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(Senate - May 23, 2017)

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[Congressional Record Volume 163, Number 89 (Tuesday, May 23, 2017)]
[Pages S3082-S3092]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     EXECUTIVE CALENDAR--Continued

  The PRESIDING OFFICER. The President pro tempore, the Senator from 
Utah.


                       International Data Privacy

  Mr. HATCH. Mr. President, I rise today to discuss international data 
privacy. This is a critically important issue that has become all the 
more important over the years as we become more sophisticated. It has 
become all the more pressing in recent months as a result of court 
decisions impacting law enforcement's ability to access electronic 
communications overseas.
  I don't think it would surprise anyone to hear me say that our 
privacy laws have not kept pace with technological developments. The 
primary statute that governs law enforcement's ability to access 
electronic data, the Electronic Communications Privacy Act, or ECPA, 
was enacted over 30 years ago--long before most people had even heard 
of email or the internet. ECPA was drafted in a world in which 
electronic data was stored on personal computers or on servers located 
in offices or homes. It presumes a world where data is in one location 
and where in order to access data, a person simply goes to the relevant 
location and retrieves it. But that is not the world we live in, at 
least not today. Nowadays, much of our data is stored not on home or 
office computers but in the cloud, a network of remote servers spread 
throughout the world that allows us to access data from literally 
anywhere.
  The rise of cloud and remote network computing has transformed the 
way companies and individuals store data. No longer is data stored on 
sites or in one discrete location; rather, data pertaining to a single 
individual or even to a single document may be stored at multiple 
sites, spread across countries or even across continents. This has 
created all sorts of complications for our laws.
  ECPA requires law enforcement to obtain a warrant before it can 
access many types of electronic communications. It also prohibits 
disclosure to foreign entities. Warrants, however, traditionally have 
stopped at the water's edge. A judge here in Washington can issue a 
warrant authorizing law enforcement to search an office here in 
Washington but cannot issue a warrant for searches in London or Paris.
  So what is law enforcement to do in a world of cloud computing where 
pieces of the same electronic document might be stored in Washington, 
London, and Paris?
  One possibility is to say that as long as the data is accessible from 
the United States--that is, so long as you can retrieve it by logging 
on to a computer somewhere in the United States--that is all that 
matters; law enforcement can order its disclosure.
  This sort of maximalist approach, however, brings with it a whole 
host of problems. To begin with, it pays scant attention to the laws 
and interests of other countries, including our closest allies. Other 
countries, it turns out, have data privacy laws of their own, and just 
like ECPA, sometimes these laws prohibit disclosure to foreign 
entities, including foreign law enforcement. So to say U.S. law 
enforcement can compel disclosure and data stored anywhere in the world 
so long as that data is accessible in the United States is really to 
say that U.S. law enforcement can override the laws of other countries.
  More particularly, it is to say U.S. law enforcement can order 
individuals or companies that store data overseas to violate the 
privacy laws of other countries. This is unfair to service providers 
who may find themselves on the wrong side of the law no matter which 
side they choose and does little to help international relations. It 
also undermines trust, drives customers to foreign competitors, and 
undermines the privacy of U.S. citizens by emboldening other countries 
with less robust privacy regimes that similarly seek unlimited extra 
territorial access to data.
  Another possibility is to say that if the data is stored in the 
United States, then law enforcement may access it, but if it is stored 
outside our borders, it is off limits.
  This is essentially the current state of affairs following a decision 
last summer by the U.S. Court of Appeals for the Second Circuit that 
ECPA warrants do not reach data stored abroad. Under the Second 
Circuit's decision, U.S. law enforcement can use compulsory process to 
access data stored in the United States but must work through 
diplomatic channels to obtain data stored overseas.
  This sort of domestic storage regime has the benefit of avoiding the 
conflict-of-laws problems I have just described, but it also has very 
real drawbacks.
  To begin with, it impedes law enforcement's ability to solve and 
prevent crime in cases where the needed data is stored outside the 
United States, even when the creator of the data is an American, the 
service provider storing the data is an American, and the crime being 
investigated took place here in the United States. The mere 
happenstance that the data is stored beyond our borders, even though it 
may constantly or instantly be accessed from within our borders, places 
it off limits. Service providers' varying business practices in moving 
and holding data determine whether an investigation moves forward.
  This sort of domestic storage regime also forces U.S. law enforcement 
to work through diplomatic channels, which sometimes are slow and 
sometimes very cumbersome and in many instances less protective of 
privacy than U.S. criminal process, which requires a warrant from a 
neutral magistrate and a finding of probable cause.

[[Page S3083]]

  The upshot is that neither of these regimes is satisfactory. A 
maximalist regime that extends U.S. law enforcement jurisdiction 
worldwide creates serious conflict-of-law problems and places U.S. 
service providers in impossible positions. A more modest domestic 
storage regime, by contrast, hinders law enforcement's ability to solve 
crime and protect us from harm, based solely on where a particular 
document or piece of data happens to be stored at a given moment in 
time.
  What we need is a sensible regime with clear rules that determine 
access based on factors that actually matter to the person whose data 
is being sought. Privacy laws are meant to protect people, not 
abstractions. We ought not get bogged down with mindless formalism. 
Most people could care less whether their data is stored at site A or 
site B or country A or country B as long as it is easily accessible and 
has robust privacy protections.
  At the same time, we need to take proper account of the laws and 
interests of other countries, especially our allies. We ought to avoid, 
where possible, trampling on other nations' sovereignty or ignoring 
their own citizens' legitimate claims to privacy, whether here in the 
United States or abroad.
  For this reason, I believe the right approach to international data 
privacy is to ground the analysis on the location of the person whose 
data is being sought. It is, after all, the person who has rights and 
the person whose interests are devalued when data is obtained without 
proper process.
  Accordingly, I have proposed legislation called the International 
Communications Privacy Act, or ICPA, that sets clear rules for when and 
how U.S. law enforcement can access electronic data based on the 
location and nationality of the person whose data is being sought. I 
intend to introduce an updated version of this legislation in the very 
near future.
  Here is what the updated version of this legislation will say: If a 
person is a U.S. national or located in the United States, then law 
enforcement may compel disclosure no matter where the data is stored, 
provided the data is accessible from a U.S. computer and law 
enforcement uses proper criminal process. If a person is not a U.S. 
national, however, and is not located in the United States, then 
different rules apply.
  These rules are founded on three principles: respect, comity, and 
reciprocity.
  First, respect. If U.S. law enforcement wishes to access data 
belonging to a non-U.S. national located outside the United States, 
then law enforcement must notify the person's country of citizenship 
and provide that country an opportunity to object to the disclosure. 
This protocol shows respect to the other country and gives the country 
an opportunity to assert the privacy rights of its citizen.
  Second, comity. If, after receiving notice, the other country lodges 
an objection, the U.S. court undertakes a comity analysis to determine 
whose interests should rightfully prevail--the U.S. interests in 
obtaining the data or the foreign interests in preventing disclosure. 
As part of this analysis, the court can consider such factors as the 
location of the crime, the seriousness of the crime, the importance of 
the data to the investigation, and the possibility of accessing the 
data through other means. This analysis prevents an obstinate foreign 
power from impeding investigations without good reason or where the 
U.S. interests in disclosure are particularly strong.
  Third, reciprocity. In order to receive notice and an opportunity to 
object, the other country must provide reciprocal notice-and-objection 
rights to the United States. The country must also provide robust 
privacy protections within its own borders and satisfy international 
human rights standards. These requirements ensure that the U.S. 
provides its own citizens an equal or greater level of protection 
against foreign requests for data. They also offer incentives to 
foreign governments to properly safeguard the data of U.S. citizens 
within their jurisdiction.
  Tomorrow, the Senate Judiciary Committee Subcommittee on Crime and 
Terrorism will hold a hearing on law enforcement access to data stored 
abroad. That hearing, I hope, will elucidate many of the principles I 
just described.
  Soon after the hearing, I will reintroduce the International 
Communications Privacy Act. The bill as reintroduced will incorporate 
feedback from law enforcement and privacy groups. I intend to push very 
hard for this legislation and will seek every opportunity to do so. I 
want my colleagues to know that I will be pursuing any and all 
legislative vehicles to get it across the finish line.
  In the words of Utah businessman Jeff Hadfield, writing in the 
Deseret News, ``It's imperative that Congress quickly address the 
ambiguity within our current law. As every company becomes a software 
company, we need legislation that supports our companies' ability to 
store data overseas, protects our individual privacy rights, and helps 
U.S. law enforcement do its important job.'' I could not agree more.
  The International Communications Privacy Act provides critical 
guidance to law enforcement, while respecting the laws and interests of 
our allies. It brings a set of simple, straightforward rules to a 
chaotic area of law and creates an example for other countries to 
follow. It is a balanced approach and a smart approach, and it deserves 
this body's full support.
  Mr. President, on another matter, I wish to register my strong 
support today for the confirmation of John Sullivan to be Deputy 
Secretary of State.
  The nomination of John Sullivan is another example of President Trump 
choosing the best and brightest for national security positions in his 
administration.
  I have known John Sullivan since he was confirmed as Deputy Secretary 
of Commerce during the George Bush administration. He excelled in this 
position, which bears many similarities to the Deputy Secretary of 
State role to which he has been nominated.
  For example, as Deputy Secretary of Commerce, John was responsible 
for the day-to-day operations and management of a major Federal agency. 
As Deputy Secretary of State, he will assume the same managerial 
duties, but for a different Federal agency.
  In facilitating international trade agreements at the Department of 
Commerce, John Sullivan also honed his negotiating abilities, 
developing a diplomatic skill set that will be critical in his new role 
at the State Department.
  As the chairman of the Finance Committee, I closely followed John's 
tenure at Commerce. I was consistently impressed with his ability to 
promote American interests abroad while maintaining constructive 
relations with our trading partners. I have no doubt that he will 
continue to serve our Nation well as the Deputy Secretary of State.
  In addition to his management expertise, John Sullivan is a 
practicing attorney with the law firm of Mayer Brown LLP. There, too, 
he has developed a reputation for excellence, especially in the area of 
national security law.
  In John Sullivan we have a proven manager, a seasoned diplomat, and a 
sharp policy mind who will bring strong leadership to the State 
Department. In John Sullivan, President Trump and Secretary Tillerson 
have made an inspired choice.
  Secretary Tillerson is doing a tremendous job at the State 
Department. With John Sullivan as his Deputy, even more can be 
accomplished.
  In addition, I would like to thank John Sullivan for his willingness 
to serve. Of course, I would be remiss if I did not also thank his 
family--especially his wife of 29 years, Grace Rodriguez, who has 
provided invaluable support to John throughout his public service. It 
is unlikely John would be here today without their consent and their 
constant support.
  Few have the skills that John Sullivan possesses. Fewer still possess 
the patriotism, professionalism, and integrity he has displayed over a 
distinguished career. He is the best man for the job, which is why I 
urge my colleagues to confirm him without delay.
  I appreciate this opportunity to make these points on the floor.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.


