(Senate - March 09, 2017)

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[Congressional Record Volume 163, Number 41 (Thursday, March 9, 2017)]
[Pages S1714-S1738]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

                           EXECUTIVE SESSION


                           EXECUTIVE CALENDAR

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to executive session to consider the following nomination, 
which the clerk will report.
  The bill clerk read the nomination of Seema Verma, of Indiana, to be 
Administrator of the Centers for Medicare and Medicaid Services.
  The PRESIDING OFFICER. The Senator from Florida.

                        freedom for bob levinson

  Mr. NELSON. Madam President, I come to the floor with a heavy heart 
because 10 years ago today, Robert Levinson, a former FBI agent, was 
detained in Iran on the tourist island of Kish Island in the Persian 
  Bob is a very respected, long-time FBI agent who had served his 
country for 28 years and had since retired. He is the longest held 
civilian in our Nation's history. He is a husband, a father of seven, 
and now a grandfather of six, and he deserves to be reunited with his 
  Since Bob's detention, American officials have sought Iran's 
cooperation in locating and returning Bob to his family. Of course, 
Iranian officials have promised over and over their assistance, but 
after 10 long years, those promises have amounted to nothing. Bob still 
is not home.
  The bottom line is, Iran is responsible for returning Bob to his 
family. If Iranian officials don't have Bob, then they sure know where 
to find him. So today we renew our call on Iran to make good on those 
promises and return Bob, return him to where he ought to be, with his 
  Iran's continued delay in returning him, in addition to the very 
serious disagreements the United States has with the Government of Iran 
about its missile program, its sponsorship of terrorism, and its human 
rights abuses, is just another obstacle Iran must overcome if it wants 
to improve relations with the United States.
  We also urge the President and our allies to keep pressing Iran to 
make clear that the United States has not forgotten Bob and will not 
forget him until he is home. Obviously, we owe this to Bob, a servant 
of America, and we certainly owe it to his family.
  To Bob's family, we recognize your tireless efforts over those 10 
long years to bring your dad home, and we offer our sympathies.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The majority whip.

                        American Health Care Act

  Mr. CORNYN. Madam President, this week the Senate continues to press 
forward on a number of congressional review actions; in this case, a 
disapproval that will roll back and repeal many Obama-era regulations 
that have hurt people across the country and strangled our economic 
  By doing away with excessively burdensome rules and regulations, we 
are delivering on our promise to the American people to actually do 
what we can to help the economy, to grow the economy, to create jobs 
and not hurt it with unnecessary, expensive, and burdensome redtape.
  Earlier this year, we began the legislative process to deliver on our 
biggest promise: repealing and replacing ObamaCare with more affordable 
and more accessible healthcare options, options that will work for all 
American families. The American Health Care Act, introduced in the 
House on Monday, is the first step in fulfilling that promise.
  ObamaCare is collapsing. It has already failed countless families 
across the country, and it has forced people off good insurance plans 
they liked and strong-armed them to sign up for plans that were more 
expensive, offered less care, and didn't even let them use the doctor 
of their choice. So we would be revisiting healthcare even if Hillary 
Clinton had been elected President of the United States because 
ObamaCare is in a meltdown mode.
  ObamaCare has also saddled our economy with more than a trillion 
dollars in new taxes. Most of those taxes are so hidden that most 
Americans are probably not aware of the fact that there is even a tax 
charged on the premium for their health insurance policy, for example. 
Well, all of these taxes end up being absorbed and have to be paid by 
American families.
  At its very core, the individual mandate of ObamaCare was a major 
power play and overreach by the Federal Government. Basically, what it 
said was, if you don't buy the government-prescribed health insurance 
plan, we are going to fine you; we are going to penalize you.
  The government should not be able to force anyone to spend their own 
hard-earned money for something they don't want but have to buy under a 
threat of financial penalty. The American people have spoken up loudly 
and clearly and rightfully demanded that Congress do better, and we 
  Since the 2010 timeframe--when our colleagues on the other side of 
the aisle passed ObamaCare with 60 votes in the Senate, a majority in 
the House, and with the White House--they have lost the majority in the 
Senate, they have lost the majority in the House, and they have lost 
the White House. I think ObamaCare has been one of the major reasons 
why, because people, the more they learn about it, the less they like 
it, and they don't appreciate Washington forcing them to do things they 
don't want to do with their own money.
  About 2 months ago, one of my constituents in Texas wrote me about 
her skyrocketing healthcare costs. Before last year, her premium was 
about $325 a month. A short time later, that was revised to $436 a 
month. This same Texan later moved from one city to another and, 
because of her change of address, her premium jumped to $625 a month. 
It started at $325 and is now $625. In 2017, thanks to ObamaCare, her 
premium went up again to an astronomical $820 a month. It started at 
$325 before ObamaCare and is now $820 a month. I don't know many people 
who could absorb that kind of increase in their healthcare insurance 
  In about a year, her monthly healthcare payment jumped by more

[[Page S1715]]

than 150 percent--150 percent. That is hardly what I would call 
affordable; thus, the misnamed Affordable Care Act should be the un-
Affordable Care Act.
  To make matters worse, she then found that her provider would be 
putting a halt to individual plans in Texas, something that has been a 
recurring theme in my State and across the country. So while President 
Obama said: If you like your plan, you can keep your plan, as a result 
of ObamaCare, she was not able to keep her plan so she had to find a 
new plan and a new doctor, a plan ultimately with less care, less 
flexibility, and even a higher price.
  Suffice it to say, for this constituent of mine and for millions more 
like her, ObamaCare is not working. ObamaCare is not affordable, and it 
is hurting Texans. It is time for Congress to keep its promise that we 
have made in every election since that given the privilege of 
governing--of being in the majority, being in a position to change 
things--we would repeal and replace ObamaCare with options that fit the 
needs of all Americans and their families at a price they can afford.
  Mr. SANDERS. Will my friend from Texas yield for a question?
  Mr. CORNYN. I will not, not at this time.
  Fortunately, we now have a President in the White House who clearly 
sees the failure of ObamaCare and wants to do something about it. 
Republicans in Congress have introduced a bill, which is now being 
marked up in the House, that the President can actually sign, once it 
is passed, to get us out of this mess. The American Health Care Act is 
the vehicle to do just that, and I am glad President Trump endorsed the 
plan earlier this week.
  It is a work in progress. The House committees are marking it up as 
we speak. There will be changes along the way, but, ultimately, the 
House will pass the bill and send it to the Senate. Then we will have 
an opportunity to offer our amendments during the course of its 
passage. The important point to make, though, is that this legislation 
will actually put patients first so they are not forced into a plan 
that they don't want or that provides coverage they can't afford. It 
does away with the outrageous new taxes and the penalties that have 
made the economy worse off and have made life harder for American 

  The legislation will also give families more flexibility so they can 
get the healthcare specific to their needs that actually works for 
them. If they decide, for example, to get a major medical policy that 
is relatively inexpensive and then use a health savings account to use 
pretax dollars to pay for their regular doctors' visits, they will have 
the flexibility to do that. So this legislation promotes sensible 
reforms to ensure that big ticket items like Medicaid are put on a more 
sustainable fiscal path.
  I have heard some suggestions that this legislation actually guts 
Medicaid. That is false. That is not true. It actually continues at 
current levels in this shared State and Federal program, but it is 
subject to a cost-of-living index that will actually put Medicaid on a 
more sustainable path. Just as importantly, it will also return the 
authority back to the States to come up with the flexible programs they 
need to deal with the specific healthcare needs of the people of their 
  This legislation makes sure that Medicaid doesn't lose sight of its 
design, which is to serve the most vulnerable among us who can't afford 
access to quality healthcare. It provides them that access--and better 
access--by providing flexibility to the States.
  We know that the States and the Federal Government spend an awful lot 
of money on Medicaid. In Texas, for example, my State spent close to 
one-third of its budget on Medicaid last year--one-third of all State 
spending--and it is uncapped, so it goes up every year by leaps and 
bounds. Under the American Health Care Act, Medicaid will be tied to 
the number of people in the State using it, a per capita rate, which 
makes sense, and it represents the first major overhaul of the program 
in decades.
  ObamaCare left us with unchecked government spending, more taxes, and 
fewer healthcare options. This bill is the opposite of ObamaCare in 
every way. It will control spending in a commonsense way, it will 
repeal ObamaCare's taxes and the individual and employer mandate, and 
it will provide more flexible free market options for families across 
the country. That is not just a bumper sticker or advertisement; that 
is actually what is contained in the legislation.
  I look forward to working with my colleagues in the House, in the 
Senate, and in the Trump administration to get this done in the next 
few weeks.
  Madam President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. MARKEY. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MARKEY. Madam President, here we go again, debating the 
nomination of a Trump candidate who is both unqualified and reflects an 
extreme ideology for the Department she will hope to lead. In this case 
it is Seema Verma, and the Department is the Centers for Medicare and 
Medicaid, or CMS, as it is often called.
  Why is CMS, an acronym for a department that most Americans don't 
even know about, so important that its nominee would make it to the 
floor of the U.S. Senate for debate? Because 100 million Americans 
receive health insurance coverage under one of our Federal insurance 
programs--Medicare, Medicaid, the Children's Health Insurance Program, 
and the health insurance marketplace created by the Affordable Care 
Act, all of which are under the jurisdiction of CMS.
  CMS is the traffic cop of our Federal Government healthcare system. 
It makes sure that Americans have access to affordable, quality 
healthcare by administering and overseeing all aspects of our Federal 
health program. It promotes healthcare innovation and works to reduce 
waste, fraud, and abuse throughout our healthcare system.
  Under the Trump administration and Republican leadership, which has 
vowed to repeal ObamaCare and get rid of Medicaid as we know it, the 
leader of CMS will be the person responsible for reducing Federal 
spending on public insurance programs, particularly for the poor, the 
elderly, and the disabled. Seema Verma is President Trump's nominee to 
try to meet that misguided and heartless challenge.
  Republicans have an ancient animosity toward Medicaid, and it would 
seem that Ms. Verma shares that prejudice. Ms. Verma is most well known 
for proposals that penalize and create roadblocks to coverage for low-
income Americans. She supports changes to Medicaid that would make it 
harder for those who need Medicaid to access it. This stance is 
fundamentally antithetical to the core principle of Medicaid, which is 
providing coverage for those who cannot afford it. For the most part, 
we are talking about poor people in the United States of America in 
  Despite the fact that research shows the onerous premiums or cost 
sharing for low-income individuals served as barriers to enrolling in 
and obtaining care, Ms. Verma supported a plan to require Medicaid 
enrollees to pay premiums through monthly contributions to a health 
savings account. Guess what. People who are poor enough to qualify for 
Medicaid rarely have enough money to dedicate to savings accounts of 
any kind. They are living day to day, week to week, month to month.
  She also supports putting in place restrictions that put more burdens 
on low-income Americans than even private insurance. It will be Grandma 
and Grandpa who will pay the highest price.
  Medicaid isn't just a line in our healthcare budget; it is a lifeline 
for millions of seniors in every State of the country. Here are the 
facts about the importance of Medicaid to our seniors. It is 
anticipated that by 2060, there will be more than 98 million Americans 
over the age of 65. The number of individuals over the age of 85 is 
expected to reach 14.6 million in 2040--triple the number in 2014. Of 
this population, 70 percent will likely use long-term services and 
supports, of which Medicaid is the primary player. Medicaid spent $152 
billion on long-term support services like nursing home care in 2014.

[[Page S1716]]

  Let me say that again. The entire defense budget is about $550 
billion. We spent as a nation $152 billion--a little less than one-
third of the defense budget--to take care of Grandma and Grandpa in 
nursing homes in 2014. They may have Alzheimer's, they may have other 
diseases, but, unfortunately, most families can't save $50, $60, 
$70,000 for year after year of nursing home coverage; that is Grandma 
and Grandpa.
  The anticipated growth rate for Medicaid beneficiaries over the age 
of 65 is four times the rate of growth for all Medicaid beneficiaries. 
The only thing growing faster than the need for Medicaid is the number 
of people who are opposed to repealing the Medicaid expansion under 
ObamaCare. Medicaid pays for nearly two-thirds of individuals living in 
nursing homes.
  Can I say that again? Medicaid pays for two-thirds of individuals 
living in nursing homes in our country. So if you know a family member 
who is in a nursing home who has Alzheimer's or some other disease, you 
can just assume that Medicaid is helping that family to ensure that 
Grandma or Grandpa is getting the care they deserve for what they did 
to build this great country.
  Fundamentally restructuring Medicaid will place additional strain on 
already strapped State budgets because nursing facility care is a 
mandated Medicaid benefit. States may offset the increased costs in 
covering this service by further cutting payments to providers or 
removing benefits that seniors want and need, like home- and community-
based services. It also puts more strain on working-class families 
because if Medicaid isn't picking up the cost of putting your grandma 
in a nursing home, that comes out of the pockets of other contributors 
to the family.
  Unfortunately, Republicans want to undermine the Medicaid expansion 
under the Affordable Care Act, which is benefiting millions of seniors. 
They want to force seniors to pay more out-of-pocket for healthcare or 
forgo coverage because they cannot afford it.
  What Republicans refuse to accept is that the Affordable Care Act is 
the most important program we have put in place for seniors since 
Medicare. The uninsured rate for Americans aged 50 to 64 dropped by 
nearly half after the passage of the ACA. The uninsured rate for this 
older population living in Medicaid expansion States was 4.6 percent 
while the uninsured rate for the same population living in a non-
Medicaid expansion State was 8.7 percent--almost double.
  Not only does the Republican proposal amount to an age tax by 
substantially increasing the amount an insurance company can charge for 
an older person, but it provides older Americans with fewer resources 
than what is available under ObamaCare to help cover their increased 
costs for care.
  Unfortunately, as Republicans attempt to repeal ObamaCare, CMS is 
authorized by President Trump's Executive order to ``minimize the 
unwarranted economic and regulatory burdens'' of ObamaCare. In simple 
terms, that means undoing and privatizing vital provisions of the 
Affordable Care Act as soon as possible under the law.
  CMS has also picked up a sledgehammer. It has already proposed new 
rules of slashing open enrollment times for the exchanges by over a 
month. It has proposed rules to relax the minimum standards for what 
qualifying health plans sold on the exchanges have to cover.
  Now, more than ever, we need a leader at CMS who understands and 
respects the fundamental need for healthcare for our seniors, and for 
so many of them, that need is met by Medicaid. Ms. Verma's disdain for 
Medicaid is simply an insurmountable problem for the millions of older 
Americans in this country who rely upon this fundamental program.
  Given her lack of experience and extreme views, several major groups 
that represent millions of working-class Americans have voiced strong 
opposition to her confirmation.
  This is what the American Federation of State, County and Municipal 
Employees of the AFL-CIO said:
  ``Leading CMS is too important a role to be held by an individual who 
is committed to policies so radical they would jeopardize the health 
and lives of ordinary Americans.''
  I could not agree more.
  Seema Verma is the wrong person to run CMS at a time when millions of 
Americans are relying on the dignity and coverage that Medicare and 
Medicaid provide.
  Instead of cutting funding for defense, Donald Trump wants to cut 
programs for the defenseless. The Trump administration would rather 
bestow billions more to the Pentagon to pay for new nuclear weapons, 
which we do not need and cannot afford, all the while supporting cuts 
to Medicaid and senior health. We should be cutting Minuteman missiles 
instead of Medicaid. We should be cutting gravity bombs instead of 
Grandma's prescriptions.
  The Trump administration's plan for Medicaid and our overall 
healthcare system would be a nightmare for Grandma and Grandpa and 
millions of middle-class Americans.
  I am opposed to Seema Verma's nomination, and I call on my colleagues 
to join me in voting no on her nomination when it is presented on the 
Senate floor.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Sasse). The Senator from Colorado.

                       Nomination of Neil Gorsuch

  Mr. GARDNER. Mr. President, I rise to support the nomination of Judge 
Neil Gorsuch to the U.S. Supreme Court. Hopefully, we will see his 
confirmation in the weeks to come.
  As I have come to the floor and talked about before, Judge Gorsuch is 
a fourth-generation Coloradan who serves on the Tenth Circuit Court of 
Appeals, which is the U.S. circuit court that is housed in Denver, CO. 
It is the circuit court that oversees about 20 percent of the land mass 
in the States of Colorado, Oklahoma, and places in between. Once he is 
confirmed to the Supreme Court, Neil Gorsuch will become the second 
Coloradan to have served on the Court.
  We have a great history of another Supreme Court Justice who served 
on the highest Court. Associate Justice Byron White had the distinction 
of being the only Supreme Court Justice to lead the NFL in rushing, and 
he was also from Colorado.
  If Judge Gorsuch is confirmed, Justice Gorsuch will join Byron White 
as another Coloradan on the High Court. Justice Rutledge also received 
his bachelor's of law degree from the University of Colorado. So we do 
have a great history of Colorado westerners joining our Nation's 
highest Court.
  Mr. Gorsuch was confirmed to the Tenth Circuit Court a little over 10 
years ago--11 years ago--in 2006, by a unanimous voice vote. He was so 
popular and so well supported that there was not even a rollcall vote 
taken in this Chamber. It was a simple acclamation by a voice vote. In 
fact, Gorsuch's nomination hearing was deemed so noncontroversial that 
the last time, Senator Graham was the only committee member to attend.
  One may ask oneself what made and continues to make Judge Gorsuch 
such a mainstream nominee. I do not think we need to look any further 
than his original Judiciary Committee questionnaire to see that Judge 
Gorsuch possesses the right temperament and the right view of the role 
of judges.
  I thought it was important that I read this from 11 years ago when 
Judge Gorsuch was confirmed to the Tenth Circuit Court. The 
questionnaire he filled out for the Judiciary Committee included then-
Neil Gorsuch's--trying to be Judge Gorsuch--response to judicial 
activism and what it meant to Neil Gorsuch prior to his confirmation to 
the Tenth Circuit Court.
  Here is what he replied to the Judiciary Committee in that committee 

       The Constitution requires Federal judges to strike a 
     delicate balance. The separation of powers embodied in our 
     founding document provides the judiciary with a defined and 
     limited charter.
       Judges must allow the elected branches of government to 
     flourish and citizens, through their elected representatives, 
     to make laws appropriate to the facts and circumstances of 
     the day.
       Judges must avoid the temptation to usurp the roles of the 
     legislative and executive branches and must appreciate the 
     advantages these democratic institutions have in crafting and 
     adapting social policy as well as their special authority, 
     derived from the consent and mandate of the people, to do so.
       At the same time, the Founders were anxious to ensure that 
     the judicial branch never becomes captured by or subservient 
     to the other branches of government, recognizing

[[Page S1717]]

     that a firm and independent judiciary is critical to a well-
     functioning democracy.
       The Constitution imposes on the judiciary the vital work of 
     settling disputes, vindicating civil rights and civil 
     liberties, ensuring equal treatment under the law, and 
     helping to make real for all citizens the Constitution's 
     promise of self-government. There may be no firmly fixed 
     formula on how to strike the balance envisioned by the 
     Constitution in specific cases, but there are many guideposts 
     discernible in the best traditions of our judiciary.
       A wise judge recognizes that his or her own judgment is 
     only a weak reed without being fortified by these proven 
       For example, a good judge recognizes that many of the 
     lawyers in cases reaching the court of appeals have lived 
     with and thought deeply about the legal issues before the 
     court for months or years. A lawyer in the well is not to be 
     treated as a cat's paw but as a valuable colleague whose 
     thinking is to be mined and tested and who, at all times, 
     deserves to be treated with respect and common courtesy.
       A good judge will diligently study counsels' briefs and the 
     record and seek to digest them fully before argument and then 
     listen with respectful discernment to the arguments made by 
     his or her colleagues at the bar.
       A good judge will recognize that few questions in the law 
     are truly novel, that precedents in the vast body of Federal 
     law reflect the considered judgment of those who have come 
     before us and embody the settled expectation of those in our 
     own generation.
       A good judge will seek to honor precedent and strive to 
     avoid its disparagement or displacement.
       A good judge will listen to his or her colleagues and 
     strive to reach consensus with them. Every judge takes the 
     same judicial oath; every judge brings a different and 
     valuable perspective to the office.
       A good judge will appreciate the different experiences and 
     perspectives of his or her colleagues and know that reaching 
     consensus is not always easy but that the process of getting 
     there often tempers the ultimate result, ensuring that the 
     ultimate decision reflects the collective wisdom of multiple 
     individuals of disparate backgrounds who have studied the 
     issue with care.
       Throughout the process of adjudicating an appeal, a good 
     judge will question not only the positions espoused by the 
     litigants but also his or her own perceptions and 
     tentative conclusions as they evolve.
       And a good judge will critically examine his or her own 
     ideas as readily and openly as the ideas advanced by others.
       A good judge will never become so wedded to any view of any 
     case so as to preclude the possibility of changing his or her 
     mind at any stage--from argument through the completion of a 
     written opinion.
       Pride of position, fear of embarrassment associated with 
     changing one's mind, along, of course, with personal politics 
     or policy preferences have no useful role in judging; regular 
     and healthy doses of self-skepticism and humility about one's 
     own abilities and conclusions always do.

