(Senate - June 15, 2017)

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[Congressional Record Volume 163, Number 102 (Thursday, June 15, 2017)]
[Pages S3528-S3547]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

                           EXECUTIVE SESSION


                           EXECUTIVE CALENDAR

  Mr. McCONNELL. Madam President, I move to proceed to executive 
session to consider Calendar No. 97.
  The PRESIDING OFFICER. The question is on agreeing to the motion.
  The motion was agreed to.
  The PRESIDING OFFICER. The clerk will report the nomination.
  The senior assistant legislative clerk read the nomination of 
Marshall Billingslea, of Virginia, to be Assistant Secretary for 
Terrorist Financing, Department of the Treasury.

                             Cloture Motion

  Mr. McCONNELL. Madam President, I send a cloture motion to the desk.
  The PRESIDING OFFICER. The cloture motion having been presented under 
rule XXII, the Chair directs the clerk to read the motion.
  The senior assistant legislative clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     do hereby move to bring to a close debate on the nomination 
     of Marshall Billingslea, of Virginia, to be Assistant 
     Secretary for Terrorist Financing, Department of the 
         Mitch McConnell, Orrin G. Hatch, John Hoeven, John 
           Cornyn, John Barrasso, John Boozman, Mike Rounds, Chuck 
           Grassley, Steve Daines, Thom Tillis, John Thune, Mike 
           Crapo, Bill Cassidy, James M. Inhofe, Thad Cochran, Tom 
           Cotton, Roger F. Wicker.

  Mr. McCONNELL. Madam President, I ask unanimous consent that the 
mandatory quorum call with respect to both cloture motions be waived.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Virginia.

        Individual Health Insurance Marketplace Improvement Act

  Mr. KAINE. Madam President, I rise to speak about the ongoing debate 
in the body concerning the next chapter in healthcare and what we can 
do about it together and, especially, to address one part of the 
healthcare market--the individual market.
  As most know--and this has been an item about which we are deep into 
discussions, the people and the Members of this body--before the 
passage of the Affordable Care Act, Americans with preexisting 
conditions faced unfair barriers to accessing health insurance 
coverage, and healthcare costs had risen rapidly. Prior to the passage 
of the Affordable Care Act, my own family, which is probably like the 
healthiest family in America because the five of us have only had three 
hospitalizations for three childbirths--all for my wife--we had twice 
been turned down for insurance coverage for at least one member of our 
family because of preexisting conditions.
  Since 2010, the rate of uninsured Americans has declined to a 
historic low. More than 20 million Americans have gained access to 
health insurance coverage--many for the first time in their lives. In 
Virginia, over 410,000 Virginians have accessed care on the individual 
marketplace and another 400,000 would be eligible if Virginia decided 
to expand Medicaid.
  Many Virginians use the individual market, and they have shared their 
stories with me on my website. I have on my Senate website ``ACA 
Stories,'' where I encourage people to share their stories.
  The individual marketplace, as folks know, is if you are buying 
health insurance, not through an employer, and you are buying 
individually--you may or may not be qualified for a subsidy--that 
particular marketplace is really important for people who aren't 
employed by companies that offer group plans, but it also has its 
  One of my stories was from Lauren Carter, who lives in Lovingston, 
VA, in Nelson County. She wrote in to say:

       My 39-year-old son has cerebral palsy and a blood clotting 
     disorder. His ``pre-existing conditions'' started at 
     conception. Three years ago, he lost his full time job with 
     health insurance benefits.
       The ACA allows him to continue receiving medical care and 
     purchase his life saving medications. He supports himself 
     through multiple part time jobs--

  This young man with cerebral palsy--

     employer based insurance is not an option for him at this 

  Laura Kreynus from Mechanicsville, VA, near Richmond wrote:

       My daughter was diagnosed with Crohn's Disease in April of 
     2013. That September, my husband was diagnosed with 
     Parkinson's Disease. We are farmers, we raise the food for 
     America. As such, we are independently insured.

[[Page S3529]]

  They have no large employer to cover them.

       Prior to finding a plan through the ACA in January 2015, 
     our monthly insurance premiums were to increase to nearly 
     $3,000 a month . . . yes, each MONTH! On top of that, our 
     health insurance had an annual cap on prescription coverage 
     of $5,000. The Humira that my daughter takes to combat her 
     Crohn's Disease retails for $3,800 a month, and that is not 
     the only medication she requires. So basically, after one 
     month, we reached the prescription coverage cap, meaning we 
     would have to pay $3,800 a month for medication on top of 
     $3,000 a month premiums. Who has an extra $6,800 a month to 
     pay for this? That is way more than we earn monthly as 
       With the health insurance plan we got through the ACA, our 
     premiums for 2015 were $1,500 a month, less than half of what 
     we would have been paying under the previous plan. But the 
     real saving grace was no prescription cap, so my daughter's 
     medications are covered with a copay after we reach the 
     deductible. This is still a lot of money, but at least we can 
     treat our daughter's disease and hopefully keep her healthy. 
     And even though our premiums have gone up to nearly $2,000 a 
     month from $1,500 a month under the ACA, at least we can 
     still have insurance.

  For families like Lauren's and Laura's, the individual marketplace is 
critical. But like Laura said, premiums are frequently too high. You 
have to have robust enrollment, competition, and certainty for premiums 
to come down.
  Unfortunately, there has been increasing uncertainty in the 
individual market due to actions taken by the current administration. 
On January 20, 2017, President Trump signed an Executive order 
directing relevant agencies not to enforce key provisions of the 
Affordable Care Act. Later in January, the administration terminated 
components of outreach and enrollment spending, including advertising 
to encourage people to enroll in the individual marketplace.
  The administration has also repeatedly threatened to end cost-sharing 
reduction payments, which reduce costs for approximately 6 million 
people with incomes below 250 percent of the poverty level. These 
actions, these statements, these inactions, and this uncertainty have 
created uncertainty in the individual marketplace, leading to 
instability for insurance carriers, higher premiums, and reduced 
  In Virginia, we have seen Aetna and United leave the individual 
marketplace, and they have cited this uncertainty created by this 
administration as the principal reason. In other States, there are 
counties that are at risk to have no insurers offering coverage on the 
marketplace in particular States or sometimes in regions in the States.
  So this is a problem we can address, and we don't have to repeal the 
Affordable Care Act to do it. We just need to improve the Affordable 
Care Act, using a tool that has had bipartisan support in this body for 
some time.
  So yesterday Senator Carper and I introduced the Individual Health 
Insurance Marketplace Improvement Act, and I want to thank the other 
original cosponsors of the bill: Senators Nelson, Shaheen, and Hassan.
  One way to address uncertainty is to use a common insurance tool, 
reinsurance--a permanent reinsurance program to help stabilize premiums 
and increase competition. The Affordable Care Act originally had a 
reinsurance program. It was temporary. It lasted for the first 3 years 
of the program, and it did hold premiums down. What we would do is that 
we would take that idea, which worked, and we would make it permanent. 
We would make it permanent and modeled after a very successful and 
bipartisan program: Medicare Part D. Medicare Part D provides a 
prescription drug benefit for seniors. It was passed with bipartisan 
support during the administration of President George W. Bush, now more 
than a decade ago, and the reinsurance program has helped hold down 
  This reinsurance program would provide funding to offset larger than 
expected insurance claims for health insurance companies participating 
in State and Federal marketplaces. It would encourage them to offer 
more plans in a greater number of markets, thereby improving 
competition and driving down costs for patients and families. 
Basically, if reinsurance can cover high costs, an insurance company 
will know it has a backstop, which gives it a measure of stability, and 
also can set premiums at a more reasonable level for everyone.
  The bill would also do one other thing that is important. It would 
provide $500 million a year from 2018 to 2020 to help States improve 
outreach and enrollment for the health insurance marketplaces, 
especially to draw in new members and educate the public--especially 
young people who are maybe moving just past their 26th birthdays and 
can no longer be contained on family policies--about the need to be 
insured. The outreach funding prioritizes counties where there are 
limited insurers left in the marketplace.
  This is not the only improvement that is needed for our healthcare 
system. We need to do more to keep costs down, figure out a way to have 
prescription drugs be more affordable, and we can certainly use 
technology and data to drive better health outcomes, but this is a fix. 
It is a fix of an important part of our system, the individual market. 
It is a fix using an idea that has already worked and has already 
compelled the support of both Democrats and Republicans--reinsurance in 
Medicare Part D. This should be something Democrats and Republicans can 
agree to.
  My worry is that we are participating now in a secretive effort to 
write a healthcare bill behind closed doors and possibly put it on the 
floor for a vote without hearing from a single patient, without hearing 
from a single provider, a hospital, a business that has a hard time 
buying insurance for its employees, an insurance company, or 
pharmaceutical company.
  We ought to be debating these bills in the world's greatest 
deliberative body and proposing amendments and hearing from 
stakeholders and then doing the best job we can when we are dealing 
with the most important expenditure that anybody ever makes in their 
life, healthcare. Healthcare is also one of the largest segments of the 
American economy, one-sixth of the economy. Why would we want to pass a 
bill in secret?
  Senator Carper, my colleagues, and I have introduced this bill as a 
good faith effort to say what I actually said when I first got on the 
HELP Committee in early January of 2015. There is a huge group of us 
just waiting for the door to open so that we can have a meaningful 
discussion about moving our system forward, and I believe this bill 
could be a very good part of stabilizing and improving the individual 
market and bringing relief to many Americans.
  With that, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Sasse). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. PETERS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                       Resolution of Disapproval

  Mr. PETERS. Mr. President, I rise today to reiterate my support for 
the resolution of disapproval related to the sale of certain defense 
articles to the Kingdom of Saudi Arabia. While the resolution, 
unfortunately, did not pass the Senate in a recent vote, I believe its 
goals remain important.
  The Saudi-led military campaign in Yemen is fueling a humanitarian 
disaster. Over 10,000 people have died, and over 3 million people have 
been displaced as the conflict has exacerbated poverty, famine, and 
disease. According to UNICEF, the United Nations Children's Fund, a 
cholera outbreak in Yemen could quadruple to infect 300,000 people in 
the coming weeks. Half of the current cholera cases affect children, 
and the ongoing conflict leaves few hospitals to turn to and almost no 
medical supplies.
  In addition to deaths related to famine and the outbreak of other 
diseases, we are seeing civilian casualties as a direct result of Saudi 
military action. Earlier this year at a Senate Armed Services Committee 
hearing, I asked General Votel, the commander of U.S. Central Command, 
which is responsible for the Middle East, to assess the cause of the 
large number of civilian casualties in Yemen. General Votel responded: 
``I attribute those type situations more to the competence of the 
forces that are operating there, and their ability to properly 
  I am concerned that even with the precision munitions the United 

[[Page S3530]]

has sold to Saudi Arabia in the past, air strikes continue to hit 
civilian targets. The number of civilian injuries and deaths shows that 
there is simply not enough progress to reduce civilian casualties.
  I could not in good conscience vote to support providing advanced 
precision munitions--bombs capable of hitting targets guided by laser 
targeting or GPS--to a campaign conducted by forces unable or unwilling 
to limit strikes to targets of military necessity.
  Civilian casualties are a tragedy, and they threaten to make us less 
safe by radicalizing populations that otherwise would not be 
sympathetic to violent extremist groups like al-Qaida. It is critical 
that the U.S. military is certainly able to hunt down terrorists 
wherever they operate or wherever they seek haven.
  The deployment of remotely piloted aircraft has allowed for 
persistent intelligence, surveillance, and reconnaissance, which is 
used to minimize the risk of civilian casualties. When the U.S. 
military carries out air strikes, we know our men and women in uniform 
are the best trained in the world and are informed by the best 
available intelligence.
  Precision-guided munitions alone do not avoid preventable tragedies. 
It takes capable and fully trained personnel. This is what we must 
expect from our partners for the sake of innocent civilians caught in 
conflict zones and for our own national security. Failing to do so sets 
back the potential for a political solution.
  We simply should not send precision munitions or any weapons system 
to any partner with personnel who are not capable or trained to use 
them. That is why I supported the resolution of disapproval, which 
specifically objects to the sale of three specific types of precision-
guided munitions and related technology. While this measure failed, I 
will continue to work as a member of the Armed Services Committee to 
provide oversight and hold the Saudi Government and military 

            Countering Iran's Destabilizing Activities Bill

  Mr. President, I was proud to support the Countering Iran's 
Destabilizing Activities Act. This is important legislation that I was 
also proud to cosponsor. It will require sanctions on those supporting 
Iran's ballistic missile program and imposes terrorism-related 
sanctions on Iran's Revolutionary Guard Corps.
  For too long, Iran's state sponsorship of terrorism and their 
repeated ballistic missile tests in defiance of U.N. Security Council 
resolutions have destabilized the Middle East and threatened Israel, 
our strongest ally in the region. Their destabilizing actions are 
fueling the ongoing violence causing widespread humanitarian suffering 
in Yemen. Iran provides weapons and troops that fuel conflicts, and 
Iran's military consistently behaves in an unprofessional manner, 
putting American troops at risk.
  I believe most Iranian citizens want to play a productive role in the 
world. It is their government that is the problem. I believe that 
pressure provided by additional sanctions for destabilizing activity 
can improve the behavior of the Iranian regime, and we must send a 
clear signal to this regime that their actions are simply unacceptable.
  This legislation also provided a vehicle to address another nation's 
leadership whose actions have warranted international condemnation--
Russia. This bill includes an amendment that I supported to enhance 
sanctions on Russia.
  This amendment ensures that sanctions imposed by President Obama are 
codified in law and cannot be removed without congressional review. It 
also imposes new sanctions on Russians who facilitate human rights 
violations, supply weapons to the Syrian Government, conduct cyber 
attacks on behalf of the Russian Government, and do business in the 
Russian intelligence and defense sectors.
  Let me be clear: Russia is not our friend. The Russian Government has 
conducted an information warfare campaign against our own country and 
sought to undermine our democratic process.
  This is not a one-time incident. Russia continues to attempt to 
disrupt democratic institutions and interfere with our allies.
  Congress has supported imposing tough sanctions on Russia, and it is 
important that Congress has an opportunity to review any attempt to 
remove them. I am glad this amendment was adopted on a broadly 
bipartisan basis.
  Finally, I am a cosponsor of an amendment offered by Senator Graham 
that reaffirms the importance of NATO, particularly article 5, the 
collective defense provision, which states that an attack on one is an 
attack on all. Article 5 has been invoked only once, in response to the 
September 11 attacks on the United States. With the inclusion of this 
amendment, the Senate sends a strong, clear signal that the United 
States stands by our commitment to security and stability throughout 
the world, and we always will.
  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. WICKER. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                 Building and Sustaining a Larger Navy

  Mr. WICKER. Mr. President, I rise to continue my discussion about the 
case for a bigger Navy, a bigger fleet, and to endorse the requirement 
of the experts in the Department of Defense that we move to a 355-ship 
  When a crisis strikes around the world, the President asks his 
national security team: Where are the carriers? Where are the aircraft 
  Each of our carriers is a 100,000-ton giant, accompanied by an entire 
carrier group that consists of mighty warships and aircraft. The 
carrier, itself, represents 4.5 acres of sovereign U.S. territory.
  In early January of this year--and Senators do not know this--a 
strange and profoundly disturbing thing happened. The answer to the 
Commander in Chief's question, had it been asked at that point--where 
are the carriers?--would have been that none of them had been 
deployed--not a single one. For the first time since World War II, the 
United States had no carriers deployed anywhere--not in the Persian 
Gulf, not in the Mediterranean, not in the Western Pacific.
  There is a gap in our global carrier presence, and there is a gap in 
our fleet. This comes from years of complacency. Also, it comes from a 
different set of facts that we are faced with and a different set of 
challenges that we are faced with in our quest to make our presence 
known and to protect our national security interests on the open seas. 
We have ignored the great naval competition that is taking place 
elsewhere--the fact that it is accelerating. We have taken our Navy and 
our sailors and marines for granted.
  Simply put, the Navy we have today is too small. We cannot accomplish 
the critical missions that we have by preserving the status quo. Right 
now, we have 277 ships, and we need to get to 355 ships. That was 
reiterated today by the Chief of Naval Operations and the Secretary of 
the Navy in a hearing before the full Armed Services Committee.
  I will reiterate to my colleagues and to the American people what the 
Navy does for America and why the current fleet is too small to meet 
current and emerging challenges.
  First, the global presence of the Navy ship matters to American 
prosperity--to the quality of life of Americans. Ninety percent of 
global trade is seaborne. Maritime traffic has increased by 400 percent 
over the past quarter century. In addition to commerce, nearly all 
intercontinental telecommunications transit via a web of undersea 
cables. Undersea cables are responsible for nearly all of our 
intercontinental telecommunications.
  Second, a strong Navy deters aggressive behavior and reassures our 
allies as the Nation's first-on-the-scene force. A strong Navy can help 
keep bad situations from spiraling out of control and getting worse. 
For example, the President recently dispatched multiple carrier strike 
groups to the Sea of Japan following North Korea's missile tests. The 
President asked where the carriers were, and he dispatched them to a 
place of crisis. A mix of ships gives our Commander in Chief a range of 
military options, and their deployments to areas of instability can 
send a message of resolve to our friends and foes alike.

