half of america. social security numbers, birth dates, home addresses, phone numbers, even credit card numbers -- all in the hands of criminals. i've heard from working families in massachusetts and all across the country since then. the equifax is a nightmare. at best it is a giant hassle. time on hold with credit reporting agencies, fees for this service and that service, confusion about what's been stolen and what to do about it. at worst, it could be ruinous, a lifetime of responsible spending and borrowing wiped out by identity theft and fraud. people are outraged and rightly so. bad enough that equifax was so sloppy that they let hackers into their system, but the company's response has been even worse. first, equifax hid the information about the breach for 40 days -- 40 days. equifax gave criminals a 40-day head start to use the information they had stolen while the rest of us were left in the dark. and then, when equifax fine lily decided to disclose the breach, they didn't call or send letters to the millions of americans who were victims of the hack. nope, they announced the breach and then made everyone go to an equifax website, turn over more personal information to see if they were one of the people who'd been affected. and once equifax had the new information, they provided confusing and misleading information about whether the person had actually been a victim of the breach or not. worse still, while equifax was unclear about whether someone's information had been stolen, they were very clear about one thing: everyone, whether information was stolen or not, should sign up for a supposedly free equifax credit monitoring service called "trusted i.d. premier." the terms of use for this program required anyone who signed up to have a credit card. why? because after the first year, equifax could start automatically charging the credit card or the service if the customer hadn't already canceled. you know, that's right. equifax was trying to impose secret fees and profits off the back of their own system. but wait -- it got even worse. to sign up for this credit monitoring service, equifax first forced consumers to give up their right to go to court and sue equifax if they had any disputes about the product. now, equifax changed some of the terms after there was a lot of public pressure, but let me see if i can recap all this. after allowing hackers to steal personal information on as many as 143 million americans, equifax hid the breach from consumers for more than a month, failed to clearly inform people whether the information had been stolen, then tried to profit off the breach by tricking people into signing up for a costly credit monitoring product that also required them to give up their legal rights. wow. in the last decade, there has been so much corporate misconduct, so much bald-face contempt for consumers that at times it feels like we've all just grown numb to it. but even against that backdrop, equifax's behavior is just jawdropping. it is time for us to fight back. it is time for all of us to fight back -- democrats, republicans, independents, libertarians, vegetarians. it doesn't matter. we have all been victims of equifax's hack or we know someone who has. and we all deserve better. that's why i partnered with senator schatz and ten of our colleagues to introduce the freedom from equifax exploitation act -- or free act -- last thursday. our bill empowers consumers to take back control of their personal credit data. the equifax hack has highlighted the strange role of credit reporting agencies like equifax and how they interface with our financial system. banks and other big companies feed agencies like equifax information about every major financial transaction that you make, from purchasing a car to taking out a mortgage to buying a home to getting a student loan. they get information on every monthly payment you make, and they note where you live and how long you've lived there and what your phone number is, and every day the credit reporting agencies package up that information about you into files that they then sell to other people. and sometimes it's people you know about, like when you apply for a mortgage or a car loan, but a lot of times equifax is just selling data to people who want to sell you something -- credit cards or a student loan refinance or even a cruise. the bottom line is that companies like equifax are making billions of dollars a year collecting, sharing, and selling highly personal information about you. and all without your explicit permission or without paying you a penny. the free act tries to level the playing field. first it allows every consumer to freeze and unfreeze their credit file for free. if you freeze your credit file, no one can access it and the credit reporting agency can't use it either. a freeze is kind of like a do not call list for your credit information, and it's about security. it means even after the equifax hack that thieves can't open credit cards or take own loans in your name, even if they have your personal information. but it's also an easy way to give you the power to decide who gets your information for any other reason. the basic idea is simple: equifax doesn't pay when you they sell your data, and you shouldn't have to pay equifax to keep them from selling it. our bill says the same rules apply to all three credit reporting companies and all three companies must refund your money if they charged you for a credit freeze in the aftermath of the equifax breach. no one in this industry should profit from this hack. this bill doesn't fix all the problems in the credit reporting industry. it is only a first step. congresswoman maxine waters has been looking into the credit reporting industry for years and she's introduced legislation to reform the industry and empower consumers. i think the senate ought to take a very close look at her bill. and i've also launched an investigation into the equifax breach and the whole credit reporting industry. in the upcoming weeks i will be gathering more information from equifax, from the other credit reporting agencies, from federal regulators, and from legal experts. i'm going to keep fighting to make sure credit reporting agencies can't exploit consumers and put their personal information at risk. this is a test for congress. if we act quickly to protect american consumers -- or are we going to cave in to firms like equifax who have spent millions of dollars lobbying to congress for weaker rules? which is is it? the free act is an important but simple response to the equifax hack. i hope my colleagues to join me to help pass this bill. thank you, mr. president. i yield, and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: the presiding officer: the senator from maryland. mr. cardin: i would ask unanimous consent that the quorum call be dispensed with. the presiding officer: without objection. mr. cardin: mr. president, there are reports that we may be having a vote next week under reconciliation dealing with the health care system of this country. we know that our colleagues have filed a new bill, but it is basically the same bills we've seen in the past, but this time even more consequential to our health care system of the people of this country. now, i mention first the process because this bill has not gone through any regular order. it has not been referred to a committee for consideration. it has not been marked up or debated in our committees. it is going to be supposedly brought up as an amendment, but with us returning to reconciliation. so let me first explain what that means. that means that there will be no chance for us to offer amendments to the legislation. that means there'll be no opportunity in our committees to mark up legislation or to get the cost of the legislation or the technical help we do in doing any bill, let alone a bill that affects a large part of our economy. the presiding officer and i both serve on the senate finance committee that has jurisdiction over health care. we're not going to have an opportunity to get the expertise help from our staff to look at the consequences of the cassidy bill and have a chance to work on it to make it work. instead, what is going to happen, if the game plan goes forward, this bill is likely to be on the floor next week where a simple majority will be able to pass it. there will be no chance for debate on the floor because we're at what's known as a vote-a-rama and we'll be affecting one-sixth of our economy. that is not the way we should be operating. i'm also told that it will be done without a congressional budget office score. now, that's unconscionable. we know that four previous congressional budget office scores on the other proposals that have been brought out, that tens of millions of americans would lose their health insurance coverage. premiums would increase by, in some cases, 20%-25%. it was certainly information from our objective staff that caused many of us to say, what are we doing? well, at least we had that information before we voted. we're now being told that we may get a one-liner from the congressional budget office giving us the bottom-line impact on the deficit but 0 not the specific -- but not the specific information as to how many millions of americans are going to lose their coverage and what is going to happen with those of us who currently have insurance with our premium increases. this is not the way we should be proceeding. it retreats against the progress we've made against the abusive practices of the insurance industry. under this bill, as i understand the cassidy bill, each state could basically set up its own rules for how they wish to have coverage. the entire medicaid system in this country would be block granted and would be capped, so the federal government would be getting out of the medicaid business. states would be given greater flexibility on how to operate the exchanges in their state, would no longer be subject to the same national requirements. and that means, for example, we all pride ourselves that we eliminated preexisting conditions, but in reality if the state determines what benefits are going to be covered and under what conditions, preexisting conditions come back. that is something we should not ever allow to happen. and yet, under the cassidy bill, we are going to be telling people that we may not be covering their mental health needs. we may not be covering the opioid addiction problems. we may not be covering maternity benefits. we may not be covering pediatric dental coverage. we don't know what plans will be offered today. we know under the affordable care act, we have these national protections. everyone is on a level playing field. so a state could design a plan that will be totally unaffordable for people that need the coverage because they isolate the group to such a small number. that is not what we should be doing. it would provide ininadequate coverage. let me explain what i mean. i had a family came to me, young family, and they told me about the circumstance of their child being born prematurely with significant challenges. they said that if that child would have been born before the affordable care act, that parents' policy would have reached their lifetime cap within the first year. and the family would have had to make some horrendous decisions on how to take care of their child. that's why we passed the protection against annual lifetime caps. that could return again under the bill that could be brought to the floor next week. i know circumstances where families have been able to get preventive health care and discovered cancer at an early stage. that coverage wasn't there before the affordable care act. there's no guarantee that coverage will be there afterwards. we could return again to bankruptcies. what is the leading cause of bankruptcy before we passed the affordable care act, was health care cost. now we're going to say because of inadequate coverage and lack of coverage american families are going to be faced with taking care of their family, running up bills and ultimately facing bankruptcy. we're going to be affecting people's lives; make no mistake about it. but the real tragedy of this proposal, why it's so different than some of the others, is it's an abandonment by the federal government of the medicaid system. it would have draconian cuts in the medicaid system to the extent that it would cripple it. it would make it ineffective. the states would be unable to respond. it's interesting, we just got a letter, mr. president, from ten governors in our country, five democrats and five republicans. all these governors said, no, don't do this. we can't do what you're asking us to do. we would have to make horrible decisions on whether we're going to continue to provide long-term care to our seniors or whether we're going to expand coverage or whether we're going to narrow benefits or whether we're going to could have prescription drugs or whether we're going to cut providers and they may not be able to treat medicaid patients. these are decisions the states are going to have to make if this bill ever became law. it is -- it affects so many. some of the things that may be misunderstood about the medicaid system is that veterans, 1.75 million are in the medicaid system. quite frankly, their coverage has never been enough and the medicaid system has helped fill the gap. that's going to cause a problem for our seniors. i'll just give you one example. we pride ourselves on federalism and federalism to me is very important. i served for several years in the state legislature, former speaker. maryland general assembly. and i pride the fact that maryland has been an innovator in health care. they have been able to do that because of the partnership between the federal government and the states. that's federalism. it's worked. if this bill, amendment were to become law -- the cassidy bill -- it will prevent the states from innovating. it's not giving them more flexibility. when you don't give them the resources and tools to deal with issues, you can't. example, maryland. we have what's known as an all payer rate structure for hospital costs in maryland. regardless of who covers your insurance, whether you're medicare, medicaid, or private insurance, or you pay on your own, you pay the same rate in my state for hospital care at the same hospital. it's an all payer rate structure. we don't have cost shifting and charity hospitals. we have hospitals that are located in all of our communities, therefore. it saves the federal government money. it saves the state government money. and it's proven to be more cost effective. the state experimented, and it works. and the federal government has partnered with us. can we continue that program if we get these draconian cuts to medicaid? the answer is no. can we continue this program if we see the uninsured rates bloom in maryland because of the people losing their health coverage under this bill? the answer is no. you can't do this if the uninsured rates go from 6% to 12% or 15% of uncompensated care in our hospitals. that's what's at risk with the cassidy bill. it really is, to me, also an affront to federalism in that you're putting states versus states. i'm in a state that did medicare expansion -- medicaid expansion. the cassidy bill has been scored that will cost my state $2.1 billion. i know that our legislature doesn't have that money. i know the governor doesn't have it. he recently went to the department of public works and reduced the state budget because they're running a deficit and they're not allowed to run a deficit. they can't possibly cover the $2.1 billion. but here's the tragedy, another tragedy of this bill. the tragedy is that some states do much worse than other states. why? because maryland expanded medicaid, as did many other states, and, therefore, we got more federal funds because we had more people in the program. that seems fair. we're covering more people. but the cassidy bill takes away from those states that expanded coverage, and we lose more. i thought this was the united states. i thought we were all in this together. the people in maryland are proud to help the people of texas or florida because of the hurricane. and now you're coming back and say you're going to hurt the people of maryland because we did the right thing on medicaid? is that what this country is all about? is that the united states? is this body going to condone that type of discrimination against states? i hope that's not the case. so, mr. president, i hope for many reasons, on substance and on process that this bill is not brought up. let's return to regular order. i heard senator mccain say that so eloquently on the floor of the senate. we have -- for the last two weeks i've been working with my republican and democratic colleagues to come up with bipartisan ways to improve our health care system. we made progress. we have some good ideas to stabilize the individual marketplace and to bring down the cost of health care working together. and guess what? if we succeed in regular order and bipartisan, we'll not only do the right thing so people have stronger protection, but we'll also have policy that will stand the test of time and give predictability to the health care system of this country. that's what we should be doing in the best tradition of the united states senate. i urge my colleagues, let's work together and let's reject this proposal. let's not bring it up. let's go, continue our work on a bipartisan basis. certainly don't use reconciliation. let's work together for the people of this country. with that, mr. president, i would suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: 4 quorum call: the presiding officer: the senator from washington. ms. cantwell: mr. president, i ask the quorum call be dispensed with. the presiding officer: without objection. ms. cantwell: mr. president, my colleagues have been out here in the last few minutes, last night, this morning, this afternoon to talk about our distress of people trying to push again the repeal of the affordable care act without a successful strategy to move our nation forward on more afford ability. we just received a letter from ten governors telling us to slow down and work on a bipartisan basis, basically telling us that the proposal that people are trying to rush through without regular order is not the kind of thing that is going to help us making the reforms that are necessary. thing so i think that these bipartisan governors from the governor of colorado to the governor of ohio to the governor of alaska is something that the people in the united states of america should listen to because it's important that we get it right because the affordability of health care is so important. what i don't like about the proposal that is now being pushed by my colleagues even though they want the states to have some flexibility and play a larger role is that it basically ends the 52-year state partnership that we know as medicaid today. that is, it changes the dynamic that says the state and federal government are in business together to take care of a population that is the most vulnerable of citizens in our country and that giving them affordable access to health care is a priority because it actually reduces everybody's health care costs. when people think about the expense in health care, you can ask any provider, they will tell you $1 in $5 will drive the costs. if you leave people uninsured, it raises the costs fosh everybody. we have seen states that cover people on medicaid actually raise people out of poverty and help their economies and reduce the costs at individual hospitals, thereby driving down the cost of private insurance. so why would we want to destroy that by authorizing in legislation the end of this 52-year relationship between the federal government and states on trying to make sure that our populations are covered, that if a state spends a dollar, they can count on the federal government to spend that dollar as well as