assume we know what is right without seeking your wisdom. inspire our lawmakers to think your thoughts, to listen for your directions, and to follow your guidance. lord, lead them to seek what is best for our nation and world, depending always on your sovereignty and might. may they constantly remember that you possess all power and can accomplish the seemingly impossible if they would only believe. continue to sustain them with your might, showering them with your bountiful blessings. we pray in your mighty name. amen. the presiding officer: please join me in reciting the pledge of allegiance to our flag. i pledge allegiance to the flag of the united states of america, and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington, d.c., july 11, 2017. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable rob portman, a senator from the state of ohio, to perform the duties of the chair. signed: orrin g. hatch, president pro tempore. the presiding officer: under the previous order, the leadership time is reserved. morning business is closed. under the previous order, the senate will proceed to executive session to consider the nye nomination, which the clerk will now report. the clerk: nomination, the judiciary, david c. nye of idaho to be united states district judge. the presiding officer: the senator iowa. mr. grassley: i ask that the calling of the quorum be suspended. the presiding officer: the that the i -- the senate is mott in a quorum call. the senator is recognized. mr. grassley: i am going to speak for five minutes. before i start to speak, i want to get permission to put two items in the record following my speech. i rise today to share real stories of real hardships from hardworking families in my home state of iowa. seven years ago americans were promised that the affordable care act would make health insurance cheaper and health care more accessible. well, i won't pretend to break any news here. the facts speak for themselves. obamacare is not living up to its promises. when passing the law, the other side made promises that they knew could not be kept. the irony here is that the so-called affordable care act is anything but affordable. i've heard from many iowans who tell me, in no uncertain terms, they cannot actord to buy -- they cannot afford to buy health insurance because obamacare is unaffordable. in fact, 72,000 iowans can't even get help from the exchange because there isn't an insurance company to service them. one iowan wrote to me, quote, i am forced to pay $230 a month for a health care plan that covers nothing until i reach $11,000 in deductible. so on top of paying 150% of my -- 100% of my medical bills anyway, now i also have to pay for insurance i can't afford, end of quote. so how did we get to this point? seven years ago i spoke rate here on the senate floor and predicted what would happen to the cost of insurance if obamacare passed. so let's go back to that period of time when i spoke in october of 2009, and this is my own quote from that speech. and while some of the supporters of these partisan bills may not want to tell their constituents, we all know that as national spending on health care insurance increases, american families will bear the burden in the form of higher premiums. so let me be very clear, i said. as a result of the current pending health care proposals, most americans will pay higher premiums for health insurance, end of my goat a speech in the senate -- end of my quote in a speech in the senate in the october of 2009. i don't have a magic crystal ball, but it was easy to ready the writing on the wall. i knew that layers of new taxes and burdensome new mandates in obamacare would lead us to where we find ourselves today: a broken health care system that is not better off than it was several years ago, and for millions of americans, including those 72,000 iowans, much worse. so where do we go from here? after seven years of rising premiums, soaring deductibles, and climbing co-pays, republicans are committed to fixing the damage caused by the affordable care act. not only is it unaffordable, for too many people it is unsustainable. obamacare is unable to fulfill its promises to the american people. here's what every lawmaker in congress ought to agree on: insurance isn't worth happening -- or having if patients can't afford to use that insurance. and the facts are clear. a one-size-fits-all government-run plan from washington, d.c., is driving insurers out of the exchanges, driving up premiums, driving away customers, and driving up the tab to the tax-paying public. obamacare has overregulated, overtaxed, and oversold its promises to the american people. become become has not healed what ails the u.s. health care system. it is time to move forward. i also want to talk about medicaid medicaid, as we know it, is not sustainable. the federal government and states spent $553 billion in medicaid in 2016. that amount is very close to $593 billion spent on the number one responsibility of the federal government: our nation's defense. every decked since medicaid -- every decade since medicaid started, it has grown faster than the economy. medicaid now unmatched as a driver of the deficit of our country. we cannot sit by and leave this kind of debt to our children and grandchildren. but dollars are not the only metric by which we measure medicaid. medicaid is a program that should supply health care to diverse populations and should have quality measured, but it does not. medicaid dollars should be spent efficiently, but they are not. activists in washington, d.c. are fighting to preserve the status quo, and of course in the process scaring the daylights out of the american people. yet, iowans tell me that there are waiting lists for medicaid waivers to obtain services for children with disabilities. others tell me that medicines that will cure diseases are rationed to be used only with those with the most advanced disease. in other words, you have to get really sick for medicaid to cover medical expenses. it is a fact that medicaid is not working the way it should for everyone. the time to act to preserve and improve medicaid as a safety net for the most vulnerable citizens is right now. i'm holding up a letter here, because under a democratic president proposing to do what we're doing, 46 democrat senators wrote to president clinton and expressed their words -- strong support -- for medicaid per capita caps. the letter went on to say it would give states the flexibility to achieve savings without cuts to essential services. that is what the current proposal aims to do as well. we are proposing per capita caps as a way to make sure tax dollars are spent wisely on the most vulnerable people in our nation. medicaid dollars should be spent on a child with cystic fibrosis who needs a blockbuster drug. or a person with severe mental illness should be able to rely on medicaid for care. medicaid cannot continue to be a limitless credit card to the states to spend money without any accountability to the people who need it. so i aside partisan dogma and work to solve this problem for the american people. i yield the floor. mr. mcconnell: mr. president. the presiding officer: the majority leader. mr. mcconnell: i want to start this afternoon by offering deepest condolences to the marine corps and all those who lost loved ones in the tragic plane crash yesterday in mississippi. we're still learning details about the incident, but we know that at least 16 on board the plane perished as a result of the crash. our hearts break for all those impacted and the many lives cut short in this tragedy. we're reminded of the bravery that our voluntary service members exhibit, putting their lives on the line both at home and abroad, in order to defend our communities and our freedom. we're indebted to them for their courageous, courageous sacrifice. now on a totally different matter, obamacare is a direct attack on the middle class. seven years ago democrats imposed it on our country. in the years since americans have found themselves at the mercy of its failures repeatedly. choice was supposed to go up, but it plummeted. costs were supposed to go down. they skyrocketed. obamacare's defenders spent years trying to deny these clear realities. when the weight of the evidence became too clear to ignore, some appeared to bemoan obamacare's harmful impact on our country. the democratic governor of minnesota declared it was no longer affordable. president clinton branded it the craziest thing in the world. other democrats said similar things. such acknowledgements of the obvious seemed to many of us like progress, but they turned out to be just rhetoric. in the last election, voters delivered congress the opportunity to finally address the obamacare status quo. and yet, democrats made clear early on that they did not want to work with us in a serious bipartisan way to actually do so. i wish they made a different choice. i wish the sudden calls for bipartisanship now were even somewhat serious, but this is the reality before us. we must accept it because that's where we are. and as my republicans know, this is the charge we must accept as well. the american people are looking to us for a better way. that's why despite the headwinds, i chose to keep working toward a better solution than obamacare. i've seen the pain in the eyes of too many of my constituents because of this law. i think they deserve better than what obamacare has given them. and i hope in the end that a majority of the senate will agree. we've been continuing with ongoing conversations across the conference about how to get there. members shared significant input over the state work period. we're going to keep working very hard on this. we'll continue to focus on the fundamentals that have guided the process from the start, like improving the affordability of health insurance, destabilizing collapsing insurance markets before they leave even more americans without any options at all. we also want to strengthen medicaid for those who need it most by giving states more flexibility while ensuring those who rely on the program don't have the rug pulled out from under them. many states want the ability to reform their medicaid program so they can actually deliver better care at a lower cost. under current law, states have some ability to do so. indiana, for example, lost a particularly notable effort thanks to the leadership of now c.m.s. director ms. verma. she has helped states like kentucky develop their own plans. the process is still too restricted. it hinders broader innovation and it's very slow. kentucky's plan, for instance, still has not been approved by the federal government. the senate health care legislation contains a provision to dramatically expand the state's authority to improve its medicaid system. it's an idea that could significantly improve health care in states across the country. as "the wall street journal" wrote in a recent editorial, this booster shot of federalism could become the greatest evolution of federal power to the states in a modern era. it could launch a first of state innovation. the "journal" went on introducing competing health care models across the country would be healthy. california and south carolina don't and shouldn't have to follow one uniform prototype designed in washington. and even a state as large as california doesn't have the same needs from region to region within the state. if nothing else, the repeal and replace debate has shown that liberals, conservatives and centrists have different health care priorities and allowing different approaches and experimentation would be politically therapeutic. the more innovative can become examples to those that stay heavily regulated. it's clear we have an important opportunity to achieve positive things for our country. it's also clear that if we let this opportunity pass by, the options left are not good ones. senate democratic leader acknowledges that obamacare isn't working the way they promised, but his solution, as he noted in a statement last week, is simply more money for insurance companies. the solution would be an insurance company bailout. no reforms, no changes. just more money to pay -- paper over the problems under the current law. it's a multibillion-dollar band-aid, not a real solution. senator sanders acknowledges that obamacare isn't working too, but his solution, as he stated in my state over the weekend, is to move to the kind of fully government-run single-payer system that was already abandoned in his home state of vermont. 