Effect a betrayal of our trust. And i say that very seriously. I hope this body will keep faith with our democracy. And make sure that a bill that is regarded as a bad bill, and rightly so because it will eliminate insurance for 16 Million People. It will raise premiums by 20 within less than a year. It will drive costs up. It will bring down the number of people who are insured by catastrophic numbers. And we owe it to the American People to vote against the socalled skinny skinny bill whs really a sham repeal. It is a zell skeletal version of trumpcare 3. 0, 5. 0, 7. 0. We can do better. With that, i yield the floor to my colleague, my very distinguished colleague from the state of delaware. A senator mr. President. The presiding officer . Oip delaware. Mr. Coons i want to answer the calls coming to my office from folks saying whats going on . Whats happening in the u. S. Und States Senate . They cant keep track of what it is that theyve moved to. We dont know either. We are here probably all night waiting for the majority to finally produce the bill that they will use to attempt to repeal and maybe replace or not the Affordable Care act. All we know is that every single proposal thats been brought forward in recent days has two features. It reduces coverage, and it raises costs. It may be that 16 million americans will lose health coverage, might be 20 million, might be 32 million. Those are different scores for different proposed bills. It might raise costs by 15 , 20 , or 30 . Sometime later tonight you will see the final bill presented on this floor and hopefully we will get some score so that we will know what were voting on before we finally get to it. But what is so scary to families im hearing from is that after seven months of majority rule, where the Republican Party controls the senate and the house and the white house, we dont have a finished bill for us to debate tonight in detail, and we dont yet know exactly what well vote on later tonight. We just know a simple theme. Every proposal thats been brought forward when scored by the c. B. O. , the independent scorekeeper, offers less coverage and higher costs. And, folks, i want to remind you about something because i just ran into a family out on the steps of the capitol, outside the building, not inside the building. A family thats raising two typical children and one child with downs syndrome. A family where the father of the family is activeduty u. S. Military. They asked me why cant we be heard . The process that brought us here tonight did not include Committee Hearings where either doctors or nurses, patient advocates, folks who run hospitals were heard. And in a press conference earlier this evening four of our colleagues said theyre going to vote for this bill later tonight so it can go to conference and get fixed. They said that the current expected skinny repeal bill is a fraudulent disaster, to paraphrase a colleague. Well, i really think what we should do is heed the advice that senator mccain laid out on this floor a few days ago and go back to regular order. Just earlier today there was an inspiring moment when we took up and passed by a vote of 972 the russia sanctions bill. We heard the chair and the ranking speak positively of each other, speak positively of the outcome and say it is in the best interest of our country. As weve seen, we dont always follow regular order. Both parties have a responsibility for moving things over the years without fully consulting each other and without going through the committee process. I think this is the moment where we should look at what happened earlier today on this very floor and follow that process, where the committees are included and consulted and where we find a bipartisan resolution to what ails america. Im afraid thats not whats going to happen and that later tonight well be forced to vote for or against a bill that raises Health Care Costs for americans and lowers the number of americans that get health care coverage. And if thats the case, this senator will vote no. Thank you. And with that, i yield the floor to my colleague from connecticut. Mr. Murphy mr. President. The presiding officer the senator from connecticut. Mr. Murphy thank you, mr. President. We are starting to hear rumors of what is in this socalled skinny bill, and it is not skinny. It is humongous. It is filled with all sorts of conservative priorities, whether it be these are rumors the end to individual mandates, the elimination that Insurance Companies require, include certain coverage, the denial of funding to planned parenthood. This is not a bill that the designed to go to conference. This is a bill that is designed to become law. And i just want to put all of the pieces together for folks that were hearing tonight, because youre hearing if youre following this all across america, different pieces of news emerging from different parts of this city. Let me try to put it together for you for a minute. First, youre see this skinny bill get fatter and fatter. It will all of a sudden look like a piece of legislation thats not designed to go to conference. It looks