to continue the partnership that works cost effectively. what i also don't like is that it sunsets medicaid for 15 million people. sunsetting medicaid -- if you're going to sunset this 15 million people, when will you sunset medicaid for the rest of the population? when will you try by legislative action to curtail the opportunities for millions of americans who use medicaid as a stabilizing force for health insurance in america? in our state, 16,000 people, most of whom were previously uninsured would then be set for that sunset of medicaid. the legislation that my colleagues are pushing basically would end the funding for this program in 2027. so that would leaves states with an unfunded bill for those individuals of over more than $300 billion. so i doubt that states have the money. i doubt that the individual market is going to take care of those individuals as cost effectively as we're taking care of them and states will then cost shift these resources back to the cost of the public in raising everybody's rates again. our job here has to be about afford ability, it has to be about driving down costs, it has to be about driving down costs in the individual market and in the system overall. there is nothing good about kicking 15 million people off of medicaid and sunsetting it in this bill. my colleagues are advocating the privatization of medicaid. they are advocating that what you do with this population is take them off the current program and shift them on to the exchange. now, some people who are following this will say, wait, they can go to the private market. the legislation also says that you stop that support by 2027. so this is just one more sneak attack by our colleagues at kicking people off of medicaid. to start the process and agree to privatize medicaid, where is it going to end? now i'm the first to say that we can improve our delivery system, that we can save money. i've advocated what i think one of the most cost-effective aspects of medicaid is to move those who need care later in life off of nursing home care into community-based care. our state, the state of washington, saved over $2 billion over a ten-year period of time. if other states did this we could save $100 billion or more by giving states opportunity to age at home and have a long-term care delivery system that works in our communities. it is one-third the cost. now, that is innovation, that is cost savings, that is improvement on our current delivery system and hopefully covering an aging baby boomer population that is going to reach retirement and a population of americans that are going to live longer, but there is nothing innovative of privating medicaid and kicking people off by shifting them over to an exchange and then cutting the resources for the exchange. so i hope our colleagues will stop the notion that somehow this is innovation. it's not innovation, it's sunsetting, it's privatization, it's cutting people off of care, and that is why we have heard from these governors and others about why this is so important not to take this bait. we need to make sure that we're continuing our bipartisan discussions, continuing to work together about what will drive affordability into the market. bundling up a population and giving them clout to negotiate on rates and giving a state the ability to negotiate on rates, either on drug costs or on insurance, yes, can save dollars. it is being done right now in new york and minnesota and it can be done in other places. but cost shifting to the states, this $300 billion, or then making states make the draconian decision of, wait, i already shifted that population on to the exchange, oh, my gosh, the federal government just cut the funds that we're going to get, next thing you know this population is left without care. privatizing medicaid is not the way to go. i hope our colleagues will continue to discuss in a bipartisan basis the aspects of the affordable care act that could be expanded to drive down costs and increase affordability. i hope that they will continue to make sure that things like basic health, the essential elements of what should be covered in a basic plan are there for our consumers, that somehow we're not going to take the bait in thinking that by cutting essential services to people that somehow is that the way to get a private insurance plan. we have the ability to work together. my colleagues and i have been working and discussing these ideas. my colleagues senator murray and senator alexander are working on various ideas in the help comiet as well -- committee as well as the finance committee to make sure that we fund the insurance and their families under the chip program. let's not make this worse. let us not end this 52-year relationship that has successfully covered a population of americans and let's not fall for the bait and think somehow this is going to save money for the american taxpayer. it is not. it is going to cost the individuals, raise the individual rates, and we can't afford it. let's make it cost effective. i thank the president and yield the floor. the presiding officer: the senator from main -- from maine. ms. collins: thank you, mr. president. mr. president, the cost of health insurance has been a major problem with the affordable care act and with many of the bills that have been advanced repeal and replace this law. i rise today to introduce the lower premiums through reinsurance act of 2017. this bill would provide states with the flexibility and support that they need to kreet state- -- kreet state-base -- create state-based reinsurance programs for their health insurance markets in or the to lower premiums while ensuring continued coverage for people with preexisting conditions. i'm very pleased to be joined by my colleague and friend, senator bill nelson, in introducing this bill. senator nelson is a former insurance commissioner who comes to this issue with a wealth of knowledge dating to his experience with florida's innovative homeowners reinsurance program developed in the 1990's in the wake of hurricane andrew. mr. president, my own -- for my own part, i spent five years in state government overseeing a department that included the bureau of insurance. over the past two weeks, mr. president, the senate help committee, on which i'm privileged to serve, completed a round of hearings under the able leadership of chairman lamar alexander and ranking member patty murray. they looked at the steps that we could take in the near term to stabilize the individual market and help to bring down rates. reinsurance was frequently mentioned as an option that congress should consider and adopt. insurance commissioners from alaska, pennsylvania, south carolina, tennessee, and washington state all spoke positively of its benefits as did the five governors who testified before the committee, three republicans and two democrats. although the witnesses presented different views on how a reinsurance mechanism might be structured, they were in broad agreement that reinsurance funding would help to stabilize the markets and lower premiums. mr. president, the national association of insurance commissioners has recommended that congress provide reinsurance funding of $15 billion annually to help cover high-cost claims in the individual market. we realize, however, that we are living in very tight budget times and that there is an understandable reluctance among many members to provide that level of federal funding. we believe that the a.c.a. section 1332's flow-through mechanism did effectively leverage the level of funding with a much less federal dollars. our bill would appropriate $2.25 billion a year in 2018 and 2019 which should be sufficient to leverage $15 billion in total reinsurance funding annually based on the ratios in alaska's recently approved waiver. as alaska's insurance commissioner told the help committee, next year her state will be able to fund its $55 million reinsurance program with just $6.6 million of its own money. s that 15% -- money. that's 15% of the total. the remaining $448 million will be provided in federal flow-through funding that matches the savings to the federal government resulting from the reinsurance program. let me explain how -- why there will be savings for the federal government. if we're able to reduce the cost of premiums, then the federal government will be paying less by way of subsidies to individuals who qualify for those subsidies because they make 400% or less of the federal poverty level. the bill that we're introducing today would allow states to quickly stand up their own reinsurance programs through the affordable care act section 1332 waiver process. broadly speaking, the bill would create a menu of options that states could use to design reinsurance programs which in turn would be eligible for federal seed money grants. states may also obviously add funds from other sources to the mix. states that want to set up their own reinsurance could do so under our bill by using one of three options designed for expedited review. first by demonstrating their program is a visible high-risk pool along the lines of the maine and alaska models which i will describe in more detail in a moment. second, by showing that their program fits within the parameters of obamacare's transitional insurance program, which expired at the end of last year. and third, by submitting what i would call a me-too application based on another state's program that has already received approval. i would like to take a moment to explain why our legislation provides expedited review for different reinsurance pool designs. first, many of the witnesses who testified before the help committee made the point that states would have difficulty quickly coming up with their own design. we acknowledged that, and that's why we provided expedited review for a pool based on the transitional a.c.a. reinsurance program previously in effect and with which states are already familiar. second, we know from the experience of the states of maine and alaska how effective invisible reinsurance pools can be. alaska's invisible pool reduced a projected 40% rate increase to just 7% this year and is expected to contribute to a 20% decline in premiums next year. maine saw similar results in its program, the maine guaranteed access reinsurance association. the maine program which was in operation from 2012 until the end of 2013 covered approximately 3,600 insured individuals at a cost of approximately $12,500 per person per year, and reduced rates in the individual market by about 20% on average. it's important for us to keep in mind, mr. president, that the individual market is where people who do not have employer-sponsored insurance have to go to buy their insurance, and if they make 400% or less of the federal poverty level, they get premium tax credits -- subsidies, in other words -- from the federal government to assist them with the cost. but if they make a dollar over 400% of the federal poverty level, they lose that assistance altogether. that's another problem that is in the a.c.a. or those clips which makes no sense whatsoever and really penalize individuals who may work in the trades, for example, like electricians or plumbers who don't know for certain what their income is going to be and can face an unexpected bill where they have to pay back the entire subsidy. but there are others who make above 400%, knew it, didn't qualify for the subsidy, but still have to purchase in the individual market. now, i think that bet should be revisited, but that is a speech for another day. my point is that they would benefit greatly from a 20% reduction in the premiums that they pay. and that was our experience in maine, that on average there was a 20% reduction in premiums when the reinsurance pool was in effect. the reinsurance pool even generated a surplus of $5 billion during its 18 months of operation. the maine pool was successful for several reasons. first, risks were seated up front so insurers could not wait until a policyholder developed an unexpected serious health condition to decide who was going to be in the high-risk pool and who was not. the rules also required policies for individuals who suffered from certain high-risk conditions to be automatically ceded to the pool in the enrollment. i would note that when an insurer made the decision to cede to the pool the risk for a particular policyholder or if it was an automatic ceding, 90% of the premiums from that policyholder went to the reinsurance pool to help finance it. second -- and this is important -- the pool was invisible, the program was invisible to both individuals who are insured through it and to health care providers. individuals were covered seamlessly and enjoyed the same benefits as nonpool enrollees. likewise, health care providers did not know whose policy had been ceded to the pool. and third, and also very important, maine's program operated with the full set of consumer protection guide rails set by the a.c.a., including guaranteed issue, guaranteed renewability and prohibitions against taking preexisting conditions or a health status into account in issuing policies or setting rates. fourth, the maine program was designed to provide true reinsurance. insurers paid the first $7,500 in costs plus 10% of the next $25,000. after that shall -- threshold, the pool picked up the rest of the cost. finally, maine's program was backed by a stable funding source. in addition to receiving 90% of the premiums for ceded policies, it also received funding that was assessed at a rate of $4 per person per month on all health care policies. while alaska's reinsurance program differs from maine's in some respects, the success of both models shows the promise, proves the promise of invisible reinsurance pools, and that's why our bill includes invisible reinsurance pools as an option for expedited review and approval. mr. president, open enrollment in the a.c.a. exchanges begins november 1, just about six weeks from now. in just days, c.m.s. is expected to finalize the premiums insurers will charge in the a.c.a. exchanges next year. well, i personally remain ever hopeful that a bipartisan agreement on a targeted consensus approach to stabilizing the markets and reducing premiums can still be reached. clearly, we have very little time. beyond providing cost-sharing reduction funding, there is no step that would be more powerful in stabilizing markets and reducing premiums than providing reinsurance. mr. president, this chamber is deeply divided on what to do on health care policy, but surely we ought to be able to come together and build on the good work that the leaders of the help committee have done, work that more than 60 senators have witnessed that participated in by attending coffees that senator lamar alexander and senator patty murray have sponsored with our witnesses, and by participating in the help committee hearing. and they have worked hard to produce a bill that would really make a difference. the bill that senator nelson and i are introducing today helps to fill out the reinsurance provision that i know from attending each of those hearings has been widely supported by virtually every witness who testified before us. it would enable states that stand up their own reinsurance programs simply and quickly and it would reduce the costs of the federal government reuse the section 1332 flow-through mechanism far below what would otherwise be required. and most importantly of recall, it's something that we could do right off, along with the cost-saving reductions which help low-income people with their co-pays and their deductibles, their out-of-pocket costs. those two steps are actions that we could take right now to help moderate premium increases that would otherwise occur and that would be of real benefit to anyone who is in the individual market. thank you, mr. president. i yield the floor. mr. barrasso: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: thank you, mr. president. mr. president, last week the senior senator -- junior senator from vermont and a group of other democrats unveiled a proposal to have washington take over health care for everyone in america. some refer to it as berniecare. they intended to do this on the backs of american seniors which is of great concern to me as a doctor who has taken care of many senior citizens, people on medicare as part of my practice as an orthopedic surgeon. their idea is to put everyone in this country on a new program that operates like medicare. that's about 250 million americans who would be added on to a program, medicare, that is already being strained. one-third of the democrats in the senate have signed on to this plan. it seems to be the litmus test for the liberal left. several of them came to the floor last night to criticize republican efforts, efforts by the republican party to save america's failing health care system as the problems resulting to the american health care system as a result of obamacare continue to get worse and the impacts are such of those that i hear them every weekend in wyoming including this past weekend. from what i've heard from the democrats, they seem to want to let the system collapse in a way that they can then impose a complete washington takeover of health care in america. well, to me this plan that they're proposing is going to be devastating to people currently on medicare. these are the seniors that rely on medicare today. what the democrats are proposing is going to, in my opinion, undermine the stability, the integrity, and the certainty of the medicare program that our seniors rely on and for them it is truly their lives that depend upon it. you remember when president obama promised that if people liked their insurance, they could keep their insurance. if they liked their plan, they could keep their plan? well, people realize that is not exactly what happened. many people lost their plan, lost their insurance, it got more expensive, harder to afford. millions end up paying a fine, a fee, or a tax, whatever you want to call it because they weren't able to afford the premiums for the plan that president obama said they had to buy and they lost their own plans. well, now it seems if democrats have their way, millions of seniors will find out that they're not going to be able to keep the insurance that they have right now, that they depend upon, and that they use on a daily basis. the sanders plan will get rid of medicare advantage plans. we have 17 million seniors in this country who are on a medicare advantage plan. the reason they sign up for medicare advantage is that for them personally when they have studied it, there are advantages to medicare advantage for them. there's -- in terms of preventive care, in terms of coordinated care. that would all go away under berniecare. well, it's interesting to watch this whole process unfold because the one in three people that are currently on medicare have chosen to go outside the system that democrats want to put them into. they want to put everyone into it but a third of people on medicare have chosen a different way. what happens to the 17 million americans who are currently on medicare advantage? with the scheme that senator schumer and others -- senator sanders and other democrats have come up with, they don't say. did the democrats who came to the floor last night have anything to say about these 17 million seniors who would be losing their medicare? seniors who are on medicare today? what's going to happen to them? they're going to lose what they have today. a lot of seniors are probably going to lose access to their doctors as well because when their plans change, their doctors change. that's because they're going -- there are going to be doctors who won't be able to take care of these new medicare patients that the -- that obamacare has caused to have problems but has made worse with what is being proposed by senator sanders. right now, mr. president, it can be tough for a senior to find a doctor. these are seniors on medicare. that's