurance regulations, ethics and 
     campaign finance laws. He's lobbied on environmental issues 
     and product safety.
       He counts the ethics reforms of 1991 as one of his big 
     wins. As unregulated as Texas political ethics and campaign 
     finance might seem today, things were a lot looser before 
     reformers used a flurry of scandals and attendant media 
     coverage to force changes. Smith is proud of a medical bill 
     of rights that gave consumers some leverage with their 
     doctors and their health insurers.
       Public Citizen was a key player in the creation of the 
     State Office of Administrative Hearings, which took 
     administrative courts out of several regulatory agencies and 
     put them in a central office, farther from the reach of 
     regulated industries and elected officials. Smith now points 
     to the Texas Railroad Commission, which still has its own 
     administrative hearings, as an example of a too-close 
     relationship between regulators, the companies they regulate 
     and the judges supposed to referee their differences.
       He was an early and noisy advocate for renewable energy, 
     urging regulators and lawmakers to promote wind and solar 
     generation--and transmission lines to carry their power--as 
     an alternative to coal plants and other generating sources. 
     That looks easier from a 2016 vantage point than it did in 
     1989, when an appointed utilities regulator derided 
     alternative energy in an open meeting by saying that he 
     hadn't smoked enough dope to move the state in that 
     direction.
       That regulator is gone now, and Texas leads the nation in 
     wind energy. Chalk one up for the environmental advocates.
       Smitty is leaving with unfulfilled wishes. He'd like to 
     have made more progress on Texas emissions and climate 
     change, on campaign finance reforms and conflict-of-interest 
     laws.
       The ethics reforms of 1991 included creation of the Texas 
     Ethics Commission and a number of significant regulations on 
     the behavior of the Texans contending for and holding state 
     office. There is always more, of course. Smith had a list of 
     13 reforms that year, and eight made it into law. Some of the 
     remaining items remain undone 25 years later.
       ``All the time I've been working here, Texas politics has 
     been largely controlled by organized businesses pooling their 
     money together and making significant contributions to key 
     legislators,'' Smith says. ``Legislators are more concerned 
     about injuring their donors than they are about injuring 
     their constituents.''
       He illustrates that with stories, like one about a 
     legislator asking, during a House debate, if his colleagues 
     knew the difference between a campaign contribution and a 
     bribe. ``You have to report the campaign contribution.'' And 
     another, when a member--former state Rep. Eddie Cavazos, D-
     Corpus Christi, who went on to become a lobbyist--was making 
     a plea for cutting the influence of big donors. Cavazos 
     recalls telling a story about getting simultaneous calls from 
     a big donor and from someone who wasn't a political friend. 
     He says he told his colleagues, ``You know which one you're 
     going to answer first.''
       ``I'm sorry to see Smitty go,'' Cavazos said Tuesday. ``He 
     provided a large voice in the Legislature that was needed--a 
     balancing voice. He's a good guy.''

  Mr. WHITEHOUSE. Mr. President, in the article, he is quoted as 
saying: ``The thing that I learned time after time, story after story, 
is that people standing up does make a difference. It does change 
policy.''
  Good words to end the speech by. Thank you, Smitty.
  Mr. President, I ask unanimous consent that the time during quorum 
calls be charged equally to both sides.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WHITEHOUSE. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BOOKER. 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. BOOKER. Mr. President, I am really proud to stand here, having 
represented New Jersey now a little bit over 3 years in the U.S. 
Senate. I have to say that I have developed a great respect for my 
colleagues on both sides of the aisle. I have a deep belief that this 
is a body that can do good things for the American people. We don't 
always agree, and too many things are not getting done, but I have seen 
this body at its best. I have seen our ability to rise to the occasion. 
Along the way, I have made friendships and found respect for people and 
my colleagues across the aisle, as well as fellow Democrats.
  I have witnessed occasions where Members of both parties have put 
principle before partisanship and evidenced a willingness to actually 
embrace personal political risk to stand up for what they believe is 
right and honorable and in the best interest of our country. Given 
this, this is a day in which I rise with painful disappointment. 
Frankly, I feel a deep sense of astonishment and even a sense of 
crisis. Thus, I feel a deepened determination to fight with everything 
I have against the efforts of my Republican colleagues that I believe 
will harm our country as a whole but particularly the most vulnerable 
people in our country.
  This is about the Republican push, really the race--what I believe is 
a reckless race--to repeal the Affordable Care Act without putting 
forth any legislation, any proposal, any plan on how they intend to 
replace it. This is fundamentally dangerous, and it will hurt millions 
of Americans. I have heard over the past month people rightfully 
saying: Well, this is how the Affordable Care Act was implemented.
  I understand the frustrations that have resulted from that, and 
people think this was jammed through along partisan lines many years 
ago using similar legislative tactics. The truth is, that is simply not 
the case. The Affordable Care Act went through a long and arduous 
process and received input from doctors, nurses, patient groups, 
medical specialists, medical professionals of all types.
  The Affordable Care Act started with listening sessions, then 
hearings, then came the advice and counsel of policy experts, 
businesses, market experts, insurance companies, health nonprofits, 
hospitals--literally thousands and thousands of people over thousands 
of hours, often through public discourse, putting forth ideas that 
actually shaped and changed legislation. I wasn't in the body then. I 
was a mayor in Newark, NJ, but I know this occupied months of debate.
  Years later, Republicans are seeking to undo this work with a kind of 
plan to move forward. They are saying that they have a plan, but no 
plan exists.
  I am a big believer that there are things we can and we must do to 
improve health care in America, to improve the Affordable Care Act, but 
what I have to make clear is that it is profoundly irresponsible to 
repeal the Affordable Care Act and not put anything in place. There is 
no plan.
  This is at a time that everyone agrees--people in the Republican 
Party and Democratic Party continue to talk about the achievements of 
the Affordable Care Act, things that they want to maintain, things they 
believe make a real difference. Those are things I have heard 
Republicans praise and even say again they want to protect. These 
things are making a lifesaving difference for millions of Americans.
  Let's be clear. The overwhelming majority of Americans believe that 
we should not give the power back to insurance companies to deny people 
health insurance because of a preexisting condition. Let's be clear. 
Most people believe that we should allow young people, young adults to 
stay on their parents' plans up to the age of 26.