  This is the response that then-Neil Gorsuch, prior to his becoming 
Judge Gorsuch, gave to the Senate Judiciary Committee and in response 
to a questionnaire about judicial activism and about what makes a good 
judge in his talking about fidelity to precedent, talking about the 
ability to reach a conclusion that may be in disagreement with one's 
own personal opinions, making sure that we respect the different 
branches of government, making sure that one listens to one's 
colleagues who are arguing a case and who have spent years in their 
getting to know the case and its every detail, and scrubbing your mind 
to question the positions that you thought you had to make sure that 
they mesh with the law, not with opinion.
  Judge Gorsuch, when he was introduced at the White House when being 
nominated by the President, said that a judge who agrees with every 
opinion he reaches is probably a bad judge.
  The institution we serve has that fidelity to the Constitution that 
we must preserve, that we must guard. Guardians of the Constitution, 
which judges represent, is something we confirm. It is our job to make 
sure the kind of judges we place on courts represent the kind of judge 
Neil Gorsuch truly is.
  It is this temperament, this fidelity to the Constitution, this 
appropriate temperament, and remarkable humility that has made Judge 
Gorsuch a consensus pick in the past and, I believe, that could be a 
consensus pick in the near future.
  It is reflected in the fact that, on February 23, Senator Bennet and 
I, along with the Judiciary Committee, received a letter from 
Colorado's diverse legal community in support of Judge Gorsuch's 
nomination to the Supreme Court.
  The letter reads as follows:

       As members of the Colorado legal community, we are proud to 
     support the nomination of Judge Neil Gorsuch to be our next 
     Supreme Court Justice. We hold a diverse set of political 
     views as Republicans, Democrats, and Independents. Many of us 
     have been critical of actions taken by President Trump. 
     Nonetheless, we all agree that Judge Gorsuch is exceptionally 
     well qualified to join the Supreme Court. He deserves an up-
     or-down vote.
       We know Judge Gorsuch to be a person of utmost character. 
     He is fair, decent, and honest, both as a judge and as a 
     person. His record shows that he believes strongly in the 
     independence of the judiciary. Judge Gorsuch has a well-
     earned reputation as an excellent jurist. He voted with the 
     majority in 98% of the cases he heard on the 10th Circuit, a 
     great portion of which were joined by judges appointed by 
     Democratic Presidents. Seven of his opinions have been 
     affirmed by the U.S. Supreme Court--four unanimously--and 
     none has been reversed.
       We ask that Colorado's Senators join together and support 
     this highly qualified nominee from Colorado. Regardless of 
     the politics involved in prior confirmation efforts, 
     including what many consider to be the mistreatment of Judge 
     Garland's nomination, a filibuster now will do Colorado no 
       Judge Gorsuch deserves a fair shake in the confirmation 
     process. Please vote against a filibuster and vote for Judge 
     Gorsuch's confirmation to the Supreme Court.

  This letter from James Lyons is another such letter talking about the 
importance of the confirmation of Judge Gorsuch. I couldn't agree more 
with this letter and the letter that I read.
  Judge Gorsuch is an exceptionally qualified jurist, to use their 
words, and he deserves a fair shake in the confirmation process that 
includes a timely up-or-down vote.
  I ask unanimous consent that this letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                 February 7, 2017.
     Hon. Chuck Grassley,
     Chairman, Committee on the Judiciary,
     U.S. Senate.
       Dear Senator Grassley: I write this letter in strong 
     support of the nomination and confirmation of Judge Neil 
     Gorsuch for Associate Justice of the United States Supreme 
       Judge Gorsuch has been known to me professionally for over 
     twenty years, and his family even longer. In the mid-
     nineties, we were counsel together in successfully 
     representing co-defendants in a major securities matter 
     involving class action and derivative lawsuits in several 
     jurisdictions across the country as well as SEC and 
     Congressional investigations. Over the course of that complex 
     representation in the following years, I came to observe 
     first-hand his considerable lawyering skills, intellect, 
     judgment and temperament. He was one of the finest trial 
     lawyers with whom it has been my pleasure to be associated in 
     my career. We also became personal and good friends which 
     continued during the following years at his firm, later 
     during his time at the Department of Justice and since 
     returning to Denver to serve on the bench.
       I was delighted by his appointment to the U.S. Court of 
     Appeals for the Tenth Circuit based here in Denver. (He 
     honored me by having me be one of two lawyers to introduce 
     him to the court at his formal investiture.) Over his years 
     of service on that court, he has distinguished himself with 
     his work ethic, keen and thorough understanding of the case 
     under review, his formidable analytical ability, and the 
     clarity of his opinions. I have read many of his opinions and 
     watched him in oral argument. He is engaging, courteous to 
     counsel and demonstrates a full and unusual appreciation for 
     the human impact of his decisions on the people involved. 
     These are the qualities of an outstanding jurist.
       Judge Gorsuch has been active and an important voice in the 
     legal community and academy. He has written extensively, 
     lectured and taught in continuing legal education seminars 
     and served on the important federal Rules Committee, among 
     others. He also has found time to sit on student moot courts 
     and teach both ethics and federal jurisdiction at the 
     University of Colorado Law School. He is regularly regarded 
     by his students as one of their very best law professors--
     effective, challenging and personable.
       Judge Gorsuch's intellect, energy and deep regard for the 
     Constitution are well known to those of us who have worked 
     with him and have seen first-hand his commitment to basic 
     principles. Above all, his independence, fairness and 
     impartiality are the hallmarks of his career and his well-
     earned reputation.
                                                   James M. Lyons.

  Mr. GARDNER. Mr. President, I look forward to working with my 
colleagues across the aisle to make sure we fill this vacancy on the 
Supreme Court with one of this Nation's truly brilliant legal minds.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.

[[Page S1718]]


  Mr. MORAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Kennedy). Without objection, it is so 

                             Cuba Trade Act

  Mr. MORAN. Mr. President, I come to the floor today to speak about 
legislation I have recently introduced, although it is a follow-on to 
legislation I pursued over a number of years.
  We have now introduced in this Congress the Cuba Trade Act. This is 
legislation which would lift the trade embargo to allow farmers and 
ranchers and small businesses and other private sector industries to 
freely conduct business, to sell products--agricultural products in 
particular--to the nation of Cuba and to its people.
  Last month, I spoke about the terrific difficulties our farmers in 
Kansas and across the country are facing due to low commodity prices. 
The farm economy has fallen by nearly 50 percent since 2013, and that 
decline is expected to continue in 2017, making this perhaps, if not 
the worst, certainly one of the worst economic downturns in farm 
country since the Great Depression.
  In 2016, harvests in our State and across much of the country were 
recordbreaking yields and historic in their magnitude, in fact. What 
that means is there are still piles of wheat, corn, and other grains 
all across Kansas just sitting on the ground next to the grain mill 
bins that are already filled to capacity. To sell this excess supply, 
our farmers need more markets to sell the food and fiber they produce.
  Approximately 95 percent of the world's customers live outside U.S. 
borders. Markets in the United States will continue to grow, and they 
will evolve and will continue to meet the domestic consumer demand, 
providing the best, highest quality, safest food supply in the world, 
but in order to boost prices for American farmers, we need more 
markets. We need them now, we need them in the future, and we need to 
be able to indicate to our farmers that hope is in the works in global 
  We have talked about the importance of trade, of exports from the 
United States, and particularly for the citizens of Kansas. That is 
particularly true for an agricultural State like ours where, again, 95 
percent of the consumers live someplace outside of the United States. 
Cuba is only 90 miles off our border. They offer the potential for 
increased exports of all sorts of products but especially Kansas wheat.
  In fact, while we are introducing this legislation now, we started 
down this path to increase our ability to sell agriculture commodities, 
food, and medicine to Cuba back when I was a Member of the House of 
Representatives. I offered an amendment then to an appropriations bill 
that lifted the embargo--the ability to sell; it would allow the 
ability to sell those foods, agricultural commodities, and medicine to 
Cuba for cash, up front. That bill was passed. It was controversial 
then. This issue of what our relationship ought to be with Cuba has 
always been contentious. But I remember the vote was about I think 301 
to 116. A majority of Republicans and a majority of Democrats said it 
is time to do something different with our relationship with Cuba.
  This was a significant step in opening up the opportunity to the 
products of American farmers and ranchers to that country. No longer 
were food, medicine, and agriculture commodities prohibited from being 
sold. And it worked for a little while, but unfortunately, in 2005, the 
Treasury Department changed the regulations, and it complicated the 
circumstances related to the embargo.
  Cuba imports the vast majority of its food. In fact, wheat is Cuba's 
second largest import, second only to oil.
  A point I would stress is that this is a unilateral sanction. Keep in 
mind that when we don't sell agricultural commodities to Cuba, somebody 
else does. While our unilateral trade barriers block our own farmers 
and ranchers from filling the market, willing sellers such as Canada, 
France, China, and others benefit at American farmers' expense. When we 
can't sell wheat that comes from a Kansas wheat field to Cuba, they are 
purchasing that wheat from France and Canada and other European 
countries. When the Presiding Officer's rice crop can't be sold to 
Cuba, it is not that they are not buying rice; they are buying it from 
Vietnam, China, or elsewhere.

  It costs about $6 to $7 per ton to ship grain from the United States 
to Cuba. It costs about $20 to $25 to ship that same grain from the 
European Union. However, we lose this competitive advantage because of 
the regulations in place that drive up the cost of Cuban consumers 
dealing with the United States.
  To understand what we are missing out on in Cuba, consider our 
current trade relationship with the Dominican Republic. The DR is also 
a nearby Caribbean nation with a population comparable to Cuba. Income 
levels and diet are similar. Between 2013 and 2015, the Dominican 
Republic imported an average of $1.3 billion of U.S. farm products. 
During that same time span, Cuba imported just $262 million--over $1 
billion in difference. That is right. That is $1 billion of exports 
that U.S. farmers are missing an opportunity on because of the U.S. 
trade restrictions on Cuba. This example helps illustrate the 
substantial potential that exists for increased sale of agriculture 
commodities to Cuba.
  The Cuba Trade Act I just introduced simply seeks to amend our own 
country's laws so that American farmers can operate on a level playing 
field with the rest of the world. While boosting American exports 
remains the primary goal of lifting the embargo, I also think there is 
an opportunity for us to increase the reforms and to improve the lives 
of the Cuban people as well.
  I have often said here on the Senate floor and on the House floor and 
back home in Kansas we often say: We will try something once. If it 
doesn't work, we might even try it again. Maybe we will try it a third 
or a fourth time. But after more than 50 years of trying to change the 
nature of the Cuban Government through this kind of action, through 
this embargo, many Kansans would say it is time to try something else.
  The Cuban embargo was well-intentioned at the time it was enacted. 
Today, however, it only serves to hurt our own national interests by 
restricting Americans' freedom to conduct business with that country. 
In my view, it is time to make a change, and we ought to be able to 
sell wheat, rice, and other agricultural commodities from the United 
States for cash to Cuba. This legislation would allow that at no 
expense to the American taxpayer.

                            Kansas Wildfires

  Mr. President, there is a lot to be proud about in being a Kansan. We 
have lots of challenges in our State, and we are undergoing serious 
ones at the moment. For those who have noticed on the news, although it 
is not particularly a story here in the Nation's Capital, Kansas is 
ablaze. Fires are devastating acres and acres. In fact, nearly 700,000 
acres of grasslands in our State have been burned. Fires have started. 
We have had winds for the last 3 days of 50 to 60 miles an hour, and 
dozens of communities and counties have been evacuated. Lots of places 
have been hard hit. My home county of Rooks experienced those fires. 
Hutchinson, a community of 50,000 people, had to evacuate 10,000 people 
in what we would consider in our State a pretty big place. So they have 
been rampant and they have been real, and there have been significant 
consequences to many lives in our State.
  As people know, Kansas is an agriculture place. We raise lots of 
crops, but we are certainly a livestock State, and our ranchers are 
experiencing the significant challenges that come from loss of pasture, 
the death of their cattle, and the burning of their fences.
  On my way over here, I was reading a couple of articles that appeared 
in the Kansas press that I wanted to bring to my colleagues' attention. 
There is nothing here that necessarily asks for any kind of government 
help, but it does highlight the kind of people I represent.
  There is a farm in Clark County. The county seat is Ashland. It is on 
the border with Oklahoma. Eighty-five percent of the county's 
grassland, 85 percent of the acres in that county have been burned. 
This means the death of hundreds, if not thousands, of cattle in that 
county. That is the economic driver of the communities there. Ashland, 
the county seat, has a population of

[[Page S1719]]

about 900 or 1,000--the biggest town in the county--and its future 
rests in large part upon what happens in agriculture.
  There are lots of great ranch families in our State. One of those is 
the Gardiners. The Gardiner Ranch is in Clark County. Their story is 
told a bit in today's edition of the Wichita Eagle. They are known as 
some of the best ranchers in the country. For more than 50 years, they 
have provided the best Angus cattle. They have customers across the 
country. It is a family ranch. This is multigenerational, and three 
brothers now ranch together. It is not an unusual way that we do 
business in Kansas.
  In addition to the economic circumstances that agriculture presents 
in our State, it is one of the reasons I appreciate the opportunity to 
advocate on behalf of farmers and ranchers. It is one of the last few 
places in which sons and daughters work side by side with moms and 
dads, and grandparents are involved in the operation. Grandkids grow up 
knowing their grandparents. There is a way of life here that is 
important to our country. Our values, our integrity, and our character 
are often transmitted from one generation to the next in this 
circumstance because we are still able to keep the family together, 
working generation to generation. The Gardiners are an example of that, 
but there are hundreds of Kansans who exemplify this.
  I would like to tell the story of Mr. Gardiner, as reported by the 
Wichita Eagle. Mr. Gardiner said that he was slowly driving by some of 
his estimated 500 cattle that had died in this massive wildfire, and he 
complained on their behalf that they never had a chance. The fire was 
so fast. His ranch, as I said, is one of the most respected. The 
quality of the family's Angus cattle has been a source of pride and 
national attention for more than 50 years.
  Like others, the Gardiners have endured plenty of bumps--and this is 
him telling their story--over five generations of ranching. The drought 
and dust of the 1930s was tough, he said, and there were even drier 
times in the 1950s. About 5 years ago, there was another drought in our 
State that was so devastating. He said his family lost 2,000 acres when 
they couldn't make a payment to the bank. Blizzards in 1992 killed a 
lot of cattle.
  My point is that nothing is easy about this life, but there is 
something so special about it. The point I want to make is that people 
are responding to help, and I thank Kansans and others from across the 
country who are responding to the disasters that are occurring across 
our State throughout this week and into the future. This isn't expected 
to go away anytime soon.
  Mr. Gardiner said that more hay is on the way, and the process of 
rebuilding fences will begin, hopefully, within a few weeks. He said he 
was sent word that Mennonite relief teams were coming from two Eastern 
States to work on his fences and to do so without pay. Truckloads of 
hay are already en route and rolling in. This story indicates that many 
of those truckloads of hay are coming from ranchers who in the past 
have bought livestock from the Gardiners.
  Mr. Gardiner's veterinarian, Randall Spare, said that the Gardiners 
have long been known for taking exceptional care of their customers. 
The veterinarian says, ``Now it's their turn'' for the customers to 
repay them. ``The Gardiners are the cream of the crop, like their 
cattle. I'm not surprised so many people [from so many places] are 
wanting to help them.''
  The reporter says that while he was talking to Mr. Gardiner for this 
interview, Mr. Gardiner answered his cell phone as his pickup slowly 
rolled across a landscape that now looked so barren. The reporter said 
that many of the calls were from clients who just called to send their 
best or to be brought up to date and to ask the Gardiners how they 
could help and how the Gardiners were holding up.
  Mr. Gardiner said:

       It's really something [special], when you hear a pause on 
     the other end of the line and you know it's because [the 
     person who called is] crying because they care that much. It 
     gets like that with ranching. It's like we're all family.

  That is a great thing about our State. It is like that with Kansas. 
We are all a family. But the fact is that his family is still alive. He 
tells the story of not knowing whether his brother and his wife were 
alive. The fire swept around them, but they found a place that avoided 
the fire, a wheat field where the wheat was still green and so short 
that the fire didn't intrude. But he stopped his truck to think a bit 
and, the story indicates, to sob a bit.
  He watched as his brother Mark and his wife Eva disappeared behind a 
wall of fire as they tried to save their horses and dogs at their home. 
Ultimately, the house was destroyed. Mr. Gardiner, the one the reporter 
was talking to, said:

       I had no choice but to turn around and drive away, with the 
     fire all around me. For a half-hour I didn't know if my 
     brother and his wife were dead or alive. I really didn't.

  He said that then his brother and his wife and some firefighters 
gathered in the middle of that wheat field. It was so short and so 
green, it wouldn't burn. He said:

       It was so smoky I didn't even know exactly where we were 
     at. But then a firefighter came driving by and told us 
     everybody made it out. That's when I knew Mark and his wife 
     were alive. That's when I knew everything would eventually be 
     all right. I am telling you, that's when you learn what's 
     really important.

  So today I come to the Senate floor to express my gratitude for the 
opportunity to represent Kansans like the Gardiners, farmers and 
ranchers across our State but city folks, as well, who know the 
importance of family, who know that living or dying is an important 
aspect of life but that how they live is more important, and to thank 
those people--not just from Kansas but from across the country--who 
have rallied to the cause to make sure there is a future for these 
families and for the farming and ranching operations.
  It is a great country in which we care so much for each other, and 
that is exemplified in this time of disaster that is occurring across 
my State. I am grateful to see these examples, and I would encourage my 
colleagues that we behave the way Kansas farmers and ranchers do--live 
life for the things that are really meaningful and make sure we take 
care of each other.
  Mr. President, 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. MORAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                             Cloture Motion

  The PRESIDING OFFICER. Pursuant to rule XXII, the Chair lays before 
the Senate the pending cloture motion, which the clerk will state.
  The bill clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     do hereby move to bring to a close debate on the nomination 
     of Seema Verma, of Indiana, to be Administrator of the 
     Centers for Medicare and Medicaid Services, Department of 
     Health and Human Services.
         Mitch McConnell, Steve Daines, John Cornyn, Tom Cotton, 
           Bob Corker, John Boozman, John Hoeven, James Lankford, 
           Roger F. Wicker, John Barrasso, Lamar Alexander, Orrin 
           G. Hatch, David Perdue, James M. Inhofe, Mike Rounds, 
           Bill Cassidy, Thom Tillis.

  The PRESIDING OFFICER. By unanimous consent, the mandatory quorum 
call has been waived.
  The question is, Is it the sense of the Senate that debate on the 
nomination of Seema Verma, of Indiana, to be Administrator of the 
Centers for Medicare and Medicaid Services, shall be brought to a 
  The yeas and nays are mandatory under the rule.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Georgia (Mr. Isakson), and the Senator from Florida (Mr. 
  Further, if present and voting, the Senator from Florida (Mr. Rubio) 
would have voted ``yea.''
  The PRESIDING OFFICER. (Mr. Perdue). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 54, nays 44, as follows:

[[Page S1720]]


                       [Rollcall Vote No. 85 Ex.]