                         Healthcare Legislation

  Mr. UDALL. Mr. President, today many of my colleagues will come to 
the floor to speak about the devastating impact that TrumpCare will 
have on rural communities. I rise to join them in speaking on this 
topic and on the many other serious flaws in the Republicans' bill to 
replace ObamaCare.

[[Page S3084]]

  When he was elected, President Trump promised he would provide 
healthcare for everyone, but President Trump and our Republican friends 
have turned their backs on that promise. The Republican healthcare 
proposal would put insurance companies back in the driver's seat, and 
that means less quality and more costs for all of us. Rural 
communities, working families, and people with medical conditions would 
be hit the hardest.
  Today, we got a taste of how devastating TrumpCare would be. The 
President's budget proposal slashes billions of dollars for Medicaid 
and the Children's Health Insurance Program. President Trump takes 
direct aim at bipartisan programs that have made historic progress for 
kids, for the disabled, and for the elderly.
  Former Senator Hubert Humphrey once said: ``The moral test of 
government is how it treats those who are in the dawn of life, the 
children; those who are in the twilight of life, the aged; and those in 
the shadows of life, the sick, the needy and the handicapped.''
  When Senator Humphrey spoke those words, he had been diagnosed with 
terminal cancer. He died a few months later. His words are just as 
meaningful today.
  TrumpCare fails Senator Humphrey's moral test. It doesn't cover more 
people or more services or improve healthcare. It raises costs and 
reduces quality. Compared to the ACA--or ObamaCare--TrumpCare would be 
a disaster for families in my home State.
  In New Mexico, tens of thousands of people have healthcare, thanks to 
ObamaCare and the Medicaid expansion. Before the Affordable Care Act, 
New Mexico had one of the highest rates of uninsured in the country. It 
was almost 20 percent, at 19.6 percent. That rate has been cut in half 
to 8.9 percent.
  Approximately 300,000 more New Mexicans now have healthcare. And each 
one of these 300,000 people has a story about how having healthcare has 
made a difference--even saved lives.
  Thanks to the Affordable Care Act, hundreds of thousands of New 
Mexicans now have essential health benefits, including doctor visits, 
hospital care, prescription drugs, pregnancy and childbirth, and mental 
health services, and a range of preventive services, like mammograms 
and other cancer screenings, are available at no cost.
  I am not saying that the ACA is perfect. Premiums are still too high, 
deductibles are increasing too much, and we still must bring down the 
cost of prescription drugs. We absolutely need to work to bring down 
costs. But, on balance, the Affordable Care Act passes all tests--many 
with flying colors. TrumpCare does not come close. TrumpCare gets an F.

  Test No. 1: Does TrumpCare increase the number of Americans who will 
have healthcare? No, it decreases coverage and decreases it 
dramatically.
  According to the most recent figures from the CBO, 24 million 
Americans will lose healthcare coverage under TrumpCare over the next 
decade. TrumpCare would dismantle the Medicaid expansion provisions 
that help so many working Americans, including 265,000 people in New 
Mexico, and TrumpCare would hit rural communities the hardest.
  The National Rural Health Association has said that TrumpCare ``does 
nothing to improve the health care crisis in rural America, and will 
lead to poorer rural health outcomes, more uninsured and an increase in 
the rural hospital closure crisis.''
  Rural areas like the ones we have in New Mexico have more elderly and 
disabled people, and fewer people have insurance through their jobs. 
TrumpCare is the hardest on these groups.
  Rural hospitals are already struggling. They will have an even harder 
time keeping their doors open.
  Many New Mexicans would have to drive an hour or more if their local 
hospital closed. And not only would closed hospitals mean less access 
to healthcare, it would also hurt the economy. In rural areas, 
hospitals are a big employer. If they close, the rural economy takes a 
hit too.
  The administrator of the Guadalupe County Hospital in New Mexico, a 
fine woman by the name of Christina Campos, fears what might happen if 
TrumpCare becomes law. She is urging me to protect access to care in 
rural areas.
  Guadalupe County is one of our smallest counties by population. The 
hospital's uninsured payer rate declined from 14 percent to 4 percent 
from 2014 to 2016, thanks to the Affordable Care Act, and its 
uncompensated care increased 23 percent in that same period.
  I can tell my colleagues that I will fight tooth and nail to keep 
residents in our rural areas insured and to keep rural hospitals in New 
Mexico open.
  Test No. 2: Does TrumpCare increase coverage of healthcare services? 
No, it fails this test too. Under the ACA, insurance companies must 
cover essential healthcare services, period. But under TrumpCare, 
starting in 2020, States can get a waiver and define their own 
essential benefits for individual and small group plans. So States 
would be able to cut the benefits that people count on--and that are 
making patients healthier.
  Test No. 3: Does TrumpCare make healthcare more affordable? It 
doesn't. It takes aim at the most vulnerable working and low-income 
families and seniors--the people most in need of care--and it cuts 
access to healthcare out from under them. If you are older and poorer, 
you lose big under TrumpCare. If you are young and wealthy, you win.
  What is wrong with this picture? What is wrong is that it is unjust. 
And it is bad for healthcare costs over the long run. Trump and the 
Republicans are proposing drastic changes to our healthcare system--and 
they are changes for the worse. They want to go backward to a time when 
insurance companies could decide who gets healthcare and who doesn't.
  Finally, TrumpCare would hurt anyone with a preexisting condition. 
One of the most popular provisions of ObamaCare is that it prohibits 
insurance companies from dropping you if you get sick and from refusing 
to cover you because of a preexisting condition. A preexisting 
condition could be something serious like cancer, but insurance 
companies have considered everything from childbirth to hand warts a 
preexisting condition.
  Under TrumpCare, States would be able to decide whether to get a 
waiver from those patient protections. And then we would go back to 
that time when insurance companies decided who could get healthcare and 
who couldn't. States would have to set up high-risk pools to provide 
people with the option of insurance in catastrophic situations. But in 
the best cases, high-risk pools wouldn't protect many people from going 
bankrupt just to get healthcare, and TrumpCare wouldn't provide nearly 
enough funding for States to run them successfully.
  Take Alexis from Albuquerque. Alexis is here in the photograph with 
her husband. Alexis had a stroke and brain surgeries when she was 28 
years old. Even though she had no lingering effects, she was denied 
insurance in the private market and had to get insurance in New 
Mexico's high-risk pool. According to Alexis, ``It broke us 
financially.'' Alexis now has affordable health insurance with the help 
of the Affordable Care Act subsidies. Like most people, she doesn't 
want to risk going broke just to get healthcare. She shouldn't have to.
  Finally, I want to tell you about a 1-year-old from Albuquerque, NM, 
whose name is Rafe. Rafe was born with cortical visual impairment--a 
kind of legal blindness--and significant developmental delays. His 
parents--Jessica, his mom, and his father, Sam, a veteran--have been 
able to access the intensive medical care, early intervention services, 
medical equipment, and therapy he needs through a combination of the 
military's insurance and Medicaid. But TrumpCare jeopardizes Medicaid 
by turning it into a block grant for States, which will most certainly 
result in deep cuts to Medicaid. It threatens Rafe's chances of a 
better life.
  The President promised he would keep protections for people with 
preexisting conditions--people who are sick. His broken promises can 
hurt tens of millions of Americans.
  In the end, TrumpCare is not a real healthcare bill. It is a tax 
relief bill for the richest 1 percent. The CBO estimates that TrumpCare 
would cut taxes by $346 billion over 10 years, at the expense of the 
healthcare of working families and seniors.