[[Page S3531]]

  Third, if deterrence fails, our naval forces can provide a decisive 
response to aggression. Surface ships, submarines, and the aircraft on 
the carriers can launch missile strikes, control air and sea traffic, 
and intercept missile threats. The recent U.S. action in Syria is a 
good example, as the Presiding Officer knows. In using destroyers in 
the Mediterranean, the Commander in Chief delivered precision strikes 
against Syrian airfields. He enforced the redline against outlawed 
chemical weapons, and President Assad has not crossed that redline 
  Accomplishing these missions as the Nation's sentinel and first 
responder requires a big Navy. Admiral John Richardson, the Chief of 
Naval Operations, put it best in ``The Future Navy'' white paper that 
was released last month. He said:

       Numbers matter. The number of ships in the Navy's fleet 
     determines where we can be, and being there is a key to naval 

  Again, the current fleet of about 277 ships is way too small. It is 
important to remember that not all ships are deployed or deployable. In 
fact, only about 100 ships out of the 277 are currently deployed. The 
other two-thirds are undergoing heavy maintenance, routine sustainment, 
or are training to deploy. The Navy recently validated its requirement 
for 355 ships--a 47-ship increase over the previous requirement.
  The lack of ships has created coverage gaps all over the world. I 
will give two examples.
  First, the commander of Pacific Command, ADM Harry Harris, recently 
told Congress he has only half the submarines he needs. Admiral Harris 
is responsible for deterring China and North Korea, but he is missing 
half of the submarines he needs. Closer to home, the commander of 
Southern Command, ADM Kurt Tidd, has zero Navy ships permanently 
assigned to his area of operations. These are just two of the many 
alarming instances where the lack of ships is having major 
  While we watch our edge erode, America's real and potential 
adversaries are building the size and capability of their fleets. They 
are on the field competing while, in America, many of our players are 
still in the locker room.
  China is building a modern navy capable of projecting global power. 
China is modernizing every type of ship and submarine in its fleet. 
China commissioned 18 ships last year. In April, China launched its 
first domestically built carrier and plans to build at least six more 
carriers. By 2030, China will have more than twice as many attack 
submarines and four times as many small surface ships as the United 
States. Beijing is developing its first overseas naval base in the Horn 
of Africa. China's naval buildup may attempt to push the United States 
first out of the Western Pacific, away from critical trade chokepoints 
and our allies in South Korea and Japan.
  I would call the attention of Members to the poster that I have, and 
I hope it is printed large enough for my colleagues to see. In terms of 
five types of ships, it compares where we were in 2000, where we are 
today, and where we are projected to be if current trends continue.
  For example, on the farthest column shown on the chart, in attack 
submarines--and the black portion of each circle represents China's 
capability, and the blue represents our capability in the United States 
of America. In 2000, it was 64 to 55 in favor of the Chinese. In 2016, 
as we can see, 56 to 57. But under current projections, by the year 
2030, when it comes to attack submarines, the Chinese will have 87 and 
the United States will have only 42--a disturbing trend which the Navy 
would like to reverse if we have the ability and the wisdom to give 
them the requirement they have said they need.
  With regard to ballistic missile submarines, in 2000, quite a 
mismatch--only 1 for China as compared to 18 for the United States; 
then, only last year, 4 for China and 14 for the U.S. Navy; and then 
projected for 2030--and really that is in only 13 short years, which is 
hard to believe--there will be more Chinese ballistic missile 
submarines than American ballistic missile submarines unless we take 
the Navy's requirement to heart and take action beginning this year to 
rectify that situation.
  With regard to small surface ships, as we can see, there was a 79-to-
62 advantage in sheer numbers in 2000 and a 103-to-23 advantage of the 
Chinese in 2016. In 2030, there will still be a mismatch, in terms of 
numbers, of 123 small surface ships compared to only 40 for the United 
States of America.
  With large surface ships, it was 20 to 79, then 19 to 84, and by the 
year 2030, as we can see, the Chinese are projected to have 34 large 
surface ships.
  With regard to aircraft carriers, as I pointed out, they were not in 
that game at all in 2000. They delivered their first last year, and 
they are projected to go to four by the year 2013.
  It all adds up to 260--a 260-ship fleet for China and only 199 for 
the United States unless we act, and act responsibly, in response to 
what the Navy and the Marine Corps and the best military minds in the 
Pentagon are telling us, and I hope we will do that.
  An increasingly aggressive Russia is also modernizing. The Kremlin is 
pouring money into new attack and nuclear ballistic missile submarines. 
Russian submarine patrols have doubled, and those patrols are 
stretching closer to the U.S. homeland. The Russian Navy's operating 
areas have expanded to include regular operations in the Baltic, Black, 
Mediterranean, and Caspian Seas. Russia is also exploiting new 
opportunities in the Arctic by building naval bases in the High North.
  So both China and Russia are investing heavily in their fleets and in 
new ballistic and cruise missiles that can target U.S. naval forces.
  And, of course, we need to turn to the subject matter of North Korea. 
Kim Jong Un will stop at nothing to develop a nuclear weapon that can 
strike our allies and that can strike deployed U.S. forces and 
eventually our homeland. A nuclear ballistic submarine would 
essentially make North Korea impervious to threats of preemption. North 
Korea is building fortified submarine bunkers and began testing 
submarine-launched ballistic missiles within the last year.
  Iran is another rogue state developing a massive fleet of fast attack 
boats and mini-submarines to deny the free passage of ships through the 
vital Strait of Hormuz.
  Naval competition is a fact. China, Russia, North Korea, and Iran 
have clearly been building up the size and the sophistication of their 
fleets. The Chief of Naval Operations has a word to describe the pace 
of competition, and that word is ``exponential.'' The CNO puts it this 

       Time is an unforgiving characteristic of the maritime 
     [environment]. Things are moving faster, including our 

  So let's start competing again. Building a larger fleet is a national 
project. It will require sustained commitment by the President, the 
Congress, and the Department of Defense. As chairman of the Seapower 
Subcommittee, I intend to begin laying a firm foundation this year for 
a significant buildup in the future, and I hope my colleagues will join 
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.

  Thoughts and Prayers for the Victims of the Congressional Baseball 
                           Practice Shooting

  Mr. CASEY. Mr. President, I wish to start this afternoon with a 
reflection on what happened yesterday. We are thinking today of the 
individuals who were hurt in the attack during the baseball practice in 
Virginia, and, of course, we are praying for those who were injured. I 
will list them. Many of the names we already know, but it is important 
to list them.
  Of course, Representative Steve Scalise from the State of Louisiana--
we are thinking of his family and praying for them, and we hope for his 
speedy recovery. Matt Mika, who works for Tyson Foods, was also a 
shooting victim like Representative Scalise. Zack Barth, who works for 
Congressman Roger Williams, was a shooting victim, and Special Agent 
Crystal Griner, of course, of the Capitol Police, who exhibited such 
courage in the line of duty. We are thinking of Crystal at this time as 
  We know there were individuals injured at the scene, including 
Special Agent David Bailey of the Capitol Police, who was not shot, 
apparently, but suffered an injury and was released from the hospital. 
We are happy to hear he has been released. Representative Roger 
Williams, who was hurt at the scene as well--not a shooting victim but 
hurt--and, of course, two of

[[Page S3532]]

our colleagues were there at the time, Senator Rand Paul and Senator 
Jeff Flake. We are thankful they were not injured in any way.
  On these days, we come together as a family to remember those who 
have been the victims, and we are thinking of them and their families 
and praying for them.

                         Healthcare Legislation

  Mr. President, I rise today to talk about the healthcare debate and 
in particular not just the issue of healthcare but the effort underway 
by Senate Republicans in their attempts to repeal the Patient 
Protection and Affordable Care Act.
  I have grave concerns about the substance of the legislation--what we 
know about it. It has been kind of a secret process. We don't know a 
lot, but we have some general sense of where they are headed. I also 
have grave concern about the lack of transparency employed by the 
Republican majority around the development of this healthcare plan.
  Like millions of Americans, I oppose this secretive process--and I 
have to say it is a partisan process as well--that could result in 
major legislation that would harm children who will lose their 
healthcare, especially by way of the cuts to Medicaid. It could harm 
individuals with disabilities--and by one recent estimate in 
Pennsylvania, that means over 720,000 Pennsylvanians with a disability 
who rely upon Medicaid; and, of course, seniors--a lot of seniors 
across the country cannot get into a nursing home absent the full 
support of the Medicaid Program, and we are concerned about them as 
well; and finally, middle-class families who may not be able to afford 
healthcare if the House bill were to become law or a substantially 
similar bill passed by the Senate.
  In 2009, the legislation passed the Senate after a yearlong, open 
process that included a total of 44 bipartisan hearings, roundtables, 
and summits. That was in the Committee on Health, Education, Labor, and 
Pensions, of which I was a member at the time and remember well those 
hours and hours and days and days of hearings. The Committee on Finance 
at that time also had many hearings over many months. This whole 
process by two committees led to the consideration of some 435 
amendments offered by both parties, majority and minority, and a full 
debate on the Senate floor that lasted over 25 consecutive days. In 
fact, a number of Republican Senators were able to offer and get a vote 
on their amendments, some of which passed and became part of the 
Patient Protection and Affordable Care Act.
  Yet, in the last 5 months, there have been no Senate hearings on this 
proposed legislation, no hearings on the House proposal, and certainly 
no hearings on what is being developed here in the Senate. If that is 
the case--if that remains the case over the next couple of days and 
weeks--then I believe we should institute a very basic rule: If you 
have no hearings, you have no vote. In other words, you can't have a 
vote on the Senate floor on a bill that will affect so many tens of 
millions of Americans and will change dramatically and, I would argue, 
adversely, to the detriment of a lot of people, our healthcare system. 
I hope the majority will agree with that--that if you don't have a 
hearing, you shouldn't have a vote on the Senate floor.
  There have been no relevant bills considered in executive session by 
any of the committees of jurisdiction. Every indication is that the 
Republican majority will jam this legislation through with minimal 
opportunity for debate. This is unacceptable to me, but I also believe 
it is unacceptable to people across the country in both parties.
  We know, for example, the reason--or one of the many reasons--folks 
would want a hearing before a vote, and that is because we are getting 
a sense of what the substance is. Just to give one example, I won't 
enter this whole report into the Record, but I am holding a full copy 
of the Congressional Budget Office cost estimate. This estimate is 
dated, May 24, 2017, analyzing H.R. 1628, the American Health Care Act 
of 2017. This is the bill which passed the House. Page 17 of the CBO 
report says:

       Medicaid enrollment would be lower throughout the coming 
     decade, culminating in 14 million fewer Medicaid enrollees by 
     2026, a reduction of about 17 percent relative to the number 
     under current law.

  That is quoted directly from page 17 of the CBO report, that over the 
decade, 14 million people will lose their Medicaid coverage.
  I know some here and across the city who were commenting on this 
legislation--either members of the administration, Members of Congress, 
or otherwise--are refuting this, but I think when you have a 
Congressional Budget Office report which is an independent entity that 
both parties have relied upon--and it is not only the CBO. This is a 
report authored by not just the Congressional Budget Office but also 
the Joint Committee on Taxation.
  So 14 million fewer people on Medicaid--why is that relevant to the 
Senate debate if the CBO report was analyzing the House bill? Here is 
what one think tank, which has analyzed healthcare policy for years, 
the Center on Budget and Policy Priorities--they put forth a report 
this Monday, June 12. In that report of just a couple of pages, they 
had a chart--I am holding it. I do not expect people to see it, but 
here is what it says. It has four columns. The first column has the 
major provisions of the House bill; and then what are likely, based 
upon reporting and information we can ascertain so far, major 
provisions of the House bill; what happens if the House bill passes; 
and then major provisions of the Senate bill.
  There is a section entitled ``Medicaid Expansion.'' When the Center 
on Budget and Policy Priorities analyzed and compared the House bill to 
what we know so far about the Senate bill being proposed or at least 
the development of it, basically the Center on Budget says there is no 
long-term impact on any reported changes from one bill to the other. 
The Medicaid per capita cap--another very disturbing development that 
is being considered--when they compare the Senate bill to the House 
bill, they say no major changes.
  So we are very concerned about what happens to Medicaid. I am very 
concerned because of the 1.1 million children in Pennsylvania, the 
disability number I mentioned before of over 722,000 people with 
disabilities who get Medicaid, and of course the seniors who depend 
upon Medicaid. So we are concerned about the elimination, even over 
time, of the Medicaid expansion. We are also concerned about the 
Medicaid Program itself.
  In addition to those numbers, I want to highlight a few individual 
stories of people to get a sense of what is at stake when it comes to 
this bill and when it comes to Medicaid.
  This past Friday, I met with German Parodi from Philadelphia. Here is 
his story:
  In 2001, he was a victim of a carjacking and was shot in the neck, 
leaving him paralyzed and unable to use his legs and having limited use 
of his arms. He was nursed back to health by his grandmother and has 
worked for the past 16 years to be a full citizen, going to school, 
working, owning his home, now caring for his grandmother who once cared 
for him. German, who now uses a wheelchair to get around, has worked to 
achieve what every American wants--to be a successful student, to own a 
home, and to care for his family. He can do this because of his 
knowledge, skills, and perseverance, and he has been able to achieve 
these goals because he gets direct care services paid for by Medicaid. 
His direct care professional helps him get out of bed in the morning, 
get showered, dressed, breakfast, and get to work. Medicaid and the 
services it provides makes it possible for him to use his skills to be 
  German told me that without Medicaid, ``I would end up having to live 
in an institution. This would dramatically affect my life and my 
grandmother's life.''
  While talking with me, he said: ``Please do everything in your power 
to protect my life and the lives of millions like me.''
  I am short on time but here is another example. Latoya Maddox, whom I 
met at the same meeting, is from the Germantown section of 
Philadelphia. She was born with arthrogryposis multiplex congenital, a 
disability that limits the use of her limbs. Latoya also uses a 
wheelchair to get around, including getting to school and getting to 
work. She is smart, energetic, and the mother of a soon-to-be 6-year-
old. She is now a junior at West Chester University working on her 

[[Page S3533]]

degree in social work and works part time at Liberty Resources, 
Incorporated, one of Pennsylvania's independent living centers.
  Like German, Latoya is a successful young professional because she 
works hard and takes advantage of the opportunities presented to her. 
She has support from Medicaid in the form of direct support 
professionals who help her with her daily tasks. Without Medicaid, the 
wheelchair and other medical equipment she needs and her direct care 
workers, Latoya would not be able to work, attend school, and care for 
her son.
  While I was talking with Latoya, she told me: ``Medicaid makes it 
possible for me to live a regular, full, productive life, to be a 
parent, to go to school, and to be a reliable employee.''
  While talking with her, it was clear that Latoya was proud of her son 
and proud to be his mother. She was clear that the support she receives 
from Medicaid makes it possible for her to be that proud parent.
  She closed her remarks by saying that Medicaid ``makes it possible 
for me to be me.''
  My last example is Karen Stauffer. Karen Stauffer is from Bucks 
County, PA. She is a small business owner. She operates the River of 
Life Natural Foods store. Karen purchased her healthcare policy from 
the Pennsylvania Affordable Care Act exchange. She said to me that 
prior to the passage of the ACA, she saw her healthcare premiums 
increase from $300 a month in the late 1990s to $1,300 in the mid-
2000s. She said to me that because of preexisting conditions such as 
high blood pressure and a long bout of Lyme disease, she was worried 
she would lose her healthcare. She said passage of the ACA was both an 
emotional and financial relief for her. Her premiums were reduced to 
$500 a month after being as high as $1,300, and she knew she had the 
protection of the law when it came to nondiscrimination because of her 
preexisting conditions.
  As she spoke, she shared her fears from what she has been hearing 
about the House bill and what might come out of the Senate; that, at 61 
years of age, her premiums could be five times that of younger 
policyholders and that the meager subsidies proposed by the Republican 
majority would make healthcare unaffordable for her. She said to me: I 
am frankly terrified about what could happen to me in the next 4 years. 
My income has gone down, I have preexisting conditions, and instead of 
making adjustments and improvements to the ACA, legislators are causing 
insurers to become concerned about the future.
  Karen was distraught when talking about the future and reminded me 
that ``we all could be one accident or illness away from disaster.'' 
That is what Karen said.
  So German, Karen, and Latoya, I think, give us a lot to think about. 
I hope the majority, when they are making the final edits to their 
bill, will make sure that any American with Medicaid, for example, who 
has it now--a child who comes from a low-income family, an adult or 
child with a disability or a senior trying to get into a nursing home--
if they have Medicaid today and need it in the future, that there would 
be a guarantee that they don't lose their Medicaid, that they don't 
lose it this year or 5 years from now or 10 years from now, or longer. 
Stretching it out over many years and eliminating that coverage year 
after year, a little bit each year, is going to be just as bad in the 
long run.
  I hope the majority would think of those families and the families in 
their own States when they are considering healthcare legislation in 
the Senate. We should have a vote only if there is a hearing on this 
legislation or, frankly, more than one hearing to consider something 
this complicated.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.