80% of the voters recently rejected in colorado, and that even the california legislature and its huge democratic majority is finding rather hard to swallow. is it any wonder the so-called single-payer plan senator sanders proposed in his presidential campaign would strip americans of so many facets of decision-making over their own health care, and literally hand it over to the government. it would require almost unimagineably high tax increases. unimagineably high. and the cost, according to a recent analysis by the urban institute stands at an astonishing -- listen to this, mr. president -- $32 trillion. that's interest with -- that's trillion with a "t." that represents a greater sum than the entire economy of the most populist nation on earth: china. more than japan's economy too, and germany's and britain's and france's. same with italy's, brazil's, indian's and canada's. in fact, the cost of senator sander's health care plan is projected to be roughly equal to the size of all nine of those countries' economies combined. it would total more than the entire economy of the european union. twice over. if you laid out 32 trillion one-dollar bills end to end, they would stretch from the earth to neptune. it took voyager 2 spacecraft 12 years to reach neptune. well, that's the government-run single-payer plan put forward by the most famous proponent of the idea. many in the senate democratic leadership now support single-payer too. and these days increasing numbers on the left seem to openly comment on the failures of obamacare as if they see an opportunity actually -- an opportunity to finally realize their left-wing dream of total government dominance of the health care system. that's the dream of many on the other side in this body. that, mr. president, will not happen if we succeed in our charge today. americans deserve better than what they're getting under obamacare. they deserve better than what they're getting -- they deserve better than what they get under an even more government-heavy system than we have now. they also deserve better than ba band-aid solution. the people we represent deserve more affordable health insurance. they deserve improved health care choice. they deserve a more flexible medicaid system that can help improve outcomes for those truly in need. they deserve a more responsive health care market that trusts the american people to make more of their own choices, not the government. that's what we have been fighting for throughout this debate. that's what we're going to keep fighting for today. now on one final matter, believe it or not, mr. president, the current business before the senate is the consideration of a noncontroversial nominee for u.s. district judge in idaho. idaho. how do we know he's noncontroversial? well, the judiciary committee reported out his nomination on a voice vote, and then every single senate democrat voted yesterday for cloture on his nomination. thereby agreeing that there's no need to continue debate on this noncontroversial nomination. a noncontroversial district court judge. why are we still having a debate on a noncontroversial district court judge? if they agree the senate should bring the debate on the nomination to a close, why do they insist on dragging out the 30 hours of postcloture debate time in order to have a debate a nomination not one senate democrat said they needed to have more debate. we know the answer. the procedural vote yesterday served our colleagues the apparent purpose of wasting, literally wasting more of the senate's time. unfortunately this has become a common practice for our friends across the aisle. at this point in president obama's presidency, we allowed more than 90% of his nominees to clear by simple voice vote. let me say it again, mr. president. at this point in president obama's presidency, we allowed more than 90% of his nominees to clear by a simple voice vote. and we only ask for those procedural votes known as cloture votes eight times. at the same point under this current president, president trump, democrats have allowed voice votes 10% of the time. 90% of obama's nominees got a voice vote, 10% of trump's got a voice vote. and they forced procedural hurdles 30 times. often these needless delays have nothing to do with a nominee's credentials or whether or not the democrats support the nominee. in many cases, in fact, they actually do support the nominee, like the nominee before us. as "the wall street journal" observed, democratic obstruction against nominees is nearly total. most notably a demand for cloture vote filings for every nominee no matter how minor the position. what does this mean? it means a two-day waiting period and then another 30 hours beyond that. it's not about changing the outcome. it's about wasting it time to make it more difficult for the president to make appointments. according to the nonpartisan partnership for public service at about this point in president obama's presidency, he had 83 of his nominees confirmed. while the current president made 178 nominations, almost as many, the senate's confirmed only 46 of them. "the wall street journal" editorial i mentioned goes on to note that the extent of this democratic obstruction extends far beyond the cloture vote issue. i've discussed this issue before and i urged the democratic minority to think critically about the cons queesstions for -- consequences for the sena and the country if they alw this total obstruction to continue. so, mr. president, i ask unanimous consent "the wall street journal" editorial that i just mentioned appear in the record at this point. the presiding officer: without objection. mr. thune: mr. president. the presiding officer: the senator from south dakota. mr. thune: mr. president, as the leader has very ablably pointed out, the democrat obstruction when it comes to president trump's nominees is reaching an unprecedented level if you compare it to any past administration. he pointed out the number of nominees president obama was able to get in the way that republicans had here -- republicans here in the senate cooperated with him on his nominees. this state of affairs here in the senate really is taking the obstructionism when it comes to it trying to block even getting people into the administration into their positions to an entirely new level. and, frankly, mr. president, about the only thing that probably exceeds the pileup of president obama's -- president trump's nominees to getting into his administration is the pile up of bad obamacare news stories. just take a look at a few of the recent headlines. from the "cincinnati inquirier." this is a headline, "another insurer leaves a ohio exchange." from bloomberg, anthem exit creates across for nevadans. recent obamacare insurer exits leaves ii counties without choices. this is it another headline from the "washington free beacon "19th obamacare co-op folds leaving four operating in 2018. across the united states, mr. president, the story is the same. huge premium increases, fewer choices, and a system that is well on its way to complete collapse. in late may the department of health and human services released a report comparing the average individual market insurance premium in 2013, which was the year when most of obamacare's regulations and main dates were implemented, with the average individual market exchange premium in 2017 in the 39 states that use usehealthcare.gov. between 2017 and 2018, the average premium in the health care states increased by 105% -- 105%, mr. president. that in a four-year time frame since obamacare was implemented. on average, individual market premiums more than doubled in just those few years. in my home state of south dakota premiums increased by 124%, or $3,588. 124% rin crease in premiums -- increase in premiums or $3,588. that is money that south dakota families had to take for other priorities, like saving for reel timer or in -- retirement or investing in their child's education. the average has increased by $8064 in alaska, by $3,684 in louisiana, by $5,064 in north carolina, by $4,488 in tennessee, by $5,292 in west virginia. and premium hikes aren't over. in fact mrks in many case -- in fact, in many cases they are getting worse. here are s premium hikes propod for 2018. inle maryland one insurer proposed an increase of 52%. an iowa insurer is seeking an average of 43.5% premium increase. in north carolina insurer is pursuing $22.9% hike. a virginia insurer is looking for an average rate increase of 38%. a delaware insurer is looking for an average rate hike of 54 hrn, a maine insurer is seeking a hike of 40%. mr. president, i could go on. remember, these are rate hikes for just one year. the double-digit rate hikes for next year are in addition to years upon years of dramatic obamacare premium increases. mr. president, the obamacare status quo is not sustainable. this law was fatally flawed from the beginning and it is rapidly imploding. the american people need relief. inaction is not an option. my colleagues across the aisle seem to want to do one of two things, first, they want to do nothing, which would leave americans worse off than they are now or they want to double down on obamacare's failures by giving the government even more control over americans' health care and then raising americans' taxes to pay for it. mr. president, neither one of these so-called slawtions will -- solutions will provide relief to the american people. republicans are committed to providing real health care to the millions of americans. and we are working on mygislation to dohat. colleagues in the house have made a good start and we are working on a new bill in the united states senate. we are working to help millions of americans who were left with no options. we are committed to frame the american people from the onerous obamacare mandate which requires americans to purchase insurance that they may not want or can't afford. we're committed to improving the affordability of health insurance which keeps getting more expensive under obamacare and we're committed to preserving access to care for americans with preexisting conditions. and we're committed to strengthening medicaid for those who need it most by giving states more flexibility while insuring this that -- ensuring that those who rely on this program don't have the rug pulled out from under them. mr. president, the american people have suffered under obamacare for long enough. it's time to give them some relief and that's what we intend to do. mr. president, i'd also like to take just a few minutes to discuss the very serious threat posed by a nuclear-capable north korea. last week, the north korean leader took the latest step in his unwavering quest by testing an intercontinental ballistic missile. estimates suggest that the missile tested at a range of more than 4,000 miles which means it could reach alaska. north korea has not yet demonstrated the ability to arm these missiles with nuclear warheads but that day may not be far off. north korea's nuclear program has achieved a disturbing number of milestones in in year alone. mr. president, the united states must do everything that we can to prevent a nuclear-capable north korea, but we also must be prepared should kim jung-un put the final pieces together. this weekend's b-1 bomber flights were a sliver of the response that the united states could bring to bear in military engagement. the commander of the pacific exercises said, let me be clear, if called upon, we are trained, equipped and ready to unleash the full capability of our allied air forces. unquote. mr. president, we need to make sure that we maintain that lethal capability. congress has a key role to play here by making sure w adequately fund our military and pass convention appropriations in a timely manner. while the leader of north korea has not shown much of seeing reality, with we must remind him that his regime would not survive a war in the peninsula. this is an important component of the u.s. response to north korea, a key part of building our defenses should be a rigorous test schedule to inform development of anti-blissic technology. it's in new that some missile intercept tests have failed but those setbacks have led to improvements. some of our best men and women are working to keep us ahead of threats and must repeatedly test intercept systems to ensure they are effective. the head of u.s. strategic command has pointed out that our testing schedule lags behind the pace of north korea's aggressive missile testing. tuesday's thaad missile defense against a simulated ballistic missile attack was a timely demonstration of this critical defense capability and i hope that we can see further deployment of this promising system. placing thaad, or the assured missile defense system, would bolster front line defenses against future north korea launches. we should have military cooperation in the area around the kreern peninsula to en -- korean peninsula. the military marytime self-defense force are a good example of this cooperation. mr. president, we must also examine how we have gotten to this state. for a so-called hermit kingdom, north korea has made significant advancements while evading economic sanctions. those advancement have been facilitated by north korea's ties to iran and a passive china providing north korea with an economic lifeline. not all the blame rests with china, but we know that president xi has proved largely unwilling to curtail north korea's agenda. last month treasury secretary announced sanctions on chinese entities with financial ties to north korea. this is a positive first step, but more can be done to target banking and front companies that serve as conduits for north korea. increased transparency in export reporting should re -- would restrict oil and steel exports to north korea and assure china is adhering to its ban on imports to north korea. the u.s. should weigh weather new sanctions could exert additional pressure on china to rein in north korea. mr. president, i hope the administration will seriously consider such sanctions alongside measures to address other problematic chinese actions such as its continued military buildup on disputed reefs in the south china sea. mr. president, kim jing-un is willing to threaten the united states and its allies and we should have no illusions that is he planning to reverse course. we need to make sure we are prepared for any threat that he or his regime poses. 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. nelson: mr. president? the presiding officer: the senator from florida. mr. nelson: mr. president, i ask consent that the quorum call be lifted. the presiding officer: the senate is not in a quorum call and the senator is recognized. mr. nelson: thank you, mr. president. i want to speak on behalf of a group of floridians that i have met with that would be tremendously hard hit by the health care bill, whether it be the one that has already been published by the majorit leader or some of the iterations that are being discussed. i want to talk on behalf and be the spokesperson for these people who have cried out to me. i want to say that people are crying out. it's not just the group of four families that i assembled in my tampa office last week, but it's also just walking down the street in an airport, going into a public building. constantly folks are walking up to me and saying please don't let them take away my health care. just this past week, i was in it shall remain nameless, a republican senator's state and happened in the airport there is my colleague, the republican senator in that other state other than mine, and the travelers, the constituents of that senator constantly in the airport as we are waiting for the airplane walking up to that republican senator and begging, please don't take away my health care. and what we've seen in this republican bill, it takes away health insurance from millions of americans. that's not my conclusions. that's the conclusions of the congressional budget office. it also cuts back according to c.b.o. some $800 billion over a decade out of medicaid, and it allows insurance companies to hike rates for older americans. under the bill 22 million people would lose their insurance by 2026. over two million of these folks are in florida. in fact, the bill would increase the uninsured rate in florida by 62%. that's not what i want inflicted on the folks in florida. this bill lets insurance companies go back to the days when they had annual and lifetime limits on coverage and refused to cover basic health benefits like prescription drugs and mental health services and even maternity care. this republican health bill that has been so much the subject in the news and the center of the debate here for the past innumerable weeks, it really does cut medicaid. now, according to c.b.o., again not my words, c.b.o.'s word, funding will be 26% lower in medicaid by the year 2026 under -- than under the