[[Page S3085]]

  Our priorities for healthcare reform should be increasing coverage, 
increasing the services provided, making people healthier, and 
providing affordable healthcare. I strongly and unequivocally support 
all Americans having healthcare.
  Let's get to that goal, and let's get to that goal now. Ninety-one 
percent of the American people are insured, thanks to the steps taken 
under the Affordable Care Act. Rather than repealing it, let's build on 
its strengths so 100 percent of people can afford to see a doctor when 
they are sick. We can do this. We can do better. Let's ensure that 
Americans in the dawn of life, the children; those who are in the 
twilight of life, the aged; and those in the shadows of life, the sick, 
the needy, and the disabled, have the right to healthcare so that 
America meets the moral test of good governance.
  I yield the floor.
  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. THUNE. 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. THUNE. Mr. President, if there is one thing that has become 
clear, it is that the ObamaCare status quo is not sustainable.
  Prices continue to soar while choices are rapidly dwindling. Between 
2016 and 2017, the average premium for a midlevel ObamaCare plan on the 
Federal exchange went up 25 percent--25 percent for just 1 year. Let's 
remember that this is on top of years--year after year--of premium 
increases under ObamaCare.
  How many families can easily absorb a 25-percent premium increase? I 
would submit that not many. Again, that is just for 1 year. ObamaCare 
rate hikes aren't going anywhere. Numbers for next year are starting to 
emerge, and they are not looking good. Connecticut's ObamaCare insurers 
are requesting average premium increases in the double digits. One 
Connecticut insurer has requested an average rate hike of 33.8 
percent--33.8 percent. In Virginia, one insurer has requested an 
average rate increase of 38 percent. Another has requested an average 
45-percent rate hike. In Maryland, average increases range anywhere 
from 18 percent to almost 59 percent. One insurer has requested a 
staggering 150-percent rate increase--150 percent.
  Obviously, these kinds of price increases are unaffordable for most 
families, but ObamaCare isn't leaving them any options. Along with 
soaring prices, choices on the exchanges are rapidly dwindling. Roughly 
one-third of U.S. counties have just one choice of health insurer on 
their exchange for 2017. Several States--including Alabama, Oklahoma, 
Alaska, and Wyoming--have just one choice of insurer for their entire 
State, and things are only getting worse.
  In 2018, a number of counties may lack an ObamaCare insurer at all. 
In February, health insurer Humana announced its decision to completely 
withdraw from the ObamaCare exchanges for 2018, and 2 weeks ago, Aetna, 
which had already sharply reduced its participation in the exchanges 
for 2017, announced its decision to fully exit and completely get out 
of the market in 2018. That leaves the Nebraska and Delaware ObamaCare 
exchanges with just one insurer for 2018.
  UnitedHealthcare is leaving Virginia, and Wellmark Blue Cross Blue 
Shield is withdrawing from Iowa. In the wake of Aetna and Wellmark's 
decision, Medica, the last ObamaCare insurer for most of Iowa, 
announced it will likely leave the State in 2018. That would leave 94 
out of 99 counties in Iowa with no ObamaCare insurer next year--all but 
five counties in the State of Iowa with no ObamaCare insurer. Iowa 
families with ObamaCare subsidies would have no place to spend them. As 
my colleague Senator Alexander likes to point out, that is like having 
a bus ticket in a town where there are no buses running.
  Dwindling healthcare choices aren't limited to the ObamaCare 
exchanges, either. Aetna is not only withdrawing from the exchanges. It 
is also withdrawing from the non-ObamaCare individual health insurance 
markets in several States. More than one insurance CEO has suggested 
that ObamaCare is in a death spiral, and I would have to say it is 
pretty hard to disagree. Combine soaring premiums with a steady insurer 
exodus, and sooner or later you get a partial or complete exchange 
collapse.
  Then there are the other ObamaCare problems--like deductibles which 
are sometimes so high people can't afford to actually use their 
healthcare plans; or, narrow plan networks with few provider choices.
  ObamaCare may have been well-intentioned, but good intentions don't 
make up for a lack of good policy--and ObamaCare was not good policy. 
ObamaCare took a healthcare system with problems and it made things 
worse. It is time to repeal this fatally flawed law and replace it with 
real healthcare reform.
  Three weeks ago, the House of Representatives passed an ObamaCare 
repeal and replacement bill. The House's legislation repeals 
ObamaCare's tax increases, penalties, and mandates, and starts the 
process of restoring control of healthcare to States and individuals. 
My colleagues in the House have made a good start, and I am looking 
forward to building on their bill here in the United States Senate. We 
have a lot of Members with good healthcare ideas, and we are going to 
work hard to produce a bill that will start the process of giving the 
American people real healthcare reform.
  ObamaCare is failing, and it is failing rapidly. Our Democrat 
colleagues need to stop pretending this law is ever going to do what it 
was supposed to do and come to the table to work with us on real 
healthcare reform. There is no question our healthcare system has 
problems, but ObamaCare is not, and it never has been, the solution.
  Real reform is possible, though, and that is what we are focused on 
now here in the United States Senate--the kind of reform that will 
actually drive down prices, that will put patients and their doctors--
not the government--in charge of healthcare decisions, that will 
empower States to embrace the solutions that are right for the citizens 
in their States and will give Americans more choices and real 
healthcare freedom.
  That is the kind of healthcare reform Republicans are committed to 
delivering for the American people.
  I yield the floor.
  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.
  Ms. CANTWELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Hoeven). Without objection, it is so 
ordered.


                                Medicaid

  Ms. CANTWELL. Mr. President, I come to the floor to talk about the 
President's proposed budget as it relates to Medicaid and the fact that 
it is just a war on Medicaid; that is, it continues the wrongheaded 
ideas that have been proposed in the House bill on healthcare reform 
and takes that and continues to make cuts to Medicaid that are 
unsustainable for our healthcare system.
  The President's budget would impose a block grant or per capita cap 
on States in 2020 in exchange for so-called flexibility. I haven't met 
one State administrator of healthcare in our State who says they need 
more flexibility. They have a lot of flexibility on Medicaid currently, 
but they know this is just a budget cap and a budget cut.
  The budget would result in $610 billion in cuts to States, in 
addition to what would happen if they were successful in passing the 
House bill in the Senate. As the Center on Budget and Policy Priorities 
put it, the Trump budget cuts Medicaid ``considerably more deeply than 
the House bill's per capita cap proposal would do.''
  No doubt what the budget is proposing from the President today and 
what our House colleagues have proposed on healthcare means more damage 
for healthcare and more damage for Medicaid.
  Let's be more specific. Medicaid for healthcare is about children. It 
is about seniors. It is about the disabled. It is about working 
families. It is about young people. Medicaid covers half of the births 
and the majority of long-term care stays.

