EXECUTIVE SESSION
(Senate - May 25, 2017)

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[Congressional Record Volume 163, Number 91 (Thursday, May 25, 2017)]
[Pages S3161-S3179]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           EXECUTIVE SESSION

                                 ______
                                 

                           EXECUTIVE CALENDAR

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will proceed to executive session to resume consideration of the 
Thapar nomination, which the clerk will report.
  The assistant bill clerk read the nomination of Amul R. Thapar, of 
Kentucky, to be United States Circuit Judge for the Sixth Circuit.
  The ACTING PRESIDENT pro tempore. The Democratic whip.
  Mr. DURBIN. Mr. President, I rise in opposition to the nomination of 
Judge Amul Thapar to serve on the Sixth Circuit Court of Appeals.
  Judge Thapar is President Trump's first nominee to serve on a Federal 
appeals court. Last week, the Senate Judiciary Committee considered 
this nomination and no Democrat voted for it.
  Judge Thapar is on the list of 21 candidates that the Federalist 
Society and Heritage Foundation have selected for President Donald 
Trump to choose from when filling Supreme Court vacancies.
  Judge Thapar is well known to the Federalist Society. He was a member 
of that organization prior to becoming a district court judge, and 
since he became a judge he has spoken at Federalist Society events 17 
times.
  Some of my colleagues on the Republican side are like Captain Renault 
in Casablanca, who claimed he was ``shocked, shocked'' to find out 
there was gambling going on in Rick's Cafe.
  They are shocked that anyone could be concerned about the Federalist 
Society, which they claim is just a simple debate club. Far from it--
consider the following background.
  The organization was founded in 1982 by students at two law schools, 
Yale and the University of Chicago, under the faculty supervision of 
Robert Bork and Antonin Scalia, who just happen to be the two most 
prominent conservative legal scholars of their generation.
  According to a recent article about the Federalist Society by Jeffrey 
Toobin: ``within just a few years, the group was embraced and funded by 
a number of powerful, wealthy conservative organizations, which 
eventually included foundations associated with John Olin, Lynde and 
Harry Bradley, Richard Scaife, and the Koch Brothers.''
  The Federalist Society's website includes the group's purpose 
statement. It claims that the legal profession is: ``currently strongly 
dominated by a form of orthodox liberal ideology which advocates a 
centralized and uniform society.''
  The statement describes the Federalist Society as a group of 
conservatives and libertarians calling for: ``reordering priorities 
within the legal system,'' to fit their principles. Does that sound 
like the mission statement of a nonpartisan debate society?
  How has the Federalist Society gone about this reordering? It's been 
largely the work of Mr. Leonard Leo, the longtime executive vice 
president of the Federalist Society who is currently serving as an 
advisor to the Trump White House.
  Mr. Leo has been credited with being a driving force behind the 
Supreme Court nominations of Justice Neil Gorsuch, Chief Justice John 
Roberts and Justice Samuel Alito. That is one-third of the current 
Supreme Court that he has helped put in place.
  Mr. Leo recently gave a speech where he said: ``I've seen that 
comment about the third of the Supreme Court. I prefer controlling 
interests. But we haven't quite been able to launch a hostile takeover 
yet.''
  Mr. Leo went on to advocate for radical change, saying: ``I would 
love to see the courts unrecognizable.'' He has said of the judicial 
confirmation process: ``it's like war.''
  In an unprecedented move, President Trump outsourced the selection of 
Supreme Court candidates to Mr. Leo, the Federalist Society, and the 
right-wing Heritage Foundation. He publicly thanked these special 
interest groups for putting together his list of 21 Supreme Court 
candidates, and Mr. Leo was the first person to call Neil Gorsuch about 
his nomination.
  As Jeffrey Toobin wrote, Leonard Leo: ``knew how to play the game--
how to find a nominee who met Trump's ideological requirements as well 
as his own, while observing the proprieties expected for judicial 
nominees.''
  Mr. Leo told Mr. Toobin that it was: ``easy'' to find these nominees 
because: ``when you've been working in this vineyard for twenty-five 
years you know everybody.''
  That brings us back to Judge Thapar.
  Leonard Leo, and the big money right-wing interests that fund the 
Federalist Society, feel that they know Judge Thapar well enough to 
include him on the list of 21.
  They have had plenty of opportunity to get a sense of his views, as 
Judge Thapar had been a member of the Federalist Society and has 
frequently spoken at their events.
  At his hearing and in my questions to him, I sought reassurance from 
Judge Thapar that he would be independent from this right-wing group 
and President Trump.
  His answers did not provide that reassurance.
  For example, I asked Judge Thapar whether he agreed or disagreed with 
the Federalist Society's purpose statement. He ducked the question, 
saying he didn't know what the Federalist Society meant by the 
statement.
  I asked him if he thought it was appropriate for the President to 
delegate his Supreme Court selection process to the Federalist Society 
and Heritage Foundation, since this creates incentive for judges not to 
contravene the views of those organizations and their big-money donors. 
He ducked again, saying he would not opine on this because he claimed 
it was a ``political question.''
  In the aftermath of Citizens United, special interest groups pour 
dark money into campaigns in support of Republican judicial nominees 
like Judge Thapar. I asked Judge Thapar if he would discourage secret 
donations in support of his nomination.
  After all, if we don't know who is secretly donating in support of 
his nomination, how will we know when Judge Thapar needs to recuse 
himself because one of those donors has an interest in a case he is 
considering?
  He dodged that question too, saying he wasn't aware of any donations 
about his nomination. Of course, he wouldn't be aware of secret 
donations--that's the problem.
  I also asked him about the original understanding of the 
Constitution's Emoluments Clause. He said he could not discuss it 
because there is pending litigation on the matter.
  That is curious, because I thought the Federalist Society's view was 
that the original meaning of constitutional provisions was immutable 
and unchanging. If the meaning of the Constitution doesn't change, why 
do Federalist Society nominees decline to tell us this meaning when 
there is litigation underway affecting President Trump?
  I asked Judge Thapar about his decision in Winter v. Wolnitzek. This 
was a major campaign finance decision in which he applied strict 
scrutiny to invalidate a ban on judges making political contributions. 
A unanimous Sixth Circuit panel reversed his ruling.

[[Page S3162]]

  A group of 24 campaign finance reform organizations sent a letter 
saying: ``Judge Thapar embraced the troubling `money is speech' 
paradigm in a radical way that goes beyond Supreme Court doctrine.'' 
These groups oppose his confirmation, and I ask unanimous consent to 
have their letter printed in the Record at the conclusion of my 
remarks.
  Given Judge Thapar's evasiveness on questions about his views, I am 
left to judge him on his record, such as his troubling decision in the 
Winter case, and the fact that the Federalist Society and Heritage 
Foundation handpicked him for their judicial wish list.
  I need more reassurance than that to support a nominee for a lifetime 
appointment on the Federal court of appeals. I will oppose his 
nomination.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                     May 17, 2017.
     Senate Judiciary Committee,
     Washington, DC.
       Dear Senators: We the undersigned organizations write to 
     oppose the confirmation of Judge Amul Thapar to the United 
     States Court of Appeals for the Sixth Circuit due to his 
     troubling record on the issue of money in politics.
       We are deeply concerned with the power of wealthy campaign 
     donors in American politics, and specifically with the 
     aggressive role the U.S. courts have played in undermining 
     our democracy by elevating the voices of a wealthy few over 
     the views of everyday Americans.
       Much of the problem can be attributed to four decades of 
     flawed Supreme Court rulings. These decisions have twisted 
     the meaning of the First Amendment and prevented our elected 
     representatives and the people from enacting reasonable 
     protections against big money. In fact, nearly half of the 
     money in the 2016 federal elections--more than $3 billion--
     can be directly tied to a few of the Court's most damaging 
     rulings.
       What concerns us about Judge Thapar's record is that he has 
     gone beyond the Supreme Court's directives in his antagonism 
     towards basic rules designed to ensure we have a government 
     that is of, by and for the people.
       In Winter v. Wolnitzek, 186 F.3d 673 (E.D. Ky. 2016), Judge 
     Thapar struck down a prohibition on judges making political 
     contributions by applying strict scrutiny to this 
     contribution ban, in spite of the fact that the Supreme Court 
     has been clear that contribution limits and bans are to be 
     reviewed under a lower form of scrutiny. The Sixth Circuit 
     overturned Judge Thapar's ruling on this point and reinstated 
     the contribution ban.
       Further, Judge Thapar embraced the troubling ``money is 
     speech'' paradigm in a radical way that goes beyond Supreme 
     Court doctrine, writing ``there is simply no difference 
     between `saying' that one supports an organization by using 
     words and `saying' that one supports an organization by 
     donating money.''
       Sen. Whitehouse pointed out in Judge Thapar's Senate 
     Judiciary Committee hearing that ``those of us who are in 
     politics know that that is a false statement, that it is 
     indeed a preposterous statement factually because money has a 
     completely different effect than speech once it enters the 
     political arena.''
       The Supreme Court itself does not treat financial 
     contributions as being equal to actual speech. Rather, the 
     Court considers contributing to a campaign a form of 
     association or attenuated speech since the contributor does 
     not control the content of the communication resulting from 
     the contribution.
       If Judge Thapar had his way, wealthy donors and special 
     interests could be able to give unlimited sums of money 
     directly to candidates for office. Thapar would make it even 
     harder than it is now for everyday people to be heard and 
     affect who runs for office, who wins elections, and what 
     issues get attention; and easier for powerful politicians to 
     make secret wink and nod deals with their richest 
     contributors.
       Judge Thapar's responses to questioning on the subject 
     during his hearing and in subsequent ``questions for the 
     record'' did nothing to allay our concerns. In response to 
     Sen. Klobuchar's questions about why he applied strict 
     scrutiny to the contribution ban, for example, Judge Thapar 
     struggled to explain why he assumed (without analysis) that 
     the same standard should apply to contributions as to 
     solicitations.
       The role of big money in politics became a central issue in 
     the debate over Justice Neil Gorsuch's confirmation to the 
     U.S. Supreme Court because the public cares deeply about this 
     issue. To ensure that all voices are heard, not just those of 
     powerful corporations and wealthy donors, it is essential 
     that we confirm judges and justices who understand that the 
     Constitution gives we the people the power to protect our 
     democracy from big money.
       Unfortunately, Judge Amul Thapar does not appear to see our 
     pro-democracy Constitution as the vast majority of Americans 
     do--and for this reason we urge you to oppose his 
     confirmation to the U.S. Court of Appeals for the Sixth 
     Circuit.
           Sincerely,
       American Federation of Teachers, Americans for Democratic 
     Action, Center for American Progress, Center for Emergent 
     Diplomacy, Class Action, Communications Workers of America, 
     CODEPINK, Democracy Spring, Demos, End Citizens United, Every 
     Voice, Free Speech for People, Friends of the Earth, Just 
     Foreign Policy, Maplight, MAYDAY, National Association of 
     Social Workers, Participatory Politics Foundation, People for 
     the American Way, PeopleNow.org, Reverb Press, Small Planet 
     Institute, United for Democracy, Voices for Progress.


                         Healthcare Legislation

  Mr. DURBIN. Mr. President, I would like to address the comments that 
were made by the Republican majority leader about the issue of 
healthcare. What he said today I have never heard him say before. He 
said it was the fault of the Democrats for refusing to work with the 
Republicans to change the Affordable Care Act. I had not heard that 
before.
  I find it an interesting suggestion because what happened after the 
House of Representatives passed a measure 3 weeks ago to change the 
healthcare system in America, the issue then came to the Senate but did 
not go through the regular order of business.
  It is my understanding--and has been reported widely in the press--
that Senator McConnell, the Republican leader, assembled a group of 13 
Republican Senators who have been meeting in private over the last 3 
weeks to discuss an alternative to the healthcare bill that passed in 
the House of Representatives. There are no Democrats in that room. None 
have been invited. Incidentally, there are no women in that room from 
the Republican side--13 male Senators meeting in private.
  So to hear this suggestion from the Republican leader that the real 
problem they are running into is that the Democrats are not helping, we 
were not invited to this party. They are meeting privately to come up 
with something, and I don't know what it might be, but I have an idea 
of how we can achieve a bipartisan real effort when it comes to 
healthcare in America.
  I would suggest we create a committee in the Senate. I have a name 
for it, the Health, Education, Labor, and Pensions Committee. I suggest 
we have 12 Republicans and 11 Democrats on that committee. I suggest 
they sit down, take the bill sent by the House, and improve it, make it 
better. Now, this suggestion is such a good one that the committee 
already exists.
  It is under the chairmanship of Lamar Alexander--whom I respect 
personally very much--and the ranking member, Patty Murray of the State 
of Washington, a Democrat. I know, having spoken to Senator Murray, she 
is ready to roll up her sleeves and go to work to write a revision to 
the healthcare bill, the healthcare system in America.
  There have been no hearings, none, on the measure passed by the House 
of Representatives. So when the Republican leader says he wishes the 
Democrats would join in the effort, this committee is ready and willing 
to work. I am sure, if he picked up the phone and called Senator 
Alexander and Senator Murray, they could get to work on doing a much 
better job than what the House of Representatives did.
  Why am I so critical of the House of Representatives? Not because of 
the traditional rivalry between the Chambers, but because yesterday the 
Congressional Budget Office took a look at the bill that passed the 
U.S. House of Representatives 3 weeks ago by two votes. It was all 
Republicans voting for it. It passed by two. A number of Republicans 
refused to support it. It had no support from the Democratic side.
  It was an unusual bill because it went out of the regular order of 
business. The regular order of business suggests that when you are 
going to do something that might have an impact--a large impact--on 
America, you should go to an agency that is a nonpartisan, expert in 
the field, that will analyze your bill and tell you what impact it will 
have. Most of us think we have pretty good ideas for making America a 
better place to live and good ideas for legislation.
  Luckily, we have something called the Congressional Budget Office, 
which sometimes brings us back down to Earth and says: It might not 
work exactly as you thought it would work. Traditionally, bills--
significant bills that affect a lot of Americans and families and 
things important like healthcare--they are submitted to the

[[Page S3163]]

Congressional Budget Office so they can analyze them and decide the 
impact they will have.
  Well, 3 weeks ago, Speaker Paul Ryan and Republicans in the House 
said something I had not heard before in my service in Congress. They 
said: We are not going to wait for this analysis. We are going to vote 
on this bill even before the Congressional Budget Office has a chance 
to analyze its impact. Remember, we are talking about changing the 
healthcare system in America, and that literally impacts every single 
American. It is one-sixth of our Nation's economy. You would think, 
before anyone was bold enough to suggest they wanted to change the 
system, they would at least send their proposal to the Congressional 
Budget Office for an analysis. The Republicans in the House failed to 
do so, refused to do so, passed the measure by two votes, and sent it 
to the Senate.
  So, yesterday, the Congressional Budget Office completed its 
analysis. Now that we have an analysis of what is known as TrumpCare or 
the Republican healthcare approach, it is pretty clear why they did not 
want the Congressional Budget Office to take a look at it. This is what 
the Congressional Budget Office reported publicly last night: Next 
year, under the Republican proposal for healthcare reform, 14 million 
Americans will lose their health insurance. Over the next 10 years, 23 
million Americans will lose their health insurance.
  Do you remember when we started this conversation? The goal was to 
make sure we changed the laws in America so more Americans would have 
the protection of health insurance. Just the opposite occurs if the 
Republican plan goes forward. The second thing we were looking for is a 
goal in healthcare reform to reduce the growth, the rate of growth, in 
health insurance premiums.
  Every one of us knows what that is all about. Health insurance 
premiums have been going up way too high for way too long. The 
Republicans have been critical of the current system, saying the cost 
of health insurance is going up too fast. So they put in their reform 
proposal which passed the House of Representatives.
  Here is what the Congressional Budget Office had to say about the 
Republican approach: Next year, premiums for health insurance will 
increase by 20 percent in the individual market. That is the market 
where we have seen this dramatic growth in costs already, and the 
Republican plan makes it worse.
  The third thing we find is this argument by the Republicans that 
somehow the current healthcare system in America, the Affordable Care 
Act, is in a death spiral. Listen to what the Congressional Budget 
Office said about the health insurance market in America today. The CBO 
affirms that under current law, marketplaces--health insurance 
marketplaces--are stable.
  However, under the Republican repeal bill, one out of every six 
Americans will be living in parts of this country where the individual 
market would become unstable as a result of the Republican bill. So 
instead of stabilizing the market and ending the so-called death 
spiral, the Republican bill makes it worse.
  It turns out that when you take a close look at this so-called death 
spiral, you find the Republicans have their hands around the throats of 
the healthcare system of America choking it and claiming this patient 
is not looking good, Doctor. If they would stop their efforts to 
sabotage the current system and work to improve it and make it 
stronger, then we could save health insurance for a lot of Americans 
and bring stability to the system.