existing law. my home state of florida is projected to lose $5.7 billion in federal medicaid funding from 2020 to 2026 under the bill that is proposed by the majority leader. and if that's not enough, the senate bill would dramatically increase health care costs for americans between the ages of 50 to 64 before they turn that magic age of 65 when they are eligible for medicare. dramatically increase those costs. now, that dramatic rise in cost is due in large part to a provision that would allow insurance companies to charge older americans up to five times what younger people are charged. the current law, the affordable care act, has a differential of 3-1. this bill, as proposed, is a differential of 5-1. so if you're not on medicare because you haven't turned 65, and you're an older american in those ages, which increasingly seems very young to me, those ages up to age 64, then the differential from what the insurance company charges the young person is five times, not three times, as the current law is. this would especially be felt among those older individuals making between $42,000 and $48,000 a year who, after that point, they no longer qualify for the tax credits under the republican bill to make coverage more affordable. remember, the current law up to 400% of poverty you're entitled to get tax credits, according to what your income is, to help you buy private health insurance from insurance companies on the marketplaces in each state. even that is going to be reduced. and this bill also includes a backdoor provision that undermines the provisions that currently -- the protections that currently exist with preexisting conditions. now, you will hear people argue defending the bill that it doesn't do that, but look what the bill says. it says that you leave it up to the states to determine that. what's a way that the state can lessen the cost of insurance premiums? take away the guarantee that you can get insurance if you have a preexisting condition. well, i've given a number of speeches, i've had some experience in this as the former elected insurance commissioner of florida when it was an elected position. it was also the constitutional position of state treasurer. i held that position for six years, and i've dealt with insurance companies, and i've seen some of the insurance companies say, you have a preexisting condition. we're not going to insure you. you have asthma. i've seen an insurance company even say, we're not going to insure you because you have a preexisting condition; you had a rash. under the current law, an insurance company cannot deny you insurance because whatever your preexisting condition is. your preexisting condition might be that you have a weak heart. well, you of all people would want health insurance. before, you couldn't get it. now, under the current law, you can. but i don't want you to hear this over and over plea from me. i want the pleas from several floridians to reach out across the state lines and to get to the senators who are going to be voting on this. i want you to hear from some of my constituents. so when i met with them last week in tampa, i had many who said that they would be devastated if medicaid were cut. i want to share with you how this has personally affected them and how apprehensive and plain scared they are right now that the health care that they are getting, that they're not going to get it if this bill proposed by the majority leader were to become law. so take, for example, michael phillips. he's 36 years old, and he has spinal muscular atrophy. it's a genetic disorder. it affects control of his muscle movement. he relies on a tracheotomy -- a trace, tha -- a trach, that ther to it. it is a breathing tube, and he uses assistive computer technology to be able to talk. the computer talks for him. michael was supposed to join us on that day, but he wasn't feeling well, and, of course, there's always thed ad d. -- the added exposure to germs a understand his -- and his weakened immune condition but instead came his two caregivers, his single mother karen and his brother brian. michael relies on medicaid, and it allows him to live at home with his mom and to have a personal care assistant. he benefits from medicaid home and community-based waiver, and if the waiver is eliminated because you start whacking out billions and billions of dollars out of medicaid, he would ultimately end up in a nursing home away from his mother, away from his family, and be forced to compromise his level of care and quality of life. you may have seen this fellow interviewed by the national news networks. his mom as well. this is one in the same, michael phillips. the senate health care bill ends medicaid as we know it. it comes in, and whether it's a cap on the amount of money going to the state or call it a block grant, the effect is the same: it will put people like michael at risk of losing critical services, and it certainly will take away his independence and his quality of life. now, i've already said that the bill certainly takes away the guarantee from a preexisting condition. well, let me tell you about another floridian that was in that meeting. elizabeth eisem. she's from st. petersburg, and she told me that the affordable care act saved her life and allowed her to purchase insurance for the very first time. she doesn't know how she's going to be able, if it's taken away, to be able to afford coverage because the lifetime caps that an insurance company cannot put those lifetime caps on of what they pay out. for example, in the old days before the existing law, an insurance company would say, i'll pay you as long as it doesn't exceed, say, $25,000, $50,000. that was all figured into their insurance payment and their premiums. and in the current law there are essential health benefits. there are about a dozen of them. elizabeth was a social worker before she developed a sinus tumor. she went without insurance for three years, during which time her health was deteriorating, she could not afford because she did not have health insurance. she could not afford to have that tumor operated. what i do not know is if she knew at the time, because she hadn't had the operation, if she thought it were cancerous, as it turned out later when she was able under the affordable care act to get health insurance and to have the operation, thank the good lord, it was benign. but her health deteriorated to the point that she actually thought as this thing starts to grow in her sinus passages and into her brain cavity, she thought she was approaching death. it ended up being vital organ damage. it reached the point of complete disability. the mass in her sinus had extended into her skull. and after the a.c.a. before the law of the land, she purchased insurance through healthcare.gov. she says it's the best insurance she's ever had because it covered essential health benefits like preventive services, and it certainly provided so that she could go on and get the operation, and it saved her life. and if this senate bill passes, services that elizabeth relies on may no longer be covered, and she would likely never be able to afford a decent health insurance package again, and she obviously has a preexisting condition. she'd be one of the 22 million people that the congressional budget office estimated would lose their health insurance, if the bill proposed by the majority leader, senator mcconnell, were to become law. let me tell but another floridian. regina herbert from tampa. she is a small business owner. she was diagnosed with stage 2-b breast cancer at the age of 57. she, too, told me that the a.c.a. saved her life. without the a.c.a., she would not have received health insurance because her cancer is considered a preexisting condition. 57 years old. preexisting condition. stage 2 breast cancer. she had obtained health insurance through the a.c.a. two surgeries. months of chemo and radiation. she told me that if her cancer comes back and she doesn't have insurance, then she's going to have to choose between going bankrupt, not to what she's doing now, which she's got a small business. she's paying taxes. she's contributing to society. what's her other choice? the other choice is to give up. you take away her insurance, that's her choice. bankrupt or giving up. i don't think we want to put americans in that position. and the senate health care bill allows states -- it allows states to waive the essential health benefits, that dozen that i talked about that are listed, like those needed if they have a preexisting condition. so there was another lady that i met with. her name is olivia babbis. she is from outside tampa, a place called looks. she also has a preexisting condition. she told me that she uses the essential health benefits guaranteed by the existing law. she's scared of insurance companies that they would take away the coverage of treatments for her disability and also reinstate annual and lifetime limits on her coverage. let me tell you about this young lady. she is just amazing. she was born without arms. no arms. she uses her feet and her toes to be able to function in the place of hands and fingers. and then, in one leg, she had to have a total knee replacement by the time she was 30. she works as a community organizer. she doesn't qualify for medicaid in florida because her income is considered too high. she actually has an income. and olivia purchased health insurance through healthcare.gov with the help of tax credits to help her afford health insurance. and this young lady, now in her mid 30's, is just amazing. with no arms, she uses her feet and her toes, and she is capable of getting around in her wheelchair. she is capable of driving a car. she has a business. she has an income. she's paying taxes. but it's because she is able to function because she has health insurance. now, thanks to the a.c.a., people like olivia benefit because there's not a ban on a lifetime limit o t insurance policy. thanks to the a.c.a., she lives an active life, and she goes snorkeling, hiking, and even skydiving. her legs are good except for the knee replacement that she had so she can walk, but then when she has to do the normal functions of hands and arms, she sits down and she uses her legs, her feet, and her toes. she told me without the a.c.a., she's trapped. and as i told you about this unnamed republican senator in an airport in another state of that republican senator, what happened to that republican senator happens to me back in florida. people coming up, begging me please don't take away my health care. well, we shouldn't continue to waste our time with this health care bill that only takes away health care and charges more for less coverage. we have said it. so many of us out here on this floor, we should be looking for ways to improve the existing law, the affordable care act, not undo all of the good that it's done. we have floridians and folks across the country who are grateful for it. they want us to fix it, not repeal it. and they say that over and over. why can't you guys get together in a bipartisan way and fix it so the personal stories of olivia, michael, regina, elizabeth, along with the hundreds of people who have come up to me just in the street or in the airport and begged me don't take it away. they don't want us to get rid of this. and as you have heard, several of them claim they would not be alive today without the a.c.a. or alternatively, they would be bankrupt if it weren't for medicaid in the a.c.a. in order to truly improve our health care system, why don't we work together to make it better? we need to look at real solutions. and so i'm happy to say that this senator has been talking to republican senators, and she have talked, and we have talked about specific things. and i told some of these senators about my experience as the former elected insurance commissioner of florida. when i had a problem after the monster hurricane andrew in the early 1990's, and we had a paralyzed marketplace where you couldn't get homeowners insurance in florida from an insurance company because they were scared to death that the next big one was coming and it was -- the losses were going to be so great that they would have to price the premiums so high, so what did we do? we created a reinsurance fund called the florida hurricane catastrophe fund, that built up a reserve that would reinsure the companies if they had a catastrophic loss. the same principle with hurricanes can apply to health insurance. create a reinsurance fund that will ensure the health insurance the health insurance company against the catastrophic loss, which occasionally they will have. and, you know, i costed that out in florida, and it would reduce the premiums in florida from the marketplace in florida. 