[[Page S3086]]

  What people may not realize is that the President's budget cut to 
Medicaid also cuts children's healthcare, as a new study reveals, by at 
least $43 billion, according to Avalere Health. That is taking 
healthcare away from children, poor children, who need access to 
healthcare. Additionally, the budget impacts 1.75 million veterans who 
also get healthcare through Medicaid.
  How can we possibly be standing here with a budget proposal by the 
President of the United States--after he promised not to cut Medicaid--
that not only proposes to cut Medicaid but cuts childrens' and 
veterans' healthcare when they need it most?
  Medicaid is a lifeline for people who can't get covered or can't get 
a fair deal. It is a highly cost-effective, dynamic, and innovative 
program that has worked well, and Medicaid is a winning economic 
strategy for how to help families get out of poverty. It is one of the 
most successful anti-poverty programs in the United States and the 
second largest program to combat extreme poverty.
  Its expansion in Washington has helped create jobs indirectly and 
directly and has saved our State about $353 million in our State 
budget. It injects billions into the economy and supports our high-
wage, high-skill jobs throughout the healthcare economy.
  As we know, our colleagues, in the House draconian healthcare act, 
would for the first time cut Medicaid's successful program by 
introducing a cap that would result in reductions every year to the 
Medicaid Program. Regardless of who needs access, regardless of those 
children, regardless of those veterans, it would continue to push down 
Medicaid funds by more each year.
  I have said to my colleagues in the House that there are far more 
innovative ways to help our healthcare delivery system that are cost-
effective, but simply cutting veterans or families or children off of 
Medicaid is not the way to do it.
  The President's budget released today would reinforce this permanent 
cap. Currently, Medicaid is a needs-based partnership between the 
States and the Federal Government. During economic recessions, natural 
disasters, or public health emergencies, States know they can count on 
the Federal Government.
  Under what has been proposed in the House, the per capita cap would 
give States only a fixed amount and start reducing the amount of money 
each year. It would leave a tsunami of seniors and others without new 
technologies, prescription drugs, or tools to address new healthcare 
threats.
  There is nothing about it that is reform. It is not innovation. It is 
simply a budget mechanism to cut Medicaid. I don't know how the 
President, given that he promised before not to cut Medicaid could do 
this. He said: ``I was the first & only potential GOP candidate to 
state there will be no cuts to Social Security, Medicare & Medicaid.''
  If that is what the President tweeted, if that is what he said he was 
going to do, why is he now proposing a budget that actually cuts 
Medicaid?
  We do not want to throw 600,000 Medicaid beneficiaries off of 
coverage in my State--and 14 million across the country--and take $1.4 
billion out of Washington State's economy every year. These are numbers 
according to the Congressional Budget Office's most recent estimates 
and estimates by the State of Washington.
  I think it is time to say no to the President's budget proposal. It 
is time to remind the President of his promise not to cut Medicaid, and 
it is time to stop talking about the silly idea of capping Medicaid and 
reducing funding to the States.
  I mentioned the impact on children and veterans. I also want to 
mention the impact on those suffering from the opioid epidemic and what 
we have been trying to do to treat those individuals. Also, those 
facilities would be in great danger in continuing to treat that 
population if they don't have Medicaid.
  So the notion that this is a smart healthcare strategy or a smart 
healthcare budget--it is not. It is a draconian measure that is going 
to leave many more Americans without healthcare. As I said, Medicaid is 
a successful program. The promise should be kept, and we should 
continue to improve the delivery system as a way to make it more cost-
effective. I know we can't afford to leave sick children without access 
to healthcare, and now is not the time to leave veterans without the 
healthcare they deserve.
  I thank the Presiding Officer.
  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.
  Mr. FRANKEN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Strange). Without objection, it is so 
ordered.


                         Healthcare Legislation

  Mr. FRANKEN. Mr. President, I rise to talk about the healthcare bill 
the House of Representatives passed and is currently being considered 
behind closed doors by my Republican colleagues.
  I travel around greater Minnesota all the time, and when the 
Republicans' healthcare plan first came out, I traveled to rural 
Minnesota to meet with rural hospitals, nursing home providers, and 
constituents to hear how this bill would impact their lives and 
communities. They are upset and they are frankly scared.
  In Perham, MN, I heard from a woman who was in tears, not knowing 
where her mother would go if the Republican plan passed and she lost 
her nursing home coverage. This woman and her husband work full time, 
but together they cannot afford the around-the-clock care her mother 
needs.
  Later, at a nursing home in Moorhead--that is in Minnesota across the 
river from Fargo--I also heard from a resident, Chrysann, who said this 
new plan wasn't about taking care of people but about ``survival of the 
fittest.'' The hospitals and nursing home administrators I met with 
said the financial blow they would receive would cause them to cut 
services and in some cases even close their doors.
  What I heard, and the real panic that I saw, is a far cry from what 
President Trump promised this past January when he said: ``We're going 
to have insurance for everybody.'' He went on to say it would be ``much 
less expensive and much better.''
  Versions of these promises keep coming from President Trump, his 
Cabinet, and from his allies in Congress--coverage for more people, at 
lower costs, with better quality. Those things all sound great, things 
that might help people like Chrysann, but the fact is, the Republican 
bill does the exact opposite. It takes coverage away from people, it 
drives up costs, and it makes coverage worse. In other words, the GOP 
is selling this healthcare bill on false pretenses.
  Today I would like to explain how the Republican bill betrays each 
one of these three fundamental promises, and let's take them one by 
one. We can start by the number of people who will be covered. 
President Trump promised that everyone would have insurance, but an 
analysis of an earlier version of the healthcare bill--the first 
iteration of this, which is actually not as bad as this one--an earlier 
version analysis conducted by the nonpartisan Congressional Budget 
Office found that under current law the House Republican plan would 
leave 24 million fewer people with health insurance by 2026. That means 
by 2026, nearly 1 in 5 Americans under the age of 65 would be 
uninsured, compared to just over 1 in 10 today.
  One particular way the Republican bill cuts coverage is by gutting 
Medicaid, a program that covers more than 60 percent of all nursing 
home residents nationwide, covers kids with disabilities, and benefits 
nearly 70 million Americans. The Republican plan ends Medicaid 
expansion. It fundamentally undermines the structure of the Medicaid 
Program and cuts the program's budget by as much as one-quarter over 10 
years, a more than $800 billion cut.
  On May 7, journalist Jake Tapper of CNN asked Health and Human 
Services Secretary Tom Price whether the hundreds of billions of 
proposed cuts would result in millions of Americans not getting 
Medicaid. Secretary Price responded: ``Absolutely not.'' Well, that is 
absolutely false. When I say ``absolutely,'' I mean that literally.
  It doesn't take an expert to know that if you take funding away from 
this program, which provides health coverage for millions of Americans, 
the program will suffer, and the human beings who rely on Medicaid will 
suffer as well. Specifically, according to the

[[Page S3087]]