     Cortez Masto
     Van Hollen

                             NOT VOTING--2

  The PRESIDING OFFICER. On this vote, the yeas are 54, the nays are 
  The motion is agreed to.
  The Senator from Kansas.
  Mr. MORAN. Mr. President, I ask unanimous consent that 
notwithstanding the provisions of rule XXII, following leader remarks 
on Monday, March 13, the Senate resume executive session for the 
consideration of Executive Calendar No. 18, and that the vote on 
confirmation occur at 5:30 p.m.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. MORAN. Mr. President, on behalf of the majority leader, there 
will be no further votes this week in the U.S. Senate.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. WYDEN. 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. WYDEN. Mr. President and colleagues, today the Senate turns to 
consider the nomination of Seema Verma to be the Administrator of the 
Centers for Medicare and Medicaid Services.
  I would be the first to say that in coffee shops across the land, 
people are not exactly buzzing about the office known as CMS, but the 
fact is, this is an agency that controls more than a trillion dollars 
in healthcare spending every year. Even more important and more 
relevant right now, if confirmed, and if TrumpCare somehow gets rammed 
through the Congress over loud and growing opposition, this is going to 
be a major issue on her plate right at the get-go.
  I thought it would be useful to just give one example of the 
connection involved in this legislation. TrumpCare cuts taxes for the 
special interests and the fortunate few by $275 billion, stealing a 
chunk of it from the Medicare trust fund that pays for critical 
services to the Nation's older people.
  If TrumpCare passes and Ms. Verma is confirmed, under section 132 of 
the bill, she would be able to give States a green light to push the 
very frail and sick into the high-risk pools that have historically 
failed at offering good coverage to vulnerable people at a price they 
can afford. Under section 134 of TrumpCare, Ms. Verma would be in 
charge of deciding exactly how skimpy TrumpCare plans would be and how 
much more vulnerable people would be forced to pay out of their pockets 
for the care they need.
  Under section 135 of the bill, if confirmed, Ms. Verma could be 
paving the way for health insurers to make coverage more expensive for 
older people approaching retirement age.
  Given all that, I want Members to understand there is a real link 
between this nomination and the debate about TrumpCare, and this is, in 
effect, the first discussion we have had about TrumpCare since these 
bills started to get moving without any hearings and getting advanced 
in the middle of the night.
  The odds were against Republicans writing a single piece of 
legislation that would make healthcare more expensive, kick millions 
off their coverage, weaken Medicare and Medicaid, and produce this 
Robin Hood in reverse, this huge transfer of wealth from working people 
to the fortunate. Nobody thought you could do all of that at the same 
time, but somehow the majority found a way to do it. Republicans are 
rushing to get it passed before the American people catch on.
  As part of this debate about Seema Verma, we are going to make sure 
people understand this nomination is intertwined with what happens in 
the discussion about TrumpCare and how these particularly punitive 
provisions with respect to Medicare and Medicaid would affect our 
  For 7 years, my colleagues on the other side have pointed to the 
Affordable Care Act as pretty much something that would bring about the 
end of Western civilization and, at a minimum, would basically continue 
a system responsible for every ill in our healthcare system. That was 
the argument. The Affordable Care Act is responsible for just about 
every ill and will practically be the end of life as we know it.
  Their slogan was to ``repeal and replace,'' and it was a slogan they 
rode through four elections to very significant success. The only 
problem was, it was really repeal and run, and that replacement was 
nowhere in sight. Now the curtain has been lifted. The lights are 
shining on TrumpCare, and it sure looks to me like there are a lot of 
people not enjoying the movie. TrumpCare goes back to the days when 
healthcare in America mostly worked for the healthy and the wealthy.
  We have a lot of debate ahead, so we are not going to just lay it all 
out here in one shot.
  I do want to mention some key points on the roll that Ms. Verma, if 
confirmed, would play. I want to start by addressing what this means in 
terms of dollars and cents.
  If you look at the fact that the Medicare tax, which everybody pays 
every single time they get a paycheck, and that money is used to 
preserve this program that is the promise of fairness to older people--
the Medicare tax would be cut for only one group of Americans in this 
bill. I find this a staggering proposition. The people who need it the 
least, couples with incomes of over $250,000, people who need it the 
least would be given relief from the Medicare tax--not working 
families, just the wealthy.
  As I indicated, we are talking all told about $275 billion worth of 
tax cuts to the special interests and the fortunate few, and it is 
largely paid for by taking away assistance to working people to help, 
for example, pay for their premiums.
  I brought up the ACA Medicare payroll tax for a reason because I 
think when Americans look at their next paycheck--if you are a cop or a 
nurse and you get paid once or twice a month and you live, say, in Coos 
Bay, OR, or in Medford, another Oregon community, you will see it on 
your paycheck. If you are a cop or a nurse, no tax relief for you, but 
if you make over $250,000--on a tax that is used to help strengthen 
Medicare's finances, at a time when we are having this demographic 
revolution--the relief goes to people right at the top, and you reduce 
the life expectancy of the trust fund for 3 years.
  The first thing I will say with respect to what this means, the 
provision I have just outlined breaks a clear promise made by then-
Candidate Trump not to harm Medicare.
  I remember these commercials--we all saw scores and scores of them--
Candidate Trump said to America's older people--many of whom voted for 
him, I think, to a great extent because they heard this promise--he 
said: You know, you have worked hard for your Medicare. We are not 
going to touch it. We are not going to mess with it.
  When the President was asked about cutting Medicare, here is what he 
said: Medicare is a program that works. People love Medicare, and it is 
unfair to them. I am going to fix it and make it better, but I am not 
going to cut it.
  The President of the United States said he is not going to cut it.
  Well, that promise not to harm Medicare lasted 6\1/2\ weeks into the 
Trump administration so the wealthy--the wealthy--could get a tax 
reduction, the fortunate few who need it least, and

[[Page S1721]]

the effect would be to cut by 3 years the life of the Medicare trust 
  I think that ought to be pretty infuriating and concerning for people 
who work hard--cops and nurses and people who are 50, 55, 60 today. 
They are counting on Medicare to be around when they retire, but 
because TrumpCare made it a focus to give tax relief to the fortunate 
few, that tax relief cuts 3 years off the life of the Medicare trust 
  If that wasn't enough, people who are 50, 55, 60, before Medicare, 
they are going to get another gut punch. This one is in the form of 
higher costs.
  In parts of my home State--particularly in rural areas like Grant 
County, Union County, and Lake County--I am sure I am going to hear 
about this. I have townhall meetings in each one of my counties. A 60-
year-old who makes $30,000 a year--now those are the people we have 
long been concerned about, particularly people between 55 and 65 
because they are not yet eligible for Medicare.
  A 60-year-old, in communities like I just mentioned, who makes 
$30,000 a year, could see their costs go up $8,000 or more. The reason 
that is the case is a big part of TrumpCare. It is based on something 
we call an age tax.

  Back in the day when I was the director of the Oregon Gray Panthers--
and I was really so fortunate at a young age to be the director of the 
group for close to 7 years--we couldn't imagine something like the hit 
on vulnerable older people that this age tax levies. Republicans want 
to give the insurance companies the green light to charge older 
Americans five times as much as they charge younger Americans. The 
reality is that older people are going to pay a lot more under 
TrumpCare. That is what we were trying to prevent all those years with 
the Gray Panthers. We didn't want to see older people pay more for 
their healthcare, the way they are going to under TrumpCare if they are 
50 or 55 or 60.
  I think the real question is whether they are going to be able to 
afford insurance at all. The reality is that a lot of those older 
people whom I have just described--and I have met them at my townhall 
meetings--every single week they are walking on an economic tightrope. 
They balance their food costs against their fuel costs and their fuel 
costs against their rent costs. Along comes TrumpCare and pushes them 
off the economic tightrope where they just won't be able to pay the 
bills, particularly older people in rural areas.
  So the reality is that it is expensive to get older in America, and 
we ought to be providing tools to help older people. But what TrumpCare 
does is, instead of giving tools to older people to try to hold down 
the costs, TrumpCare basically empties the toolbox of assistance and 
basically makes older people pay more.
  Next, I want to turn to the Medicaid nursing home benefit. Working 
with senior citizens, I have seen so many older people--the people who 
are on an economic tightrope, who are scrimping and saving--even as 
they forego anything that wouldn't be essential, burn through their 
savings. So when it is time to pay for nursing home care, they have to 
turn to Medicaid. The Medicaid Program picks up the bill for two out of 
every three seniors in nursing homes.
  Now, today the Medicaid nursing home benefit comes with a guarantee. 
I want to emphasize that it is a guarantee that our country's older 
people will be taken care of. All of those folks--the grandparents whom 
we started working for in those Gray Panther days--had an assurance 
that grandparents wouldn't be kicked out on the street. TrumpCare ends 
that guarantee.
  You could have State programs forced into slashing nursing home 
budgets. You could see nursing homes shut down and the lives of older 
people uprooted. We could, in my view, have our grandparents that are 
depending on this kind of benefit get nickeled and dimed for the basics 
in home care that they have relied on.
  When it comes to Medicaid, TrumpCare effectively ends the program as 
it exists today, shredding the healthcare safety net in America. It 
doesn't only affect older people in nursing homes. It puts an 
expiration date--a time stamp--on the Medicaid coverage that millions 
of Americans got through the Affordable Care Act. For many of those 
vulnerable persons, it was the first time they had health insurance. So 
what TrumpCare is going to come along and do is to put a cap on that 
Medicaid budget and just squeeze them down until vulnerable persons' 
healthcare is at risk.
  If low-income Americans lose their coverage through Medicaid, it is a 
good bet that the only TrumpCare plans they will be able to afford are 
going to be worth less than a Trump University degree.
  I want to move next to the effects of the bill on opioid abuse. 
Clearly, by these huge cuts to Medicaid, TrumpCare is going to make 
America's epidemic of prescription drug abuse-related deaths even 
worse. Medicaid is a major source of coverage for mental health and 
substance use disorder treatment, particularly after the Affordable 
Care Act, but this bill takes away coverage from millions who need it. 
We have had Republican State lawmakers speaking out about this issue as 
well as several Members of the majority in the Congress.
  Colleagues, just about every major healthcare organization is telling 
the Congress not to go forward with the TrumpCare bill--physicians, 
hospitals, AARP--that is just the beginning. But the majority is just 
charging forward, rushing to get this done as quickly as possible.
  We are going to have more to say about these issues.
  I see my colleagues here.
  To close, just by intertwining, how this appointment is going to be a 
key part of the discussion of TrumpCare revolves around the questions 
we asked Ms. Verma.
  For example, I was trying to see if this bill would do anything to 
help older people hold down the cost of medicine. Now we have heard the 
new President talk about how he has all kinds of ideas about 
controlling the cost of medicine. Here was a bill that could have done 
something about it.
  I see my colleagues, Senator Stabenow and Senator Cantwell.
  I said to the nominee: I would be interested in any idea you have--
any idea you have--to hold down the cost of medicine. On this side we 
have plenty of ideas. We want to make sure that Medicare could bargain 
to hold down the cost of medicine. We have been interested in policy to 
allow for the importation of medicine. We said: Let's lift the veil of 
secrecy on pharmaceutical prices.
  I asked Ms. Verma: How about one idea--just one--that you would be 
interested in that would help older people with their medicine costs. 
She wouldn't give us one example.
  I am going to go through more of those kinds of questions, because 
the reality is--and I see Senators Stabenow and Cantwell here--that 
what we got in the committee was essentially healthcare happy talk. 
Every time we would ask a question, she would say: I am for the 
patients; I want to make sure everybody gets good care.
  So I thank my colleagues, and I yield for Senator Cantwell.

  The PRESIDING OFFICER. The Senator from Washington.
  Ms. CANTWELL. Mr. President, will the Senator yield for a question?
  Mr. WYDEN. Of course.
  Ms. CANTWELL. Mr. President, I ask this of my colleague, the Senator 
from Oregon, because Washington, Oregon, and so many other States spend 
so much time innovating. The proposal we are seeing coming out of the 
House of Representatives really isn't innovation. I like to say that if 
you are looking at this, just at the specifics, the per capita cap is 
really just a budget mechanism. It doesn't have anything to do with 
innovation. It just has to do with basically triggering a cut to 
Medicaid and shifting that cost to the States. My concern is that we 
already do a lot with a lot less, and we know how to innovate. We would 
prefer that the rest of the country follow that same model. I would ask 
the Senator from Oregon: Do you see any innovation in this model, in 
capping and cutting the amount of Medicaid and shifting that to the 
  Mr. WYDEN. My colleague from Washington is ever logical.
  When I looked at this, I thought of it as an innovation desert 
because I was looking for some new, fresh ideas. We have seen some of 
them from Senator Cantwell's State, and I think the Senator from 
Washington makes a very

[[Page S1722]]

important point with that poster because the reality is that this is a 
cap. This is a limit on what States are going to get. As I touched on 
in my comments, I think what is going to happen is this cap is not 
going to be enough money for the needs. I think this is going to slash 
the help for nursing home care under Medicaid, which pays two-thirds of 
the bill, and I think the nursing home care under this flawed TrumpCare 
proposal is going to get nickeled and dimed.
  My colleague from Washington is right. I tried to read section by 
section, and we have read it several times. But we wanted to make sure 
to look--to my colleague's point--for innovation, and this proposal is 
an innovation desert.
  Ms. CANTWELL. I ask the Senator from Oregon this through the 
Presiding Officer. The innovation that was already in the Affordable 
Care Act really did address the Medicaid population, in which so much 
of that cost is for long-term care and nursing home care. So Medicaid 
equals long-term care for so many Americans. In the Affordable Care Act 
we accelerated the process of shifting the cost to community-based care 
because it is more convenient for patients and up to one-third of the 
cost of a nursing home. So if we keep more people in their homes, that 
is better innovation.
  In the Affordable Care Act, we incentivized States. In fact, we had 
21 States take us up on that--including Arkansas, Connecticut, Georgia, 
Iowa, Kentucky, Louisiana, New Hampshire, Texas, Ohio, Nevada, 
Nebraska. There are many States that are doing this innovation and 
basically trying to move the Medicaid population to community-based 
care so we can save money.
  Savings from rebalancing could make up for a large portion of the 
money the House is trying to cut in this bill. Basically, they are not 
saving the money. They are shifting the burden to the States, instead 
of giving innovative solutions to people to have community-based care; 
that is, long-term care services and staying in their home longer. Who 
doesn't want to stay in their home longer? Then we support them through 
community-based delivery of long-term healthcare services, and we save 
the Nation billions of dollars.
  In fact, our State did this over a 15-year period of time, and we 
saved $2.7 billion. That is the kind of innovation we would like to 
see. But instead of implementing the innovation we started in the 
Affordable Care Act, they are trying to cap the Medicaid funding, which 
basically is changing the relationship from a mutually supported State 
and Federal partnership to a capped federal block grant. They are just 
saying: We are going to cost-shift this burden to you the States.
  I saw that the Center on Budget and Policy Priorities analyzed the 
current House proposal and found it would result in a $387 billion cost 
shift to the States. Does the Senator from Oregon think that Oregon has 
the kind of money to take its percentage of that $370 billion?
  To my colleague from Michigan: Does the Senator think the State of 
Michigan has the dollars to take care of that Medicaid population with 
that level of a cut?
  Ms. STABENOW. If I might lend my voice on this and thank both of my 
colleagues. Senator Cantwell has been the leader in so many ways on 
innovation in the healthcare system as we debated next to each other in 
the Finance Committee on the Affordable Care Act.
  I wanted to share that in Michigan, where we expanded Medicaid, 
because of changes that have been made and work that is being done in 
the budget going forward in the new year, there is now close to $500 
million more in the State of Michigan budget than was there before 
because of Medicaid expansion and the ability to manage healthcare 
risk. People have more healthcare coverage. We actually have 97 percent 
of the children in Michigan who can see a doctor today, which is 
incredible. At the same time the State is going to save close to $500 
million in the coming year's budget.
  Mr. WYDEN. If I can add this, because I think my colleagues are 
making a very important point. If you look at the demographics, there 
are going to be 10,000 people turning 65 every day for years and years 
to come. Senators Stabenow and Cantwell are making a point about 
flexibility. The reality is, if I look at the demographic picture, we 
are going to need more out of a lot of care options--institutional 
care, community-based coverage. But I think the point Senator Cantwell 
started us on is that, at a time when we have a demographic where we 
are going to need more for a variety of care options--a continuum of 
care--what my State is basically saying is that we are going to get 
less of everything. There is going to be less money for the older 
people who have nursing home needs. I am looking at a new document from 
the Oregon Department of Human Services, and it indicates that we are 
going to lose substantial amounts--something like $150 million for 
community-based kinds of services. So I appreciate the point my two 
colleagues are making.
  Ms. CANTWELL. Mr. President, if I could, I will ask the Senator from 
Oregon one more question, and maybe my other colleagues will join in.
  When you do not realize the savings and you cost-shift to the States, 
some of the key populations that you hurt are pregnant women and 
children. We do not want to have less money. If you think about 
Medicaid, pregnant women and children are a big part of the population.
  I know our colleague from Pennsylvania has joined us, and he has been 
a champion for the Children's Health Insurance Program--CHIP--and 
everything that we do for women and children. I don't know if he has 
seen this in his State. I don't know if the Senator from Oregon or the 
Senator from Michigan or the Senator from Pennsylvania wants to comment 
on this--on the notion that we are not realizing the savings from 
delivery innovations like rebalancing, and then figuring out how to 
best utilize those for the delivery of the services that so many people 
are counting on. With a per capita cap, you are really going to be 
starting in a very bad place with the people who need these resources 
the most, and when it comes to Medicaid, women and children are front 
and center in this debate.
  I hate the fact that somebody is going to cost-shift to the States, 
that the States are not going to have enough money, and then the very 
people who would end up paying the price are the women and children. I 
don't know if the Senator from Oregon, the Senator from Michigan, or 
the Senator from Pennsylvania wants to comment on that.
  Ms. STABENOW. I thank the Senator very much. I will say this briefly 
and then turn to our colleague from Pennsylvania, who has been such a 
champion for children.
  I would say first--again, as I said a moment ago--that, because of 
Medicaid, because of the healthcare expansion, 97 percent of the 
children in Michigan now can see a doctor. That means moms who are 
pregnant and babies, and moms and dads are less likely to be going to 
bed at night and saying: Please, God, do not let the kids get sick, 
because they can actually go to a doctor.
  It reminds me, though, of the other thing happening on the floor and 
the larger question of the nominee for the Centers for Medicare and 
Medicaid Services. In the larger context, I asked her about whether or 
not maternity care and prenatal care should be covered as a basic 
healthcare requirement for women. I mean, it is pretty basic for us. 
She wouldn't answer the question. Essentially, she said women can buy 
extra if they want it. The new Secretary of Health and Human Services 
said that we, as women, can buy extra coverage for basic healthcare 
coverage for us. So it all comes together--Medicaid, the nominee on the 
floor, and what the House is doing to take away maternity care. It is 
really just bad news for moms and babies.
  Mr. WYDEN. I would only add that what we learned in our hearings and 
in our discussion is that women, particularly the women served by the 
Medicaid Program, are really dealing with the consequences of opioid 
addiction as well.
  In our part of the world, I would say to Senator Stabenow and Senator 
Casey--in Oregon and Washington--we feel like we have been hit with a 
wrecking ball with this opioid problem. Again, when Senator Cantwell 
talks about shifting the costs, she is not talking about something 
abstract. This

[[Page S1723]]

is going to take away money for opioid treatment.
  So I am very pleased that my colleague is making these points, and I 
look forward to the presentation.
  Mr. CASEY. Mr. President, I thank Senator Cantwell for raising the 
issue about the impact of this decision that the Congress will make 
with regard to a particular healthcare bill and then also, 
particularly, the Medicaid consequences.
  I was just looking at what is a 2-page report that was just produced 
today and that I was just handed from the Center on Budget and Policy 
Priorities. It is State specific.
  In this case, looking at the data from Pennsylvania--I will not go 
through all of the data on Medicaid--just imagine that three different 
groups of Americans have benefited tremendously from the Medicaid 
Program every day. That is why what is happening in the House is of 
great concern to us.
  We have in Pennsylvania, for example--just in the number of 
Pennsylvanians who have a disability--722,000 Pennsylvanians with 
disabilities who rely upon Medical Assistance for their medical care. 
Medical Assistance is our State program that is in partnership with 
Medicaid. There are 261,000 Pennsylvania seniors who get their 
healthcare through Medicaid. Hundreds and hundreds of thousands of 
people who happen to be over the age of 65 or who happen to have a 
disability of one kind or another are totally reliant, on most days, on 
Medicaid. The third group, of course, is the children, and 33 percent 
of all of the births in Pennsylvania are births that are paid for 
through Medicaid.
  When we talk about this bill that is being considered in the House or 
when we talk about the confirmation vote for the Administrator for the 
Centers for Medicare and Medicaid Services, this is real life. What 
happens to this legislation and what happens on this nomination is 
about real life for people who have very little in the way of a bright 
future if we allow some here to do what they would like to do, 
apparently, to Medicaid.
  It sounds very benign to say that you want to cap something or that 
you want to block-grant. They are fairly benign terms. They are 
devastating in their impact, and we cannot allow it to happen. That is 
why this debate is so critical.
  I have more to say, but I do commend and salute the work by Senator 
Cantwell, Senator Stabenow, and Senator Wyden in fighting these 
  I will read just portions of a letter that I received from a mom in 
Coatesville, in Southeast Pennsylvania, about her son, Rowan. The mom's 
name is Pam. She wrote to us about her son, who is on the autism 
spectrum. In this case, she is talking about the benefits of Medicaid--
Medical Assistance we call it in Pennsylvania.
  Here is what she wrote in talking about the benefits that he 
receives. After he was enrolled in the program, she said that Rowan had 
the benefit of having a behavioral specialist consultant. That is one 
expert who was helping Rowan, who was really struggling at one point. A 
second professional they had helping him was a therapeutic staff 
support worker. So there was real expertise to help a 5-year-old child 
get through life with autism.
  Here is what his mom Pam wrote in talking about, since he was 
enrolled, how much he has benefited and how much he has grown and 

       He benefited immensely from the CREATE program by the Child 
     Guidance Resource Centers, [which is a local program in 
     Coatesville]. Thankfully, it is covered in full by Medicaid.