13%. now, that's real savings. and that's just one solution of a fix. we ought to be looking at approaches like this. i welcome all of our colleagues on this side and that side, and i have been talking to some on that side, to let's join together and do something productive like getting behind ideas just like the one that i suggested. i heard our colleague this morning, one of our favorite colleagues out here is joe manchin from west virginia, and i heard him interviewed on one of the morning shows. he was terrific. he said we need to be working together. we shouldn't be divided over party by this. we shouldn't be divided ideologically on this. we all ought to be openly trying to work together to figure how to drive down health care costs and increase coverage for more americans. and that's what those folks in florida and tampa told me last week that i met with, and that's what those hundreds of folks that come up to me in the airport, on the airplane, on the street corner, in the public buildings, in the hospitals, wherever i am, that's what they're telling me, please get together and work it out. they're asking us to fix what needs fixing. and that's what the american people are asking us to do, and that's what i beg the senate. some, as the good book says, come, let us reason together. let us use some of our common sense. mr. president, i yield the floor. mr. schumer: mr. president. the presiding officer: the democrat leader. mr. schumer: first, i thing my good friend from florida for his inspiring words. he's always trying to work together on bipartisan solutions. he represents one of the largest and most diverse states in the country, a state that very much depends on having good health care, and i hope my colleagues on the other side of the aisle will heed his words. now, first, mr. president, i want to send my sincere condolences to the marine corps who lost 15 of their finest today in a plane crash in mississippi. as well as one navy corpsman. it was the deadliest crash in the marine corps family since 2005. according to reports, the aircraft that crashed this morning was based at stewart air force base in my home state of new york. our hearts break for these families of sailors and marines. we wowrn their loss, wish comfort that their families and loved ones in this time of tragedy. may they rest in peace. now, mr. president, on an entirely different matter, well, the majority leader today said that we are going to stay an extra two weeks in the august break. we democrats are willing to stay two weeks, two months, two years to get a good health care bill, but in all due respect to my good friend, the majority leader from kentucky, it's not time that's the problem here. our republican colleagues for seven years said repeal obamacare. they had nothing to put in its place. then president trump was elected. a republican majority in the house and the senate. and since january 4 when they deliberately excluded us from all discussions by enacting a reconciliation bill, they have been trying to put together a health care bill. they can't. it's not because of lack of time. two weeks isn't going to help. the problem is the substance of the bill. the bill provides massive tax cuts for the wealthy and just as bad if not worse puts a dagger in the heart of the medicaid program which has become a program that affects so many americans. kids, poor kids, that's where it started, but now it's people who have mom and dad in a nursing home who might face thousands of dollars of expenses, those on opioid treatment, those who have kids with disabilities. and many, many, many with preexisting conditions. those are all helped by medicaid and our republican colleagues here want to slash them. well, just like my colleague from florida, i was in some very conservative parts of new york state, places that voted for trump by over 60%. the revulsion, revulsion is the word, the fear that this health care bill has put in the hearts of those folks in republican areas was dramatic. and so i'd say to my good friend, the leader, we're willing to stay as long as he wants, but he's not going to solve this problem until he abandons tax cuts on the rich, abandons the decimation of medicaid, and works with us to improve the existing law. his problem, our republican colleague's problem is not time, it's the substance of the bill. and i'd say one more thing, mr. president. if i were a republican, i wouldn't want to go home either. every time they go home, they are lambasted because the american people have such a negative feeling about the bill, so of course they would want to stay here, but that's not the answer. the answer is change the bill, work with us. we have been begging, pleading, asking, cajoling for a month or two when it was clear their bill was going to fail. so i would say that that is very important. now, i heard the majority leader complain about the slow pace of nominations. our republican friends, when they are worried about the slow pace of nominations, ought to look in the mirror. this president has nominated fewer nominees than anyone else, and so many of these, seven of the major nominees had to withdraw their nominations. many more with brought to the -- brought here to the senate without the necessary documentation, the paperwork, the ethics reports, the f.b.i. reports. and the chaos in the white house is now spreading to the republican senate. so, again, our president seems to, and his administration when they make a mess, they blame somebody else. let's not do that here. let's not do that here. again, the number of nominees that this president has submitted is lower than any president in recent memory. my colleague complained about this nominee from kentucky -- from idaho. he was outraged that he had to file cloture. i'd remind the majority leader this district judge was nominated by president obama in the last congress, that he was the majority leader in the last congress responsible for putting nominees on the senate calendar. the district court judge is only one of many nominees the republicans failed to move in the last congress, a congress which confirmed the fewest number of judges of any congress since the eisenhower administration. and that goes to show how desperate our republican leadership is to shift blame and attention away from their health care bill, to hypocritical and preposterous complaints on nominations to distract from the health care bill, they can try other tactics. and one more point. i'd remind my colleagues that it's the majority leader who has the power to put nominees on the floor. in the department of defense, we have been asked about three nominees. leader mcconnell had the power to put them on the floor instead of this judge from idaho, instead of the nominee from o.m.b., and instead of the ambassador to japan tomorrow, if he chose. his choice. and if he puts them on the floor, these defense nominees in regular order next week, they will be approved. so again, to deflect from health care and the mess that our poor republican colleagues are in, to point falsely at the nomination process which has been slowwalked by trump -- slow-walked by president trump and many of the committees is not going to succeed. i yield the floor. mrs. murray: mr. president. the presiding officer: the senator from washington. mrs. murray: mr. president, i ask unanimous consent to speak as if in morning business. the presiding officer: without objection. mrs. murray: mr. president, from the moment president trump and republicans began trying to jam trumpcare through congress, i heard from family after family in my home state about the damage their efforts to undermine families' health care would do, and this last week was no different. again and again my constituents told me what a difference it makes to have affordable insurance, to know that benefits like substance abuse treatment are covered or to worry about how they would manage if trumpcare ever became law. now i heard some of my republican colleagues went out of their way to avoid those kinds of stories wn they were home, so i want to make sure they heard a few examples now that they are back in town. and i appreciate that many of my democratic colleagues will be sharing stories as well that they heard from their constituents over the past few days. mr. president, like many of my colleagues on both sides of the aisle, i come from a state where the opioid epidemic has had a devastating impact. it has been both heartbreaking and inspiring to talk with patients and families who are doing everything they can to fight back. and right now the message i'm getting from them loud and clear is we do not want trumpcare. one of my constituents, a guy named daniel, was injured in the military. he was given a prescription for painkillers. he was on them for eight years, and during that time he told me his three daughters wondered why he wouldn't play with them. eventually daniel changed doctors and was prescribed suboxone which made all the difference for him. he is now able to work again. he meantions a grocery -- he meantions a grocery store but he relies on medicaid for health care coverage which covers the hundreds of dollars a month his prescriptions cost. daniel told me that if he loses medicaid under trumpcare, he will not be able to make ends meet. and all of the progress he has made will be threatened. i heard from a constituent named rachel in seattle who is addicted to opioids and living in her car when she found out she was eligible for medicaid. she got connected with swedish medical center in seattle where she received rap-around health -- wrap around health serves including mental health care and primary health care. now she and her husband are successfully in recovery and they're raising a family, and rachel is going to school. but just like daniel, they do not know what they will do if trumpcare becomes law and the medicaid coverage that is keeping them going is taken away. those are just two of the countless stories i heard from patients and families and doctors in my home state and nationwide. i've heard from cancer survivors who have fought back as hard as they can and worry tha allow ine companies to price them out of care because they are labeled now with a preexisting condition. i heard from young parents of medically fragile children who stayp at night worrying about how to afford care for their toddler if lifetime caps on coverage are imposed under trumpcare. seniors who simply don't have the savings to cover the premium spikes that trumpcare would cause, women and men who are furious and rightly so that a group of 13 men wrote a bill in secret to defund planned parenthood, the nation's largest provider of women's health care, removing a quality, affordable provider from communities where it is now very difficult to get care. these stories are all powerful. they make it undeniably clear just how much trumpcare would hurt people. so it is no wonder that senate republicans spent the last week laying low and avoiding defending, ielieve, the indefeible. mr. president, senate republicans have read the same independent congressional budget office analysis as we all have. they have heard from countless doctors and nurses and hospitals and nursing homes and patient advocates about all of the way that trumpcare would raise families' costs and take away coverage. they know people across the country are completely, resoundly rejecting trumpcare. it is the least popular bill in three decades, according t one study. all inll trumpcare shatters every promise president trump and republicans made about providing insurance to everybody and making sure no one is worse off, and incredibly the extreme right wing still think it leaves too much of the affordable care act intact. mr. president, even though it seems you would be hard pressed to find anyone who wants to stick up for trumpcare, including, by the way, president trump, senate republican leaders are still doing everything they can to jam this through congress as quickly as they can. they are working on back room deals as we speak and coming up with new ways to sweeten the deal for senate republicans who are rightly wary of voting for a bill that would so clearly do so much harm. inarticular, i wanted to address thisfternoon the ongoing effort conservative senators to double down on pulling the rug out from under patients with preexisting conditions. they put together this two-track plan to make middle-class workers and families pay more. if they get their way, insurance companies would be back in charge and tell patients who have preexisting conditions or anyone who happens to get sick in the middle of the year, tough luck. and they will do that in a way that even conservative experts predict will cause premiums and deductibles to skyrocket. senate republicans are coming up with other ideas too, like an opioid fund that a republican governor said is like spigot in the ocean -- is like spitting in the ocean. let me be clear. there is no fixing trumpcare. no tweak around the edges is going to turn trumpcare, which, by the way, is just a tax break for special interests in the health care industry on the backs of patients, by turning it into a health care bill that actually helps people. there is just no way. trumpcare, as the president said, is mean at its core. and unless it is dropped altogether, senate republicans are going to have to decide whether they stand with their party or the people they came here to represent. so to everyone out there who has called and written and rallied and tweeted, you are having an impact. you are why trumpcare isn't already law. but you cannot give up now, and democrats here in the senate won't either. we're going to keep doing everything we can to make sure senate republicans can't hold their noses and vote for trumpcare just to hand big corporations a tax break and president trump a hollow political win. whether it's next week or the weeks into august. and i also want to remind my sena republican colleagues, again, we have madear all along the way there is a better way to do this. democrats are ready. we are willing to work with you on policies that make health care more affordable and workable for patients and families. so i'm here today to say i hope you all listen to the stories that our democratic colleagues are bringing to the floor. think about how devastating trumpcare would be and do the right thing. drop this mean bill once and for all so all of us can get to work on real health care solutions that actually help people afford care, get covered and stay healthy. if you do, you don't have to defend this defenseless bill a minute longer. thank you, mr. president. i yield the floor. a senator: mr. president. the prg ofesidincer: the tor from oregon. mr. wyden: mr. president, firs of all, i want to thank senator murray, a member of our leadership, for taking this time to talk about accounts from home, what we heard from those we have the honor to represent. and i think this is exactly what's appropriate at the beginning of this work period. mr. president and colleagues, i've just come off eight open-to-all town hall meetings in my home state of oregon. five were in counties won by president trump. three were in counties won by hillary clinton. and the single unifying issue that dominated each one is that trumpcare is a loser. and across the political spectrum -- democrats, republicans, liberals and conservatives -- what i was told is that congress ought to set this trumpcare bill aside. but mitch mcconnell has been working, and it ought to be dropped. and after it's dropped, democrats and republicans ought to get together and look for the common ground by trying to show some common sense. and so i'm going to spend a little time talking about what i heard and what people are concerned about and then just iefly talk about, as senator murray said, what we would like to do if our colleagues on the other side of the aisle will drop this ill-advised our-way-or-the-highway approach, and do what the senate has traditionally done when you're talking about tackling a big issue, which is finding common ground. it doesn't get much bigger than health care. we're spending $3.2 trillion each year now on health care. it comes to something like $10,000 for every man, woman, and child. we're spending enough money. the real question is about whether we spend it in the right place, and this very flawed trumpcare bill will compound that problem. so during those eight town hall meetings over the past week, mr. president, oregonians asked me when is this flawed trumpcare bill coming to a vote. how are my frail, not physically well, older parents supposed to get by if this bill passes and they lose their health coverage? mr. president, as i've