Congressional Budget Office, 14 million of those 24 million people who 
will lose coverage under the Republican bill would lose their health 
insurance because of cuts to Medicaid. ``Absolutely not,'' says the 
Secretary of HHS.
  It is bad enough to push a bill that will take away care from 
millions who need it; it is extra galling to be so fundamentally 
dishonest about it in the process. Look, the Affordable Care Act is far 
from perfect and we have problems that need to be fixed, but let's step 
back and review how far we have come because of the ACA. Since it came 
into effect, about 20 million Americans have gained health insurance 
coverage, producing the lowest uninsured rate in the history of this 
country.
  In Minnesota, the number of uninsured dropped by nearly half, with 
people in rural areas seeing the largest gain in coverage. As a result, 
we have eliminated the gap in coverage between rural and urban 
Minnesotans. These coverage gains have increased access to vital health 
services, including access to treatment for mental illness and 
substance use disorders, but the Republican healthcare plan throws all 
of these gains into jeopardy, which is particularly troubling given 
that the country is still in the midst of battling a devastating opioid 
and heroin epidemic. Researchers estimate that 2.8 million Americans 
with substance use disorders will lose some or all of their insurance 
coverage under the ACA repeal.
  Let's be clear. People will lose coverage as a result of the proposed 
Medicaid cuts; people will lose coverage because of the proposed 
insurance reforms; and tens of millions of more people will be 
uninsured and without care in the Republican plan than under current 
law.
  Let's move on to the second point; the assertion that is repeated 
constantly by President Trump and by others that their bill brings down 
costs. In his Rose Garden celebration after the Republican health care 
bill passed the House--not after signing it into law but sort of an 
unprecedented Rose Garden celebration after merely the House passed the 
bill--President Trump said: ``As far as I am concerned your premiums 
they are going to start to come down.''
  When Secretary Price was asked, again by Jake Tapper, if he stands by 
the President's statement, he responded: ``Absolutely.''
  On an earlier date, Secretary Price actually said: ``Nobody will be 
worse off financially'' under the Republican plan.
  This is just blatantly wrong. Republicans are actively sabotaging the 
individual market, needlessly driving up premiums in the short term, 
and in the long term what they are doing will result in exorbitant 
premium hikes for older, sicker people--so much so that CBO estimates 
some will eventually drop out of the market altogether.
  Let me explain. For years, Republicans have taken deliberate steps to 
sabotage the individual market. First, Senator Rubio ran through a 
last-minute change to the 2015 spending bill that undercut the Risk 
Corridor Program. The Risk Corridor Program, which was modeled after a 
similar program in the Medicare Part D Program, was included as part of 
the ACA to offset high costs incurred by insurers as they took on new 
enrollees in the early years of the ACA.
  Here is how it worked. The Federal Government would make payments to 
health plans that enrolled a group of people who were sicker than 
expected and had higher healthcare costs than the insurer predicted 
when it set its premiums. On the flip side, the Federal Government 
would receive payments from health plans that enrolled a group of 
people who were healthier than expected and needed less care. By 
limiting losses incurred by insurers, the Risk Corridor Program was 
designed to help make premiums more affordable for individuals and 
families who bought coverage on the exchange. Senator Rubio's provision 
undercut all of this. It severely curtailed the payments that could be 
made under the Risk Corridor Program, which meant that premiums soared 
and health insurers left the market.
  For example, Blue Cross and Blue Shield of Minnesota lost about $220 
million between 2014 and 2016 under the weakened Risk Corridor Program, 
which the CEO told me in a meeting late last spring was a huge setback 
for the company. I was dismayed but not surprised when I heard, shortly 
after our meeting, that the company was leaving the individual market, 
which affected coverage for more than 100,000 Minnesotans and 
contributed to average premium increases of 36 to 67 percent in 
Minnesota's individual market in 2017.
  Insurers across the country faced similar destabilizing losses, but 
that is not all. On top of that, for months, President Trump has been 
doing his part to sow uncertainty by repeatedly arguing that the 
individual market is in a death spiral. For example, on May 4, in 
response to Aetna's exit from the individual market in Virginia in 
2018, President Trump shouted on Twitter: ``Death spiral!'' This is 
similar to his post on March 13 in which he said: ``ObamaCare is 
imploding. It's a disaster and 2017 will be the worst year yet, by 
far!'' But he is wrong.

  Even the CBO noted in one of its scores that barring any significant 
changes, the individual market would probably be stable in most areas. 
This confirms what other research has found, which is that this year 
markets were starting to stabilize, which led Standard & Poor's to 
issue a report last December predicting that 2017 could see ``continued 
improvement, with more insurers getting close to breakeven or better.''
  But this didn't faze President Trump or any of the Republicans. 
Instead, they seem to have used these reports as a guidebook on what 
changes are necessary to actually cause the individual market to 
collapse. For example, President Trump has been playing games with 
payments that are due to insurance companies that reduce out-of-pocket 
costs for working families. On numerous occasions, he has threatened to 
stop these payments altogether, but in practice, he has been holding 
these payments hostage on a month-to-month basis to push forward other 
insidious reforms. Just yesterday, his administration announced that it 
would seek another short-term delay in the House's lawsuit, which aims 
to stop these payments permanently. These games are driving up the 
premiums for families and rattling health insurance markets.
  Lastly, the administration has stopped enforcing the individual 
mandate. As a result, we are seeing enrollment in the individual 
markets stall for the first time since 2010, and if this results in 
younger, healthier people dropping their coverage, we could see prices 
rise dramatically for those left behind.
  That is right. President Trump and the Republicans are actively 
attacking the insurance markets, causing premiums to go up. So if these 
markets falter and consumers suffer, it is because of what Republicans 
are doing right now and have been doing for years to undermine the 
individual market.
  Still, you will often hear Republicans talk about the need to reduce 
costs. They even claim that their proposed healthcare plan would lower 
premiums in the long run. For millions of Americans, that is not true, 
but the reasons why it is untrue are slightly complicated. It goes to 
the CBO report for the Republican healthcare plan.
  The March 13 CBO score says that average premiums for single people 
in the individual market would be 15 to 20 percent higher than under 
current law--than under the current ACA--in the first 2 years of its 
implementation. But it does say that they would be roughly 10 percent 
lower in 2026 under the House bill than they would be under current 
law.
  At first blush, this sounds like prices would be coming down for 
people, right? That is certainly what the Republican leadership wants 
you to think. That day, House Speaker Ryan stated: ``This report 
confirms that the American Health Care Act will lower premiums and 
improve access to quality, affordable care.'' House Majority Leader 
Kevin McCarthy got more specific. He said: ``After 10 years, premiums 
will be 10 percent lower than under ObamaCare.'' But Speaker Ryan and 
Majority Leader McCarthy are being deliberately misleading. One of the 
reasons that average costs go down is that the price for some people 
would go up so much that they couldn't afford any insurance at all. If 
the people facing the most expensive insurance

[[Page S3088]]

simply dropped out of the market, sure, average costs go down.
  Here is how this works: Under the Republican plan, insurers would be 
able to charge older enrollees five times more than younger ones, which 
would dramatically increase premiums for people aged 50 to 64 years old 
while decreasing premiums for younger people. Meanwhile, the tax 
credits that help older Americans afford their premiums would be 
drastically slashed. The result is that, especially for older people of 
modest means, coverage would become unaffordable, so they disappear 
from the market. If only younger, healthier people can buy insurance, 
average premiums go down, but you have actually made the system much 
worse and much more expensive for the people who really need it.
  But that is not all. The Republican plan would also allow States to 
waive crucial protections for patients with preexisting conditions, 
which means that in those States, we could go back to something like 
the old days when insurance companies could charge people with 
preexisting conditions much more--potentially as much as $25,000 more 
for their coverage, as estimated by the AARP.
  Republicans are quick to point out that their bill maintains a 
requirement that insurance companies have to offer plans to everyone, 
but it abandons the principle that the plans must be affordable, and an 
unaffordable plan does people about as much good as no plan at all.
  If you are young, if you have no preexisting condition, it might be 
true that your premiums will go down under the Republican plan. But for 
millions of Americans, though, if the Republican bill passes, insurance 
costs are going to go up. For many people, they will go up so high that 
they will be out of reach.
  That brings me to the third claim the Republicans are peddling--that 
their plan will result in higher quality coverage. In fact, Republicans 
want to open the door to junk insurance.
  In defending the House Republican plan, Secretary Price recently 
stated that the plan allows ``for every single person to get the access 
to the kind of coverage that they want.'' We have heard this before. 
This is a code for allowing insurers to offer garbage insurance plans 
that offer skimpy benefit packages and impose much higher deductibles 
and cost sharing on consumers.
  Under the Affordable Care Act, you cannot sell junk plans on the 
insurance exchanges. Plans have to cover the essential health benefits. 
This is key. Under the ACA, plans have to cover the essential health 
benefits--10 key categories of benefits such as prescription drugs, 
maternity care, and mental health services. On top of that, the law 
prohibits insurers from imposing annual or lifetime limits on these 
essential health benefits. The goal is to make sure that when people 
get sick or if they have a preexisting condition, they don't go broke 
getting the care they need because of fine print in their health 
insurance plan.

