Ms. Heitkamp mr. President. The presiding officer the senator from north dakota. Ms. Heitkamp mr. President , i ask that the quorum call be vitiated. The presiding officer without objection,so ordered. Ms. Heitkamp thank you, mr. President. Congress said our country desperately needs to have an honest, meaningful, transparent and bipartisan conversation about improving our health care system. You know, it shouldnt be a tall order, but around here things that seem common sense to the rest of the country are never simple. Instead partisanship too often wins. Weve seen that with the Senate Republican Health Care Bill. As it was crafted behind closed doors without allowing any democrat or the public to see it until it was a proposal. Its good news that the vote on the bill was delayed, but we must continue to have this conversation as the debate continues, because that bill was bad for north dakota. Only when we seek real Bipartisan Solutions do i believe that we will be successful in improving our health care system. We need to reform our health care system. Ive been saying it for years. In fact, i proposed a number of fixes over the past three and a half years, but none of those fixes are embodied in the Republican Health care bill. Its just not the right direction. Just yesterday joined many of my colleagues to bring up some commonsense bills that we can and should take up right now to make sure American Families arent hurt in the near term. We called on republicans to work with us, but unfortunately they objected. I want to work in a bipartisan way. I want Real Health Care reform, but unfortunately i do not believe everyone in congress feels that way. First, we immediate to talk about the facts of the Senate Republican bill, facts which are from very reputable nonpartisan sources. Earlier this week the Congressional Budget Office issued a report reinforcing that the Senate Republican bill is just as terrible as the bill that came out of the house of representatives a few months ago. The senate bill would rip away Health Insurance from 22 million americans by 2026, including 31,000 North Dakotans who would lose private health coverage. You cant put a few bandaids on a bad bill and expect that north dakota will not feel that pain. Just like the house bill, the biggest savings would come from severe cuts to medicaid, a program that would see a 26 cut in 2026. The bill would slash a lifesaving program that 90,000 north dakota children, individuals with disabilities, seniors, and lowincome families rely on for affordable, quality care, and that includes 36,000 children in my state. The Senate Republican Health Care Bill would get rid of the Medicaid Expansion and cap the amount of federal funding states can get to cover those traditional medicaid patients. That would drastically reduce the amount of medicaid funds that are going to the states. This would push those remaining costs on to states and counties that cant afford it, and importantly, it also would push the cost on to other patients. The north dakota or the American Hospital Association Estimates that north dakota medicaid would lose 1. 2 billion through 2026. At the same time north dakota forecasts a 46 million shortfall for 2015 through 2017. Thats our biennial period. And another 300 million shortfall for 2017 through 2018. You can tell me how our state would pick up these extra costs for our families and our children. Unfortunately, we just wont be able to do it. We would be forced to discontinue care. That is just wrong. Those medicaid cuts would also imperil rural hospitals which have seen their amount of bad debt fall 45 because of Medicaid Expansion. Helping those rural hospitals keep their doors open and deliver care close to home for farmers, ranchers and communities is absolutely vital to Rural Development and vital to those people who are still working to put food on our table in rural america. Additionally, the north dakota Hospital Association released a study showing that health care and social assistance accounts for one of every seven workers in this state. I want to repeat that. That health care and social assistance accounts for one of every seven workers in our state. And spending reductions under this senate bill would curtail those jobs, hurt Economic Development especially in Rural Communities, and make delivery of Health Care Even more expensive for our rural families. The cuts to medicaid would take away coverage from many North Dakotans also seeking treatment for opioid abuse and addiction, which has reached an epidemic level in our state as well as across the nation. In fact, i had one north Dakota Health care provider who was looking at providing some additional behavior and Mental Health services in the traditional hospital setting, about 14 to 15 of the patients are medicaid. He believes that once this hospital opens, anywhere from 60 to 70 of the patients will be dependent on medicaid funding for their health care. If that money is not there, if there is no reliability about that money, how about do we build the Treatment Services that we need to build to attack this epidemic . I want to dispel a myths about medicaid, and that is that these are just people who can go to work every day, that theyre just theyre not even working. Theyre just on the public dole. Theyre just getting this money. The truth is in north dakota 83 of adult medicaid enrollees are in families with a worker. Thats a statistic according to the nonpartisan Kaiser Family foundation. For North Dakotans who get coverage on the individual marketplace, this bill would raise premiums 76 higher than what would