[[Page S100]]

We also believe that requiring health plans cover preventive services 
is a profoundly important thing to do for individuals in this country, 
but it actually saves Americans money by pushing people to do 
preventive care--mammograms, birth control, and mental health care--
without cost sharing. These are logical things that the majority of 
Americans believe in, such as closing the prescription drug coverage 
gap, which too many seniors on Medicare and people with disabilities 
have had to face, known as that doughnut hole. We believe in 
prohibiting insurance companies from charging women more money simply 
because of their gender. The overwhelming majority of Americans believe 
in requiring the insurance companies to spend more on patient care and 
less on administrative costs, and the insurance companies shouldn't be 
allowed to gouge the American people while making massive profits at 
the same time.
  There is so much that people believe in and want to have preserved, 
and these are tremendous things for America. There are bank account 
savings; there are lifesaving policies, all of which are popular with 
Democrats, Republicans, and Independents. They are popular with people 
on both sides of the aisle in this body.
  Some Republicans have said that what they are doing will not threaten 
these accomplishments, but this couldn't be any further from the truth. 
The way they are going about this puts the health care system in a 
perilous position. The health care system is complicated in nuance, and 
to think you can repeal something without replacing it right away shows 
a lack of understanding of what is going to happen and what the 
consequences will be.
  What the Republicans are doing now is quite contrary to what the 
Democrats did before the ACA passed in 2010. Republicans are not 
putting forth a proposal. They are not speaking to the health care 
needs of all Americans. They are not inviting professionals from all 
different backgrounds to help shape a plan for America. They are not 
even fulfilling what I heard countless Republicans on the campaign 
trail, including our President-elect, say: They would repeal and then 
replace. They are just not replacing.
  The replace part put forth by the mantra of many Republicans has not 
materialized. It doesn't exist. There is no plan to replace, no 
statement of principles, no outline of features, no framework for a 
plan, no explanation of how they would pay for the things they claim 
they like. There is no specific timeline for when a plan might 
materialize or even any substantive hint of what many Republican 
colleagues plan on doing to address the crisis--the crisis that will 
surely come as a result of repealing the Affordable Care Act without 
giving forth any replacement.
  I say time and again: Show us the plan before you repeal this 
legislation. If you do not do that, you will be responsible for pain, 
suffering, chaotic markets, and for many Americans' health care 
problems. There are many people who don't understand this. They listen 
to the political rhetoric, and they think: Hey, you might be that one 
who, if you are wealthy enough or secure enough, if you are a Member of 
this body, in fact, this concept of repealing and maybe figuring out a 
replacement down the road might sound good. But if you are one illness 
away from bankruptcy, if you know and remember the challenges of having 
a child with a preexisting condition, if you know that one injury, one 
unexpected fall could place your family in peril but for the insurance 
you have, if you are one of the 20 million Americans who used to be 
uninsured and now you have insurance, you know how perilous this moment 
is. You know that you can't afford the recklessness of any politician--
a Republican move that equates to jumping off a cliff and then packing 
your parachute on the way down.
  Repealing without replacing is simply irresponsible, it is dangerous, 
and it is threatening to our country's well-being. People--families, 
children, the elderly--will suffer.
  This is a moment where we need Republican leaders to tell the truth 
and say: We want to improve our health care system. We may not believe 
in ObamaCare, but we can't tear it down unless we do the responsible 
thing and put forth a replacement.
  Right now, what we have is political rhetoric that is not just 
rhetoric. It is perilous. It is dangerous. It is threatening to our 
Nation. This will inflict immediate catastrophe upon families, causing 
millions to lose their health insurance, and it will unleash chaos with 
market uncertainty and cost spikes.
  There is no defense for what is being done. I don't understand it. 
There is no logic here whatsoever. Elections were won. You now have the 
floor and the ability to put forth your great vision for health care in 
America, but doing it backward and repealing something and not offering 
up a plan is truly putting politics before people. This is a move of 
grand political theater that comes with profound public consequences 
affecting millions.
  As a Democratic Senator, some people will say that this is just 
political rhetoric, but these are not just partisan words. This is the 
truth and don't take my word for it. Look at the words of other more 
thoughtful--other very thoughtful people, Democrats and Republicans, 
businesspeople and nonprofit leaders, conservative think tanks and 
nonpartisan groups, speaking with a chorus to the point I am making. 
Experts across sectors, across industries, and across the country are 
taking a hard look at what a repeal will mean for the American people 
without a replacement. People from all across sectors of our country 
are saying what the Republicans are doing is reckless, and the 
consequences are dire.

  Take the American Medical Association, the preeminent association of 
physicians. Mind you, this is an organization that opposed the 
enactment of the Affordable Care Act. They have urged--this chorus of 
doctors has urged that ``before any action is taken, policymakers 
should lay out for the American people, in reasonable detail, what will 
replace current policies. Patients and other stakeholders should be 
able to clearly compare current policy to new proposals so they can 
make informed decisions.''
  The American Medical Association isn't a political organization. They 
are thoughtful people whose fundamental concern is the doctors in this 
Nation and the health care of the people. Another respected 
organization representing American hospitals made it clear. The 
American Hospital Association warned that Republican action of 
repealing without a plan would result in an ``unprecedented health care 
crisis.''
  Are Republicans listening to doctors and hospitals or are they 
rushing forth, willing to risk a crisis for our country, and for what? 
They are a President for 4 years, a Congress for 2. What is the rush to 
put forth a plan and just repeal? Will they listen to these experts? 
What about the president of America's leading cancer group, the 
American Cancer Society? Will they listen to them? They urge Congress 
to ``consider the future of the Affordable Care Act. It is critically 
important that cancer patients, survivors and those at risk of the 
disease don't face any gap in coverage of prevention or treatment. . . 
. Delaying enactment of a replacement for 2 or 3 years could lead to 
the collapse of the individual health market with long-term 
consequences.''
  This organization is respected by people on both sides of the aisle 
and is not playing partisan games. They are calling out the truth; that 
it is a reckless Republican move to repeal without replacing. Will 
Republicans listen to the American Diabetes Association? Folks with 
diabetes are Independents, Republicans, and Democrats, and this is an 
organization respected by people on both sides of the aisle. They say:

       The Association strongly opposes going back to a time when 
     . . . treatment for preexisting conditions like diabetes 
     could be excluded from coverage; when people could find their 
     insurance coverage was no longer available just when they 
     needed it most.