  The Republican bill would allow States to eliminate these essential 
health benefits. Consumers would be left with plans that leave them up 
a creek if they actually get sick. And plans for people who are sick--
the price of those plans will go sky high. No one would call that 
``better care,'' which is why Republicans aren't really being straight 
about it. What they call ``flexibility'' is actually just the removal 
of consumer protections.
  To review, the Republican plan covers fewer people, costs too many 
people more--in many cases, much, much more--and provides worse 
coverage, and it is being sold by misleading people on each of these 
points.
  It is not as though there aren't ways to cover more people, reduce 
costs, and provide better coverage. You could do a public option, for 
example. You could reduce prescription drug costs--an issue on which I 
recently introduced a comprehensive bill. You could improve coverage by 
increasing the number of healthcare providers in rural areas, as I 
proposed last year in my rural health bill. But the Republican plan 
does none of these things, which raises the question: What does it do? 
Why would anyone take the time to propose such a terrible bill? The 
answer is this: It gives a giant tax cut to the wealthy. That is the 
real point of this bill. It is not a healthcare bill; it is a ``take 
healthcare away from people who need it and use the money to give a tax 
break to the rich'' bill.
  As Chrysann in Moorhead, MN, said, it is about ``survival of the 
fittest.''
  The average tax savings for the 400 richest Americans under the 
Republican plan is $7 million each--again, $7 million each. For 
households earning $1 million or more a year, it is more than $50,000 
apiece, each year. But for households earning $50,000 a year, which is 
about the median income in the United States, the tax cut is next to 
nothing, or you could even face a tax increase. There are tax cuts 
specifically for insurance company CEOs. There are tax cuts 
specifically for drug companies. There is nothing comparable for the 
middle class. And all of those tax cuts are paid for by cutting 
healthcare programs that keep people alive, by cutting off funding that 
lets seniors age with dignity, and by cutting services for kids with 
disabilities.
  This bill would take us back in time and roll back our progress. It 
is up to us here in the Senate to stop that from happening. This bill 
is literally sickening. It is vicious, it is cruel, and it should never 
be passed into law. I urge my Republican colleagues to walk away from 
this cruel effort and work with us to actually improve healthcare for 
Americans. And I urge everyone considering this bill to be straight 
with the American people about exactly what it is that this bill will 
do to them.
  Thank you, Mr. President.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CASSIDY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Johnson). Without objection, it is so 
ordered.
  Mr. CASSIDY. Mr. President, obviously, a big problem before the 
country right now is, What do we do about rising healthcare premiums?
  What we know under the Affordable Care Act--or the un-Affordable Care 
Act--or ObamaCare, as some call it, is that premiums are rising more 
and more. One of President Trump's campaign pledges was that premiums 
would come down and, actually, come down with, as he said in one place, 
beautiful coverage--that it is actually good coverage and premiums are 
lower. So let's kind of set the stage.
  I just got a message on my Facebook page. I will read it. By the way, 
anybody can post on our Facebook page these sorts of stories, if they 
are interested in them.
  Brian from Louisiana sent a message saying: My family plan is $1700 a 
month for me, my wife, and two children--so roughly about $20,000 a 
year. The ACA, or the Affordable Care Act, has brought me to my knees. 
I hope you can get something done as my credit cards are all maxed out. 
And 80 percent of my friends are in the same situation. The middle 
class is dwindling away. Can everyone just come together and figure 
this out?
  Think about this: $1,700 a month. He did not write this, but what 
would be standard for this sort of policy is a $13,000 family 
deductible.
  I say that because I have an acquaintance in San Francisco. San 
Francisco is so expensive for housing, transportation, and food, and 
the premium for their young family is $20,000 a year, with each family 
member with their own separate $6,000 deductible. This is under the un-
Affordable Care Act, as I call it, or the Affordable Care Act, as 
others do.
  A friend of mine back in Baton Rouge, whom I have quoted many times, 
put this on my Facebook page because people would not believe it: He 
and his wife, 60 and 61, their quote for their insurance last year was 
$39,000. Their quote for their insurance was $39,000.
  Then I spoke to a fellow who is an insurance consultant here in 
Washington, DC--an insurance consultant. If anyone can get their 
premiums down, it would be he. For his family, their premium is $24,000 
a year with a $13,000 family deductible. If they get in a car wreck, 
their family will be out $37,000 before the insurance kicks in. Who can 
afford this? We must do something better.

[[Page S3089]]

  When President Trump ran for office, President Trump clearly 
recognized this. On the campaign trail, he said over and over that he 
wished to lower premiums. It is the President's genius, if you will, 
that he knew how to do so. You do so by expanding the risk pool. He 
said he wanted to continue coverage for all.
  He gets away from the ObamaCare mandates, which people hate. The 
American people don't like being told what to do.
  He also said he would care for those with preexisting conditions. 
This is how it works. When you cover many, you have a bigger risk pool. 
Those with preexisting conditions have the cost of their illness spread 
out over the many. So premiums come down for all.
  My hat is off to the President for coming up with that. In fact, 5 
days before he was sworn in, he echoed this, because one way to lower 
premiums is to give poor coverage. One way to lower premiums is to give 
folks such terrible coverage that it doesn't cost anything. On the 
other hand, it doesn't cover anything. The President seems to know 
this.
  Five days before he was inaugurated, he said to the Washington Post 
about people covered under his replacement for ObamaCare:

       [They] can expect to have great healthcare. It will be in a 
     much simplified form. Much less expensive and much better.
       We're going to have insurance for everybody. There was a 
     philosophy in some circles that if you can't pay for it, you 
     don't get it. That's not going to happen with us.

  I am a physician, a doctor. Again, I admire President Trump's 
insights. As a physician, I know that whoever wants healthcare gets 
healthcare. Twenty or so years ago, Congress said that if you walk into 
an emergency room, the emergency room has to take care of you. It 
doesn't matter if you are an American citizen. It doesn't matter how 
much it costs. The hospital has to take care of you.
  I told folks when I was practicing--it would be the middle of the 
night--that as long as that emergency room was open--and it was open 
24/7--in through the door came folks vomiting blood, heart failure 
patients, folks with drug overdoses, schizophrenics, diabetics, 
asthmatics--you name it. They came through that door, and we cared for 
them all--and somebody paid.
  President Trump understands that even if you say you can't afford it, 
everybody is going to be treated. That is our current system, and that 
is not going to happen under his watch.
  We mentioned that one way to lower premiums is to give poor coverage. 
I think everyone knows, or many people know, of Mr. Kimmel, the late 
night comedian who pointed out that when his child was born, instead of 
celebrating and handing the baby to the mother so the mother could kiss 
and the father, Mr. Kimmel, could cuddle the baby, the nurses and the 
doctors looked at the baby and immediately recognized that something 
was wrong. They recognized that this child was blue. He didn't have 
oxygen, and if something wasn't done immediately, this child would die.
  Folks criticized Mr. Kimmel for being emotional. I totally get it. 
Instead of cuddling, you are signing a release waiver so your child can 
be transferred across the city of Los Angeles for emergency surgery. In 
his emotion, he asked that all children--and I would expand to all 
Americans--have the ability to get that sort of emergency care done.
  Again, the President was about that. I came up with what I called the 
Kimmel test. Again, it echoes President Trump's contract with the 
American voter--that we would protect those with preexisting 
conditions, that we lower premiums, but as we lower premiums, we make 
sure that the coverage is adequate.
  The Kimmel test, making sure there is adequate coverage while 
lowering premiums and caring for those with preexisting conditions, is 
so compatible with what President Trump said, because Americans need 
lower premiums.
  Let me echo that one more time. We need to lower premiums. The 
President's approach, the contract he made with the voters on the 
campaign trail, is the right approach. You get a bigger risk pool, lots 
of younger people, so those who are older and sicker have the cost of 
their care spread out among the many.
  We have a plan, the Cassidy-Collins plan, or the Patient Freedom Act, 
which I introduced with Senator Susan Collins and four other Senators. 
We have a way to go about it. One way to get young, healthy folks 
involved is to do something that we do on Medicare. If you are 
eligible, you are enrolled unless you call up and say you don't want to 
be. That is what we do with Medicare. By the way, that is what Fortune 
500 companies do with their employees for 401(k) plans, and it works 
really well.
  Ninety-five percent of employees are likely to participate in a 
401(k), and they love it. As to people on Medicare, 99 percent stay on 
Medicare, and 1 percent call up and say: I don't want it. Usually they 
have better coverage someplace else. As a rule, no one feels coerced 
because they all know they can call up and say: I don't want it; I 
don't get it. As it turns out, most do.
  The plan we have taken with Cassidy-Collins, in our attempt to 
fulfill President Trump's contract with the American voter, is that we 
allow a State to automatically enroll for this, and you would be in. 
The credit you receive would be sufficient to pay for the annual 
premium.
  If you don't want it, call up. Make it easy. Get out of here. I don't 
want it.
  As a rule, we think folks would be in. By doing this, you expand that 
risk pool so those old and sicker, those with preexisting conditions, 
can have their conditions cared for, but we fulfill President Trump's 
campaign pledge. We also lowered those premiums.
  Ultimately, to lower the cost of insurance, you have to lower the 
cost of healthcare. Cassidy-Collins does that with some conservative 
approaches that even liberals will like. One way is that we put in what 
is called price transparency. You would know the price. A mother would 
know the price of a procedure--an x-ray, a blood test--before she gets 
it for her daughter, as opposed to finding out 6 months later when she 
gets the final bill.
  Let me give one example. We have all seen those urgent care centers. 
Some are run by hospitals. Typically, a visit there will cost you $500 
to $1,500. Others are run by a group of physicians, or maybe a small 
business decides to set up an urgent care center. The same visit might 
cost you as little as $75 to $150. The patient doesn't know that until 
she gets the bill.
  One door has exactly the same appearance and exactly the same type of 
facility with the same capabilities. In one door and it can cost $500 
to $1,500, and in the other door and it can cost $75 to $150, and the 
patient never knows.
  I think we can lower the cost of healthcare by giving the patient the 
power of knowing what is the price of healthcare.
  Think of it. You walk up to a French restaurant in a city you are not 
familiar with, and you look at the menu posted on the door. You see the 
prices of the food. Oh, the food is pretty good, but look how expensive 
it is. Let me go down the street. You go down the street. The food 
looks good, and it is less expensive.
  The power of price informs the patient of what is the best deal for 
both our health and for our pocketbook. One way we can lower the cost 
of health insurance is by lowering the cost of healthcare. There are 
other ways of doing so as well.
  Let me return once more to what I said earlier. Americans need lower 
premiums. President Trump, during the campaign--his contract with the 
voter, I think, is the right approach to get there.
  I will summarize with this. He said he wanted to maintain coverage 
for those who have insurance, lower premiums, that preexisting 
conditions would be cared for, and eliminate the ObamaCare mandates. If 
we fulfill President Trump's goals--and these are goals that folks on 
the right and left can get behind. By the way, if we do get behind 
them, premiums will be lower. If we can fulfill President Trump's 
campaign contract with the American voter, we will lower those 
premiums, and we will do so by achieving these other great goals.
  I yield back.
  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.