  She goes on to write the following, and I will conclude with this:

       Without Medicaid, I am confident I could not work full time 
     to support our family. We would be bankrupt, and my son would 
     go without the therapies he sincerely needs.

  Here is how Pam concludes the letter. She asks me, as her 
representative--as her Senator--to think about her and her family when 
we are deliberating about a nomination like this and about healthcare 
  She writes:

       Please think of us when you are making these decisions. 
     Please think about my 9-month-old daughter, Luna, who smiles 
     and laughs at her brother, Rowan, daily. She will have to 
     care for Rowan later in life after we are gone. Overall, we 
     are desperately in need of Rowan's Medical Assistance and 
     would be devastated if we lost these benefits.

  This is real life for people. Sometimes it is far too easy here in 
Washington for people to debate as if these things are theoretical--
that if you just cut a program or cap a program or block-grant a 
program, you are just kind of moving numbers around and moving policy 
around. This is of great consequence to these families, and we have to 
remember that when we are making decisions around here.
  Everyone who works in this building as an employee of the Federal 
Government gets healthcare. We do not have someone else around the 
country who is debating whether or not we are going to have healthcare, 
like those families on Medicaid are having to endure.
  I thank the Senator from Washington. I know that Senator Stabenow 
from Michigan may have more to add on this. We have a big battle ahead, 
but this is a battle that is not only worth fighting, but it is 
absolutely essential that we win the battle to protect and support 
  Ms. STABENOW. Mr. President, as Senator Wyden's colloquy comes to an 
end, I will make a few comments in addition to those of my colleagues, 
and I very much appreciate all of their work.
  There are so many different things to talk about as it relates to how 
healthcare impacts people. As Senator Casey said, this is very 
personal; it is not political. There are a lot of politics around this, 
but it is very, very personal.
  In Michigan, when we are talking about healthcare, in Medicaid alone 
we are talking about 650,000 people who have been able to get coverage 
now. Most of them are working in minimum wage jobs, and they now are 
able to get healthcare but couldn't before, as well as their children. 
That adds to the majority of seniors who are in nursing homes now, 
folks getting long-term care, folks getting help for Alzheimer's and 
other challenges and who are relying on Medicaid healthcare to be able 
to cover their costs.
  I want to share a letter, as well, from Wendy, a pediatric nurse 
practitioner from Oakland County in Michigan. We have received so many 
letters--I am so grateful for that--and emails.
  She writes:

       As a pediatric nurse practitioner, I have seen so many of 
     my patients benefit from the Affordable Care Act. Physical 
     exams for the kids are now covered in full, with no co-pay. 
     This means the kids are in to see us, which means we catch 
     healthcare issues and early problems with growth or 
     development that otherwise might be undetected and left 
     untreated until it became a much bigger problem.

  Isn't that what we all want for our children, to catch things early?

       Immunizations are covered, which keeps everyone safer. 
     Screening tests are covered, so potential problems are caught 
     while they can still be managed. This better care keeps kids 
     healthier and happier and prevents longer term care costs.

  She goes on to write:

       The Medicaid expansion means even more kids are covered, 
     keeping not only those children healthier but keeping 
     everyone around them healthier. Previously, parents of 
     children who did not have insurance coverage would not seek 
     care until the children were so ill that they could not see 
     another option. Frequently, these children then utilized 
     emergency room care--

  Which, by the way, is the most expensive way to treat health 

     [it was] not only a missed opportunity for complete and 
     preventative healthcare but at a cost passed on to the 
       On a much more personal level, in 2015, our granddaughter, 
     at age 3, was diagnosed with epilepsy related to a genetic 
     condition . . . which made her brain form abnormally. On top 
     of the epilepsy, she has developmental delays and autism, all 
     related to her double cortex syndrome. Although our daughter 
     and son-in-law are fully employed (teacher and paramedic), 
     she qualifies for Children's Special Health Care (under 
     Medicaid). This has been a huge blessing for us, and without 
     it our family would have been financially devastated.
       We are hopeful that my granddaughter will continue to have 
     good seizure control and will develop to reach her full 
     potential, but without the care that her private insurance 
     and Children's Special Health Care provides, she would not 
     have much of a chance of getting anywhere near her potential. 
     I do not want to even consider how it will affect her future 
     if insurance companies can refuse to cover her care due to 
     her preexisting condition.

  She concludes:

       Please do not let partisan politics take precedence over 
     doing what is right and what is best for the health of every 
     U.S. citizen.

  I know we are all getting hundreds of thousands of letters and emails 
and phone calls of very similar stories because healthcare is personal 
to each of

[[Page S1724]]

us--to our children, our grandchildren, our moms, and dads, and 
grandpas and grandmas. It is not political.
  I am very grateful for my colleagues' being here today. I want to 
speak not only about the importance of expansion under Medicaid but 
also about the person who would be in charge of that very, very 
important set of services. That is the nomination in front of us, that 
of Seema Verma to be the Administrator of the Centers for Medicare and 
Medicaid Services.
  This is a critical position, especially given the ongoing efforts 
that we are seeing right now to repeal healthcare--the Affordable Care 
Act--and replace it with legislation that would literally rip away 
coverage for millions of people and pull the thread that unravels our 
entire healthcare system. The decisions of the Administrator, both as 
an adviser to the President and as someone with the authority to make 
large changes in the implementation of existing law, will have far-
ranging consequences for all of us--certainly, for the people whom we 
represent and especially for those who need healthcare, have begun 
receiving it, and now may very well see it taken away.
  In the Finance Committee, when I asked Ms. Verma about Medicaid, I 
found that her positions would hurt families in Michigan, would hurt 
seniors in nursing homes, and would hurt children. And looking at her 
long record as a consultant on Medicaid, we know that Mrs. Verma's 
proposals limit healthcare coverage and make it harder to afford 
healthcare coverage, putting insurance companies ahead of patients and 
families once again.
  I am also very concerned about her position on maternity coverage. 
During the hearing, I asked Ms. Verma whether women should get access 
to basic prenatal care and maternity care coverage as the law now 
allows--I am very proud of having authored that provision in the 
Finance Committee--or whether insurance companies should get to choose 
whether to provide basic healthcare coverage for women. I reminded her 
that before the Affordable Care Act, only 12 percent of healthcare 
plans available to somebody going out to buy private insurance offered 
maternity care--the vast majority did not--and that the plans that did 
often charged extra or required waiting periods. Her response indicated 
that coverage of prenatal and maternity care should be optional--
optional. We as women cannot say our healthcare is optional.
  The next CMS Administrator should be able to commit to enforcing the 
law requiring maternity care to be covered and commit to protecting the 
law going forward for women. Being a woman should not be a preexisting 
condition. Getting basic healthcare should not mean we have to buy 
riders or extra coverage because being a woman and the coverage we need 
is somehow not viewed as basic by the insurance company. We have had 
that fight. Women won that fight with the Affordable Care Act. We 
should not go backward.
  I followed up with Ms. Verma, along with many colleagues, but have 
not received a response.
  Over 100 million Americans count on Medicare and Medicaid. They need 
a qualified Administrator who puts their needs first, and I cannot vote 
for a nominee who does not guarantee that she will fight for the 
resources and the healthcare that the people of Michigan count on and 


  Finally, I wish to take a moment to talk about the healthcare bill 
that has now come out of committees in the House and will be voted on 
in the House and then coming to us in the Senate. Frankly, let me start 
by saying that this is a mess--it is a mess on process, and it is a 
mess on substance.
  As a member of the Finance Committee, I can tell my colleagues 
firsthand that this was not rammed through the Senate Finance Committee 
when we passed the Affordable Care Act. We had months and months and 
months of hearings, of which I attended every one, I think, and after 
that, the floor debate and that discussion and the discussion in the 
House. We knew what it would cost before we brought it up, by the way, 
which saved a lot of money by doing a better job of managing healthcare 
costs and creating innovation for our providers.
  But the truth is that when we look closely at what is being debated 
in the House, for families in Michigan and across the country, it is 
really a triple whammy: higher costs, less healthcare coverage, and 
more taxes. Overall, it means more money out of your pocket as an 
American citizen, unless you are very wealthy, and it means less 
healthcare. This is not a good deal.
  It cuts taxes for the very wealthy and for insurance companies. It 
gives an opportunity for insurance company execs to get pay increases 
and cuts taxes for pharmaceutical companies. Someone making more than 
$3.7 million a year would save almost $200,000. Let me say that again. 
Someone making more than $3.7 million a year would put $200,000 in 
their pocket as a result of this healthcare bill, TrumpCare. To put 
that in perspective, 96 percent of Michigan taxpayers would not qualify 
for this. Ninety-six percent of everybody in Michigan who gets up every 
day, goes to work, works hard--some take a shower before work, some 
take a shower after work--they are working hard every single day, and 
they would pay more, while the small percentage of those at the very 
top would get $200,000 back in their pockets.
  As I indicated, it provides a tax break for insurance company CEOs to 
get a raise of up to $1 million but increases taxes and healthcare 
costs for the majority of Americans. Middle-class Americans and those 
working to get into the middle class would see tax increases and lose 
healthcare coverage at the same time--such a deal.
  For seniors, this would allow insurance companies to hike rates on 
older Americans by changing the rating system. AARP, a nonpartisan 
organization, has indicated that premiums would increase up to $8,400 
for somebody who is 64 years of age earning $15,000 a year. So they 
earn $15,000 a year, and their premiums could go up by more than half 
of what they are making. To put that in perspective--again, a 
comparison of who wins and loses under this plan--if you are 64 years 
old and earn $15,000 a year, you pay more--$8,400 more. If you are 65 
years of age and earn over $3.5 million a year, you put $200,000 more 
back in your pocket. This is a rip-off for the majority of Americans 
and should not see the light of day.
  On top of that, TrumpCare creates Medicaid vouchers. We have been 
talking with colleagues about the change in Medicaid. What does that 
mean? Well, instead of being a healthcare plan that covers nursing home 
care, whether that is someone who needs very little care or someone who 
has Alzheimer's or other extensive needs, your mom and dad or grandmom 
and granddad would get a voucher, and if it didn't cover the care in 
the nursing home, as it does now, then your family would have to figure 
out a way to make up the difference. We could very possibly have the 
situation we had before the passage of the Affordable Care Act where a 
lot of folks were going bankrupt trying to figure out--you use the 
equity in your home, except because of what happened in the financial 
crisis, you may not have much equity in your home anymore. So you 
try to figure out, how do I make up the difference to help my mom or 
dad or granddad and grandmom in the nursing home? That will be a very 
common discussion, I would guess, if this passes. So turning Medicaid 
into a voucher system would cut nursing home care and healthcare for 

  Let me also say that when there is a healthcare emergency like we had 
in Flint, MI, with 100,000 people being poisoned with lead and over 
9,000 children under the age of 6 with extensive lead poisoning, and we 
had the President and the past administration step in to help those 
children because of the health problems from the lead exposure, that 
would not be possible under this new regime. It will not be possible to 
step in when there is a healthcare emergency for children or for a 
  In Michigan today, 150,000 seniors depend on healthcare through 
Medicaid for long-term care. Three out of five seniors in nursing homes 
in my State--three out of every five seniors--count on Medicaid for 
their long-term care. This radically changes and dismantles that 
healthcare system. We have nearly 1.2 million children in Michigan and 
380,000 people with disabilities who use this system.
  So we have a situation where we would see a radically different

[[Page S1725]]

healthcare system for seniors and additional costs for seniors, which 
is why the AARP is calling this the senior tax. We would see children 
losing their healthcare. We would see insurance companies being put 
back in charge of decisions--decisions about whether women can get 
basic care and what, if any, kind of preexisting condition coverage 
happens. What I have seen is something that doesn't work and is going 
to put more costs back onto families.
  There is mental healthcare and the ability to make sure that if you 
have a healthcare challenge, such as cancer or some other kind of 
challenge, your doctor is going to be able to treat you and give you 
all the care you need, not just a lump sum that the insurance company 
has decided that they are willing to spend. Then there is 
accountability as it relates to how much of your healthcare dollars 
that you spend goes into your medical care. There are a whole range of 
things that have been put in place so that you have more confidence 
that at least you are getting what you are paying for. Those things go 
away and insurance companies are put back in charge. They are given a 
big tax cut. The insurance company execs are given an opportunity for 
big increases in their pay, while everybody else is paying more.
  So let me go back to where I started. TrumpCare, the bill being voted 
on in the House, is really a triple whammy for the people of Michigan: 
higher costs, less coverage, and more taxes. It makes no sense. I will 
strongly oppose it when it comes to the Senate. I am hopeful that we 
can put this aside, stop all of the politics about repeal, and have a 
thoughtful discussion about how we can work together to bring down 
costs and to be able to address concerns to make healthcare better, not 
take it away.
  Thank you, Mr. President.
  The PRESIDING OFFICER (Mr. Cassidy). The Senator from Rhode Island.
  Mr. REED. Mr. President, I rise today in opposition to the nomination 
of Ms. Seema Verma to be Administrator of the Centers for Medicare and 
Medicaid Services, or CMS.
  As a $1 trillion agency with oversight over Medicare, Medicaid, and 
the Children's Health Insurance Program, as well as State health 
insurance marketplaces, CMS is providing affordable health insurance to 
100 million Americans, including nearly half a million Rhode Islanders.
  Given the responsibility that this post entails of ensuring access to 
health care coverage for our most vulnerable citizens, coupled with a 
lack of commitment to fighting back against proposals by this 
administration and some of my colleagues on the other side of the aisle 
to dismantle these programs, I cannot support Ms. Verma's nomination to 
be CMS Administrator.
  CMS is responsible for a key aspect of the Affordable Care Act--the 
health insurance marketplaces--which provide an avenue for all 
consumers to shop for the health insurance options that fit their needs 
and connect consumers with tax credits and subsidies that make the 
coverage affordable.
  President Trump and his new Health and Human Services Secretary Tom 
Price are adamant about repealing the ACA and rolling back these 
benefits. In her confirmation hearing, Ms. Verma was asked multiple 
times to commit to protecting the ACA for the millions of Americans who 
were able to access coverage for the first time because of the law, but 
she would not do so. This, to me, is unacceptable.
  CMS also works with States and other agencies at the Department of 
Health and Human Services to ensure that the plans offered on the 
exchanges are not only affordable but also provide real coverage for 
when it is most needed. I am concerned with Ms. Verma's beliefs about 
what health insurance coverage should look like.
  During her confirmation hearing, she spoke at length about providing 
consumers more choices about their healthcare. Yet she opposes many of 
the protections the ACA provides for consumers. For example, she 
implied that she thought maternity care should be optional. It seems to 
me that for many families, they would be left with the choice to either 
pay for maternity care entirely out-of-pocket--all the while paying 
premiums and copays to the insurance company--or to go without care at 
all. I don't think these are the kinds of choices we should be imposing 
on families.
  Turning my attention to Medicaid for a minute, I am deeply concerned 
about the Republican proposals to fundamentally change Medicaid and 
shift costs to States and to consumers. These proposals aren't new. 
Year after year, Republicans--often under the leadership of then-
Congressman, now-HHS Secretary Tom Price--have proposed block-granting 
Medicaid, cutting the program by hundreds of billions of dollars. While 
Ms. Verma is not yet confirmed, she did express support in her 
confirmation hearing for this very concept--block-granting or capping 
Medicaid spending. Just this week, we saw a new version of this 
proposal, which simply delays cuts to Medicaid until 2020. In my 
opinion, this is just a veiled attempt to help gain support for the 
effort now and then turn around and decimate Medicaid in a few years.
  In my home State of Rhode Island, nearly 300,000 Rhode Islanders 
access healthcare through Medicaid. That is about one-third of our 
population, roughly. That is a significant number for a small State 
like Rhode Island. Let's break down that number to see who would be 
impacted by these across-the-board cuts to Medicaid.
  One out of four children in Rhode Island gets care from Medicaid and 
half of the births in the State are financed through Medicaid. One in 
two Rhode Islanders with disabilities are covered by Medicaid, and 60 
percent of nursing home residents in the State get their care from 
Medicaid. Think about what would happen if this funding is cut--and 
that is the trajectory of the Republican proposals--States would have 
to decide, among these populations, who will get health care, children 
or the elderly in nursing homes, the disabled or other Medicaid 
recipients. If States try to make up the difference, that would result 
in cuts elsewhere, such as education and infrastructure. Indeed, given 
the demands for health care, given the tensions between seniors and 
nursing homes, and children needing care, the States will try their 
best to pull from other areas. What is the next biggest area of State 
expenditure? Education. Now you will have pressure on State education 
budgets. Higher education particularly will be pressured. All of this 
will be the ripple effect from these proposed cuts to Medicaid. And 
make no mistake, when Ms. Verma and my colleagues talk about converting 
Medicaid to a block grant program or capping spending, it is not about 
flexibility for the States, it is about reducing the Federal commitment 
to providing funding to the States.
  Lastly, I am concerned about Ms. Verma's ability to safeguard 
Medicare for our seniors. Over 200,000 Rhode Islanders access care 
through Medicare, a benefit they have worked for and earned over their 
entire careers. I believe Medicare is essential to the quality of life 
for Rhode Island's seniors and for seniors across the country, and 
indeed for the children and families of these seniors. In fact, I 
supported the ACA because it made key improvements to Medicare that 
strengthened its long-term solvency and increased benefits, such as 
closing the prescription drug doughnut hole and eliminating cost-
sharing for preventive services such as cancer screenings.
  Over 15,000 Rhode Islanders saved $14 million on prescription drugs 
in 2015, an average of $912 per beneficiary. In the same year, over 
92,000 Rhode Islanders took advantage of free preventive services, 
representing over 76 percent of the beneficiaries. Repealing the ACA 
means repealing these benefits for seniors and shortening the life of 
the Medicare trust fund by over a decade.
  Unfortunately, Ms. Verma has little to no experience working with 
Medicare, and in her hearing and written responses to questions, she 
appeared to have very little to no familiarity with major aspects of 
Medicare. In her confirmation hearing and accompanying documents, she 
simply has not proven herself to be an effective advocate for 
protecting these earned benefits for our seniors.
  We need an Administrator for CMS who will work to safeguard health 
care coverage for children, seniors, and people with disabilities, who 
will seek to strengthen Medicaid, Medicare, CHIP, and our entire 
healthcare system. For the reasons I have outlined, along with other 
reasons some of my colleagues have raised, Ms. Verma, in my opinion,