like its a piece of legislation designed to become law. Its health care arson. It sets the Insurance Markets on fire. It immediately takes insurance from 16 Million People and drives rates up by 20 on a compounding basis. This is insanity. But its getting bigger and bigger, which makes you wonder, wait a second, is this really about going to conference or is this becoming law . Then we get another piece of information. The white house doesnt support a conference. The white house really likes the skinny bill and would like it to become law. Then we get another piece of information. The house of representatives tomorrow morning will declare what is called martial law. That is a procedural move that will allow the house to pass the bill that comes from the senate as quickly as possible. Its all coming together now. This isnt going to conference. This is becoming law. And then finally the icing on the cake is the most curious piece of news, a statement from the speaker of the house in which he says not we will go to conference. He says im willing to go to conference. Why im willing to go to conference and not we will go to conference . Well, maybe you get the clarification from his spokesman who says, quote, Conference Committee is one option under consideration, and something worth taking steps to prepare for, should we choose that route after first discussing with the members of our conference. Can you see whats happening here . Can you see whats happening here . This is a bill that is being sold as just a procedural step to get to conference, but Everything Else thats happening around it suggests that this is becoming law. And even if im not right, lets just also be clear about the process. Even if there is a conference, how on earth is the conference going to come to a conclusion that the senate could not . Youre going to introduce the Freedom Caucus to the united States Senate and think that you are going to get more functionality, not less functionality . Even if you get to that conference, it will last for a couple days, maybe a couple weeks. They will come to no conclusion, and then guess what . The skinny bill, which is not so skinny any longer, is there for the United States house of representatives to pass and put into law, all the while the president of the United States cheering that on. Thats the signal he gave you. The president of the United States does not support a conference. He supports the bill that we are going to have unveiled later tonight and pass. He supports that bill going into law. So even if you get to conference with the president chiding the conference to give up and pass the senate bill with it available to the house for passage, thats what the outcome will be. For our senate friends who want some assurances that this bill will not p become law, you are getting tonight exactly the opposite. And with that, i yield the floor to the senator from minnesota. Ms. Klobuchar mr. President. The presiding officer the senator from minnesota. Ms. Klobuchar mr. President , i want to thank my colleague from connecticut for that really good, detailed description of how we got to where we are. Because i think it is really hard to explain to americans at home who are watching this, whether it is really a debate i dont see my friend from the other side of the aisle here right now but to watch whats happening here today. Because what i have seen in my state over the last few months is extraordinary. Families coming up in the middle of a fourth of july parade with their child with downs syndrome, bringing him over and saying he is not just a preexisting condition. He is our child that we love. Or this last weekend when i was with a family with two identical twins, moriah and evelyn. One is the catcher and one is the pitcher on their 11yearold softball team. Just in the last few years one of them found out that she has a severe case of juvenile diabetes. The other one is perfectly healthy. And what the mom told me was that they can hardly make it paying for the cost of the insulin which has gone up astronomically over the years, paying for the testing strips, paying for everything involved in this. And yet now instead of seeing a bill which reduces the cost of Prescription Drugs by including some of the provisions i have long advocated for from ending pay for delay, where Big Pharmaceutical Companies are paying off Generic Companies to keep their products off the market or bringing in less expensive drugs from other countries, or allowing for negotiation under Medicare Part d. Instead of doing some of those innovative things that we need to bring costs down for regular americans, what we see here is going to make it worse. And when i met with these two girls, i told them and their family that i had their back and that i would tell their story on the floor of the united States Senate. Never once did i think id be saying it, even this last week when we are facing this kind of onslaught to this family. Because what i would tell these girls now is that this bill from what weve learned we have not seen it. We dont know exactly whats in it. But what weve