be required to be paid under the current law. That statistic, again according to Kaiser Family foundation. Seniors would be especially hard hit with premiums more than doubling for those older than 55. The bill would disproportionately push the costs on to Older Americans who tend to live in Rural Communities, like all of those across north dakota. Under the senate bill, in 2026, a 64yearold with an income of 56,800 would pay annually 20,500 for a silver Level Health Care insurance plan. That is more than onethird of his or her entire income. And that is more than eight times what the same person would pay under the current law, which is 6,800. The bill would also enable Insurance Companies to impose lifetime maximums on coverage, once again making it unaffordable for many people with lifethreatening or longterm illnesses or disorders to get the treatment they need to live by. This bill is a not so thinly veiled attempt to provide tax cuts for the wealthiest individuals at the expense of Rural Communities like those across our state. Nearly 45 of the tax cuts in the senate bill would go to the top 1 of incomes, those would be people making over 875,000 a year. I say that again. Nearly 45 of the tax cuts in the senate bill would go to the top 1 of incomes, those making over 875,000 a year. And thats according to the tax policy center. But whats more telling about these striking statistics are the stories. Ive heard from so many North Dakotans about how scared they are that this bill could pass and how it would hurt them if it ever happened. Ive heard from North Dakotans with preexisting conditions like cancer or asthma, parents of children with disabilities on medicaid, adults with elderly patients in Nursing Homes, farmers and those in Rural Communities who rely on rural hospitals, and those receiving treatment for opioid abuse. The consequences of this bill for North Dakotans are real, and i want to tell some of those very real stories across my state because way too often we forget that this is an issue that could not be more personal. I want to introduce you to allison and jennifer risenmeyer. This is her wonderful family. This is allison here. Allison was from west fargo was almost two years old when diagnosed with a rare genetic disease. Allisons parents were told she would become severely mentally delayed by age three and she would likely pass away by the time she was ten years old. Im so proud to tell you and so glad to tell you that prediction did not come true. Over the past several years allison has been able to get new, very expensive therapy that helps slow the progression of her disorder. Because there are no, currently no lifetime limits on coverage, allisons family has been able to afford this treatment. Today allison is 16 years old. Allison needs physical therapy multiple times per week to truly make a difference in her life day to day and to help her live longer. Her private insurance coverage, just 12 physical therapy appointments per year. Allison is one of many children with disabilities on special for special needs on medicaid, which covers the rest of her physical therapy for her. For her and her family who you can see here, who are so proud of the courage of allison, its been a lifeline. Its been a life giver. But the republican bill will enable Insurance Companies to impose lifetime maximums on coverage, which many North Dakotans like allison would reach in no time. It would slash medicaid, both expansion and traditional medicaid, making it harder for families like allison to afford coverage and critical treatment for their children with special needs. This family sthud never ever should never, ever have to worry. I want to tell you i have spent a lot of time with allison, and i think anyone who meets her knows that this world is a much, much better place with allison healthy and allison alive. And so we are so proud to call her one of our friends. Shes been an inspiration to me and my staff. She has participated in a lot of dialogues and her advocacy has been absolutely instrumental in telling the story of families like hers in ntd north dakota in north dakota. I want to talk about emory and amy thom. She is beautiful. Just two month 2 months old, ann mary had a set of seizures and diagnosed with a rare neurological disability. Her family has taken her to many hospitals to control her seizures. She is almost 4 years old and spent a total of 8 weeks in the hospital since she was born. She receives therapy multiple times per week. One week of therapy outofpocket would cost her family 3,000. Emory is on medicaid, which has afforded her family to keep their daughter home with them in a loving family relationship, in a lovely family situation. Its because of the access to medicaid that this familys been able to stay in their home and keep their jobs. But the Senate Republican Health Care Bill would rip medicaid away from families like emory and this family does not deserve that, neither does any family that is working hard to take care of their children. These are all of our children. The children that you see today that suffer from disabilities, that live and inspire us with their disabilities and their hope, the small, small help that these families ask for from the medicaid system should not be threatened and these families should not be calling congressional offices begging us to please, please do everything that we can. Finally, i want to talk about francis. Francis frances is one of the nices people you are ever going to meet. For 25 years she was a thirdgrade teacher. She was diagnosed with a syndrome that affects her nerve ending