because today about one in four doctors doesn't take new medicare patients or take any medicare patients. but certainly as more and more people and 10,000 baby boomers a day are turning 65 going on to medicare, there are more and more people on medicare without an expansion of the number of doctors to take care of them. and since the reimbursement is lower, what doctors and hospitals are paid to take care of medicare patients is lower than what those doctors or hospitals get paid for patients with private insurance, their priority when they're already crowded and loaded in their office and very, very busy taking care of patients, with waiting rooms full, their choice, of course, is then to choose patients who get -- who pay them more than what they get from the government. you say why is that? is that right? well, having practiced medicine for 24 years, having run an office, there are issues related to paying nurses, health care personnel, rent, electricity fees, all of the cobbss of running -- costs of running an office, let alone the high cost of medical malpractice insurance. we know the huge cost of that. so a physician who wants to be able to pay his or her bills needs to take all those things into consideration. and with medicare paying less than the current going rate for care at hospitals and doctors, the concerns is will medicare patients be able to find a doctor in the first place. so the democrat solution is cram more people on to medicare when we already have 10,000 people a day joining the ranks on medicare and on social security. so if a doctor is allowed medicare patients, he or she has to make sure they have enough other patients who have insurance to make up for the lower rates that washington pays. well, under the democrat plan, doctors won't have the backup of private insurance companies because that's all going to go away. all of those things will be lost to people who even want to buy private insurance under the plan that the democrats are now owe owe a majority of the democrats in the house of representatives have cosponsored legislation by representative conyers that does exactly the same thing, puts everyone on a medicare program, a government takeover of health care. so when the democrats came to the floor last night, i didn't hear them say anything about that. how are they going to guarantee that seniors can keep their doctors? seniors are not going to be able to keep their doctors under the sanders liberal left plan that's being proposed and cosponsored by half of the democrats, over half of the democrats who are in the house of representatives. mr. president, we're already facing a shortage of doctors in this country. the association of american medical colleges that helps oversee training of doctors says that shortfall could be as many as a hundred thousand doctors across the country within the next decade. and if we have fewer doctors and more people trying to get appointments, that means less access for seniors. it's not even clear if washington can afford to add every man, woman, and child on the government program like medicare because washington has done a terrible job in running medicare as it is. the medicare trust fund is supposed to be exhausted at the end of the 2020's. that's what the medicare trustees are telling us. in 12 years they say there will only be enough money coming in to fund about 8 or 9 cents on the dollar of what the benefits for medicare are supposed to be paying out. so the program is going to have to start doing something, either raising taxes or cutting benefits. and from what i've seen proposed by senator sanders, it would be raising taxes a lot. the medicare trustees say the program needs significant reform. they say it's already unsustainable. the democrat plan does nothing to change any of that. it does nothing to reform the program. all it does is crowd more people into a system that is already struggling financially. mr. president, the democrats' plan, my concern is, is going to undermine the stability of the medicare program that our seniors desperately need. we should be taking steps now to shore up, to strengthen medicare so it's able to keep the promises that we made to our seniors. my goal is to save, to strengthen, and to simplify medicare. that's not what we're seeing here. a few years ago we knew that medicaid program, not medicare but the medicaid program needed help. democrats just threw more people on the system with obamacare. that's what they did. the expansion of obamacare, the majority of people that have new coverage under obamacare, they didn't do it through private insurance. they got it by being put on the medicaid program which has significantly strained medicaid and has made it much harder for people on medicaid who it was originally designed for. low incowomen, -- low income women, children, people with disabilities. it was designed to help them. it made it harder for them to get care because of all these added individuals who were working age adults were put on in addition. well, now it looks like the democrats want to do the same thing that they did to hurt medicaid to make it harder for our patients on medicare. mr. president, it won't work. an insurance card does not equal accessible, available access to care. the people who suffer the most are going to be the seniors who have no other options. these are seniors who are relying today on medicare. they were promised that medicare would be there for them. we need to keep that promise. instead of protecting seniors today, however, democrats are trying to give medicare to everyone else. 17 million seniors are going to lose access to the plans that they've chosen, that have worked for them, that they want to keep. seniors are going to lose access to the doctors the democrats push out of the system as they continue to put more and more people on medicare. democrats should not be building their takeover of the american health care system, president, on the backs of our seniors. thank you, mr. president. i yield the floor i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call: mr. mcconnell: mr. president. the presiding officer: the majority leader. mr. mcconnell: i ask consent that further proceedings under the quorum call be dispensed with. the presiding officer: without objection. mr. mcconnell: i ask unanimous consent that not withstanding rule 22 at 4:00 p.m. today there be two minutes of debate equally divided between the managers or their designees and that following the use or yielding back of that time the senate vote on the motion to invoke cloture on the emanuel nomination. the presiding officer: is there objection? without objection. a senator: mr. president. the presiding officer: the senator from new hampshire. mrs. shaheen: thank you, mr. president. it feels like groundhog day again because once more we're seeing republican leadership here in the senate advancing another bill to repeal the affordable care act to make radical cuts to the medicaid program. and as with previous efforts, this new bill -- they call c graham-cassidy, but it really is trumpcare, a third version -- and it's strictly partisan legislation drafted in secret outside of regular order without hearings or consultation with most senators or stakeholders. but here's what's different, because this bill is even more reckless, more destructive than previous bills to repeal the affordable care act. it would take away health coverage from estimated 30 million americans. it would effectively end protections for people with preexisting conditions by allowing insurers to charge exorbitant rates. it would make profound cuts to the medicaid program which is a lifeline to 33 million children and 10 million people with disabilities, for 6 million seniors in nursing homes. and it would be a tragic setback in the fight against the opioid epidemic because it would end access to lifesaving treatment for an estimated 1.3 million with substance use disorders. and in new hampshire, where we are at the epicenter of the heroin and opioid epidemic, it would have a huge and tragic impact. now president trump said that a previous republican bill to repeal the affordable care act was mean, and make no mistake, this bill is far worse. as i've said repeatedly, the only constructive way forward is for us democrats and republicans to come together in a good-faith bipartisan effort to repair and strengthen the current law. as senator mccain said in this chamber in july, quote, let's return to regular order. we've been spinning our wheels on too many important issues because we keep trying to find a way to win without help from the other side. well, when senator mccain said that, we gave him a standing ovation on the floor of this body. and in the weeks since the vote on the last attempt to repeal the affordable care act, the senate has actually been acting on his advice. we've been working under the leadership of senators alexander and murray, the chair and ranking member of the health, education, labor and pensions committee, on bipartisan legislation to restore certainty to the health insurance market to fix problems with the affordable care act that we all acknowledge. this effort includes a version of legislation that i've been working on to make regular appropriations for the cost-sharing reduction payments. those are payments that keep co-pays and deductibles affordable for low- and middle-income americans. i participated, as have so many senators, in the bipartisan meetings that they have held with governors, with providers, with stakeholders, with insurers, with state insurance commissioners to craft a positive way forward. and it's very disappointing that we are here today with another attempt to blow up all of these bipartisan efforts by bringing to the floor yet another divisive partisan bill. now to understand why people are upset and fearful about this latest attempt to repeal the affordable care act, i would call our attention to the many positive impacts that the affordable care act has had across the country and in my home state of new hampshire and the consequences of repealing that law. thanks to the affordable care act, more than 49,000 granite staters have been able to get health insurance coverage through the marketplace. thanks to the medicaid expansion, more than 110,000 people in new hampshire have gotten lifesaving treatment. the medicaid expansion, which has been a bipartisan effort between then-democratic governor maggie hassan and the republican legislature, it has been a critical tool in our fight against the opioid epidemic. and hundreds of thousands of granite staters with preexisting conditions of one kind or another no longer face discrimination by health insurance companies. and in one fell swoop, this graham-cassidy trumpcare legislation would put all of these gains in jeopardy. i would appeal to my colleagues here in the senate to stop and reconsider what's going on. listen to the stories. look at the faces of everyday americans whose lives would be devastated by this legislation. from children to seniors to veterans. several months ago on facebook and other social media platforms, i asked people across new hampshire to tell me their stories, stories about how the affordable care act has made a lifesaving difference or has improved their lives and their families' well-being. and i was overwhelmed by the response. here in washington, some seem to think that repealing the affordable care act, no matter how destructive the consequences, is just about politics, that it's about notching a win for their team. for the people in new hampshire and across the country, repealing the affordable care act and slashing medicaid isn't about politics. it's about life and death. it's about people being cut off from vital lifesaving treatment for substance use disorders. it's about families losing affordable health coverage, about seniors being unable to pay for nursing home care. it is about millions of vulnerable people with preexisting conditions who would effectively be denied health coverage. it's about returning to the pre-a.c.a. days when simply being a woman was considered a preexisting condition, justifying much higher rates. so i urge republican leaders to stop this latest effort of destructive partisanship. there should be no retreat in the progress we've made in recent years, including in the progress against the opioid epidemic. i encourage senators who support this ill-conceived legislation to listen to the governors, to listen to the insurance commissioners, to listen to patient and provider groups. and most importantly, to listen to their constituents. let's fix what's not working about the affordable care act and let's change -- let's not take away legislation. let's not pass legislation to take health care away from people. let's support bipartisan efforts now underway in the senate to stabilize the marketplaces and to provide access to quality affordable health care for every american. thank you, mr. president. i yield the floor. and note the absence of a quorum. the presiding officer: the clerk will call the roll. the presiding officer: the senator from maine. . a senator: mr. president, i rise to discuss this issue of health care. mr. king: in real disappointment. over the last several weeks there have been bipartisan discussions, true bipartisan discussions. the presiding officer: the senate is in a quorum call. mr. king: i would ask unanimous consent that the quorum call be dispensed with. the presiding officer: without objection. mr. king: mr. president, over the past several weeks there have been real discussions, bipartisan discussions about fixing the problems in the affordable care act, about controlling the growth of premiums, about being sure that there is some certainty in the market to prevent the collapse of the individual market which, by the way, will not only affect people who are participating in the affordable care act exchanges, but will affect all those in the individual market. and we could stop that. and the senate health committee had four days of hearings and round tables, coffees with other senators to talk about what are the problems, what can we do to solve them. and we were making some real progress. and then all of a sudden up comes trumpcare 4.0, or 5.0. i've lost track. another bill to essentially repeal and not replace the affordable care act. on july 21, 1861, there was an occurrence at the beginning of the american civil war. it was the first battle of bull run, and the union troops were routed that day and there was a disorganized retreat back towards washington. that's been known holily as the the -- historically as the great skidaddle. that's what is known today, the great senate skidaddle because what the senate is doing is avoiding responsibility. you don't want to be discriminated against because of preexisting conditions, well, that's not our decision. we're passing it on to the governor. the governor can make that decision. it's not us doing it. you don't want to have the bans for the differential tweeng young people and -- between young people and old people changed so elderly people pay twice, three times, four times, five times as much for health insurance as young children. you don't want responsibility for that? fine. pass this bill and give it to the governors. that's what we're talking about here, is a cop-out. it is the senate majority once again trying to jam down the throats of the american people a change they don't want. they don't want it. everywhere i went in maine in july and august after our vote back at the end of july, people said thank you. they said thank you. and they said tell susan collins thank you for the vote to preserve our health care. and yet, here we are back at it again. but i think we need to understand what this bill does. essentially it does two things. it shifts all the responsibility for the health care provision to the most vulnerable americans entirely to the states with very little in the way of guardrails or protections. and it gives them less money. in order to provide that kind of health care. that's called shift and shaft. shift the responsibility and shaft the people who have to try to meet that responsibility. i've been a governor. what we're talking about here is cutting off the support and the dollars that are needed to meet those responsibilities. and everybody says, well, this is all flexibility. we're providing flexibility. flexibility to make agonizing decisions between providing health care to seniors or to children, to people who are disabled or people who are just trying to get on their feet and go to work without the specter of a health care disaster hanging over them. i suspect we'll have more to say about this next week, but it's a travesty. and i understand there's going to be a little hearing on monday. i call it a fig leaf hearing. there's going to be a hearing. we don't know who's going to be there. we don't know exactly what the testimony is going to be. it's going to be a hearing so people can say, yeah, we had a hearing. well, come on, this is not a responsible way to legitimate and the people of this country expect more of us. i hope that both parties will recognize the folly of what's being proposed here and say no and go back and talk on a bipartisan basis and go back and fix the problems that need to be addressed. mr. president, i yield the floor. the presiding officer: under the previous order there will be two minutes of debate equally divided between the two parties. is there objection? without objection. all time is yielded back. the clerk will report the motion to invoke cloture. the clerk: cloture motion. we, the undersigned senators, in accordance with the provisions of rule 22, do hereby bring to a close debate on on the nomination of william emanuel of california to be a member of the national labor relations board, signed by 17 senators. the presiding officer: by unanimous consent, the mandatory quorum call has been waived. the question, is it the sense of the senate that the debate on william emanuel to be a member of the board shall come to a close. the clerk will call the roll. vote: vote: vote: the presiding officer: are there any senators in the chamber wishing to vote or wishing to change their vote? if not, on this measure the ayes are 49. the nays are 44. the motion is agreed to. mr. mccain: mr. president? the presiding officer: the senator from arizona. mr. mccain: mr. president, i ask unanimous consent to address the senate as if in morning business. the presiding officer: without objection. mr. mccain: mr. president, this week marks 30 years of loyal service to the senate by one joe donahue, my legislative director. 