  The Republican bill at its heart is not about a healthcare bill, 
though, it is about tax cuts. The Republican proposal for healthcare 
reform starts with eliminating almost $900 billion in taxes paid by the 
wealthiest people in America. By taking $900 billion out of the 
healthcare system, they are unable to keep health insurance alive for 
so many Americans. The Republican approach eliminates $834 billion in 
the Federal Medicaid Program. What is the Federal Medicaid Program? Let 
me give you three examples of what it is.
  In Illinois today, half of the babies who are born are paid for--
their medical care is paid for by the Medicaid system: prenatal care 
for mom so the baby is healthy, the delivery of the baby, and postnatal 
care afterward. These are lower income individuals. Half of them are 
paid for by Medicaid today, but that is not the most expensive part of 
Medicaid.
  The most expensive part of Medicaid is for your mom and dad and your 
grandmother and grandfather who are in a nursing home and have no 
savings left. All they have is Social Security, Medicare, and Medicaid. 
That is the most expensive part of Medicaid. Those who are disabled 
living in my State, in Alabama, in New York, and other States--disabled 
people and low-income people need medical care and they rely on 
Medicaid.
  So when the Republican healthcare reform and repeal cuts $800 
billion-plus out of Medicaid, it is at the expense of the groups I just 
mentioned: babies and moms, elderly people in nursing homes, and the 
disabled. Those are the ones who will see a cutback in medical services 
so we can give a $900 billion tax cut to the wealthiest people in 
America.
  I know the Democratic leader is here. I want to yield the floor when 
he arrives, but I want to close by telling a story. Yesterday, I had 
three moms and a dad who brought their children to a press conference. 
It was a great press conference, if I may say so. These kids stole the 
show, as they should. Each one of them--each one of them had a 
compelling story about having survived a terrible illness. Many of them 
were cancer victims.
  Moms told stories. One mom said: I was changing my little girl, and I 
noticed a lump in her abdomen. It turned out to be a neuroblastoma 
cancer tumor. It was removed. My little girl spent weeks, months in the 
hospital, and she is still going back.
  Each one of them told a story. As you looked at these kids, smiling 
and happy and bouncing around, you thought to yourself: Thank goodness. 
Thank goodness for America, with its great medical care, and thank 
goodness these families had health insurance--because they were there 
concerned about what the Republicans are doing when it comes to 
preexisting conditions.
  Because these kids have survived cancer, they are risky from an 
insurance viewpoint. We decided 6 years ago to put an end to that worry 
for these families. You cannot discriminate against a person or a 
family in America based on a preexisting condition--thank goodness--
because one out of three of us have a preexisting condition. The 
Republican approach takes away that protection and says Governors can 
ask for a waiver so health insurance in their State can discriminate 
against people with preexisting conditions.
  So three moms and a dad came yesterday and said: Please stop this 
Republican plan. What will our families do? Our kids have preexisting 
conditions. We cannot afford to see our premiums go through the roof 
because the Republicans withdraw this protection.
  That is the real-life consequence of this debate. This is not just 
about a lot of politicians on Capitol Hill blowing hot air. It is about 
families--real families with real kids and real challenges and whether 
they are going to have real protection when they need it.
  The Congressional Budget Office yesterday came out with a report and 
said the measure that passed the House, the Republican measure, is a 
disaster for families across America. We have to stop it. We have to do 
everything in our power to do it. I might say to my friend from New 
York, the Democratic leader, that when the Republican leader came to 
the floor this morning and said: Why won't the Democrats join us in 
repairing the Affordable Care Act? I say to the Republican leader: Open 
the door of that room where you have 13 male Republican Senators 
sitting down and debating the future of healthcare. Open the door, open 
the windows, and let's have an honest, open, bipartisan conversation 
not about repealing our healthcare system but making it stronger, 
protecting the very families who showed up yesterday at a press 
conference and whom I am going to remember for a long time.
  I yield the floor.


                   Recognition of the Minority Leader

  The ACTING PRESIDENT pro tempore. The minority leader is recognized.

[[Page S3164]]

  



                         Healthcare Legislation

  Mr. SCHUMER. Mr. President, first, let me thank my good friend from 
Illinois for, as usual, his articulate, compassionate, and outstanding 
work and for the great job he and others did yesterday when they 
invited the people here. I reiterate just what the Senator from 
Illinois stated; that is, once they take repeal off the table--they are 
having real trouble with repeal--we want to sit down and make our 
healthcare system better. It is not perfect. No one thought it was.
  It is better than it was. Many more people are covered. Preexisting 
conditions, college kids--kids get out of college, and they get 
healthcare. All of that is better. We don't want to get rid of 
everything, but we want to improve it. We are working. Forty-eight 
Senators, as my colleague from Illinois knows--every Democrat signed a 
letter to Leader McConnell saying we want to work with you to improve 
this system, not to sabotage the existing system, not to repeal the 
good things we have but to improve it.
  And we have gotten no answer in that regard.


                        Tribute to Bill Dauster

  Mr. President, I have just a few words first about Bill Dauster, 
someone who has labored long and hard and well in this body. We depend 
on our hard-working staff. I am so blessed to have such a great, 
dedicated, loyal, hard-working, smart staff. One of their best traits 
is that they are not afraid to tell me when they think I am off base, 
and it helps keep things going right.
  Well, Bill Dauster was one of the great staffers I have met in all 
the years I have been here in the Senate. He worked, of course, for 
Harry Reid, my dear friend. He is now working for Senator Van Hollen, 
but he will be retiring tomorrow.
  Now, Bill was Leader Reid's deputy chief of staff for policy for many 
years. Before that he worked for the Budget Committee, the Finance 
Committee, and for Senator Feingold of Wisconsin. The list of 
legislation that Bill has worked on is long and illustrious. He was 
known as a great friend and mentor to his colleagues wherever he went.
  In Reid's office, he was jokingly called ``the butler'' because he 
was constantly trying to help other members of the staff. Senator 
Reid's staffers fondly remember Bill Dauster during the final days of 
the debt ceiling negotiations, running in and out of Senator Reid's 
office as he rushed to go meet with younger staffers on the Hill who 
were sent to him for advice. Even on his busiest days, Bill made time 
for others.
  In an industry in which many rub shoulders and network after work, 
Bill was a different kind of guy. He was known to give the same 
response to any coworker who asked him to come to a social event. He 
would repeat: I love you, but I love my family more, and I need to be 
home with them. He was so dedicated to his family, we heard. He would 
regale us with many stories about them.
  He came up with great ideas. He was a great sounding board for me.
  So on behalf of all of us in the Senate, we want to thank Bill for 
his long service to the Senate, for his role in crafting legislation 
over three decades, and for his mentorship to other Senate aides, old 
and young. He is retiring, but his influence in this body will last 
long after he has left.
  We all wish him well in this next phase of life, where, hopefully, he 
will be able to spend more time where he enjoys it the most--at home 
with his family.


                               TrumpCare

  Mr. President, another matter--healthcare. Yesterday, the 
Congressional Budget Office, led by a Director who was handpicked by 
current HHS Secretary Tom Price, Donald Trump's appointee, released its 
analysis of the House Republican healthcare bill--TrumpCare.
  The report makes clear that TrumpCare would be a cancer on the 
American healthcare system--causing costs to skyrocket, making coverage 
unaffordable for many seniors and those with preexisting conditions, 
all the while leaving 23 million fewer Americans with health insurance.
  Now, when people hear this, they say: Why would the Republicans want 
to do it? That just seems mean-spirited. Well, I will tell you why: 
because their No. 1 goal is to give a tax break for the wealthiest of 
Americans. People making above $250,000 pay an additional charge to 
help everyone else with healthcare on their unearned income--not on 
what they do when they are working, but on stocks, bonds, and 
investments. The No. 1 goal of our colleagues across the aisle, sadly, 
is to help those very rich people get even richer.
  Now, to do that, they have to take away people's healthcare. To get 
the money for those tax breaks, they take away people's healthcare. So 
the bottom line is very simple: Unless you are a healthy millionaire, 
TrumpCare is a nightmare. I think that is why our Republican colleagues 
are having such trouble putting together their own bill, because, as 
Senator Durbin has noted, they have excluded us from their 
negotiations.
  Well, the CBO report ought to be a final nail in the coffin of the 
Republican effort to sabotage our healthcare system. Republicans in 
Washington and the President should read the report cover to cover, 
throw their bill in the trash can, and begin working with Democrats on 
a real plan to lower costs and improve care.
  There is a lot to unpack in this report. It came out late yesterday. 
So I want to focus on a couple of provisions this morning.
  First, on health insurance costs, the CBO report makes clear that 
premiums under this bill are headed up in the next several years. 
Consumers would see their premiums increase by 20 percent for next 
year's plans. Now, Republicans will crow about premiums going down in 
the outer years--years away. But the decrease in premiums occurs for 
only one reason: The quality of the insurance will plummet. If you have 
a barebones plan that hardly helps you, where you have to pay huge 
deductibles, huge copayments, and huge premiums and it covers next to 
nothing, of course, the cost will eventually go down. What good is 
that? Why even talk about that kind of healthcare? People don't need it 
and don't want it. Cheaper insurance isn't going to help anyone if it 
doesn't actually lead to the healthcare people need.
  Listen to this one. Older Americans--everyone in America 50 to 64 who 
doesn't have a lot of income, making say $25,000 a year--TrumpCare is 
going to force you to pinch pennies just to be able to afford health 
insurance. The CBO report says that some seniors could see their 
premiums go up a whopping 800 percent under this bill.
  In one of the newspaper articles I saw, I think the senior citizen 
was in his early sixties. They were making about $25,000 or $30,000 a 
year--not unusual for a senior of that age--and their premiums went up 
from $1,700 to $13,000. How are you going to vote for that, my friends, 
telling these people who have worked hard their whole lives that they 
have to pay a lot more and a lot of that money is going to wealthy 
people for a tax cut?
  What about out-of-pocket expenses? By the way, out-of-pocket expenses 
really bother people. How many of us have heard over and over again: I 
have healthcare, and, when I went to the doctor, they said: You, first, 
have to lay out $5,000. How many of us have heard that? Everybody. The 
Republican bill makes it worse.
  According to the CBO report, out-of-pocket costs could balloon for 
vital services in States where they decline to cover essential health 
benefits. Americans could be paying thousands of dollars more every 
year if they need maternity care or programs that treat substance abuse 
or mental health services.
  Listen to this one. According to reports, in States that elect not to 
include maternity care, which every State could elect to do under the 
Republican bill--and many will--insurers would most likely sell 
maternity benefits as an add-on at $1,000 a month--$17,000 more in 
total. Under TrumpCare, women may well have to pay more--much more 
insurance--just because they are a woman, because of pregnancy. So 
costs go up, up, up. If, God forbid, this bill becomes law and costs go 
up, any citizen of this country should go to their Senators who voted 
for this and say: What the heck did you do? You made it worse.
  Now, uncertainty in the market is the second issue. The CBO report 
confirms that the Republican attempts to

[[Page S3165]]

repeal the Affordable Care Act and the Trump administration's refusal 
to guarantee to continue making cost-sharing payments is causing the 
instability in the market.
  Here is what the report says. Now, this is the report put out by the 
Republican-appointed head of the CBO. So this is not some Democratic 
propaganda-type document. These are ``just the facts, ma'am,'' as Mr. 
Friday said. Here is what the report says: ``Substantial uncertainty 
about the enforcement of the individual mandate and about future 
payments of the cost-sharing subsidies'' have led insurers to withdraw 
from the current marketplace.
  AHIP--that is the biggest organization of our Nation's insurers, the 
insurance companies; they are nonpartisan--said the same thing.

  Why, if our colleagues want more people to stay in the market and are 
complaining that people are leaving the market, don't we come 
together--hopefully, with the President, who thinks that he could do 
this on his own--and say: We are going to make this cost-sharing 
permanent. We all know insurers want certainty in the future or they 
pull out. That is what the insurance business is all about. Yet, 
grudgingly, one little step at a time, they don't take away the cost-
sharing because they know the damage it would do--this is President 
Trump--but they are afraid to make it permanent and that causes 
problems.
  So there is only one word for what the President is doing and our 
Republican colleagues are doing when it comes to the present healthcare 
system--sabotage. If our Republican friends continue to allow the 
President to play coy about these cost-sharing payments--which bring 
premiums down, which bring costs for average citizens down--as a 
potential threat, if we don't make cost sharing permanent, the system 
will deteriorate. Again, it will be on the President's back, on our 
colleagues' backs. I hate to say that, but those are the facts.
  We want to make it permanent. We tried to put it in the 
appropriations bill, to make it permanent, which would have kept costs 
low or kept people in the exchanges. Our colleagues said no.
  Finally, as to preexisting conditions, the CBO report states:

       People who are less healthy would ultimately be unable to 
     purchase comprehensive non-group health insurance at premiums 
     comparable to those under current law, if they could purchase 
     it at all.

  Let me repeat the last part of the CBO report written by an appointee 
of our Republican head of HHS: ``if they could purchase it at all.'' 
Think about that for a minute.
  Under TrumpCare, if you have a preexisting condition, if you are 
sick, your health insurance costs could go up so high that you can't 
afford insurance. Before the new healthcare law passed under President 
Obama, how many of us heard from families: My daughter has cancer, but 
the insurance company won't cover me, or I got kicked off and I have to 
watch her suffer because I can't afford the treatment, the payments. It 
is horrible, heart-wrenching. It is going back to those days under this 
bill, unfortunately.
  This report ought to be the final nail in the coffin of the 
Republican effort to sabotage our healthcare system. It will make much 
more certain that sick people are priced out of insurance companies, 
that the most vulnerable are left high and dry when they need care the 
most, when there is an illness in the family.
  Is that the sort of healthcare system our colleagues envision for 
this country? When you are sick, when one of your family members is 
sick, is that when they are not allowed to give you healthcare? What in 
the heck do you have it for?
  I certainly hope that is not the idea on the other side of the aisle, 
but this bill that the House passed would do it.
  In conclusion, the nonpartisan scorekeepers have spoken loudly and 
clearly--no ambiguity. TrumpCare means higher costs and less care for 
the American people, the average American. Let's not lose sight of what 
is at stake here. The health and well-being of the American people is 
on the line. There are life-and-death consequences for so many millions 
of people. They are relying on us to get this right.
  So for the good of the country, President Trump and our Republican 
colleagues should abandon TrumpCare, stop sabotaging the healthcare 
system, and work with Democrats--we are waiting--to fix our healthcare 
system, not pull it from under them.