[[Page S3090]]

  

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


                             Jerusalem Day

  Mr. CRUZ. Mr. President, I rise today to mark a momentous day. 
Starting this evening, millions around the world will celebrate Yom 
Yerushalayim, also known as Jerusalem Day. I am proud to join our close 
ally, Israel, and the Jewish people in celebrating this historic 50th 
anniversary of the reunification of Jerusalem.
  Half a century ago, overcoming Arab armies intent on Israel's 
destruction, the Israel defense forces liberated the Old City of 
Jerusalem during the Six-Day War. They courageously and miraculously 
fought their way to the Temple Mount and the Western Wall, the holiest 
sites in Judaism. The commander of the paratroopers, Mordechai Gur, 
unable to contain his emotion, exclaimed through his wireless radio: 
``The Temple Mount is in our hands!'' The army rabbi blew the shofar, 
and the eternal capital of Israel was reunited.
  This war was not the first time that Israel was threatened with 
annihilation. After the Jewish people established the modern State of 
Israel in their ancient homeland just 19 years earlier, neighboring 
Arab States responded to Israeli Prime Minister David Ben-Gurion's 
declaration of independence with an invasion. The Arab armies failed to 
destroy the newly established Jewish State, but Jerusalem, the ancient 
and Holy City central to the identity of the Jewish people, was left 
divided and occupied by Jordan.
  Residents of the Old City were murdered or expelled. Jews were 
prohibited from visiting and praying at the Temple Mount and Western 
Wall. Their synagogues were destroyed, and their cemeteries, such as 
the Mount of Olives, were desecrated. Access for Christians to their 
holy sites was also severely restricted.
  Leading up to June of 1967, Arab leaders repeatedly and openly 
expressed their desire to wipe Israel off the map. Syria was engaging 
in attacks on Israel from the Golan Heights and soon started to 
mobilize its forces for battle. Egypt began moving troops into the 
Sinai Peninsula in a massive military buildup, demanded and achieved 
the withdrawal of the U.N. Emergency Force that had been stationed in 
the Sinai, and then closed the Straits of Tehran, imposing an illegal 
blockade on Israel and cutting off a vital shipping lane for the Jewish 
State. Jordan then signed a mutual defense agreement with Egypt.
  Outnumbered and outgunned and against all odds in the face of 
external pressure not to act first to ensure its survival, the Jewish 
State launched a successful, preemptive strike against its hostile 
neighbors and prevailed in a defensive war. When it was over, Jerusalem 
was liberated, reuniting the city and Judaism's holiest sites with the 
Jewish people and putting an end to almost two decades of exclusion 
from the Old City.
  Since coming under its sovereignty, Israel, the one true democracy in 
the Middle East that shares our values of freedom, has protected people 
of all faiths in Jerusalem and ensured their access to holy sites so 
that they might worship freely. They have protected the rights of Jews, 
of Christians, and of Muslims. This has occurred even while religious 
minorities are being targeted, persecuted, and attacked throughout the 
Middle East and religious and historical sites are being demolished 
today by radical Islamic terrorists.
  Today is a day where we must also reassert historical truth: The 
historical connection between the Jewish people and Jerusalem and the 
land of Israel did not begin in 1967. These profound ties to Jerusalem 
have existed for thousands of years. They can be traced back and have 
been reaffirmed through numerous archeological excavations such as 
those in the city of David.
  In the past several years, I have traveled to Israel three times. 
There is something that stirs inside each time I am there. It is 
remarkable to observe the great successes and achievements of this 
small and yet mighty country that is one of America's strongest allies 
in the world.
  It is long past time that America do something it should have done 
two decades ago: Move the American Embassy to Jerusalem and formally 
recognize Jerusalem as Israel's eternal and undivided capital. In every 
nation on Earth our Embassy is in its capital city except for Israel. 
There is no reason Israel should be treated any worse when they are 
such a reliable and unshakeable ally.
  We should honor the promise that Democratic Presidents and Republican 
Presidents have made for decades and move our Embassy to Jerusalem. So 
I stand today to express my solidarity with Israel and with the Jewish 
people during this major celebration. Now, more than ever, America 
stands strong with our unshakeable friend and ally, the nation of 
Israel.
  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. WHITEHOUSE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Rubio). Without objection, it is so 
ordered.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent to speak for 
up to 15 minutes as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                             Climate Change

  Mr. WHITEHOUSE. Mr. President, I am here to discuss what you might 
call the Scott Pruitt philosophy of environmental regulation. In a 
recent interview, the Administrator of the Environmental Protection 
Agency expressed his view that the EPA should ``simply pass regulations 
that provide fairness and equity and allow utilities to make decisions 
based upon stability, cost, and security to the consumers that they 
serve.'' Did we notice anything missing in that assertion of what EPA's 
role should be? How about no mention of the environment, no mention of 
climate change, no mention of public health? So my 168th ``Time to Wake 
Up'' speech will look at how paid-for Administrator Pruitt is by the 
very industries he is supposed to be regulating. Often, the word for 
this is ``corruption.''
  Scott Pruitt is a functionary of fossil fuel money. He has a long 
record of dark money fundraising and long, cozy relationships with big 
fossil fuel political donors.
  As you can see, energy interests contributed over $136,000 to 
Pruitt's 2014 campaign even though he ran unopposed. During the 2010 
and 2014 election cycles, oil and gas giants Devon Energy and Koch 
Industries--yes, of those infamous Koch brothers--maxed out to Pruitt's 
campaigns.
  Thanks to Pulitzer Prize-winning reporting by the New York Times, we 
know that backing Pruitt was a good fossil fuel investment, 
particularly for Devon Energy. In 2011, Attorney General Scott Pruitt 
took a letter written by Devon Energy, he put it onto his Oklahoma 
attorney general letterhead, he signed it for them, and he sent it off 
to EPA, pleading Devon Energy's anti-regulatory case as if it were his 
own.
  As attorney general of Oklahoma, Pruitt directly solicited political 
donations from companies now regulated by EPA, then regulated by EPA as 
well.
  He spoke at dozens of industry events but never at a public health or 
environmental event.
  He led the boards of political organizations, like the Republican 
Attorneys General Association and its dark money political fundraising 
arm, the so-called Rule of Law Defense Fund, this thing. Pruitt was a 
member of the RAGA executive committee--RAGA being Republican Attorneys 
General Association. He was a member of their executive committee 
between 2014 and 2016, when RAGA raised $530,000 from Koch Industries--
yes, those same infamous Koch brothers--and $125,000 from Devon 
Energy--yes, of the letter he put onto his own letterhead.
  Coal giant Murray Energy donated $50,000 to Liberty 2.0, Pruitt's own 
super PAC, and it donated $350,000 to RAGA between 2014 and 2016.
  The Rule of Law Defense Fund doesn't have to disclose its donors. 
They hide in a loophole in the law. But other public reporting has 
shown that it received at least $175,000 from something called Freedom 
Partners. With a name like that, you know it is up to no good. Sure 
enough, it is another dark