[[Page S1726]]

is not up to this task. As such, I will oppose the nomination and 
encourage my colleagues to do the same.
  I yield the floor.
  Mr. President, I request the ability to yield the remainder of my 
postcloture time to Senator Wyden.
  The PRESIDING OFFICER. The Senator has that right.
  Mr. REED. 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. WYDEN. 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. WYDEN. Mr. President, here we are, with our colleagues on their 
way home, and I thought it would be helpful to take a minute and give 
an assessment of where the TrumpCare debate is at this point because we 
have seen the two major committees in the House act. Some $300 billion 
was slashed from safety net health programs, while insurance company 
executives making over $500,000 annually were given a juicy tax break 
as a bonus.
  To put this into perspective, this tax break that the insurance 
companies' CEOs seem to have after two committees in the other body 
have acted on TrumpCare--the amount of the bonuses for the insurance 
company executives would be enough to cover the TrumpCare-created 
shortfall in Oregon's community-based services for the elderly and the 
disabled two or three times over.
  What we are talking about is how hundreds of billions of dollars in 
tax breaks are going to the fortunate few and special interests, while 
some of the money is coming from stealing a chunk of those dollars from 
the Medicare trust fund. And this is very much intertwined with the 
nominee's work because she would be overseeing Medicare payments to 
rural hospitals in places like Louisiana and Oregon.
  What I am going to turn to now is what TrumpCare, based on these two 
committees, means for rural areas. And, of course, it repeals the 
Medicaid expansion. It caps the Medicaid Program. In my own view, and I 
know the Senator from Louisiana knows a lot about healthcare, in rural 
communities--and most of our towns are under 10,000 in population. I am 
from southeast Portland. I love southeast Portland. The only regret is 
I didn't get to play for the Portland Trail Blazers. Most of the 
communities in our State are under 10,000 in population. As the Senator 
from Louisiana knows, we are talking about critical access facilities. 
We are talking about sole community hospitals. We are talking about the 
facilities that deal with acute care.
  During the last major break over the President's holiday, I started 
what is going to be a yearlong effort for me, and I called it the rural 
healthcare listening tour. It is eye-popping to have those rural 
healthcare providers who in my State have worked so hard to find ways 
to get beyond turf and battles, to work together--the hospitals, the 
doctors, the community health centers, and the like. They have built an 
extraordinary effort that helps to wring more value out of scarce 
dollars. Their programs are based on quality, not on volume.
  By the way, they are a huge source of economic growth and jobs for 
our rural communities. I spent the President's Day recess, and the next 
major recess as well getting out and listening to them. The verdict 
from Oregon's healthcare providers, who have worked very hard at being 
innovative, trying to make better use of what are called nontraditional 
services, said these kinds of cuts are not an option if you want to 
meet the needs of so many who have signed up as a result of the 
Medicaid expansion.
  TrumpCare ends the Medicaid expansion, rolling back Federal matching 
funds in 2020. The rural hospitals in my State are frequently the only 
healthcare provider available for hundreds of miles. The Medicaid 
expansion helped these hospitals keep their doors open.
  I don't think it is hard to calculate why the hospitals are speaking 
out against the flood approach of TrumpCare. They have a lot of 
facilities in rural areas that are already on tight margins. If these 
communities lose the ability to cover needy people, some of the 
essential hospitals--and I just described three types of them--are 
going to have to close, and the reality is going to be that patients 
aren't going to have any doctor anywhere nearby.
  Understand, if the majority insists on ramrodding TrumpCare through--
and at this point we have, I believe--staff just told me that there 
aren't any budget estimates. As of now, the Congressional Budget Office 
is tasked with providing accurate assessments of the budget 
implications. There are not any budget implications.
  So here is the latest. It comes from media that I think is not 
considered by many Trump supporters to be a purveyor of fake news. This 
comes from FOX News. They said: Unknown in the new healthcare plan, 
unknown in TrumpCare--the cost. How many lose or gain insurance?
  I am very pleased that my colleague from New Hampshire has come to 
join me because some of this, I would say to my friend from New 
Hampshire, leaves you incredulous because this comes from FOX News. FOX 
News is hardly a source for what many Trump supporters would consider 
fake news. FOX News is asking the question because they are saying it 
is unknown. It is unknown in the new healthcare plan, Senator Shaheen, 
according to FOX News. The cost is unknown, and how many lose or gain 
insurance is unknown.
  I would say to my colleagues, because my friend from Louisiana has 
joined the Finance Committee, and I remember welcoming him and Senator 
McCaskill, our new members. My colleague from Louisiana is a physician 
and is very knowledgeable about these issues. I don't know how you have 
a real healthcare debate in America--and I have been working on this 
since I was director of the Gray Panthers at home back in the days when 
I had a full head of hair and rugged good looks. When we would start a 
debate, nobody would consider starting it without having an idea of 
costs or how many lose or gain insurance. How much more basic, I say to 
Senator Shaheen, does it get than that? Are these ``gotcha'' questions? 
Are these alternative facts? Are these people who are hostile to 
conservatives? I think not. FOX News--unknown in the new healthcare 
  I have been outlining what this means in terms of the transfer of 
wealth from working families in New Hampshire and Oregon to the most 
fortunate in our country--people who make $250,000 or more. They are 
actually going to be the only people in America who get their Medicare 
tax cut. So you have this enormous transfer of wealth, what I call the 
reverse Robin Hood: taking from the working people and giving to the 
fortunate few.
  After two committees have now acted in the other body--two committees 
have acted--FOX News says the big questions are outstanding. The 
Senator from New Hampshire knows a lot about rural healthcare. I was 
just outlining to my colleagues what this means for critical access 
hospitals, sole community hospitals, acute care facilities. These are 
the centerpieces of many rural communities, the essence of rural life. 
You can't have rural life without rural healthcare.
  Here we are on Thursday afternoon--with many of our colleagues out 
there tackling jet exhaust fumes heading home--and the big questions, 
according to FOX News, are outstanding.
  I am very pleased the Senator is here. As usual, she is very prompt 
and appreciated.
  I look forward to her remarks.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, before my colleague from Oregon leaves, 
I want to ask him a question.
  I am reminded, in 2009 and 2010, as we were working on the Affordable 
Care Act, that the HELP Committee held 14 bipartisan roundtables, 13 
bipartisan hearings, 20 bipartisan walkthroughs on healthcare reform. 
The HELP Committee then considered nearly 300 amendments and accepted 
more than 160 Republican amendments, and the Finance Committee--where 
my colleague is the ranking member--held 17 roundtables, summits, and 
hearings on the topic. The Finance Committee also held 13 member 
meetings and walkthroughs, 38 meetings and negotiations, for a total of 
53 meetings on

[[Page S1727]]

healthcare reform. During its process, the Finance Committee adopted 11 
Republican amendments.
  Don't you find it particularly ironic that we are seeing this 
TrumpCare legislation being pushed through on the House side--and what 
we are hearing, the rumors about what is going to happen in the Senate 
is it is not going to have any hearings and it is going to be brought 
to the floor and we are expected to vote on it without having a chance 
for the public to know what is in it.
  Mr. WYDEN. My colleague is making a very important point. I think we 
all know the Senate budget process is a lot of complicated lingo. 
People in the coffee shops in New Hampshire and Oregon don't follow all 
the fine points of reconciliation.
  As the Senator has just said, what they are using is a process that 
is known as reconciliation. That is the most partisan process you can 
come up with. There is no more partisan kind of process, and we were 
talking about the tally. As of this afternoon, two committees in the 
House have acted.
  The Senator from New Hampshire just mentioned, I think, there were 11 
Republican amendments in just one of the committees.
  Mrs. SHAHEEN. Right.
  Mr. WYDEN. As of this afternoon at 4, after hours and hours of 
debate, I am of the impression that not a single significant Democratic 
amendment has been adopted--so the Senator's point of highlighting the 
difference in the process, where we had all of the hearings and all of 
the opportunities that you have to have to get a good, bipartisan bill.
  As my colleague knows, I don't take a backseat to anybody in terms of 
bipartisan approaches in healthcare. I have worked with Republicans--
Chairman Hatch, chronic care. Senator Bennet and I worked on a bill 
with eight Democrats and eight Republicans. I appreciate your making 
this point.
  As of this afternoon, as far as I can tell, no Democratic amendment 
has been adopted. You highlighted 11 Republican amendments getting 
adopted in just one committee. As we indicated, FOX News--not exactly 
hostile to some of the ideas being advanced by the majority--has 
certainly called them out on this.
  Mrs. SHAHEEN. I appreciate the eloquent comments from the Senator 
from Oregon and all of his efforts to make sure we don't take away 
healthcare for so many people who desperately need it.
  That is why I came to the floor today, because I spent the week we 
were back home--not last week but the week before--talking to 
constituents in New Hampshire and listening to what their concerns 
  What I heard was that people were deeply, deeply concerned and very 
upset by the efforts here to repeal the Affordable Care Act, when they 
didn't know what the replacement meant for them. In dozens of 
conversations and roundtable discussions at a townhall forum, Granite 
Staters shared stories of how the Affordable Care Act has been a 
lifeline for them. I heard from people who say their lives have been 
saved by the law.
  In fact, we can see what is at risk in the State of New Hampshire, 
where we have almost 600,000 Granite Staters who have preexisting 
conditions. We have 118,000 people who could lose coverage. We have 
50,000 Granite Staters with marketplace plans who are in the exchange, 
42,000 who are enrolled in Medicaid, and 31,000 who have tax credits 
that lower the cost of healthcare for them. If that is taken away, so 
many of those people have no option for getting healthcare.
  What we know now, after we have finally seen the plan Republican 
leaders are talking about, we know those fears were well founded that 
they were worried they were going to lose their healthcare. What we 
have seen is legislation to repeal the Affordable Care Act that would 
have catastrophic consequences not only for people in New Hampshire but 
for people across this country.
  It is especially distressing that TrumpCare--as it has been 
introduced by the Republicans--would roll back expansion of the 
Medicaid Program, which has, in New Hampshire and across this country, 
been an indispensable tool in our efforts to combat the opioid 
epidemic. In addition, we are seeing, as the Senator from Oregon 
pointed out, that TrumpCare would terminate healthcare subsidies for 
the middle class and for other working Americans, and it would replace 
those subsidies with totally inadequate tax credits--as low as $2,000, 
which doesn't begin to pay for healthcare coverage for an individual, 
much less a family. This means as many as 20 million Americans could 
lose their healthcare coverage.
  Even as the bill makes devastating cuts to the middle class, it gives 
the wealthiest Americans a new tax break worth several hundred thousand 
dollars per taxpayer. I think this proposed legislation is totally out 
of touch with the lives of millions of working Americans, people whose 
health and financial situation would be turned upside down by the bill.
  Last week, in his response to President Trump's address to Congress, 
former Gov. Steve Beshear of Kentucky said something that really 
resonated with me. He reminded us that people who have access to 
healthcare thanks to ObamaCare are ``not aliens from some other 
planet.'' As he described, ``They are our friends and neighbors. . . . 
We sit on the bleachers with them on Friday night. We worship in the 
pews with them on Sunday morning. They're farmers, restaurant workers, 
part-time teachers, nurses' aides, construction workers, 
entrepreneurs,'' and often minimum wage workers. ``And before the 
Affordable Care Act, they woke up every morning and went to work, just 
hoping and praying they wouldn't get sick, because they knew they were 
just one bad diagnosis away from bankruptcy.''
  To understand why people in New Hampshire are so upset and fearful 
about efforts to repeal the Affordable Care Act, we have to look again 
at this chart because some 120,000 Granite Staters could lose their 
health insurance. That is nearly 1 in every 10 people in the State of 
New Hampshire.
  In particular, repeal of the Affordable Care Act would very literally 
have life-or-death consequences for thousands of people who are 
fighting opioid addiction, who have been able to access lifesaving 
treatment thanks to the expansion of Medicaid and the Affordable Care 
  Sadly, one of the statistics we are not happy about in New Hampshire 
is that we have the second highest rate of per capita drug overdose 
deaths in the country. We trail only West Virginia. The chief medical 
examiner in New Hampshire projects that there were 470 drug-related 
deaths in 2016, including a sharp increase in overdose deaths among 
those who were 19 years old or younger. For a small State like New 
Hampshire, this is a tragedy of staggering proportions, affecting not 
just those who overdose but their families and entire communities.
  I am happy to say, in the last couple of years, we made real progress 
in combating this epidemic because we had the Affordable Care Act and 
its expansion of Medicaid, which has given thousands of Granite Staters 
access to lifesaving treatment. Over the past year, I had a chance to 
visit treatment centers all across New Hampshire. I met with 
individuals who are struggling with substance use disorders and 
providers who are trying to make sure they get the treatment they need.
  Last month, at a center in the Monadnock region of New Hampshire, I 
had an amazing private meeting with more than 30 people in recovery 
from substance use disorders. They are putting their lives back 
together, hoping to reclaim their jobs, to get back with their 
families, and they are able to do that largely because of treatment 
that is made possible by the Affordable Care Act.
  One patient shared her story with me. As with so many others in 
treatment, her story is one of making mistakes, of falling into 
dependency, of struggling with all her might to escape her addiction. 
She is in recovery for the second time, and she said that this time for 
her is a life-or-death situation. She has no family support. She 
worries that she will be homeless when she leaves the treatment 
program, but she is grateful for the Affordable Care Act because it has 
given her one more shot at getting sober and the chance for a positive 
  At a forum in Manchester--New Hampshire's largest city--a courageous 
woman named Ashley Hurteau said

[[Page S1728]]

that access to healthcare as an enrollee in Medicaid expansion was 
critical to her addiction recovery. She had been arrested following the 
overdose death of her husband. Ashley said an understanding police 
officer and a drug court were key to her recovery. She added this:

       I am living proof that, by giving individuals suffering 
     with substance use disorder access to health insurance, we, 
     as a society, are giving people like me the chance to be who 
     we really are again.

  Without that access to treatment, where would Ashley be?
  Several weeks ago I received a letter from Nansie Feeny, who lives in 
Concord, the capital of New Hampshire. She told me the Affordable Care 
Act had saved her son's life. This is what she wrote:

       [My son] Benjamin went to Keene State College with the same 
     hopes and dreams many have when building their American 
     dream. While there he tried heroin. Addiction overcame him 
     but did not stop him from graduating. After graduation he 
     suffered a long road of near death existence. After a couple 
     of episodes where he had to be revived (fentanyl) he chose 
     recovery. And it was due to ObamaCare that we were able to 
     get him insured so he could get the proper help he needed and 
     [into] a suboxone program that assisted him with staying 
       In April--

  She wrote, and you could read between the lines how relieved she 

       it will be a year for Ben in his recovery. Without 
     ObamaCare, this would not have been possible. . . . I can't 
     find the words to define my gratitude to President Obama. I 
     believe my son would not be alive today if it were not for 
     this plan that provided the means he needed to get the help 
     he needed at the time he needed it. Ben still has a long road 
     ahead of him but I will see to it that he never walks it 

  I also want to share a powerfully moving letter from Melissa Davis, 
an attorney in Plymouth, NH. Ms. Davis writes:

       I am a lawyer who frequently works on behalf of clients who 
     are suffering from substance use disorder, mental health 
     conditions, or a combination of both. I have been working 
     with these clients for over 10 years and I can tell you that 
     access to health insurance has always been the biggest 
     obstacle in obtaining quality and consistent treatment. Since 
     passage of the Affordable Care Act and the expansion of 
     Medicaid, my clients are actually able to access real 
     treatment in ways they never were before. Before the ACA, 
     there were far too many times where my clients were unable to 
     afford private substance use disorder treatment, wait lists 
     at community mental health agencies were extremely long, and 
     AA and NA were not enough. Without treatment, these clients 
     often ended up in jail or worse, dead. I still have clients 
     who face obstacles to obtaining quality treatment, but the 
     ability to get insurance removes a huge obstacle.

  Ms. Davis concludes with this warning:

       I am sincerely afraid for what will happen to my clients 
     and my community if access to quality substance use disorder 
     and mental health treatment is taken away from those people 
     who need it most because they are unable to get insurance. 
     Please do everything you can to save the ACA.

  In dozens of visits to New Hampshire during the campaign, President 
Trump pledged aggressive action to combat the opioid crisis. In his 
address to Congress last week, he once again promised action to expand 
treatment and end the opioid crisis. But despite these bold words and 
big promises, the President's actions have sent a totally different 
signal. His actions threaten an abrupt retreat in the fight against the 
opioid epidemic.
  By embracing the House Republican leadership's plan to repeal the 
Affordable Care Act, President Trump has broken his promise to the 
people of New Hampshire. This misguided bill would roll back the 
expansion of Medicaid, and it could terminate treatment for hundreds of 
thousands of people in New Hampshire and across America who are 
recovering from substance use disorders.
  Meanwhile, the President's nominee to serve as Administrator of the 
Centers for Medicare and Medicaid Services, Seema Verma, has been an 
outspoken advocate of deep cuts to Federal funding for Medicaid. As we 
have seen with so many of the Trump administration nominees, Ms. Verma 
has an underlying hostility to the core mission of the agency that she 
has been asked to lead.
  Seema Verma is currently a health policy consultant who has called 
for less Federal oversight of the Medicaid Program and advocated for 
policies expressly designed to discourage patients from seeking care--
for instance, by imposing cost-sharing burdens on Medicaid recipients. 
In addition, she is a staunch advocate of block-granting Medicaid and 
turning it into a per capita cap system. Over time, this would lead to 
profound cuts to Medicaid, forcing States to raise eligibility 
requirements and terminate coverage for millions of recipients.
  Let's be clear as to who these recipients are. In 2015, the 97 
million Americans covered by Medicaid included 33 million children, 6 
million seniors, and 10 million people with disabilities. Seniors, 
including nursing home costs, account for nearly half of all Medicaid 
  These are some of the most vulnerable people in our society, and they 
will be the targets of Ms. Verma's determined efforts to cut funding 
for Medicaid and terminate coverage for millions of current recipients.
  I also have deep concerns about this nominee's commitment to 
protecting women's healthcare. During her confirmation hearing in the 
Finance Committee, Ms. Verma was asked if women should get access to 
prenatal care and maternity coverage as afforded under the Affordable 
Care Act or whether insurance companies should get to choose whether to 
cover this for women.
  Ms. Verma tried to clarify when she met with me that she hadn't 
really meant what she said. But what she said was that maternity 
coverage should be optional, that women should pay extra for it if they 
want it. Of course, the problem with this position is that it takes us 
backward to the days before the ACA, when only 12 percent of policies 
on the individual insurance market offered maternity coverage.
  In the State of New Hampshire, before the Affordable Care Act, you 
could not buy an individual policy that covered maternity benefits. 
They were not written. Insurers who offered coverage charged exorbitant 
rates with high deductibles, plus benefit caps of only a few thousand 
dollars. This is a major reason why, before the Affordable Care Act, 
women were systematically charged more for health insurance than men. 
In the eyes of insurance companies, being a woman was seen as a 
preexisting condition, and they charged us more accordingly.
  Well, the American people don't want drastic cuts to Medicaid, cuts 
that will threaten coverage for children, for seniors, for people with 
disabilities, and for those receiving treatment for substance use 
disorders. That is why I intend to vote against the confirmation of 
Seema Verma to head CMS.
  In recent years, we have made impressive gains, securing health 
coverage for millions of Americans and significantly improving the 
health of the American people. I can't support a nominee who wants to 
reverse these gains.
  In recent weeks, all of our offices have been flooded with calls, 
with emails, with letters opposing the Trump administration's plans to 
repeal ObamaCare and undermine both the Medicare and Medicaid Programs. 
We need to listen to these voices. We need to keep the Affordable Care 
Act and the expansion of Medicaid.
  There are things we can do to make it better, and we should work 
together to do that. But we have heard from people loud and clear 
across this country. It is time now to respect their wishes, to come 
together to fix this landmark law, and to ensure that it works even 
better for all Americans.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before my colleague from New Hampshire 
leaves, does she have a quick minute for a question?
  Mrs. SHAHEEN. Absolutely.