in her body, she became paralyzed but taught herself to walk again. For the rest of her life she had to face the challenges that come with this disorder. Today fran cant walk anymore. For most of her life fran lived independently with her husband who passed away in 2000. She is 84 and lives in a nursing had home in harvey. Fran has been in and out of Nursing Homes a few times beforehand all of which required private pay. Because of the extreme costs, she does not have any money left had she spent it on health care. She is one of many on medicaid which allows her to live with dignity and support. At the nursing home she gets extensive assistance in bathing, dressing, and doing any activities. Fran doesnt know what she would do without medicaid. She is made but doesnt have children to help her. Her siblings are all older with with than she is. If it werent for medicaid, she would be out of options. The Senate Republican bill, again, threatens the coverage fran has and so many others rely on. But you know what, we cannot let that happen. This issue has many faces. These are just three north dakota faces i want to talk to you about. They these families arent interested in politics. They could care less about politics. They want the ability it take care of themselves and if not for any of us, theres theres no guilt to any of this these conditions. Theres no, you know, you did it to yourself to any of it these conditions. This is the human condition. And we have to decide as a country are we together in taking care of each other or are we all on our own . Thats the issue here. How do we take care of the sickest among us . Are we together or are we on our own . I believe that we are stronger when we stand together to provide care to each other, to those who are not as fortunate. I was talking to some of the families, and its hard when youre a mom, i think, to think about well, you know, what was your life with your child growing up . Well, i had two children born extraordinarily healthy, really barely missed a day of school they were so healthy, had an opportunity to engage in every level of activity, giving me and my husband the freedom to pursue other things in our life. Thats a gift, but its also a gift that we, as a society, can help those who dont have that level of good fortune but have children who need some special attention, children whose care you cannot afford on your own. Very, very few people, from the discussions ive had with so many of the families, very few of us could ever afford the medications, could ever afford the therapies that guarantee quality of life, not only for the child but for the family in terms of respite care. So allison, emory, and fran, we are going to keep talking about this and we are going to keep evaluating all of the proposal thats come our way, and when they dont do right by you, emory, allison, and fran, if its not the right solution for your family, not the right solution for north dakota, its not the right solution for this country. We have work to do and i know the presiding officer has been one of the leaders in analyzing and reviewing these bills. We have had the chance to have some discussions. I hope we will have more discussions about how do we care for these wonderful north dakotaians and im sure the wonderful people who live in your state of louisiana. You know story after story having been a physician. My husband can tell you story after story, being a physician, of those who have had challenges. But we have to decide in this health care system, do he we do we stand alone or together . I believe america is stronger when we stand together and help each other. With that, mr. President , i yield the floor and suggest the absence of a quorum. The presiding officer the clerk should call the roll. Quorum call quorum call quorum call quorum call mr. Cornyn mr. President . The presiding officer the majority whip. Mr. Cornyn mr. President , id ask unanimous consent that the quorum call be dispensed with. The presiding officer without objection, so ordered. Mr. Cornyn mr. President , i want to come to the floor to talk about health care, a subject that i know the presiding officer feels passionately about as a medical doctor, but before i delve into the health care debate, i want to discuss to important bipartisan pieces of legislation that ive been working on with my colleagues across the aisle that are moving forward today. I know the strange thing about this place by this place i mean washington, d. C. Is the bipartisan work that were able to do rarely gets much attention because what gets attention in the news is when we fight over controversial topics. But Bipartisan Legislation that actually helps people that gets done here is rarely heralded or even noticed. So i just think its worth highlighting a couple of examples here today. Today in the Senate Judiciary committee, we passed the abolish Human Trafficking act that i introduced with senator klobuchar. As a father of two daughter, im always reminded of the profile of a victim of Human Trafficking in this country. Its a girl between the age of 12 and 14 years of age old who perhaps has run away from home. Who knows what the circumstances are at home, but theyre looking for a better life only to find themselves in too many instances exploited and the victims of Human Trafficking. So this bill reauthorizes several critical trafficking victims protection act programs to help fight the scourge of trafficking so that survivors can get the help they need and our Law Enforcement officers can go after the perpetrators of this terrible crime. A vital provision of this bill