heard, what would happen, well, according to the nonpartisan Congressional Budget Office, it would kick 16 Million People off of health care. And i would tell those girls, you know how many people that is, girls . It is 14 states worth of people. It is the combined population of 14 states in the United States of america. What we have learned about this bill is that it would increase premiums by over 20 . Again, according to the nonpartisan Congressional Budget Office. What i would tell them is that is more than their school clothes. Its more than their softball clothes. Its a good chunk of what could be their college education. Sos this is real money for real people. And this reduces coverage, and it makes it more expensive. We can do so much better. A few months ago we went to that softball game, the baseball game where the republican mens team played the Democratic Team. I was there in the stands, and i watched at the end this beautiful scene when the Democratic Team won, they took the trophy and they gave it to the republican team. And they said to put it in representative scalises office. Why did they do that . Because they were saying were all on one team. And thats what this should be. When we are feeling with onesixth of the american economy, we shouldnt be at night passing a bill that one of our most trusted colleagues on the other side of the aisle, a republican, has just called a fraudulent disaster. Thats not what we should be doing. We should be working on the fixes that so many of my colleagues have been working on for years. Bringing those drug prices down, making the exchanges stronger with reinsurance and cost sharing. These are things we could actually do together. So i ask my colleagues to work with us. We have opened the doors. We want to Work Together on these changes and not pass this fraudulent disaster. A senator mr. President. The presiding officer the senator from colorado. Mr. Bennet thank you, mr. President mr. President. I appreciate so much my colleagues being out here on the floor. Were debating a bill that relates to 16 of our gross domestic product, almost 20 of our economy. And i wish that there were folks on the other side of the aisle that were out here tonight having this debate. So i thank my colleague from minnesota for the point that she made. And i want to say, mr. President , that i am really discouraged about where we are in our political system right now. And part of that is because politicians seem to think they can say one thing when theyre running for office and do another thing when they get here. And that somehow theres not a consequence. And i guess one of the reasons that people think there is a no consequence is we have begun to treat edited content, journalism as though somehow its inferior to Somebody Just shooting their mouth off on the internet. And you hear the president assaulting journalists who have verbally, assaulting journalists who have covered terrorism, trying to bring the story of syria in the United States. Some lost the lives and the president said theyre not covering terrorism. Then he attacks the fake news. He goes and does rallies in places like youngstown and gets people to attack . N cnn or the New York Times or the wall street journal, anything thats actually edited content. And i think its because, a, he wont withstand the scrutiny of real journalists. Burkes i think, b, he thinks it will help with this anything anythinggoes style of politics that you can say one thing during the election and do Something Else when id ask for an additional three minutes. The presiding officer without objection. Im so, the democratic time has expired. Mr. Bennet i would ask for an additional five minutes. The presiding officer without objection. Mr. Bennet thank you, mr. President. And i just dont think that democracy is going to work very well. This republic wont work very well if we dont have a free press thats respected. And if we dont hold people accountable for their campaign promises. Heres what donald trump said this is one of the things he said during the campaign about what he was going to produce for the American People with respect to health care. He said, it was going to be beautiful, terrific, a beautiful and terrific plan to provide such Great Health Care at a tiny fraction of the cost, and its going to be so easy. Thats what he said in rally after rally across the United States of america, and a lot of people believed it. He talked about how much he hated the Affordable Care act or obamacare, whatever you want to call it and all the reasons why, many of the reasons he talked about were manufactured. But that doesnt really matter anymore. Hes the president. The republicans are in the majority of the senate and the republicans have a majority of the house. Their characterization or mischaracterization of the Affordable Care act is not the issue anymore. The issue is, what are they going to do for People Living in the state of colorado who are dealing with a Health Care System thats not supporting them terribly well . And you heard that right. People who support the Affordable Care act or oppose it, in