30 years working for the citizens of arizona and trying to make me a better senator. during those three decades, he worked his way from the mail room to a position of considerable importance on my staff. he's made himself something of an expert not only on senate procedure but all the many issues our staff has worked on over the years from budget matters to immigration reform to national security. joe is capable, intelligent, hardworking and trustworthy, a justifiably proud professional staffer, a pro's pro. he's well liked by staff and members on both sides of the aisle, especially by those who like him have dedicated most of their careers to the senate. i've come to depend on his professionalism and his counsel. more than that, my wife cindy and my children treasure his friendship as do i. joe and i began our senate careers around the same time. he started sorting mail and performing other entry-level duties in the first year of my first term. he was 18 years old. i wasn't quite that young but it was a long time ago for both of us. when he came to work with us, i don't think i knew if i was -- joe knew if i was a republican or democrat. he just knew he needed a part time job to pay for books and beer. these were preinternet and e-mail days and making certain the immense amount of mail we received from constituents was opened, given to me or to appropriate staff, and answered as quickly as possible. it was very labor intensive and challenging. but he did well as he has with every responsibility he has accepted on my behalf. his work ethic and reliability quickly made him indispensable. he worked his way up to legislative cores upon dent and less tif assistant with the lead responsibility for among other things helping me fight years of pitch battles with appropriations bills, targeting wasteful spending, and the practice of earmarking. those were the days when the senate actually debated appropriations bills, and i have many fond memories of joe drafting thousands of amendments at my direction to strike wasteful earmarks, although i'm not sure they're fond memories for the floor staff who had to process the amendments. as i mentioned. in addition to his legislative work, joe was my driver for over 20 years. i travel an awful lot back and forth to arizona on weekends campaigning for colleagues and on overseas trips. during the week when the senate is in session, my nights are often consumed with meetings, dinners, and speefes. -- speeches. joe worked a long shift in the office during the day and driving me to various appointments day and night, taking me to airports and picking me up, getting me safely in on time through washington traffic to keep a schedule that was always impossiblely crowded. he spent -- we spent a lot of hours together, thousands of hours. joe was almost always good company, even when i was not. he always made a point on those drives to tell me a joke and some of them got me in trouble when i repeated them in public. during my 2008 presidential campaign, joe worked as my assistant traveling from campaign stop to campaign stop doing all manner of small and large tasks for me. even once holding an umbrella overhead while i gave a speech in the rain in manchester, new hampshire. as my legislative director, joe is someone everyone on my staff looks to for policy guidance and instruction on senate procedures and for insights into the personalities and priorities of senior staff in other offices and for the leadership. he goes out of his way to make sure each one of my staff knows they're appreciated and an integral part of our office. mr. president, i'm grateful for joe donahue's faithful service to my office, the senate, the people of arizona, and to me. on their behalf and mine, i want to thank joe. i barked at you, teased you, laughed with you and counted on you. we've been through a lot of highs and lows in our 30 years of association, good times and bad. the good times were better and the bad times easier because of your help and friendship. thank you, my friend, my dear friend. it's been quite a ride together. i cannot imagine serving here without you. mr. president, i yield the floor. mr. mcconnell: mr. president? the presiding officer: majority leader. mr. mcconnell: i listened carefully to chairman mccain talking about his long association with joe. i thought maybe it was appropriate, ifd' say to my -- i'd say to my colleague from arizona, to point out that he eliminated an awful lot of my earmarks over the years. so i'll have fond reflections as well in a sense. no, i want to just join you, senator mccain, in congratulating joe for a great job for you and for our country for a very long time. a senator: mr. president? the presiding officer: the senator from virginia. a senator: mr. president, i rise to talk -- much attention our efforts to improve health care for americans. mr. kaine: before the passage of the affordable care act in 2010, americans with preexisting conditions faced serious barriers and since 2010 the rate of uninsured americans has declined to a historic low with 20 million more americans, the combined population of 16 or 17 states getting access to health insurance coverage. 410,000 virginians have received care through individual marketplaces. just last year an additional 400,000 are eligible to receive medicaid if virginia ever chooses to expand it. since being put on the help committee or being notified i would be put on it in december, i visited community health centers, med schools, behavioral treatment centers, nursing programs all across virginia talking to people about their health care needs. and i'm committed to work together with my colleagues to improve the health care of virginians and americans. there's a right way and a wrong way to do it. after there was the failure of an effort in late july, early august to pass a partisan repeal and replacement of obamacare using the budget reconciliation process, the success of which would have taken health insurance away from 20 million americans, i am disappointed that we haven't learned the lesson about the right way for do this and are apparently poised to explore yet again doing it the wrong way. there's a proposal on the table that's designated the graham-cassidy proposal, and it's just as threatening as the a.c.a. repeal that we voted on just two months ago. it restructures traditional medicaid funding using per capita caps and block grants, the core of this bill is an effort to dramatically go after restructure and shrink medicaid which is critical to so many people. it ends protections for people with preexisting conditions by allowing states to essentially rewrite essential health benefits. it would eliminate medicaid expansion and the affordable care act subsidies and replace them with a block grant that would be insufficient to cover the needs of virginians. and that funding, even that block grant funding would end after 2026 as if the need to help low and moderate income people would dramatically disappear overnight. the proposal is new and is newly on the floor and there isn't a full c.b.o. analysis of it, but initial indication has led groups like the american medical association, the aarp to come out against it. they're worried that it would leave insurance out of the reach of millions of americans, and in virginia alone, more than 301,000 marketplace enrollees would have their tax credits to help them afford insurance jeopardized. what would it mean for the health care system, we're not completely sure -- at least on the earlier versions vietnamed on we had c.b.o. scores telling us how many millions might lose their insurance. there seems to be a rush to get this through prior to a c.b.o. analysis. i don't know why. 60% of those on medicaid in virginia are children but the majority of spend on medicaid is for our parents and grandparents, and folks with disabilities and elderly. i was just in bristol, virginia, and i heard very, very palpable requests for the need for better health care especially in rural virginia. here's what we know about the graham-cassidy proposal, at least based often the analysis by this thus far by my state health care officials. we will see a $1.2 billion health care cut on this plan. the cuts will impact families like those i visit with as i travel around virginia. i recently had a roundtable with parents of children with severe disabilities, though they have disabilities they're doing some remarkable things because they receive some support from medicaid for assistive technologies and inschool programs. dillon has a rare neuromuscular condition. gets all of his nutrition through a g-tube. hayes a tracheotomy tube. he needs a ventilator to breathe. he requires inhome skilled nursing home services and also requires a nurse to attend school with him. he's successful student because medicaid funding enables him to go and then medicaid helps reimburse the school system for the services they provide him. for us, affordable and quality health care means that dillon can lead a normal life despite his medical issues. that's what his mom says. can lead a fairly normal life hon a vent -- 0en a ventilator with a tracheotomy with a nurse. can lead a fairly normal life despite his medical issues. he is participate in activities that any kid his age enjoys. without the assistance of medicaid he wouldn't be able to do those things. reducing medicaid spending would limit the state ability to provide waivers for medically complex kids and the mother adds, the possible return of lifetime caps and limitations on preexisting conditions would be devastating. i also met with a mother amy from richmond who has a son declan. medicaid helps her son have the best quality of life possible and helps him with the prospective that she prays deeply forks that one day despite his condition he can live independently as a productive adult. the graham-cassidy cuts the funding to medicaid and could cut the protection for these children. why don't we have an open process to truly debate improvements to our health care system instead of a rush to close secretive process that threatens mothers like amy and children like declan? after the efforts last summer, i hoped that the colleagues in this world's greatest deliberative body would stop secretive and harmful and rushed and instead embrace dialogue hearing from experts and witnesses as we would improve health care. attempting to stabilize the individual marketplace, lower premiums, and expand care rather than reduce it. we gave a standing ovation on the floor of this senate in late july when our colleague senator john mccain returned from a very, very difficult diagnosis of brain cancer. and we gave him a standing ovation after he spoke to us. and here's what he said. he talked about the fact that we've had a challenge around health care. he talked about the then-skinny repeal bill that was on the floor of the senate. he said, quote, we've tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them that it's better than nothing, asking us to swallow our doubts and force it past a unified opposition. i don't think that's going to work and in the end and it probably shouldn't. why don't we try the old way of legislating in the senate, the way our rules and customs encourage us to act. if this process ends in failure, which seems lukely, then let's return -- which seems likely, then let's return to regular order. let the health, education, labor, and pensions committee under chairman alexander and ranking member murray hold hearings, try to report a bill out of committee with contributions from both sides, then bring it to the floor for amendment and debate, see if we can pass something that will be imperfect, full of compromises and not very pleasing to implacable partisans on either side but that might provide workable solutions to problems americans are struggling with every day. and to my great satisfaction, after the skinny repeal bill went down and this body decided that it didn't want to precipitously take health care insurance away from more than 20 million people, that is the course that this body embraced. what our heroic colleague suggested that we embrace. the help committee, which had, as a member of this, aim he very aware, it refused to hold a hearing on any of the proposals in the house or in the senate around the repeal of obamacare, decided finally to do what the help committee should do, the "h" is for help to pass a bill reorienting one-sixth of the american economy around the most important expenditure that anybody ever makes in her to life without letting the -- in their life without letting the help committee hear from it was foolish to start with. l now we've embraced it doing it the right way, under the leadership of senator alexander and senator murray, we've had four robust hearings. we've invited governors to come from around the country. insurance regulators, insurance executives, patients, doctors, hospitals -- four hearings each with multiple witnesses -- we've turned their schedules topsy-turvy. we've had them here. we invited all members of the senate, not just those on the help committee. we've gotten advice from them on what we need to do to stabilize the individual insurance market and what we can do in the long-term to make health care better for everyone. we should take advantage of those recommendations and so when the fourth hearing was completed last week, the chairman of the committee, senator alexander, and the ranking member, senator murray, with the support of this very diverse committee, left, right, and center, democrats and republicans, have embarked on a bipartisan process to find, after a full and airing of the arabs, a way -- airing of the issues, a way to stabilize the insurance market. we're on the way to doing that. instead of going through a committee process and hearing and airing it before the public, now there's a new bill that's just recently come out with no full c.b.o. score and the idea is to try to force that through with no c.b.o. score, with no full committee process that would enable us to hear from witnesses, with no opportunity for members of any of the committees, finance or help, to offer amendments, with no meaningful floor debate, and with no opportunity for amendments on the senate floor. why did we give senator mccain a standing ovation just six weeks ago when he suggested, when it comes to something as important as health care, we should treat it with seriousness so that we can get it right and not rush and get it wrong? and so i stand here and i hope i'm on my feet a good bit more between now and the end of the month to ask this question: why backslide? why go backward when we had embraced a process of bipartisan discussion? and i'm in full awareness of the fact that as a member of the minority party i have no power except my ability to convince republicans that actually i have a good idea. but a one-party process on the floor that tries to end-run the relevant health committee is guaranteed to fail. it might parks but it's -- it might pass, but it's guaranteed to fail because it's guaranteed to hurt people. it's guaranteed to have some consequences that are harmful and known, and other consequences that are harmful and unknown because it has been rushed and it hasn't been done in the view of the public with the ability to fully listen to them. just think about it this way: what does it say about your commitment to your legislation if you are not willing to have it subjected to a normal review by the committees that have jurisdiction over it? the graham-cassidy bill has some provisions in it that are relevant to the finance committee's jurisdiction, but financial is not going to do a markup of the bill and they're not going to hear from experts about the bill. there are other provisions in graham-cassidy dealing with essential benefits that are squarely within the jurisdiction of the help committee, but apparently the help committee isn't going to have a hearing either. and so in spite of the good recommendation that we were given by our senior colleague who was just on the floor who was characteristically here to talk in kind words about the public service of somebody who has worked with his staff for 30 years, we listened to his words, we gave him a standing ovation and we are prepared to violate everything that he just suggested that we do. and as i conclude, i'll just say this. this isn't just about health care. health care is important enough. no one ever spends a dollar on anything that's more important than their health. it is the most important thing that anybody ever spends a dollar on -- health. my health, the health of my family. i think we could all share that. snog more important. and it also happens to be the largest sector of the american economy between 15% and 20% of america's g.d.p. is health care. and there isn't a close second in terms of sector. so this is a very important issue. if you're trying to reorient one-sixth, or one-fifth of the economy and you're touching the expenditure, the priority, the single-most important priority of anybody's life, that's important enough. but i would argue in closing that there is something that i think is equally important much that's this body. we celebrated the 230th anniversary of the constitution this past sunday. james madison and others in philadelphia trying to figure out how this government should work. they made a very unusual decision that would be different than the decisions that are made in many countries and that's -- they would put the legislative branch first. there were three coequal branches but in most societies the executive is first. but not here. the legislative is first. first among equals. we are meant to really play an a-game. we are meant not to be an article 2 branch just reacting to a presidential tweet owner couragement. we're supposed to be an article 1 branch p. the senate is given a very particular role. we are called the world's greatest deliberative body. we are the saucer into which the partisan heat of the day is poured and allowed to cool so that the decisions made in the senate are supposed to be more careful and more deliberate. this is a great body that has been sadly hobbled by partisan gridlock and we have not achieved what the senate should achieve. we learn in math that the whole is equal to the sum of the parts -- that's what the nuns taught me. what you find in life is that of course the math doesn't work out. sometimes -- i think this describes the senate now -- there are 100 wonderful, accomplished people in this body and yet again and again and now for years the whole has been equal to less than the sum of the parts. we've done very little of meaning. very little of substance. and yet now we are poised to tackle the most important issue that most affects people and the biggest sector of the american economy. if we get it right, we can send a message to the public that the senate will once again be the senate. we will once again be a deliberative body. we will once again do what we're supposed to do. and i think this country now needs to see some adult in the room, some group of people willing to work together -- democratic and republican -- to solve problems and do the right thing for the american public. if we do this right, we can send that message. if we do it wrong, we will hurt people and we will also hurt the credibility of this institution in a way that i think will last for years. we have the choice. it's up to us. we either follow the advice that our colleague gave us on the floor six week ago that we gave him a standing ovation for and we gave him the ovation because we knew he was right. we either follow that advice or we decide to ignore it and continue the downward spiral of a great body. with that, mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from minnesota. mr. franken: thank you, mr. president. in may jimmy kimmel shared the story of his newborn son billy, who was born with a life-threatening condition that required open-heart surgery. kimmel said that he was fortunate to have -- to have had good health coverage and was able to pay for the care that his son needed, something he believed every american deserved. a few weeks later, as efforts to repeal obamacare were gaining steam, senator bill cassidy explained that the bar that he believed that any health care bill had to clear to get his vote was what he called the jimmy kimmel test. he said, quote, will a child born with congenital heart disease be able to get everything she or he would need in the first year of life? when kimmel interviewed senator cassidy a few days later, kimmel explained the test this way -- quote -- no family should be denied medical care, emergency or otherwise, because they can't afford it. well, i'm here to report that this latest version of trumpcare offered by none other than senator cassidy himself fails the jimmy kimmel test miserably. over the past few weeks there have been two ongoing conversations about the future of health care in the united states. the first has been conducted in an open bipartisan manner in the senate health, education, labor and pensions committee in full accord with the traditions of this body. in the help committee, republicans and democrats alike have been talking with governors, insurance commissioners and other experts on ways to address concerns of states and consumers by