                              Memorial Day

  Mr. President, finally, I have one more note. It is Memorial Day. I 
want to take a moment to express my deep and abiding gratitude for the 
men and women in our armed services who gave their last full measure of 
devotion in defense of our Nation and our liberty.
  In big cities and small towns throughout America and in my home State 
of New York, we will honor our fallen veterans and pay tribute to them. 
We will give a hug to the Gold Star moms who have made the ultimate 
sacrifice. May we never forget their sacrifice so that we may enjoy the 
blessings of freedom.
  Since the founding of this country, since the farmers on Bunker Hill 
put down their plows and took up muskets, Americans have been willing 
to make that ultimate sacrifice for our great way of life, our freedom. 
May we never forget them.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Sullivan). The Senator from Connecticut.


                         Russian Investigation

  Mr. BLUMENTHAL. Mr. President, I join my colleague from New York in 
expressing the special respect and passion that we all feel in honoring 
this great holiday that remembers the service and sacrifice of great 
Americans, to make sure we sustain and preserve and enhance our 
democracy. Part of that democracy is indeed the rule of law, as well as 
protecting the institutions that make us great as a Nation, including 
our elections system and its integrity.
  Today should also be a time to observe and commemorate the continued 
respect for the law that makes us great. Part of that respect was 
demonstrated recently when the Deputy Attorney General appointed a 
special counsel to investigate possible coordination between the Trump 
administration and the Presidential campaign with the Russians as they 
interfered with those democratic institutions. Make no mistake, there 
is consensus and unanimity in the intelligence community, and more 
broadly among us in this body, that the Russians purposefully and 
relentlessly interfered in the 2016 election through a cyber attack on 
this Nation. In my view, it was an act of cyber warfare.
  The questions now are who and how in the Trump team may have colluded 
with the Russians in that illegal, outrageous activity and, indeed, 
whether there has been obstruction of justice since then. Mounting 
evidence indicates that there has been.
  I have joined many of my colleagues in praising the appointment of a 
special prosecutor because it is vitally necessary for a fair and 
impartial, as well as aggressive, investigation. The special prosecutor 
must follow the evidence wherever it leads, and I have confidence that 
Bob Mueller is the right person for this assignment. He has the grit 
and backbone to stand up to pressure. He has the prosecutorial 
experience and expertise to conduct a truly professional investigation.
  I called for a special prosecutor back in February. I was one of the 
first, if not the first, among our colleagues to do so because the 
conflicts of interest raised by the recusal of the Attorney General and 
the potential involvement of the Deputy led me to think that such an 
appointment was absolutely necessary.
  I now call on the President to support this investigation. With the 
utmost respect for the Office of the President, it should be 
unnecessary to call for that cooperation and support. My hope was that 
the President would say as soon as the appointment occurred that he 
would indeed cooperate. But, instead, he has continued to characterize 
this investigation as a witch hunt and a charade. He has demeaned and 
disrespected it and indicated that, if anything, there will be less 
than full cooperation. That would be a grave disservice to our 
democracy and to the American people.
  The integrity of our electoral system is bigger and more important 
than any single electoral contest or even any occupant of the White 
House. It is about the freedom and independence of this Nation, 
something we cherish and celebrate on this Memorial Day weekend.
  I urge President Trump to demonstrate his adherence to the rule of

[[Page S3166]]

law by cooperating and articulating fully his cooperation with this 
investigation. I hope that not only President Trump but all of his 
associates will do so and that they will provide whatever testimony and 
documents are necessary to complete this investigation as quickly and 
effectively as possible.
  I also believe that the Attorney General of the United States owes 
the American people his adherence to the rule of law by committing 
himself to follow the guidelines that respect the press. Indeed, we 
would know very little, if anything, about many of the events that 
prompted the appointment of a special prosecutor without the free press 
reporting development after event after development that have led to 
this day.
  There are guidelines and regulations that protect the President 
against any kind of compulsory process or punishment. If there is 
punishment to be accorded to lawbreakers, the press should be 
recognized for the special role they have in our democracy and the 
special protections, the constitutional guarantee they enjoy under the 
First Amendment. There are guidelines under 28 CFR 50.10 that provide 
legal guidance and regulations that should be observed, and I hope that 
the Attorney General will demonstrate in deed and word his adherence to 
those guidelines rather than threatening to lock up reporters--as the 
President has unfortunately done currently in conversations with 
Director Comey--or punishing them.
  Whatever the violations of government officials may be, there should 
be an articulate, clear, and explicit adherence to those regulations by 
the Attorney General.
  Let's take a moment to go through where we are right now.
  Last July, after a disturbing series of reports suggesting the 
attempt by a foreign power to influence an American election, the 
Federal Government began to investigate the Russian Government's 
interference in the Presidential election.
  We learned just yesterday from a published report that this activity 
included conversations among Russian officials regarding how best to 
sway individual Trump officials and that the FBI's early handling of 
this matter may have been influenced by an unreliable document 
traceable to Russian intelligence--a form of interference in our 
justice system that is stunning.
  In December of 2016, U.S. intelligence officials concluded that the 
Russians had orchestrated the theft of electronic materials from the 
Democratic National Committee and John Podesta in an attempt to 
undermine Hillary Clinton's Presidential campaign. The Obama 
administration responded by implementing sanctions on the Russian 
Government.
  Shortly after President Trump took office, Attorney General Sally 
Yates warned the White House that National Security Adviser Michael 
Flynn had lied to officials about discussing sanctions with the 
Russians and was vulnerable to Russian blackmail. The White House 
waited 2\1/2\ weeks to take action and did so only after a March 9 
Washington Post report and, in fact, days after Sally Yates' warning, 
fired her.
  We also know that Director Comey was warned or asked--in fact, 
demanded by President Trump that he pledge his loyalty and that he 
would be in jeopardy of losing his job if he did not. Shortly 
thereafter, the President clearly expressed to Director Comey his sense 
of that warning when he asked Director Comey to shut down, in effect, 
the Flynn investigation. As we all know, Director Comey resisted both 
of the President's requests.
  In early March, following sharp criticism about his failure to 
disclose meetings with Russian officials under oath, Attorney General 
Jeff Sessions recused himself from the Department of Justice 
investigations.
  Later that month, President Trump's son-in-law, Jared Kushner, became 
the third high-ranking Trump administration official caught 
misrepresenting potentially his ties to an admitted meeting with 
Russian officials from his security clearance application.
  On May 9, President Trump fired FBI Director James Comey, a stunning 
event amidst these unprecedented revelations. After clumsy and 
contradicting explanations seeking to advance a false narrative that 
the firing was a result of Director Comey's handling of the Hillary 
Clinton email matter, the White House essentially abandoned that 
conflicting series of stories, and President Trump admitted publicly 
that he was thinking about the FBI's Russia investigation when he 
decided to fire Comey. He boasted the next day in his meeting with the 
Russian Foreign Minister that he felt greatly relieved of pressure 
resulting from that investigation.
  The New York Times has reported that Comey was seeking increased 
funding and resources to expand the Russia probe. The Times also 
subsequently revealed that Director Comey had discussed with others and 
wrote memos detailing how President Trump asked him to pledge his 
loyalty and shut down the Federal investigation into Mr. Flynn.
  We must wait for all the facts to emerge, but even if only some of 
these reports are accurate, the conclusion is almost inescapable that 
the President of the United States fired the FBI Director in an attempt 
to shut down the investigation into ties between his associates, 
including Michael Flynn, and the Russian Government. The names of these 
associates have been well documented--Paul Manafort, Roger Stone, 
Carter Page, as well as Michael Flynn.
  There is, unfortunately, more. Just in the past few days, additional 
disturbing facts and press reports have surfaced, including testimony 
by former CIA Director John Brennan before the House Intelligence 
Committee. He said that before he left office, he became deeply 
concerned that Russian intelligence services were attempting to 
manipulate Trump associates to influence the Presidential campaign. He 
noted that many Russian contacts of individuals linked to the Trump 
campaign emerged in those reports. The Washington Post reported that 
Comey had informed Congress about the FBI Russia investigation late in 
March and that Trump had asked Director of National Intelligence Daniel 
Coats and National Security Director Michael Rogers to push back on 
that investigation--in effect, to clear the President--and deny Trump 
campaign collusion with the Russians. According to this report, both 
officials, to their credit, refused to do so.
  In the Armed Services Committee, I asked Director Coats whether he 
discussed with Director Rogers any attempts by the administration to 
interfere with the investigation. He refused to answer--a pause and 
silence that spoke volumes.
  Revelation after revelation shakes our confidence in this 
administration's truthfulness and confidence. This investigation by the 
special prosecutor is vitally necessary.
  We must not lose sight of the damage that has already been done. 
These reports paint a deeply disturbing picture of possible 
obstruction, a mosaic pieced together by facts that show not only 
events and conversations but also motives. After a series of these 
events and conversations, they can no longer be seen as isolated or 
accidental or inadvertent. The cumulative effect, like threads in a 
fabric, is to establish a picture of motive, intent, mens rea, and 
criminal activity.
  Special Counsel Mueller must have the mandate and all of the funding 
and resources that he needs to follow the facts wherever they may 
lead--resources, independence--but also support.
  That is why, again, I call on the administration to express its 
support and its intention to cooperate.
  This kind of investigation can mean the difference between the 
upholding of our democratic institutions and placing them in jeopardy. 
Therefore, I urge that we as a body remain vigilant and continue the 
Judiciary Committee's oversight, inquiry, and investigative activity so 
as to assure that we know the reasons then-FBI Director Comey was 
fired--we have that responsibility as a matter of oversight--and 
continue that kind of scrutiny in order to assure the independence and 
resources the special prosecutor needs. Likewise, the Intelligence 
Committee's activities are absolutely necessary.
  Almost certainly, the special prosecutor will produce no report or 
elaborate public explanation. He will bring criminal charges if they 
are warranted by the evidence. He will seek convictions in court if 
those prosecutions are

[[Page S3167]]

justified under his finding. A report with recommendations and finding 
as to how we can avoid this kind of interference with our democratic 
institutions in the future must be the work of the Intelligence 
Committee and of an independent commission, which I have supported. An 
independent, bipartisan commission can do the kind of public, 
transparent, vigorous, and independent work that is necessary, just in 
the way that we have done in the wake of other crises.
  I urge that we proceed on all of these fronts. They are vital to our 
democracy. They are an essential, inextricable part of freedom, the 
rule of law, and freedom of the press.
  I hope that the press will continue its unfettered use of its First 
Amendment freedom to give us the truth and to continue those reports 
that have brought us to this day, because the truth will be uncovered 
in the course of the criminal process. It will be uncovered by the 
Intelligence Committee and, hopefully, by an independent commission. 
The essential role of the free press in fostering government 
accountability is recognized by existing regulations, and the Attorney 
General of the United States should leave no confusion that the 
Department of Justice will adhere to those regulations.
  Indeed, 28 CFR 50.10 recognizes the ``essential role of the free 
press in fostering government accountability'' and, therefore, sets 
parameters and procedures, for approval by the Attorney General of the 
United States, under standards that are set forth for any government 
action that may, in any way, inhibit or impede the press.
  We will probably never know the real impact of Russia's intervention 
in the outcome of the 2016 election. These investigations are not about 
assessing the impact. They are about determining who participated 
criminally with the Russians in that interference. The American people 
deserve a thorough and impartial investigation into the Trump team's 
ties to that interference and the effort by President Trump and others 
to cover it up.
  In the wake of Watergate, the saying arose that the coverup was worse 
than the crime. It was then, and it would be worse--or at least as 
heinous--in the crime here. Make no mistake that the crime is, 
actually, a theft of our democracy--an interference by the Russians in 
our democratic institutions--which they will repeat if we do not make 
them pay a price and, likewise, if we do not make the Americans who 
cooperated with them pay a price as well. This principle is central to 
our democracy and our rule of law.
  In closing, I urge my colleagues to join me in calling for the 
cooperation of the Trump administration as well as for recognizing the 
importance of the investigation--its independence, its resources--for 
the free press and the rule of law.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.


                             Opioid Crisis

  Ms. KLOBUCHAR. Mr. President, I join my colleagues in speaking about 
the opioid crisis that has devastated families in States across the 
country.
  I thank my colleague, Senator Manchin, for organizing the speeches 
today.
  In my State, deaths from prescription drug abuse have now claimed the 
lives of more Minnesotans than have homicides or car crashes. We lost 
our beloved Prince because of an opioid overdose, which is still being 
investigated. Just as importantly, we lost a student in Duluth and a 
mom in Rochester, MN--over 400 people in just the last year. We 
continue to see dangerous synthetic opioids shipped across our borders 
in increasing amounts--a trend that the U.S. Customs and Border 
Protection expects to continue, as we heard in a Judiciary Committee 
hearing last week.
  Today, I joined Senator Portman in his subcommittee on Homeland 
Security and Governmental Affairs, and we talked about what is going on 
from that perspective as well.
  While there is more work to do to combat this epidemic, first, I 
recognize that we have made some meaningful progress on a bipartisan 
basis. We passed the CARA Act, which is something that was led by 
Senators Portman, Whitehouse, Ayotte, and me. We set a framework up for 
the Nation, and I look at it in three ways.
  The first way is that we have to do everything we can to prevent 
addiction. That means changing some of our prescription practices 
across the country. Do you really need 30 pills when you get your 
wisdom teeth out? It is about asking those questions and changing those 
practices.
  The second thing would be to look at prescription drug monitoring. 
Senator Portman and I have a bill that would make it mandatory for 
States to share their data across State borders. I found a guy in 
Moorhead, MN, through his rehab counselor, who had 108 different 
prescriptions for opioids from something like 80 different doctors in 
50 different cities. He went from North Dakota to South Dakota, to 
Minnesota, to Wisconsin. That is why sharing that data would greatly 
reduce that doctor shopping.
  I see here the Senator from Texas, Mr. Cornyn. Senator Cornyn and I 
led a bill years ago to make it easier for people to throw away their 
leftover prescription drugs so they would not get in the hands of those 
who should not be taking them. Those are ideas for reducing that 
demand.
  Then you go to the next area, which, of course, is that of trying to 
reduce the illegal drugs from coming in, like with the STOP Act, which 
Senator Portman and I introduced, making it harder to get these drugs 
in through the Postal Service, and doing more with law enforcement. By 
passing the SALTS Act, which is a bill that Senator Graham and I 
introduced, it will make it easier for prosecutors--the Presiding 
Officer is a former prosecutor--to prove up cases with analogue drugs, 
which is when perpetrators basically take a substance, change it a 
little, and then say: Hey, it is a new drug. Then it makes it harder 
for the Feds to go after it, and you have to prove it up in court.
  So we are making some changes to our law to make it easier, 
especially in rural areas, where they are not going to be able to get a 
medical doctor in to prove up what the substance is in order to make it 
easier to prove these cases.
  These are all very good ideas, but what we are here to talk about 
today is the issue of the funding and what will happen if we do not 
have the funding for treatment. We did a good job with the Cures Act 
last December, in which we made $1 billion available over 2 years, as 
well as the work that was done on a bipartisan basis with the budget 
for the rest of the year. I consider those good signs.
  Unfortunately, the budget and the CBO score of the healthcare repeal 
bill that was released this week--the bill that came over from the 
House--shows us that we are at risk of working backwards on this issue.
  According to the nonpartisan Congressional Budget Office, mental 
health and substance abuse benefits could be cut under the healthcare 
bill, which would increase out-of-pocket costs by thousands of dollars 
for those who need these vital services. This is on top of the $839 
billion in cuts to Medicaid under the bill and additional cuts in the 
President's budget of more than $600 billion to Medicaid and the 
Children's Health Insurance Program, even though these programs cover 3 
out of every 10 people who have an opioid addiction. This would be 
devastating for so many, if these budget cuts took effect.
  I would like to do more. I would, actually, like to pass the LifeBOAT 
Act, which Senator Manchin introduced and I am a cosponsor. That would 
simply put an extra fee on some of these opioids so that the people who 
have been reaping the profits from these drugs would be helping to pay 
for the treatment. I think that is a great idea. Unfortunately, this 
budget takes us the other way.
  It eliminates programs that help rural communities build hospitals 
and get access to vital telemedicine services. It cuts critical medical 
research that is happening at the NIH--just when, at the end of last 
year, we added that money to the NIH's funding. It was shown just in 
the last month that, with the budget for the rest of the year, we have 
continued that positive trend. The budget also doubles down on other 
cuts that would hurt small towns and rural communities, which would 
impact jobs and opportunities. It eliminates rural business programs, 
which have helped to create hundreds of thousands of jobs. It cuts 
rural housing programs and infrastructure grants and loan programs.