prayers for the Victims of the Congressional Baseball Practice Shooting

  Mr. MERKLEY. Mr. President, yesterday we had a horrific tragedy here 
in the capital area. I know I speak for all of my colleagues who are 
holding the victims of that attack in their hearts and in their 
prayers: Congressman Steve Scalise, still in critical condition; Zack 
Barth, legislative correspondent who works for Congressman Williams of 
Texas, who was injured; Matt Mika of Tyson's Foods, who represents them 
here on the Hill; and two of our police officers, David Bailey and 
Crystal Griner of the U.S. Capitol Police. Without those two police 
officers present, this could have been a much more tragic event.
  We have to reinforce the understanding that we are blessed to have 
the opportunity to raise our voices in our democratic Republic. We are 
able to raise them by speaking to our members who are elected in local 
and State and Federal Government, by writing to them, by meeting with 
them in townhalls. In my State, you can call them up, and they will sit 
down with you in a cafe. We have an opportunity to weigh in through 
writing letters to the editor, by protesting in the streets, by 
overflowing the email lines and flooding the phone lines. We have all 
kinds of ways to weigh in, in America, but violence is absolutely 
unacceptable. We have to try to diminish and eliminate the hate speech, 
which so often becomes the foundation for hate violence.
  We have had a very divisive 18 months here in America, where various 
folks have sought to increase the divisions between groups of 
Americans, to attack women, to attack African Americans, to attack 
Hispanics, to attack Muslims, to attack LGBT citizens. We need to 
eliminate that strategy of division.
  Here, in America, we are a tapestry of talents from all over the 
world, of different cultural backgrounds who come together to make this 
Nation incredibly strong. Unless you are 100 percent Native American, 
you are either an immigrant yourself or the son or daughter of 
immigrants. We bring that diversity to bear and we make this Nation 
powerful in ways few other nations could even come close to having.
  Let's take this as a moment in which we seek to encourage public 
participation in all the legitimate forms of free speech but put hate 
speech out of bounds and hate violence out of bounds.

                         Healthcare Legislation

  Mr. President, it is ironic that this conversation takes place at a 
moment where we really have a unique process underway designed to limit 
political discourse. Everything I am saying about participation assumes 
you will have a chance to weigh in, whether you are elected or whether 
you are a citizen.
  We have a process in the Senate that is designed to prevent the 
citizens of America from weighing in and to prevent debate by the 
Members of the Senate. That is not acceptable. It is not acceptable 
that in a ``we the people'' constitutional republic, a democratic 
republic designed to facilitate conversation and dialogue to produce 
decisions that reflect the will of the people, that work for all 
Americans--instead, we have a secretive process, more the type of 
process you would expect in a kingdom where the King and the counselors 
hide themselves away, with no public input, and make decisions for the 
masses. That is not the design of our government. Our government is 
designed for public input.
  Here is a phrase that should resonate: no public input, no vote; no 
hearing, no vote.
  I am speaking specifically about the dialogue on TrumpCare. 
TrumpCare, which was passed by just a few votes in the House and came 
to the Senate, doesn't reflect a process of the people, by the people, 
and for the people. In fact, it is by the privileged, for the 
privileged, and by the privileged.
  The House deliberately excluded the public. They had their own 
consolidated, confined process to make sure it was difficult to have a 
full debate and an amendment process, for folks to weigh in and 
consider alternatives and improvements.
  Here we are in the Senate, and it is even worse because we have the 
secret 13 crafting a plan, planning and plotting to bring it to the 
floor of the Senate probably 2 weeks from today in order to hold a 
vote, with only a few hours of debate and no committee process of any 
kind--not a single committee hearing, not a single committee 
opportunity to consider amendments--and no chance for the public to get 
a copy and read through it and weigh in with their Members of the 
Senate. There is no chance for healthcare stakeholders and experts to 
examine it and point out the difficulties and the flaws. What I think 
is most egregious

[[Page S3534]]

of all is the complete exclusion of the United States of America. It is 
  I was fascinated by the fact that the majority decided to have this 
secret 13 committee. Thirteen is considered to be an unlucky number by 
much of America--Friday the 13th or buildings that don't have a 13th 
floor. In this case, I hope that having 13 Members meet in secret is 
unlucky; that is, unlucky in terms of trying to fulfill their mission 
of passing a bill with no input by the public.
  Last week, the majority leader started the process to make this 
happen without a committee. It is called the rule XIV process. It is a 
process designed to bring up a healthcare bill that would rip 
healthcare coverage from millions of Americans and, by the way, give 
away billions of dollars to the richest Americans, all in the same 
bill, straight to the Senate floor without a committee being involved--
not the Finance Committee, which certainly has many elements related to 
the financing of healthcare in America, and not the HELP Committee, 
which has Members of both parties who have worked for years to develop 
expertise and consult with stakeholders to understand what works and 
what doesn't work, and they benefit from each other's input.
  I was part of the HELP Committee in 2009. For 5 weeks we sat in a 
room with a television camera operating so the public could see what we 
were doing, and we proposed amendments and debated them around this big 
square set of tables. There was full public scrutiny. There was 5 weeks 
of bipartisan dialogue about what should go in healthcare. That was 
2009. The Finance Committee had a very similar process.
  But now we have a different objective by the majority leader wanting 
to bring this bill with no Finance Committee involvement, no HELP 
Committee involvement, and no citizen involvement. In fact, there is no 
chance for Senators who aren't in the secret circle to participate and 
see the bill and hold townhalls and ask people what they think of this.
  I do a lot of townhalls. I am doing a couple more this weekend. I 
have had 20 townhalls this year. I have had a townhall an average of 
every 10 days since I was elected in 2000 and came to the Senate in 
2009. I am going to keep holding these townhalls.
  I know that my citizens would like to see this bill and be able to go 
through the elements and give me feedback on what makes sense and what 
doesn't. That is a ``we the people'' democratic republic. This secrecy 
strategy--that is not. That is not. That is a strategy for 
nonconstitutional governments. That is a strategy for dictators. That 
is a strategy for Kings and Queens. That is a strategy for people who 
hate democracy.
  Let's not have that process in the United States. Let's have 
colleagues from both sides of the aisle go to the leadership and say: 
This is unacceptable. I want my citizens to have a chance to see this 
bill. I want to benefit from talking to the hospitals in my community 
and my State and get their feedback. I want to talk to the healthcare 
clinics and get their feedback. I want to talk to the doctors and find 
out what they think. I want to hear from the nurses because they are so 
respected in their understanding of the direct delivery of healthcare.
  That is what every Member of the Senate should be saying to our 
majority leader. This process of secrecy, no debate, and the public 
being excluded is totally unacceptable.
  Why is this process going on? In fact, earlier today, the secret 13 
went into a room off a hallway where the press is not allowed so they 
couldn't be seen coming and going from the room. When they were coming 
and going from the room, they couldn't be talked to by the press. Why 
all this secrecy? It boils down to this: They know the American people 
don't like what is in this bill. They are terrified of getting that 
feedback. If they get that feedback, they might lose a majority in 
passing this bill.
  How much public support is there for the TrumpCare bill? Just 21 
percent, according to a recent Quinnipiac poll. That is not very much 
support for it.
  Even President Trump said TrumpCare is terrible. He said it this way: 
That bill from the House is ``mean.'' That was his exact quote, that it 
is ``mean.'' Then he used another phrase, which I won't repeat on the 
floor of the Senate, to say just how absolutely awful that bill is.
  Today in committee, I asked the Secretary of Health, Tom Price: Do 
you share, as Secretary of Health, the President's opinion that his own 
bill, his own TrumpCare bill passed out of the House, is an absolutely 
terrible bill, a mean bill?
  He didn't want to answer the question. Certainly, I found that 
curious, that the Secretary of Health will not tell us whether he 
shares the President's opinion.
  Then I asked him: Why did the President call it a mean bill? Is it 
because it throws 20 million people out of healthcare?
  The Secretary didn't want to answer.
  Did the President say it was a mean bill because it eliminates the 
guarantee of essential health benefits so that an insurance policy is, 
in fact, insuring you when you get sick rather than perhaps not even 
being worth the paper it is printed on?
  There were a lot of healthcare insurance policies before we had an 
essential care package, essential benefits package. You paid the 
insurance company, but when you got sick, they didn't cover anything. 
Those policies weren't worth the paper they were printed on.
  So I asked the Secretary of Health: Is that the reason the President 
said this is a mean process or a mean bill? Is that the reason he 
described this bill in terms that I won't repeat on the floor?
  The Secretary of Health wasn't interested in relaying or giving 
insights into why the President said it was a mean bill.
  I asked: Is it because the bill destroys the guarantee that if you 
have preexisting conditions, you can still get a policy at the same 
price as everyone else?
  Again, there was no answer.
  I said: Or is it a mean bill because if you are an older American, 
you have to pay perhaps up to eight times more for the same policy as 
you pay under current law?
  You know, an individual who is 64 years old, a man who is earning 
$26,500 a year, currently that individual would pay about $140 a month 
for a policy under current law. The same policy under TrumpCare would 
cost $1,200 a month. Is there anyone in this Senate Chamber who thinks 
an individual earning $26,500 a year can afford a healthcare policy 
that costs $1,200 a month?
  Let me translate this. If you are earning $26,000 a year, you are 
earning a little over $2,000 a month. Is there anyone in this Chamber 
who believes--please come to the floor and tell us if you do--that 
individual can buy a healthcare policy costing $1,200 a month? Is there 
anyone who thinks it is an egregious mistake to use high pricing to 
force older Americans out of our healthcare system? I believe in 
treating our citizens of all ages graciously, not forcing them out of 
healthcare through an eightfold increase in their premiums. Is that the 
reason the President said that this healthcare bill, this TrumpCare 
bill from the House, is a mean bill and spoke of it in derogatory 
  The TrumpCare bill isn't even popular in the President's own party. 
Just 48 percent of Republicans surveyed in the same poll supported 
President Trump and Speaker Ryan's healthcare plan. But when asked if 
they like the current healthcare plan, 55 percent said they do.
  Right now, regular order, the regular legislative, deliberative 
process that makes sure there is a full debate before a significant 
bill comes to a vote, that makes sure there is significant and 
substantial time for the citizens of America to weigh in, that regular 
order or regular process is being run over by a steamroller. It is 
being crushed. It is being demolished. Why would my colleagues support 
destroying the fundamental principles of legislative debate? I would 
love to hear the answer. Perhaps it is because, like President Trump 
said, the bill is mean. Perhaps it is because it is extremely unpopular 
with the American people, who believe there should be affordable, 
quality healthcare available to every single American.
  We have heard that the secret 13 have a plan to sweeten the bill, a 
little spoonful of sugar to make the medicine go down. What is that 
plan? Well, we are hearing that maybe they will put

[[Page S3535]]

in extra funds to help take on the opioid addiction epidemic. That is a 
good thing. Why have they fought so hard against supporting such 
programs to help Americans on this crucial question?
  We have heard they want to slow down the process of throwing people 
off healthcare so it will not hurt them in the 2018 elections and maybe 
not even hurt them so much in the 2020 elections. But if you are 
destroying something piece by piece, you are still destroying it. If 
you are cooking a lobster and you turn up the heat fast or you turn up 
the heat slowly, you still kill the lobster. And this bill is still 
going to kill healthcare for millions of Americans. Doing it more 
slowly doesn't make it a good thing. Putting in a spoonful of sugar 
doesn't make a diabolical act better.
  Franklin Roosevelt once said:

       Let us never forget that government is ourselves.

  And he continued:

       The ultimate rulers of our democracy are not a President 
     and Senators and Congressmen and Government officials but the 
     voters of this country.

  And isn't that what ``we the people'' means--government of, by, and 
for the people? But nowhere in the Republican secret 13 process can the 
voices of the people of the United States be heard. How about if one of 
the 13 comes to the floor now and distributes the bill? I mean we 
should have weeks to consider this. We should have maybe a month to 
consider it. We had a whole year of process in 2009.

  Wouldn't that be the right thing to do, to clue in folks about what 
is in this bill so we can get the stakeholders engaged and the citizens 
engaged and hold those townhalls and get that feedback? Wouldn't that 
be the right thing to do?
  Well, unfortunately, we are still waiting. We are still paused, 
saying: Please, bring the bill to the floor. Distribute it. Maybe it is 
not your final draft, but that is OK.
  We had draft after draft after draft of the healthcare bill in 2009. 
We had, in the Senate Finance Committee, 53 hearings on healthcare 
reform. They spent 8 days marking up their version of the ACA--the 
committee's longest markup in 22 years. During those 8 days, 135 
amendments were considered--amendments from both Republicans and 
Democrats. Then, there was the HELP Committee, which I served on, and 
it held 47 bipartisan hearings, roundtables, and walkthroughs. There 
were 300 amendments during a month-long markup--one of the longest in 
the history of Congress. More than 100 Republican amendments, minority 
amendments, were accepted into the committee's version of healthcare 
  Right here in this Chamber, we spent 25 days considering the bill 
before we voted--25 days considering a lot of floor amendments, a lot 
of floor time. Is there a single member of the majority party who will 
commit to having at least 25 days of debate on the floor of the Senate 
so we can get a full vetting of the issues, so we can get full input by 
the citizens of the United States of America?
  Well, I am concerned that we are not on the path that values the 
construction of our government, our constitutional ``we the people'' 
government. I am concerned and afraid we are on a path where powerful 
special interests meeting secretly with 13 Members of the Senate are 
crafting a bill that is great for the powerful and the privileged but 
in fact is terrible for Americans, and that is why they are so afraid 
to show us the bill.
  So this is unacceptable, and we need the citizens of America to pay 
attention because why is this happening right now? Well, because the 
fact that this secret process is going on, it can be camouflaged by all 
the conversation about Russiagate--how much did the Russians interfere 
in our elections, and what about all those secret meetings by members 
of the campaign team, were they coordinating or collaborating? We don't 
know the answer, but that question is central to whether there was 
treasonous conduct undermining the integrity of our elections.
  So let's do this now, the secret healthcare plan, with no debate 
while America is trying to fight for the fairness and integrity of our 
elections. Let's do it now when schools are out of session and we are 
in summer and people are on vacation. Let's sneak it through now, this 
act that strips healthcare for millions of Americans.
  Here is the principle we should come back to: No hearing; no vote. No 
hearing; no vote. No vote on a piece of legislation that affects the 
lives of millions of American families if we haven't had due 
deliberation by the key committees. No vote on a bill that destroys 
healthcare for millions of families if we haven't had the chance to 
consult with the experts in healthcare--the nurses, doctors, hospitals, 
and clinics.
  No hearing; no vote. No vote if we haven't had a full chance for the 
citizens of America to weigh in, to see the full details, and say what 
they like and what they don't like and share that with their respective 
Senators. On an issue of this magnitude, one that will affect the peace 
of mind and the health of millions of Americans, we need a full, 
thorough legislative process.
  The choices that are made in this Chamber over the next few weeks 
will have a big impact on the quality of life of millions of American 
citizens. A provision that eliminates Medicaid expansion, the Oregon 
health plan expansion in my State, whether it is implemented slowly or 
implemented fast is going to rip healthcare from 400,000 Oregonians. 
That is enough Oregonians that if they were holding hands, they would 
stretch from the Pacific Ocean to Idaho, 400 miles across the State. 
That is a profound impact.
  In addition, those folks who are going to the clinics and hospitals 
who don't have healthcare, they will not be able to pay for it. So the 
finances of the clinics and the hospitals will be dramatically hurt. I 
asked Secretary Price today: Is that the reason the President said the 
TrumpCare bill out of the House is a mean bill? Is that the reason he 
used a derogatory phrase to attack the TrumpCare bill out of the House? 
Is it because of the fact it will undermine the finances of the clinics 
and the hospitals.