is the extension of the domestic trafficking victims fund, which provides Critical Resources that victims need to recover from this crime. Part of the fund is financed through fines collected on convicted traffickers and last year it provided almost 5 million in victim services. Let me dwell on that for just a minute. When i was privileged to be attorney general of the state of texas, part of the job was to administer the crime Victims Compensation fund, and this was a fund into which fines and penalties of people convicted of criminal acts, that went into the crime Victims Compensation fund so we could then use grants to the victims of crime to help them recover. Thats exactly the kind of model that we created with the domestic trafficking victims fund. And my hope is that over time it will produce more money that will be available to help the victims of Human Trafficking to a greater extent. But thats the idea. And these are not tax dollars. So that is an additional benefit that it actually is the fines and penalties of the perpetrators that go into this fund that then help the victims to heal. This bill also makes the Human Trafficking Advisory Council permanent so the group of survivors who advise People Like Us so the tools needed to combat trafficking can continue to do so. On the preventive end this legislation lends a hand to our nations Law Enforcement so they can track down perpetrators of the crime and bring them to justice. It implements screening protocols for the department of Homeland Security so that Law Enforcement officials at every level know how to spot trafficking victims and how to respond. This is actually a really important element of fighting Human Trafficking. A few years ago when we had the super bowl in dallas, texas, i was shocked to learn that the super bowl is one of the largest Human Trafficking events during the year. Thats pretty sobering. And, frankly, disgusting. But training people, including Law Enforcement, to be able to identify victims of Human Trafficking, some of whom may not consider themselves a victim until its too late only to find themselves a victim of modern day human slavery, but being able to identify victims of trafficking so that we can get Law Enforcement involved and get them rescued is a big, important part of fighting this crime. And for the long run, this legislation requires the department of justice to implement a National Strategy to reduce the demand of Human Trafficking by essentially putting the johns, the people who buy sex from trafficking victims, out of service. This is a cause that clearly crosses partisan lines and is literally a nonpartisan issue. So im glad that we are making progress on this. Im thankful for the bipartisan support of my colleague from minnesota, senator klobuchar, as well as the Judiciary Committee members, like the chairman, senator grassley and the ranking member, senator feinstein, and many other members on both sides who are cosponsors. The second piece of legislation i want to mention is our jobs for heroes act of 2017. This, too, is a bipartisan bill that makes it easier for our veterans to get jobs in our nations trucking industry. You know, the men and women in our military learn valuable skills that could easily be transferred to the private sector when they leave the military and become a veteran. And this bill is designed to help veterans transition from their military service to getting jobs in our nations trucking industry, and thats this is an area where were constantly in need of trained people with commercial drivers licenses that can work in this industry. As i suggested, many of our military Service Members have experience driving similar vehicles while serving in the armed forces. Yet for them to get a job in trucking, theyre required to go through a very expensive and timeconsuming Training Program as if they have absolutely no experience whatsoever, largely duplicate whag they already duplicating what they already knew but because of the regulations. That doesnt make any sense to me. The legislation i introduced with Senators Elizabeth Warren and Tammy Duckworth and thom tillis take into consideration the previous training and experience of veterans and allows them to apply for an exemption so they can quite literally get on the road and start working without delay. This bill is twofold. Not only does it encourage our Transportation Industry to hire veterans, it helps our veterans transition into civilian life connecting them to a wellpaying job and a meaningful career. And i expect the Commerce Committee to consider and pass this bill as well today. So these are two bipartisan examples that show that we actually can Work Together here in the United States senate in ways that will help all of our states and the people we serve. Now, there are subjects that are controversial. And if theres one that sort of stands out above the rest its health care. And unfortunately, this has become all too much of a polarizing issue politically. I happen to be here in the Senate Chamber on Christmas Eve in 2009, 7 30 in the morning, right before christmas, of course, where our democratic friends jammed through on a partyline vote the Affordable Care act. Now known as obamacare. And i remember the promises that the president made at the time, president obama. If you like your policy, you can keep your policy. That proved not to be true. He said if you like your doctor, you can keep your doctor. Well, that wasnt true either. And then he said well, youll be able to save 2500 per 2,500 per family of four on your premiums. What the experience has shown us, instead of