[[Page S3168]]

  Altogether, these cuts not only threaten the progress we have made in 
fighting against the opioid crisis, but they also threaten the 
prosperity of the rural communities, which have been the hardest hit. 
We need a budget that helps and not hurts rural America.
  We have a lot of work to do. I appreciate, again, the work of our 
Democratic and Republican colleagues in the Senate. As we have shown 
with the budget--from last month through the rest of this year--we have 
put some common sense in there and have done a good job and have gotten 
a lot of bipartisan support. My hope is that we will do the same thing 
here and make a smart budget and reject the one that has been proposed 
by this administration and come up with something much better that 
helps and not hurts the people of our States.
  I yield the floor.
  The PRESIDING OFFICER. The majority whip.


                         Healthcare Legislation

  Mr. CORNYN. Mr. President, I want to spend a little bit of time today 
talking about how badly ObamaCare is failing the American people and 
how my Republican colleagues and I are working to repeal and replace it 
with healthcare that works. I wish I could say that Democrats and 
Republicans were working together to replace it with healthcare that 
works. Unfortunately, our Democratic colleagues have taken a walk on 
this particular topic and, apparently, are not interested in 
participating.
  Even though 30 million Americans remain uninsured under ObamaCare, 
the individual market--where people buy their health insurance if they 
do not have employer-provided coverage or government-provided 
coverage--is in a death spiral. This was confirmed by a study by the 
Department of Health and Human Services. It was also the subject of a 
Wall Street Journal article today that makes the point that average 
premiums in the individual market have increased 105 percent since 2013 
in the 39 States in which the ObamaCare exchanges are federally 
run. This translates into $3,000 more out-of-pocket for middle-class, 
hard-working families--a 105-percent increase in premiums since 2013.

  I dare anybody to say ObamaCare is working as it was intended. All 
one has to do is look back to President Obama's very words, when he 
said: If you like your doctor, you can keep your doctor; if you like 
your health insurance policy, you can keep that. He also said: Oh, by 
the way, we are going to save you money too. A family of four will save 
$2,500 a year. Contrast that to the $3,000-a-year increase since 2013 
in the individual market--a 105-percent increase.
  As I said earlier, this week the Department of Health and Human 
Services released a report that underscores the negative impact 
ObamaCare is having on families across the country. The report 
highlights the incredible increase in annual premium prices since 
ObamaCare took effect, and I mention that in the aggregate.
  Let's look at places like Texas. In Texas, the average monthly 
premium jumped from $222 in 2013 to $404--about an 82-percent increase. 
If you are a young person buying health insurance, a young family or 
anybody, for that matter, spending $222 a month and it jumps 82 
percent, to $404, that is a big bite out of your disposable income. 
That is pretty bad, there is no question about it, but Texas wasn't 
close to being the hardest hit.
  For example, in Wisconsin, premiums have almost doubled. In Montana, 
they have gone up 133 percent. In some States, the premiums have 
actually tripled. As I said, the average individual premium has more 
than doubled in the 39 States using healthcare.gov--an increase of 105 
percent since 2013.
  That is not the only problem with ObamaCare. This year, one in three 
counties across the United States have just one insurer on the 
ObamaCare exchange. In other words, ObamaCare has gotten it so wrong 
that the risk pools are mainly people who are older and who need 
healthcare more, and many younger people--young, healthy people who are 
important in the risk pool to help bring premiums down for everybody--
are simply taking a walk. This isn't the mark of a healthcare law that 
is working for the American people or helping our country grow 
healthier. It is the mark of a law that is actually hurting families by 
giving them fewer options at a higher cost and failing to deliver on 
any promises. We wonder why people are cynical about their own 
government. Well, it is because of promises made and promises not kept, 
and ObamaCare--I have said it before and I will say it again--is one of 
the biggest examples of consumer fraud I have ever seen in my lifetime.
  We are talking about real-world consequences here. My colleagues on 
the other side of the aisle like to talk about how many people would be 
potentially hurt by repealing and replacing ObamaCare. Of course, that 
is purely speculative. They are making it harder because they refuse to 
participate in this process, but we are determined to make sure we 
bring premiums down and make health insurance more affordable for those 
who want to buy it.
  Let me talk about concrete examples of people terribly affected by 
the ObamaCare healthcare law. One of my constituents wrote me a few 
weeks ago and said she and her husband got their insurance from her 
husband's job, but since ObamaCare came into effect, their premiums 
have tripled, and she estimates their deductibles have doubled. What is 
also frightening is that her prescriptions have skyrocketed too. As an 
example, an inhaler that previously cost her $35 now costs almost 10 
times that amount--well over $300.
  Given the outrageous costs, this Texan decided to see if she could 
get a better deal on the exchange since her insurance costs kept going 
up and up and up. She said the deductible she would have gotten was 
$6,000 a year. Add that to higher premiums, and she said ObamaCare was 
too high to even think about changing to.
  ObamaCare has had so many negative ripple effects throughout our 
entire economy. It restricted the number of hours people can work 
because of the employer mandate. It raised taxes, depressing economic 
activity and growth--things like the medical device tax. The medical 
device industry is one of the most innovative, lifesaving industries in 
our country and literally in the world. Yet ObamaCare imposed a medical 
device tax and chased those jobs and the innovation that goes along 
with them offshore. I remember one of my constituents from Dallas, TX, 
said they had a location in Costa Rica, and as long as the medical 
device tax applied to things they did in Texas and in the United 
States, they were going to take their business and build it in Costa 
Rica for one reason and one reason alone; that is, to avoid this 
crushing tax.
  The result has not been good for the economy, and it has not been 
good for healthcare. Many folks can't find any reasonable insurance 
that will actually pay for what they want. They can't afford what 
insurance they do have, and they feel hopeless and helpless as the 
rates keep climbing.
  Because I know these stories apply not only in Alaska or in Texas, 
they apply all across the country, one would think we would have 
Senators on both sides of the aisle clamoring and working together to 
try to come up with some solutions, but, once again, it is stony 
silence from our colleagues across the aisle.
  As my constituent rightly pointed out, so much of their income is now 
going toward premiums and other healthcare costs, she said she and her 
husband feel like they are actually being robbed. That is why we 
believe, on this side of the aisle--I wish I could say on both sides of 
the aisle but certainly on this side of the aisle--that we need to find 
a solution that works for our country.
  So here is an open invitation to any of our colleagues in either 
House of Congress: Please come work with us, not for our benefit, not 
for any political gain or advantage but because it is the right thing 
to do. That is why we get elected. That is why we serve, not to engage 
in petty politics but to actually do things that help our constituents.
  This isn't just a red-State problem. I pointed that out earlier when 
I referenced Wisconsin and Montana. This is a problem that confronts 
our entire country.
  So we are going to continue to keep working on a bill that repeals 
this ObamaCare disaster and replaces it with patient-centered, 
accessible healthcare that make sense for the

[[Page S3169]]

American people. I hope our colleagues on the other side of the aisle 
come around to join us because we do intend to get this done.
  I just want to read a couple of other excerpts from this Wall Street 
Journal editorial today. They talk a little bit about how to read the 
CBO report. The Congressional Budget Office, as the Presiding Officer 
knows, really has the final word on interpreting, from an official 
standpoint, what the impact of proposed legislation would be, but I 
have to say this is far from the holy writ.
  Here is a good example. In this article, they point out ObamaCare 
coverage estimates--CBO estimates for ObamaCare coverage by year in 
millions of enrollees. For example, in 2013, they projected that 7 
million enrollees would enroll in ObamaCare, and it was 6 million. That 
is not too far off, but let's look at 2015. In 2015, they said 13 
million would enroll, and 11 million enrolled. Again, that is ballpark, 
but then we go to 2016. They predicted that 21 million people would 
enroll in ObamaCare. Do you know how many enrolled? Twelve million. 
They missed it by almost 50 percent. That is not close. Then, in 2017, 
they projected it would be 15 million, and it was 10 million.
  I say that not to disparage the Congressional Budget Office because I 
know they are doing the best they can, but it is hard to predict the 
future, and it is also hard to predict how markets will work and how 
people will respond to the incentive of more choices and lower costs.
  This is not a red-State or a blue-State issue because, as I 
mentioned, in Missouri alone HHS has said that premiums have increased 
145 percent. So wouldn't we think we would have both Senators from 
Missouri on the floor working with us to try to solve the problem? I 
know Senator Blunt is working with us to try to solve the problem, but 
we would benefit from having a bipartisan effort to address the 
problem.
  They also point out that there are other things the CBO report talks 
about which is significant, particularly in terms of getting our 
economy growing again. They said, for example, that the House bill cut 
taxes by $992 billion, spending by $1.1 trillion, and reduced the 
deficit by $119 billion. Now, I know that is not the primary effort 
here when it comes to healthcare, but if we want to get our economy 
growing again, if we want to make it possible for more people to buy 
healthcare coverage at a price they can afford, it helps if they have a 
job, and it helps if the economy is growing.
  Here is the thing that, to me, is perhaps the most cynical argument 
by the critics of what we are trying to do in repealing and replacing 
ObamaCare. Despite the fact that there are 30 million people uninsured 
now--hardly a success, hardly the gold standard for providing access to 
healthcare coverage--the Congressional Budget Office points out what I 
think is pretty obvious. If you take the gun away from people's heads 
and you don't force them to buy a product they really don't want, fewer 
people are actually going to buy it because it doesn't suit their 
needs, and it is not available at a price they can afford. As the Wall 
Street Journal points out, without the threat of government to buy 
insurance or else pay a penalty, some people will conclude that 
ObamaCare coverage isn't worth the price, even with the subsidies.
  Sometimes I wish we would have honest and open debates about the 
problems that confront our country, and certainly healthcare is 
something near and dear to all of our hearts. Too often I feel as 
though we are ships passing in the night or reverting to our talking 
points rather than having an open and honest discussion. This is an 
area where we can benefit from an open and honest discussion and an 
acknowledgment that the status quo is unsustainable.
  If Hillary Clinton were President of the United States today, we 
would be revisiting ObamaCare because the individual market is, as I 
described earlier, failing. It is failing. I am confident our 
colleagues across the aisle would be eager to try to step forward to 
address that, but because the candidate they did not choose won the 
Presidency, then they are in full-blown resistance, not offering to 
lift even a finger to try to help us solve this problem, and it is a 
shame, but it is not too late.
  We invite them again to join us as we repeal and replace ObamaCare, 
providing people with more choices at a price they can afford, not 
because we are going to hold a gun to their head and say you are going 
to have to buy a product you don't want, at a price you can't afford, 
we are going to give people the freedom to choose. That is not a bad 
thing. That is a good thing. That is what America is all about--not 
having government force you to make decisions that you don't view are 
in your own economic self-interests.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Fischer). The Senator from Connecticut.
  Mr. MURPHY. Madam President, I rise to speak on the same subject as 
my friend from Texas.
  Listen, Democrats are ready to talk to Republicans about improving 
our healthcare system, but we aren't going to engage in a debate that 
presupposes that the end result is going to be millions of people 
losing care and rates going up for everybody in order to fund a tax cut 
for the wealthy. That is the plan Donald Trump and the Republicans are 
pushing.

  So my Republican friend is right: Democrats are not interested in 
having a discussion about how many people are going to lose coverage. 
We are not interested in having a discussion about how high the rate 
increases are going to be. We are not interested in having a discussion 
about big tax breaks for millionaires, billionaires, insurance 
companies, and drug companies.
  Let's be honest. If Republicans were serious about working with 
Democrats, we wouldn't be using an arcane Senate rule which allows them 
to push through a bill with 50 votes. If Republicans really wanted to 
work with Democrats on healthcare reform, they would do it through 
normal business. If Republicans were really serious about working with 
Democrats on healthcare reform, they would be going through regular 
order and going through the committee process.
  Whatever we want to think about the Affordable Care Act, it went 
through the committee process. I think 160 Republican amendments were 
accepted in the Health, Education, Labor, and Pensions Committee in 
2009. The Finance Committee held multiple meetings. The bill was on the 
floor of the Senate for a month. Republicans are jamming this bill 
through--no committee process, no committee meetings, no committee 
markups, no open-floor process.
  Even Senator Corker called out his own party and said that this is no 
way to rewrite one-sixth of the American economy--13 male Republican 
Senators, behind closed doors, in secret.
  Democrats are desperate to work with Republicans on fixing what is 
wrong with our healthcare system. Not every problem has been fixed, but 
we are not going to start with 17 million people losing healthcare or 
rates going up by 20 percent. And we want to do it in a way that is 
transparent to the American public, where everybody can see.
  On the second point my friend from Texas raised--this idea that CBO 
got the numbers wrong when they estimated how many people would be 
insured by the Affordable Care Act in 2009--as he mentioned, they 
weren't off by that much, but to the extent they were off, there is a 
simple reason for it: CBO did not take into account that Republican 
States would seek to undermine the Affordable Care Act in every 
conceivable way possible. CBO gave Republican Governors and State 
legislatures the benefit of the doubt that once this law was passed, 
once it was presenting an avenue to insurance for millions of people 
across the country, both parties would seek to implement it. That is 
not what happened. Republican States refused to set up State-based 
exchanges. Republicans brought lawsuit after lawsuit to try to stop the 
Affordable Care Act from going forward. Republicans, in control of the 
House and the Senate, jammed through legislation that reduced the risk 
insurance provided to insurance companies. CBO did not estimate that 
Republicans would wage a 6-year-long campaign to undermine and undo the 
Affordable Care Act.
  In States that implemented the act, such as Connecticut, numbers met 
or beat expectations. In States that didn't

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implement the Affordable Care Act, sought to undermine it, numbers 
didn't meet the expectations.
  Then comes President Trump, who openly telegraphs his desire to 
undermine the Affordable Care Act, cuts off all of the advertising, 
tells the IRS to stop enforcing the law, bleeds out payments to 
insurance companies one month at a time, teasing that this will be the 
last month they get their money.
  Finally, on this question of a gun to the head of consumers--I guess 
that is a reference to the provision of the Affordable Care Act that 
says: If you don't buy insurance, then you will pay a penalty. That is 
absolutely part of the Affordable Care Act. Why? Because if you want 
protection for people with preexisting conditions, then you have to 
have a mandate that people buy insurance, or else people just won't buy 
insurance until they are really sick, knowing they can't be charged 
more.
  Actuarially, the protection for people with preexisting conditions 
only works with the individual mandate. I remember Senator Cruz, during 
his marathon filibuster, admitting that. Republicans and Democrats know 
that. That is why the American Health Care Act, which just came out of 
the House of Representatives, includes an individual mandate. So let's 
not pretend like this is a partisan issue.
  The rightwing American Health Care Act that came out of the House of 
Representatives 2 weeks ago includes an individual mandate--it is in 
there--because they know the same thing: If they want to preserve any 
modicum of protection for people with preexisting conditions, they have 
to require people to buy insurance. They just put the mandate in a 
different place. In the Affordable Care Act, the penalty kicks in if 
you don't buy insurance. In the House bill, the penalty kicks in after 
you have lost insurance and you try to sign up again. It is the same 
mandate, the same penalty, just a slightly different timetable for 
payment.
  Here is what TrumpCare does: higher costs, less care, tax cuts for 
the rich.
  I want to talk about the CBO score that came out last night--not 
major adjustments from the first CBO score, but there are some 
important amendments that they make. But the bottom line is that if you 
care about costs, there are going to be higher costs. That is what CBO 
says. There is a 20-percent increase in cost the first year, 5 percent 
in the next year for good measure. There is less care--I mean 
significantly less care--23 million people. Big improvement--24 million 
people lost care in the first House bill; 23 million people lose care 
in the second House bill. And all of this is done in order to pass 
along tax cuts to the wealthy. We are talking about $662 billion of tax 
cuts for the wealthy.
  Here is what CBO says: Premiums are projected to rise 20 percent in 
2018. So our Republican friends who came down to this floor for 6 years 
and said we need to repeal the Affordable Care Act because costs are 
too high just passed a bill in the House of Representatives that CBO 
guarantees will raise premiums by 20 percent in 2018.