  What is the Republican plan to address these concerns and to pay for 
these concerns? Will they listen to private businesspeople? They, too, 
join in the chorus of Americans urging that Republicans not endanger 
the lives and livelihoods of millions.
  The Main Street Alliance. We all have main streets in our States and 
our communities. A group representing these small businesses from 
across the country urges lawmakers to consider the devastating effect a 
repeal without

[[Page S101]]

replace would have on small businesses:

       Small business owners depend on healthy and vibrant 
     communities to keep us profitable in the engines of economic 
     growth. . . . Changes to our current health care system are 
     needed, but not in the form of cuts to critical programs or 
     through taking away our health coverage.

  There are some Senators who are speaking out. It is not the entire 
Republican caucus. There are some who are saying exactly what I am 
saying. Yet we are still rushing toward a vote, even with Republican 
Senators having the courage to stand up. Just yesterday Republican 
Senator Rand Paul of Kentucky, before voting to proceed to this 
measure, said: ``It is imperative that Republicans do a replacement 
simultaneous to a repeal.'' I respect my Republican colleague for 
saying what is common sense and speaking up against the reckless 
actions being taken by the Republican Party as a whole, and some fellow 
Republican Senators have joined him in similar statements, including 
Lamar Alexander, the chair of the Health, Education, Labor, and 
Pensions Committee. The Republican from Tennessee, who noted in an 
interview in November 2016 that when it comes to the ACA, ``what we 
need to focus on first''--Senator Alexander said--``is what would we 
replace it with and what are the steps that it would take to do that?''
  Republican Senator Susan Collins of Maine shared in an interview last 
month that she was ``concerned about the speed in which this is 
occurring'' and expressed concern over what would happen to her 
constituents in Maine who had signed up for insurance through the ACA, 
saying: ``You just can't drop insurance for 84,000 people in my 
State.''
  I not only talk about Republicans in this body, but there are 
conservative think tanks focused on our country that are speaking out 
now as well. The American Enterprise Institute said in a 2015 report 
that ``repealing the law without a plausible plan for replacing it 
would be a mistake.''
  So here we have it from all over the country, people across the 
political spectrum, experts, market analysts, insurance executives, 
doctors, nurses, hospital leaders, patient groups; these people in our 
country who are beyond politics and even beyond their opinions of the 
Affordable Care Act when it was enacted are now speaking in a chorus of 
conviction in one voice: Don't repeal the Affordable Care Act without a 
clear plan to preserve the things that are making America healthier and 
more financially strong and secure. Don't recklessly rush into a 
politically motivated move that would endanger the health care of 
millions of Americans, increase the costs for millions of Americans, 
throw insurance markets into chaos, endanger our hospitals' financial 
stability, and put our most vulnerable Americans into crisis: our 
seniors, people in nursing homes, retired coal miners, people 
recovering from drug addiction, the poor and other underserved 
communities.
  We are America, and this is a time that we must call, not to party 
rhetoric but to who we are and what we stand for. We cannot let this 
repeal without replacement happen. We must know what the Republican 
plan is so experts, market analysts, insurance folks, doctors, everyone 
understands what will happen. Americans will be hurt. It is time to put 
our country and the people first. There is no rush. The voters gave 
this body 2 years. It gave the Presidency 4 years. We must now fight 
these efforts. We must resist. We must call to the conscience of 
neighbors and appeal to the moral compasses of our Republican leaders 
to do what they said they would do--put forth your plan. Let the 
American people know what they are going to do and do not thrust 
millions of your fellow country men and women off a cliff and shout 
promises to them as they fall: ``Hey, don't worry. We will figure 
something out before you hit the ground.'' Where is the honor in that 
strategy? Call the public together, gather your experts, put forth a 
thoughtful process, and develop what you think is better, what improves 
upon what we have now, what doesn't diminish our unassailable gains 
that we have had but build upon them. Give us a plan, not empty 
promises. Give America hope. Don't plunge millions into despair and 
uncertainty. Show decency, not costly craven politics. We know who we 
are as a country. Profound are the words, ``We hold these truths to be 
self-evident, that all men are created equal, that they are endowed by 
their Creator with certain unalienable Rights, that among these are 
Life, Liberty and the pursuit of Happiness.--That to secure these 
rights, Governments are instituted among Men. . . . `'
  This government, this body, the United States Senate, led by 
Republicans here and in the House and in the White House, must stand 
for these ideals. Health care is critical to life. We must stand for 
these ideals. Health care is critical to liberty, our freedom from 
fear, our freedom from illness, our freedom from deprivation. We must 
stand for these principles. Health care is critical to the happiness, 
the joy, the greatness of America. To secure these rights, governments 
are instituted, and we were elected to stand for the American people, 
by the American people, to fight to defend our brothers and sisters. 
This government and actors must put our ideals first, not partisanship 
and not theater. Do not attack these ideals through a rash and reckless 
repeal. Be thoughtful. Be kind. Be magnanimous. The well-being of our 
Nation is in the balance.
  May God bless us in this time of crisis. May wisdom prevail over 
politics.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mrs. FISCHER. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mrs. Ernst). Without objection, it is so 
ordered.


                       Tribute to Stephen Higgins

  Mrs. FISCHER. Madam President, I rise today to offer my warmest 
wishes to my legislative director, Stephen Higgins, as he begins the 
next chapter of his truly remarkable professional career. It is a 
career that is characterized by unshakable dedication to the common 
good and supreme attention to detail. These qualities make Stephen 
Higgins a true professional. His service is a labor of love for our 
country and this institution in particular.
  Stephen has worked in the Senate longer than all but nine of its 
current Members, serving this Chamber for 23 years. Stephen still 
remembers his first day on payroll: March 21, 1994. He began with 
Senator William Cohen of Maine as a counsel on the Juvenile Justice 
Subcommittee of the Judiciary Committee. There he began what would 
become a decades-long mission: to advance crime victims' rights.
  A year later, Stephen joined the office of Senator Jon Kyl of 
Arizona, where he would distinguish himself as a committed, talented 
lawyer over the next 18 years, serving as chief counsel in Senator 
Kyl's personal office and for 14 years as chief counsel on his 
Judiciary Committee staff. During that time, Stephen played the lead 
role, supporting efforts to pass a bipartisan crime victims' rights 
constitutional amendment. The end result: After 8 years of hard work, a 
landmark statute was passed by a vote of 96 to 1. This is one of 
Stephen's proudest accomplishments. ``We did something significant to 
help crime victims,'' he said. ``We enshrined into law the rights of 
crime victims to be informed, present, and heard.''
  To put it simply, Stephen Higgins helped humanize America's criminal 
justice system. This work reflects his sincere beliefs about that 
system. ``The criminal justice system is about seeking the truth,'' he 
said. ``The truth matters.''
  For Stephen Higgins, the truth has always mattered. He is a man of 
high character and great personal integrity. These attributes made him 
exceptionally well-suited for work in another critical realm of the 
Senate: judicial nominations. ``Judges hold people's lives in their 
hands,'' Stephen said. ``Their decisions have life-altering 
consequences.''
  Most recently, Stephen played a key role in the nomination of Omaha 
attorney Bob Rossiter to serve as U.S. district court judge for the 
District of Nebraska, and last year, the Senate confirmed Judge 
Rossiter unanimously. This was a beautiful capstone to Stephen's Senate 
career.
  He leaves the Senate now for a new position: managing director of the