  He said: You know, I don't accept the premise that will happen.
  Well, covering your eyes and covering your ears and pretending, on 
such an important issue, is not a responsible act by a Secretary of 
Health. The clinics have been coming to us and saying this is how our 
finances improved when our citizens were able to pay for the services 
because our rate of uncompensated care dropped dramatically and, with 
that income, we hired a lot more people.
  I have a clinic in the northeast corner of our State where the number 
of people employed, they told me, doubled from 20-something to 50-
something. They are able to provide a lot more healthcare in that 
local, rural community, and that is true in clinic after clinic after 
  If one would take their hands off their ears or off from in front of 
their eyes and listen to the presidents or the executive directors of 
rural hospitals, they would hear them say: This will really hurt us. 
This will hurt, not just our ability to provide care to those who will 
not have insurance, it will hurt our finances. It will diminish our 
care for everyone in this rural community. Everyone will be hurt by 
  Is that what the President meant when he said this bill is mean? 
Well, if that is what he meant, if what he meant is it is mean because 
it rips healthcare from 20 million Americans, then I agree with the 
President. If when the President criticizes the TrumpCare bill as being 
mean, if he meant that because it was going to destroy the guarantee of 
access by folks with preexisting conditions, then I agree with him. If 
he said it because it will destroy essential benefits and allow there 
to be insurance policies that aren't worth the paper they are written 
on, then I agree with the President.
  If it does, it is going to greatly increase the cost of insurance for 
older Americans, up to eightfold times. If that is why the President 
said it is mean, I agree with the President.
  The President should weigh in and say: No secret process on a bill so 
important to the healthcare of millions of Americans. President Trump 
should weigh in and say: I don't want a bill that looks anything like 
that House bill because it is defective in this area, in this area, and 
in this area, hurting everybody in the communities, undermining the 
clinics, undermining the

[[Page S3536]]

hospitals, destroying insurance, destroying the opportunity of access 
for preexisting conditions, and ripping away the guarantee that 
essential benefits will be covered. That is what the President should 
  He thinks the bill is terrible because he finally looked at it. Well, 
he is going to think the bill crafted by the secret 13 is terrible too. 
He has a chance to stand up and fight for the American people and say: 
I will never sign a bill that goes through a secret process that 
excluded the insights from our rural hospitals, insights from our rural 
clinics, insights from our nurses, and insights from our doctors. I 
will never sign a bill in the Oval Office that excluded the American 
people from being allowed to weigh in on the conversation. I will never 
sign a major bill that hurts so many people in my Oval Office if it 
never had a committee hearing and never had amendments, never had a 
chance to go through the legislative process the way envisioned in our 
``we the people'' Constitution. That would be the right thing for 
President Trump to do.
  He has recognized the bill is profoundly flawed. He has a chance to--
not only a flawed bill but a profoundly, unacceptable process in our 
constitutional democratic Republic.
  Former Chief Justice Hughes said: We are here not as masters but as 
servants, not to glory in power, but to attest our loyalty to the 
commands and restrictions laid down by the people of the United States 
in whose name and by whose will we exercise our brief authority.
  Each one of us is here for a short period of time, but we take our 
constitutional roles as Senators from the foundation of the power of 
the American people, the ``we the people'' Constitution. To exclude 
them from the process is to violate the very premise on which our 
Nation is founded.
  So we have to stop this process. We have to stop it in its tracks. 
Whether you are a Democrat or Republican, whether you come from a rural 
State or a highly populated State, it is a responsibility to stop this 
process, return to regular legislative deliberation so that we can, in 
fact, have a ``we the people'' conversation, fully honoring the experts 
and the feedback from ordinary citizens across our Nation.
  No hearing, no legislative deliberation, no vote. No hearing; no 
  Thank you, Mr. President.
  The PRESIDING OFFICER (Mr. Perdue). The Senator from South Dakota.
  Mr. THUNE. Mr. President, once again, we have more bad news about 
ObamaCare. Last week, Anthem announced it will pull out of Ohio's 
health insurance exchange for 2018. That means that a minimum of 18 
Ohio counties will be without an exchange insurer next year. Twenty-
five Missouri counties are in the same boat, and more Americans are 
likely to find themselves in the same situation.
  On June 2, the Omaha World-Herald announced that 100,000 Nebraskans 
could end up with zero options for individual coverage in 2018. 
Insurers have been pulling out of the exchanges right and left.
  In February, Humana announced its decision to completely pull out of 
the exchanges for 2018. Three months later, Aetna, which had already 
sharply reduced its exchange participation in 2017, also confirmed it 
would pull out completely in 2018.
  In 2016, 7 percent of U.S. counties had just one choice of insurer on 
their healthcare exchange. In 2017, this year, roughly one-third of 
U.S. counties have just one choice of insurer. Based upon the 
information available so far, the New York Times is currently 
estimating that about 45 percent of U.S. counties will have one or no 
insurer next year.
  One thing is for sure, Mr. President, Americans are facing fewer and 
fewer health insurance choices, and the prices of those choices are 
going up.
  Proposed rates, proposed rate increases for 2018 are emerging, and 
once again they are not looking good. Some of the average rate hikes 
facing Americans around the country include 17.2 percent, 33.8 percent, 
30 percent, 45 percent, 38 percent, 58.8 percent.

  Three weeks ago, the Department of Health and Human Services released 
a report comparing the average individual market insurance premium in 
2013, which is the year that most of ObamaCare's regulations and 
mandates were implemented, with the average individual market exchange 
premium in 2017 in the 39 States that use healthcare.gov. What they 
found is that between 2013 and 2017, the average individual market 
monthly premium in the healthcare.gov States increased by 105 percent--
105 percent.
  In other words, on average, individual market premiums more than 
doubled in just 5 years. That is from HHS in their report that just 
came out in the last couple of weeks. Three States saw their premiums 
triple over the same period--triple in just 5 years.
  I don't know too many families who can afford to have their premiums 
triple over 5 years. What we know is that the ObamaCare status quo is 
unacceptable, and it is unsustainable.
  More than one insurance CEO has suggested that ObamaCare is in a 
death spiral, and it is pretty hard to disagree. Combine soaring 
premiums with a steady insurer exodus, and sooner or later we get a 
partial or complete exchange collapse, which is what we are facing 
today, not to mention all the other ObamaCare problems, such as the 
deductibles that are so high that sometimes people can't actually 
afford to use their healthcare plans or narrow plan networks with few 
provider choices. We have higher premiums, higher deductibles, higher 
costs, fewer options, fewer choices.
  Republicans are currently working on legislation to help Americans 
struggling under ObamaCare. My colleagues in the House made a good 
start, and in the Senate we are working to build on the bill they 
  We are committed to helping Americans trapped on the ObamaCare 
exchanges. We are committed to addressing ObamaCare's skyrocketing 
premium increases. We are committed to preserving access to care for 
Americans with preexisting conditions, and we are committed to making 
Medicaid more sustainable by giving States greater flexibility while 
ensuring those who rely on this program don't have the rug pulled out 
from under them. We need to make healthcare more affordable, more 
personal, more flexible, and less bureaucratic.
  My colleague from Oregon was just talking about the complaints they 
have about the healthcare process, the discussions that are going on, 
and how much pain, if this passes, it is going to cause the American 
people. I can tell you one thing: Today, it is pretty darn painful for 
families I have talked to in my State of South Dakota, hard-working 
farm and ranch families who are having to pay $2,000 a month, $24,000 a 
year for insurance coverage--in some cases with $5,000 deductibles, 
assuming they can even afford to use that expensive policy by being 
able to cover the deductible. There are people across this country who 
are hurting because of this failed healthcare insurance program. It is 
high time for us to fix it.
  I believe the American people want to see Congress act in a way that 
will make healthcare insurance more affordable to them, more personal, 
so that they will have more choices, greater options, and more 
competition that will help bring those premiums down to a more 
reasonable level. They need to have more than one choice. When 45 
percent of the counties in America have one choice or no options on the 
exchanges, that is an unacceptable situation and one that we have to 

            Countering Iran's Destabilizing Activities Bill

  Mr. President, I also want to take a few minutes today to discuss the 
national security bill the Senate just passed, the Countering Iran's 
Destabilizing Activities Act.
  I hardly need to recite the long list of Iranian activities that make 
this country a clear and present danger to peace and stability in the 
Middle East and outside it. Iran remains the world's leading state 
sponsor of terrorism. It engages in systematic human rights abuses from 
torture to the targeting of religious minorities. Of course, Iran has 
long provided critical support to Syrian President Bashar al-Assad, who 
is perhaps most notable for the repeated use of chemical weapons on his 
own people. The fact that Assad still remains in power after the long 
list of atrocities his regime has committed is due in no small part to 
the support that Iran has provided.

[[Page S3537]]

  In addition to propping up Assad's reign of terror, Iran also 
provides support to the Houthi rebels in Yemen. Secretary of Defense 
James Mattis recently noted: ``We see Iranian-supplied missiles being 
fired by the Houthis into Saudi Arabia.''
  Well, providing these missiles puts Iran in violation of at least two 
U.N. Security Council resolutions--not that Iran appears to care. In 
fact, violating U.N. Security Council resolutions and international law 
is common practice for the Iranian Government, whether it involves 
supplying missiles to the Houthis or increasing Iran's own stockpiles.
  When it is not violating the letter of the law, Iran is also happy to 
violate the spirit of international agreements. After the misguided 
Iran deal went into effect, Iran resumed ballistic missile testing, 
even though the U.N. Security Council resolution endorsing the nuclear 
deal called upon Iran not to engage in these activities.
  Most recently, Iran unsuccessfully tested a submarine missile in the 
Strait of Hormuz in May, following ground-based missile testing in 
January and March. Many of those missiles have a range to reach 
targets, not only throughout the Middle East but outside it.
  Under the last administration, Iranian belligerence was too often 
ignored or even rewarded. That needs to end now. We cannot afford to 
let Iran continue to destabilize the Middle East. We need to make it 
clear that the United States and its new leadership will not tolerate 
Iranian aggression and the terrible human suffering that has resulted.
  We need to assure our allies--especially Israel, our closest and most 
reliable ally in the Middle East--that we are committed to standing 
with them against Iranian threats. The Countering Iran's Destabilizing 
Activities Act will send a clear signal to Iran that the United States 
and its new leadership are serious about cracking down on Iranian 
  This bill will sanction individuals involved in Iran's ballistic 
missile program or any other program designed to deliver weapons of 
mass destruction. It will sanction individuals who contribute to 
Iranian violations of arms embargoes. It will allow the President to 
impose sanctions on individuals who have perpetrated human rights 
violations against human rights crusaders in Iran. Perhaps most 
importantly, this legislation identifies and will hold accountable the 
entire Iranian Islamic Revolutionary Guard Corps, not just the Quds 
Force, for its role in implementing Iran's destabilizing agenda.
  There is no easy solution to the unrest and violence in the Middle 
East, but this bill offers one commonsense step forward.
  Yesterday the Senate passed an amendment to this bill imposing 
additional sanctions against another country stirring up unrest in the 
Middle East, and that is Russia. Russia's increasing boldness on the 
international stage is a natural consequence of the Obama 
administration's passive foreign policy. From annexing Crimea to 
supporting the murderous Assad regime in Syria, to meddling in 
elections, we cannot allow this level of Russian aggression to go 
  The Russia sanctions amendment codifies and strengthens existing 
Russia sanctions and imposes a number of new ones. Human rights 
abusers, individuals supplying weapons to Assad's regime, hackers 
acting on behalf of the Russian Government, and Russians involved in 
corruption are all sanctioned in this amendment.
  I am grateful to Senators Corker and Crapo, the chairman of the 
Foreign Relations Committee and the chairman of the Banking Committee, 
for all the work they have done on this bill and on the Russia 
sanctions amendment. It was a bipartisan bill. Our colleagues on the 
other side, the Senator from Maryland and others, were involved in 
crafting this legislation, and it is a demonstration that this body can 
come together and do consequential things. These are two big national 
security and foreign policy measures that we have moved today.
  There have to be consequences for Iranian and Russian aggression, and 
this legislation makes sure there will be. I am pleased that it moved 
today with largely bipartisan support in the U.S. Senate because it 
will send a clear message.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.

                            Minority Health

  Mr. CARDIN. Mr. President, April was National Minority Health Month. 
I point that out because I have worked with many of my colleagues in 
order to advance minority health.
  We have done some very important things in recent years that I am 
very proud of, and many of those are included in the Affordable Care 
Act. I know that Senator Carper and Senator Blumenthal will be on the 
floor; Senator Carper is here now. They have been instrumental in 
advancing quality healthcare for all Americans, but we do recognize 
that we have a special role in regard to historic discrimination on 
minority health. I was pleased that the Affordable Care Act included 
the National Institute on Minority Health and Health Disparities so 
that we could have a focal point at NIH to deal with the historic 
problems and have a game plan to advance that.
  I was also pleased that the Affordable Care Act provided coverage for 
minorities in greater numbers because when we looked at the number of 
uninsured, the number of minorities were a much higher percentage than 
the general population of uninsured. When we looked at inadequate 
coverage, we saw the same numbers. So we have made advancements.
  In April, historically, I had filed a resolution in order to 
acknowledge the progress we made and to continue our commitment to make 
sure that all Americans have access to affordable, quality healthcare 
and that we do not discriminate. That resolution had always cleared 
without any difficulty until 2017. For reasons I cannot explain, there 
were Republican objections, and we were not able to adopt the 
resolution commemorating minority health month.
  Mr. President, I ask unanimous consent that the text of that 
resolution be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       Promoting minority health awareness and supporting the 
     goals and ideals of National Minority Health Month in April 
     2017, which include bringing attention to the health 
     disparities faced by minority populations of the United 
     States such as American Indians, Alaskan Natives, Asian 
     Americans, African Americans, Latino Americans, and Native 
     Hawaiians or other Pacific Islanders.
       Whereas the origin of National Minority Health Month is 
     National Negro Health Week, established in 1915 by Dr. Booker 
     T. Washington;
       Whereas the theme for National Minority Health Month in 
     2017 is ``Bridging Health Equity Across Communities'';
       Whereas, through the National Stakeholder Strategy for 
     Achieving Health Equity and the HHS Action Plan to Reduce 
     Racial and Ethnic Health Disparities, the Department of 
     Health and Human Services has set goals and strategies to 
     advance the safety, health, and well-being of the people of 
     the United States;
       Whereas a study by the Joint Center for Political and 
     Economic Studies, entitled ``The Economic Burden of Health 
     Inequalities in the United States'', concludes that, between 
     2003 and 2006, the combined cost of health inequalities and 
     premature death in the United States was $1,240,000,000,000;
       Whereas the Department of Health and Human Services has 
     identified 6 main categories in which racial and ethnic 
     minorities experience the most disparate access to health 
     care and health outcomes, including infant mortality, cancer 
     screening and management, cardiovascular disease, diabetes, 
     HIV/AIDS, and immunizations;
       Whereas, in 2012, African American women were as likely to 
     have been diagnosed with breast cancer as non-Latina White 
     women, but African American women were almost 40 percent more 
     likely to die from breast cancer than non-Latina White women;
       Whereas African American women are twice as likely to lose 
     their lives to cervical cancer as non-Latina White women;
       Whereas African American men are 60 percent more likely to 
     die from a stroke than non-Latino White men;
       Whereas Latinos are 1.7 times more likely to be diagnosed 
     with diabetes by a physician, and are 40 percent more likely 
     to die of diabetes, than non-Latino Whites;
       Whereas Latino men are 3 times more likely to have HIV 
     infections or AIDS than non-Latino White men;
       Whereas Latina women are 4 times more likely to have AIDS 
     than non-Latina White women;
       Whereas, in 2014, although African Americans represented 
     only 13 percent of the population of the United States, 
     African Americans accounted for 43 percent of HIV infections;
       Whereas, in 2010, African American youth accounted for an 
     estimated 57 percent, and

[[Page S3538]]