my state, are deeply discouraged about the way our Health Care System works. And i think that if the president were keeping his promise, youd see 100 people support the bill, because its actually consistent with what people at home want. They want more transparency when this comes to health care. They want more affordability. They want more predictability. Thats what they want. And if i set out to write a bill less responsive to that aspiration of people i represent, who are critics of the Affordable Care act republicans in my state i couldnt write a bill less responsive than the one the house of representatives has passed and the one that was introduced by the majority leader after he wrote it in secret. Its 8 20, mr. President. On the night were going to have this vote, and we havent seen the bill. After a year and a half of countless Committee Hearings, after adopting almost 200 republican amendments on the Affordable Care act and then going to town hall after town hall, being accused of being a bolshevik who hadnt read the bill, my question is why arent people being held to that standard tonight . Maybe theyre not asking us to read the bill because there is no bill. At 8 20 on the night that were supposed to take away 16 million Americans Health care. Or 20 million Americans Health care. On the night were supposed to vote for a bill that the Congressional Budget Office says will jack up insurance rates by 20 . They wrote the bill in secret, they didnt have a single hearing in the senate not one hearing in the senate and now its 8 20 at night and there are people in my state who think theyre going to lose their Health Insurance because they might be one of those 16 Million People or they might have a kid or a parent who has a preexisting condition, like the thousands of people that have contacted my office, and theyre terrified. And theyre not even on the floor. And they cant read the bill read the bill. And now were told theres going to be a procedural trick thats going to allow the house of representatives just to pass this through over the weekend. This is a shameful way to run the senate. It is exactly the opposite of what the majority leader promised he would do when he was the minority leader in the senate. Hes the one who said, if you cant get a vote from the other side if you cant get one vote from the other side, you maybe should acknowledge that the American People arent behind your bill. With they cant even get all the republicans to vote for this. They had to have mike pence, whos the Vice President , come here to break a tie. What a disgrace to ask the executive branch to come here and save your bacon because you cant get the votes. And theres not a democratic vote for this bill tonight because it doesnt meet the test that the minority leader himself had. So, mr. President , i see my colleague from michigan is here. I will yield the floor just by saying that we should stop this catastrophe. The only thing we know about this catastrophe is, if it passes, therell be 16 Million People who lose their Health Insurance and a bunch of rates go up. If we dont do it, that wont happen. I yield the floor. The presiding officer the senators time has expired. Ms. Stabenow mr. President . I would ask consent for five minutes. The presiding officer is there objection . Without objection. Ms. Stabenow thank you very much. Mr. President , i want to support what my colleagues have been saying on this floor, and the reason that we havent seen a bill, the reason that we have no idea what is coming is because this is a political exercise by the republicans. Its about winning and losing, but for people in the country, for people in michigan, its personal. This is not a political game. This is personal for everyone who cares about their their children and wants to make sure they can take them to the doctor. If youve got a whom with alzheimers and you might lose the ability to have nursing home care, if you have cancer and know you might not be able to get the full treatments you need, this is personal. And as has been said, every single proposal of theirs is higher costs and less coverage. So door number one we voted on, which would gut Medicaid Health care. Three out of five michigan seniors get their nursing home care from medicaid. Half of the people that receive Medicaid Health care are children. All the funds in the first proposal would go to tax cuts for the wealthy few and pharmaceutical drug companies. And it would destabilize and undermine and raises costs for everyone else. So thats door number one higher costs, less coverage. So then when that didnt go forward, then it was door number two. Door number two repeal everything that was passed under the Affordable Care act and then say to folks somewhere down the road well figure out how to replace it. That is higher costs and less coverage. And now were at door number three, and we dont know whats behind door number three. All we know for sure is that it will be higher costs and less coverage. Now, we, as democrats, want just the opposite. We want to Work Together with our republican colleagues to lower