[[Page S102]]

Human Ecology Institute at the Catholic University of America. This is 
an interdisciplinary research institute that will apply the rich 
intellectual tradition of the Catholic Church to contemporary problems 
in our society. As Stephen said, ``I love the Senate. The only 
institution I love more is the Catholic Church.'' Sounds like a match 
made in Heaven. As he takes his new post, I know Stephen will work like 
it all depends upon him and pray like it all depends upon God.
  I thank Stephen's wife of 18 years, Lauren, and their two children, 
James and Elizabeth, for loaning him to us here in the Senate, because 
it is a sacrifice. I know they are proud of you, Stephen, as are your 
parents, Joe and Shelley, and your brother, David.
  So, Stephen, thank you so much for all you have done for my office, 
for the Senate, and for the people of this country. Good luck. God 
bless.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. If no one yields time, the time will be 
divided equally.
  The Senator from Utah.


                      Bears Ears National Monument

  Mr. LEE. Madam President, on January 20 of this year, change is 
coming to the White House. But until that day, it appears that 
President Obama will desperately cling to the status quo and continue 
to do what he has done on far too many occasions: abuse his Executive 
powers to put in place unpopular policies without the cooperation of 
Congress and then pretend as if everyone somehow supports him.
  The most recent case in point involves President Obama's recent 
decision to designate as a new national monument some 1.35 million 
acres of public land in San Juan County, UT--the poorest county in the 
State of Utah, nearly the size of Delaware. This is a small county that 
is tucked into the southeast corner of our State. It includes--and the 
national monument is named after--the region's distinctive Bears Ears 
buttes, which mark the ancestral homeland and sacred site of many 
members of the Navajo and Ute Tribes who live in San Juan County, UT.
  President Obama announced the Bears Ears National Monument on 
December 28, right between Christmas and New Year's Eve, as most 
Americans were busy enjoying the holiday season and when he was still 
enjoying time with his family in Hawaii. That same day, his 
administration released an explanatory document that was officially 
christened a ``Fact Sheet.'' It was christened that way by the White 
House officials who wrote it. But, in reality, it reads much more like 
an elaborate book of fiction.
  Of all the falsehoods peddled in this bogus fact sheet, the most 
egregious--and, in many ways, the most insulting--is the claim that the 
residents in San Juan County, including local members of the Navajo 
Nation and members of the Ute Tribe, supported the President's decision 
to turn Bears Ears into a national monument.
  The document says:

       The creation of the Bears Ears National Monument in Utah [. 
     . .] follow[s] years of robust public input from tribes, 
     local elected officials, and diverse stakeholders, and draws 
     from legislation introduced in Congress. In addition to 
     protecting more land and water than any administration in 
     history--

  And here is the kicker--

       President Obama has taken unprecedented steps to elevate 
     the voices of Native peoples in the management of our 
     national resources.

  ``Unprecedented steps to elevate the voices of Native peoples.'' 
Nothing could be further from the truth in this situation. Perhaps if 
we replace the word ``elevate'' with the word ``exploit,'' that 
sentence might apply to the situation in Bears Ears.
  Now, there is no denying that many Native American people supported 
President Obama's designation of the Bears Ears National Monument. But 
the inconvenient truth too often ignored by the Obama administration 
and its supporters is that virtually all of this tribal support came 
from Native Americans residing outside of Utah, not inside Utah, and 
certainly not within San Juan County where this 1.35 million-acre 
designation occurred.
  In fact, the most prominent Native American group that advocated for 
a national monument in Utah is actually an alliance called the Bears 
Ears Inter-Tribal Coalition, which is made up of several tribes, and 
most of its members reside outside of the State of Utah.
  Yet, national monument advocates routinely invoke the Inter-Tribal 
Coalition as the authoritative mouthpiece of all Native Americans in 
the Southwestern United States.
  So how did a coalition of Native American tribes from Colorado, 
Arizona, and New Mexico rise to such a position of prominence in a 
debate over a national monument in a remote corner of Utah? Well, part 
of the answer can be found in the cozy relationships between well-
funded environmental advocacy groups, powerful outdoor retail 
companies, and tribal organizations.
  Recent investigative reporting by the Deseret News shows how radical 
wealthy environmental organizations, supported by the outdoor 
recreational industry, channeled millions of dollars to the Bears Ears 
Inter-Tribal Coalition only after they realized that ``hitching [their] 
success'' to the Navajo Nation was the only way they could achieve 
their longstanding goal of creating a national monument in Southeastern 
Utah.
  The ability of uber-rich environmentalists to essentially buy a 
national monument in Bears Ears explains why the people of San Juan 
County--including the Navajo residents, whose lives and livelihoods are 
intricately linked to the Bears Ears Utes--stand united in opposition 
to a monument designation.
  For the people of the Navajo Nation who live in San Juan County, 
taking care of their ancestral land--protecting and preserving it for 
the next generation--isn't optional, it is a sacred duty. It is part of 
their faith. It is part of who they are.
  The same is true in many respects in my own faith. As a member of the 
Church of Jesus Christ of Latter-day Saints, I share many of these 
views. My church teaches that the Earth is a divine creation that 
belongs to God. This means that human beings have a spiritual 
responsibility--an obligation to God--to be wise stewards over the 
Earth, to conserve it for our children and our grandchildren.
  The Navajo people of San Juan County have always faithfully fulfilled 
their responsibility in the Bears Ears region, and so have the Utes who 
reside in the area. Caring for their homelands--and respecting it as 
their forefathers did--is the cultural lifeblood of the Native American 
people of Southeastern Utah. Take away their access to their land--
restrict their stewardship over the Earth's bounty for the sake of 
increasing the access of wealthy urbanites who use the outdoors for 
their own purposes--and it won't be long before their culture begins to 
fade away.
  The people of San Juan County understand this. They have seen their 
worst nightmares become reality in other Utah counties as a result of 
Presidential national monument designations. That is why on December 
29, the day after President Obama announced the Bears Ears monument, a 
crowd of Utahns assembled to hold a protest on the steps of the San 
Juan County Courthouse.
  Braving the frigid weather of that day, they gathered together to 
demonstrate that they--the individuals and the families who will be 
most directly affected by a Bears Ears national monument--believe that 
the President has no business seizing vast stretches of land to be 
micromanaged and mismanaged by distant Federal land agencies.
  But the protesters weren't just angry. They were resolute, confident 
about the future, and determined to keep fighting for their right to 
participate in the management of the land in their community--the land 
that most directly affects them.
  Of course, environmentalists and national monument advocates want the 
people of San Juan County to believe that this fight is simply over, 
that they have lost, that there is nothing they can do about something 
that affects them in a very real, very personal, very intimate way. In 
their view, President Obama's proclamation of the Bears Ears National 
Monument is permanent. It is irreversible, as if it were carved into 
stone. As one White House official recently told the Washington Post: 
``We do not see that the Trump administration has authority to undo 
this.''
  But they say this only because they are not looking hard enough. The 
truth is what can be done through unilateral