     Latino youth accounted for an estimated 20 percent, of all 
     new HIV infections among youth in the United States;
       Whereas, between 2005 and 2014, the number of Asian 
     Americans diagnosed with HIV increased by nearly 70 percent;
       Whereas, in 2014, Native Hawaiians and Pacific Islanders 
     were 1.7 times more likely to be diagnosed with HIV than non-
     Latino whites;
       Whereas Native Hawaiians living in the State of Hawaii are 
     5.7 times more likely to die of diabetes than non-Latino 
     Whites living in Hawaii;
       Whereas Native Hawaiians and Pacific Islanders are 30 
     percent more likely to be diagnosed with cancer than non-
     Latino whites;
       Whereas, although the prevalence of obesity is high among 
     all population groups in the United States, 42 percent of 
     American Indian and Alaskan Natives, 41 percent of Native 
     Hawaiian and Pacific Islanders, 40 percent of African 
     Americans, 31 percent of Latinos, 24 percent of non-Latino 
     whites, and 11 percent of Asian Americans are obese;
       Whereas, in 2013, Asian Americans were 1.2 times more 
     likely than non-Latino Whites to contract Hepatitis A;
       Whereas, among all ethnic groups in 2013, Asian Americans 
     and Pacific Islanders had the highest incidence of Hepatitis 
       Whereas Asian American women are 1.3 times more likely than 
     non-Latina Whites to die from viral hepatitis;
       Whereas Asian Americans are 3 times more likely than non-
     Latino Whites to develop chronic Hepatitis B;
       Whereas of the children living with diagnosed perinatal HIV 
     in 2014, 65 percent were African American, 15 percent were 
     Latino Americans, and 11 percent were non-Latino whites;
       Whereas the Department of Health and Human Services has 
     identified heart disease, stroke, cancer, and diabetes as 
     some of the leading causes of death among American Indians 
     and Alaskan Natives;
       Whereas American Indians and Alaskan Natives die from 
     diabetes, alcoholism, unintentional injuries, homicide, and 
     suicide at higher rates than other people in the United 
       Whereas American Indians and Alaskan Natives have a life 
     expectancy that is 4.4 years shorter than the life expectancy 
     of the overall population of the United States;
       Whereas African American babies are 3.5 times more likely 
     than non-Latino White babies to die due to complications 
     related to low birth weight;
       Whereas American Indian and Alaskan Native babies are twice 
     as likely as non-Latino White babies to die from sudden 
     infant death syndrome;
       Whereas American Indian and Alaskan Natives have 1.5 times 
     the infant mortality rate as that of non-Latino whites;
       Whereas American Indian and Alaskan Native babies are 70 
     percent more likely to die from accidental deaths before 
     their first birthday than non-Latino White babies;
       Whereas only 5 percent of Native Hawaiian and Pacific 
     Islanders, 6 percent of Asian Americans, 8 percent of 
     Latinos, 9 percent of African Americans, and 14 percent of 
     American Indians and Alaska Natives received mental health 
     treatment or counseling in the past year, compared to 18 
     percent of non-Latino whites;
       Whereas marked differences in the social determinants of 
     health, described by the World Health Organization as ``the 
     high burden of illness responsible for appalling premature 
     loss of life'' that ``arises in large part because of the 
     conditions in which people are born, grow, live, work, and 
     age'', lead to poor health outcomes and declines in 
       Whereas the Patient Protection and Affordable Care Act 
     (Public Law 111-148; 124 Stat. 119)--
       (1) has reduced the uninsured rate for minority communities 
     by at least 35 percent;
       (2) has helped further combat health disparities for low-
     income individuals through coverage expansions in the 
     Medicaid program under title XIX of the Social Security Act 
     (42 U.S.C. 1396 et seq.) and the individual health insurance 
     marketplaces; and
       (3) provides specific protections and rights for American 
     Indians and Alaskan Natives, 21.4 percent of whom lack health 
       Whereas, despite the substantial improvements in health 
     insurance coverage among women overall, women of color are 
     more likely to be uninsured;
       Whereas, in 2012, 36 percent of Latina women, 29 percent of 
     American Indian women, 23 percent of African American women, 
     19 percent of Asian and Pacific Islander women, and 14 
     percent of non-Latina White women were uninsured;
       Whereas community-based health care initiatives, such as 
     prevention-focused programs, present a unique opportunity to 
     use innovative approaches to improve health practices across 
     the United States and to sharply reduce disparities among 
     racial and ethnic minority populations: Now, therefore, be it
       Resolved, That the Senate supports the goals and ideals of 
     National Minority Health Month in April 2017, which include 
     bringing attention to the severe health disparities faced by 
     minority populations in the United States, such as American 
     Indians, Alaskan Natives, Asian Americans, African Americans, 
     Latino Americans, and Native Hawaiians or other Pacific 

  Mr. CARDIN. I thank Senators Menendez, Blumenthal, Brown, Hirono, 
Markey, Klobuchar, Van Hollen, Booker, Peters, Duckworth, and Carper 
for their help in regard to minority health and the resolution.

                         Healthcare Legislation

  So we couldn't do that, which is a pretty easy thing to do, but now 
the Republicans are looking to bring out in the next 2 weeks a 
rewriting of our entire healthcare law, one-sixth of our economy, and 
they are talking about bringing this out for perhaps passage in the 
U.S. Senate during the next 2 weeks.
  I don't know of anyone who has seen a copy of this bill. I certainly 
have not seen it, and I am a member of the Senate Finance Committee. 
Senator Carper is a member of the Senate Finance Committee. We have not 
seen a copy of the bill, even though we are the committee of 
jurisdiction, along with the HELP Committee. I certainly want to be 
able to look at this bill, make sure that there are public hearings and 
an opportunity for input from all Members of the U.S. Senate--first 
those who serve on the relevant committees through the committee 
markups and then on the floor of the U.S. Senate. But what I understand 
from the majority leader is that may not be the case. That would be an 
affront to our Democratic institution. That would be insulting the 
Members of the Senate and the committee that I serve on, the Senate 
Finance Committee.
  I need to mention that because we do know what the House of 
Representatives sent over to us. We don't know if that is going to be 
the bill that is going to be brought out, but there hasn't been any 
hearing on the bill that the House of Representatives sent over to us.
  Compare that to the passage of the Affordable Care Act. We had 
numerous, dozens of hearings on the Affordable Care Act. We had months 
of negotiations on the Affordable Care Act back and forth--bipartisan 
negotiations. We had committee markups in two of our committees, and 
hundreds of amendments were considered. Many Republican-sponsored 
amendments were adopted on the Affordable Care Act. We went through a 
regular legislative process.
  Yet the Republican leadership is telling us that we are going to 
totally change the Affordable Care Act, totally change the healthcare 
system, and not offer the American people an opportunity to see what we 
are doing--or their elected Representatives to be able to offer 
comments or amendments to that? That is outrageous. That is not a 
democratic institution. We need to speak out about it.
  Now we are all vulnerable to that, all Americans. I have thought 
about the people in my State, the 400,000 who have coverage under the 
Affordable Care Act, who didn't have coverage prior to the Affordable 
Care Act. They are very much at risk because, according to the 
Congressional Budget Office, if we have on the floor of the Senate 
anything similar to what the House passed, most of those 400,000 are 
going to lose their insurance coverage. What are they going to do?
  Then we are talking about putting a cap on Medicaid. Well, have you 
talked to the Governor of your State? Have you talked to your State 
legislature as to how they are doing with their budgets? Do you really 
believe the States can pick up what we cut? The answer is obviously no.
  We offered an expansion of Medicaid so more working families, more 
veterans, more people who are vulnerable could get coverage. That is 
gone under the caps that the Republicans are talking about, putting our 
most vulnerable at risk.
  I started talking about minority health. Let me just underscore that 
with Medicaid. In my State and in every State, when you look at the 
percentage of people who are covered under Medicaid, it is much higher 
for the minority community because they historically have been 
discriminated against. They do not have the coverage going into the 
Affordable Care Act. That is going to affect our most vulnerable. It is 
also interesting to note that a higher percentage of veterans is under 
the Medicaid system. That will affect our veterans. Of course, our 
seniors depend upon Medicaid for longer long-term care. They are going 
to be adversely affected by these caps under the Medicaid Program.
  Then we have the impact on all of us who have insurance and may be 
able to

[[Page S3539]]

keep our insurance after this type of legislation. We are going to be 
adversely affected. Why? Because who do you think pays for those who do 
not have health insurance? You get cost shifting, and it is done in a 
more costly, expensive way so our healthcare costs go up. Those of us 
who have insurance pay more, and those who do not have insurance do not 
get the early interventions they need in order to stay healthy.
  The vulnerabilities continue because one of the things that was 
affected by the House-passed bill was what we call the essential health 
benefits. What we did is require that those benefits be provided under 
all healthcare plans, including Medicaid.
  So, yes, I could talk about obstetrics for women, which would be 
covered under all plans, and that women who need obstetrics would not 
have to pay a much higher premium as they would be in a high-risk pool. 
Because of the way the insurance would be done, only women who would 
need that would get into the plan, and it would cost a lot more. Yes, 
that discriminates against women.
  Again, I could also talk about minority communities that now have 
coverage for mental health and addiction because that is required under 
the Affordable Care Act. When it becomes discretionary with the States 
and they get into tight budget problems, they will lose that coverage.
  We are all talking about the explosion of opioid addiction in our 
communities. In Maryland, I think the rate now is 60 percent higher 
this year than last year of overdose deaths. Do we really want to cut 
one of the major tools we have in trying to get this epidemic under 
control? That is what we are talking about in regard to what the House-
passed bill does.
  At a minimum, we need to have public hearings to know what we are 
doing. This is a democratic institution. Under the Affordable Care Act, 
we had dozens of hearings. The committees of jurisdiction need to work 
on this bill. They need to be able to mark it up. They need to be able 
to offer amendments, which was afforded to every Senator in this body 
under the Affordable Care Act. Many of our colleagues who voted against 
the Affordable Care Act have amendments that were included in the 
Affordable Care Act. That is how a democracy works.
  Everyone is affected by this process but particularly the vulnerable, 
particularly those who are uninsured and those who will become 
uninsured. Those who have insurance and who have very few other options 
are going to find their benefits reduced. Minorities, our disabled 
population, older Americans, and women all will be discriminated 
  At a time at which we want to focus on the progress that we have made 
to narrow the gap in minority health and health disparities, it would 
just be a tragedy to move in the wrong way, to reverse the progress we 
have made, and to do that without an appropriate process of 
transparency, which has been the hallmark of American democracy.
  I urge my colleagues in that there is still time. If you have 
proposals, work with us--all 100 Senators. I, certainly, have worked 
with my Republican colleagues on many healthcare issues that are now 
the law of this land.
  We offer to work with you. All we say is don't tell us that you are 
going to do this by repealing a bill and then come to us to try to fix 
it. Work with us to improve our healthcare system, and we will work 
with you. There is still time. Let's work together. Let's have public 
hearings. Let's get public input. Let's use the old-fashioned process 
of allowing us to offer amendments. Let's debate those amendments. The 
end result will not only be better legislation for the American people 
but legislation that we know will stand the test of time and give 
predictability to the healthcare stakeholders in our country.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, I thank my friend, my neighbor from 
Maryland, for inviting a number of us to come to the floor today, this 
afternoon, to talk a bit about the Affordable Care Act. I am really 
honored to stand next to him here as we do sit next to each other on 
the Finance Committee and on the Environment and Public Works 
Committee. He is a great leader on both of those committees.

                         Sanctions Legislation

  Mr. President, Senator Cardin and I were on the floor earlier today, 
along with the Presiding Officer, and we voted on legislation that 
attempts to send a message to Iran.
  By the way, it just had elections, gosh, not even a month ago, 
whereby the reformist President Rouhani was reelected by a big margin. 
Reformists-moderates were elected as the mayor of Tehran and in other 
municipalities across the country. There are a lot of young people in 
that country who want a better relationship with this country, and they 
actually had a chance to speak at the voting box. They elected a number 
of women to serve in positions of real responsibility, not just in 
their Parliament but as members, say, of Tehran's city council.
  By the way, the Iranians are basically keeping their word with 
respect to the agreement between five nations, including the United 
States, China, Russia, Britain, France, and Germany. They are actually 
keeping their word with respect to complying with the nuclear agreement 
that was entered into, oh, gosh, 2 years ago. What they are doing and 
that we disagree with is they are testing ballistic missiles, and there 
is basically the U.N.'s strong message to Iran not to do that. ``If you 
do, we will sanction you in different ways,'' but they have continued 
to test ballistic missiles. They say it is for defensive purposes, but 
you cannot be sure so we strengthened those sanctions.
  With those sanctions, we also included sanctions that basically say 
to Russia--and all 17 intelligence agencies say Russia intervened in 
our last election--no question. They intervened on behalf of one 
candidate, Mr. Trump. They wanted to elect him, and they wanted to make 
sure Hillary Clinton did not get elected. They succeeded. That is not 
just Democratic messaging. Every one of our 17 intelligence agencies 
has come to the same conclusion and has testified publicly to that 
  As a result, this legislation was initially focused just on Iran, but 
it refocused and pivoted--maybe refocused even more--on Russia in order 
to sanction them for their misdeeds, which I think are, in many ways, 
more significant than what the Iranians have done and have been 
sanctioned for again.
  Why do I go back to this legislation that we just debated and adopted 
here this morning?
  Consistent with what Senator Cardin has talked about--and he is very 
much an architect involved right in the middle of the effort to bring 
that legislation to the floor. It came out of his committee. He is the 
senior Democrat, the ranking member. Bob Corker, of Tennessee, is the 
chair. A number of members--Democratic and Republican--on that 
committee worked together to fashion that legislation, to bring 
bipartisan legislation to the floor.
  I say to my colleague Senator Cardin that I didn't know what the 
final vote count was. It was 98 to 2. That is what we can accomplish 
when we work together, and I think it is a great message as we pivot 
and talk about the Affordable Care Act.

                         Healthcare Legislation

  Mr. President, when our friend from South Dakota, Senator Thune--a 
great friend for, I think, all of us and admired by both sides--was 
talking about how deplorable ObamaCare was and how it is in a death 
spiral and so forth, I just wanted to stand up and ask him to yield to 
me so I can say that when Barack Obama and Joe Biden stepped down as 
President and Vice President of the United States, my recollection was 
that every county of every State in this country had access to 
healthcare through the health exchanges.
  Where did the idea for health exchanges come from? It came from the 
Republicans in 1993, from the Heritage Foundation, the rightwing 
Republican think tank.
  They came up with an idea that says: Let's create exchanges in every 
State, where people who don't have healthcare coverage can get their 
coverage through large purchasing pool. There would be one in every 
State. The legislation said: Let's have a sliding scale tax credit to 
make sure low-income families who do not have coverage can afford that 
coverage in the

[[Page S3540]]

exchanges. As their income goes up, the tax credit buys down the cost 
of coverage. The exchange goes down, and it eventually goes away.
  The Republican legislation in 1993, fashioned by Heritage, said there 
was going to be an individual mandate. People would have to get 
coverage in this country. If they did not, they would have to pay a 
fine. One could not make people get coverage, but there would be a 
fine. There was the idea that employers of a certain size and with a 
certain a number of employees would have to get coverage. We call that 
an employer mandate. Finally, the health insurance companies could not 
deny coverage to people in this country because of preexisting 
  Those are all concepts that were in the 1993 legislation that was 
introduced by Senator John Chafee and was cosponsored by, among others, 
Senator Hatch, of Utah, Senator Grassley, of Iowa, who are now two of 
the most senior Republicans in the Senate, including being the two most 
senior Republicans on the Finance Committee on which Senator Cardin and 
I are privileged to serve.
  I said as recently as last week, when the Secretary of Health and 
Human Services was before our committee to defend the President's 
budget, that I applauded Senator Hatch and I applauded Senator Grassley 
for cosponsoring that 1993 legislation, which became the foundation for 
healthcare coverage in Massachusetts, which is where they cover 
everybody. It is called RomneyCare. It was adopted when he was the 
Governor, and it was fashioned very much under the same foundation.
  Senator Cardin and I are on the Finance Committee, and when we were 
debating the Affordable Care Act, we literally took those Republican 
ideas from Heritage, from Senator Chafee, from the 23 Republican 
cosponsors for RomneyCare and sort of made them the foundation of 
ObamaCare. It is ironic just to hear my friend Senator Thune talk today 
about the tale of horribles from the Affordable Care Act. Actually, the 
things my Republican friends are criticizing the most were their ideas 
from 24 years ago. Personally, I think they were pretty good ideas, and 
if they were given a fair chance, they could be very effective.
  One of my Republican friends said the other day that when the 
Affordable Care Act was debated and voted on and so forth, the 
Republicans were pretty much shut out of the process. So it is too bad 
the Democrats are shut out of the process now as we revisit healthcare 
coverage with the terrible legislation that has come out of the House 
of Representatives. I think, if I am not mistaken--correct me if I am 
wrong, Senator Cardin--they adopted it without a hearing. I think they 
adopted it on a straight party-line vote. I think they did it without 
any kind of score from the Congressional Budget Office and just sent it 
over here.
  While they were doing that, I will just go back in time, if I can, to 
the year of 2009, when we debated the Affordable Care Act here. We had 
two committees of jurisdiction. One was the Health, Education, Labor, 
and Pensions Committee. That committee held no fewer than 14 bipartisan 
roundtables. A roundtable is very much like a hearing, but it is not 
quite as formally structured. It held 14 bipartisan roundtables, which 
were designed to try to build a consensus around the Affordable Care 
Act, or healthcare coverage, in this country. Again, this was in 2009.
  In 2009, the same committee--the Health, Education, Labor, and 
Pensions Committee, the HELP Committee--held 13 bipartisan hearings. So 
there were 14 bipartisan roundtables and 13 bipartisan hearings in all 
during the actual time they were debating on and voting on the 
legislation itself. During the HELP Committee's debate and in actually 
marking up the bill, some 300 amendments were considered that were 
offered by Democrats and Republicans. More than half of those were 
accepted. Of the more than half of those 300 accepted--we turned down 
160 or so--160 of them happened to be offered by Republicans. Think 
about that. There were 14 bipartisan roundtables and 13 bipartisan 
hearings. There were 300 amendments offered, and over half of those 
were Republican amendments. Over half of those 300 were actually 
adopted, and 160 in all were Republican amendments. That does not sound 
like they were shut out on the Health, Education, Labor, and Pensions 
  On the Finance Committee, on which Senator Cardin and I serve, we had 
17 roundtables and hearings. We held 13 member meetings, 38 negotiation 
meetings, and a 7-day-long actual business meeting and markup in 
public, during which we offered amendments and voted on amendments. I 
think, roughly, a dozen Republican amendments were offered and 
  I have a friend who, when you ask him how he is doing, always 
answers: ``Compared to what?''
  I would say, as to the process right now that we are looking at with 
the Republicans' belated response, if you will, to the Affordable Care 
Act that came out of the House and is now being negotiated in private--
not debated but negotiated and some would say in secret. It is hard to 
keep a secret around here, but it is certainly in private. To my 
knowledge, there are no bipartisan roundtables and no bipartisan 
hearings. To my knowledge, there will not be an opportunity for markups 
or business meetings at which hundreds of amendments could be offered 
and debated and voted on--none of that. And it will use a process 
called reconciliation, where they will bring whatever they come up with 
in these closed meetings, and we have a chance to vote on it up or 