costs. By the way, starting with the outrageous increases in Prescription Drug costs. And we want to increase coverage options, increase Health Insurance. Thats what we are all about. And i believe i know in michigan thats what people want me to be focused on. Are there problems in the Current System . Of course, and we should fix those. But you dont have to rip away health care and raise everybodys costs 20 a year, like is being talked about now, in order to fix the problems that are there. And so, mr. President , i do want to quote senator mccain who said it is time to return to regular order, Work Together to reduce outofpocket costs and learn to trust one another again. Its pretty tough to trust colleagues, to trust the majority when we are arent even given the respect of knowing what we are going to be voting on. And its not just its not about us. Its not about us as individuals. Its about the fact that every person who is gating cancer treatments right now needs to know what the united States Senate is going to be voting on and have a chance to respond. Every person who cares about their child, who cares about their parent in a nursing home, who conveyors about their future who cares about their future, has the right to know and to read a bill and know whats going on. So i just want to say in conclusion i want to close with the words of margot, who manages a Health Clinic in kent county in michigan. Margot knows the benefits of increased access to health care because she sees it every day. She knows i. T. Not political. She knows its not political. Its personal. Theres nothing more personal than to be able to take your child to the doctor and get the health care you need. Or care for your parents. Margot wrote, seeing working people who are struggled all of their adult lives to manage their Chronic Health conditions finally have access to regular doctor visits, health education, and Prescription Medications has been a tremendous relief. Its amazing how different the lives of our patients are today compared to what they were a few years ago. She added, you cant imagine the sense of dignity the people i see feel. Mr. President , its time to bring back some dignity to the united States Senate. I yield the floor. Mr. Enzi mr. President . The presiding officer the senator from wyoming. Mr. Enzi i heard somebody said say that nobody was listening. Well, i was listening. And ive read a little bit from this book before on the floor about health care. Its called demystifying obamacare by david g. Brown, who is a doctor. And he does a marvelous job of going through the history of how we got to where we are. And he says, maybe we need to answer the question, what does obamacare do . What does obamacare purport to do . What does obamacare not do . He says, those answers are relatively simple. Obamacare is not a system of health care, nor is it a health care reform. Its a system of health care control. Obamacare was supposed to significantly reduce Health Care Costs, but instead it has dramatically increased costs for even those who are not directly within the obamacare program. He also says, obamacare was supposed to increase access to care, but instead it can actually reduce access, availability of care. He says, obamacare reduces the effectiveness of the safety net program, which is so very important to economically poor americans. He says, the quality of health care in america was derided when obamacare was passed, but obamacare instead reduces the quality of u. S. Health care by reducing innovation. And then it says, obamacare removes a persons ability to make his own decisions about his health care and that of his family. It does so by removing the freedom to make those decisions. What were trying to do is correct those problems and get back to a system of health care, where the patient and the doctor get to make some of the decisions, where we encourage more people to be in the system, where we expand the use of h. S. A. s, refundable tax credits, where we also allow people to buy insurance across state lines, we could put money back into statelevel highrisk pools. I really like the invisible risk middle schools allow people to pay what they were paying before but to get the unique care. We pass medicaid to the states in terms of block grants or per capita allotments and we partially privatize medicare starting in 2024 with a premium support system thats not in the bill. Thats one of the im reading suggestions that he gives. Cap the amount for tax exclusions in highercost employerbased plans. Now, you need to know that the proposals that weve been putting out, in spite of what ive been hearing over on this side, kids under 26 still get to be on their parents insurance. Were not taking that off. I keep hearing that were eliminating the preexisting conditions. We are not. There hasnt been a proposal to eliminate the preexisting conditions. So quit saying that. Thats just fearmongering. And eliminating the lifetime caps on insurance. I havent heard a proposal for that. Also allowing people to continue to be insured even if they change jobs. Thats what this guy wrote in