talked about with senator murray, we know that medicaid picks up the bill for what amounts to two out of three older people in nursing homes. what often is not mentioned is that it also covers home and community-based services for seniors. and i remember from my days as director of the oregon gray panthers, that the whole goal was to create this continuum of choices for older people. and as senator murray touched on, the older people who need nursing homes and nursing home benefits, i said she's absolutely right, and we need to protect the medicaid guarantee for the seniors for whom care is appropriate in other settings like home and community-based services. now, at those town hall meetings in community centers and auditoriums, folks knew that i was the senior democrat on the senate finance committee. we have another talented member from the committee, senator bennet, here. my knowledgeable from oregon, senator merkley. so i've worked on these issues with respect to taxes and health care for some time. and i've really dedicated my professional life to trying to find that common ground, show common sense in the areas of health care and taxes. but the fact is this version of trumpcare is a tax break for some of the most powerful special interests masquerading as a health plan. and when oregonians heard that, whether it was in trump counties or in clinton counties, everybody started nodding. the secret's out. this is not a plan to fix anybody's health care or hold down the premiums. this is one big handout to the most powerful special interests. and people heard that republicans were saying it's going to create jobs, those tax cuts. not very likely when they made the tax cuts retroactive, mr. president. what this means, that made them retroactive, the big one until january 1, is if you have a capital gain, say, in march, and you pass this bill in its present form, if that capital gain is $1 million, you get a tax break of $38,000. that's not creating jobs, mr. president. it's creating windfalls, and the american people have caught on. now that the senate's back in session, the public is reading about the newest proposal and offer. it's a hail mary pass from senator cruz and republican leaders, trying to put together $50 billion for their version of trumpcare. and we know in the finance committee, they have billions and billions of dollars they can use to try to find those extra votes. i'll tell you, this senator cruz proposal as it relates to health care is a prescription for mayhem in the private health insurance marketplace. and it's going to mean misery for so many americans dealing with illnesses, and forget the talk about bringing costs down. this plan will send health expenses into the stratosphere. the plan tells companies that you're off the hook as far as basic consumer protections. you get to bring back annual and lifetime caps on coverage. mr. president, think about that. in the state of alabama and everywhere else in america under the affordable care act,, the 1660 million people who get their care -- 160 million who get their care through their employer heard about this bill and said, we're home free. it doesn't really affect us, and they got a little extra bonus. the affordable care act gave them a major catastrophic benefit if they had that employer coverage. this republican bill, for all of those folks who thought they were home free with employer coverage, they should know that once again there would be limits on what insurance companies could pay. i'll tell you, for anybody whose listening to this, someby gets cancer, they are going to bust that cap in a hurry. this bill means they are not automatically protected. you can forget about essential health benefits. you get to flood the market with bargain-basement insurance plans as long as you have one option and can price that through the roof. if you pass this bill, the cruz fantasy proposal, it's going to be a tale of two, the young and healthy will get the insurance that won't cover anything, but there are those who can't make it with skimpy insurance that covers nothing but stitches an aroma therapy. there are people who have had a cancer scare or suffered from diabetes or hurt on a ski slope or slip off a ladder, the only coverage for them will come with an astronomical pricetag. the people between 55 and 64 could get charged five times as much as younger people, b, gets fewer tax credited up this republican proposal -- they can't get by with skimpy coverage. a lot of them have really serious health problems, and skimpy coverage for them is just a prescription for trouble. the fact is this new proposal basically starts marching america back to the days when health care was reserved for the healthy and wealthy. and what i'll say is there would be plenty of opportunities for democrats and republicans if this proposal is set aside to find common ground. nobody has said the affordable care act is perfect. what we would do is go to work to stabilize the private insurance market, that would be business number one. weed look at -- we would look at ideas, like senator nelson has just thoughtfully outlined, like reinsurance, and then a special priority of mine, mr. president, is to clamp down on skyrocketing prescription drug prices. and i think there are a number of ideas that are teed up for both sides to come together. it recently put in a bill called the spike bill. what it said is that these big drug companies should have to justify their big price hikes. i don't think that is an extreme position to say they ought to have to publicly justify them, make it part of the public record. we've had, in the last few years, a whole new industry emerge. they represent states and companies and labor unions, and they are supposed to be negotiating a good deal for patients. they are called pharmaceutical benefit managers, but we don't know what they put in their pocket and what they put in our pocket. so i've said -- how about some transparency, folks? sunlight is the best disinfectant. those are the kinds of ideas -- reinsurance, stabilizing the private insurance market, clamping down on prescription drug prices, particularly using the power in the marketplace that both sides ought to be able to get together. so the recess is over but the health care debate is far from over and what i will say in wrapping up, mr. president, is what i told my constituents -- i see my friend, senator merkley here, we have rallies at home. i said, folks, in stopping the mcconnell bill before the july break, you proved that political change in america is not trickle down, it's bottom up. and for weeks before that july break, americans of all ages and political philosophies called and texted and wrote and came to rallies and town meetings and they said this trumpcare bill is a loser for us. it doesn't work. so drop it and move on to approaches that involve common sense, look for common ground, and both sides could support. so it's absolutely vital, mr. president, because the events of the last few weeks have shown the power of the grassroots. i walked through for my constituents what could have happened if two weeks ago the republican leader had brought his bill to the floor. it was in described how the bill could have got through the senate, maybe the house would have stayed it, maybe the house would have passed, maybe the president would have signed it. one of my constituents said that morning that if that had happened and we had lost the a.c.a., even though it's not perfect, that morning we would be in mourning. so let us show today that we can tackle this in a way that the president -- excuse me -- that the senate historically has worked best. let's block the deeply flawed bill and then let's turn around immediately to show that we can come together, find common ground. i see one of our colleagues, the distinguished senator from virginia, who has one of the important reinsurance bills here. we've got a variety of ideas that we can pursue that i think would appeal on both sides of the aisle, but there's a step you have to take before you get on to those commonsense ideas. you've got to stop the flood bill before the united states senate at this point and i would ask the people of this country to continue what they've done over the last few weeks and show political change is bottom up rather than top down. mr. president, i yield the floor. the presiding officer: the senator from colorado. mr. bennet: thank you, mr. president. i thank the senator for his leadership on this bill and on health care over the decades. he knows something about the right way of doing it rather than the wrong way of doing it which is partly why i am on the floor today. i will saying is that i think will be uncontroversial to people at home and maybe news to people here. and that is whether you support the affordable care act or whether you don't support the affordable care act, whether you've been a supporter of obamacare or whether you're a supporter of what is it called obamacare. in general, people are pretty dissatisfied with our health care system at home. in general people are pretty dissatisfied with the rate their insurance goes up. they are pretty dissatisfied with the fact that a lot of people are still uncovered in this country. if they are a senior, they are pretty satisfied -- not just the idea, but with the practice that month after month after month, people have to cut their medicines in half just to get through the month. they are pretty dissatisfied with the fact that when they call an insurance company to make a claim to say, my child was sick, to point out that month after month after month they paid their premiums in only to find that on the day they make that claim there is somebody at that insurance company who has more time than they do to stay on the phone, to keep them on that phone to deny them their claim. they are pretty dissatisfied about that. as a whole, i think the american people are dissatisfied by the fact that we spend 16% of our gross domestic product, our entire economy, on health care when every other industrialized country in the world spends half that or less than half that on health care. this is going to come as news to some people in this chamber, and get better results because we're moving in the wrong direction on too many dimensions when it comes to health care. i said that as a proponent of the affordable care act. spent a year and a half in colorado in certain places being called a socialist, being accused of advocating for a government takeover of our health care system. this was a time when the tea party was very active and people would come assay, quite rightly, read the bill. read the bill. we need to take our government back. and we tried to do some things to help in that bill. we -- we -- we tried to say for the first time in the country's history that it wasn't okay to discriminate against people who were sick, had what is called a preexisting condition when they went to buy health insurance. it wasn't okay, as -- as -- as the senator from oregon said -- it wasn't okay that if you did get sick when you had insurance and you got something like cancer, that an insurance company could just throw you off their rolls because you hit their cap. we said we thought wasn't okay that there were millions of people, many of them children, who didn't have something s. -- access to primary care, that is a doctor to give you a checkup and see how you were doing so that you weren't getting treated in the emergency room, the most expensive, the least intentional way of running a health care system that is imaginable. i would say that is the bulsic way of running a health care system. is that you show up to the emergency room and somebody will take care of you and it gives you the results of that system because you are paying more for less of an outcome. so we tried to address some of those things and that game the affordable care act, that became obamacare, that became something that was politicized for seven years as the house of representatives cynically -- cynically month after month voted to repeal the affordable care act and then they went home to their districts -- the majority of the house -- they went home to their districts and said, we repealed obamacare. we voted to repeal obamacare. well, you didn't repeal it. no, we voted to repeal it. and you send me back there next week and i will do the same thing and i will do it the week after that. some people said, you keep having votes on repealing obamacare, why haven't you actually done it? they said, well, we didn't have the senate. well, they've had the senate an hour for two congresses. they said, well, we didn't have the presidency. well, now we have the same party in the presidency, the senate, and the house of representatives. and this terrible bill that we are considering, which is not a bill that anybody -- that's an exaggeration -- virtually anybody in my state supports or have asked for is what we've got in front of us. now i know somebody else who knew that the american people were dissatisfied with their health care system and that was donald j. trump was when he running for president of the united states. and i hope the people in particular that voted for the president as a way of keeping washington accountable will remember that what he said was that he was going to provide to the american people a, quote, terrific plan to, quote, cover everyone at a fraction of the cost. you know, the president when he was still running -- he still does it -- was very fond talking about -- his words -- how stupid everyone in washington was. he was going to come here and make great deals. he was going to cover everybody, everybody at a fraction of the price with a terrific plan. that's what he promised the american people. that's what he was peddling when he was running for president. he said, quote, you're going to be taken care of much better than you're taken care of now. that's what he said. this isn't fake news. this isn't cnn or "the new york times" or "the wall street journal" or whoever is in the crosshairs. this is what the president said on the campaign trail when he was running because he detected quite rightly that the american people are unhappy with the way our health care system works, unhappy in the richest country of the world to have a health care system where people have to make decisions about their lives and about their children's lives that no one else in the industrialized world has to make about their lives or their children's lives. and they wonder why. and i think the diagnosis has a lot to do with what some people have said which is special interests having a grasp on washington, d.c. but that's what the president said he was going to give to the american people. this