a 2,500 saving, a family of four has experienced a 3,000 increase in their premiums. Thats 105 in the 39 states or so that have obamacare exchanges. So obamacare has been a failure if you consider the promises that were made and the promises that were broken and in experience, what weve seen is Insurance Companies because of flaws in the design literally leaving states, leaving insured people with no option when it comes to their insurance. Or perhaps they do have an insurance policy available, but their premiums have gone through the roof as i indicated earlier, 105 on balance since 2013. Or i should say and their deductible is frequently so high that theyre denied the benefit of what insurance they have because theyre basically selfinsured 5,000, 6,000 it 7,000 or more. Yesterday we announced that our work on a marketdriven, patientcentered Health Care Plan would continue over the next few weeks and as i said yesterday i expect we will real estate visit the bettercare act when we come back for the july work period, which is next week over the 4th of july. As the republican conference continues our discussion on our plan to replace the failed Affordable Care act, a couple of things have become clear to me. Well, i would say three. Let me start with the first one. The first one is our democratic colleagues arent willing to lift a finger to help. Theyre not willing to lift a finger to help. Surely they have constituents like i do in texas who are contacting them, telling them about their Horror Stories with regard to no access to policies, premiums sky high, deductibles unaffordable. But partnersly they are unmoved but partnersly they are unmoved by but apparently they are unmoved by thats stories. As we continue to move toward a Republican Health care solution, because our democrat colleagues refuse to participate, i want to remind us why the hard work is worth it. Each of us have our stories from our states about premium hikes and lost coverage and frustration at the hands of a convoluted law. I want to talk about the story of a young lady from fort worth, texas. Shes a nurse. Shes a nurse. She graduated from Texas Christian University in 2010 and by her own account shes young, in good health, and has a fulfilling career in the health care industry. Her first job took her to the Rio Grande Valley in south texas. And while she had to pay out of pocket for health care, she only had a monthly premium of 71. 71 for a health care premium. But after the obamacare bill passed in 2013, she said, my plan disappeared. In other words, she was one of those who suffered from the broken promise that if you like your plan, you can keep it, because it disappeared. There was a new plan, but her deductible rose to 8,500. Now, i dont know many people who could pay out of pocket for their health care 8,500 before their Health Insurance kicked in. And toed a insult to injury, her and to add insult to injury, her monthly premium skyrocketed t. One year later this plan under Blue Cross Blue Shield also disappeared leaving her to consider the cheapest marketplace plan for 400 a month. So she start with 71, went to 300 and then to 400 a amongst for what she called a month for what she called a dismal policy. Now, she did ultimately find a more affordable plan for 247 a month. Yet every year shes seen her premium grow. So she started out at 71. Finally to end with 247. Whats that . Three timesplus what she originally paid and seeing her premium continue to grow every year. As nurse, her perspective is not just about herself. She cares passionately about her patients as well. She wrote me this. She said, im irritated, but at least i can afford it. But who cant . Lots of folks and lots of my patients, she said. She said, i certainly couldnt if i had a family. So, mr. President , doing nothing is not an option, which is why i am mystified that our democratic colleagues have simply refused to participate in the process. For seven years we have promised the American People that wed replace obamacare with Something Better, Something Better that includes marketbased solutions that provide care that more people can afford. This is based on a principle that i believe is a core principle, and that is if people have the choice between products, they will choose the one thats best for them at a price they can afford. So competition actually benefits consumers by providing a better product at a cheaper cost. Thats what competition, thats what marketdriven competition is all about. So, to me, the choice is pretty simple. We either get rid of this failed law and replace it with real reform, or obamacare will continue to collapse and millions more people will continue to be harmed. Now, this is something that former president clinton said youll remember during the campaign, it proved to be a little bit of an impair acing comment embarrassing comment when he said obamacare is the craziest thing in the world. This is the husband of the democratic nominee for president in the 2016 election. He called obamacare the craziest thing in the world. Because he knew well that no matter who won the election, whether it was Hillary Clinton or president trump, that wed be talking about how do we save how do we protect the American People from this failing system known as obamacare . But our democratic friends apparently are resigned to continuing to let the American People suffer rather than trying to do whats right and help make things better. So the work were left to do is hard, but thats no excuse for not trying. Obamacare is hurting our country, and we have a chance to make it better and to right the path. so