  And it got a lot worse. CBO says that if you are an individual with a 
preexisting condition and you live in a State that takes advantage of 
one of these waivers, the premiums, frankly, don't even matter to you 
because you won't be able to afford the catastrophic high cost 
associated with your illness.
  If you are an older American, especially an older American living on 
Social Security, then you are targeted by the American Health Care Act. 
A 64-year-old making $26,000--and I have a lot of 64-year-olds in 
Connecticut making $26,000, and I bet a lot of my colleagues here who 
live in lower cost and lower income States have even more of this 
population--today you are paying about $1,700 a year for healthcare. 
That is what your premium is after taxes. Under the American Health 
Care Act, your premium would go up to $21,000 a year. You are making 
$26,000, and your premium goes up to $21,000. You would receive about 
$5,000 in tax credits, but in the end, you would be paying $16,000 in 
healthcare premiums.
  Now, obviously you wouldn't be paying $16,000 in insurance premiums 
because you couldn't afford healthcare if you still want to pay your 
rent and you still want to pay your gas bill and you still want a few 
groceries.
  The reason why massive numbers of people lose insurance is because 20 
percent is just the average; for some people, premiums will go up 700 
to 800 percent, especially if you are older or if you are lower income.
  Here is what CBO says will happen if the Affordable Care Act stays: 
The number of uninsured will go up a little bit. It will tick up to 
about 28 million. But for all my colleagues on the Republican side who 
have been claiming that the Affordable Care Act is in a ``death 
spiral,'' CBO tells you that you are wrong. You are wrong. They state 
clearly that the marketplaces will remain stable. Now, again, they may 
not be counting on the kind of sabotage President Trump is engaged in. 
If President Trump continues to destabilize the markets, maybe this 
number will be wrong. But if you had an administration that was 
attempting to enforce and implement the Affordable Care Act, you would 
get about the same number of people who are uninsured.
  Here is what happens if you pass the American Health Care Act: The 
number goes immediately up to over 40 million uninsured and peaks after 
10 years at 51 million people.
  Senator Cornyn said: Listen, we still have 30 million people who 
don't have insurance; let's try to solve that problem. But CBO says 
that the House bill doesn't solve the problem. It turns a problem of 28 
million Americans without health insurance into a humanitarian 
catastrophe--more people uninsured at the end of this than were 
uninsured before the Affordable Care Act passed.
  So I guess what Senator Cornyn is saying is that whatever product 
emerges from these secret meetings will insure more people and that CBO 
will verify that. That is something on which we can work together. Let 
me guarantee, that won't be the case.
  To give a sense of how many people 23 million is, because I know that 
is kind of a hard number to get your head wrapped around, this is the 
number of people who lose insurance under the House bill, according to 
CBO. CBO's new numbers just came out last night. That is the equivalent 
population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, 
Nebraska, Nevada, New Hampshire, New Mexico, South Dakota, Rhode 
Island, North Dakota, and West Virginia. When we put up this chart a 
couple months ago, I think there was one additional State. So by moving 
from 24 million losing insurance to 23 million people losing insurance, 
one State came off this list. But that is the equivalent population of 
how many folks lose healthcare in this country. That is why I call it a 
humanitarian catastrophe.
  Then let's just think about what CBO says about who benefits. Here 
are 23 million people who lose insurance--and that is a pretty simple 
formula. The bill takes insurance from 23 million people in order to 
pass along a $173 billion tax break for the pharmaceutical industry and 
the insurance industry and a $230 billion tax break for very rich 
people. Some of it will go to people making above $200,000 a year, but 
most of it will go to people making over $1 million or $1 billion a 
year. The numbers actually work out pretty squarely. The cuts to 
healthcare in the bill roughly work out to be about the same amount in 
tax cuts for the wealthy.
  By the way, there is another chart here that is a great one. There is 
another chart that shows who benefits when we look at the tax breaks. 
If you make under $200,000 a year, you get zero benefit from the 
American Health Care Act. Every single dime of the tax cuts for 
individuals or families goes to those making over $200,000 a year. How 
about that--a $230 billion tax break, and not a dime of it goes to 
people making under $200,000 a year. So this bill was a nightmare 
before the CBO score, and it is even more of a nightmare today.
  Let me point out one more important thing that CBO says about this 
bill. Inside this bill, in a new amendment that allowed it to pass the 
House of Representatives, is a provision that allows States to get 
waivers from the essential healthcare benefits requirement that 
insurance actually provide you coverage for healthcare and the 
community rating requirement that you spread out the costs of 
healthcare across the entire population of people who are insured.

[[Page S3171]]

  What CBO says is that about one-sixth of the population--that is 
equivalent to about 25 States and Washington, DC--who might obtain 
waivers, including both the essential benefits requirement and the 
community rating benefit--that would result in insurance markets coming 
apart at the beginning of 2020.
  CBO states that ``less healthy people would face extremely high 
premiums, despite the additional funding that would be available'' 
under the bill to reduce premiums. CBO says specifically: ``In 
particular, out-of-pocket spending on maternity care and mental health 
and substance abuse services could increase by thousands of dollars in 
a given year for the nongroup enrollees who would use those services.''
  Let me put a finer point on this. The legislative jujitsu that 
Republicans did in the House to get this thing passed involved 
eliminating the requirement that people with preexisting conditions be 
protected from premium increases, combined with a high-risk pool that 
would have a bunch of money in it to help reduce premiums for those 
people.

  CBO tells you essentially that those high-risk pools are a fraud. CBO 
says there is not enough money in the high-risk pools in order to 
provide any meaningful benefit for people with preexisting conditions. 
In particular, they say, women going through pregnancy, families going 
through pregnancy, and individuals with mental health and substance 
abuse will see thousands of dollars in additional costs because the 
money in the risk pools cannot cover the cost of that care.
  We have an opioid epidemic raging throughout this country, and the 
House just passed a bill that will increase costs for people suffering 
from substance abuse by thousands of dollars. We can do better. 
Republicans can emerge from these secret meetings, set aside their plan 
to ram through this vote with no committee process through 
reconciliation, and we can start talking about what to preserve in the 
Affordable Care Act and what we need to change. That is what Americans 
want us to do.
  The majority of Americans do not want this bill repealed. The 
majority of Americans today support the Affordable Care Act. Yes, that 
number is different than what it was a few years ago. Maybe that is 
because, faced with this benefit, faced with these insurance 
protections being eliminated, Americans are rallying to the defense of 
the Affordable Care Act. That doesn't mean Democrats don't believe we 
can make some commonsense amendments, but it does mean we are not 
willing to participate in a process that presupposes that the outcome 
will be less people being insured, costs getting higher in order to 
finance tax breaks for the very wealthy and for insurance companies and 
drug companies.
  Republicans should come out from behind closed doors, work with 
Democrats. CBO tells you a humanitarian catastrophe is coming if you 
don't.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mr. MORAN. Madam President, I am here to visit about the topic of 
healthcare. I will be spending time in Kansas this week, and there 
probably will be no topic of conversation that will be greater than 
people's concerns about healthcare. I will tell you, as I have 
indicated to many of my colleagues, this is like no other issue I have 
ever dealt with as an elected official in how personal the consequences 
are of the decisions we make here.
  While I certainly admit there is plenty of politics and partisanship 
and too much back and forth that revolves around this concern about 
healthcare, what I do know is, the people who visit with me, in so many 
instances, are my friends, my neighbors, our kids' teachers, they are 
people I go to church with, and in many instances, as they have a 
conversation with me about what we are going to do in regard to 
healthcare, tears begin to stream down their cheeks as they worry about 
themselves but, more importantly, they worry about their family 
members, their sons, daughters, husbands, wives, and parents.
  This is a very personal issue. The concerns Kansans have about this 
and what we might do is sincere and real. I also know the Affordable 
Care Act--the law that is in existence today--is failing many Americans 
as well. In fact, just this week, yesterday, we learned the company 
Blue Cross and Blue Shield of Kansas City is exiting the market and 
will no longer provide a product in the Kansas City area of our State, 
which means, in most instances, individuals will no longer have an 
option in regard to the Affordable Care Act.
  What we have in place doesn't work, but I also know what has come 
from the House isn't the solution to this problem either. The work we 
have to do--you and I, Madam President, and our colleagues--is serious 
and one that has real and personal consequences for every American, and 
we must take our responsibilities seriously.
  I have indicated to my colleagues that neither the Affordable Care 
Act, which I voted against, nor what the House has passed, is anything 
I would vote for. I really wish we were doing something different than 
either one of those things.
  As I thought about my remarks today, I was about to say that I 
suppose I came too late to get my ideas adopted by Congress, but really 
I came to this issue early, and I think it was 2004, maybe 2006, in 
which, at least in my own mind, I penned on paper and worked on 
drafting legislation on what I called a 10-point plan to address the 
affordability and availability of healthcare.
  I can tell you that my ideas, which predate President Obama's, were 
nothing like the Affordable Care Act, and they really were nothing like 
the conversation we are having today. I wish we would be addressing the 
underlying reasons that healthcare costs so much rather than focusing 
so much attention on the issue of health insurance and its premiums.
  If we can drive the things out of healthcare that unnecessarily raise 
the price, the cost of access to healthcare, we can make a tremendous 
difference in healthcare premiums and the affordability of healthcare 
for all Americans, not just trying to figure out what kind of plan we 
can develop, what kind of insurance program, what kind of subsidy or 
tax credit we can provide, but we would be treating the underlying 
problem, not just the symptoms.
  I suppose, to give a little understanding of what I am talking about, 
in my view, the things we ought to consider are allowing more 
competition in the market, more free enterprise opportunities, allowing 
people to purchase insurance from coast to coast, expanding the support 
for community health centers. These centers are already in existence. 
They need to be more available in more places.
  We are a very rural State, and it is hard to find those community 
health centers, but they provide healthcare services to people who have 
no ability to pay and no insurance. We ought to be more supportive of 
community health centers, not less, providing, particularly, primary 
care for people in difficult circumstances.
  We also need to give small businesses and organizations the ability 
to organize and create larger pools so they can negotiate for better 
premiums. We need to utilize health savings accounts. We need to 
support medical research. If we can find a cure for cancer, the delay 
of the onset of Alzheimer's, we can save billions of dollars in our 
healthcare system as well as save lives and improve the quality of life 
of people who suffer from the diseases that are so prevalent.
  We need to address the issue of prescription drug costs. How do we 
make certain no drug company takes advantage of cornering the market or 
how do we make certain they don't utilize our current laws to extend 
the life of their patent, eliminating the chance for competition to 
come into play and the introduction of generic medicine that can save, 
again, consumers and patients lots of money.
  We need to promote preventive healthcare. Wellness, fitness, diet, 
and nutrition are the things that probably give us the biggest bang for 
our buck and don't necessarily need to be a government program, but 
people need to work at living healthier and healthier lives and prevent 
diseases from occurring in the first place.
  We need additional physicians and other healthcare providers--nurses 
and others--and we have not put the attention into developing programs 
to educate and train the next generation of medical providers. We need 
to make sure Medicare and Medicaid actually