a book. Id like for everybody to read it. He said there are five factors that drive up Health Care Costs. One is taxes. Another is mandates. Another is regulations. Another is lack of competition and flexibility within the marketplace. And the fifth one, i dont know of anybody addressing yet, but its medical Liability System that encourages defensive medicine and drives the cost up. Seniors need to be protected. There needs to be an effective and viable safety net system. Nobody is trying to work against that regardless of what youre hearing here. I understand that my time has expired. Ive got a lot more in the book id like to share, but im not sure that its productive anyway, so i yield the floor. Mr. Schumer mr. President. The presiding officer the democratic leader. Mr. Schumer first i ask unanimous consent before the next amendment each side be given two minutes. The presiding officer is there objection . Without objection. Mr. Schumer thank you. Now, mr. President , i have a motion to commit at the desk. The presiding officer the clerk will report the motion. The clerk the senator from new york, mr. Schumer, moves to commit the bill h. R. 1628 to the committee on finance with instructions to report the same back to the senate within three days not counting any day on which the senate is not in session, with changes that, one, are within the jurisdiction of such committee. And, two, strike the subsequent Effective Date of the repeal of the tax on employee Health Insurance premiums and Employee Benefits which may affect tax in later years. The presiding officer the question occurs on the motion. Mr. Schumer mr. President , i ask for the yeas and nays. The presiding officer is there a sufficient second . There appears to be. The clerk will call the roll. Vote vote the presiding officer are there any senators in the chamber wishing to vote or change their vote . Amber wishing to vote or change their vote . If not, the yeas are 43, the nays are 57. And the motion to commit is not agreed to. There are now two minutes equally divided prior to the vote on the heller amendment. Mr. Heller mr. President . The presiding officer the senator from nevada. Mr. Heller thank you very much. The presiding officer could we have order in the chamber, please. Mr. Heller thank you, mr. President. My amendment at the desk, heller amendment number 502, repeals the cadillac tax plain and simple. No gimmicks, repeals the cadillac tax plain and simple. This is a bipartisan issue. With bipartisan support. And under these circumstances, its probably appropriate that we have a bipartisan issue thats here in front of us. Ill just take a minute to thank senator heinrich, a friend of mine, my friend from new mexico, for his hard work and effort on behalf of this particular issue. Hes worked hard. The presiding officer the senate will come to order. A senator thank you, mr. President. This is an issue thats well endorsed. We have the endorsement of organized labor, chambers of commerce. Local and state governments. Small business organizations. Theyve all supported repealing this bad and onerous tax. 83 groups endorsed full repeal. Theyre saying the same thing that the cadillac tax needs to be fully repealed or employees will experience massive changes in their health care. So previously, mr. President , in this chamber they have voted nearly unanimously to support this full repeal. The presiding officer the senators time has expired. Mr. Heller thank you, mr. President. I would ask support of my colleagues on this heller amendment. Mr. Schumer mr. President ,. The presiding officer the democratic leader. Mr. Schumer thank you. On the issue before us, most democrats, the vast majority that were for repeal of the cadillac tax were not for many of the other provisions being put before us. This requires the two being tied together. Were for repealing the cadillac tax but not with harming the health care of millions of americans. I want to make another point especially to my friends, senators mccain, graham, johnson and cassidy who said correctly that the skinny bill was totally inadequate and they would require ash h shiewrnses from the house require assurances from the house. Let me first read what mr. Ryan said. If moving forward requires a Conference Committee, thats something the house is willing to do. That is not worth anything. Only if moving forward if required. But id make another case that makes this Proof Positive that this bill could pass and there is no assurance from the house. The house rules committee, there was a motion to limit the waiver of clause 6a of rule 13 to i ask unanimous consent for 30 seconds. The presiding officer is there objection . Without objection. Mr. Schumer to limit it just for motions to go to conference. Rejected 49. If the house was intent on going to conference, they would have voted for this rule. It means they want to pass this bill, skinny repeal, and send it to the president. I would urge my colleagues and all the others to vote no until they get that assurance. I yield the floor. The presiding officer is there a sufficient second . There appears