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Executive action can also be undone the same way. Such is the 
impermanence of Executive power in our constitutional republic, where 
major policy changes require broad consensus, forged through 
legislative compromise, to endure the test of time.
  In a recent Wall Street Journal article, two prominent constitutional 
scholars, Todd Gaziano and John Yoo, explain this point as it relates 
specifically to President Obama's use of the Antiquities Act to 
designate the Bears Ears National Monument. The Antiquities Act of 
1906, as they explain, does not create an irreversible monument. When a 
President uses it, its use is not necessarily indelible.
  Gaziano and Yoo write:

       After studying the President's legal authority [under the 
     Antiquities Act], we conclude that he can rescind monument 
     designations [. . .] the law's text and original purposes 
     strongly support a president's ability to unilaterally 
     correct his predecessor's abuses.

  In other words, starting on January 20, President-Elect Trump can use 
his Executive powers to rescind President Obama's designation of the 
Bears Ears National Monument. I have asked the future Trump 
administration to do precisely that.
  I have also recently cosponsored Senator Murkowski's bill, the 
Improved National Monument Designation Process Act, which would require 
all future Presidents to obtain congressional and State approval prior 
to designating a national monument. I have done these things, and I 
will do more, because I believe the preponderance of evidence proves 
that President Obama abused his powers--the powers granted to him under 
the Antiquities Act--in designating the Bears Ears National Monument.
  This isn't just my opinion. It is the opinion of most of my fellow 
Utahns, including those patriots who assembled on the county courthouse 
steps in the rural town of Monticello on December 29.
  These are the people who were ignored by the Obama administration. 
These are the people who were cut out of the decisionmaking process 
that produced this particular national monument designation. These are 
the voices that were stifled by the wealthy, out-of-State, well-
connected environmental groups that spent millions of dollars to lock 
up our land for their exclusive use.
  So it is fitting to let one of them--one of the residents of San Juan 
County--have the last word today. I think Suzy Johnson put it best when 
she said:

       Mr. Obama, you have failed the grassroots natives. A true 
     leader listens and finds common ground. The fight for our 
     land is not over. Your name will blow away in the wind.

  I yield the floor.
  The PRESIDING OFFICER (Mr. Sasse). The Senator from Maryland.
  Mr. VAN HOLLEN. Mr. President, I ask that the time I use be charged 
against the resolution.
  The PRESIDING OFFICER. The Senator is recognized.
  Mr. VAN HOLLEN. Mr. President, this is the first time I have risen to 
speak on this Senate floor. I want to start by thanking my fellow 
Marylanders for the honor of representing them in this great United 
States Senate. I want to thank my colleague Mr. Cardin, the senior 
Senator from Maryland, for joining us. I thank the new Senator from 
California, Ms. Harris, for joining us as well. I want to say to my 
fellow Marylanders that I look forward to working every day for their 
benefit and for the benefit of our Nation. I want to say to my new 
colleagues in the Senate--Republicans and Democrats alike--I look 
forward to working with all of you in the years to come for the good of 
our Nation.
  I understand it is somewhat unusual for a new Member to speak so soon 
on the Senate floor, but what we are witnessing today in the Senate is 
not business as usual, and these are not ordinary times. Having served 
as the lead Democrat on the House Budget Committee, I know that never 
before has the Senate rushed out of the gate so quickly to enact a 
budget procedure to deny the minority party--and by extension, hundreds 
of millions of Americans--their rights in this United States Senate. 
Yet here we are, speeding to use the budget process to fast-track a so-
called reconciliation bill that will destroy the Affordable Care Act 
and, in doing so, wipe out access to affordable care for over 30 
million Americans and create total chaos throughout the American health 
care system. That is reckless. It is irresponsible, and it violates the 
traditions of this institution.
  I may be new to the Senate, but I am not new to the way this Senate 
has proudly been described by its Members, both Democrats and 
Republicans, both current and former Members. My colleague Senator 
Harris will attest that one piece of advice we all received from both 
Republican and Democratic Members of this Senate was to read the 
chapter in Robert Caro's book about Lyndon Johnson entitled ``The Desks 
of the Senate,'' where Robert Caro talks about the burnished mahogany 
tops, and he tells the story of the Senate through the Senators who 
were protagonists in great debates throughout our history. He 
highlights the idea that this Senate is supposed to be a deliberative 
body that reflects on issues with a thoughtful exchange of ideas. 
Unfortunately, that certainly does not describe the Senate of this 
moment. Having just arrived from the House of Representatives, what we 
are witnessing today is much more like the tyranny of the majority 
characteristic of that body.
  This Senate is supposed to be different, but at least for now it 
seems very much like the House I just left.
  As a result of the fast-track process in the Senate, we will be 
overriding and roughshodding over the will of a majority of the 
American population, and Americans are just now waking up to learn 
about the bait-and-switch scheme that has been perpetrated on them. For 
more than 6 years, Republicans in this Senate and in the House of 
Representatives have said repeatedly that they would repeal ObamaCare 
but replace it--replace it with something, they said, that will be much 
better. Now we know, as the clock ticks down, that has been a farce. 
There is no Republican replacement bill to provide the kind of coverage 
and benefits of the Affordable Care Act, and the consequences of that 
failure are going to be devastating for the country.
  Let us take a moment to look at the human toll. First, there are the 
22 million Americans who previously had no health insurance before the 
Affordable Care Act but are now covered through the health care 
exchanges and through expanded Medicaid. These are people who have been 
denied access to coverage because they had preexisting conditions or 
their kids had preexisting conditions--whether it was asthma, diabetes, 
heart conditions--so they were either outright denied by insurance 
companies or priced out of the market. That 22 million may be a big 
number, hard to comprehend, but behind that number are many families 
like Carlos and Isabelle Martins, who live not far from where I live in 
Silver Spring, MD. They could no longer afford health insurance through 
their employer. Shortly before the Affordable Care Act was enacted, 
Carlos was told he needed a liver transplant to survive. His wife 
Isabelle said that without the Affordable Care Act, he would never have 
received that lifesaving treatment.
  There is the case of Diane Bongiorni, who now lives in Hyattsville, 
MD. She previously had open-heart surgery. When her Cobra expired, it 
was only because of the Affordable Care Act that she was able to get 
coverage and not be denied because of that earlier, relevant 
preexisting condition. Days after she was on the Affordable Care Act, a 
cardiologist told her one of her heart valves was failing and she would 
need another surgery immediately, and she has told us that she ``would 
have died'' had she not had that coverage.
  In addition to Diane and Carlos and the other 22 million Americans 
who would have been denied affordable health care before the Affordable 
Care Act and Medicaid expansion, there are an additional 7 million 
Americans on the health care exchanges today who are projected to 
totally lose that coverage if Republicans pull the plug on the 
Affordable Care Act. That is over 30 million Americans who will lose 
access to affordable care directly.
  There is no doubt that in those health care exchanges, we have seen 
increases in premiums and some of the copays, and we need to do 
something about it, which is why I and many of my colleagues have put 
forward ideas to address the increases we are seeing in the health care 
exchanges in terms of costs. We put those ideas on the