stabilizing the individual market and lowering premium costs. that's how the senate is supposed to work. and the bill that emerges from that process will be one that makes things better, not worse. it will create certainty. it will bring down costs for consumers. it's a bill that any senator should be proud to vote for. the second conversation is a model of how things shouldn't work. it has occurred behind closed doors between senate republicans and party operatives. it's not about making the system work. it's about passing something, anything that could be said to repeal and replace the affordable care act, and along the way it destroys the medicaid program as we know it. as many of us have argued before, this conversation is an affront to the traditions of this body and, more importantly, to the will of the american people. i urge my republican colleagues to oppose the graham-cassidy bill, the newest iteration of trumpcare which will rip health care coverage from tens of millions of people, create higher costs for consumers, and ensure the destabilization of the individual health insurance market. while i have worked closely with senators cassidy and graham on other bills, and i respect them, i have grave concerns with this legislation. first, the bill undermines protections for people with preexisting conditions. states could apply for waivers that would allow them to charge people more based on their health status, age, or any other factor other than race or ethnicity. this means premiums would be higher just for being older or sicker or having had an illness in the past. in other words, there would be no protection for people with preexisting conditions. additionally, states can also seek waivers to remove the a.c.a.'s essential health benefit requirements which mandate that insurers offer plans on exchanges -- that are offering plans on the exchanges include coverage for vital services like prescription drugs, maternity care, and mental health and substance disorder services. while the bill technically requires states to describe, just simply describe how they will, quote, maintain access to adequate and affordable health care for individuals with preexisting conditions, end quote, there's no definition of what that means, and there are no enforcement mechanisms. insurers would still be able to charge people with preexisting conditions more for their care or exclude services altogether. under this plan, millions of people with preexisting conditions would face much, much higher costs if they can get coverage at all. again, this bill rips away protections for people with preexisting conditions. second, the bill would wouldundoubtedly reverse the significant coverage gains we've seen in years and drive up the number of americans without health insurance. the graham-cassidy proposal eliminates the a.c.a.'s premium subsidies, eliminates the medicaid expansion, eliminates cost-sharing reduction payments, and more. instead of funding these critical aspects of the a.c.a., the bill would return some but not all of this funding to the state in the form of block grants which are authorized in this bill from 2020 to 2026. the bill also proposes to dramatically reduce funds for states that have expanded medicaid. and have successfully enrolled more adults in a.c.a. changes. states like minnesota. instead of incentivizing success, the bill will reward failure, initially increasing funds for states that refuse to expand medicaid and have done little to encourage enrollment. but even these states lose out in the end. in fact, the funding stops completely after 2026, resulting in enormous losses for every state. and even prior to 2026, the center on budget and policy priorities estimates that most states will receive significantly less funding from the federal government under this block grant than they do under current law. minnesota could lose $2.7 billion. and other senators who have expressed various levels of concern with this legislation can see their states lose significant sums. those include arizona, which would lose $1.6 billion. alaska, $255 million. maine, $115 million. colorado, $823 million. the list goes on. health care isn't free. these shortfalls will mean that families don't get the services they need. on top of all that, the graham-cassidy proposal caps and cuts medicaid, a program that provides coverage to seniors, families with children, and people with disabilities. in minnesota alone, that's 1.2 million people facing cuts to their benefits or losing coverage altogether. i believe many of us truly want to help our constituents access the care they need. as i've said before, the a.c.a. is far from perfect, but it has resulted in significant improvements in millions of people's lives. i have heard from countless minnesotans who have literally had their life, or the life of a loved one saved by the a.c.a. the same way that jimmy kimel's life was saved -- billy kimel's life was saved by the treatment he was able to receive at the beginning of his life. take, lee anna. her three-year-old son henry has been diagnosed with an acute lymphoblastic lieu keep i can't. treatment will -- leukemia. his treatment will last until 2018. he needs around the clock care to manage his nausea, vomiting, pain and sleepless nights. a three-year-old. henry's immune system is so compromised that he's not supposed to go to day care, so lee anna left her job to care for him. lee anna and henry are supported by her spouse, but they couldn't pay for henry's treatment on one salary. lee anna says, and i quote, it is because of the affordable care act that henry gets proper health care. henry can get therapy and the things he needs to maintain his health and work towards beating cancer. henry is still with us because of the a.c.a. end quote. let me say that again. three-year-old henry is still with us because of the a.c.a. or consider maria's story. maria enrolled in minnesota's medicaid program after finishing her graduate degree and while looking for full-time employment. maria was grateful for the coverage because she needed access to treatments for her endometriosis which was diagnosed a few years prior while she had insurance through her employer. soon maria found her dream job, but it came with a catch: no health insurance. days before she was set to move and start work, she decided to go in for one last big checkup. the results were unnerving. at the age of 35, maria was diagnosed with bilateral breast cancer. maria had to give up her job offer and aggressively pursue treatment for the cancer. fortunately, because minnesota had expanded medicaid, all of maria's treatments were covered. and lucky for her, they worked. maria's cancer is in remission. maria explains that, quote, the medicaid expansion of the a.c.a. literally saved my life. end quote. she told me that anyone could find themselves on medicaid, and i quote, without that comprehensive, affordable, accessible health insurance, i wouldn't be here. but now that all of these programs are in jeopardy, my constituents are genuinely scared. they come to me in tears. explaining that if the affordable care act is repealed or draconian changes and cuts to medicaid go through, they don't know how they will care for their elderly parents. keep their rural hospital open, or afford treatments that they or their children need. i believe it is legislative malpractice to pass partisan legislation that would undermine this progress, people's economic security and their livelihood all to achieve a destructive political end. to do it without holding thorough hearings in the committees of jurisdiction, without hearing from experts and without complete assessment from the congressional budget office on how this legislation would affect the american people. i urge my republican colleagues to once again abandon their efforts to ram through dangerous legislation that would fundamentally restructure our health care system. this new iteration of trumpcare fails the jimmy kimel test. it's the result of a horrible process that is not worthy of this body. we have a better option. over the past few weeks chairman alexander and ranking member murray have held four bipartisan hearings on individual health insurance market reforms that are working to forge a legislative compromise to reduce premiums for consumers. we've heard from governors. we've heard from insurance commissioners. and we've heard from experts, all of whom span the ideological spectrum. this is what regular order looks like, and this is the way the senate is supposed to work. i worked with all of my colleagues on this committee in good faith, and i am proud of what we've been able to accomplish so far. but all of that work, all of that work is in jeopardy because of a destructive partisan last ditch effort to repeal the affordable care act and end the medicaid program as we know it. do not shortchange those important legislative developments and do not shortchange the american people. think of the millions of children and families that need our help right now. oppose obamacare and instead let's work to improve care, lower costs, and insure access to health care when people need it the most. it is within our reach. mr. president, i would suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: soo mr. president. the presiding officer: the senator from new hampshire. a senator: thank you. i ask to vitiate the quorum call. the presiding officer: without objection. ms. hassan: i oppose the graham-cassidy proposal. mr. president, it is disappointing that we are here once again. in july granite staters breathed a sigh of relief when the senate defeated a proposal that would have raised health care costs and stripped health insurance away from millions. when that bill failed, i was hopeful that we would move forward on a bipartisan process to make key improvements to the affordable care act, and that's exactly the process we've started on in the help committee, focusing on bipartisan solutions to stabilize the health insurance market. now in direct contrast to this important bipartisan work, some of our republican colleagues are making one last ditch effort to pass partisan legislation. make no mistake, graham-cassidy is more of the same and it is every bit as dangerous as the trumpcare plans we saw this summer, if not worse. granite staters and all americans should be concerned if this bill is rushed into law. mr. president, my colleagues are moving so quickly to try to get this bill passed that the c.b.o. says that it won't be able to score it by september 30. but it's clear that this bill would make things worse for most americans. if you have a preexisting condition, including cancer, asthma, or diabetes, you could once again be discriminated against with higher costs that make health coverage unaffordable. this bill would end medicaid expansion, a program that democrats and republicans in new hampshire came together to pass and reauthorize. medicaid expansion has provided quality, affordable health insurance coverage to over 50,000 granite staters and experts on the fentanyl and opioid crisis said it is the number one tool we have to combat this epidemic. ending medicaid expansion would pull the rug out from under those receiving coverage. it would put thousands of people at risk. in addition graham-cassidy would cut and cap the medicaid program. those words, cut and cap, are really just code for massive cuts to the funding that tates -- that states receive, including new hampshire losing millions of dollars in medicaid. this cut would force states to choose between slashing benefits, reducing the number pf people who can get care, or in some cases, having to do both. it would impact some of our most vulnerable people, seniors, children, and people who experience disabilities. graham-cassidy would not include essential benefits like maternity care, prescription drugs, and substance use disorder services. finally, this bill would continue republican efforts to roll back women's access to health care by defunding planned parenthood which provides critical, primary and preventive health care services to thousands of new hampshire women. mr. president, as we continue to debate the future of our nation's health care system, we have to understand how things would actually play out on the ground for the people we are trying to serve. over the course of this year the people of new hampshire has laid themselves bear and shared story after story of how they would be impacted by these dangerous attempts to roll back access to health care. people like the keene resident would has a preexisting condition and had health insurance through his job. but when he lost that job, he was able to start a new, successful small business all because he knew he would be able to get quality health insurance under the affordable care act. or people like the granite stater who experiences disabilities but is able to live independently in his home and in his community as a result of the personal care services that he receives through medicaid. and people like the mom from rochester who is benefiting from substance abuse disorder services that are included in medicaid expansion and would be taken away under this bill. you know, it really shouldn't be necessary for people to have to come forward and share their most personal stories all in an attempt to get their elected representatives to work together in a bipartisan manner and not take coverage away. we actually should be able to did that in the united states senate on our own. but now just as we are starting to work on a bipartisan basis as our constituents asked us to do, the american people are faced with another harmful partisan trumpcare bill that will destabilize our health care system, drive premiums up, and make care less affordable. mr. president, we must come together to build on and improve the affordable care act and ensure that every american has meaningful, truly affordable access to the type of care that each of us would choose for our own family. and we must reject this proposal and continue moving forward on the bipartisan path that we've started on in the help committee. i'm going to keep standing with my democratic colleagues and i urge the people of new hampshire and all americans to continue to speak out and to share their stories. together we will once again defeat this attempt to undermine the health care of millions of americans. and we will make clear that in the united states of america, all of our people must be able to get quality, affordable care. thank you, mr. president. and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: mr. blunt: mr. president? the presiding officer: the senator from missouri. mr. blunt: move that the quorum call be suspended. the presiding officer: without objection. mr. blunt: mr. president, i want to talk about health care and what it means to families and what it means to communities. it's the most personal thing that families deal with. every family knows that at some point they're going to deal with not one but multiple health care issues as life progresses, as things happen in life at times you don't expect them to happen in life, and nothing is more rivetting or focusing than health care. somebody told me one time, and i've said this on the floor of the senate before because i think it's such a good observation about what happens in health care. somebody told me when everybody in your family is well, you've got lots of problems. when somebody in your family is sick, you've got one problem. so it's not like tax policy or energy policy or the intricacies of this or that. it's something that every family and every individual identifies with in a unique way. one of the reasons the debate gets so passionate, i think it may be one of the reasons that sometimes we see exaggerated claims about how a plan that i may be for is going to cause more people to have health care problems if that plan didn't pass. i certainly wouldn't intend for that to be the case. what we're all looking for here is the best plan that addresses this problem in the best way. and the debate we had six weeks ago, i remember looking across the senate floor at one of my colleagues who stood up and said if the plan passes, that many of my colleagues are going to vote for, he may have said the people across the aisle are going to vote for, he said health insurance rates go up next year by 20%. well, missourians have already seen 145% increase under the plan we have now in three years. and the rates that were just filed range from a 35% increase to a 47% increase, so it's a pretty safe prediction by my friend on the other side who said if the plan i was for passed, health insurance rates would go up 20%, the plan he had been for, the plan they were defending is out on of control. there's no argument that what we have now is not working. families that have coverage don't really have access. so many families with coverage have these high deductible policies with insurance rates that, first of all, they can't afford the premium. and if he are somehow able to scrape the money together to afford the premium, i think the average deductible in the bronze plan was $6,000 per individual and almost all of those plans, if you have more than one individual in your family, you had to hit the per individual rate twice if two people got sick. so you were paying maybe $1,000 or more a month. that was for insurance coverage and if somebody got sick, you had another $12,000 that would kick in before your insurance plan would help at all. it not only wasn't real coverage, but it also didn't provide the opportunity for you to go to the doctor for the help you need so that you have -- some of us will have problems no matter how well we take care of ourselves, but access to health care matters. and health care where you live matters, and, frankly, that's the plan that senator cassidy and senator graham have come up with, a plan that would take the decision making for government-assisted health care out of washington and put it back in the states. one of my colleagues, one of my comment from -- congressmen when he was at a hearing when he was on the committee at the time that wrote the laws and regulations for washington, d.c., said, you know -- somebody asked him why he thought he was smart enough to write the laws for washington, d.c., and his observation was, he said my hometown almost everybody knows where washington, d.c., is but here in washington almost nobody knows where this town of sarkoxyi is. did it mean they were smarter? probably not. but it probably meant they knew what was better for sarkxyi than washington, d.c., did. what senator graham and senator cassidy is talking about is taking all the money that we are currently spending in this government-assisted health care world and divide it among the states in a more equitable way. right now 37% of the states get all of the money. that means that the other 46 states must get about 63% of all the money. now, if 37% of all the people in the country lived in those four states, that might be a reasonable way to divide up the money or even if 37% of all the people within common health needs that were so significant that they needed more help than everybody else lived in those four states, that might be a reasonable way to divide up all the money, but neither of those things are true. what this plan would be is to look at a way to fairly allocate the way that we spend money on health care, and let state governments experiment what to do about that. jefferson said in our system the states had the unique ability to be laboratories for change because they could try things and see if they worked and then shared with the other states what worked, but there was no vision at the time that the federal government was the best place to do everything. this is really a debate between federalism or for government-run everything? now, 15 -- 30%, i guess, of democrats in the senate said a few days ago they were for government-run everything in health care, for single-payer