  Mr. WYDEN. I thank her for her presentation. It was factual and very 
specific, and I think it really highlighted so many of the concerns 
that we have at this point.
  I want to see if I could get this straight on the opioid issue. Here 
you all are in New Hampshire, right in the center of the Presidential 
campaign. All of the candidates are coming through, and they are 
practically trying to outdo each other in terms of their pledges to 
deal with this wrecking ball that is the opioid addiction that has 
swept through New Hampshire

[[Page S1729]]

and, of course, my own home State as well.
  I remember then-Candidate Trump being particularly strong and 
assertive about how he was going to fight opioids.
  I think what my colleague said--and I am curious, so I am going to 
ask a couple of questions because I don't think folks even in my home 
State are aware of some of these things. So I am going to ask my 
colleague about it.
  Are folks in New Hampshire aware at this point--my colleague put up 
that Trump chart, showing how the people didn't know what was being cut 
and how much it was going to cost and all the rest. Are people in New 
Hampshire at this point aware of the fact that this is essentially 
after a campaign in their home State, which certainly put out a lot of 
TV commercials and campaign rhetoric in the fight on opioids?
  I think my colleague said that when people unpack this, they are 
going to see that this is a major broken promise, that TrumpCare is a 
major broken promise on opioids because, in terms of the time sequence, 
they all had debates and commercials, then we finally got some money in 
order to have treatment.
  And I think what my colleague said is that now, as a result of 
TrumpCare and the cap on Medicaid, there will not be the funds to get 
the treatment to people who are so needy. Is that what this is going to 
be about in New Hampshire?
  Mrs. SHAHEEN. That is absolutely correct.
  I remember meeting one young man early in the fall, in the middle of 
the campaign early last year. He came up to me in Manchester and said: 
I am so worried about what is going to happen in this election because 
I am in recovery; I am an addict. He said: I am worried that whoever 
gets elected is not going to continue to make sure that I can get the 
treatment I need. He said: I am worried about Mr. Trump.
  As my colleague pointed out, Donald Trump, when he was campaigning in 
New Hampshire, made a lot of promises about how he was going to address 
the heroin and opioid epidemic, how he was going to make sure that 
people could get treatment, treatment at a cost they could afford.
  Well, thanks to the Affordable Care Act and the expansion of Medicaid 
and the great work by our Republican legislature and our Democratic 
Governor--then-Governor Hassan, who is now in the Senate--we passed a 
plan to make sure that people who had substance use disorders could get 
  Last year we had 48,000 applications submitted under the expansion of 
Medicaid for treatment of substance use disorders. If we pulled the 
plug on that Medicaid expansion so that people couldn't get that 
treatment, they wouldn't have anywhere to go.
  That is what I heard when I was at Phoenix House in Dublin, in the 
western part of New Hampshire, a couple of weeks ago. I was sitting 
around with about 30 people in recovery, people who are hopeful for the 
first time in a long time because they are in treatment and they can 
see they can put their lives back together.
  I said to them: What happens if we no longer have the Medicaid 
  They said: We don't have any other options. We don't have treatment.
  What we heard from President Trump is that he was going to introduce 
a healthcare plan that was going to cover more people for less money 
and better quality. Well, that is not what we are seeing.
  The TrumpCare that was introduced in the House this week that they 
marked up and that is going to be coming to the Senate doesn't do that. 
It reduces coverage under the Medicaid Program. It would throw 
thousands of people off of their treatment for substance use disorders, 
and there is nowhere else for them to go.
  This is not an acceptable plan. This does not do what the President 
promised he was going to do. It is not what he promised in New 
Hampshire, it is not what he promised in the campaign, and it is not 
what he has promised since he became President.
  Mr. WYDEN. I think my colleague's point is well taken.
  As we have been saying, this is very much intertwined with the Seema 
Verma nomination because what we learned in the committee is, in 
Indiana, where she touts her pioneering work, if somebody had an 
inability to pay for a short period of time, they would be locked out 
of the program. So in terms of Medicaid, this is going to cause a real 
  I had already outlined that it is going to cause a hardship in 
another program that is important to New Hampshire, and that is 
Medicare, because we are implementing what is called the MACRA, the new 
reimbursement system for doctors. We asked her questions about rural 
care, and she didn't know the answer either.
  I particularly wanted my colleague to walk us through this situation 
with respect to how New Hampshire residents are going to see TrumpCare 
as it relates to opioid addiction after they have all these grandiose 
promises and the many debates and commercials.
  I thought I would ask if my colleague has time for one other 
  In New Hampshire, as in Oregon, we have a lot of seniors. It looks to 
me as if somebody who is, say, 58 years old or 62 years old is just 
going to get hammered by what we call the age tax because in these 
bills, which are now moving like a freight train with the House already 
moving in two committees, Republicans want to give insurance companies 
a green light to charge older people five times as much as they charge 
younger people. So I cited a number of my small, rural counties--Grant 
County, Union County, Lake County--and how a 60-year-old who makes 
$30,000 a year can see their insurance costs, because of the age tax, 
go up something like $8,000 a year.
  I don't have the numbers as of now--Finance staff is still working on 
that for every single State--but obviously that tax sure looks like it 
is going to hit somebody in New Hampshire, an older person, people 
before they are eligible for Medicare, and particularly in that 55-to-
65 bracket. It looks like it is going to hit them very hard. How is 
that going to be received, because in my time in New Hampshire, we 
talked about it, and a lot of those people really are walking on 
economic tightropes. They are balancing their food bill against their 
fuel bill and their fuel bill against their rent bill. I know my 
colleague spends a lot of time trying to advocate for them, help them 
through small business approaches. How are they going to be able to 
absorb what is clearly going to be thousands of dollars in new out-of-
pocket health costs?
  Mrs. SHAHEEN. I think that is a huge problem. New Hampshire has a 
population that is one of the fastest aging in the country. As Senator 
Wyden points out, not only does the TrumpCare legislation change how 
people on Medicare are charged for their health insurance, but it also 
would change the other aspects of the Affordable Care Act that have 
been beneficial, such as preventive care under Medicare.
  It would also change the effort to close the doughnut hole--the cost 
of the prescription drugs that seniors buy. That has been a huge 
benefit to people in New Hampshire over the last few years because they 
are beginning to see their costs for prescription drugs affected 
positively. So it will have a huge impact on seniors in New Hampshire.
  The other issue that will have an impact not only on seniors but on 
everybody is what will happen to our rural hospitals. In New Hampshire, 
because we have a lot of rural areas in the State, we have a lot of 
small towns. Most of our hospitals are small and rural. They have 
benefitted significantly under the Affordable Care Act because they 
have been able to get paid for people who come to the emergency room 
for treatment. We have gotten a lot of people out of emergency rooms 
and into primary care. Most hospitals have seen about a 40-percent 
decline in people using emergency rooms for their healthcare. That has 
been a huge, important benefit to our rural hospitals that are 
operating on very thin margins that we need to keep open, not just 
because of the healthcare they provide but because of the jobs they 
provide. In most of our small communities, those hospitals are among 
the biggest employers.
  There are huge impacts if we repeal the Affordable Care Act and we 
put in place this TrumpCare policy that doesn't cover as many people. 
It is going to cost more, it is going to reduce the help people are 

[[Page S1730]]

through their healthcare coverage, and it is going to have a 
detrimental impact on people in the State of New Hampshire and across 
this country.
  Mr. WYDEN. I thank my colleague.
  We have heard Republicans say repeatedly that anything they are going 
to do with Medicare is not going to hurt today's enrollees or people 
nearing retirement. The fact is, TrumpCare hurts both. It is going to 
shorten the life expectancy of the Medicare trust fund, and those older 
people--I will be curious, when my colleague returns--I will be very 
interested to hear what seniors in New Hampshire who are 56 to 68 and 
are walking on that economic tightrope are going to say.
  I thank my colleague from New Hampshire for the excellent 
  Mrs. SHAHEEN. I thank the Senator, and thank the Senator for his 
fight to help as we try to prevent people across this country from 
losing their healthcare.
  Mr. WYDEN. I thank my colleague, and we are going to prosecute this 
cause together.
  I see that the chairman of the Finance Committee has arrived. He 
graciously said I could take another 5 minutes or so of our time.
  Before we wrap up this part of our presentation, I want to point out 
that we have outlined how people who are dealing with the consequences 
of opioid addiction would be hurt by TrumpCare. We have outlined how 
seniors who are not yet eligible for Medicare are going to be hurt and 
how seniors who are now on Medicare are going to certainly be hurt by 
reducing access to nursing home benefits. Now I would like to wrap up 
by going to the other end of the age spectrum and talk for a moment 
about children.
  Nearly half of Medicaid recipients are kids, and the program of the 
Republicans--now that we have two committees in effect out of chute 
with their proposals--restructures the program in the most arbitrary 
way, using these caps, shifting costs to States. And the reality is 
that Medicaid is a major source of help for children. There is early 
and periodic screening, diagnosis, and treatment benefits. But with 
reduced funding, the States are going to be forced to make difficult 
decisions about which benefits they can keep providing. States are 
going to be forced to reduce payments to providers, particularly for 
kids, providers such as pediatric specialists, and limit access 
to lifesaving specialty care.

  My own sense is that this is shortsighted at best, and it is like 
throwing the evidence about children and their health needs in the 
trash can. Children receiving Medicaid benefits are more likely to 
perform better in school, miss fewer days of school, and pursue higher 
  Before I yield the floor to my good friend and colleague Chairman 
Hatch, I want to come back to what disturbs me the most about all of 
this. All of these dramatic changes to Medicare and Medicaid that strip 
seniors and some of our most vulnerable citizens are being made at the 
cost of hundreds of billions of dollars to these programs while, in 
effect, there is an enormous transfer of wealth given to the most 
fortunate in America in the two bills that were passed by the other 
body today in the committee. In effect, for example, people who make 
over $250,000 will not have to make the additional payments under the 
Medicare tax. If ever there were a group of people in America who 
doesn't need additional tax relief, it is those people.
  As we wrap up this portion of the presentation, I want people to just 
think about looking at their paycheck. Every time you get a paycheck in 
America, there is a line for Medicare tax. Everybody pays it. It is 
particularly important right now because 10,000 people will be turning 
65 every day for years and years to come.
  What the tax provisions of this legislation mean--and they are part 
of hundreds of billions of dollars of tax cuts--for insurance 
executives making over $500,000 annually, there are yet additional 
juicy writeoffs, while seniors and those of modest means are going to 
bear the brunt of those reductions. Nothing illustrates it more than 
cutting the Medicare tax, colleagues.
  I don't know how anyone can go home in any part of the country and 
say: You know, we are going to have to charge older people between 50 
and 65 a lot more for their coverage, and by the way, insurance company 
executives making $500,000 a year are going to get more tax relief. I 
don't think it passes the smell test in America. It is reverse Robin 
Hood. There is no other way to describe it. It is transferring wealth 
from working families and those who are the most vulnerable. When 
working Americans see their paycheck and see the Medicare tax, I hope 
they remember that in this bill, the Medicare tax is reduced for only 
one group of people--people making more than $250,000 a year.
  I want tax reform. The chairman of the Finance Committee knows that. 
I have introduced proposals to do that. But I don't know how we get tax 
reform when they are giving the relief to the people at the top of the 
economic ladder and it is coming out of the pockets of working people 
and working families. Everybody is going to be able to see it right on 
their paycheck, right there with the Medicare tax.
  I think we will continue this debate, but on issue after issue, with 
the nominee on the floor, Ms. Verma, what she will do if confirmed is 
directly related to TrumpCare. For example, we told her in the 
committee that we wanted her to give one example--just one--of an idea 
to hold down pharmaceutical prices, which is something else that is 
important to older people.
  TrumpCare, by the way, could have included proposals to try to help 
hold down the cost of medicine. Guess what, folks. On pharmaceutical 
prices, there is no there, there either. It doesn't do anything to help 
  This vote we will have on Tuesday is the first step in the discussion 
of how this particular nominee would handle the implementation of 
TrumpCare. Her job oversees Medicare payments to hospitals. It is 
really intertwined, this nomination and TrumpCare, and we couldn't get 
any responses to how she meets the needs of working families, as I just 
mentioned, with respect to pharmaceuticals, and we are pretty much in 
the dark with respect to how she would carry out her duties. As of now, 
we don't see how she is going to do much to try to eliminate some of 
the extraordinary harm that is going to be inflicted on the vulnerable 
and seniors on Medicare and Medicaid as a result of TrumpCare.
  I reserve the remainder of my time, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.

                       Republican Healthcare Bill

  Mr. HATCH. Mr. President, I rise today to speak once again on the so-
called Affordable Care Act and the ongoing effort to repeal and 
replace. We all know the House of Representatives has produced a repeal 
and replace package, and both the Ways and Means and Energy and 
Commerce Committees have been marking it up. We don't know what it is 
right now. In other words, the endeavor to right the wrongs of 
ObamaCare is moving steadily forward on the other side of the Capitol, 
and soon it will be the Senate's turn to act. I commend my colleagues 
for introducing this legislation and moving it forward. This is an 
important step, and I don't think I am alone when I say that I am 
watching the progress in the House very carefully to see how things 
proceed and what the final House product will look like.
  Of course, virtually all Republicans in Congress want to repeal and 
replace ObamaCare. We are in unison there. While there are some 
differences of opinion on how best to do that, there is generally 
unanimity on that point. I am confident that whatever differences exist 
among House Members will be worked out through the House's legislative 
  In addition, whatever passes in the House will be subject to the 
input and review of the Senate and to the rules of the budget 
reconciliation process. I want to note that I have heard from a number 
of Senators who have items they would like to see included when the 
bill comes before the Senate. I actually have several ideas of my own. 
However, there are limits as to what we can do under the budget 
reconciliation rule. Many of the proposed policy changes I have heard, 
although they have merit, would be banned by the rules and subject to 
the 60-vote threshold. That said, I am committed to working with my 
colleagues on both sides of the floor to ensure that the

[[Page S1731]]

Senate process on this bill is productive and that it yields a result 
we can support.
  Long story short: This process is far from over. We have a lot more 
work to do. It is worth pointing out that the vast majority of the 
policies at play in this discussion and virtually all of the spending 
fall under the exclusive jurisdiction of the Senate Finance Committee, 
which I chair. Make no mistake. The Finance Committee is already hard 
at work and has been for some time. In many respects, I suppose you 
could say we have been working on this effort since the day ObamaCare 
was signed into law. However, for obvious reasons, our work has 
intensified over the past several months.

  In working through this process, I have been in constant contact with 
Chairmen Brady and Walden, who head up the relevant committees in the 
House. I have also been working closely with the Speaker's office, and 
I have been gathering input from Governors around the country. In 
addition, I have been working closely with the distinguished chairman 
of the Senate Budget Committee, Senator Enzi, who has the chief 
responsibility of navigating the budget process and shepherding a final 
repeal-and-replace bill through all the necessary rules and 
  In all of those conversations, we have been talking about the 
process, and we have been talking about the timing. Most importantly, 
we have been talking about the substance of the healthcare reforms and 
how we can best serve the interests of the American people.
  Throughout this effort, we have been reminded that Republicans 
currently control the White House and both Chambers in Congress due, in 
large part, to our stated commitment to repeal and replace ObamaCare, 
and we intend to deliver on that promise.
  I would like to take a few minutes to talk about some of the policies 
we will need to tackle as we take up the House healthcare bill in the 
coming weeks.
  Once again, the vast majority of the policies and virtually all of 
the spending involved in this effort fall under the Finance Committee's 
exclusive jurisdiction, and I intend to make sure all of my colleagues 
are well informed on the issues and that in the end whatever version of 
the bill we pass in the Senate reflects the collective will of a 
majority of Senators.
  All told, there are five major policy areas that are addressed in the 
House bill that fall under the Finance Committee's purview.
  First, there are the provisions to repeal the ObamaCare taxes. This 
is big. If one recalls, I came to the floor a few weeks ago and pointed 
out how misguided it would be, in my view, to start picking and sorting 
through the ObamaCare taxes to decide which to keep and which to leave 
in place. The House bill repeals them, along with the individual and 
employer mandates, both of which reside in the Tax Code. I have been 
working with Chairman Brady on this issue. In the end, I believe the 
Senate version of the bill should do the same, and I am going to 
continue to push to ensure it does.
  Second, there is the issue of premium tax credits. Chairman Brady and 
I have been working extensively on this issue as well. The House bill 
replaces the ObamaCare premium subsidies with a refundable tax credit 
for the purpose of State-approved health insurance, limited to those 
who do not qualify for other governmental healthcare programs and who 
have not been offered insurance benefits from their employers. Most 
major ObamaCare replacement proposals that we have seen contain some 
version of health insurance tax credits. The House approach represents 
a significant improvement over the ObamaCare premium subsidies. The 
Senate, when it takes up the bill, will have to consider how best to 
implement the tax credits. I will continue to work with my House and 
Senate colleagues to ensure that the tax credits are designed to help 
those lower and middle-income Americans who are the most in need.
  Third, there are the issues surrounding Medicaid. Chairman Walden and 
his predecessor, Chairman Upton, and I have been working extensively on 
this matter. As we know, the vast majority of the newly insured people 
who the proponents of ObamaCare have cited as proof that the system is 
working have been covered by the expanded Medicaid Program.
  The problem, of course, is that the Affordable Care Act did not do 
anything to improve Medicaid, which was already absurdly expensive for 
States, and ultimately unsustainable, not to mention the fact that it 
provides substandard healthcare coverage.
  The House bill draws down the ObamaCare Medicaid expansion and makes 
a number of significant changes to the underlying program. Most 
notably, it establishes per capita caps on Federal Medicaid spending, 
which are intended to give States more flexibility and predictability 
while also controlling Federal outlays related to the program.
  We have received substantial input on this matter from Governors 
around the country, and virtually all of them agree changes need to be 
made. Given these concerns and the sheer vastness of the Medicaid 
Program under ObamaCare, the Senate will have to tackle this issue when 
it takes up the budget reconciliation legislation in the next few 
  I am confident that in working with my colleagues in the House and 
Senate and with the Governors, we can find the right solution.

  Fourth, there is the issue of savings accounts for healthcare costs. 
I have long been an advocate for the expanded use of HSAs and FSAs. 
Needless to say, I was particularly opposed to the ObamaCare provisions 
that limited the use of these savings accounts and essentially 
marginalized their usefulness for consumers and patients.
  The House bill removes a number of restrictions on these accounts 
that have been imposed by ObamaCare, and it goes further to remove 
longstanding restrictions on HSAs in order to expand their use and give 
patients and consumers more options to pay for health expenses.
  I am very supportive of this approach. In fact, the language from the 
House bill mirrors the legislation I introduced this year--the Health 
Savings Act of 2017.
  Fifth, there are some important transition issues that need to be 
  To get at these issues, the House bill creates a Patient and State 
Stability Program, under the Social Security Act, that would distribute 
$100 billion to States over 10 years to enhance flexibility for States 
in how they manage healthcare for their high-risk and low-income 
  For example, the funds could be used to, among other things, help 
individuals with cost-sharing. This program was proposed with the idea 
of giving States an expanded role in the healthcare system, a goal that 
is shared by most Republicans in Congress and something that almost all 
of the Governors have told us they want to see.
  There are other issues from the House bill in the broader healthcare 
debate that will demand some attention when we consider the bill in the 
Senate. However, almost all of them fall under these general 
categories. Once again, the vast majority of them fall under the sole 
jurisdiction of the Senate Finance Committee, the primary committee.
  There are other critical issues out there which do not involve the 
Tax Code, the Social Security Act, or Federal health programs. Yet they 
are extremely important.
  The biggest mistake made by those who drafted ObamaCare and forced it 
through Congress was their failure to address healthcare costs in any 
meaningful way. After all, cost is the largest barrier preventing 
people from obtaining health insurance coverage, and the increasing 
healthcare costs are among the most prominent factors leading to wage 
stagnation for U.S. workers. Yet ObamaCare did little to address this 
problem, and in fact it has made things worse.
  If we are going to fully keep our promises to the American people 
with regard to ObamaCare, we are going to have to eventually address 
these issues. After all, most people's negative interaction with the 
Affordable Care Act has come in the form of increased healthcare costs. 
If we are going to truly right all of ObamaCare's wrongs, we need to 
tackle the costs head on.
  This will mean, among other things, fixing the draconian regulatory 
regime in our health insurance markets and giving individuals the 
ability to select only the coverage they want and need.

[[Page S1732]]

Many of these types of issues fall far outside of the Finance 
Committee's jurisdiction and are under the watchful eye of the 
distinguished chairman of the Senate HELP Committee.
  The House bill also includes some provisions that are intended to 
address these concerns. I assume our distinguished colleague running 
the HELP Committee is working tirelessly to address the issues, and 
others, both through the reconciliation exercise or some alternative 
  Ultimately, if our goal is to place the healthcare system in a better 
position than it has been under ObamaCare, costs will have to factor 
heavily into the equation. I am looking forward to receiving guidance 
and leadership on the HELP Committee on these important market reform 
  Overall, I believe we can and will be successful in this endeavor to 
fix our broken healthcare system. The American people are counting on 
us to do so. At the end of the day, success in that endeavor is, in my 
view, going to require a robust Senate process that allows this Chamber 
to work its will.
  We have two Chambers in Congress for a reason. The House 
reconciliation bill needs 218 votes to pass. The Senate will also have 
to act when we receive the bill, and we will need to produce a package 
that can get at least 51 votes in this Chamber and hopefully more. That 
may mean some differences between the Senate and the House versions of 
the bill, but that is not problematic in my view. It is not 
particularly novel or unusual for different views and ideas to be 
resolved through the legislative process rather than simply dissipating 
when a bill is introduced. It seems to me that is not novel, and I am 
not the only one who has this view.
  Earlier this week, Secretary Price sent a letter to the chairmen of 
the House Ways and Means and Energy and Commerce Committees. The letter 
commended the chairmen for their work and praised the legislation they 
unveiled to repeal and replace ObamaCare.