  The House never had it scored. The Congressional Budget Office never 
had a chance to say: This is how many people will lose coverage. This 
is what it is going to cost if people don't get help through Medicaid. 
This is what is going to happen to folks losing their coverage 
  They never did that in the House. I don't know if we will see that in 
the Senate either.
  (Mr. CASSIDY assumed the Chair.)
  There is a right way and a wrong way to do this stuff. Our Republican 
friends will probably never agree that we were trying to do it the 
right way in 2009. What we came up with was the Affordable Care Act at 
the end of the day, and I would be the first to say it is not perfect. 
There are things I would like to change. I am sure Senator Cardin feels 
that way. I am sure the Presiding Officer who is with us today knows a 
lot about healthcare. He probably would be willing to change a number 
of things. For years, I have said: Why don't we just figure out as one, 
as a bipartisan group--as we were today on the sanctions legislation 
for Russia and Iran--why don't we try working together on this stuff? 
And we are sort of waiting to see if we might have a taker.
  The Presiding Officer has been very good about reaching out, and I 
applaud him for that. I think he and I will be in a forum together 
maybe next week to talk about some of this stuff in public, but I 
applaud his efforts to reach out and see if we can't foster a better 
way forward.
  Let me close with this: Some of you know I spent some of my years of 
life in uniform. For a while, I was a civil air patrol cadet growing up 
in Virginia. I wanted to go to the Air Force Academy, but I just didn't 
know how to apply. I applied too late and missed it. I learned about 
the Navy ROTC and applied for a scholarship, was fortunate enough to 
win it, and went to Ohio State. I became a midshipman and 4 years later 
a naval flight officer and then off to Pensacola. I spent 5 years in 
Active Duty in Southeast Asia and after that in the Cold War as a P-3 
Navy aircraft commander. I loved the Navy. I feel privileged that it 
helped me go to undergraduate school and, after Active Duty, to move to 
Delaware and get an MBA thanks to the GI Bill. I was privileged to be 
elected Governor and serve as the commander in chief of the Delaware 
National Guard for 8 years beyond that. Over half of my life has been 
involved in the military.
  A lot of times when I was younger, I would think about who is helped 
in healthcare under Medicaid. I used to think that folks who are helped 
the most by Medicaid are women, poor women, and their children. As it 
turns out, today, especially as the baby boomers get older, more and 
more of them are being covered by Medicaid. They receive their coverage 
because they spend down their assets. A lot of them have dementia and 
have other

[[Page S3541]]

disabilities, and they end up in nursing homes. More than half of the 
money we are spending on Medicaid these days is on those folks. A lot 
of them are part of my generation and older--our parents, uncles, and 
  As it turns out, unbeknownst to me, about 2 million of the roughly 23 
million veterans we have in this country--22 million veterans we have 
in this country are served by Medicaid.
  The day I showed up at Ohio State to be a Navy ROTC midshipman, we 
had only White males in our ROTC. It turned out that is what they had 
in the Army ROTC and in the Air Force ROTC at Ohio State. When I got to 
my squadron on Active Duty--in the many years I was in my Active Duty 
squadron, I think we had just two or three African-American officers. I 
don't remember ever having an Asian-American officer. There were no 
women who were officers or even among our enlisted personnel. That has 
all changed now. The face of our military officer corps and enlisted 
corps looks a whole lot more like America today than it used to.
  As it turns out, the folks who are veterans in this country--those 22 
million people--look a whole lot more like America today than maybe was 
the case a number of years ago. They are Caucasian, they are African 
American, they are Latino, they are Asian American--all of the above. A 
number of those 22 million veterans who are depending on Medicaid are 
minorities. They are going to be adversely affected if we are not 
careful of what we do in the House or if we in the Senate replicate 
something like that or similar to that and ultimately in a conference 
try to represent a compromise between what we do in the Senate and what 
they have done in the House.
  I will close with this: This story can end badly, or it can end in a 
better way. We have just gotten a good example of how to do it right 
with the legislation we just passed earlier today, the sanctions 
against Russia and Iran. My hope is that we will use that as a template 
to come back and make changes to the Affordable Care Act and that we 
will do it in a way that fixes what needs to be fixed and preserves 
what needs to be preserved.
  I thank my friend from Maryland for his leadership on this and God 
knows how many other issues.
  If I could have one more moment to say that Senator Kaine and I have 
offered legislation that I think has probably been shared with the 
Presiding Officer's office that seeks to help stabilize the exchanges 
and the ability of the health insurance companies to have some 
additional predictability and certainty through reinsurance. My hope is 
that we will have a chance to share what we have offered and maybe see 
if that is something the Presiding Officer would be interested in 
joining us in supporting.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Georgia.

                                The Debt

  Mr. PERDUE. Mr. President, I rise today to speak about a train wreck 
that is coming to our country right before our very eyes.
  Yesterday, the Federal Reserve, for the fourth time in the last year 
and a half, increased the Federal discount rate by one-quarter point--
one-quarter point. That is a rounding error in most people's 
imaginations; yet, I think it is a very impactful number. That is the 
fourth increase in the last year and a half that amounts to 100 basis 
points or a 1 full percentage point increase in the discount rate. With 
a $20 trillion debt, that equates to about $200 billion of new interest 
that we will be required to pay out of the revenue we get off the backs 
of working men and women in America.
  I have frequently come to this floor to speak about the $20 trillion 
debt, but, as we see what is happening now, we see the reality of what 
has been predicted over the last few years; that is, as we start 
talking about growth in the economy, we see a demand for capital and 
interest rates rising. We also see the Federal Reserve talking about 
adjusting their balance sheet--some $4.5 trillion on their balance 
sheet, the largest balance sheet they have had in history--they are now 
talking about unwinding that.
  So these are dramatic impacts on what we are talking about right now; 
that is, how we fund what we are going to be doing not only in 
healthcare but also our military, as well as the domestic programs we 
are here to talk about.
  What is even more disturbing about the debt we are talking about and 
the increases in interest is the structure of that debt. Over the last 
8 years, the prior administration decided strategically to keep our 
bond portfolio that supports this debt, the bonds we issue that pay for 
this debt--the average duration, the length of those bonds, is under 3 
years. Some 60 percent, almost, of all the government debt we have in 
the United States today matures in 3 years or less. That means these 
increases we are talking about are going to roll on us and the backs of 
the American taxpayer almost immediately. This is not something that is 
going to happen in 10 or 15 years; it is right here on us.
  Let me put that in perspective. Most every other country in the world 
that has significant debt--and there are a lot of them; not to the 
percentage that we do--have already dealt with this duration problem. 
The UK, for example, over the last 8 years, instead of going short when 
interest rates were virtually zero, they went long. Forty-eight percent 
of the United Kingdom's debt is 20 years or longer in maturity. Again, 
60 percent of our debt, because of the last administration's strategic 
decision to stay short--borrow short and spend long--that is a 
prescription for failure, in business and in government.
  Sixty percent of our debt matures in less than 3 years. That is a 
formula for absolute disaster, and that is what I am talking about.
  But even more important than the debt and the duration and the way 
these interest rate increases are going to impact us almost readily is 
the fact that we have about 43 days--I came to the floor last week and 
reported that we had 50 days left, and today we have 43 working days 
left in this fiscal year before September 30. That means we have to 
fund the Federal Government for fiscal year 2018 by the end of 
September. In the last 43 years, this body--Congress--has only done 
that four times in regular order; according to the 1974 Budget Act, 
only four times.
  What is worse than that is that in the 43 days that we have, from an 
effective standpoint, we really only have 25 working days left in this 
Senate. I would argue that with the debt ceiling, with healthcare, with 
the tax package, with the appropriations process, and the funding of 
the government, I just don't see any way that is possible. I think that 
when we are talking to the American public, we need to come clean.
  I believe that, like in most years in the past, we are going to be 
pressured in this body again, just like we have 178 times. We have been 
forced into a continuing resolution in this body in order to get past 
some arcade financing limitation we have had. So that means we have by 
the end of September to fund the Federal Government. Historically, we 
have only done that four times, according to regular order. The other 
times of the 43 years, either a CR or an omnibus was done. But 178 
continuing resolutions got us past the end of the fiscal year, moved on 
to an omnibus of some sort, and then the release valve in all of those 
occasions was more debt, more spending.
  It is very difficult because the budget process itself is broken. And 
because of that, between now and the end of September, I personally--I 
am just a business guy, but I have no imagination of how we are going 
to fund this government by passing 12 appropriations bills. As a matter 
of fact, since 1974, this body has only averaged passing 2.5 
appropriations bills a year out of the 12. Now, you tell me, in the 
next 43 days, are we going to pass 12 bills to fund this Federal 
Government? There is no way.
  So my call on our colleagues here on both sides of the aisle is, 
let's get busy right now. I don't care what the structure is, as long 
as it is not a continuing resolution because that ties the hands of our 
military. They cannot deal with that. It limits their ability to move 
money from one department to another. If they wanted to move money from 
armor to infantry just in the Army alone, they cannot do that. And with 
the risks we face around the world today, that is an impossibility.
  We are working feverishly right now to change the budget process. It 
will not affect us this year. This is something we have to get serious 
on right now.

[[Page S3542]]

  I believe we are poised to have a turnaround in this economy. 
Consumer confidence is up. It hasn't been higher than this level in 13 
years. CEO confidence is higher than it has been in 15 years. 
Manufacturing confidence hasn't been this high in over 20 years. Why? 
Because they see some regulations being rolled back right now by this 
administration and this Senate.
  We passed 13 bills out of 14 that we brought forward that pulled back 
onerous regulations. Just this week, we had the Secretary of Treasury 
tell us that some 70 percent of the limitations on our banks--not the 
controls that protect us against another 2008 and 2009 disaster but the 
controls that are unnecessary and keeping capital tied up in small and 
regional banks unnecessarily.
  We have some $6 trillion not at work in this economy because of bad 
fiscal policy right here in Washington. What we are trying to do is 
unwind that, get it back into the economy.
  By the way, if the Federal Reserve releases their $4.5 trillion and 
we don't find a way to unleash this $6 trillion, tell me where the 
capital is going to come from.
  I am here to tell you that I believe we are on the brink of an 
economic turnaround if we can, in fact, effect a reasonable improvement 
in healthcare, get on and fund the government in a responsible way 
before September 30, and move on and get a tax package done this year.
  People right now are working on their budgets for business for fiscal 
year 2018--right now. By the end of their Q3, they will have that done. 
Their capital budgets, which go out many years, are being done too. So 
they are handicapping right now whether we will in fact get that tax 
package done.
  My argument is this: Let's get these things dealt with right now on a 
timely basis--the debt ceiling, funding the government--and move on to 
this tax package so we can, in fact, get that done so that business 
entities and our free enterprise system can, in fact, budget 
accordingly so that we can get some of these benefits into the economy 
as early as late next year. If we don't get that tax package done 
before Christmas, I don't believe we will have any impact in fiscal 
year 2018 from that.

                         Healthcare Legislation

  Mr. President, with the events this week, I would hope our body could 
find a way to lower the vitriol, to lower the hysteria when we have a 
difference of opinion and to find a way to look at what we might agree 
on, on an issue, as well as what we might disagree on. Yet, as I stand 
here today listening to some of the speeches, just today I am shocked 
because it is business as usual in this body. The vitriol is at a very 
high level. The misinformation is at an extremely high level.
  Remember when then-President Obama said: If you like your insurance 
you can keep your insurance; if you like your doctor you can keep your 
doctor; premiums will go down under ObamaCare; deductibles will go 
down; everybody will have insurance. The CBO overestimated by 20 
million the number of people who would sign up for ObamaCare, and, oh, 
by the way, we are going to institute a 30-hour workweek limitation to 
define ``full-time work'' and we are going to limit it so anybody with 
over 51 employees has to comply.
  We now know--both sides even agree--that it is failing. What they are 
saying now, though, is that they are relying back on the argument: 
Let's move to regular order now; let's make sure we all get this done 
together. Where was that conversation in 2008 and 2009, when behind 
closed doors a supermajority crammed down the throat of the minority 
this thing called ObamaCare? Remember that in the House of 
Representatives then-Speaker Pelosi said: If you want to find out what 
is in the bill, you have to vote for the bill. I think it was a matter 
of hours that day before when the Senate got the bill. They had to look 
at the bill before they had to vote on it that night.
  But let's look at the reality. ObamaCare is collapsing under its own 
weight. We know rates are up over 105 percent nationally. In my State 
alone, they have more than doubled in the last 3 years. Deductibles are 
up even more than that. Forty-five percent of the counties in the 
United States are down to one carrier. In my State alone, Georgia, we 
have 159 counties and 96 are down to one carrier. States like Ohio, 
Virginia, Iowa, Tennessee, and Missouri are told now that they are 
losing their last carrier in the individual market.
  But let me highlight the reality here. Before the Affordable Care 
Act, 48 million people in the United States did not have insurance. 
That was a catastrophe. We all agree with that. Today, however, what 
nobody on the other side talks about is that 28 million people today in 
America--the richest country in the history of the world--still do not 
have healthcare coverage. I can't see how that is a success by any 
measure. Of the 20 million who got insurance over the last 6 years, 16 
million of them did not got get it through ObamaCare. It came through 
the Medicaid expansion. Of the remaining 4 million, 2 million are like 
me and my wife, who were canceled and then had to come back into the 
Affordable Care Act unwillingly. That was our only choice. Oh, by the 
way, we had to have a program that had so many other features in it 
that our rates doubled over that period of time.
  It just seems to me that what we have before us today is an 
opportunity to clean up this mess and provide for the things that were 
broken in 2008. We know we have to cover preexisting conditions. We 
don't want people to have their insurance canceled just because they 
get sick. That is not the American way. That had to be fixed, and we 
are going to continue that.
  People have to have access, though, and right now, with the cost, 
many people are coming off of healthcare in the individual market 
because they simply can't make the financial equation work. The 
premiums are too much. In my own family, one of my sons can't 
understand the deductibles. So the financial equation for the very 
people who need it doesn't make any sense.
  We can do things to get premiums down by allowing the free market to 
provide the types of services inside insurance products that people 
actually want and not ask them to pay for products they don't need.
  We have to make sure Medicaid can be sustained long term.
  Lastly, I think we have to make sure that, as we deal with the 
preexisting conditions, we make sure that everybody in America has 
access to healthcare. Nobody is talking about taking away access from 
the American people in terms of healthcare.
  Whether it is healthcare, the military, the VA, or any of our 
domestic programs, we have a serious funding problem. Our mechanism 
that funds the programs is broken. It has never worked since 1974, 
except for four times, and that was prior to 1980, and we have to fix 
it. But right now, in 43 days--between now and September 30--we have to 
fund this government, or all the other rhetoric will be idle chatter.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. INHOFE. Mr. President, I ask unanimous consent to be recognized 
for such time as I may consume as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. INHOFE. Mr. President, first of all, let me say that I am really 
glad the junior Senator from Georgia has taken this on. This is 
something that some of us who have been around a little bit longer have 
gone through before.
  I think everyone realizes that what was attempted to be done by 
President Obama was a single-payer system. Ultimately, that is what 
liberals want. I remember back in the 1990s what was referred to at 
that time as Hillary healthcare during the Clinton administration. I 
remember so well the efforts that were taking place.
  Sometimes I go back to my State of Oklahoma just to be around logical 
people, and they will ask the question: If this system is not working 
in Canada, is not working in Sweden, and is not working in Great 
Britain, why do they think it will work here? Liberal individuals will 
never tell you this, but what they are really thinking is this: It 
would work if I were running the show.
  So we are going through a similar thing again, and I am so happy we 
have leaders, as the occupier of the Chair,

[[Page S3543]]

and we have more doctors right now in the Senate. This is the time to 
make these changes and really accomplish things. But that is not why I 
am here.