health care. i'm not for that. i don't think that's the best way for our system to work or if the access to health care for people in desperate moments should always have. but i do think that we could do a better job serving health care needs for people in the 50 states and the territories if, in fact, we gave more authority to do that. you know, first of all, you're going to get your health care in all likelihood in the place you live and you're going to more likely be able to get access to the same health care that your local state representative gets where it's not just me arguing for what's good for missouri or my colleague in the senate arguing what's good for our state or the eight people we have in the house, it's all 163 house members in our state and the 34 senators and the governor leading to have a real understanding of what 200 legislative families, where they get their health care, and where 200 families -- people who are making that decision who see people at school and the grocery store, that's a lot different than just seeing ten people and sending them to washington and try to fit the one size fits all to serve the state better. if you have bought a one size fits all clothes, you are unique if it fits you. one size fits all almost never fits anybody. it is hard to fit nrve the state -- fit everybody in the state in the best possible way, but we would be more likely to do that than what happens in manhattan and marsh field, missouri, the same, because they are not the same. people in new york are more likely to figure out what health care is there, what they need do to augment that, what they need to do to be sure that is available to more people in the most cost-effective way. and in missouri they are likely to be able to answer that in our state than they are at the department of health and human services in washington, d.c. even if they wanted to do that, even if all missourians took over the department of health and human services, their goal wouldn't be to find out what is best for where i live but come up with a plan that is best for the whole country and it is not working very well. it is not divided in an equitable way. no matter how you do it, four states having that much of the money spent in their states is not the right kind of system to have. there are ways to adjust for need, there are ways to adjust for location, but those ways are not only going to be found in waivers that governors are going to ask for, but more likely to be found at state capitals than they are here. this is the classic example of why our government has worked as long as it has in so mn ay areas -- many areas, but every time we try to become responsible for everything at every level, we mess up. every time we think the regulations have to be passed -- different regulations by city government, county government, state government, the federal government, that never works very well. this is an opportunity to say to states, we're going to let you be responsible for devising a system for people in your state that meets the needs of people in your state and we're going to do that in a more effective way than has deny done in the past. the growth -- has been done in the best. the growth of these health care programs has never been done in a way that really works. so, mr. president, we're going to have an opportunity to make a big decision about the future of health care. we're going to be deciding, among other things, do we trust people to make that decision better closer to the problem or do we think it's better to try to solve the problem further away from the problem? i think the right answer here is clearly what we're doing isn't working. let's take advantage of the constitution and federal system of the government and come up with a plan that uniquely can work in florida where you live, in louisiana, that can serve the families where the number one thing that they take most personally is the health and welfare of their family. everybody has to deal with this. let's try to create an environment where everybody has to deal with this in the case of greatest opportunity, greatest sensitivity, greatest ability, and greatest understanding if those things aren't working, you can uniquely come up with a solution to solve the problems in that state that are very likely not the problems that need to be solved in the entire country. with that, mr. president, i would yield the floor. the presiding officer: the senator from louisiana. mr. kennedy: i want to change the subject slightly, mr. president. i will be back on the floor to defend my good friend and colleague senator cassidy's ideas. he received a letter from the governor and the secretary of health and hospitals that, in my opinion, ee spouses -- espouses issues with health care that are not in the best interest of the people of louisiana. but right now i want to talk about tax reform. like you, mr. president, i have been in government for quite a while. it has been my experience that for every economist there is an equal and opposite economist and they are both usually wrong. economics today, mr. president, is more art than science, and that's why i say it doesn't take an expert economist to see that something is wrong with the american economy. 2016 was the 11th straight year that our economy failed to achieve 3% annual growth, and that's been our average annual growth every year since 1960. now, i've heard numerous pundits act like returning to 3% growth is something special, something extraordinary. no, sir. look at the numbers. it's just average. i think the american people deserve better than just average growth. but even average growth, mr. president, is optimistic if we keep hamstringing the men and women who help create jobs in this country. our 40% business tax rate -- let me say that again -- our 40% business tax rate and our broken tax code are chasing our ideas, chasing our jobs, and chasing our investors into the open, waiting arms into foreign countries. our 40% business tax rate and broken tax code are keeping wages and productivity low, crippling our small business men and women and they have to go. but, mr. president, when we're talking about tax reform, i think it's very important that we not forget that the primary vehicle, not the only exvehicle -- not the only vehicle, but the primary vehicle for growth in america is the middle class. that's what i want to talk about, tax relief for ordinary people. my constituents tell me every day, mr. president, they say, kennedy, we look around in our economy today and we see too many undeserving people at the top getting bailouts and we see to many undeserving people at the bottom getting handouts and we're stuck in the middle and they say, kennedy, we can't pay it anymore because our health insurance has gone up thanks to obamacare and our kids' tuitions have gone up and our taxes have gone up, but i'll tell you what hasn't gone up, our wages and our income. they feel like we in washington don't listen and that we don't care. they feel like they have no voice and no chance. and that anger, mr. president, is understandable. this bar graph shows u.s. real median household income going back to 1999. you can see it was just over $58,000 in 1999. of course, it took a dip in 2012 because of the recession, but look where we are in 2016. we're practically right where we were in 1999. the middle class, the ordinary people of america, have made virtually no progress. and they have every right to be angry about that because it has been 16 years since president bush's tax cuts since the middle class has gotten a tax break, and that's why i wanted to come to the floor today, mr. president, to say a word. somebody has to speak up for the ordinary people of america and for our middle class. middle-class families drive our economic engine. we are a consumer economy. 70% of our economy is based on consumers many they buy the goods and services that our businesses are selling. they work hard to able to spend and save and invest. most middle-class americans get up every day, go to work, obey the law, pay their taxes, try to do the right thing by their kids and they are falling further and further and further behind. and now, as they are trying to balance their checkbook, nearly one-third of their income is automatically withheld and sent off to washington, d.c. they never even see it and come april they may owe even more on savings and investments. you don't believe me? look at the numbers. you think america is broke? between october 2016 and january 2017, just one-quarter, the u.s. treasury set a brand new tax revenue record. $1 trillion. $1,084,840,0,00 and a lot of ma money came out of the hydes of -- hides of ordinary people. i'll give you an example. right now if you're a middle class family in louisiana, right smack in the dab of the middle of my state, you have a household income of $59,000. you have two children. you want the children to have a better future than you had. you claim all your exemptions and you take the standard deduction. you're going to be paying the federal government about $3,500 a year. now, that's not even counting what that middle class family has to pay to state and local taxes or their payments to social security or their payments to medicare. by the time their bills are paid, mr. president, and by the time they put gas in the car, that doesn't leave them much to work with. but i have an idea about how tax reform can tackle ow -- can tart the middle class and bring ordinary people some badly needed relief. 70% of americans, mr. president, opt to take the standard deduction when filing their taxes. 70%. they do that because it's simple, it's fair, and it requires less documentation than itemizing. in 2014 this option, the standard deduction, saved taxpayers of america about $217 billion. yet they're still having trouble getting ahead. if congress were to make one simple change as we enter upon this endeavor that we call tax reform, i call it tax cuts, like doubling the standard deduction across the board for everybody, including but especially the middle class, that would potentially inject about $600 billion back into our economy over ten years. that's according to a 2014c.r.s. report. that's an immediate shot in the arm for the american economy. that family of four in alexandria and louisiana that i just talked about would have their tax bill, their federal tax bill cut to $1,700, freeing up almost $2,000 of their hard-earned income. that's $2,000 toward a new car or a new lawnmower or fixing their home or putting money back into their business or saving money for their children's college education. it's pretty simple. it's also $2,000 right back into the economy. and as the cost of earning more is reduced, people will want to work harder, mr. president. i believe people respond to incentives, not just americans but that's human nature. that means more productivity and more growth. it's -- it's economics 101. unless you're throwing the frisbee in 101 class, you give people more to spend and they spend it, the economy is going to grow in the process. and i believe, mr. president, as i know you do, that people can spend their own money better than government can. the strength of the middle class was the cornerstone of our past economic growth, and i think it will be the key to our future. i've said it before and i'll say it again. we do need tax reform for businesses. i repeat. we do need tax cuts for business men and business women, not just the large c corporations but also for the pass-throughs, the llc and l.l.p.'s and the sole proprietorships and the families farms. but if tax reform does not include relief for the middle class, if it doesn't include relief for the ordinary americans, then we have lost a historic opportunity. it will be another generation before we'll have this opportunity again, mr. president, and we'll never get our economy back on track unless we can close that loop. we need to liberate the middle class and their power to spend and the power to save and renew their belief in the american dream. a tax reform policy, mr. president, that provides relief to the middle class like doubling the standard deduction, that's certainly not the only way to do it, but it would certainly do the trick, will return the incentive to work and to save and to invest. our economic fate is tied to the health of our middle class. i'm not saying that other parts of our great nation, our economy, are important, but the bedrock is the middle class. and the bedrock is small business and it's high time that we offer ordinary americans a tax code that believes in them. with that, mr. president, i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call: mr. whitehouse: mr. president? the presiding officer: the senator from rhode island. mr. whitehouse: i ask the pending quorum call be vitiated. the presiding officer: without objection. mr. whitehouse: mr. president, each week that you see me standing here means another week in which the senate of the united states has sat out doing anything to address climate change. another week of carbon pollution streaming into our atmosphere and oceans. carbon dioxide from burning fossil fuels is changing our atmosphere and our oceans. we see it everywhere. we see it in storm-damaged homes and flooded cities. we see it in drought-stricken farms and raging wildfires. we see it in fish disappearing from warming, acidifying waters. we see it in shifting habitats and migrating contagions. all these harms we see carry costs, real economic costs. -- to homeowners, business owners, and taxpayers. that cost to homeowners, business owners, and taxpayers is known as the social cost of carbon pollution. it's the damage that people and communities and states suffer from carbon pollution and climate change. the office of management and budget last calculated the social cost of carbon to be around $49 per ton of carbon dioxide emitted. if you just do some simple math, you can multiply the total measured u.s. emissions coming from energy production alone in 2016, which was emissions of over 5.7 billion tons of co2 -- the emissions number, then you multiply it by the $49 cost per ton. it is pretty simple math. $49 per ton times 5.7 billion gives you about $280 billion. $280 billion is the annual cost that the fossil fuel industry offloads onto the american public in harm from the carbon dioxide emissions. that is a big number and a big consequence -- $280 billion per year. there was a more complex analysis than my simple math that was done by the international monetary fund. the international monetary fund has a lot of smart people. they don't have any conflict of interest that i'm aware of in dealing with this issue. and their calculation puts the annual subsidy, just in the united states of america, for the fossil fuel industry at $700 billion per year. so is it my simple math where the social cost of carbon is $280 billion per year or is it what the international monetary fund calculated at $700 billion per year? whichever it is, it is a big enough harm to the american public that you'd think we might do something about it here in the senate. but, of course, we don't because that huge social cost of carbon and that huge subsidy gives the fossil fuel industry the biggest incentive in the world to instead of fixing up its situation and cleaning up its mess, come over here and instead mess with our politics so that our ability to deal with this issue is silenced by their political muscle and manipulations. one way in which they play this game is to populate the climate-denial machinery with one-eyed accountants, accountants who can only see the polluters' side of the ledger. honestly, we hear their testimony. the only thing they see is the cost to polluters of reducing their pollution. they don't see the public harm side of the ledger. they pretend it is a liberal conspiracy cooked up by the obama administration or even say, if you're the republican chairman of the house science committee, you say -- and i quote here -- the social cost of carbon is a flawed value to justify the e.p.a.'s alarmist reasoning for support of the clean power plan and other climate regulations. you know, actually if you take away the bad words -- flawed and ad larmist and all that stuff -- the statement is actually true. there is a value to avoiding carbon pollution, and defending that public value from the polluters does justify the clean power plan. this is the social cost of carbon. let's go back for a minute to 2006 when the bush administration's national highway transportation association administration put out a rule for vehicle fuel economy standards. there was some dissatisfaction with that rule. states and other stakeholders complained that this rule failed to take into account the social cost of carbon emissions from cars, something that should matter for a rule that is looking to reduce emissions from cars. well, that went up on appeal to the united states court of appeals for the ninth circuiting, and in 2007 the circuit court of appeals agreed. the court acknowledged that there is a cost of carbon pollution and that that cost is, and i quote, certainly not zero. so it told the agency to go back, redo the rule, and come up with a real social cost of carbon. thus was born the legal requirement that agencies consider a social cost of carbon in decisions. because of this decision, the bush administration produced a wide range of numbers up to $159 per ton of carbon emissions. the obama administration continued the effort to calculate a social cost of carbon. an interagency working group including scientists and economists from across the federal government relied on existing scientific literature and on well-vetted scientific mod tolls produce a first standard in 2010 with additional updates in 2013, 2015, and 2016. when federal agencies didn't apply any social cost of carbon, courts corrected them. in 2014, a federal judge in colorado faulted the bureau of land management for failing to account for greenhouse gas emissions when it approved an arch coal mine expansion in the gunnison national formity the court suspended the approval until the bureau of land management actually used the cost of carbon or gave a valid explanation as to why not. when agencies did use the social cost of carbon, their decisions were uphold. in 2016, the seventh united states circuit court of appeals uphold the use of social cost of carbon in the agency standards for commercial refrigeration equipment. the industry observed and on appeal the seventh circuit said, no, they did the right thing putting that in there. just last month a three-judge panel from another united states circuit court of appeals -- in this case, the united states court of appeals for the district of columbia circuit -- ruled that the federal energy regulatory commission has to consider the effects of carbon emissions that would result from building three pipelines in the southeast. specifically, the ruling directed ferc to either better calculate the project's carbon emissions, use the social cost of carbon, or explain why it didn't use it. also last month another u.s. district court blocked another coal mine expansion in montana, citing the agency's failure to assess the environmental effects of coal. specifically, the judge referenced the agency's failure to include any social cost of carbon. and just last week, a federal appeals court in denver told the bureau of land management that its lack of analysis on the climate effects of four coal leases in the cloud river basin was, to quote the court, irrational. and told them to start over. it's not just federal courts. agencies at the state level are also using the social cost of carbon pollution in their activities. the new york public service commission, affirmed the importance of the social cost of carbon in its zero-emission credit program. the illinois state legislature also incorporated a social cost of carbon into its zero-emissions credit program and prevailed in a challenge in