  The Secretary also noted that this was not the end of the process but 
that the introduction of the House bill was a ``necessary and important 
first step'' and that the administration anticipated that the Congress 
would be ``making necessary technical and appropriate changes'' to get 
a final bill to the President that he can sign, which reminds us of the 
other important advocate in this endeavor. President Trump ultimately 
needs to support the bill that is passed by each Chamber of Congress, 
and his support for our efforts is paramount.
  While, at this point, it may not be entirely clear what the final 
bill will look like, we do know two things for certain. First, we know 
that ObamaCare is not working. As the majority leader said yesterday, 
ObamaCare is a direct attack on the American middle class. Thanks to 
skyrocketing premiums, shrinking options in the health insurance 
market, burdensome mandates, and harmful taxes, millions of Americans 
are dealing with the failures of ObamaCare on a daily basis. We need to 
act now to fix these problems.
  Second, we know that by introducing its bill and moving it through 
the legislative process, the House has taken significant steps in 
advancing this effort, and the leaders in the House should be commended 
for doing so.
  Long story short, I have nothing but praise for the leaders in the 
House this week for the work they have done on these issues. Remember, 
this is just the beginning. I look forward to working with my 
colleagues in both Chambers to get this over the finish line so the 
Republicans can collectively make good on our promises with regard to 

                       Nomination of Neil Gorsuch

  Mr. President, I rise to speak on the nomination of Neil Gorsuch to 
the U.S. Supreme Court.
  Later this month, Judge Gorsuch will come before the Senate Judiciary 
Committee for his confirmation hearing. I wish to speak today on what 
we can and should expect to happen during that hearing.
  First, some background. This will be the 14th Supreme Court 
confirmation hearing I have participated in. I have seen some truly 
outstanding hearings in which both the nominee and the Senators 
acquitted themselves well. I have also seen some hearings that have 
gone far off the rails, in which some Senators hurled unfounded 
allegations or sought to twist the nominee's clearly distinguished 
record. I am hopeful Judge Gorsuch's hearing will be the former type.
  We have before us a supremely qualified, highly respected, and 
extremely thoughtful nominee. Judge Gorsuch has had a stellar legal 
career, and by all accounts, he is a man of tremendous integrity, 
kindness, and respect. He is the sort of person all Americans should 
want on the Supreme Court. He does not approach cases with preconceived 
outcomes in mind. He seeks to apply the law fairly and impartially in 
line with what the democratically elected representatives who enacted 
the law had in mind. He will be a truly outstanding Justice.
  Judge Gorsuch's hearing will focus on his background, his 
temperament, and his approach to judging. So let's talk a little about 
what we know about Judge Gorsuch. We know he has an outstanding 
academic record. He graduated from Columbia University and Harvard Law 
School and obtained a doctor of philosophy in law from Oxford 
University. We know he had a highly successful legal career before 
becoming a judge.
  He clerked for two Supreme Court Justices before entering private 
practice here in Washington. He made partner in only 2 years, which 
shows how highly his colleagues at the firm thought of him and his 
  Following a decade in private practice, Judge Gorsuch was appointed 
Principal Deputy Associate Attorney General at the Department of 
Justice, where he oversaw the Department's antitrust, civil, and 
environmental tax units.
  In 2006, President Bush nominated Judge Gorsuch to the U.S. Court of 
Appeals for the Tenth circuit--the circuit in which I reside. The 
Senate confirmed Judge Gorsuch unanimously by voice vote a short 2 
months later. At Judge Gorsuch's investiture, then-Senator Ken Salazar, 
who later served as President Obama's Interior Secretary, praised Judge 
Gorsuch's ``sense of fairness and impartiality.'' That fairness and 
impartiality, which was evident to my colleagues even then, was a large 
reason why Judge Gorsuch won confirmation without a single dissenting 
  Judge Gorsuch's hearing will also affect us on his temperament and 
approach to judging. No one can seriously doubt that Judge Gorsuch has 
an excellent judicial temperament. A recent article in Slate--no 
rightwing paper, by any means--described the judge as ``thoughtful and 
fair-minded, principled, and consistent.''
  The Denver Post, which twice endorsed President Obama for President 
and endorsed Hillary Clinton in this past election, also recently 
endorsed Judge Gorsuch's nomination, saying: ``From his bench in the 
U.S. Tenth Circuit Court of Appeals, he has applied the law fairly and 
  Clearly, Judge Gorsuch has the right temperament to serve on the 
Supreme Court.
  His approach to judging is also spot-on. Judge Gorsuch's opinions 
show that he is not only an excellent writer but also that he 
understands the proper role of a judge in our constitutional system. He 
consistently explains his reasoning by reference to fundamental 
constitutional principles. He does not seek to push the law toward the 
outcomes he favors but instead tries to apply it in harmony with the 
understanding of those who wrote and passed it. In so doing, he shows a 
healthy respect for the legislative process and for the democratically 
elected branches of government.
  As Judge Gorsuch said in a speech shortly after Justice Scalia's 
passing, ``Judges should be in the business of declaring what the law 
is, using traditional tools of interpretation, rather than pronouncing 
the law as they might wish it to be in light of their own political 
  Judge Gorsuch's opinions demonstrate that he understands 
fundamentally the importance of this principle and that he seeks 
faithfully to apply it in his own judging.
  Against this impressive list of qualifications, Democrats and their 
liberal allies strain mightily to find plausible grounds to oppose 
Judge Gorsuch's nomination. They misread his opinions, misstate his 
reasoning, and in

[[Page S1733]]

general paint a picture of a man who simply does not exist. We can 
expect more of this at his confirmation hearing. In particular, we can 
expect to be raised again and again the risible and flatly false claim 
that Judge Gorsuch is outside the ``judicial mainstream.'' These 
arguments against Judge Gorsuch are not persuasive--not even close. We 
see hints of them in the various letters liberal interest groups have 
sent Congress claiming that Judge Gorsuch is a threat to the Republic--
a danger to our very way of life. The over-the-top language these 
groups use only serves to highlight the weakness of their case against 
Judge Gorsuch.
  One such letter called the judge ``an ultra-conservative jurist who 
will undermine our basic freedoms and threaten the independence of the 
Federal judiciary.'' The letter goes on to say that there is ``zero 
evidence that Judge Gorsuch will be an independent check on this 
runaway and dangerous administration.''
  As an initial matter, I would ask: If Judge Gorsuch is such an 
existential threat to the Republic, where were all these groups 10 
years ago when he won confirmation to the Tenth Circuit unanimously? 
Did Judge Gorsuch spend the first 40 years of his life hiding what a 
monster he is, revealing his true self only once safely ensconced on 
the Federal bench?
  The outlandishness of these claims against Judge Gorsuch is made 
clear by the support he has received from prominent liberals, including 
President Obama's own Solicitor General, Neal Katyal. In an op-ed 
published in the New York Times, Neal Katyal praised Judge Gorsuch's 
fairness and decency and said that he had no doubt that, if confirmed, 
Judge Gorsuch would ``help to restore confidence in the rule of law.'' 
Katyal further wrote that Judge Gorsuch's record as a judge reveals a 
commitment to judicial independence, a record that should ``give the 
American people confidence that he will not compromise principle to 
favor the President who appointed him.''
  It bears mention here that Mr. Katyal is no shrinking violet when it 
comes to standing up to the executive branch. He rose to prominence in 
the legal community through his work representing Guantanamo detainees. 
So when he says Judge Gorsuch will not shy away from holding Federal 
officials to account, frankly, his words carry weight.
  Then there is the phrase we are likely to hear invoked again and 
again at Judge Gorsuch's hearing and beyond: ``judicial mainstream.'' 
Liberals will tie themselves in knots claiming that Judge Gorsuch is 
some sort of fringe jurist, that his views place him on the far flank 
of the Federal judiciary. Any honest observer will tell you that these 
claims are complete bunk. President Obama's Solicitor General and 
liberal publications like Slate would not offer praise for Judge 
Gorsuch if he were some kind of a nut.
  In reality, the claims that Judge Gorsuch is outside the mainstream 
boil down to three things: a willful misreading of his decisions, a 
disingenuous attempt to redefine what it means to be mainstream, and an 
inability to count. On the misreading point, opponents of Judge Gorsuch 
claim that his decisions say things that they very clearly do not say 
or stand for propositions that even a generous reading cannot 
substantiate. They say he favors large corporations over employees, 
when really he just believes Federal employment laws mean what they 
say. They say he opposes contraception and family planning, when really 
he just believes religious liberty statutes should be enforced.
  Judge Gorsuch's opponents also cite as examples of his purported 
extremism decisions that liberal Democratic appointees joined or that a 
majority of his colleagues agreed with. They will take a case in which 
more than half--or sometimes all--of the judges who heard the case 
agree with Judge Gorsuch and say the decision was outside the 
mainstream. I don't know about my colleagues, but I always thought that 
being in the mainstream had something to do with being somewhere in the 
vicinity of your peers or colleagues on a given issue. But, apparently, 
that is not what the left means.

  Rather, in their failing campaign against Judge Gorsuch, liberals 
have redefined ``mainstream'' to really mean nothing at all. It has 
become a code word for liberal, for the sorts of results that liberals 
would like to see. But being in the mainstream and being liberal are 
not the same thing, despite Democrats' fondest desires. There is such a 
thing as diversity of thought, which the left used to venerate, at 
least until the confirmation wars and the rise of the conformity cult 
on college campuses.
  So to my colleagues--and to the American people--I say: Do not be 
deceived when liberals say that Judge Gorsuch is outside the 
mainstream. He understands that the proper role of a judge in our 
constitutional system is to interpret the laws in accordance with the 
understanding of those who wrote and ratified those laws. This approach 
to judging leaves lawmaking power to the people's elected 
representatives and confines the judge's role to implementing the 
policy choices selected by those representatives. It is an approach 
consistent with our Constitution, our core values, and democracy 
  It may be at times that this approach yields results that liberals 
don't like, but that doesn't place it outside the mainstream. It cannot 
be the case that the test of whether a judge is in the mainstream is 
whether that judge reaches consistently liberal results. When the 
people's elected representatives enact into law a conservative policy, 
a judge faithfully applying that law may well reach a conservative 
result. The opposite is true when the people's elected representatives 
enact into law a liberal policy.
  All of this is to say that we cannot judge a nominee solely on the 
basis of whether we like the results he or she reaches. As Justice 
Scalia famously said:

       If you're going to be a good and faithful judge, you have 
     to resign yourself to the fact that you are not always going 
     to like the conclusions you reach. If you like them all the 
     time, you are probably doing something wrong.

  That is an interesting statement by one of the great judges, whom 
Judge Gorsuch will replace.
  Liberals want judges who will always reach liberal results, but that 
is not the role of the judge. It is the role of a legislator, and a 
judge is certainly not a legislator.
  So when you hear liberals say Judge Gorsuch is outside the 
mainstream, recognize that they are talking about results--
specifically, liberal results--and recognize that that is not the 
proper inquiry for a Supreme Court confirmation hearing.
  A Supreme Court confirmation hearing should be about the nominee, the 
nominee's experience, and whether the nominee understands his or her 
properly constrained role as a judge under our Constitution. On all of 
these metrics, Judge Gorsuch is off-the-charts qualified.
  When the good judge comes before the Judiciary Committee, listen to 
the answers he gives. Ask yourself whether what he says is consistent 
with the separation of powers and the system the Framers designed. 
Compare his measured demeanor and thoughtful responses to the 
histrionics you see from his opponents on the left.
  I have full confidence that when the hearing is over and the last 
question has been asked, Judge Gorsuch will have shown the Senate that 
he is unquestionably qualified and fully prepared to serve our Nation 
on the Supreme Court.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Blunt). The Senator from Delaware.
  Mr. CARPER. Mr. President, it is good to be with my colleagues and 
the chair of the Senate Finance Committee. I am pleased to say a few 
words about the President's nominee, Seema Verma, who, if confirmed, 
will lead us at the Centers for Medicare and Medicaid Services. She is 
from Indiana, and folks I know in Indiana have said that she knows a 
lot about Medicaid, but not nearly so much about Medicare, which is a 
cause for some concern.
  If confirmed, let me just say we certainly look forward to working 
with her and with the team she will have around her in that 
responsibility. It is a very tough job, as the Presiding Officer knows.


  What I would really like to focus on is that I want to go back in 
time, if I could. I want to go back to 1993. I am

[[Page S1734]]

not sure what the Presiding Officer was doing in 1993, but I was a 
brand-new Governor in 1993. We had a brand-new President and a brand-
new First Lady. She was asked--I presume by her husband, or maybe she 
just decided on her own--to try to do what Presidents had talked about 
doing for a long time; that is, to try to make sure that everybody in 
our country had healthcare coverage. Her name was Clinton, and what she 
came up with, in consultation with a lot of folks, was something that 
was called HillaryCare--not always as a compliment, but sometimes, in 
some cases, derisively. I think our Republican friends, who were 
somewhat pointed in their criticism of it, were basically asked: Well, 
where is your idea?
  In 1993, a guy named John Chafee, whom the Presiding Officer knows--
we served with his son Lincoln in the Senate, and Lincoln went on to be 
Governor of Rhode Island--took up the challenge, along with at least 20 
other Senators--I think mostly Republican and a couple of Democrats--
and they offered legislation in 1993 that was the Republican 
alternative to HillaryCare.
  At the end of the day, HillaryCare did not survive, as we know, and 
the Chafee proposal from that time essentially went away in that 
particular Congress. What he had proposed had five major concepts to 
it. One of those was the idea that folks who didn't have healthcare 
coverage should be able to get their coverage in their own State--
unless they were very wealthy--and to be able to get coverage in a 
large group plan. They called them exchanges or marketplaces, which 
would be established in each State. If that sounds familiar, it should.
  They also said that folks who were going to get their coverage who 
didn't have coverage for healthcare in these 50 States would get some 
help in buying down the cost of their healthcare, and they would get 
that by the adoption of a sliding-scale tax credit which would buy down 
the cost of premiums for low-income people. The lower their income, the 
bigger the tax credit was; the higher the income, the lower the tax 
credit. And finally, it phased down.
  There were concerns raised by insurance companies that it would be 
hard to insure folks who were going to be getting healthcare coverage 
on these exchanges in each of these States because a lot of these 
people hadn't had healthcare in a long time. There was an expectation 
that they would have a high demand for healthcare, they would need a 
lot of healthcare, and they would be a hard group to insure because 
their need for healthcare was very large. The insurance companies were 
fearful that the group of people in each of the States they would be 
asked to insure on the exchanges would not be insurable--not in the way 
in which the insurance companies could break even or make money.
  This idea came along. Just to insure that we have a good mix of 
healthy and maybe not-so-healthy people in the exchanges to insure in 
each of the States, Senator Chafee and these folks came up with the 
idea that people would be mandated to get coverage in the States--
everybody. You can't make people get coverage, but under the Chafee 
plan, for folks who didn't, they would have to pay a fine, and the 
fine, over time, would go up and become stiffer. So finally, people 
might say: Well, I am paying all this money for no healthcare coverage. 
Maybe I ought to get coverage and stop having to pay this fine. At 
least I would have something for my money.
  The two other things in the original legislation from Senator Chafee 
and company were something called an employer mandate, the idea that 
employers were mandated to provide coverage. At least employers with a 
minimum number of employees would have to provide coverage--to provide 
a large group plan within their business or within their employment. 
That was the employer mandate in the Chafee proposal.
  The other thing that was in Chafee, as I recall, was something like a 
provision that said to insurance companies: You can't just stop 
providing coverage for people because they have a preexisting 
condition; you have to insure people.
  So those are the five major precipes: No. 1, creating exchanges in 
every State or marketplaces for people to get their coverage; No. 2, 
sliding-scale tax credits to help drive down the costs for low-income 
people for their coverage in their States; No. 3, individual mandates, 
or trying to make sure the mix of people insured was actually 
insurable, without the insurance companies losing an arm and a leg; No. 
4, employer mandates that employers of a certain size have to provide 
coverage for their employees; and, finally, the idea of knocking people 
off coverage because of preexisting conditions was a no-no.
  As we know, HillaryCare was not adopted, and neither was the Chafee 
plan. But it turned out the Chafee plan had legs, as they say in show 
business. It means it actually lasted beyond just being a bill 
introduced in the Senate in 1993.
  It surfaced in Massachusetts about 10 years later, thanks to Governor 
Mitt Romney, who was thinking about running for President. Some of the 
people advising him said: You know, Governor, you could probably help 
your chances of running for President if Massachusetts could be the 
first State to have universal healthcare coverage for its residents. 
That sounded pretty enticing.
  He said: How do we do this?
  They looked up the Chafee bill. They apparently knew about it, 
thought about it, and said: Let's take the Chafee proposal and do that 
in Massachusetts.
  That is what they did. Guess what. They found that they did a pretty 
good job in terms of covering more people on the coverage side. It 
worked pretty well. Where it didn't work very well was on the 
affordability side. As we might imagine, there were the young 
invincibles--like some of these pages we have down here and their older 
brothers and sisters who maybe say: I don't need healthcare coverage. I 
am young and invincible. I will never get sick and go to the hospital.
  They had a sliding scale. They had an individual mandate, but they 
had a fine people had to pay over time. Eventually, as more years went 
by, the young and healthy people said: I might as well get coverage. It 
helped provide for a better mix of folks in the exchange to provide 
insurance for. So they did a better job on the cost and, after a while, 
  When we went to work in the beginning of the Obama administration in 
2009 on the Affordable Care Act, some people think Democrats just sat 
down in our caucus and just rolled out a plan and said: This is what we 
are going to do to provide healthcare coverage to people. That is not 
what we did. We spent a lot of time trying to figure out what we should 
do. We had, I want to say, dozens of hearings in the open, in public, 
on the Finance Committee. I am sure they had other hearings in the 
Health, Education, Labor, and Pensions Committee, which shares 
jurisdiction with Finance on this subject. We had dozens of hearings. 
We actually had the head of the Congressional Budget Office come and 
  We had a pretty good idea of what it would cost. We had a pretty good 
idea of what impact it would have on the Medicare trust fund. It turned 
out that the adoption of the Affordable Care Act extended the life of 
the Medicare trust fund by, I think, 12 years. It actually brought down 
the Federal budget deficit over the next 10 years by quite a sizeable 
amount, and over the 10 years after that by even more. The idea was to 
provide coverage for a lot of people who wouldn't have it--actually, 
using the Chafee plan.
  I think it is really ironic, sometimes almost humorous, when my 
Republican friends--and they are my friends--attack the Affordable Care 
Act. The piece that they attack is, I like to say, their stuff. They 
are the Chafee-Romney ideas.
  I studied economics at Ohio State and studied some more in business 
school after the Vietnam war. I like market approaches to problems. So 
I find real virtue and interest in what Chafee came up with and what 
Romney put to work. Romney provided kind of a laboratory in 
Massachusetts to see how that idea would work--maybe not on a national 
scale but at least on a statewide scale, with a lot of people involved.
  I am troubled by where we find ourselves today. During Presidential 
campaigns, I know people say things in campaigns that maybe they don't 