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table, and we would welcome our Republican colleagues to join us to 
improve the Affordable Care Act. You don't fix a health care system, 
you don't fix those problems by blowing up the entire Affordable Care 
Act. That is not a solution.

  I also want to focus for a moment on the tens of millions of 
Americans who are not included in that 30 million who benefit directly 
from the Affordable Care Act but who are benefitting right now from 
ObamaCare. They may not realize it now, but mark my word they are going 
to face very unpleasant and unexpected consequences if the Affordable 
Care Act is ripped apart.
  First, let us take a look at the overwhelming number of Americans who 
get their health care not on the health care exchanges but through 
their private employer--most Members of this body, most Americans. The 
premiums in those plans have actually risen much more slowly since the 
Affordable Care Act was enacted than before. The overwhelming number of 
Americans who are on those plans have benefited dramatically from the 
reduction of costs. Why did that happen? Because all those people who 
had been previously denied access to health care who are in the 
ObamaCare exchanges, they used to show up in the hospital as their 
primary care provider or, since they weren't getting any care at all 
because they couldn't afford the bill, they were showing up at those 
hospitals when there was an emergency, when cost was most expensive. We 
don't deny people care in an emergency, and then they get the bill and 
they can't pay the bill. That is why so many people were going bankrupt 
in America before the Affordable Care Act. But somebody pays. Who pays? 
Well, everybody else in the system pays. Everybody else who has private 
insurance through their employer pays or taxpayers in States pay for 
the uncompensated care that hospitals would otherwise have to carry. In 
the end, people's premiums were going up really fast, but by providing 
the health care system through ObamaCare for those exchanges, however 
imperfect, it has helped those other tens of millions of Americans. Let 
us look at Medicare beneficiaries, millions of seniors. Watch out. 
Their costs are going to rise in three and maybe four ways right away.
  First of all, their Part B premiums that every senior on Medicare 
pays are going to go up. Why is that? Because as part of the Affordable 
Care Act, we got rid of some of the overpayments, the excessive 
subsidies that were being paid to certain providers, including some of 
the managed care providers who were paid, on average, 115 percent more 
than fee for service. We said that makes no sense. That is a waste of 
Medicare beneficiaries' money. So we reformed that by saving the 
Medicare system money. We also save the Medicare beneficiaries money in 
their premiums because those premiums are set partly to the overall 
cost of Medicare. If you reduce the cost of Medicare in a smart way, 
you reduce those premiums. That is why seniors have seen such slow 
increases in their Part B premiums since the enactment of the 
Affordable Care Act. Those will go right back up.
  Second, seniors on Medicare no longer have to pay for preventive 
health screenings, cancer screenings, diabetes screenings, other kinds 
of preventive health care because we want to encourage them to identify 
the problems early and solve them for their own health care purposes 
but also because it saves money in the system. You get rid of the 
Affordable Care Act, those seniors are going to be paying premium 
copays for those preventive health services.
  Prescription drug costs. Seniors--and there are millions and millions 
of them who face high prescription drug costs--are benefiting today 
from the fact that we are steadily in the process of closing the 
prescription drug doughnut hole. We had an absolute crisis in this 
country where so many seniors were faced with the difficult choices of 
getting the medications they needed to live day-to-day and keep a roof 
over their head. That is why we are closing the prescription drug 
doughnut hole. You get rid of the Affordable Care Act, all those 
seniors who, on average, have saved thousands of dollars with the 
Affordable Care Act are going to see their costs go up.
  Finally, if you enact the plan that has been put forward by the 
Speaker of the House, Paul Ryan, and by the person who President-Elect 
Trump has nominated to be his Secretary of Health and Human Services, 
Tom Price--I encourage every American to look at their plan because 
they want to voucherize Medicare, and they want to save the Medicare 
system money by raising the prices and the risks on every Medicare 
beneficiary. That is the result of that plan.
  The Affordable Care Act benefits 30 million people directly, and we 
need to make sure we don't put them in harm's way, but it also benefits 
all these other people in the system, the people on the employer-
provided health plans who have seen historically low premium increases 
and seniors on Medicare.
  Rural hospitals will be particularly hard hit by repealing the 
Affordable Care Act. So the proposed Republican action is going to hit 
those 30 million Americans, including my neighbors in Silver Spring. It 
is also going to hit those other tens of millions of Americans who 
right now may not realize the extent to which they are benefiting from 
the Affordable Care Act. Yet our Republican colleagues have not put 
forward a single plan to help either the 30 million or all the other 
Americans who are benefiting from the Affordable Care Act. Instead, we 
see a rush to generate chaos throughout the health care system. That is 
counter to what the President-elect has said he wants. Here is what 
Donald Trump said on ``60 Minutes'':

       Everybody's got to be covered.