                   Climate Change and Paris Agreement

  Mr. President, I noticed in the news this morning one more of these 
incidents happened where they had groups of people going to either the 
Antarctic or the Arctic to try to reaffirm their positions that somehow 
the world is coming to an end because of global warming and global 
warming is because of manmade gases, which, of course, we know is not 
the case. The interesting thing about yesterday was that a group of 
some scientists, some individuals, and some environmental extremist 
activists was going to the Arctic to show that things were melting, and 
they got stuck in the ice. This is the fourth time this has happened in 
the last 4 years because they didn't anticipate the fact that we have 
actually some areas where it is increasing.
  I thought, well, it is time to make one last compliment to the 
President when he had the courage to pull out of the Paris climate 
  A lot of people don't know what these climate agreements are. This 
was the 21st year we had a climate agreement. It was all started by the 
United Nations some 21 years ago. The idea was to go to exotic places 
around the world and invite all 192 countries to come in to convince 
them that they need to reduce their own greenhouse gases, their 
CO2 emissions.
  Toward the end of the Obama administration, after eight such meetings 
they decided this wasn't going to work. They finally decided they would 
go ahead and try to make one look like an agreement, and, hence, there 
was the Paris Agreement--not a treaty but an agreement, not anything 
that would come through ratification, obviously.
  I have been over there for some of these meetings. What is 
interesting about this is that most of the 192 countries involved in 
these meetings think that if the President says something, it is going 
to happen. They forget about the fact that we have another branch of 
government called Congress, and we have to ratify some of these 
  So I do want to make a couple of comments about what the President 
has accomplished by getting out of this agreement.
  First, since there is a deliberate effort to make people who are 
reluctant to believe one narrow view, in terms that the world is coming 
to an end is a reality, they try to make it change into the argument 
that as to climate change, anyone who is against the idea that we are 
having these problems out there is opposed to the idea of climate 
  Look, we have said so many times on the floor that the climate has 
always changed. All the evidence--historic evidence, scriptural 
evidence, archeological evidence--shows very clearly that climate is 
always changing. The arrogance is that somehow climate change can be 
managed by man. Did man ever cause the ice age or any of the other 
extreme weather patterns the Earth has seen just over the last few 
thousand years? The answer is no.
  But earlier this year, a climate change study was released which 
found that little agreement is found with climate modeling simulations 
and consistently overstate recent summer warming and underestimate 
preindustrial temperature changes. That was the study. It is no 
surprise they found forecasts to be inaccurate. According to the 
environmental extremists, every summer is going to be the hottest. I 
have yet to see a summer that wasn't going to be the hottest. Every 
year they say that is going to take place.
  In one of the charts from the study I have here, all you have to do 
is go back and look historically at what has happened in this country. 
We go through warming periods. We go through ice ages. I will tell you 
what is interesting about this chart. The largest increase we had in 
global warming happened right after World War II, in 1945. That was the 
year we had the largest number of CO2 emissions that took 
place. Historically, no one disagrees. That precipitated not a warming 
period but a 20-year cooling period. So we have been going through this 
for a very long period of time now.
  Essentially, the findings of the study show that the climate patterns 
we see now are not significant in the grand scheme of things, as we can 
see by this chart. People like to vilify those of us who talk about 
this subject and openly question the inaccurate statements and so-
called findings of fearmongering scientists who tell everyone the world 
is ending because of manmade gases. They think that just because many 
of us recognize that science is not settled and we question exactly how 
much man affects climate change, corruption must be involved, and so 
  But we look at the real science. I have not yet met him personally, 
but I know about a guy named Dr. Richard Lindzen. Dr. Richard Lindzen 
is an MIT professor. He arguably could be considered the most 
knowledgeable person in this field. He made this statement: Regulating 
CO2 is a bureaucrats dream. If you regulate CO, you regulate 
life. So that is what is behind this, and we have watched this play out 
now for about 20 years. To question the idea that man is single-
handedly responsible for the changes in climate and doomsday is near 
due to the fact that we burn fossil fuels is entirely inappropriate 
and, frankly, unnecessary.
  I remember very well a climate fanatic named Michael Mann. I 
mentioned that Paris was the 21st meeting the United Nations has had. 
In 2009, that meeting was held in Copenhagen. At that time, I chaired 
the Environment and Public Works Committee. The first year of the Obama 
administration, I remember getting ready to go to Copenhagen to explain 
to people they had been lied to. At that time, Obama was going over, 
Hillary Clinton was going over, John Kerry was going over, and all the 
rest, saying we in the United States were going to pass cap and trade. 
I wanted to make sure they knew we were not going to be passing cap and 
  I was getting ready to go over. Lisa Jackson was the first Obama 
designee to be the Director of the EPA. I looked at her, and I said: I 
have a feeling that as soon as I leave town, you are going to have an 
endangerment finding so you can start regulating this stuff. She kind 
of smiled. I said: When that happens, it has to be based on science. So 
tell me, what science will you base this on? She said: Well, it is 
going to be based on the IPCC.

  IPCC stands for the Intergovernmental Panel on Climate Change. That 
is the United Nations.
  As luck would have it, right after that, a matter of days after that 
statement was made by her, we had climategate. Do you remember 
climategate? Not many people remember it because the media didn't play 
it up here like they did in Europe and around the world. Climategate 
was where they caught two scientists--one was Michael Mann and one was 
Phil Jones--who had rigged--there was evidence of this through 
communications that were disclosed--they were actually rigging the 
science. They didn't pay much attention to it here in the United 
States, but I remember at the time that Christopher Booker of the UK 
Telegraph--that is one of the biggest communication operations in the 
UK--they called this the worst scientific scandal of our generation. 
That is climategate. That is cooking the books on science to make 
people believe things that weren't true.
  Clive Cook of the Financial Times said:

       The close-mindedness of these supposed men of science, 
     their willingness to go to any lengths to defend a 
     preconceived message, is surprising, even to me. The stink of 
     intellectual corruption is overpowering.

  That is the science on which they have relied for a long period of 
time. In fact, to give you an example of the hockey stick--that was 
what Michael Mann came up with in trying to show, instead of what we 
are showing on this chart here, that somehow this all happened in a 
recent period of time. It is another research exploration that was 
  I started off talking about what happened on the climate change 
research exploration that just took place in the last few days. Many of 
these were postponed in the Arctic because of the unusual amount of ice 
that has taken place. Before a research team could embark on their 
exploration to study climate change--keep in mind, this group went 
there to try to show what things are happening, that ice is melting all 
over the world. Their ship, the Canadian research icebreaker Amundsen, 
had to be borrowed by the Canadian Coast Guard for search and rescue

[[Page S3544]]

efforts to help fishing boats and supply ships that were trapped in the 
unexpected, large amount of ice.
  This is at least the fourth time this has happened in recent years to 
research ships around the world. There was a situation a few years ago 
where a Russian ship carrying climate scientists and journalists and 
activists and tourists and an entire crew became trapped in ice that 
was at least 10 feet thick. An Australian icebreaker arrived 6 days 
later to rescue them, but it was unable to do so because of the ice. A 
few days after that, a Chinese icebreaker sent out a helicopter that 
was able to airlift 52 of the passengers from the Russian ship to 
safety on the Australian icebreaker. Unfortunately, during the rescue 
effort, the Chinese icebreaker became trapped as well.
  I tell you these stories because all of these expeditions that were 
going to the various posts were doing so to try to prove that ice was 
not accumulating, and they got stuck in the ice.
  Most of the predictions that have been published over the last few 
decades have been widely inaccurate, but most have been accepted by the 
environmental groups and some of the extremists because they are 
maintaining their war on fossil fuels, although Trump has ended that.
  I have to say that one of the reasons I go back to my State of 
Oklahoma every weekend is to talk to real people. They will ask a 
question. I remember that during the Obama administration, he had a war 
on fossil fuels--fossil fuels are coal, oil, and gas--but he also 
didn't like nuclear. You don't get these questions asked in Washington. 
They asked me: Inhofe, explain this to me. We have a President who is 
trying to do away with fossil fuels--coal, oil, and gas--and nuclear, 
and we are currently dependent upon coal, oil, gas, and nuclear for 89 
percent of the power it takes to run this machine called America. What 
is going to happen if we are not able to do it?
  Of course, as I said, you don't hear those questions around 
  Anyway, by fearmongering techniques, environmental extremists and the 
Al Gore fan club can easily convince a large number of people that 
regulatory burdens like the EPA's Clean Power Plan, the Quad Oa, the 
venting and flaring rules, and the waters of the United States rule are 
a good thing and that we can save the Earth without any consideration 
of the effect these rules have on energy.
  By the way, for any conservatives who are out there, I would like to 
remind them that even though it didn't get much play in the media, this 
President in the first 100 days in office has been able to do away with 
some 47 of the regulations. The two ways of doing away with a 
regulation--one is through Executive order, and the other is the CRA, 
the Congressional Review Act. In fact, I was proud that the first 
signing ceremony our new President had was signing a bill that I had 
passed. It is one that has really made an effort to try to save enough 
of the oil and gas industry to run this machine, as I mentioned, called 
  Now we are actively working to face the problems inherited from the 
previous administration. For the past 8 years under the Obama 
administration, the American economy suffered under the effects of his 
climate agenda. That era is over. President Trump has delivered on his 
campaign promises since he was sworn in. The strongest signal of this 
was President Trump's decision to pull out of the Paris climate accord.
  It was just a few weeks ago that I was on the Senate floor urging 
President Trump to pull out of this Paris Agreement. That same day, 21 
of my Senate colleagues and I sent a letter to the White House with 
that same request. Our message resonated with the President, and it was 
clear that our voices were heard because it was exactly 1 week later 
that the President announced to the world he was getting out of a bad 
  Let me mention one thing about this Paris Agreement. The Paris 
Agreement supposedly is something that 192 countries--each said what it 
was going to do to reduce greenhouse gases, their CO2 
emissions. For example, the agreement President Obama said at that 
time--he said: We commit that we will reduce our CO2 
emissions by between 26 and 28 percent by 2096.
  The interesting thing about that is that it can't be done. In fact, 
immediately after he made that statement, we had a televised public 
hearing of the EPA to ask them how in the world we could reduce by some 
27 percent greenhouse gases in the United States of America. They said 
it is impossible and we couldn't do it. So what the President was doing 
then was telling people that we in the United States were able to do 
something--were going to do something that was very meaningful by our 
reduction, even though he knew at the time it could not be done.
  Then we have the other countries--China, for example. China is the 
second largest emitter of CO2. Currently, as we speak right 
now, they are cranking out one coal-fired powerplant every 10 days. 
What did they agree to in this Paris accord? They said: Well, we will 
continue to increase our output in China. We will continue to have a 
new powerplant every 10 days or so until 2025. At that time, we will 
consider reducing it.
  Then along comes India, the third largest emitter of CO2. 
India said: Yes, as long as we get $2.5 trillion, we are willing to do 
it. Well, where would that $2.5 trillion come from? The good old United 
States. The big green fund.
  That is how ridiculous that whole thing was. It was the right 
decision for him to make this a reality.
  Many believe that if we lose our ability to negotiate with other 
nations--this is the only legitimate complaint I have gotten that I 
really heard during the time. They said: Well, if we don't have a place 
at the table, then we are not going to be able to be in on any future 
  That was wrong, and those who are using that argument were wrong 
because the agreement that gave us a seat at the table has already been 
ratified by the United States, meaning the Senate gave its advice and 
consent. It is known as the United Nations Framework Convention on 
Climate Change. This was in the 1992 treaty that supports all of the 
big parties that are held every December. We are still at that table. 
That decision was made a long period of time ago. We will be at any 
future activities that take place.
  I will wrap up by saying that this was the right thing to do. Stop 
and think about it. The previous speaker on the floor, the junior 
Senator from Georgia, was talking about the dilemma we have in this 
country, the spending dilemma, and how we are going to have to do 
something about it. We are going to eventually have to get to some of 
the entitlements, the big spending items.
  If we had stayed with the program that the President had outlined and 
had committed to the other 192 countries, that would have constituted 
arguably the largest single tax increase in the history of America, and 
there would have been nothing that would have been accomplished by it.
  My final thought. I would like to thank President Trump for pulling 
out of the Paris Agreement. It is the right decision, and it will 
without question help the United States in the long run.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. MORAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MORAN. Mr. President, I ask unanimous consent to be able to 
address the Senate as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

            Countering Iran's Destabilizing Activities Bill

  Mr. MORAN. Mr. President, I joined our colleagues today at lunch, and 
one of the conversations I had with one of my Democratic colleagues was 
how surprising, perhaps, but certainly how pleasing it was that today 
the Senate, in a bipartisan fashion, addressed some contentious issues 
related to sanctions in regard to Iran; issues related to sanctions in 
regard to Russia. Both of those issues, because of the political 
climate and because of past history, could be fraught with great 
opportunity for partisanship to be exhibited in full force. The 
conversation I had with my colleague was how surprising and, more 
importantly, how pleasing it was that didn't happen.

[[Page S3545]]

  I commend the Senate and its leadership for working together to 
resolve their potential differences and creating this opportunity for 
us to have a debate, a discussion, both on public policy--that I think 
is important to the security of the world--and the safety of Americans 
here in the United States.
  I am here, in part, to express my support for the Countering Iran's 
Destabilizing Activities Act, the legislation we addressed today. It 
permits our government to target those individuals and institutions 
responsible for a foreign policy that puts American lives at risk and 
undermines the security, particularly in the Middle East, but really of 
the globe.
  The theocratic, autocratic regime's survival in Iran depends 
currently on the human rights abuses and political oppression. Eight 
years after the Green Movement's protests, the group's leaders remain 
under house arrest. Members of that movement were tortured. Still, 
today, Iranian Americans are unreasonably detained without hope for 
release in Iran. The Iranian regime's survival depends further on its 
control of its economy. When it was brokered, proponents of the Joint 
Comprehensive Plan of Action argued it would provide economic benefit 
to the Iranian people.
  So when President Obama negotiated--and this Congress, this Senate, 
failed to reject the JCPOA--one of the arguments about its benefits is 
that everyday Iranians would enjoy greater economic opportunity. 
Instead, a recent Reuters study shows businesses directly tied to the 
Supreme Leader and the IRGC are the main beneficiaries of those changes 
in our relationship with Iran. Despite renewed economic growth, Iran's 
unemployment rate is estimated to be as high as 12 percent, and that 
figure could be as high as almost 30 percent among Iranian youth.
  Survival of Khamenei's regime depends on stoking hatred of America as 
a way to whip up support. Iran uses small boats to swarm American Navy 
ships protecting the free navigation of the Strait of Hormuz in the 
Persian Gulf. This is disturbing for a number of reasons, but the 
importance of that Strait's role in global economy certainly is one of 
them. In addition, it is linked to scouting soft American targets for 
  So we continue to see bad behavior, threatening behavior by the 
Iranian government toward the United States and our global interest in 
the Strait of Hormuz and the suggestion that Iran is preparing and 
looking for opportunities for terrorist attacks against the United 
States and its allies in the Middle East.
  Last week, two Hezbollah operatives were arrested here in the United 
States. They were doing surveillance on targets in New York and on our 
embassies as well in Israel and Panama. Two terrorism specialists, Dan 
Byman of Georgetown and Scott Stewart of Stratfor, tweeted in reaction 
to this news that this could be a case of Iran sending us an ominous 
message; that Iran can play the terror card if it wants to. If that is 
indeed the signal Tehran is sending to us, it is important--it is 
imperative, in fact, that we send a message of our own that no 
civilized country resorts to planning to kill innocent civilians. The 
legislation we passed today informs that regime that the JCPOA does not 
provide impunity for Iran to make such plans.
  Iran threatens its neighbors with its ongoing ballistic missile 
development, which was not part of the JCPOA. Hezbollah is armed with 
tens of thousands of rockets, threatening Israel's security. This is 
the same group which has been instrumental in propping up the Assad 
regime in Syria and which is responsible for the deaths of hundreds of 
thousands. The head of the IRGC forces was seen on the Syria and Iraq 
border just this past weekend. We know Assad's regime would have not 
survived without Iran's continued financial and military support. 
Again, this legislation underscores the Senate's belief that the 
Iranian regime must not be allowed to continue conducting and 
destabilizing activities under the shield of the JCPOA.
  I was an opponent to the JCPOA, but today's actions are unrelated to 
undermining that agreement, which is now in place. They are designed to 
hold back further activities by the Iranian regime against America and 
its interests. It is really a requirement that Iran act within the 
nation-states' Code of Conduct--the normal behavior of a country around 
the globe.
  Previous administrations, in my view, failed to challenge Iran on way 
too many fronts. With this legislation, the Senate is intent on pushing 
back on Iran's adventurism in the Middle East and beyond. By imposing 
appropriate sanctions and requiring the Secretaries of State, Defense 
and Treasury, as well as Director of National Intelligence, to 
formulate a coherent strategy to counter Iran's influence in the 
region, we say to the regime that their activities will be countered 
every step of the way.
  This legislation plays a part in doing what Dan Byman, the 
professor--the terrorism expert--testified to our House counterparts 
last month. His words were to ``highlight the costs of Iran's 
adventurism to ordinary Iranians to raise domestic awareness of, and 
discontent with, the regime's foreign policy.''
  There remains more that can be done to challenge Iran and constrict 
its resources. Many amendments were filed to strengthen this 
legislation that were not ultimately considered. One of those was mine. 
Last year, the Obama administration announced it would pay $1.7 billion 
to Iran in an effort to settle a longstanding financial dispute. 
Transferring cash to a leading state sponsor of terror was a bad idea 
when the Senate considered the 2015 nuclear agreement, and it remains a 
bad idea, a terrible idea today.
  The amendment I offered to today's legislation would limit the 
President's ability to transfer funds to Iran. This amendment directs 
that the U.S. Government puts justice for American victims of Iranian 
terrorism ahead of the payments to the Iranian's regime. No 
administration should transfer funds related to the Iran-United States 
Claims Tribunal without first requiring settlement of all damages 
already awarded in judgments made in the U.S. courts against Iran for 
their terrorism crimes against our own citizens. Paying our own 
citizens from that fund before any money is transferred to the Iranian 
regime makes sense, common sense, and it is surrounded by the sense of 
justice and right.
  While my amendment was not one of those considered by the Senate yet, 
we will be introducing this concept as freestanding legislation in the 
near future.
  I know sanctions alone will not change Iran's regime's behavior. 
Incidentally, we need our allies and friends to join us in this 
sanction effort. Yet we know the Countering Iran's Destabilizing 
Activities Act remains an important bill to impose costs on the regime 
in Iran and, hopefully, to encourage more of the discontent we saw 
during the recent elections. Perhaps there will rise an equivalent to 
the 2009 Green Movement that offers Iranians one more opportunity to 
throw off the yoke of theocratic rule of tyranny and get the government 
they deserve--one that respects their rights and has the desire to 
coexist peacefully with its neighbors.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. WYDEN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                         Healthcare Legislation