i remain hopeful and optimistic, because doing nothing is not an option. So, mr. President , let me just conclude with this observation. What we are trying to accomplish with the better care act is four things. Were trying to stabilize the current Insurance Market to make sure there are actually insurance policy available for people to buy, rather than to see them flee the marketplace. Were trying to make sure that we do everything we can to bring insurance premiums down. In other words, to make it more affordable, by eliminating some of the mandates that make it unaffordable right now. The third thing were trying to do is to protect people with preexisting conditions. The better care act, or the bcra, as its own Better Care Reconciliation Act maintains the status quo when this comes to protecting people against preexisting conditions. Because we dont want anybody whos lost their coverage to be denied coverage when they try to buy it from another Insurance Company because of preexisting conditions. Thats what happens when you change your job. Thats what happens when Insurance Companies decide to leave the marketplace because they simply cant afford to continue to write policies, so you have to change policies, like this young lady, the nurse that i mentioned, had to do on a couple of occasions. And then the fourth thing we are trying to do is to stabilize one of the most important safety net programs in our country, medicaid. Theres three basic entitlement programs medicaid, medicare, and Social Security and we are doing everything we can to stabilize medicaid. Because we believe its important for lowincome citizens to have access to health care. Through medicaid, if they cant get it through or cant afford it through private insurance. But i want to just address some of the misinformation, and i think outright falsehoods, that weve heard from some people about what the Better Care Reconciliation Act does to medicaid. I keep hearing people say, well, this cuts medicaid. Well, it reduces the rate of growth of medicaid. Thats true. What we do is we basically put medicaid on a budget and we grow it rear after year after year, as ill mention in aempt mo. But nowhere other than washington, d. C. , would anybody consider this a cut. For example, in 2017, well spend 393 billion on medicaid, 393 billion. Now, because this is a statefederal costshare, my state is the either numberone or numbertwo most expensive item on our spending under our state budget each year. It crowds out a lot of other things because it is so expensive, but its uncontroll uncontrolled. So in 2017, well see 393 billion spent. At the end of the budget window, ten years, reflected by 2026, the federal government would spend under the budget control act 464 billion. Thats a 71 billion difference between 2017 and 2026. Nowhere else that im aware of, no other alternate universe would this be considered a cut. This is an increase in medicaid. We can have discussions and we are. Is this adequate, the rate of growth of medicaid to meet growing populations and to make sure that people are tan care of . Taken care of . But nothing we do in this bill drops anybody from medicaid, and the suggestion that it does is simply, i suggest, not accurate. Nor is it a cut. We can have discussions about what the proper rate of growth is and we are having those discussions but it is a fact reflected by the Congressional Budget Office theyre the official scorekeeper here in congress that in 2017 well spend 393 billion and under the Better Care Reconciliation Act, well spend 464 billion, a difference of 71 billion over that ten years. So, mr. President , i know well have a lot more to talk about as we continue to debate this bill. My hope is that well have a bill that we can send to the Congressional Budget Office, which is going to take a couple of weeks to score thats a requirement before we can actually bring it to the floor. But that at some point in the nottoodistant future we can bring a bill to the floored and we can have a real debate, and we can have an amendment process that allows everybody and anybody in the senate to offer amendments to change or modify the bill. But, in the end, i believe we have to decide, because doing nothing is not an option. Doing nothing, it means consigning to the meme being hurt by become to the people being hurt by obamacare today to continue to be hurt and to be priced out of health care entirely. That, to my mind is not a responsible thing for us to do, and so thats why i support the Better Care Reconciliation Act. Thats not a perfect bill, but it is a next step to helping us turn our Current Health care disaster around, and at some point, i would hope that our democratic friends would join with us, as they have done under the two bills that i mentioned earlier on. This is one of the most important things that we will do here in the congress, and if you think about what touches peoples lives in such a personal way, its hard to think of anything that does that more than health care. But right now were hearing a lot of scare stories and inaccuracies about p what this bill does. Theres plenty of room for debate and differences of opinion based on the facts, but as the saying goes, youre entitled to your own opinion, but you are not entitled to our own facts. Facts are facts, and we ought to argue based on facts our policy differences and then vote. Mr. President , i would yield the floor and note the absence of a quorum. The presiding officer and the clerk should call the roll. Quorum call quorum call quorum call quorum call
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