  Everybody.

       I am going to take care of everybody.

  Well, it is really important that the majority in the Senate and the 
House talk to the President--elect because they are not on the same 
road when it comes to that commitment. When the President-elect was 
asked about finding a way to keep the ObamaCare rules that prevent 
discrimination based on preexisting conditions, he said, ``I like those 
very much.'' When he was asked about the provision that allows children 
to stay on their parents' insurance plans until they are 26 years old, 
he said, ``We're going to very much try to keep that.''
  Here is the dirty little secret. Many people--Republicans and 
Democrats in this Chamber--know there are only a very few ways you can 
design a health care system that meets those conditions. One way, which 
many Democrats have historically supported, is the idea of Medicare for 
all. The other way is the ObamaCare model. It was not always known as 
the ObamaCare model.
  The foundation for ObamaCare actually had its roots in the 
conservative Heritage Foundation think tank reports. It was an idea 
long promoted by Republicans, including many Republican Senators, some 
of them still here today. It is an idea rooted in the concept of 
personal responsibility, the idea that every American needs to do their 
part and help pay for their health insurance, otherwise, if they don't 
pay, they are going to force other people to pay when they go seek that 
care in the emergency room or wherever it may be. In order for that 
idea to work, the idea that was put forward by the Heritage Foundation, 
the idea in ObamaCare, everyone needs to have coverage because it would 
not make a lot of sense for us to be paying out all the time if we were 
able to wait until we got sick and then decide to pay. That is the idea 
of having everyone in the pool have insurance. The idea is, you don't 
want to use it, but you buy that protection. If other people don't buy 
the protection, then the rest of the folks feel like they are being 
taken advantage of, which is why everyone has to be in the pool, which 
is why it was an idea that came out of the Heritage Foundation.
  In fact, I have the Heritage official report right here: Critical 
issues--a national health care system. This was back in 1989.
  I want to read the three elements in the Republican plan.
  Element No. 1, every resident in the United States must by law be 
enrolled in an adequate health care plan that covers major health care 
costs.
  No. 2, for working Americans, obtaining health care protection must 
be a family responsibility.
  No. 3, the government's proper role is to monitor the health market, 
subsidize needy individuals to allow them

[[Page S105]]

to obtain sufficient services, and encourage competition.
  That sounds like a description of ObamaCare. It is--which is why, of 
course, it was dubbed ``RomneyCare'' when they adopted this model for 
the State of Massachusetts. He adopted it based on the Republican's 
Heritage model.
  So here is the problem: Republicans can't come up with an 
alternative. That is why it has not happened for 6 years, because if 
you are going to come up with an alternative, you have to go to either 
one of two models. One is Medicare for all. The other is the idea that 
every American has to be in the system and the idea based on personal 
responsibility, which at its start was a Republican idea. When 
President Obama adopted it, for many months, some Republican Senators 
were willing to go along, but then the politics overtook them, and 
since then, we have had the Republicans opposing their own proposed 
model for providing health care. So rather than repeal and replace, 
since there is no replace, it is repeal and run.
  Here is the problem for our colleagues politically, but more 
importantly, here is the problem for all Americans and all our 
constituents: No one is going to be able to hide from the devastating 
consequences of undoing the Affordable Care Act, which is going to hurt 
not just the 30 million Americans who are directly benefiting through 
the exchanges and the Medicare expansion, the Medicaid expansion, but 
also all those seniors on Medicare and the others getting health care 
through their private employers.
  As I said at the outset, it is truly sad to see the Senate at this 
point and in this state, especially because of the terrible 
consequences it is going to have on the American people.
  You know, the very first time I was ever on the floor of the Senate 
was in 1985. I was not thinking of running for office myself at that 
time. It was the farthest thing from my mind. I was actually working--
it was in the middle of the Cold War. I was working on national 
security and foreign policy issues for a moderate Republican Senator by 
the name of ``Mac'' Mathias from the State of Maryland.
  I talked about the desks of the Senate at the outset of my remarks. 
Senator Mathias sat right there, one seat behind the seat Senator 
Booker is sitting in right now.
  Great to see you.
  That is where Senator Mathias sat. The reason I happened to be 
sitting next to him that day is he was working with Senator Kennedy 
that day. Senator Kennedy was at a desk back there, I believe. It was 
the second from the aisle. It had been his brother Jack Kennedy's desk 
in the Senate before him. Even though there were many desks between the 
desk of Senator Kennedy and the desk of Senator Mathias and the center 
aisle between them, they were able to work together for the good of the 
country, just as many Senators from both parties have done since. That 
is the way the Senate is supposed to work. That is the way the Senate 
was described in the Robert Caro book that Republicans and Democrats 
alike told us to read as new Members before we came here.
  I am really glad to be here. I am excited to get to work on behalf of 
Marylanders and work for the good of our State and the country. I wish 
it could have been at a moment when the Senate was not hellbent on 
breaking the very traditions that have made it great, the tradition of 
being a deliberative body and not using right out of the gate, the very 
first thing, a process to short-circuit the will of the minority party. 
That is not what any of us were taught the Senate was about.
  It is particularly troubling that the Senate is engaged in breaking 
that tradition in order to undermine affordable health care for tens of 
millions of Americans and generate chaos in our health care system. I 
will fight every day to prevent that from happening.
  I will also fight every day to try to live up to the true tradition 
of the Senate, which is people trying to work together for the good of 
the country. It is disappointing to be here at a time when the Senate 
is embarked on violating that tradition in order to strip Americans of 
their health care. I hope we will not let that happen. I will fight 
every day to prevent that from happening and then work with my 
colleagues to try to make sure we address the real priorities and 
concerns of the American people.
  I thank my colleagues for joining me on the floor.
  The PRESIDING OFFICER (Mr. Sullivan). The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, because----
  Mr. CARDIN. Mr. President, may I ask my colleague to yield for just 
one moment?
  The PRESIDING OFFICER. Will the Senator from Iowa yield?
  Mr. GRASSLEY. Yes, for one moment.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Thank you. I appreciate the courtesy. I just wanted to 
take this time to welcome Senator Van Hollen to the Senate. Senator Van 
Hollen gave his maiden speech from the desk that was held by Senator 
Mikulski. I know Senator Mikulski would be very proud of what he said 
here on the floor and very proud of Senator Van Hollen being here in 
the Senate. I look forward to working with him.
  I want to tell the people of Maryland and the people of this Nation 
that what you heard tonight, you heard a person who is committed to 
making our system work, who is committed to working with every Member 
of the Senate. But he will stand up for the principles and will stand 
up on behalf of the people of Maryland.
  Again, welcome. It is wonderful to have him here in the Senate.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. SCHUMER. Mr. President, I just want to add my commendation. It 
was such a well done, brilliant, articulate, carefully thought out 
speech. But it is not a surprise because our new Senator, the junior 
Senator from Maryland, is like that. We are so excited to have him and 
our freshman class--some of his colleagues came here today. We wish it 
had been larger in quantity, but they sure make up for it in quality, 
as Senator Van Hollen's speech showed. And parenthetically, maybe he 
will be able to increase that quantity in one of his other new jobs.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, it is because of ObamaCare that the 
health insurance markets in this country are badly damaged. They have 
gotten worse each year. They are now near collapse.
  You were told 8 years ago that if you like your health insurance, you 
can keep it. Millions can't. If you like your doctor, you can keep your 
doctor. Millions of Americans were not able to keep their doctor. You 
were told that your health insurance premiums would go down $2,500. 
They have actually gone up probably $3,500. Some people don't have a 
choice in plans. Some counties don't even have a plan in the exchange. 
If you could get a plan, you might not be able to afford it. If you 
could afford the plan, you might not be able to use it because of the 
high copayments you have to have. So it is not a very good situation.
  It took 6 years for the health insurance market to get as bad as I 
just described. It will take time for those markets to be restored. The 
next few years in health care will be challenging if ObamaCare is 
repealed or even if it is not repealed. If ObamaCare is not repealed, 
it will be even longer before Americans have access to a functioning 
health insurance market and the insurance plans they want.
  When it comes to health care, every second counts. We owe it to the 
American people who are sick or who could get sick, as well as families 
and businesses trying to plan for the future, to start fixing that 
problem right now. That is the result of the election. That is what the 
Senate is going to do.
  The Affordable Care Act, which could more appropriately be called the 
Unaffordable Care Act, has been a case of over-promise and under-
delivery. People were told that their premiums would go down and that 
if they liked their doctor, their hospital, or their health care plan, 
they could keep all of it. The reality is much different. More than 
half of the country had two or fewer insurance plans from which to 
choose this year. Some regions had no insurance plans available at all. 
Even those who were strong supporters of the health care law, like the 
Minnesota Governor whom I like to quote, have