the courts. these state zero-emissions programs were the programs that were rolled out to help existing nuclear energy providers against competition by natural gas plants. a carbon price allowed carbon-free nuclear generation to better compete in the wholesale markets. up in minnesota, since 1 1993, e public utilities commission has required utilities to require the estimated cost of carbon emissions in planning for new infrastructure projects. this year the commission voted to raise its social cost of carbon to $43 per ton. the colorado public utilities commission recently ordered the local utility excel to use the social use of carbon in its resource planning documents. colorado told its utilities to use $43 per ton starting in 2022 and ramp up to nearly $70 per ton by 2050. and it is not just federal courts and state agencies. private companies in the united states and around the globe are incorporating the social cost of carbon into their own operations and accounting. investors are beginning to demand that corporations perform this kind of analysis in order to qualify for investment. big investors like blackrock have taken on big companies like exxon in order to break through the denial. just last week "the washington post" reported that 1,200 global businesses either have adopted or are adopting a carbon price in some form. the center for climate energy solutions found that companies like microsoft, disney, the insurance giant swiss reed, unilever, shell, and b.p., the mining corporation riotinto and general motors have all taken steps to put a price on carbon in their own use. mr. president, courts have made it the law for agencies to use a social cost of carbon. states are deploying a social cost of carbon. the business community recognizes and is incorporating into its financial planning the social cost of carbon. yet, here in congress and down at the trump white house, the leaders of the republican party continue to ignore climate change, pretend that it doesn't exist and ignore the very real costs that society bears from carbon pollution. it goes without saying that the storm that has just ravaged florida was spun up by warmer ocean waters, carried more rain because of warmer air, and dumped more rain and pushed storm surge factor -- farther into florida because of risen seas and those other characteristics. seeing any action? no. the president in march issued a sweeping executive order rolling back federal energy and environmental standards. if disbanded the interagency working group and it asserted that the social cost of carbon was, quote, no longer representative of governmental policy. nice try with that, given where the courts are. of course the house and the senate republicans followed suit by introducing a pair of bills out of congressman evan jenkins on the house side and our colleague from oklahoma, senator lankford on our side, that purport to prohibit the federal government from using the social cost of carbon in rule makings and in regulatory processes. of course you can't do that, and those laws aren't going anywhere. why? because they violate a very basic principle both in courts and in administrative agencies. that very basic principle is at the heart of rule of law and it is that facts have to be factual and that conclusions have to be logical. any decision that fails this standard, that is to use the administrative law terms arbitrary and capricious or not based on substantial evidence, fails as a matter of law. although congress of course is bound and gagged by the polluters and their front groups , it's going to be hard for those polluters to try to stop the social cost of carbon in courts and administrative agencies. despite the efforts of exxonmobil and the koch brothers to make america their fossil fuel banana republic, we still are a rule of law country, and those rule of law principles that facts must be factual and that conclusions must be logical are two -- too basic for our courts and administrative agencies to ignore. in our courts and administrative agencies, lying and misleading can be exposed on cross-examination, for instance, and lying and misleading gets you punished, unlike in congress where lying and misleading have been fossil fuel tactics for decades and sickeningly successful ones backed up by huge political muscle. the failure in congress and the remedy in the courts is one reason the founding fathers designed our government that way. so that even where political branches of government were captured by special interests, there would still be a path for the truth and there would still be a means for justice to have its way. so if the courts and the states and so many major businesses are all behind recognizing the social cost of carbon, who's behind the president and our republican colleagues in denying that it's real? well, in my experience, it's powerful trade associations like the american petroleum institute, the american chemistry council, national association of manufacturers, the u.s. chamber of commerce, and others who have a distaste for any honest assessment of the social cost of carbon. and right now since the tha they represent, pollution is off loaded to the rest of us for free, why not? why would they want to start paying for the harm they cause right now? so think tanks and front groups funded by the koch brothers and other polluters have vigorously fought against recognizing the fact of the social cost of carbon for years. these groups have neutral-sounding names, maybe even friendly-sounding names like the competitive enterprise institute, the american energy alliance, the heritage foundation, freedom works. my personal favorite, the heartland institute, a group so good that it put up billboards comparing climate scientists to the unabomber, really a classy contribution to the debate. well, one thing this crowd of bad actors does know is how to throw its weight around, especially since the citizens united decision threw open the floodgates of special interest money into our politics. that is what has put congress in the throe of the polluters. it is an indecent and wrong place for us to be, but with any luck the adherence of courts and administrative agencies to rule of law, the principles that facts must be factual and conclusions must be logical will help us get out of the political trap that the fossil fuel industry has constructed. with that, i yield the floor. the presiding officer: the senator from florida. mr. rubio: mr. president, two weeks ago this very evening i had just finished my time as the presiding officer over the senate and made the decision that early the next morning i would be returning to florida instead of staying here the following day. the reason was that at that time and in that moment the strongest storm ever recorded out of the flick was bearing down first -- out of the atlantic was bearing down first on the caribbean not just towards florida but the city in which i lived and the nation watched over the next few days as that storm took its track. there has been a lot said about hurricane irma since that time. i heard some say that it could have been worse, and i imagine some particular instances perhaps that is true. had that storm entered through tampa bay in florida, it would have been an incal cliewbl lost through the counties of miami-dade, broward and palm beach counties, the economic loss would have been very significant. so it's possible that the storm could have had an even greater impact. but it's difficult to say that to the people that were impacted by it. it was a unique storm in a lot of different ways. the sheer scope of it. one of the things that really kind of perplexed people in florida, including myself, who were thinking perhaps we should move our families to another part of the state because we have a very good building code in florida but there is no structures under our building code that could withstand the hurricane winds of a category 4 storm. very difficult to do that unless there is a heightened level of construction. one of the difficult things about figuring out where to go is the whole state was covered by it. it was a huge storm in its size and an enormous storm in its impact. i know for a fact dozens of people who left south florida as an example, drove to another part of the state only to find themselves actually worse off than they would have been had they stayed home. there is no way to know that at the time. i can tell you maybe it's because of our history with hurricane. in 1992 at the university of florida i was home, the semester was about to begin and hurricane andrew came barreling through there and fundamentally altered what south dade looked like and whether it was the impact of the storms in 2004 or 2005 or perhaps it was the images from harvey from just a few weeks ago and the impact it has had on houston and the state of texas, people took the threat incredibly seriously and massive evacuation, perhaps the single largest evacuation in the history of the united states. in any event, the storm did come and we measure the impact of the storm first and foremost by the loss of life. and there are 59 people who lost their lives directly related to the storm in juan way or another. -- in one way or another. 11 of those people died after the storm from carbon monoxide poisoning. you lose your power, people run these generators, sometimes running them inside their home, carbon monoxide gets on them and before you know it they are dead. at least a dozen others didn't die but it posed an incredible threat after storms we see every time. nine people died in monroe county, some from natural causes, although it's hard to imagine that someone who had a heart attack in the middle of a storm or in the aftermath wasn't somehow related to the stress that such storm brings. of course we all saw the horrifying news last week that eight senior citizens have lost their lives because of nursing home's air conditioning unit failed them, and in the middle of the night the heat became unbearable and they passed. but you can only think despite these horrible tragedies of losing 59 people, how many more would have died had they not heeded the warnings to evacuate. so i begin talking about the storm today by just thanking the men and women who responded before and after the storm and even during it, who kept so many people safe. and they did so even though their own families were being impacted by the storm. you see a police officer or firefighter from a community in florida, they have homes. they have children. they have families. and they too are concerned about the impact it could have on them. and so even as they're out there getting ready, getting the rest of us ready, they have to think about themselves and about their own families. so we thank them for the extraordinary work they do every day, but in particular at this moment because of the storm. we think about the national guard. these are people that on monday or tuesday of that week were at the accounting firm or doing whatever their job might be, were called up and within a matter of hours found themselves on the road and headed toward an uncertain number of days that lie ahead. we think of all the people throughout the emergency operation centers from the state one and the capital to all the counties who put in dozens of hours a day -- over a dozen hours a day, if not more, preparing to handle the storm. we thank the coast guard for the extraordinary work they do and the department of defense, particularly the navy, who were prepared to respond and did so to the storm, even as many of them were coming off similar duty just a few days earlier or a few weeks earlier responding to harvey. of course we want to thank the first responders that came in from all over the country. i was in the florida keys on friday, and i ran into firefighters and police officers from as far away as colorado. and we thank them for coming all the way here to help us. could not have done it without them. i would also be remiss if i didn't thank the national hurricane center and the improvements that have continued to happen year after year, which have helped improve not just the forecast track of a storm, but its intensity. even though i can tell you all hurricanes are bad. obviously the stronger they get, the more damaging they become. and i would just say that the work they do is -- we had five, six days to get ready for this and it all began because the national hurricane center -- they don't always have that much time -- were able to give us and everyone the proper notice. you can't carry out these e eevacuations unless you've got accurate meteorological information. they did an extraordinary job and continue to do so now monitoring a new storm that tomorrow is going to make landfall over the island of puerto rico potentially as a category 5. but certainly a category 4. i'll talk about that more in a moment. so we thank them and so many others that i -- too many to mention that we would run out of time but we thank them. so let's first talk about some of the challenges. the first challenge, as i said earlier, is the scope of the storm. if you know anything about florida, it is a peninsula, third largest state in the country in terms of population. but it's a peninsula that sticks out into the gulf of mexico and into the caribbean basin there in the florida straits. it's a huge state. from jacksonville, florida, in the northeast, all the way down to key west is a long distance. and we are talking about a storm that had damage in key west, damage in jacksonville and the southwest to naples and the central part of the state and literally the entire state of florida was impacted by the storm because of its size and because of the route that it took. and and that poses all kind of challenges. our emergency operations system is built on the idea that if two counties are hit, all the other counties help respond. well, every county was being hit, every county was getting ready. so that right away put a real strain on our emergency operations system. because you were counting on other counties being able to help you, but they couldn't because they themselves were getting ready to deal with the impact of the storm on them. you realize that there were prepositioned assets in alabama, georgia ready to come down and help us, but they themselves were also in the track of tropical storm winds headed in that direction, not to mention the impact it would have on their ability to get down to us. so it impacted the entire state. and, you know, we are -- we have gotten trained in watching these storms to see images of destroyed buildings, and obviously that's a terrible thing. we lived that through andrew, and we have our share of that. if you see the images of the florida keys, you can tell very quickly that a storm wept through there. but i tell you that underneath the surface, underneath the structures that might be standing and the roofs that are still intact are deep scars and damage that will be around and impacting us for months if not years to come. think, for example, of the florida keys. if you haven't been there, it is an incredibly unique place. there is only one way in, one way out. it's a chain of little islands built on coral rock formation. it's truly unique. the further west in the keys you get, the more southwest you turn, the more unique it gets. it's where i have spent many days. some of the best memories as a family were made in the florida keys. i spent a number of days there not too long ago before the storm. if you know the florida keys, you know this is not a place with a bunch of johnny rockets and t.g.i. friday's. it has a lot of small businesses, the bait shops, charter captains, everything in between. it has a lot of small businesses. many of them are generational businesses. the family is there and have been doing it 60 years. those businesses are literally going to have no customers now and for the foreseeable future. they still don't have power in many places. they still don't have internet. they still don't have fuel. and they certainly don't have tourists. i want you to imagine for a moment that you are the owner of a small restaurant and you have to go 30, 60 days without any revenue. i can tell you most businesses don't have that kind of reserves, not to mention your employees who may not get paid. you think about the florida keys. it's an expensive place to live because it's a valuable piece of land right on the water, which is an enormous challenge for the work force. you know, the people that work in the keys who don't want to drive three and a half days a day from south dade to get down to the lower keys or anywhere, for that matter, depending on the day. that housing stock in many cases, there is trailer parks and mobile homes or small apartments. the trailers are gone. the apartments could have suffered water damage, but at a minimum they are certainly not livable in many cases now because of water and wind damage. you think about florida agriculture. i know florida is not often thought about as an agricultural state. i promise you, it has an extraordinary presence of agriculture in our state and a great variety of crop. florida's one of the largest cattle producers in the country. you don't associate florida with cattle, but it's an enormous part of our agriculture industry. our signature crop is citrus. sugar cane growers. fresh vegetables. the farm -- the nurseries, the nurseries. all of these tropical plants that you see, whether it's in big developments or the indoor plants, a lot of that is grown in florida. dairies. florida is a dairy provider to much of the southeast. every single one of them has suffered significant damage, and in the case of a couple of them, catastrophic damage. the citrus industry was already being hurt by citrus greening, a disease that kills the tree. well, i can tell you, you go to any of those grove -- senator nelson and i went to a grove after the storm. half of it was on the ground and more dropping. it was gone. the farmer takes it, the whole fruit goes to the whole fruit market. the bulk of it goes to the juicing market. once that fruit hits water -- much of it was green so it wasn't even ready. once it hits floodwater, you can't tell it, you can't use it. the f.d.a. says it can no longer be consumed safely. they lost all of that. on top of the fact that their yields were already lower historically. because of greening, they lost the fruit they had. it gets worse. they lost trees. it's not simple. you don't go to home depot and buy an orange tree and put it in the grouped and next year get the oranges. these new trees, they take at least four years before they can produce the fruit to sell, if it survives greening. they lost trees, and they are still losing fruit, and they will still lose more trees. some of those groves are under water. all of that water sitting on those roots, those trees will not survive. this is a catastrophe for the citrus industry and a running tally every single day that goes on. i don't mean to leave any of these out, but i can tell you some truths. florida vegetables, there will be no florida vegetables, fresh vegetables in november. those green beans that many of you are eating on thanksgiving will not come from florida this year. we'll have to make up the gap from foreign producers because that crop is gone entirely. so i don't mean to leave any of them out. i'm just telling you the hit to agriculture was extraordinary, and unfortunately for agriculture -- and it's not mean-spirited why this happens, but there is not a lot of agriculture near major metropolitan centers, meaning there is not as much media coverage. i'm not here to beat up the media. in fact, i thank the media and i have done so because a lot of the work they did on the national networks and the local news is what got so many people motivated to get up and go out of harm's way. but there aren't a lot of camera crews stationed live from a citrus grove, so the power gets back on and the schools reopen and