[[Page S1735]]

or maybe they exaggerate or something like that. But I think the 
campaign might have been over and Donald Trump had been elected 
President. He promised, I believe shortly thereafter, that his plan to 
repeal and replace the Affordable Care Act would lower the cost of 
health insurance, while providing better coverage for everyone. That is 
what he said. His plan to repeal and replace the Affordable Care Act 
would lower the cost of health insurance, while providing better 
coverage for everyone.
  I realize that the ink is barely dry on what the two House 
committees--the Ways and Means Committee and the Energy and Commerce 
Committee--have been working on. As best we can tell at this point in 
time, the bill they reported out of the committees--and I presume they 
are going to vote in the full House pretty soon, if they haven't 
already--but the House Republican bill to repeal the Affordable Care 
Act does just the opposite of what Donald Trump called for. It does not 
lower the cost of health insurance, as best we can tell, and it doesn't 
provide better coverage for everyone. The House Republican bill to 
repeal the ACA does nothing to slow down the growth of healthcare 
  One of the great virtues of the Affordable Care Act is the focus on 
value. How do we get better results, better healthcare outcomes, for 
less money? If we go back to where we were 8 years ago and compare how 
much we were spending in this country for healthcare as a percentage of 
gross domestic product, we were spending 18 percent. One of our major 
competitors in the world--a major ally but a major competitor--is 
Japan. In 2009, while we were spending 18 percent of GDP, Japan was 
spending 8 percent--less than half as much, 8 percent of GDP. They got 
better results, and they covered everybody.
  So as we were approaching the debate and eventually the markup on 
voting on the Affordable Care Act, we had this in the back of our mind. 
We looked around the world to see what seemed to be working to get 
better results for less money, and we looked at Massachusetts to see 
how that was working and what we could learn from what they called 
RomneyCare up there.
  But the House Republican bill to repeal the ACA does, as best we can 
tell at this point in time, very little--maybe nothing--to slow the 
growth of healthcare costs, and that is a shame. Apparently, fewer 
people will be insured. I think Standard & Poor's estimates as many as 
10 million people could lose coverage under the House Republican plan. 
Insurance markets will destabilize faster. I mentioned earlier that a 
great concern insurance companies had is that they would end up in each 
or in a number of States with a pool of people to insure in the 
exchanges that were uninsurable--the elderly, maybe the sick, people 
who hadn't gotten healthcare for a long time. It is hard to insure that 
group and stay in business if you are a health insurance company. There 
was a concern about destabilization and instability within the markets 
for health insurance.
  The individual mandate is replaced by something called the continuous 
coverage requirement. I would like to think it is going to work. I am 
not sure it would. But under this, I understand that people who go 
without a health insurance plan for more than 2 months will be charged 
a 30-percent surcharge when they are able to get back on and reenroll. 
People with expensive healthcare conditions will be willing to pay a 
penalty. But how about healthier people who often chose to stay out of 
the health insurance markets?
  Also, as best we understand, in the House Republican plan, health 
insurance plans will become less robust, and many Americans will only 
be able to afford rather skimpy insurance plans. Preliminary estimates 
of the House GOP plan shows that insurance costs for the average person 
would increase by roughly $1,500. By 2020, the average person would pay 
$2,400 more.
  I had the privilege of representing Delaware as Governor. One of the 
things I was responsible for in the treasurer's office was 
administering fringe benefits for State employees and teachers and a 
lot of folks. So this is something I have thought about over the 
years--about healthcare coverage for people.
  We have only three counties--unlike Missouri, where the Presiding 
Officer is from, which has probably hundreds of counties--maybe not 
that many. But we only have three. In our southernmost county, Sussex 
County, we have a lot of chickens, a lot of corn, and a lot of 
soybeans. We have five-star beaches. A number of people like to come to 
Delaware to retire. We have no sales tax. We have very low property 
taxes in Sussex County. And for people who are not making a ton of 
money, we have pretty low personal income tax.
  Take the example of a 60-year-old Delawarean in Sussex County who 
makes $30,000 a year. Under the Affordable Care Act, they get a tax 
credit. I mentioned earlier a sliding-scale tax credit. If you are 
lower income, it is a bigger tax credit. If you are a higher income, it 
finally fades out when your income goes up to a certain level. But for 
somebody making $30,000 a year in Sussex County, under the current 
law--the Affordable Care Act--the tax credit in 2020 will be about 
$10,000 to help buy down the cost of their coverage.
  As I understand it, under the GOP health plan, for their comparable 
tax credit for the same person in Sussex County--which, quite frankly, 
has a lot of people 60, 65, 70 years old who make this amount of money 
down there; a lot are retired or semi-retired--the tax credit in 2020 
would be $4,000. That is about $6,200 less. If you happen to be this 
person, you may want to think twice about which of these two paths you 
want to take.
  We have another chart here that might be helpful. This is something 
we got from AARP. When we are passing legislation or drafting 
legislation or debating legislation, we are always interested in what 
key stakeholders feel. AARP is a big stakeholder. They represent a lot 
of people 50 and older. We are interested in hearing from folks who 
represent seniors. AARP represents the views of a lot--not all. We are 
interested in the views of those like doctors, the American Medical 
Association, nurses, providers. We are interested in hearing from 
hospitals. As it turns out--again, while the ink is barely dry on what 
is coming out of the House of Representatives--AARP tells us they are 
not very excited. Well, maybe they are excited about it, but not in a 
good way.
  They say the change in structure will dramatically increase premiums 
for older consumers. That is what we have seen from the previous chart. 
In their example, AARP tells us about a 64-year-old person who is 
earning about $15,000. Their premiums go up $8,400. They are making 
$15,000 a year. I don't know how they pay for much of anything else 
with that kind of increase in their premium costs. That is a concern 
for me and certainly a concern for the folks at AARP and the people 
they represent, the millions of people they represent.
  TrumpCare. The House has come up with different names. Some call it 
ObamaCare light, ObamaCare 2.0 or .5. Some people call it TrumpCare. 
The House is working on it. The concern we are hearing from a lot of 
folks is that it forces women to pay more for basic care.
  Let's go back to the care for women. My wife and I have been married 
31 years. I don't know everything about healthcare needs for women, but 
I do know this. A lot of women I have known--including my own family, 
my sister, my mom, and my wife's family--their primary healthcare 
provider is their OB/GYN. I didn't know that for a long time--not for 
everybody, but for a lot of people that is who their primary care 
provider is. For millions of women, surprisingly, their primary 
healthcare provider happens to be an OB/GYN or healthcare provider who 
works at Planned Parenthood.
  For some people, Planned Parenthood is synonymous with abortions, but 
I think a very small percentage of what they do relates to abortions. 
What they do, for the most part, is try to make sure women get the 
healthcare they need, a lot of times in the OB-GYN realm but also in 
terms of contraception.
  Somebody told me the other day that the cost of contraception for a 
woman in a year could be as much as $1,000. It is not cheap. The cost 
of a single delivery of a child from an unplanned pregnancy that is 
paid for by Medicaid is over $10,000, if I am not mistaken.
  A lot of times, as we know, especially if a young person brings a 
baby into

[[Page S1736]]

the world, maybe doesn't finish high school or whatever, the outcome 
can be not that good for that child. I heard Mary Wright Edelman of the 
Children's Defense Fund say these words. If a 16-year-old girl becomes 
pregnant, does not graduate from high school, does not marry the father 
of her child, there is an 80-percent likelihood they will live in 
poverty. The same 16-year-old girl who does not have a baby, finishes 
high school, graduates, waits until at least 21 to have a child, 
marries the father of the child, there is an 8-percent likelihood they 
will live in poverty. Think about that.
  That suggests to me that we should--particularly for young people and 
those not so young who are sexually active--we want to make sure that 
when they are ready to bring a child into the world they can do that, a 
healthy child, a child with a lot of promise in their life.
  For those who aren't prepared to bring that child, raise that child, 
prepare that child for success, contraception is needed. One of the 
things the Affordable Care Act does is provide access for that 
contraception. I am fearful the plan in the House of Representatives, 
however well-intentioned, will take away that opportunity for a lot of 
women and frankly for their children.
  We have other people who have arrived on the floor. I want to be 
mindful of their time.
  I don't know if we have another chart to look at before I yield.
  We have all heard of double whammy. This has been described as 
TrumpCare, ObamaCare light, whatever you want to call it. It has a 
triple whammy. One of those is higher costs, a second is less coverage, 
And for some people, particularly low- and middle-income folks, more 
taxes. For certain people whose income is over one-quarter million 
dollars, they get a tax break. It adds up to quite a bit for somebody 
who makes a lot of money, but this is not the kind of triple whammy we 
ought to be supporting.
  When the bill gets over here, if it gets out of the House, we will 
have a chance to slow down and hopefully do hearings in the light of 
day and bring in the folks from CBO, ask them to score this, let us 
know what is the real impact of what is being proposed in the House. 
Does it really save money? Does it do what President-Elect Trump said 
he wanted to do, which is make sure everybody gets coverage and be less 
expensive. Does it really do that? And we need to find out what the 
impact is on taxpayers. Is this the holy grail of better results for 
less money or is this something altogether different?
  The Presiding Officer, from Missouri, is somebody who is pretty good 
at working across the aisle. I would like to think I am too. We have 
worked together on a number of issues. When you are working on 
something that is this big and this complex and has this kind of impact 
on our country, we are always better off if we can somehow fashion a 
bipartisan compromise and something that would have bipartisan support.
  We tried to do that in the Affordable Care Act. I know my Republican 
friends feel we didn't, but I was there. I know we tried. In fact, the 
evidence that we tried was literally the foundation for what we do for 
the Affordable Care Act, a Republican proposal from Senator Chafee and 
20 other Republicans, including Orrin Hatch and including Chuck 
Grassley from Iowa. I think that was a pretty good effort.
  If this bill makes its way over here, we need to have at least a 
strong effort, maybe a better effort, maybe a more successful effort in 
the end.
  If we are not going to repeal the Affordable Care Act, actually find 
a way to repair it and make it better, there are things we can do. I 
know I can think of some--I know the Presiding Officer can as well--
that would move us closer to better coverage at a more affordable 
  The last thing I would say is this. I have a Bible study group that 
meets here on Thursdays with Barry Black, who opens our session with a 
prayer every day that we are in session. We also have his Bible study 
group that meets for about a half an hour, 45 minutes in the Capitol--
Democrats and Republicans. We pray together, share things together. I 
describe it as the seven or eight of us who need the most help.
  He is always reminding us of our obligation to the least of these. 
There is a passage of Scripture in Matthew 25 that a lot of us have 
heard of, and I am sure you have heard this in Missouri too. It says: 
When I was hungry, did you feed me? When I was naked, did you clothe 
me? When I was thirsty, did you get me to drink? When I was sick and 
imprisoned, did you visit me? When I was a stranger in your land, did 
you take me in?
  It doesn't say anything about when I didn't have any healthcare 
coverage and my only access to healthcare was an emergency room to a 
hospital. It doesn't say that in Matthew 25. I think the implications 
are clear. They are the least of these as well. They need our help, and 
I think we have a moral obligation, as people of faith, to help them.
  We also have a fiscal imperative because while the Federal deficit is 
down from $1.4 trillion 6, 7, 8 years ago, down to about one-third of 
that, it is still high. We need to make more progress on that. We have 
a fiscal imperative to meet that moral imperative.
  With that, I think I will call it quits. I know my colleagues will be 
disappointed, but they are standing here, from all over the country, 
waiting to say their piece. I am going to yield to them and wish them 
all a good weekend, and I look forward to seeing you on Monday.
  I yield the floor.
  Before I do, I yield the remainder of my postcloture debate time to 
Senator Ron Wyden of Oregon.
  The PRESIDING OFFICER. The Senator has that right.
  The Senator from Arkansas.

                           Homeland Security

  Mr. BOOZMAN. Mr. President, when President Trump began his campaign 
for the White House, he made national security and, in particular, 
homeland security a cornerstone of his platform. His calls to secure 
the border to keep terrorists off U.S. soil and to protect our 
communities struck a chord with a large majority of Americans who for 
years felt that Washington ignored their very real concerns about our 
porous borders and broken immigration system.
  As expected, the President moved quickly to deliver on his promises 
to fix this broken system. This week, the Trump administration rolled 
out a revised version of this Executive order aimed at restoring 
confidence in the procedures we have used to vet refugees fleeing from 
nations that are known to harbor radical and violent extremists.
  The revised version appears to have benefited from the engagement of 
the President's Cabinet, especially the key input of Homeland Security 
Secretary Kelly. This valuable input underscores how important it is 
for the President to have his team in place to govern effectively.
  Senate Democrats have slowed the confirmation process at every turn. 
I encourage them to abandon the political games so we can quickly fill 
the remaining vacancies that require Senate confirmation.
  It is vital that every affected agency is engaged in these types of 
decisions. That isn't possible if the Senate is failing to do its duty 
to confirm the President's nominees. Congress has many problems to 
tackle, but protecting our Nation is at the top of that list. That 
requires we work together to govern.
  It also requires we take a step back from the heated rhetoric and 
have honest conversations. Taking the fundamental steps to protect our 
homeland does not diminish the fact that we are a welcoming nation that 
strives to help the vulnerable.
  It is no secret that ISIS and other volatile extremists want to 
exploit our Nation's generosity and welcoming spirit to sneak 
terrorists onto American soil. This plan has worked well in Europe. 
ISIS believes it can work here as well. We can, and must, take 
reasonable measures to prevent that.
  It is reasonable, responsible, in fact, to put a pause on accepting 
refugees from these nations in order to fix the flaws in the process 
and instill confidence in the system. The revised order removes Iraq 
from the list of countries. That is a move in the right direction. It 
shows that the Iraqis have taken the right steps in agreeing to 
increase their cooperation with us, and effecting positive outcomes in 
our relations with these nations is what this pause is all about.

[[Page S1737]]

  Four of the countries on this list don't even have a U.S. Embassy. So 
you can understand how difficult it is to get a complete picture of the 
refugees seeking asylum from those countries when we don't even have a 
means by which to communicate.
  Once the President's Executive order goes into effect, every country 
will be evaluated within 20 days. If a country comes up short of where 
it needs to be, it will have 50 days to fix the failures and 
communications with us.
  The reasonable measures we are taking to reduce this threat in no way 
run counter to the ideals our Nation is built upon. We can be proud of 
the resources the United States has provided to support those fleeing 
persecution in war-torn Syria. I have visited the refugee camps we 
support in Jordan and Turkey. Our commitment to their well-being is 
strong. The rhetoric doesn't match the realities when it comes to this 
  The administration's efforts to secure our borders has been met with 
similar hyperbole. Again, there is nothing unreasonable about ensuring 
that we know who is coming into our Nation. We are a nation of 
immigrants and must remain welcoming to those who want to achieve the 
American dream. We should be proud of our record to naturalize those 
who immigrate here legally. We naturalize more new citizens per year 
than the rest of the world combined. Enforcing the law, ensuring the 
safety and security of our Nation, will not change our commitment to 
being a welcoming society to those who seek a better life.

  But you can't create policies to secure our homeland while wearing 
rose-colored glasses. There are terrorists seeking to exploit our good 
graces so they can attack us here at home. This is not a scare tactic; 
this is reality, and we have to root our policies in reality.
  As chairman of the Appropriations Homeland Security Subcommittee, I 
strongly support President Trump's efforts to get Washington to uphold 
our most important responsibility: protecting the American people. I 
stand ready to work with him, Secretary Kelly, and my colleagues to 
accomplish this goal.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Mr. PETERS. Mr. President, I rise today to express my opposition to 
the confirmation of Seema Verma as Administrator of the Centers for 
Medicare and Medicaid Services, known as CMS.
  As CMS Administrator, Ms. Verma would oversee healthcare coverage for 
more than 55 million seniors and disabled individuals in the Medicare 
Program. In addition, she would be the primary authority for the 
Medicaid Program, the Children's Health Insurance Program, and our 
Nation's health insurance marketplace. Together, these programs cover 
over 70 million Americans.
  I have serious concerns that if confirmed, Ms. Verma will pursue 
shortsighted changes to our healthcare system that could jeopardize 
care for working families, while providing huge benefits to corporate 
  Ms. Verma has openly stated her desire to put insurance companies 
back in charge of our healthcare by allowing insurers to deny women 
maternity care coverage as an essential health benefit. She has also 
expressed support for proposals that would weaken essential health 
benefits that ensure coverage for mental healthcare, preventive 
screenings, and comprehensive pediatric care for children. These 
comprehensive services form the backbone of the healthcare system that 
invests in preventive care, improving outcomes, lowering costs, and 
puts consumers in charge of their own healthcare. Ms. Verma is 
proposing to take us back to the days when insurance companies were in 
control and when they would tell you what was best, not you or your 
  She has also expressed support for dangerous and radical proposals 
that would change Medicare as we know it. I believe that when it comes 
to Medicare, our future CMS Administrator should be doing everything he 
or she can to strengthen an incredibly successful program. Ms. Verma, 
instead, supports policies that reduce the quality of care and increase 
costs on older Americans.
  Our Nation's seniors have worked hard their entire lives. We owe them 
a secure and dignified retirement. When Congress was first debating the 
Affordable Care Act in 2009, I heard from seniors who had split their 
pills in half or would forgo their prescriptions altogether just to put 
food on their table. This is simply unacceptable in this great country 
of ours.
  It is important to remember that the Affordable Care Act extended the 
solvency of Medicare by more than a decade, while simultaneously 
bringing down prescription drug costs for seniors. Because of 
improvements to Medicare in the Affordable Care Act, the average senior 
in Michigan saved over $1,000 on prescription drug costs in 2015.
  While this shows the success the ACA has had in helping older 
Americans, there is still much more work to do. We must keep moving 
forward to strengthen and improve Medicare. I am concerned Ms. Verma 
will move us backward.
  During her confirmation hearing, she failed to express her opposition 
to proposals that would increase Medicare's eligibility age. This means 
that Michigan's construction workers, nurses, and autoworkers would 
need to spend more years on their feet before they see the coverage 
they have earned.
  Ms. Verma provided no clear direction on what she will do to 
strengthen the Medicare Program, and I am concerned that she sees older 
Americans as just one more line on a budget. These Americans have 
worked hard their entire lives, and the very last thing we should be 
doing is making cuts at their expense. Instead, we should focus on 
proven advances in technology that improve Medicare and cut costs 
without jeopardizing care for seniors and disabled individuals.
  I worked with my colleagues in Congress to introduce bipartisan 
proposals that will do just that. For example, Medicare spends one out 
of every three dollars on diabetes treatment. The total economic cost 
of diabetes is estimated to be $245 billion every year. I have 
introduced bipartisan legislation that allows Medicare to enroll 
individuals at risk for developing diabetes into medical nutrition 
therapy services proven to decrease the likelihood they will develop 
diabetes in the first place. I have also introduced bipartisan 
legislation that expands Medicare's use of telemedicine, increasing 
access for patients in rural and underserved communities and bringing 
down future health costs by ensuring patients get the preventive care 
they need to stay healthy.
  I will keep working to improve and modernize our healthcare system 
without sacrificing care for the most vulnerable. Unfortunately, I do 
not believe Ms. Verma shares this commitment. I am voting against Ms. 
Verma's nomination because our seniors and working families deserve a 
CMS Administrator who is fighting to improve their healthcare, not one 
who merely sees them as a budgetary obligation.
  I will oppose her confirmation, and I strongly urge my colleagues to 
do the same.
  Mr. President, I yield 35 minutes of my postcloture debate time to 
Senator Wyden.
  The PRESIDING OFFICER. The Senator has that right.
  Mr. PETERS. I yield the floor.
  Ms. CANTWELL. Mr. President, I rise to discuss the nomination of 
Seema Verma for Administrator of the Centers for Medicare and Medicaid 
Services, CMS.
  We have before us a nominee that would run an agency responsible for 
the healthcare of more than 100 million Americans, with an annual 
budget of about $1 trillion. This is the agency that administers 
Medicare, Medicaid, the Children's Health Insurance Program, and health 
insurance exchanges. In short, CMS is the single most consequential 
agency in health care.
  Yes, I am deeply concerned about this administration's ideas on 
Medicare and on the individual insurance market, over both of which CMS 
has profound influence, but I am most concerned about their plans for 
  Based on Ms. Verma's history, her actions, her statements, and her 
testimony before the Senate Finance Committee, it is clear to me that 
Mrs. Verma is not only complicit but is leading the charge to wage a 
war on Medicaid.
  Why do I say that? Let us look at Ms. Verma's record, actions, and 
testimony on Medicaid. In Indiana, Ms. Verma made millions of dollars 
in consulting

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fees by kicking poor working people off of Medicaid for failure to pay 
monthly contributions similar to premiums. This plan forced people 
making $10,000 a year, $5,000 a year, or even homeless people with 
virtually no income to pay a monthly contribution or be penalized. As a 
result of Ms. Verma's work, about 2,500 Hoosiers have been cut from 
care. Evaluations of this plan by independent experts show it is 
confusing to beneficiaries and has not demonstrated better results than 
traditional Medicaid expansion. Meanwhile, enrollment is far lower than 
  During my meeting with her and in her testimony before the Senate 
Finance Committee, Ms. Verma stated that Medicaid should not be an 
option for able-bodied people. Ms. Verma seems to think the private 
sector can serve this population on its own. Based on what we know 
about the historical affordability challenges in the individual health 
insurance market, I find this notion hard to believe.
  My State is innovating in Medicaid through ``rebalancing'' from 
nursing homes to home and community care, integrating behavioral health 
and primary care, and adopting of innovative new waivers through 
collaboration with the Federal Government. In fact, Washington State 
realized more than $2.5 billion in savings over 15 years through 
rebalancing efforts; yet Ms. Verma will not commit to a single delivery 
system reform idea.
  Ms. Verma claims Medicaid is a top-down Federal power grab. On the 
contrary, Medicaid is an optional State program, with all States 
participating. Every State participates because they know Medicaid is a 
good strategy for covering a low-income and vulnerable population and 
supporting their healthcare delivery system. Medicaid is highly 
flexible right now, and States have wide latitude over eligibility, 
benefits, provider reimbursements, and overall administration of their 
Medicaid programs.
  Ms. Verma claims Medicaid produces poor outcomes, but she cannot 
offer a single credible clinical outcome or quality measure that the 
program is not achieving. Meanwhile, data show that patient 
satisfaction in Medicaid is high and the program achieves improved 
public health and clinical outcomes for its patients.
  Most concerning, Ms. Verma has repeatedly endorsed the administration 
and Republicans' plan to permanently cap Medicaid, which would hurt 
patients, States, health providers, and local economies.
  I am voting no on Seema Verma's nomination for CMS Administrator 
because I cannot endorse a full-scale assault on the Medicaid Program.
  Mr. RUBIO. Mr. President, Seema Verma has a proven track record of 
helping States create patient-centered healthcare systems that improve 
quality and access and give individuals and families more control over 
their healthcare. Due to a family commitment, I was unable to 
participate in the cloture vote. However, I strongly support Ms. 
Verma's nomination and look forward to working with her on the many 
important healthcare issues facing Florida and our country.
  The PRESIDING OFFICER. The Senator from Alaska.