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pay for the cost of the services they promised to pay for on behalf of 
low-income citizens as well as citizens who are seniors, instead of 
having the cost shifting that occurs as a result of the system we have 
today, in which Medicare doesn't pay or Medicaid doesn't pay sufficient 
amounts of money to actually pay for the services a patient receives 
under either one of those programs.
  Again, those are things that I think would be beneficial to every 
American, and it wouldn't be spending our time trying to figure out how 
we modify the insurance system, how we figure out about subsidies or 
tax credits for people within the system. Again, I don't come late to 
this issue, but it doesn't seem to be the direction we are going.
  Before my time expires, one of the items I wanted to particularly 
highlight is the value of medical research. I am proud this Congress 
passed an appropriations bill that includes an additional $2 billion 
for use in medical research for the National Institutes of Health, and 
perhaps something that we can even be additionally proud of is, we did 
that without spending more money. We simply--I shouldn't say 
``simply.'' Nothing is easy about it. I am on the Appropriations 
subcommittee that is responsible for the funding of NIH. We reallocated 
money that was being spent someplace else in support of medical 
research. Again, if we find the cure for cancer, if we reduce the 
onset, the time in which people suffer from Alzheimer's, if we can find 
the cure for diabetes and other diseases, the lifesaving changes that 
are being made through that medical research and the costs that will 
accrue to our healthcare delivery system are hugely important.
  I particularly commend the Director of the National Institutes of 
Health for working so closely with Members of Congress and the American 
people in support of medical research. Dr. Francis Collins is a 
national resource. I am not a scientist. I don't understand all the 
concepts that are spoken about when we talk about medical research--a 
long shot from that. One of the things Dr. Collins, the Director of the 
National Institutes of Health, has been able to do is explain to me and 
to my colleagues and to others across the country the value of medical 
research without getting me lost in the details of the actual science. 
He is someone who can talk to a layperson about medical research and 
science in a way that captures me, captures my attention, but I don't 
get lost in the medical or technical or scientific words and jargon 
that so often scientists use in having the conversations.
  Dr. Collins has been so bipartisan in his approach. I smiled when I 
read the story. He indicated that when he was being chosen to be the 
Director of the National Institutes of Health, he called his mother 
back home and indicated to her: Mom, I am going to become the Director 
of the National Institutes of Health.
  She said: But we are Republicans. I don't want you working for 
government.
  Here is a man who has used his time not working for government, 
perhaps working in government, but working for the American people and 
really for worldwide solutions to problems we all face in our families.
  There is no American, there is no one in this Chamber whose family 
has not been affected by the diseases I described and the other long 
list of afflictions we have as human beings that NIH is not working to 
make a difference in their lives.
  We need to continue that support for the National Institutes of 
Health as we pursue appropriations bills into the future, and our 
ability to do that together is important and a source of satisfaction 
that can come.
  I have indicated, from time to time, that it is sometimes difficult 
to find the things in the jobs that we have as U.S. Senators where you 
get the sense of accomplishment. There are a lot of challenges in 
getting things done, but the idea that we have come together to support 
medical research and find lifesaving cures gives us something to take 
great satisfaction in and gives us hope that what we have been able to 
accomplish in this regard, as Republicans and Democrats but really as 
Americans, can be a role model as we try to find solutions to other 
problems. I hope that will be the case as we try to find solutions with 
regard to how do we care for the American people when it comes to their 
affordability and availability of healthcare.
  You and I, Madam President, come from States that are very rural. In 
any kind of healthcare solution that we find, we need to make certain 
we are increasing the chances that hospital doors remain open in rural 
communities across our States, and we need to make certain there are 
more physicians, not less, there are more healthcare providers, that 
nursing home and healthcare services are more available, and that 
pharmacy remains on Main Street.
  In fact, in the cases of our States, you could find ways, I suppose, 
that reduce the cost of healthcare only to discover that you no longer 
have a provider, no longer have a hospital or a physician or a pharmacy 
in your hometown. Sometimes when you talk about the affordability, you 
must quickly couple that with availability. Whatever its price is, if 
it is not in your community, if it is not in your county, if it is not 
in your region of the State, it doesn't necessarily matter what it 
costs.
  Our work is serious, and I look forward to working with you and my 
colleagues as we try to find solutions to make certain healthcare is 
something every American has access to.
  I yield the floor.
  Mr. LEAHY. Madam President, just 1 week after a party-line vote in 
the Judiciary Committee, the Senate is about to vote on the nomination 
of Judge Amul Thapar to the Sixth Circuit Court of Appeals. It has been 
more than 16 months since the Senate confirmed a Federal appellate 
judge and almost 11 months since we voted on a circuit or district 
nomination. That is because of Leader McConnell's unprecedented 
obstruction, blocking any votes on President Obama's qualified, 
consensus nominees, all in an effort to leave as many judicial 
vacancies as possible for President Trump and the far right special 
interest groups who are charged with selecting his nominees.
  The 7 days Judge Thapar has waited for a vote is quite a contrast 
with the last circuit judge that Leader McConnell permitted to be 
confirmed. Judge Felipe Restrepo's nomination languished for 6 months 
on the Senate floor last Congress before he was finally given a floor 
vote. Of course, there was no good reason for that. Judge Restrepo had 
bipartisan support at every step of the process: positive blue slips 
from his Democratic and Republican home State Senators, a voice vote in 
the Judiciary Committee, and a bipartisan 82-6 confirmation vote. 
Likewise, there was no good reason for Leader McConnell to deny votes 
on other circuit nominees like Donald Schott and Jennifer Puhl. They 
were reported with strong bipartisan support in the Judiciary Committee 
and had bipartisan support from their home State Senators, but were 
left languishing on the Executive Calendar for months, without ever 
receiving floor consideration. We should not forget the 20 district 
nominees and the five Court of Federal Claims nominees, who were 
reported with bipartisan support and then fell victim to Senate 
Republicans' unprecedented obstruction and were denied a vote after 
waiting months or even years. Of course, we cannot overlook one of the 
most shameful inactions of the Senate--the treatment of Chief Judge 
Merrick Garland, who did not even receive a hearing for his nomination 
to the U.S. Supreme Court.
  So why are we now rushing to confirm Judge Thapar? It is only fair to 
note that the seat to which he has been nominated has been vacant for 
nearly 4 years. President Obama's nominee to that seat did not receive 
this expedited process. She did not even receive blue slips from the 
Kentucky Senators. Now, that is their right. Had I still been chairman, 
I would have honored that decision--as I did for both circuit and 
district nominees--however much I might have disagreed with it. We 
should not pretend that we are required to vote so quickly on Judge 
Thapar simply because the Republican leadership held this seat vacant.
  This is a nomination that requires thorough consideration by the 
Senate. It is no secret that Judge Thapar is a favorite of the same far 
right groups that handpicked Justice Gorsuch--in fact, Judge Thapar was 
on the same shortlist that they gave to President

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Trump. Given Judge Thapar's apparent views on campaign finance 
regulation, it is no surprise that these groups, who are some of the 
biggest opponents of any efforts to bring transparency to campaign 
financing, want to see him elevated to a circuit court. His answers 
during his hearing did not allay my concerns.
  I was also troubled by Judge Thapar's responses to my written 
questions. Like Justice Gorsuch, he dodged a very simple question about 
whether the First Amendment permits a religious litmus test for entry 
into the United States, but even that nonanswer was inaccurate. Judge 
Thapar responded that the constitutionality of a religious litmus test 
is an active question in pending litigation regarding the president's 
Executive order targeting Muslim-majority countries, and that he could 
not comment on it. That is not accurate. There is no question that such 
a religious litmus test is unconstitutional--even the Trump 
administration does not argue otherwise. Instead, they are arguing that 
the Executive order does not impose such a litmus test. Judge Thapar 
failed to get the facts right, and failed to show me that he 
understands one of the most fundamental principles of our Constitution. 
It will be very difficult for me to support any judicial nominee who 
fails to answer this question with adherence to both the Constitution 
and the facts.
  The role that far right interest groups have played in this 
nomination and the Gorsuch nomination is troubling. A President is free 
to consult with whomever he wishes on potential nominees, but the 
``advice and consent'' power belongs to the Senate, not the Federalist 
Society. For decades, Presidents of both parties have consulted with 
home State Senators, a requirement formalized through the Judiciary 
Committee's blue slip process. This tradition protects the role of all 
100 Senators in the confirmation process and helps ensure that 
Presidents work with Senators of both parties to find consensus 
nominees.
  During my nearly 20 years as either chairman or ranking member of the 
Judiciary Committee, I encouraged Republicans and Democrats to work 
with President Clinton, President Bush, and President Obama to find 
qualified, consensus nominees, and I protected the rights of Senators 
in both parties. As Ranking Member Feinstein noted in a memo that was 
circulated yesterday, no judicial nomination made by the last three 
Presidents was confirmed without the support of both home State 
Senators. I cannot recall a nominee being confirmed over the objection 
of his or her home State Senator. The blue slip is not a partisan 
issue; it is about constitutional checks and balances and the Senate's 
role in protecting the independence of our Federal judiciary. I 
encourage President Trump to follow the example of his predecessors 
from both parties and work with us to find consensus nominees to ensure 
that our Federal courts remain the envy of the rest of the world.
  The PRESIDING OFFICER. The Senator from Illinois.


                             Opioid Crisis

  Ms. DUCKWORTH. Madam President, I would like to take this time to 
discuss a critical public health crisis affecting constituents in 
Illinois and all across the country. Each day, 46 people die from 
overdose of prescription painkillers in the United States. In Illinois, 
that number is only growing.
  Overdose deaths in Illinois from opioids rose about 275 percent from 
2008 to 2014. There are an estimated 460,000 nonmedical prescription 
opioid users in Illinois alone. A major portion of the total number of 
drug-poisoning deaths between 2013 and 2015 were a result of opioid and 
prescription drug abuse. Over 4,000 people died as a result of opioids 
and prescription drugs, and 2,000 people died due to heroin. Illinois 
also had the third fastest rising death rates from synthetic opioids in 
the Nation, with overdoses rising by 120 percent from 2014 to 2015. 
Unfortunately, Illinois is third from the bottom for treatment of 
substance abuse because of lack of funding and resources to healthcare 
providers and law enforcement partners in the State.
  These numbers are alarming, but I would like to share a story behind 
those numbers--a face. Laura Fry is a mother whose family has 
experienced the worst of the opioid epidemic. Her son, Alexander, is 29 
years old and in remission from heroin use disorder.
  Alexander was just a normal kid growing up in Wauconda, IL. He had 
his entire life ahead of him. Then, when he was 17, he had a 
snowboarding accident and was taken to the emergency room after he lost 
consciousness. That is when doctors found a mass on his cerebellum and 
he had to undergo major brain surgery. It was after this surgery that 
Alexander became addicted to morphine, and his drug abuse began.
  When Alexander graduated from high school, he began working at a 
hospital, where he was able to steal drugs to fuel his abuse. Over 
time, his drug abuse spiraled out of control. He was fired from his job 
for stealing narcotics and was arrested for possession of heroin. But 
because this was his first offense, he was given a very strict 2-year 
probation. Over the next 4 months, he tested positive for heroin 
several times, and then he simply disappeared. Laura did not know where 
her son was or whether he was even alive for 10 months. Finally, he was 
arrested and taken into custody.
  In Lake County, IL, we thankfully have a criminal justice system that 
recognizes addiction is a disease. The court gave Alexander the 
opportunity to continue his probation, and he was allowed to perform 
hundreds of hours of community service and to attend an intensive 
outpatient program.
  In the spring of last year, Laura and her son Alexander appeared in 
court for the last time. Alexander is now a volunteer for Live4Lali, a 
substance abuse program in Illinois. He attends community outreach 
events, shares stories, and offers trainings in naloxone use--a 
lifesaving drug that reverses opioid overdoses. He has gone from being 
a user to someone who is transforming lives.
  Alexander's story is a reminder that Congress must focus on enhancing 
recovery efforts, and we are beginning to take steps in the right 
direction. For example, I was a proud supporter of the Comprehensive 
Addiction and Recovery Act, also known as CARA, when I served in the 
House. CARA, which passed with overwhelming bipartisan support, 
establishes, supports, and strengthens a number of programs to fight 
the opioid crisis in communities. It provides opportunities for 
rehabilitation, like the outpatient program Alexander attended, and 
expands access to drugs like naloxone, which are saving lives on the 
frontlines of this epidemic.
  I applaud these efforts, but I have serious concerns about the 
majority's commitment to actually funding these essential programs to 
rehabilitate our fellow Americans who are suffering from opioid 
addiction because, while we can all agree that CARA's intent was to 
transform our opioid crisis, the bill failed to provide any actual 
funds to enact these effective programs.
  I, along with many of my colleagues, have asked for CARA to be fully 
funded and to provide additional funding to the drug courts and veteran 
treatment courts, which essentially reduced crime, saved taxpayer 
dollars, and saved the lives of more than 1.25 million civilians and 
veterans. In addition, we must also make sure families have access to 
medicine that can save lives during an overdose by calling on 
manufacturers to offer naloxone to rein in the costs.
  I share this story because the turmoil that the Fry family faced is 
not unique. Millions of Americans are experiencing the impact of opioid 
abuse, and many of these American stories have much more tragic 
endings. We can and must do more for these families.
  I ask that we take the time, consider the story of Alexander and his 
family, and step up and do the right thing. Let's fund CARA fully.
  Thank you. I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. REED. Madam President, let me thank my colleague, Senator 
Manchin, for arranging the time to talk about the ongoing opioid 
epidemic across the country. I know his home State of West Virginia--
much like my home State of Rhode Island--has been hit particularly hard 
by this epidemic.
  This is not happening in some far off place or some distant country. 
It is happening in Rhode Island, West Virginia, and, indeed, every 
State throughout the Nation. Last year, over 330 Rhode Islanders lost 
their lives due to opioids.

[[Page S3174]]

  Rhode Island is a small State, so let me talk about a national 
statistic that shows the extent of this crisis. Last year, drug 
overdoses killed 50,000 Americans. That means more people died last 
year because of drug overdoses than due to car crashes or gun violence. 
These numbers are staggering, and it is happening in all of our 
communities.
  Since 2011, the number of overdose deaths has increased by more than 
90 percent. Unfortunately, year after year, Rhode Island continues to 
top the Nation in terms of rates of overdose deaths. We must work to 
turn this around and get more people access to treatment for opioid 
addiction.
  In 2008, almost a decade ago, Congress enacted the landmark Paul 
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity 
Law. For the first time, the law required insurance companies to cover 
behavioral health services in the same way that it would cover physical 
health services. This was a critical step, but it ultimately did not 
solve the problem, as some insurance companies have continued to find 
ways to avoid complying with the law--or at least its spirit.
  It took passage of the Affordable Care Act to improve access to 
behavioral health services. For the first time, critical consumer 
protections, like banning discrimination based on preexisting 
conditions, ensured that individuals with substance abuse disorders 
could not be denied coverage.
  Further, the ACA established a set of essential health benefits that 
all insurance plans must cover, including mental health and substance 
abuse treatment. Gone are the days when consumers would pay steep 
prices for health insurance that in actuality did not even cover basic 
health services, such as mental health care or maternity care.
  In addition, the ACA prohibits lifetime annual limits on care. Before 
the ACA, many people with chronic health conditions, such as substance 
use disorders, would hit their annual cap just a couple of months into 
the year and then would have to pay all other costs out of pocket for 
the rest of the year.
  Lastly, the expansion of Medicaid has made a tremendous improvement 
in access to behavioral health services. In States like Rhode Island 
that have expanded Medicaid, we have seen a sharp drop in the 
percentage of people with substance use disorders who seek care in the 
emergency department because they are uninsured. Medicaid is the single 
largest payer of substance use disorder services and pays for one-third 
of all medication-assisted treatment in the country.
  TrumpCare would reverse all these gains. According to the Center on 
Budget Policy and Priorities, repeal of the ACA would mean 2.8 million 
people with substance use disorders would be at risk of losing their 
coverage. Repeal of the Medicaid expansion would cut $4.5 billion from 
mental health and substance use disorders for those with low incomes, 
to say nothing of TrumpCare's broader goal of ending Medicaid as we 
know it. TrumpCare would all but eliminate this critical safety net.
  TrumpCare goes even further to turn back the clock on consumer 
protections like preexisting conditions. People with substance use 
disorders would be disadvantaged immediately, as their disorder could 
be considered a preexisting condition. This has the double effect of 
pricing people with mental and behavioral health issues out of the 
market entirely and encouraging people not to seek care out of fear of 
being labeled by their insurance company as having a preexisting 
condition.
  On top of that, TrumpCare would gut the essential health benefits in 
the ACA. This means that there would be no rules about what health 
insurance must cover, such as preventive health services and mental and 
behavioral health services. Even with coverage, people will have to pay 
out of pocket for the services they need. For substance use disorders, 
which could add up to $20,000 a year in out-of-pocket costs alone.
  Over the last couple of years, I have worked with my colleagues on 
the Senate Appropriations Committee to include historic funding 
increases for programs that help the opioid crisis. In fact, the fiscal 
year 2017 omnibus provided $511 million for prevention, enforcement, 
treatment, and recovery across various agencies, including over $300 
million for the Department of Health and Human Services, $50 million 
for the Department of Veterans Affairs, and over $160 million for the 
Department of Justice. Last year, we passed the 21st Century Cures Act, 
which directed $1 billion to States to combat the opioid crisis. We 
must continue these efforts.
  However, this week, the President released his budget proposal for 
next year, and it does the exact opposite. First of all, the 
President's budget doubles down on his plan to decimate Medicaid. The 
President has proposed cutting hundreds of billions of dollars from 
Medicaid, block-granting the program with no protections for the most 
vulnerable. In fact, his budget offers no details on how it plans to 
structure Medicaid--just that he intends to cut the program beyond 
repair.
  On top of that, the President's budget makes enormous cuts to the 
Substance Abuse and Mental Health Services Agency, SAMHSA, which 
implements many of our most effective substance use disorder prevention 
and treatment programs, such as the Community Mental Health Services 
Block Grant Program, which President Trump has proposed cutting by over 
20 percent.
  Further, President Trump has proposed cutting the National Institutes 
of Health by nearly $6 billion, which would interrupt critical research 
into new and better ways to treat substance use disorders, along with 
research into how we can better treat pain without the use of addicting 
opioid painkillers. Coupled with TrumpCare, this budget proposal would 
only worsen the opioid crisis.
  I am committed to continuing to work with my colleagues to prevent 
that from happening. I am heartened to see so many of my colleagues 
talk about these very issues this afternoon.
  It is my hope that we will be able to work together over the coming 
months to ensure that the gains we have made in the fiscal year 2017 
omnibus and the Cures Act are not lost. We have much more work to do, 
and people in my State and across the country are counting on us to do 
that for them.
  With that, 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. LANKFORD. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


         Small Business Regulatory Flexibility Improvements Act

  Mr. LANKFORD. Madam President, we have a lot of issues we are working 
on right now. Some of the big ones include the budget conversation. For 
the first time in a long time, the budget conversation really circles 
around, how are we going to get back to balance? It is an interesting 
dialogue. There is going to be a lot of dispute about elements of the 
President's budget. There will be a lot of controversy back and forth 
about aspects in the House and the Senate proposals. But for the first 
time in a long time, the beginning point of the conversation is, how do 
we get back to balance? That is a good place to start. I am pleased to 
see that is a part of the conversation again.
  There are a tremendous number of things that have to be dealt with in 
this process. I want to bring up two quick ones and then talk about 
some of the small business issues we are facing.
  One of them is that when we go through the budget process, I 
encourage my colleagues to deal with the budget gimmicks that are still 
in place in the budget process--areas that seem to bring down the 
deficit but we all know actually do not. Those don't help us as 
Americans. That may help with some sort of scoring issues; that doesn't 
really help where we are.
  The second aspect to that is, let's actually put the appropriations 
bills on the floor. For the last several years, there have been 
continuing resolutions or omnibuses without any amendment process 
brought. We should be able to, in a bipartisan way, agree to bring 
these appropriations bills to the floor, actually have an amendment 
process, and actually deal with this in a public setting. There are 
straightforward ways to deal with our debt and deficit.