  Mr. WYDEN. Mr. President, I want to start my remarks on healthcare 
and what is ahead over the next couple of weeks in this way.
  For almost 7 years before I got elected to the Congress, I was the 
director of the Oregon Gray Panthers, which is a senior citizens group, 
and I ran a legal aid office for the elderly. I made the judgment then 
that healthcare was and always would be the most important issue. I 
made that judgment because I have always felt that if you and your 
loved ones do not have their health, then pretty much everything else 
does not matter.
  The Presiding Officer of the Senate, of course, is a skilled 
healthcare provider and knows a lot about these issues, and I am really 
going to use that as my reference point today in making the judgment 
that having quality, affordable healthcare for your families and 
yourselves is paramount to everything else.

[[Page S3546]]

  My view is that the proposal being considered here in the Senate of 
cutting hundreds of billions of dollars in funds from the social safety 
net--the Medicaid Program, which is the lifeline for seniors and kids 
with special needs and for the disabled--is going to put at risk the 
health and well-being of millions of Americans if it is passed.
  It is why I want to take some time to explain what it actually does 
so that people all across this country will be in a position to make 
their voices heard--to speak up, to do their part--so that when this 
debate comes to the floor of the U.S. Senate, as I believe it will in 
the next couple of weeks--and it moves very quickly--every Member of 
this body will have heard, loud and clear, what Americans think of this 
proposal, and I do not think that that assessment is going to be too 
  Now, the House passed their version of TrumpCare by a razor's edge, 
and to put it in a pleasant way, over here, Senators looked at it and 
said: No way. No thanks. My colleagues in the Senate majority said: We 
are throwing this bill out, starting fresh, and we are going to do it 
right. So I am going to start with where that process got lost.
  The majority convened a special working group made up of 13 
Republican Senators, all of them men, and it turns out, based on 
comments that have been reported, the Senate bill isn't going to be all 
that different from what the House was talking about. So Republicans in 
the Senate are pretty much picking up where the House left off on 
TrumpCare, and the legislation that is being crafted stays hidden--
stays behind closed doors and in a position where, for example, if you 
are a Democrat on the Finance Committee, you don't even know what is in 
it. It is not going before committees. It will not be put forward for 
amendment in a markup. With barely any public notice, the bill will hit 
this floor for 28 hours of debate--that is that.
  I will just briefly describe a session we had in the Finance 
Committee this week where there was discussion from the other side of 
the aisle that maybe there was a big partisan divide with respect to 
healthcare. I listened a bit. Finally, I said: I don't know how you can 
have a partisan divide about a bill that you can't read.
  I am the senior Democrat on the Finance Committee. The Finance 
Committee is the committee that has jurisdiction over hundreds of 
billions of dollars in payments for Medicare and Medicaid and the 
various tax credits that are part of the Affordable Care Act. This is 
the committee with the authority to address the management of hundreds 
of billions of dollars for those programs--Medicare, Medicaid, tax 
credits--and we see nothing. Not only have there been no hearings, we 
haven't seen anything. Something has been sent to the Congressional 
Budget Office. Who knows the answer to that. We haven't seen that 
  So that is the process that would dictate a radical transformation of 
one-sixth of the American economy--the American healthcare system--
affecting millions and millions of Americans.
  That is what we are looking at right now for the next couple of 
weeks, and it is pretty different than what happened during the 
Affordable Care Act.
  I want to focus on a few points just with respect to that. The first 
is especially important, as I have said, to the Finance Committee that 
deals with Medicare and Medicaid and these crucial aspects of 
healthcare in America. The Senate Finance Committee has been cut out of 
this process. The chairman, Senator Hatch, I, and 24 other committee 
members--there has been nothing for us to examine as a group to do what 
the Finance Committee tries to do best, which is to work in a 
bipartisan way. That is what we have done so often in the past, which 
is to sit down and try to take the good ideas that come from both 
sides, from the staff who knows healthcare inside and out, with years 
of experience working on healthcare matters.
  I have a little bit of a special interest in this because I wrote 
something called the Healthy Americans Act before the Presiding Officer 
was here in this body. Eight Democratic Senators and eight Republican 
Senators joined together in comprehensive healthcare reform for the 
first time--for the first time ever before.
  We have done a lot of good work on issues that represent the big 
challenges ahead. We know, for example, Medicare today isn't the 
Medicare of 1965, when it was about broken ankles, Part A or Part B, a 
bad case of the flu. Today Medicare is about chronic illness--diabetes 
and heart disease and strokes and cancer. We have worked on that in a 
bipartisan way. Bipartisanship is what the Finance Committee is all 
  So in the runup to the Affordable Care Act, we held more than 50 
hearings, roundtables, walk-through sessions. It wasn't exactly 
exciting. We always used to say: If you are having trouble sleeping, 
come by for a while and you will be knocked out in a matter of minutes. 
But that is where you do the hard work of legislating.
  When the Finance Committee finished the drafting process, the 
legislation sat online for 6 days before we went through the formal 
committee consideration--what we know up here as a markup. A total of 
564 amendments were posted online before the markup began for all to 
read. The markup lasted 8 days. There were 130 amendments in the 
longest markup in 22 years. Two dozen Republican amendments were 
adopted, and the bill passed with a bipartisan vote.
  We all got pretty sick of the hearing room by the time it was over. I 
will just read a quote from Senator Grassley with respect to the 
Finance Committee markup of the Affordable Care Act. Senator Grassley 
is the chairman, of course, of the Senate Judiciary Committee and the 
former committee chairman of the Finance Committee, and a very careful, 
thoughtful legislator. He said: ``This was the most open and inclusive 
process the committee has undertaken in its history. . . . ''

  He went on to say: `` . . . I believe, since I have been on the 
  So that is not a Democrat. That is Senator Grassley, the chairman of 
the Senate Judiciary Committee. I am sure Senator Murray has similar 
accounts of the process under the late Senator Kennedy. That 
legislation was online for days as well.
  That is what the legislative process is supposed to look like. It is 
a process that starts from the bottom up, and it is out in the open. 
Sunlight has always been the best disinfectant. You get hearings. You 
get study. You get debate. You marry the best ideas of both sides.
  I have always felt that bipartisanship is not about taking each 
other's lousy ideas; bipartisanship is about taking each other's good 
ideas, but because of the process the Republican leader is insisting 
on, that is not what the majority has on offer. What is in the works is 
hidden away so the public and Americans across this country who might 
be sitting in a coffee shop and would like to pull up a proposal on 
their laptop, they can't do it, and there aren't any hearings on what 
might be going in the bill as well. That, in my view, is the wrong way 
to build a sweeping, massive proposal like this, which, for so many of 
those who are walking on an economic tightrope, balancing their food 
against their fuel and their fuel against their medical care, this 
isn't some abstract issue for them. It is a matter of life and death.
  This proposal is built around an attack on Medicaid. The last version 
of the bill that anybody has been allowed to see cut the program by 
more than $800 billion, but there haven't been any hearings on what 
that would mean for the 74 million Americans who get their healthcare 
coverage through Medicaid. Nobody has been brought before the Finance 
Committee to talk about how you would not endanger the Medicaid nursing 
home benefit with this proposal, and that benefit pays for two out of 
three nursing home beds in America. There hasn't been a hearing 
examining the effect of the staggering implications of Medicaid cuts on 
37 million kids enrolled in the program, particularly what it means for 
kids with disabilities and kids in special education classes.
  At home in Oregon, when we had town meetings and roundtables on it, I 
just brought up--just raised the issue very gently--about the prospect 
of those special needs kids being hurt with this proposal, and the room 
just broke out in sobs.
  There haven't been any hearings on how much worse the opioid epidemic 
will get in States across the country when people enrolled in Medicaid 
lose access to treatment for mental health and substance abuse 
disorders. Just this morning, I talked about a

[[Page S3547]]

brandnew idea that seems to be picking up some interest in the majority 
about basically coming up with kind of a separate way to fund the 
coverage for opioids. Instead of it being a guarantee of being able to 
get access to services, it would sort of be a separate program, which 
also is not in line with sensible healthcare policy. As the Presiding 
Officer knows, so often those addicted to opioids have multiple 
conditions. In other words, if you are a young person who is addicted 
to opioids, you might well need mental health services. If you are an 
older person who is addicted to opioids, you might need services 
relating to chronic illness.
  So I want everybody in those States across the country--particularly 
in the Midwest and in the industrial Northeast--although opioid 
addiction has hit this country like a wrecking ball from Portland, OR, 
to Portland, ME. There are a lot of people paying attention to what is 
going to happen with respect to coverage for those addicted to opioids, 
and based on this proposal I have been reading about that is being 
floated, this is a prescription for trouble for those trying to come 
back from opioid addiction.
  Then, I want to mention the bill's provisions on preexisting 
conditions. When the Affordable Care Act was written in committee, the 
bedrock guarantee of protection against discrimination for those who 
have preexisting conditions and protecting those who have preexisting 
conditions with airtight, loophole-free protection--that was at the 
heart of the Affordable Care Act. My view is TrumpCare takes a 
jackhammer to that bedrock protection, cracking open loopholes that 
benefit insurance companies. Americans are aghast that their elected 
representatives would support the idea. I know that because I have had 
46 townhall meetings in my State this year, and I hear about it at 
nearly every one.
  So one would think this would generate a lot of interest in the 
Senate Finance Committee--the committee with jurisdiction over 
Medicaid, for example--because there are a lot of those folks who have 
preexisting conditions. No discussion. Zero discussion--zero--of any 
proposal that the Senate could be considering over the next couple of 
weeks that rolls back protections on preexisting conditions.
  I gather the House bill just basically takes the waiver process, 
which in the Affordable Care Act was designed to let States do better; 
in the House, they let States do worse--considerably worse--and one of 
the most objectionable features is the States can get a waiver and 
unravel some of those strong protections for people with preexisting 
  Now, if the healthcare changes I have mentioned aren't bad enough, 
TrumpCare also takes hundreds of billions of dollars of healthcare from 
needy and vulnerable people and, in effect, hands it in tax breaks to 
the most fortunate. Nobody has come before the Senate Finance Committee 
with authority over taxes to explain why the Congress ought to raid 
healthcare programs for the vulnerable to fund tax cuts for the 
fortunate few.

  Our committee--the chairman and I, along with all the Democrats and 
several of the Republicans--has been prevented from legislating out in 
the open on this proposal because the Senate TrumpCare plan has 
essentially been pushed out of view. It is clear that this isn't just 
sidestepping the Finance Committee. The public--the American people--
have been cut out of the process when healthcare policy that will 
affect millions for years to come is being written here.
  The majority leader has said he pretty much is not interested in 
input from Democrats. The Republican healthcare plan is going to move 
by reconciliation. That is a Washington word, folks--when you are at a 
coffee shop, nobody is talking about reconciliation, but it is 
basically our way or the highway. We are going to do it our way, and 
that is that. It is the most partisan road you can go down in the 
Senate. It relies on moving as quickly as possible with the least 
possible sunlight.
  As far as I can tell, the Senate bill is going to be hidden until 
virtually the last minute, at which point it will come straight to the 
floor for a very short, abbreviated debate.
  That is not what happened when the Affordable Care Act came up. The 
Senate spent 25 consecutive days in session on healthcare reform, the 
second longest consecutive session in history--week after week, 
spirited debate, mid-November into late December, vote after vote after 
vote. In total, the Senate debated the Affordable Care Act for nearly 
220 hours. That kind of extended give-and-take from both political 
parties you just can't have under this partisan ``our way or the 
highway'' approach known as reconciliation.
  When the Senate plan hits the floor, there will be 20 hours of debate 
before time expires and the final votes are cast. That is it. That is 
it. We won't have seen a bill until the last minute, and then one-sixth 
of our economy is going to be handled and framed for decades to come in 
a short and regrettably partisan debate.
  I have said from day one that the Affordable Care Act is not perfect. 
No major piece of legislation ever is. For major legislation to work 
and for it to last, it has to be bipartisan. That is why I mentioned 
that I put in a bipartisan bill--eight Democrats and eight Republicans. 
But you don't get it exactly your way. So I was very glad when the 
Affordable Care Act took that portion of our bill--the portion of the 
bill that had airtight, guaranteed protection for Americans from 
discrimination when they had preexisting conditions.
  The reason we felt it was so important--the 16 of us, eight Democrats 
and eight Republicans--is that if we open up the opportunity for 
discriminating against people with preexisting conditions again, we 
take America back to the days when healthcare was for the healthy and 
the wealthy. That is what happens if you allow that discrimination. If 
you are healthy, there is no problem. If you are wealthy, there is no 
problem, either. You can just write out the checks if you have 
preexisting conditions.
  The process the Senate is headed down now is as partisan as it gets. 
Unfortunately, what Senate Republicans are doing now makes what the 
House was up to almost transparent.
  I am going to close here with just one last comment. Now is the time 
for the American people to get loud about healthcare--really loud--
because the well-being and health of millions of Americans is at stake 
here in the Senate over the next 2 weeks. For older people who could 
need nursing home care, for seniors who aren't yet eligible for 
Medicare who are between 55 and 65 and who could face huge premium 
hikes, for the millions who work for employers who thought they were 
safe, the House bill removes the caps on the out-of-pocket expenses 
they have. If somebody gets cancer in America, they bust those caps in 
a hurry. Yet that is what the House is willing to do, and I don't see 
any evidence the Senate is willing to change.
  This debate didn't end when the theatrical production on the South 
Lawn of the White House took place a few weeks after the vote in the 
House of Representatives. My hope is--and I sure heard about it from 
Oregonians last week when we had townhall meetings across the State; 
there is concern, there is fear, and there is frustration about why 
they can't be told what is in this bill--that there is still time for 
Americans to make a difference because political change doesn't start 
from the top and go down. It is bottom up. It is not top down. It is 
bottom up. There is still time for the American people to be heard and 
to make sure their Senator understands how they feel about this, what 
is at stake, and, in particular, to get an explanation about why they 
can't be told now what is in this bill.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Blunt). The Senator from Texas, the 
majority whip.