to be. The clerk will call the roll. Vote vote vote vote the presiding officer are there any senators in the chamber wishing to change their vote . If not, the yeas are 52. The nays are 48. And the amendment is agreed to. Mr. Mcconnell mr. President. The presiding officer the majority leader. Mr. Mcconnell i call up amendment number 667. The presiding officer the clerk will report. The clerk the senator from kentucky, mr. Mcconnell, proposes an amendment numbered 667 to amendment numbered 267. Strike all after the first word and insert the following. Short title. This act may be cited as the Health Care Freedom act of 2017. Title 1, section 101. Individual mandate. A, in general, section 5000ac of the Internal Revenue code of 1986 is amended. One, in paragraph 2b3 by striking 2. 5 and inserting 0 . And, two, in paragraph 3, a, by striking 695 in subparagraph a and inserting zero dollars. And b, by striking subparagraph d. B, Effective Date. The amendments made by this section shall apply to months beginning after december 31, 2015. Section 102, employer mandate. A, in general, one, paragraph 1, section 4980hc of the Internal Revenue code of 1986 is amended by inserting zero dollars in the case of months beginning after december 31, 2015, and before january 1, 2025 after 2,000. Two, paragraph 1, section 4980hb of the Internal Revenue code of 1986 is amended by inserting zero dollars in the case of months beginning after december 31, 2015, and before january 1, 2025, after 3,000. B, Effective Date. The amendments made by this section shall apply to months beginning after december 31, 2015. Section 103. Extension of moratorium on medical device excise tax. A, in general, section 4191c of the Internal Revenue code of 1986 is amended by striking december 31, 2017, and inserting december 31, 2020. B, Effective Date. The amendment made by this section shall apply to sales after december 31, 2017. Section 104, maximum contribution limit to help savings account increase to amount of deductible and outofpocket limitation. A, in general, subsection b of section 223 of the Internal Revenue code of 1986 is amended by adding at the end the following new paragraph. Nine, increased limitation. In the case of any month beginning after december 31, 2017, and before january 1, 2021. A, paragraph 2a shall be applied by substituting the amount in effect under subsection c2a21 for 2,250, and, b, paragraph 2b shall be applied by substituting the amount in effect under subsection c2a2 for 4,500. B. , Effective Date. The amendment made by this section shall apply to taxable years beginning after december 31, 2017. Section 105, federal payments to states. A, in general, notwithstanding section 504a, 1902a23, 1903a, 2002, 2005a4, 2102a7 or 2105a1 of the Social Security act 42 u. S. C. 704a, 1396a, a23, 1396ba, 1397a, 1397da4, 1397bba hp 7. 1397 bea1 or any medicaid waiver in effect on the date of enactment of this act that is approved under section 1115 or 1915 of the Social Security act 52 u. S. C. 1315, 1396n for the oneyear period beginning on the day of enactment of this act, no federal funds provided from a program referred to in this subsection that is considered direct spending for any year may be made available to a state for payments to a prohibited entity, whether made directly to the prohibited entity or through a managed Care Organization under contract with the state. B, definitions. In this section, one, prohibited entity. The term prohibited entity means an entity including its affiliates, subsidiaries, successors and clinics, a, that as of the date of the enactment of this act, one, is an organization described in section 501c3 of the Internal Revenue code of 1986 and exempt from tax under section 501a of such code. Two, is an essential Community Provider described in section 156. 235 of title 45, code of regulations, as in effect on the date of enactment of this act that is primarily engaged in Family Planning services, Reproductive Health and related medical care, and three, provides for abortions other than an abortion, one, if the pregnancy is the result of an act of rape or incest, or, two, in the case where a woman suffers from a physical disorder, physical injury or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a lifeendangering physical condition caused by or arising from the pregnancy itself, and, b, for which the total amount of federal and state expenditures under the Medicaid Program under title 19 of the Social Security act in fiscal year 2014 made directly to the entity and to any affiliates, subsidiaries, successors or clinics of the entity or made to the entity and to any affiliates, subsidiaries, successors or clinics of the entity as part of a nationwide Health Care Provider network exceeded 1 million. Two, direct spending. The term direct spending has the meaning given that the term under section 250c of the balanced budget and emergency deficit control act of 1985, 2 u. S. C. 900c. Title 2, section 201. The prevention and Public Health fund. Subsection b of section 4002 of the Patient Protection and Affordable Care act 42 u. S. C. 300u11 is amended