is what his properly -- his promise was to the american people. what did we get instead? we have a bill passed by the house that was a massive tax cut for the richest people in america which literally nobody in my town halls in red or blue parts of my state has ever said is something that would help with their health care, not a single person, not a person has said what they want for health care is a massive tax cut for people making more than $250,000 a year. not one, not one person. there's a 25% cut to medicaid in this bill. that -- that's done in the name of i guess reforming entitlements and also the argument has been made, mr. president, that there are a lot of lazy people that are on medicaid. and if you cut medicaid by 25%, they'll go to work and they should go to work. well, two issues with that. and the first is that it's important to understand who's on medicaid. in my state 50% of the people are children. so, mr. president, are they supposed to be at work or can they go to school? then there are a whole bunch of people on medicaid. in fact, it's a very large share of the population of medicaid who have spent their entire life savings down for the privilege of being in a nursing home paid for by medicaid. are they supposed to work? and then, mr. president, there are a lot of people, i'm ashamed to say this, there are a lot of people in this country who are working one job, two jobs and can't make enough money to buy private insurance in the united states of america. that is a shame. do they need to get a third or fourth job before we're saying they're not lazy? or should we fix this health care system so that it's more affordable, more predictable, more transparent for american families. those were the promises the president made. that's the content of the bill with one addition. slipped in between that tax cut and that 25% cut to medicaid which is paying for that tax cut for the wealthiest americans is what my colleague rand paul, a republican from kentucky has described accurately as obamacare like. and he's absolutely right about that. and if you hate obamacare, you will hate obamacare-like because if you're living in a rural part of my state or the country and you already can't afford insurance because there's not a market there and you can't get a subsidy that will help you because you're making too much money, you're going to hate that even more -- and wait until they pass the cruz amendment, which he's calling the freedom amendment. freedom to have to endure something no one else in the industrialized world has to put up with which is buying lousy insurance that doesn't cover anything. you can create the worst product in the world and make it affordable. that's not hard to do. we've come a long way from franklin roosevelt's for freedoms if we're talking about the freedom of insurance companies to be able to throw you off if you've hit the lifetime cap, the freedom not to give you insurance if you've got a preexisting condition. we've come a long, long way. and finally, my colleagues are here so i'm going to stop, but i do want to say one word about the process. the majority leader today announced that he's going to keep the senate in for two weeks in august because they have to finish their work on health care, or maybe it's three weeks in august. i don't care, mr. president, if it's a month. i don't care if they cancel every recess that we have between now and the end of the year. i don't care if we work on weekends if it will create a situation where we can actually improve health care for the american people. i'm glad to stay. in fact, i think we should stay, but unfortunately that's not what he's trying to do. what he's trying to do is jam through a bill that's incredibly unpopular with the american people. that's why until two weeks ago it was a secret. until two tuesdays ago it was a secret. i have to suspect one reason they want to keep us in in august is because they don't want to go home because they were just beaten to death over the july 4th recess because people came out, republican and democrat parts of their state, and said are you out of your minds? this bill has nothing to do with our health care. they probably don't want to repeat that in august. so i'll close just by saying this. and i say this again to the people who came to my town halls and were highly critical of the affordable care act and the process, i want to remind you folks that back then, and the senator from oregon will remember, back then we spent over a year debating that bill here in the congress. we had countless -- somebody could count them up -- but pretty much countless committee hearings in the health, education, labor committee, the finance committee. we had almost 200 amendments that were republican amendments that were adopted as part of that bill. everybody remembers no republican voted for it, but there were 200 republican amendments adopted as part of that bill. we have not had a single committee hearing in the senate about this health care bill, not one. so you can keep us in for two weeks or three weeks longer in august, but a better idea might be to follow the regular order around this place. talk about take our country back. take our government back. maic it work. have hearings -- make it work. have hearings of the have witnesses. i can think a hundred coloradans off the top of my head who would like to come here and testify. i would even say 50 can be republicans and 50 of them can be democrats. have them come testify on what would make health care better for them because that's what this should be about. families all across this country that are struggling because of our health care system and who need relief from this congress and who so far aren't getting it. i'll close just by saying if the president could submit a proposal that actually would meet the criteria that he set out when he was running for president instead of having a bill that he couldn't pass with even 51 republican votes, he'd have a bill he cld pass with a hundred votes he in t senate, and that's what we should strive to do. with that, mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from oregon. mr. merkley: i ask unanimous consent that my intern gloria ramirez have privileges to the floor for the balance of the day. the presiding officer: without objection. mr. merkley: mr. president, let's revisit the recent history. four weeks ago 13 of my republican colleagues were meeting secretly here in this building on a hallway that the press is not allowed in because they didn't want to have the press see them sneaking in and sneaking out of this completely undemocratic process, 13 republican men crafting a health care plan to destroy health came irfor 22 million -- health care for 22 million americans. that's where we were four weeks ago. we made a big deal out of the fact that that's not the way congress is supposed to operate. you're supposed to have committee hearings. you're supposed to have committee debate, invite experts in. you're supposed to have time to consult with your constituents back home but none of that was happening. no. we had the republican zero, zero, zero process. zero committee meetings. how does that compare to more than a hundred committee meetings and roundtables and walk-throughs from eight years ago? zero committee amendments. how does that compare to more than 400 amendments that were considered eight years ago and more than 100 minority amendment, republican amendments that were adopted in this process? and zero exposure of the bill to the folks back home and to the health care stakeholders. but then we had two weeks ago a draft, and we had a chance to circulate that draft and get a few folks from home to weigh in on what it looked like and we got a c.b.o. analysis. yes, it looked a lot like the house bill. house bill was going to eliminate 14 million health care policies in a year. and the senate was going to best that by eliminating health came irfor 15 million americans and 22 million moarns over a ten-year period. so the president had called the house bill mean but we had the even meaner senate bill. well, fortunately we were able to create such a fuss that the majority leader canceled the vote, the vote that was going to take place with zero committee hearings and zero amendments. and that would give my colleagues the opportunity to go home and talk to their constituents. but what happened? well, in the course of this entire year, two thirmds of my republican -- two-thirds of my republican colleagues haven't held a single town hall. and last week when they had a full opportunity to finally take their secret 13 bill, their zero, zero, zero bill and ask their constituents what they thought, they didn't hold town halls. by best count two senators across the aisle held a town hall out of 52. why are my colleagues so terrified of their constituents? is it because wiping out health insurance for struggling americans is a travesty? is it because wiping out health care for working americans is a crime? a crime against decency? is it because their bill proceeds to give $33 billion to the richest 400 americans? no, that's not $33,000 or $33 million. that's $33 billion to the richest 400 americans. more than several hundred thousand billions -- excuse me -- several hundred billion dollars to the richest americans overall. you know, the money that they want to give to the top 400 richest americans would fund health care for more than 700,000 americans under medica medicaid. well, i went home. i went to a lot of places. i went to three cities in what you might call blue oregon. and i went to 13 towns in what can clearly be called red oregon, predominantly republican oregon. i went to towns like echo and helix and adams and sumter and granite. granite with 37 individuals and adams with a population of 348. and i went to larger towns like north powder and baker city and berns and anissa. in six republican towns i held full town halls. and what did i hear? i heard that the top concern was health care because constituents in red america across this country are terrified of the secret 13's bill and all that it involves. what would it do in my home state? 400,000 -- 400,000 oregonians under the oregon health plan would lose their care. at least another 100,000 would lose their care because of the changes to the way the exchange operates. and they've kind of put their minds to work at what the picture looks like from the draft that the republicans were willing to circulate after we applied extensive pressure. and what did we hear? well, we heard that they're really concerned about extinguishes the expansion of medicaid. those are folks really working hard but struggling often in multiple part time jobs. and we heard about the fact that medicaid pays for more than two out of three of the individuals on long-term care in rural america. in fact, i went to one nursing home and what does this medicaid oregon health care pay for two-thirds of their resident ?s they said no. here in klamath falls, it's nearly a hundred percent. now realize, an individual paid for in long-term care under medicaid, they have to have assets less than200,000 -- $200,000. you wipe out care for those 400,000 individuals on the expanded medicaid, many of whom are in long-term care, they have no backup plan. as one woman, deborah, said to me, she said, senator, i'm paid for by medicaid, and if they cut medicaid, i'm out on the street, and that's a problem because i can't walk. that's right. deborah, you are in trouble and so are every other set of individuals who are funded through medicaid and long-term care. what about maternity care? that one out of three voids in rural oregon -- that one out of three individuals in rural oregon are funded through medicaid. children are funded and the disabled are funded. but what do we get as an alternative, now that the republicans are barks having ducked their constituents, but they want a new plan, a new plan to offer? well, they're talking about the cruz plan. now, this is t it's a francis, an insurance company can offer policies that cover nothing as long as they have at least one policy that covers quite a bit u which means the young and the healthy buy the policy that covers almost nothing and then the policy that covers quite a bit that older americans need and those with preexisting conditions becomes incredibly expensive because the group in that pool are people with lots of health care problems and i creates a death spiral insurance. so at the one end of the spectrum you have a pool for policies that cover a lot. at the other end, it covers virtually nothing. it costs $5000 month isn't that wonderful -- until you find out it doesn't cover day in the hospital, it doesn't cover maternity care, it doesn't cover drugs, in fact it doesn't cover anything. why is it a president who's so concern about fake news, so interested in supporting paychecsupporting fakeinsurance- right now i think it is important that we hear from my colleague from virginia, senator tim kaine. because he's also been looking in detail at this bill. he also understands what a devastating consequence trumpcare will have for american health care. can't we come together with a a better vision? can't we come together and make the marketplace work better, restore the reinsurance that's ripped apart the ability of insurance companies to go into new markets? cannot we restore the cost-sharing payments that buy down the preempt, in fact improve them, so there are lower premiums and lower deductibles? can't we come together and do a better job of funding opioid treatment? can't we come together and take on the high cost of drugs in general, which is driving costs in the health care system? just those four things would be something very positive to make our current health care system even better. let's work together to make health care here in the united states of america even better, not tear it down and destroy it as being proposed by my republican colleagues. thank you, mr. president. mr. kaine: mr. president? the presiding officer: the senator virginia. mr. kaine: thank you. i also rise to talk about the health care proposal. i thank all my colleagues who have taken the floor on this. i'll just state at the top a punchline: i will vote for any health care bill that meets president trump's promises. he said his replacement, no one would lose coverage, no one would pay more, no one would get kicked around because of a preexisting condition and he wouldn't cut medicaid. any bill that meets those criteria i'm voting for, but i won't vote for a bill that shatters all these promises, and that's what this current proposal z there's a lot to talk about with the bill, and i just want to talk about one thing, the proposed cuts to medicaid and the h. effectively th effece effect on children. in the current senate proposal which is being adjusted and modified, there is a slashing of medicaid of about $770 million over ten years. if you toad that additional -- if you add to that additional cuts proposed to the president's budget, we're now to $1 trillion of cuts to medicaid. who is it is that receives medicaid? in virginia 60% of those are children. 