[[Page S106]]

said the Affordable Care Act ``is no longer affordable to many 
Americans.''
  In my State of Iowa, the Affordable Care Act premium increases this 
year were over 40 percent for many individuals. Few people, of course, 
can afford that. Families that did manage to purchase Affordable Care 
Act insurance found that they could no longer afford to use it.

  One Iowan recently called my office and told me that his premiums 
have increased 400 percent in 3 years. He also said that his deductible 
went up to--can you believe it--$14,000. Last year, one of his children 
had a major medical problem, and they had to pay for all of that care 
out of their pocket--not from the insurance. The family paid $12,000 
for the Affordable Care Act insurance, which did not pay for any health 
care. Of course, that just doesn't make any sense whatsoever.
  The problem is that the Affordable Care Act did nothing to address 
the underlying causes of the high cost of health care; that is, what it 
costs for a hospital or a doctor to purchase or maintain medical 
equipment, purchase medicines, carry malpractice insurance, and a lot 
of other costs they have.
  Rather than address the actual cost to care, President Obama and his 
colleagues chose to bypass real health care reform for an unsustainable 
entitlement and bureaucratic mandates that have priced people out of 
the health insurance market, rather than provide those same people with 
affordable and quality coverage.
  So we are at it now. It is time for real health care reform, not the 
misguided policies that we were promised 8 years ago that now have 
turned out to be what I describe as misguided policies. It is time to 
deliver to Americans what we were promised. It is time to provide 
accessible, affordable health care to all Americans. But my colleagues 
on the other side of the aisle need to work with us. They know that the 
Affordable Care Act is falling apart. They know it is unaffordable.
  As we have heard in speeches this week, the other side is trying to 
distract attention from the Affordable Care Act collapse by using scare 
tactics, like you recently heard. It is time for the Democrats to step 
up, instead of doubling down. It is time for statesmanship, not 
gamesmanship. It is time for the Democrats to stop defending the ``un-
Affordable Care Act'' and deliver Americans what was promised.
  I look forward to working with my colleagues and the Trump 
administration to deliver affordable health care to all Americans in 
the tradition of the Senate, which is what didn't happen in 2009. It 
was strictly a one-party program put before the Congress to pass. That 
is why it has failed--because so many of the people who could have made 
a good bill pass in 2009 were shut out of the process because this body 
had 60 Democratic Members and they didn't have to pay any attention to 
Republicans.
  They spent maybe 8 or 9 months trying to work with the Republicans to 
negotiate a bipartisan deal. But before that was completed, they said: 
Take it or leave it. The Republican minority at that time was not going 
to be dictated to, and we were pushed out of the room.
  Then what ended up being the Affordable Care Act was written in the 
big black hole of Senate Majority Leader Reid's office, without the 
bipartisan input which has made so many social programs in America 
successful. I would name the Social Security Act. I would name civil 
rights legislation, Medicare legislation, and Medicaid legislation, 
which all had broad bipartisan support to get them passed. In the case 
of the Civil Rights Act, a higher proportion of Republicans voted for 
it than Democrats voted for it--just one example.
  That is the tradition of the Senate when you have major social 
legislation that has been successful, and that is why the Affordable 
Care Act was not successful--because it was strictly a partisan 
approach that was used to have it become law.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. McCONNELL. 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. McCONNELL. Mr. President, I ask unanimous consent that at 5:30 
p.m. on Monday, January 9, the Senate vote in relation to the Paul 
amendment No. 1; further, that the Senate vote in relation to the 
Sanders amendment No. 19 at 2:30 p.m. on Tuesday, January 10.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCONNELL. Mr. President, it is my understanding that we will 
have a side-by-side amendment to the Sanders amendment, and we will 
circulate that amendment as soon as possible.

                          ____________________