[[Page S3091]]

money group run by several Koch Industries executives. That is not 
Coca-Cola; that is the Koch brothers' fossil fuel processing company.
  We don't know more about this. Why do we not know more about this? 
Because Republicans in the Senate protected Scott Pruitt from having to 
answer these questions during his confirmation process.
  While he was busily helping raise dark money, dark money groups, in 
turn, came back and worked hard to help Pruitt get confirmed to the 
EPA. A Republican opposition research PAC called America Rising 
launched a pro-Pruitt ad campaign, and its dark money arm, America 
Rising Squared, funded confirmpruitt.com. A 501(c)(4) dark money entity 
ironically named Protecting America Now was created solely to help 
confirm Pruitt to the EPA. Its fliers asked for contributions ranging 
from $25,000 to $500,000. Just another grassroots group trying to get a 
good guy confirmed. Koch Industries' own lobbying disclosure forms 
reveal it spent part of $3.1 million lobbying to confirm Scott Pruitt.
  In Trump's science-denial Cabinet, Administrator Pruitt seems to see 
little reason to hide his anti-environment and Republican political 
interests. He has spoken at the Conservative Political Action 
Conference and the American Farm Bureau board meeting. He attended 
rallies with coal miners against his own regulations and met with the 
National Mining Association's executive committee ``to lay out his 
concerns with the Paris accord'' the day before the mining association 
voted to press President Trump to withdraw from that agreement.
  Administrator Pruitt planned to appear as the keynote speaker at the 
Oklahoma Republican Party Gala on May 5. This invitation mentioned his 
official position as EPA Administrator three times. It featured this 
photo of him being sworn in as the EPA Administrator. It promised 
donors a ``once-in-a-lifetime opportunity to hear him discuss his plans 
to slash regulations, bring back jobs to Oklahoma, and decrease the 
size of the EPA.'' Well, the 1939 Act to Prevent Pernicious Political 
Activities, more commonly known as the Hatch Act, forbids this, so I 
filed a Hatch Act complaint and Administrator Pruitt's appearance was 
canceled. The Office of Special Counsel is now conducting a full 
investigation.

  But it wasn't just there. He goes to other dinners. On February 28, 
2017, Pruitt was a speaker at a RAGA major donors dinner. You know who 
major donors are by now. Days after the RAGA major donors dinner, 
Pruitt unilaterally withdrew an EPA request for information from oil 
and gas producers about their methane emissions, citing a letter from 
nine members of RAGA and two Republican Governors, who alleged the 
methane information request ``furthers the previous administration's 
climate agenda and supports . . . the imposition of burdensome climate 
rules on existing sites, the cost and expense of which will be 
enormous.''
  There was no public comment period. There was no request for input 
from other States. This basically was a little party favor for his RAGA 
pals right after the RAGA dinner.
  This EPA Administrator has solicited thousands, if not millions, of 
dollars from corporations he now regulates. Our current ethics laws do 
not require nominees in the confirmation process to disclose their 
political and dark money connections, so the Senate and the public are 
kept blind to the conflicts of interest of such nominees, and we have 
no idea how those conflicts would manifest in their offices. Pruitt 
knows who gave dark money to his political causes. The corporations 
know what dark money they gave. It is just the rest of us who are in 
the dark.
  This is new, and this is weird. This was not a problem for President 
Obama's nominees because the dark money political tsunami that has 
swamped our politics in slime did not exist when President Obama was 
elected. It was the Citizens United decision of 2010 that allowed 
unlimited political spending by big special interests, and that 
unlimited money found dark money channels.
  To address the gaping loophole in our Federal ethics laws, I have 
introduced the Conflicts from Political Fundraising Act with Senators 
Udall, Carper, Van Hollen, and Franken. This bill would require 
Presidentially appointed Federal officials like Scott Pruitt to 
disclose their political fundraising, and it would require Federal 
ethics officials to address these conflicts by, for example, making 
sure officials are recused from decisions affecting big political 
donors, making sure the public has the information to know they should 
ask for a recusal because the director is conflicted by reason of his 
political relationship with big dark money donors.
  I wish the conflicts at EPA stopped with the Administrator, but they 
don't. It is a swarm of swampy conflict over there. Pruitt has 
surrounded himself with political operatives and fossil fuel lobbyists. 
The Associate EPA Administrator for Policy previously worked at RAGA, 
the Rule of Law Defense Fund, and something called the Freedom Partners 
Chamber of Commerce--a Koch brothers-funded dark money group that has 
underwritten the Rule of Law Defense Fund. EPA's Senior Adviser for 
Regional and State Affairs came from Pruitt's own fossil fuel-funded 
super PAC, Oklahoma Strong. The Assistant Administrator for 
Congressional and Intergovernmental Relations came from the oil 
company, the Hess Corporation. One Deputy Associate Administrator is 
the former president of the Ohio Coal Association. Another Deputy 
Associate Administrator was a registered lobbyist at the National Rural 
Electric Cooperative Association, where she specifically lobbied 
against EPA's Clean Power Plan and New Source Performance Standard, the 
clean water rule, the ozone standard, EPA enforcement, pesticides 
bills, budget resolutions, and EPA appropriations bills.
  This corruption of EPA is the work of the fossil fuel industry. One 
day there must come a reckoning.
  Just this weekend, the New York Times reported ``How Rollbacks at 
Scott Pruitt's E.P.A. Are a Boon to Oil and Gas.'' The article included 
a checklist of rollbacks that specifically benefit long-time Pruitt 
benefactor Devon Energy--the one that got the letter--delaying a rule 
raising royalties on fossil energy production on Federal land, undoing 
new fracking standards, rolling back rules on the leaking and flaring 
of methane, and rolling back reporting of methane emissions.
  In another matter, Devon Energy had been preparing to pay a 
settlement of over $100,000 and to install emissions scrubbing 
equipment to remedy illegal emissions from a Wyoming natural gas 
facility. Five days after Pruitt was installed at EPA, the company told 
officials it was ``re-evaluating its settlement posture,'' offering a 
quarter of what it had previously proposed to settle the charges and 
scrapping the emissions controls entirely. They know their 
Administrator Pruitt.
  Pruitt's record at EPA reveals he is unabashedly looking out for his 
industry donors at the expense of public health and the environment. As 
far as I can tell, every action he has taken since taking office will 
lead to an enriched industry--at the expense of dirtier air and dirtier 
water--and a more imperiled climate.
  Myron Ebell is someone I don't quote often. He is the head of 
President Trump's EPA transition team and a prominent climate denier. 
He has something interesting to say about Scott Pruitt. He has said 
that he thinks Scott Pruitt is using EPA as a ``stepping stone to 
political office'' and that ``everything he does is going to be a 
political calculation about what furthers his own political career.''
  This is not a liberal environmentalist making these accusations. This 
is somebody who is right in Scott Pruitt's climate denial wheelhouse. 
This is someone from the Trump science denial EPA destruction team. 
This is the guy who is in the club of fossil fuel-funded climate 
denial, and he thinks everything Pruitt does is a political calculation 
about what furthers Pruitt's own political career. If that is the case, 
everything Scott Pruitt does is a conflict of interest, as he sees 
regulated industry as the funders of his next political campaign. They 
pay for him now, and he delivers.
  Sadly, the people who own Pruitt also own Congress. So good luck 
getting an honest look at this mess from our fossil fuel-funded 
colleagues in the majority.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.

[[Page S3092]]

  The bill clerk proceeded to call the roll.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered,

                          ____________________