600,000 young people are medicaid recipients in virginia. if you go to school and you're receiving an individualized education planning because you have a designated disability, medicaid is paying for it. about 50% of childbirths in virginia are paid for by medicaid. if you are a kid that's doing everything right but your family is dysfunctional and a juvenile court judge has to decide, do i keep you with the family or keep put you in a group home, i can send a social worker in your house five days a week shall medicaid pays for that. if you are a child with autism and getting services for autism after school so you can succeed in school, medicaid pays for that. 600,000 children in virginia receive medicaid. we recently had the administration's o.m.b. director, officer of management and budget, mick mulvaney buffs. i asked him about these medicaid cuts. these cuts are catastrophic. how can you say these cuts are a good thing? "we're no longer going to measure compassion by the number of programs or the number of people on programs like medicaid. we're going to measure compassion by the number of people we get off those programs and back in charge of their own lives." so the fill loss fay this drives in is we want to get people off medicaid brand in charge of their own lives. kids -- 600,000 kids. i had a roundtable yesterday in northern virginia and i had five families, parent and child come to talk about what medicaid cuts would mean to them. angie and anna are from haymarket, virginia. she has cerebral palsy and chronic lung disease. in 2014 here developed a condition that caused her to have bo bone breaks in 18 amongsts. nah is in school. ma is in school with a wheelchair that medicaid pays for. anna is in school with some home health that medicaid pays for. medicaid enables this child who has so many needs to go to school so she can be all that she can be. her family has tricare through the military because the dad in the military because they couldn't make it without medicaid. jen and kaylen from sterling, virginia. she is about 9 and a half. she was dying notioned at age 3 1/2 with a very rare, nonieritted genetic anomaly. the family was able to get her qualified for a medicaid waiver when she was about a year old. this is secondary insurance. the family works. they have private insurance. but it doesn't cover wheelchair, hospital bed, things she needs to succeed. and again this little girl who is 9 1/2 and her mother evidence that she functions on about the range of a 6-month-old, e is able to go to school because medicaid can k. pay for some of this technology. kim and eye sack from ashburn, virginia. eyissacc you his family also private insurance but couldn't get along without commitment of he's the loudoun county school succeeding because of medicaid. another kid in the loudoun county schools, corinne is the mother and dylan is the son. dylan has a neurounusual row muscular disease called spinal muscular astrofee with respiratory distress. he relies on a ventilator. he was in this meeting. the family has private insurance but couldn't succeed without medicaid. and dylan is able to go to school. because of medicaid. and finally a family with richmond, amy, the mom and son declan. he has cerebral palsy. and his medical needs are intense but with medicaid, he's able to get some home nursing help, some machinery@home that -- some machinery at home that helps him succeed. one adopted their child as a foster child, knowing the special needs of this child. this was angie and anna. geez, these parents are the saints of the world. these kids are fighting so hard. they're fighting so hard just to try to develop every talent they have, every capacity they have. but with medicaid cuts, they would be in deep, deep jeopardy. why would we vote for a bill that slashes medicaid to families like these when president trump said we're not going to cut medicaid? why would we vote for a bill that shatters those promises? that takes health insurance away from 20 million people? that increases premiums for seniors? that subjects those with preexisting conditions to being cast in the shadows yet again? that's what this bill would do. i will just conclude -- i had a conclusion written, but i tell you one of my moms yesterday gave me a better conclusion. we had this roundtable, five families, great folks the american academy of pediatricians were there, too. one of the moms after the hearing was over looked at me saying, you know, they kind of picked the wrong group of people to fight with, talking about this bill. and i said, what do you mean by that? wrong group of people fight with? she said parents of kids with disabilities. i still don't get where you're going. and this is what she said to me .from the moment our children ae born, all we do is fight u we fight so that our kids can survive. we fight so that our kids can have as normal a life as possible. we have to fight with hospitals, with insurance companies, we have to fight with school systems, we have to fight with cultural stigmas about people with disabilities. all do you if you are a parent of a child with a disability from the day they are born is fight. if they think we're going to pass a bill to cut medicaid to these kids and their families and we're not going to fight about it, we're not going to stand up and be heard, they have seriously underestimated us. i think we can dot right thing as my completion have said, if we will -- as my colleagues have said, i am on the help committee, the only topic that's been taboo is having a hearing about health. we've had hearings will nominees, the f.d.a. we have not been atloid have a hearing about this -- we have not been atloid have a hearing -- we have not been allowed to have a hearing about this bill. listen to people who are worried about their premium costs, listen to insurance companies, listen to doctors, listen to medical innovators. if we listen, we will get this right. but if we shut a process down, don't allow the public into, don't listen don't, have hearings and rush it through, we will get it wrong. this is the biggest sector of the american economics and it is the most expenditure that anybody ever makes in their life on behalf of the 600,000 children in virginia and the 30 million children in this country who receive medicaid. let's get this right. mr. president, i yield the floor. mr. crapo: mr. president, i have seven requests for committees to meet during today's session of the senate. they have the approval of the majority and minority leaders. the presiding officer: duly noted. mr. crapo: mr. president, i rise today with my colleague senator risch to speak on the nomination of judge david nye to be a u.s. district judge for the federal district of idaho. first let me acknowledge the diligent work of judiciary committee chairman grassley and ranking member feinstein in expediting the confirmation process for judge nye's renomination. i also thank both president obama and president trump for nominating judge nye to the federal bench. it is rare to be nominated by presidents of two different parties, but it is a fitting testament to judge nye's sterling reputation that he has secured that distinction. finally, i appreciate the majority leader giving judge nye the honor of being the first u.s. district judge confirmed by the 115th congress. judge nye is supremely qualified. as a candidate for the federal district court seat, having both a unanimous well-qualified rating from the american bar association and having received approval from the senate judiciary committee without dissent twice in a little less than a year. judge nye has long been read did i to a-- ready to assume this office. a longtime member of idaho's legal community, he has been a law clerk, a practicing lawyer and since 2007 a judge on idah idaho's sixth judicial district court. the court -- this court handles all felony criminal cases, major civil cases and appeals from the magistrate court from six counties throughout the southeast portion of idea hoax -- of idaho. he also served from 2009 to 2012 as the administrative district judge for the idaho sixth district elected by his peers for a three-year term to this position. he is not just a well-respected jurist in idaho. judge nye is heavily involved in the training and orientation of new idaho judges and serves on the idaho supreme court's committees on judicial education and felony sentencing. action on judge nye's nomination is critical and timely. idaho is one of only three states having just two authorized district court judgeships. the nonpartisan judicial conference of the united states judicial conference has declared a judicial emergency for idaho and has recommended in every one of its reports to congress since 2003 that idaho be authorized a third district judge position. and for the past two years, idaho has had a three-judge caseload handled by just one active judge. what is even more challenging is that our lone remaining active judge is already eligible to take senior status since this past march. even with judge nye's confirmation, idaho still needs another u.s. district court judge. today's confirmation or tomorrow's of judge nye is undoubtedly a proud day for the entire nye family, including judge nye's wife and their eight children. knowing that a successful public servant draws so much strength from the family surrounding him or her, i salute their partnership with judge nye in making this important occasion possible. again, i strongly endorse judge nye's nomination and appreciate the senate's confirmation of him. thank you, mr. president. mr. risch: mr. president. the presiding officer: the senator from idaho. mr. risch: mr. president, i want to associate myself with remarks from my distinguished colleague and close personal friend, senator crapo. i join him in urging our fellow senators to quickly confirm judge nye. as pointed out by senator crapo, this will be the first district judge who is confirmed by this congress, and so it should be an honor for judge nye, and i'm sure he views it that way. this has been literally years in the making. as senator crapo pointed out, we have only one active federal judge right now, and he is handling what is essentially a three-judge load. some time ago when this vacancy occurred, senator crapo and i went to work on this. most americans don't understand how this works, but to become a united states district judge, it takes essentially the concurrence of three people. that is, the president of the united states and the two senators from that particular state, be they two republicans, two democrats or one of each, because we have what's called a blue slip process where any one of the three can and do object to a person, and then that person will not be permitted to go forward. in this particular case, we negotiated with the obama white house for literally months and months that turned into years, and we acted, i believe, in good faith on both sides trying to find a person who will be the right fit for idaho, and we again literally vetted well over 50 individuals for this position, and for one reason or another, we were unable to get any of those across the finish line. finally we settled on judge nye, and i shouldn't say settled on him. he had not really applied. after going through the 50 that we vetted and really not getting where we wanted to be, we sought out judge nye and talked with him about it, and went forward on that basis. the white house came along, and before president obama left office, he nominated, pursuant to mine and senator crapo's requests, judge nye. unfortunately, that was just about the time we ran out of time processing judges, and so the election came and went, senator -- excuse me, president trump was nawgd and we started all over -- was inaugurated and we started all over again. i want to personally thank the white house for very quickly renominating judge nye for this position, again at the request of myself and senator crapo. too many states have a shortage of judges, and there is a movement afoot right now to attempt to boost the federal judgeship load, which is in bad need. for instance, in the last seven surveys that the -- that the judicial conference has undertaken, they recommended that idaho get a third judge. senator crapo and my predecessor before me and i think even senator crapo's predecessor before him have also been pushing for this third judge, and we'll continue to do that, and i'm seeing some green sprouts that perhaps will be moving something in that direction. in any event, yesterday, we had the vote on moving forward on his nomination, and that vote was 97-0, which certainly is a testament to judge nye himself. i would urge our fellow senators when we get to this vote, which will be either later today or midday tomorrow, to proceed with the same kind of vote. it was a bipartisan vote on cloture. we hope it will remain a bipartisan vote as we move forward on his confirmation. and with that, i want to thank senator grassley, who is obviously pressed by everyone who has a vacancy, senator mcconnell who has lots and lots of things on his mind these days and is struggling with challenges that come at him from all directions for choosing judge nye at our constant and gentle urging over the recent months and years to move him to the front of the line. i want to personally thank senator mcconnell for doing that. and of course i want to thank my distinguished colleague for his work on the judiciary committee of moving it through the judiciary committee. i think that judge nye will be a person who will make us all proud. certainly we're going to be very happy to have this judgeship filled in idaho and particularly with someone of the quality of judge nye. with that, mr. president, i yield the floor. mr. president, i notice the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: mr. cornyn: mr. president. the presiding officer: the senator from texas. mr. cornyn: mr. president, i ask unanimous consent the quorum call be dispensed with. the presiding officer: without objection. mr. cornyn: mr. president, as we move forward in our efforts to repeal and replace the failed obamacare law, it's worth remembering why this work is so urgent and why it's so important. the affordable care act has left many american families paying far more for health care than they did beforehand, and it's taken away their freedom to choose the doctor that they want or the health plan that they want. and that's of course all contrary to what was promised at the time obamacare was passed back in 2009 and 2010. we all remember what the president said, and none of it is proven to be true in terms of your plan, your doctor, or the cost. in fact, as i have mentioned before, the cost has gone up 105% for people in the individual markets since 2013 alone. 