[[Page S3175]]

It begins with actually confronting debt and deficit in a way that will 
really matter.
  It is interesting as well that when we talk about a lot of the big 
issues, regulations often come up as one of the prime problems. 
Regulations are often big, expensive, and deal with a lot of 
controversy.
  Quite frankly, there are thousands of regulations out there that 
impact small businesses. For a small business, it is not typically just 
one regulation, it is the hundreds of little ones that they are 
constantly trying to live under. It is the culmination of all of these 
different regulations and trying to figure out where they are. Most 
small businesses don't have lawyers. They don't have compliance people. 
They don't have folks lined up to monitor all of these things. They 
have to try to figure it out as they go. They are small businesses. 
They are family-owned businesses. They are trying to take care of their 
own families and the neighbors around them. But all of these 
regulations come at them as well.
  Let me read what Karen Karrigan, the president and CEO of the Small 
Business and Entrepreneurship Council, wrote in an op-ed just last 
week. She wrote:

       Red tape is strangling our small businesses and undermining 
     entrepreneurship. Indeed, according to [Small Business and 
     Entrepreneurship] Council research, the cumulative loss of 
     new businesses over the last decade totals 3.42 million 
     missing businesses--

  Not workers--

     for America's economy. For existing small businesses, the 
     per-employee cost of regulation is just over $11,000. 
     Excessive regulation in the U.S. has hurt our competitiveness 
     in the global economy. The U.S. ranks No. 51 in the world for 
     ease of starting a business, according to the World Bank. 
     This same report is consistent with other global studies that 
     have found American's friendliness and general ``ease of 
     doing business'' has eroded year after year.

  That is according to Karen Karrigan, president and CEO of the Small 
Business and Entrepreneurship Council, in her op-ed last week.
  Each new regulation on small business adds another cost, another 
burden, another requirement that small businesses have to comply with. 
This cumulative burden is crushing small business.
  Let me give some examples. Julian Lumber Company is in Antlers, OK. 
You ought to come and see Antlers, OK. It is a beautiful area of our 
State. Julian Lumber Company, a family-owned business, makes wooden 
fence posts, treated poles. If you have a telephone pole in that area 
or other posts and poles, it often came from Julian Lumber Company. It 
also has a small trucking company to be able to haul posts to retail 
stores across the Midwest and the Southwest. Julian employs about 50 
people but recently had to shift a part-time employee who was doing 
compliance to full-time--doing nothing but compliance 40 hours a week 
because of all the Federal regulations. When Robert Julian funded this 
business in 1974, he didn't set out to just create jobs for a 
compliance officer, he actually set out to do lumber work, but 
unfortunately, now his business also includes Federal compliance.
  Small businesses are vital to our economy. Surely we can agree on 
that. They drive job creation and innovation. Excessive and poorly 
crafted government regulations disproportionately--the burden of them--
fall on small businesses and on their growth. If Julian Lumber has to 
hire more people to just do compliance, not lumber, there is a problem.
  Then there is Ander's Shoe Store in Miami, OK, which was founded in 
1930 by Joe Ander after he immigrated to Oklahoma from Poland. Today, 
Ander's Shoe Store is owned and operated by Joe's daughter, Dena Ander, 
who is 102 years old. She has worked at Ander's Shoe Store for 86 
years.
  My favorite quote ever from a small business owner came from her when 
she said, at 101, that her health is better than her help, and so she 
just keeps working.
  Dena Anders is not waking up every day and reading the Federal 
Register to find out what new Federal regulation came down. She is not 
trying to track through all the different compliance officers and 
attorneys that she would have to contact to try to figure out how to 
read a new Federal regulation that comes down. She is taking care of a 
shoe store in Miami, OK. She has two employees, but her shoe store has 
to live by the same regulations that a lot of large stores also have to 
live by.
  Every Member of this body--when they are home, they talk about small 
businesses and the importance of small businesses and how to help them 
succeed. I am asking, are we as a body willing to do what we said we 
were going to do back home? Ninety-seven percent of the businesses in 
my State of Oklahoma are small businesses. Lots of us make promises to 
these small businesses. It is time to fulfill them.
  Regulatory reform for even small businesses, for whatever reason, is 
becoming politicized. This is not a political, Republican-Democrat 
issue. Small business owners are not Republicans or Democrats; they are 
Americans. They are people, and this should not be a partisan issue. I 
would be willing to work with every Senator of any party to be able to 
get this done.
  I have introduced the Small Business Regulatory Flexibility 
Improvements Act. It has passed its way through committee. It is S. 
584. It does some simple things--things that should not be 
controversial.
  It closes loopholes in the Regulatory Flexibility Act, which became 
law in 1980. That bill was designed to help small businesses, but there 
are some loopholes in it, and the agencies are going around it.
  This is not a bill that I just came up with on my own; it is a bill 
that had been drafted in direct response to small businesses and small 
business leaders around the country. It has been discussed for a long 
time, but for whatever reason, it has never been passed. I want to run 
through a few things that it does.
  First, the agencies should account for the economic impact of 
regulations, especially on small business, and it should be the full 
economic impact. Agencies have this little caveat that they will do. 
They will say: Well, it is not a direct cost, it is an indirect cost on 
business. So they will put a new regulation on them and say: We are 
only going to count direct costs of the regulations, but we are not 
going to count anything indirect, such as electricity.
  If they put a Federal regulation down and a State entity is then 
required to create new regulations based on it, they won't count the 
State regulations based on it.
  If permitting from a different agency is required, they will say: 
Well, that is somebody else who does that.
  Well, if you are a small business, cost is cost is cost. The Federal 
Government plays this game of what is a direct and indirect cost to a 
business. A small business does not get to play that game, and they 
have to pay the bills for it.

  So it is a very simple thing for us to say: Include the costs. We try 
to get some clear language on it. An agency would have to consider 
``reasonably foreseeable impacts.'' So I get that you are not going to 
get every pencil in the process, but what is reasonably foreseeable, 
you should be able to anticipate that.
  Second, we require the IRS to actually listen to small businesses 
before they release IRS rules. So many hours are spent by every small 
business complying with IRS regulations and requirements. We would like 
to have the IRS actually engage with small businesses when they put out 
policy and guidance and say: How is this going to affect small 
businesses? How can they work this out to make sure it is as easy as 
possible for small business owners?
  Third, increase the transparency in the rulemaking process. Small 
businesses tell me that when they learn of new regulatory requirements, 
they are often blindsided. They had no idea the rule was even coming. 
In the rare instance when a small business owner speaks out to an 
agency, they are often confused when they see the final rule because it 
doesn't look at all like what they had recommended or had raised.
  Years ago, there was something created called SBRFIA panels. Only 
Washington, DC, comes up with a term like that. Small businesses were 
supposed to be able to engage with the Federal Government on designing 
how regulations would come out. But, again, the loopholes were so 
present in the law that the agencies were just going around them. We 
need to close that.
  As simple as it sounds, when an agency is creating a rule, don't you 
think

[[Page S3176]]

they should call small businesses and say: How will this work at your 
place, or will it work at all?
  Fourth, let's deal with old rules. There are lots of regulations out 
there that are old, that become very complicated for small businesses 
to be able to maintain, and no one has ever gone back to look at them. 
Let's create a simple system so that when a rule comes out, it has to 
be reviewed within 10 years. That way, we have no rule that is 40, 50 
years old, and no one has even touched it or looked at it to make sure 
that it still works, No. 1, and that it is not overcomplicating the 
process.
  Finally, and here is something pretty straightforward, give first-
time forgiveness for paperwork violations. When small businesses have a 
paperwork violation, they have a paperwork violation. They are not 
trying to break the law. They are not trying to violate regulations. 
They missed one. Why don't we give first-time grace to small 
businesses? Now, I wouldn't say that if they are violating health and 
safety issues. Obviously those are things they should have already 
taken care of. But just paperwork things--we have so many small 
businesses that get a fine because they missed a piece of paperwork. 
Again, so many small businesses don't have compliance people tracking 
this stuff for them all the time, and occasionally they make a mistake. 
This is still a government that works for them. They don't work for the 
government.
  My simple recommendation is this: For small businesses, give them 
first-time paperwork forgiveness rather than a Federal compliance 
person showing up at their place with a fine. Let's be reasonable about 
this. That should be a simple, straightforward thing.
  Quite frankly, these are all things small business owners have asked 
for. These were things even in the Obama administration. The chief 
counsel for the Small Business Administration's Office of Advocacy--
this is what the Obama administration's small business advocate wanted. 
I don't understand how this could be a partisan issue. It is simple, 
straightforward, and clean. There is no hidden anything in the bill. It 
is trying to actually get regulatory relief and common sense back into 
the way we do regulations.
  Over 200 trade associations representing millions of small businesses 
have already written me in support of this bill from all over the 
country--not from Oklahoma, from all over the country.
  Many in this Chamber pride themselves on being the advocate for the 
little guy and standing up for small businesses. I would ask my 
colleagues if they are ready to actually put feet to those words. This 
is a straightforward way to do it. We talk about helping small 
businesses; let's actually do it. I ask my colleagues to be able to 
walk alongside of us and help us get this bill passed and get some 
regulatory relief.

  I yield the floor.
  The PRESIDING OFFICER. The Senator from West Virginia.


                             Opioid Crisis

  Mr. MANCHIN. Madam President, I rise to speak with a lot of my 
colleagues coming down speaking on the opiate crisis we have in all of 
our States.
  West Virginia has been hit the hardest in the Nation right now, and I 
want to speak to this because it is something we must address. This has 
been a silent killer for far too long.
  I don't know a person who I have ever met who doesn't know somebody 
in their immediate family, extended family, or close friends who has 
not been affected by either prescription drug abuse or illicit drug 
use. With that, here we are.
  I rise with my colleagues who have been coming down--they will be 
coming the rest of the day--to bring attention to this national crisis 
that is devastating every community. Many of the Senators you are going 
to hear from--and have already heard from--are from States that are 
dealing with an increase in this opiate abuse, just like my State of 
West Virginia. Just like I have, they have heard from families, 
community leaders who are on the front lines. They are begging for 
solutions, funding, and they need facilities to properly combat the 
scourge we have right now.
  Let me say to everybody who is watching, everybody who is listening 
in any way, shape, or form that you are hearing this: 20 years, 30 
years ago, I was as guilty as everybody in the public policy arena in 
government, in my State government in West Virginia. If you fooled with 
drugs back then, we thought, well, we will put you in prison; you 
committed a crime. Well, guess what. We have been putting them away for 
20, 30 years, and we never cured a single soul.
  Finally, we have come to the realization that addiction is an 
illness. Any other illness gets treatment. So we need treatment, but we 
don't have treatment centers. Budgets are tight.
  I have a cousin who is a judge. Every day he says: Joe, I sentence 
people for the crimes they commit every day. He says: I have never had 
the first person say: Hey, Judge, we don't have a prison cell or a jail 
cell to put this person in. But if it happens once a day, it will 
happen 5 or 10 times a day, if I believe someone needs to get treatment 
because of their addiction, they will say: Well, Judge, I am sorry. We 
have no place to put them. We have no treatment centers. We will find a 
jail cell for you, but we will not find a treatment center because we 
don't have them.
  The States don't have the money. Counties don't have the money. 
Municipalities don't have the money. The Federal Government has never 
dedicated enough money for this. So we keep talking about everything 
that happens.
  Last year, over 800 West Virginians died of prescription drug abuse. 
They died of abuse from prescription drugs, and everyone says: Well, 
how do people get started? I don't know. Most of them have done heavy 
work in West Virginia. We do mining and manufacturing. That is heavy 
work, and sometimes they get hurt.
  I am going to read a letter later--I do every week try to come down 
to put real families, real faces, for you all to understand that this 
is a real issue.
  When I have said this is a silent killer, we never talk about it. If 
you have somebody addicted in your family, you are kind of ashamed of 
it. You don't want anybody to know because they think that something is 
wrong with your family if someone has an addiction. They try to take 
care of themselves and they can't and that person doesn't get the help 
they need.
  So when you look back at the use and the lack of a treatment, let me 
just tell you about the epidemic we are dealing with. Any other 
epidemic of this sort--and knowing it is an illness, it can be called a 
pandemic. Remember the Ebola concerns we had. All of the different 
things we were concerned about that could turn into a pandemic, we 
acted immediately. Well, we haven't acted immediately on this. We have 
had over 200,000 West Virginians die since the turn of the century. 
That is unbelievable, and to not do anything about it and keep our 
mouths shut, we have done that for far too long.
  Today, 2.1 million Americans abuse or depend on their opiates. 
According to the CDC, Centers for Disease Control, three out of four 
new heroin users abuse prescription opiates before moving to heroin. I 
am told they move to heroin because it is cheaper, but they have 
already been hooked and addicted. Most of them got hooked and addicted 
on legal prescription drugs. That means there was some doctor who said: 
Here is something that is really going to help you, and they write that 
prescription. They think everything in a bottle is going to heal you.
  In the United States of America, less than 5 percent of the world 
population--7.2 billion people live on planet Earth, less than 330 
million in this country--4.6 percent of the world population consumes 
80 percent of all the opiates produced and consumed in the world. What 
in the world happened to us? How did we become so pain-intolerant? How 
did we become so addicted?
  Between 2009 and 2013, only 22 percent of Americans suffering from 
opiate addiction participated in any form of addiction treatment, and 
more and more people go without treatment every day.
  Misuse and abuse of opiates cost the country an estimated $78.5 
billion in 2013 just in lost productivity. So for those people who 
don't have compassion, don't think we should be doing these things, and 
you only look at the bottom line, if you are going to the bottom line, 
look at this bottom line: $78 billion of lost productivity, medical 
costs, and criminal costs.