people forget that these farmers, most of whom, by the way, are not wealthy landowners from the movies. some of these are fourth generation growers who have been on that land and producing and are already stretched because of some of the challenges they have, whether it's in trade or whether it's citrus greening or whatever the challenges might be. it's just gotten worse for them. and do you know who else got hurt boy it? it's not just the dproars. it's the entire industry that services it, everyone. and the towns built around them. big trouble. truly a catastrophic agricultural event in every part of the state. virtually none of florida's agriculture was -- went without being impacted by this. think about the migrant workers that work there. some of whom were afraid to come forward because of their immigration status. they thought if they showed up at a shelter, they would be deported. but more importantly, in terms of life, some of them have nowhere to live. their housing to begin with is precarious. a lot of mobile homes. damaged by water. no electricity. not near a metropolitan center, and afraid to come out. thank god for so many groups that have come forward to try to help them. you know, we scoff about power outages. i can tell you, i don't know how people lived in florida before the invention of the air conditioning, but the heat and the humidity is an inconvenience for a lot of people. it's life-threatening in the case of the senior citizen or people who require refrigerated pharmaceuticals for their survival. an extraordinary impact on them. so all these things have a true impact on many of the challenges we now face. a special focus is on, for example, monroe county, the florida keys. this storm threatens the fundamentally -- to fundamentally alter the character of monroe county if we do not help the florida keys, because those trailer parks are on valuable land, and the owners of that land are going to be tempted to build on them, not mobile homes again, but build on them structures designed for visitors or people that can pay more money. that means you're going to lose your housing stock but it ultimately means you're going to lose the character of the place. all those small businesses that service the fishing boats, the diving. we have got the greatest collection of coral reefs in the world right off marathon by sombrero key, in the florida keys. all of that. they're going to be out of business for a long time. can they survive? i don't know. small business owners, people that might own an apartment building and they use it in the summer for their family and then they rent it in the winter. well, it's damaged. they can't rent it this year. guess what? they may not be able to pay the mortgage, which will lead to foreclosure. real challenges in monroe county. i mentioned agriculture. i honestly do not know how florida agriculture, particularly citrus, can recover from the storm without significant help. senior citizens. this storm exposed a real vulnerability to a state with so many seniors. and it's not just nursing homes. we have apartment buildings, section 8 h.u.d. housing and the like. entire apartment buildings. 13, 14-story towers of apartment buildings populated by senior citizens. let me tell you what happens when the power goes out. the first thing is all the food in the refrigerator rots. so within 48 hours, i don't care how much they stored for the hurricane, they can no longer eat a lot of the food they need for their nutrition. you may say well, why don't they just get up and go see a relative or go somewhere that is handing out food? they are on the 13th or 12th floor. the elevator doesn't walk. they can't walk down 13 flights of stairs. this exposed the real vulnerability that we will have to examine. and then debris removal. some of these are small counties. some of these counties are still owed money from storms last year. fema disburses the funds to the state. the state hasn't disbursed it to them yet. now they have to go out and hire, hundreds of thousands, maybe millions of dollars to clean up these roads, and they don't have that in their budget. so a huge strain in that regard. what our office has done and senator nelson and i spent two days together traveling last week and continue to work together, helping so many different people. yesterday -- on friday, we had an event at imokolee, a migrant community in southwest florida. 800 people tiewrnd out to apply for assistance. we were in st. augustine yesterday. 1,000 people applied for assistance. jacksonville today, 1,800 people applying for assistance. naples, fort myers, we'll be back on friday and we're about to start up in the florida keys helping people. it's funny. they say fema, go online and apply there. here's the problem. you have no internet, no power. how do you get online and apply? we're trying to get out there and help as many people as we can. i don't want to leave on a negative note. there is nothing positive about a storm, but there are some uplifting things to point to. i will be brief and to the point. i think it's important to share. i'm uplifted by the crews sent down by the church of jesus christ of latter-day saints, l.d.s. church, who are out there helping people who can't afford it, don't know how to do it, professionals out there helping people cut down trees and remove debris from their homes and put tarps on their roof. volunteers. they came on their own to do it. uplifted on saturday by visiting the north carolina men's baptist relief society who was in south florida, 120 people, preparing hot meals to send down to the florida keys. they have fed thousands of people. a very impressive operation. uplifted by the red cross volunteers from new york, from new jersey that i run into, who flew down, rode out the storm, and were there working in these shelters. uplifted by stories of school principals who took over these shelters because people didn't show up to run them that were supposed to show up, so these principals and the custodian and the cafeteria manager showed up and took care of all these people. uplifted by stories like today in jacksonville where a gentleman and his wife who is disabled came forward. they lost their home. hethey had to be saved from floodwaters. they lived in temporary housing. a donor put them up for a week. it ran out. they had nowhere to go tonight. matched them up with a donor who insists on remaining anonymous for another week of temporary housing while hopefully we can get them the assistance they need. one of my favorite stories -- i believe senator nelson shared this the other night, and it's the one i wanted to close with. it's a story that he and i ran into at ave maria university in southwest florida. a private catholic university. literally out in the middle of the everglades between naples and miami. we went out there to visit. we were told the extraordinary story of some of their students. on the night before the storm, there was about 300 migrants from nearby communities. many of whom were probably undocumented, in the country illegally, who didn't want to evacuate, who were afraid of being deported. ultimately, they saw the storm was bad. they showed up at ave maria. they opened their doors, welcomed them into the gym, and their students that stayed behind played with the kids, entertained the kids throughout the storm and took care of them. really uplifting was the story of two nursing students. right before the storm hit, right before you could no longer go out, the sheriff's office shows up at ave maria with eight seniors from a nearby a.l.f. the staff at the a.l.f. quit. they literally left. they just didn't show up. they abandoned them. the sheriff's office brings them. these two nursing students bring the eight seniors into their dorms, the women's dorms, and care for them for two days, triaging the medicine they need to take, understanding this, that, or the other. amazing stories of these young people. if you have any doubt about the future of america, think about the extraordinary sacrifices -- or the extraordinary work these young people put in. nobody told them to do it. they could have left. they could have gone back to wherever they're from. they stayed there and took care of them. so we have a long way to go, but we want to thank all the great wishes that we got from all my colleagues here and people from around the country. this is a storm that impacts florida in ways we're going to feel for a long time. let me close by just asking all of you to take a moment tonight, if you can, and you wish, to pray for the island of puerto rico, a u.s. territory, where millions of our fellow americans are staring down the barrel of the most powerful storm that has ever, perhaps, hit that island. after already getting hit by irma just a week ago. it has the potential to be an extraordinary catastrophe. we pray that that's not the case, and i hope we stand ready to assist our fellow americans on the island of puerto rico. let's pray for them tonight because tomorrow morning is going to be a very difficult time for them as this extraordinary hurricane, hurricane maria, is about to slam right into them. with that, mr. president, i yield the floor. mr. mcconnell: mr. president? the presiding officer: the majority leader. mr. mcconnell: i ask unanimous consent that the senate be in a period of morning business with senators permitted to speak therein for up to ten minutes eve. the presiding officer: without objection. mr. mcconnell: i ask unanimous consent notwithstanding the passage of h.r. 2810 as amended that amendment number 545 be considered and adopted. the presiding officer: without objection. mr. mcconnell: i ask unanimous consent the senate proceed to the immediate consideration of h.r. 3110, which was received from the house. the presiding officer: the clerk will report. the clerk: h.r. 3110,en an act toppled amend the financial stability ability act of 20120 modify the term of the independent member of the financial stability oversight council. the presiding officer: is there objection to proceeding to the measure? without objection. mr. mcconnell: i ask unanimous consent the bill be considered read a third time and passed and a the motion to reconsider be considered made and laid upon the table. the presiding officer: without objection. mr. mcconnell: now, mr. president, i ask unanimous consent the senate proceed to the consideration of s. res. 265, submitted earlier today. the presiding officer: the clerk will report. the clerk: senate resolution 265, designating september 22, 2017, as national falls prevention awareness day to raise awareness and encourage the prevention of falls among older adults. the presiding officer: is there objection to proceeding to the measure? without objection. mr. mcconnell: i ask unanimous consent the resolution be agreed to, the preamble be agreed to, and the motions to reconsider be considered made and laid upon the table, with no intervening action or debate. the presiding officer: without objection. mr. mcconnell: so, mr. president, i ask unanimous consent that when the senate completes its business today, it adjourn, to then convene for a pro forma session only with no business be conducted on thursday, september 21, at 8:30 a.m. i further ask that when the senate adjourns on thursday, september 21, it next convene at 4:00 p.m. monday, september 25. furthering following the prayer and pledge, the morning hour be deemed expired, the journal of proceedings be approved to date, the time for the two leaders be reserved for their use later in the day, and morning business be closed. further, following leader remarks, the senate proceed to executive session and resume consideration of the emanuel nomination, with the time until 5:30 equally divided between the two leaders or their designees. finally, at 5:30, all postcloture time be expired and the senate vote on the confirmation of the emanuel nomination, with no intervening action or debate, and if confirmed the motion to reconsider be considered made and laid upon the table, the president be immediately notified of the senate's, a and the senate then resume legislative session. the presiding officer: without objection. mr. mcconnell: so, if there is no further business to come before the snarks senate, i ask it stand adjourned under the previous order, following the remarks of senator blumenthal. the presiding officer: without objection. the senator from connecticut. mr. blumenthal: thank you, mr. president. i thank the majority leader for yielding me this time before we close business today, as the last speaker of the day. let me first of all say how deeply we feel about folks who have been affected by these mammoth storms on the gulf coast and florida, the virgin islands and puerto rico, as well as others elsewhere. and our hearts and prayers are with them. i am here today to talk about another potential disaster to our country, although it is of a completely different kind and not a physical disaster made by nature but a disaster potentially of our own making, one that can be prevented and avoided. i'm horrified that i am here again fighting back again against a proposal that would devastate the health and finances of so many families in connecticut and around the country. this proposal, the so-called graham-cassidy measure, is cruel beyond measure. it is undoubtedly the most extreme proposal we have seen from my republican colleagues in their political crusade to destroy the successes of the affordable care act. how illogical and and irresponsible to pretend, as my republican colleagues continue to do, that any proposal that cuts billions of dollars from medicaid and decimates important affordable care provisions protecting people with preexisting conditions and high medical costs will somehow result in a better health care system? in fact, it will vastly diminish and, in some respects, destroy that system. the republican obsession with repealing the affordable care act and gutting medicaid really has to end. and it has to end today. my constituents in connecticut made themselves heard loud and clear in saying that past proposals were sickening attempts to ruin the gains we've made in providing better health care to many people. those folks who came to town meetings and emergency field hearings, who wrote and phoned, who made their views known were the catalyst in defeating these ill-advised efforts before. i can assure you that, once again, they will be heard. they will make themselves heard. and they will once again guarantee its defeat. under this lethal proposal, hundreds of billions of dollars will be cut from medicaid. those severe cuts would cost connecticut more than $2 billion by 2026. in 2027 alone, without authorization of fund funds -- t reauthorization -- connecticut would lose $4 billion n2027 alone -- 40 billion. in 2027 alone, $4 billion would be lost to connecticut alone. those are not just dollars. those are lives. they are hundreds of thousands of lives. and this bill would end the patient protections that countless americans have come to rely on in their oftentimes lifesaving care. states would allow insurance companies to real estate impose annual caps -- reimpose annual caps and life sometime limits. insurers could decide to drop essential health benefits like maternity care or mental health services, and those with preexisting conditions could see their premiums skyrocket, leaving them with no affordable options and nowhere to turn. it would be a humanitarian catastrophe. that's not hyperbole. that's realty. a recent report, it was a finding that a person with met it is a stick cancer would see a 142, 650 thousand dollar premium surcharge. it would be a $7,320 premium surcharge and during a deadly and unrelenting opioid epidemic people struggling with substance abuse disorders can expect to see a $20,450 premium surcharge. these effects are immoral, incomprehensible. they will lead to many, many americans needlessly losing their health insurance and very like lay their lives. -- likely their lives. when i see the true effects of this bill, i can't help but think after little -- think of a little boy in connecticut who i have mentioned on the floor before. he is 7-year-old conner curren, he has duchenne muscular dystrophy, which will slowly erode his motor functions unless there is a cure. none exists now. this disease eventually will take his life. he is a young man of extraordinary courage and strength. and so is his family. his parents have told me that although he appears healthy, he will slowly lose his ability to run, walk, or even hug them good night. in fact earlier this summer, just days before the last republican effort to gut medicaid and repeal the affordable care act, which failed in the senate fortunately, conner's family had two lifts installed in their home so he can move up and down the stairs more easily. a voidio shows conner's infectious smile as he tries out the new lift, not fully understanding the disease that yes, sir taits it but en-- that necessitatenecessitates itnecesg husband new found freedom. his mom wrote that this experience shows just how important medicaid is to their family. as conner gets onlier, he'll -- as conner gets older, he'll only need more help, more financial assistance for his family to enable that kind of care. he will need a loving and compassionate health care system that will protect and care for him when he is at his most vulnerable. that's the only way he will have a fair chance at life. and this bill, to put it mildly, deprives him of that fair chance. so i question whether my republican colleagues could look conner in the eye, or his fami family, and explain to them why protections for children with preexisting conditions should be weakened, diminished, eviscerated. i question they could look at conner's smile and tell him why medicaid will be eliminated. that's the program that one day will make sure he has everything he needs to live. it's the program that should be enhanced, not cut by hundreds of billions of dollars. tell his parents why the insufficient or temporary funds that my colleagues have proposed to replace medicaid will run out in ten years. as a shadow of medicaid that you have left goes dark, she whether conner's family cares about your legislation. see if your empty promises leave them reassured. i can tell you that conner's parents are two of the kindest, most wonderful people you will ever meet. they are also among the hardest working. they worry about countless things every single day. they worry about conner's slowing body and the medical research that could save him before that pernicious disease takes his life. they worry about his independence. they worry about his two brothers and the toll that this all of disease will have on them, and they worry about those stairs, the ones that will have a lift. i promise you, conner's parents worry nonstop. all of us worry about our children. they worry about conner unceasingly. so i'll say it again. i'm ready to work with all of my colleagues in solutions to the health care problems our country faces. they are urgent and important and critically important to address now. but i refuse to stand silently and let this cruel proposal give conner's family even more reason to worry. we as a country are better than these reprehensible proposals, first repeal and replace, now graham-cassidy. they are all different versions of trumpcare, which is a catastrophe that will lead to humanitarian crises. this heartless proposal should be put behind us. we should work together, as our colleagues senator alexander and murray are doing, and at least for the moment give conner some assurance that we're making things better for him -- not worse; that the parents who worry about their little boy know that at least we are moving in the right direction, not rolling back the progress we've made. thank you, mr. president. i yield the floor. and i suggest -- the presiding officer: the senate stands

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