[[Page S3177]]

  Talk to any of your law enforcement in any community you live in and 
ask them: Of all the calls you have gone on, how many have you gone on 
that are drug-related? A minimum of 80 to 90 percent of everything that 
they are called in, any type of assistance, any type of a crime that is 
committed, it is because of drugs. Some form of drugs are involved for 
our police. So think about what they are doing and how it takes them 
away from protecting the law-abiding citizens.
  I have a bill called--and we will talk about treatment--it is 
LifeBOAT. I am still waiting for some of my friends and fellow 
colleagues on the Republican side to look at this bill very seriously. 
All I am asking for is one penny to charge the pharmaceutical 
manufacturers--one penny per milligram--that will go toward treatment 
centers throughout America, and every State needs them.
  That one penny, they said: That is a new tax. We can't vote for a new 
tax. I said: Wait a minute. This opiate arena is pretty profitable, and 
we are not going to charge people whom opiates were designed for, which 
are people with severe illnesses, cancer patients. Basically, this is 
just for opiates, no other pharmaceutical products, just opiates. That 
is $1.5 to $2 billion a year. Can you believe that? That one penny.
  Now, when they tell me, I am not going to vote for any new tax. I 
say: Well, you didn't hesitate to vote for a tobacco tax. You didn't 
hesitate to vote for an alcohol tax.
  We have more people dying of this than anything else, and I am asking 
for a treatment plan. I can't get one penny, not one penny.
  So I am asking for everyone to consider it. I truly believe no one 
would lose their election over voting to fund treatment centers for 
people who are desperately in need. That is the LifeBOAT Act.
  I want to read you a letter, and I do this every week. It is just 
heartbreaking, these letters, but it shows real people's lives, and it 
shows what it has done to their lives.
  This letter is from Shadd Baisden. He writes:
  My name is Shadd Baisden, and I am from Dingess, WV. I am writing to 
tell you my story of opioid addiction. I am an out-of-work coal miner 
with 9 years' experience. I was injured in the mine in 2011. I was 
dragged down a belt line 200 feet and messed the disks in my back, the 
L5, S1 in my back. This was how my addiction got started.
  I was prescribed painkillers and needed surgery but felt I was too 
young for that. I was out of work for a year when I decided to settle 
my compensation claim so I could return back to work. While I was 
injured, the mine I worked in shut down so I had no job to go back to. 
I had been on painkillers the whole time I was out of work, but I 
stopped being prescribed after my settlement.
  So when he made his settlement, basically that went away, his 
healthcare on that. So he had no other way of getting prescribed 
medicine.
  He continues:
  I was buying them off the street just to ease my pain. In 2013, I 
started using oxycodone and could not stop. I even got my wife hooked 
on them.
  I have three daughters--11, 10, and 3 years of age. My youngest 
wasn't born at the time. Our addiction became so bad that we would 
steal things from our family just to get the drugs. I lost my license 
to drive. I lost my two oldest daughters because of my addiction. That 
is when I knew I had to have serious help.
  I sought counseling and treatment. I took parenting classes, and my 
wife and I worked our tails off to get our girls back. We have now been 
clean and sober for 3 years and have custody back of all three of our 
girls.
  I am currently out of work but do lots of odd jobs in my area because 
I can't afford to get my license back, and the vehicle I own was 
vandalized 3 months ago because I gave an officer info on a dealer not 
far from my home, and somehow the dealer found out and beat the windows 
out of my car while I was working.
  I thank God every day for helping me and my wife stay clean.
  I thank you for everything you do for the people of West Virginia and 
hope my story helps someone. I may be out of work right now, but good 
things will come as long as we stay clean and positive.
  Now, the conclusion of this is Shadd and his wife are perfect 
examples of the people we can help if we made it easier for people 
dealing with substance abuse to get treatment. Shadd and his wife are 
the people I am fighting for every day. I will continue to fight for 
the people and families and children who have lost their way and need 
our help, and I am not going to stop fighting until they get it.
  Every one of you all probably have a story. Every one of our young 
people--our pages and everybody else, everyone in the audience, whoever 
it may be, younger people--have probably been approached to try 
something, have probably been approached in their own schools to try 
something: Well, this is no problem. It is the hip thing to do in 
school.
  They have recreational marijuana. A lot of people tell me they get 
started by experimenting, and then it moves into different things.
  I don't know what it is. We don't know what our body chemistry is 
made up of. We don't know why some people are addicted and some people 
don't get addicted, but we know opiates are extremely addictive. We 
know that. It affects you. The only thing I can tell you is, it is 
something we are going to continue to fight. We are going to make 
people aware. We are starting education classes.
  The United States of America should start educating in every class 
from preschool, kindergarten--you are not too young to know what this 
can do to you--all the way up through adulthood. We have to prevent 
people from getting on these horrific drugs that are killing people. 
Then we have to treat the people who are addicted and get them back 
into the workforce.
  I ask all of you--and the concern we have, and I know in your 
beautiful State you have the same challenges we do. We all do. We are 
willing to fight together. This is a bipartisan effort. This is not one 
side and the other side taking credit or one side blaming the other 
side. This is one that we have to rise up as Americans--forget about 
Democrats and Republicans--and fight this. The U.S. Congress is 
responsible for fighting it and helping the people all over our 
country.
  I yield the floor to my good friend from West Virginia.
  The PRESIDING OFFICER (Mr. Sasse). The Senator from West Virginia.
  Mrs. CAPITO. Mr. President, I thank my colleague from West Virginia 
who is fighting hard on a lot of different fronts to meet the challenge 
of this opioid and drug abuse epidemic that is sweeping across the 
country, and it is really hitting us in the rural areas in West 
Virginia. I always say our State is just one big small town, and both 
Senator Manchin and I have personal experience with families who have 
been deeply affected by this. It is destroying families, lives, and 
futures.
  Chances are we all know someone, as I said, who has been affected, 
but we have been especially hard-hit in the State of West Virginia, and 
we have seen more than our fair share of devastating consequences: 
babies born exposed to drugs, families torn apart, children ripped from 
their parents because of their parents' habits and lifestyle, 
grandparents raising children when they had no real intention or didn't 
know that is what was going to happen.
  We have the unfortunate distinction as a State of leading the Nation 
in drug overdose deaths per capita. Ninety-one Americans die each day 
because of this crisis, and far too many of them are our neighbors, our 
coworkers, our friends, and our children. No community is immune. That 
is why this all-hands-on-deck, community-oriented, coordinated, 
community-focused effort must move forward.
  Fortunately, many individuals and organizations--and I get to meet 
with them regularly. It is inspiring to hear how people in the 
community are pulling together. They are already working hard 
educating--as Senator Manchin said, you can't start too early 
educating--treating, and rehabilitating people who are struggling with 
abuse within their families, helping them and those who are at risk of 
becoming addicted. From healthcare to law enforcement, we are working 
to tackle this crisis from all angles.
  Drug courts play an important role in that fight. In order to get at 
the root

[[Page S3178]]

of the problem, we must have more recovery and treatment services, and 
incarceration is not always the right answer. Sometimes treatment, not 
the criminal justice system, is the answer.
  Yesterday, I had the pleasure of meeting an incredible young woman--
inspirational, really--who knows all of this very well. Her name is 
Chelsea Carter, and she is from Logan, WV. When she met me yesterday, 
she said: We met. We met 10 years ago.
  I said: Really? Where did we meet?
  She said: I did your nails at Spa Bliss.
  I said: Oh, well, thank you for that.
  But along that journey, Chelsea has had a rough, rough go. At one 
point, Chelsea was charged with 17 felonies due to her drug habit. She 
told me her drug habit began when she was 12 years old. She said she 
was able to continue life through high school. It appeared as though 
she had a normal life. She was a cheerleader, participated in school, 
and all the time she was getting deeper and crawling deeper into a 
drug-addicted hole.
  After she faced the criminal justice system, she became committed to 
getting off drugs and getting clean the very first night she spent in 
jail, and she has been clean ever since. She went through the drug 
court system, and, basically, it has saved her life. But that is not 
the end of the story for Chelsea. She has a bright future ahead of her, 
and she has moved forward.
  She was in town for the annual conference of the National Association 
of Drug Court Professionals. She has committed her life to helping 
people like her who have had this situation and who have been at the 
bottom of the pit of hopelessness, bad health, and bad decisionmaking. 
She is committed to helping her fellow West Virginians crawl out of 
that pit, like she did, and become productive individuals. This is the 
world's largest conference on treatment courts and criminal justice 
reform.
  Back home in Logan, Chelsea is the program director at Appalachian 
Health Services. She just got her master's degree. One of the things 
that struck me is that, even in a management position, she continues to 
counsel and treat a full load of patients, and she told me she will 
always do so.
  Chelsea's story is an example of the progress that can be made by 
fully committing to fighting the drug epidemic. There are victories and 
programs that work. Drug court is not the only one, but it is one in 
the spectrum of solutions.
  I am committed to the fight and to working with all of our colleagues 
who are speaking out today. I know many of us are committed to this. It 
doesn't leave a family or community untouched. I am really inspired by 
West Virginians like Chelsea Carter who are on the frontlines.
  With that, I yield for my colleague from Nevada.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. HELLER. Thank you, Mr. President, and I thank my friend from West 
Virginia.


                             Yucca Mountain

  While I have an opportunity to take the floor, I want to change the 
subject, if I may. I want to talk about the concern I have of one of 
the President's priorities in the 2018 fiscal year budget. That 
priority is Yucca Mountain.
  Specifically, the President included $120 million in his budget for 
the Department of Energy to restart licensing activities for the Yucca 
Mountain Nuclear Waste Repository.
  As a proponent and author of the legislation called No Budget, No Pay 
Act, which would restore regular order to the budget and appropriations 
process, I am pleased to see the President did submit to Congress a 
detailed budget proposal.
  As a small government, fiscal conservative, I hoped that this new 
administration would focus on budget priorities that would reduce 
duplicative spending and streamline programs in order to save taxpayer 
dollars. You can imagine my disappointment that they, instead, decided 
to prioritize funding to restart licensing activities for a failed 
proposal.
  Over the past few weeks, I have outlined on the Senate floor some of 
the issues with Yucca Mountain, whether it is the crippling effect it 
would have on Nevada's economy or the public safety issues associated 
with transportation of this nuclear waste. I will continue to come to 
the floor to educate my colleagues on the many issues associated with 
Yucca Mountain, because, plain and simple, it is not a viable option 
for the long-term storage of our Nation's nuclear waste. Instead of 
throwing more taxpayer dollars into a failed proposal, we should be 
working on a real long-term solution rooted in consent-based siting.
  You have heard me raise the question that many Nevadans be thinking: 
Why should a State with no nuclear powerplants of its own be forced, 
against its will, to house all of the Nation's nuclear waste?
  I stand by the Department of Energy's 2010 decision to terminate the 
Yucca Mountain program, and I stand by its 2015 recommendation for a 
consent-based siting.
  Yucca Mountain is dead. Let me take you through what it would take to 
put this failed program back on life support. Prior to the suspension 
of the program in 2010, the Federal Government had spent close to $15 
billion on Yucca Mountain.
  Now, I recognize that some of my colleagues might say: Well, the 
government has already spent this much on the government repository; 
shouldn't we complete it?
  First of all, let me say that restarting the program would need $2 
billion more just to complete the licensing process--$1.66 billion for 
the Department of Energy and $330 million for the Nuclear Regulatory 
Commission.
  After 3 to 5 years spent on licensing, there could well be another 5 
years in legal challenges, and there is no certainty that Yucca 
Mountain would ever be built.
  Second, even if Yucca Mountain were to go forward, it would be an 
expensive repository project. The Department of Energy's best estimate 
is that another $82 billion--let me repeat that; another $82 billion--
would be needed to license, litigate, build, operate, decommission, and 
eventually close Yucca Mountain. On top of the money that has already 
been spent, that adds up to more than $96 billion for what is called 
the total system life cycle cost.
  That leads to my third point. We need to reevaluate the whole nuclear 
waste cost question. There is a business case to be made against Yucca 
Mountain. The Department of Energy's own estimates for Yucca Mountain 
say that the nuclear waste fund will only pay about 80 percent of the 
total life cycle costs, or about $77 billion. The remaining $19 billion 
would have to come from an annual appropriations voted by this 
Congress. That means more money for this project paid by taxpayers.
  But it does not have to be that way. In 2012, the Department of 
Energy did its own cost assessment and concluded that all other costs, 
like transportation, being equal, walking away from Yucca Mountain and 
starting with a new repository site in a deep salt bed or deep shale 
formation would actually save between $12 billion and $27 billion over 
the life of the repository.
  Before we spend any more taxpayer dollars on Yucca Mountain, we need 
to ask the Department of Energy experts to come before us and explain 
what they learned about repository costs in their previous studies. 
Beyond that, we need new cost studies on geologic disposal in 
repositories, studies that include the lessons learned from recent 
progress with repositories in Europe, and new studies that look at the 
nuclear waste program overall and incorporate the cost of safe on-site 
reactors, early removal of spent fuel from shutdown reactors, and 
consolidated interim storage facilities, as recommended by the Blue 
Ribbon Commission on America's Nuclear Future.
  It is clear that rather than forcing the State of Nevada to accept 
nuclear waste at a scientifically unsound site, taxpayer dollars would 
be better spent identifying viable alternatives for the long-term 
storage of nuclear waste in areas that are willing to house it. Finding 
alternatives is the commonsense path forward, as well as the fiscally 
responsible decision.
  I urge my colleagues, as we continue the budget appropriations 
process for this next fiscal year, to conduct oversight over the life-
cycle costs of repositories and to focus on further implementing the 
Department of Energy's consent-based siting process, instead of wasting 
more taxpayer dollars on a failed proposal.

[[Page S3179]]

  I stand ready to partner with my colleagues on both sides of the 
aisle on this issue, and I am confident that together we can find a 
solution to this problem once and for all.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nevada.


            Unanimous Consent Agreement--Executive Calendar

  Mr. HELLER. Mr. President, I ask unanimous consent that the cloture 
motion on the Elwood nomination be withdrawn, and that following leader 
remarks on Tuesday, June 6, the Senate resume consideration of the 
nomination, with the time equally divided until 2:15 p.m. I further ask 
that at 2:15 p.m., on June 6, the Senate vote on confirmation of the 
Elwood nomination, and that, if confirmed, the motion to reconsider be 
considered made and laid upon the table and the President be 
immediately notified of the Senate's action.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HELLER. 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. SASSE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Perdue). Without objection, it is so 
ordered.
  Mr. SASSE. Mr. President, I yield back all remaining time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  All time is yielded back.
  The question is, Will the Senate advise and consent to the Thapar 
nomination?
  Mr. SASSE. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Washington (Ms. 
Cantwell), the Senator from Hawaii (Ms. Hirono), the Senator from 
Hawaii (Mr. Schatz), and the Senator from New Mexico (Mr. Udall), are 
necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 52, nays 44, as follows:

                      [Rollcall Vote No. 137 Ex.]

                                YEAS--52

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

                                NAYS--44

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

                             NOT VOTING--4

     Cantwell
     Hirono
     Schatz
     Udall
  The nomination was confirmed.
  The PRESIDING OFFICER. Under the previous order, the motion to 
reconsider is considered made and laid upon the table and the President 
will be immediately notified of the Senate's action.
  The Senator from Iowa.

                          ____________________