105%. so rather than seeing a $2,500 decrease in the cost of their health coverage, they have seen a $3,000 increase, and the prices continue to go up. it's actually getting worse by the day, which is another reason for the urgency of what we are about. a report from the center for medicare studies -- services, excuse me, c.m.s., released yesterday a study that found that nearly 40% fewer insurers have filed to participate in the obamacare exchanges next year. now, the reason why that's important is because when fewer insurance companies choose to participate and of course consumers have less choice and there is less competition in terms of the quality of service or the price that they charge, but the damage goes far beyond the damage to the doctor-patient relationship and the damage to our pocketbooks when we are told things will cost us less than they -- less and they cost us more. the damage of the affordable care act has literally permeated our entire economy, and it's led to a lot of people losing their jobs along the way. obamacare consists of a number of mandates, government coercion and punishment if you didn't comply with its mandates that forced many americans to buy a product that they would not have bought of their own volition. and in many instances simply could not afford. but if you refused to do it, the government would find you. it punished you. that represents a radical change in the nature and the philosophy, guiding philosophy of this country. this country was founded on the concept of individual freedom, not on big government coercing you to buy something that you don't want and you can't afford, but that's the theory behind obamacare. but in addition to that, for small business owners, it included a penalty for any business that exceeded more than 50 employees who did not provide government-approved health insurance policies. and it cost them at least an additional $70,000 a year in addition to other increases in health care costs. so let's say you were a small business of 50 or so employees. you're sure not going to hire over the cap and subject yourself to the additional $70,000 a year in costs. what you are likely to do is to hire fewer than 50 employees in order to protect yourself from that expense. and that's exactly what happened. i still remember after the affordable care act passed, having lunch in san antonio, texas, with a friend of mine who is an architect, and when i described to him the nature of the employer mandate and its effect, he made it clear to me that he would rather lay off some of his employees to avoid that additional expense under the employer mandate. and in fact that's just what he did. so this is just another bit of evidence about the pernicious impact of the affordable care act. it's not just about premiums. it's not just about deductibles. it's not just about freedom of choice. it's literally been a wet blanket on our economy. this damage reaches across many different sorts of industries. according to a recent study by the mercadis center, an estimated 250,000 jobs nationwide were lost due to this mandate. now that strikes me, frankly, as too small a number, but that's the number that they projected. a quarter of a million people lost their jobs because of this mandate, because small employers were motivated to keep their numbers under the cap in order to avoid the extra expense. but this doesn't even take into account consideration of businesses that were forced to shut their doors altogether. in other words, obamacare was in part premised on this idea that businesses could endlessly absorb additional taxes and new costs and mandates and somehow continue to keep their doors open and do business as usual. but that's not the real world. it also doesn't take into consideration the many businesses it's used to cut the hours of their employees could work instead of firing them. so this is another one of those stealth characteristics of obamacare. so an employer was judged based on the number of full-time employees they had. i remember talking to a restaurant owner in east texas, in tyler, texas, who told me that he had to lay off a single mother who was working as a waitress in his restaurant because he couldn't afford to have her work full time, so he had to put her on part time in order to avoid the penalties associated with obamacare. so what that meant for this single mom is she essentially had to go out and get two jobs in order to fill the gap left by going from full-time work to part-time work. and that's not the only story i can tell you. a small business owner in donna, texas, epitomizes this reality in a letter that was written to me a few weeks ago. this gentleman said that he and his wife, both whom are on medicare -- of course, they're unaffected directly by obamacare because medicare covers people 65 and older, obamacare, people younger than that. while they were left unaffected personally by obamacare's changes, he said he wrote on behalf of his 54 employees. 54 employees. after obamacare went into effect he was faced with a choice. either he could buy his employees expensive health insurance that his business could not afford. or he could pay fines totaling more than $100,000. instead, he made the painful choice to lay off six of his employees in order to remain under the obamacare-imposed threshold. as he pointed out, this meant that more than simply laying off six people. it also meant risking the well-being of each of those families represented by those six people. so small business owners shouldn't be forced to choose tween grong their business and providing jobs or risking their financial livelihood of their entire company and their employees just to satisfy the demands of big government. and even beyond causing layoffs, obamacare effectively ensured that many businesses could not grow and that existing businesses would not hire any more employees. obamacare didn't just lead to a new form of health care coverage, as some have claimed. two-thirds of the small businesses surveyed by the mercadi center report already offered health insurance. so two-thirds of the businesses affected by obamacare already had health care coverage, but that was effectively displaced and replaced by government-approved health care which proved to be far more expensive. so instead of having the choice to shop around for a choice that best met their needs and the needs of their employees, these businesses were forced either to pay the penalty or to pay the piper. that is the federal government, when it comes to these mandates and these demands. it ought to be clear by now, seven years into the implementation into obamacare, that this kind of one-size-fits-all mandate should notten applied to a country of 320 million people especially when it comes to something as personal as health care. each of us are unique human beings. each of our families have our own unique needs and desires and, frankly, we ought to be able to choose the sort of health care coverage that best suits our needs as well as our income and our desire to buy health insurance. some people will want policies that provide purely for catastrophic coverage, that they go to the hospital and maybe they'd prefer to have a savings account using pretax dollars under a health savings account in order to save money in order to pay for their doctors' visits. and they combine that with a high deductible health insurance plan. you can't literally do that under obamacare. but you will be able to do that under the better care act that we will be voting on next week. what we've tried to do is look at the meltdown of obamacare and say we need some emergency measures to take place because of the phenomenon i mentioned earlier where insurance companies were pulling out, people's premiums were going through the roofs, deductibles were so high that they effectively are being denied the benefit of their health insurance. so we need to do something quickly and urgently. and what we are going to do is take measures to stabilize the insurance market, because if insurance companies continue to pull out of insurance markets and deny people a choice or competition or even access to a qualified policy at all, that's going to put people in an impossible situation so the first thing we're going to do is stabilize the marketplace. the second thing we're going to do is repeal the mandates that have made health insurance so unaffordable and restore the freedom to choose the sorts of policies and create a marketplace where people can choose the policies that best suit their needs at a price they can afford. it will literally bring down the cost of what people are charged in order to buy health coverage. and because we understand the importance of protecting families against preexisting condition inclusions we're going to make sure the current law remains in effect that protects people from an exclusion when they change jobs or lose a job based upon a preexisting condition. and then the fourth thing we're going to do in the better care act is we're going to put medicaid on a sustainable growth rate. medicaid is an important program. it provides the health care safety net for the nation. and, unfortunately, it is unsustainable at the current rate of spending. so what we are going to do is over the next ten years we propose to spend $71 billion more than we do today on medicaid. in other words, it's going to continue to grow but at a more controlled and fiscally responsible rate. and we're also going to provide people who have an income between zero and 350%, including those people left out in the event that the medicaid expansion wasn't embraced by their states, in states like texas. people now at 100% of the federal poverty level, up to 138% who are left out because of the fact that texas did not expand medicaid, the able-bodied adults, they're now going to be able to use that tax credit to buy private insurance. and private insurance provides much better access to coverage because right now medicaid pays doctors and hospitals about 50 cents on the dollar when it reimburses them. private insurance pays them much better so it exriewfs -- improves the range of choices available to consumers. so our bill continues to be a work in progress. we've done our best to try to work with everybody who's been willing to work with us to get their ideas and to build -- what we're trying to build is a consensus bill. but the fact of the matter is our friends on the other side of the aisle have simply refused to participate in the process, thus, leaving it up to us to salvage people, to save people, to help people who are currently being hurt by the status quo. so we're going to do our duty. we're going to fulfill our responsibility to our constituents the best we can under these circumstances, recognizing that no bill is ever going to be perfect, but certainly we have to do what we can in order to help people who are being hurt now under the status quo. let me just close by saying that i've heard my friend, the senator from new york, the democratic leader, talk about, well, after this bill, if we are unsuccessful getting this bill passed next week, what he's going to do, he wants to engage a bipartisan negotiation in order to address health care. but what i predict is this. what he's really talking about is a massive multibillion-dollar bailout of insurance companies without any reform. to me, that is a, an exercise that frankly i'm not willing to participate in. i will never support a bailout, a multibillion-dollar bailout of insurance and not be able to reform the system that created the problem in the first place. so i would urge all of our colleagues to work together. bring us your best ideas. work with us. try to figure a way to be constructive in this process and help us to achieve a result. it's not going to be the final result. we will have other opportunities. for example, in the children's health insurance program, which is a bipartisan program that expires by the end of september. we'll have another opportunity to come back hopefully then on a bipartisan basis to do additional things that we were unable to do because of the constraints of the budget reconciliation process and the fact our democratic colleagues simply refused to participate in saving the people from being hurt today by obamacare. but i would just encourage my colleagues not to be lured by the seductive message of our friends across the aisle about doing something bipartisan after this bill is unsuccessful, because they're not interested in changing anything about the structural defects in obamacare. and if all we're going to do is propose to pay insurance companies billions of dollars more in order to bail them out, in order to support the same flawed structural program known as the affordable care act, you can count me out. mr. president, i don't see anybody seeking to speak, so i would suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call: a senator: mr. president. the presiding officer: the senator from maryland. mr. cardin: i ask unanimous consent that the quorum call be dispensed with. the presiding officer: without objection. mr. cardin: mr. president, i take this time to share with my colleagues what -- where i took the opportunity to meet with different groups in regards to the health care debate. i had a town hall meeting this past week at atrium village, which is a senior living place in baltimore county. we had a robust discussion primarily with seniors, but not just for his, on their concern as to whether the changes in the health care law would affect their ability in the medicare system and also as it related to long-term care in medicaid. a little bit earlier than that i had a town hall meeting with one of our local hospitals in which we had a chance to talk to lots -- an open town hall meeting, a lot of people from the community showed up. they expressed their concerns about what would happen with the changes that would happen to health care on coverage and quality coverage. i had a chance to meet with leaders in the faith community as we talked about our responsibility to make sure that shc a right and -- is a right and not a privilege. i met with leaders of the community health centers, park west, in baltimore city, to talk about the impact on the reliability of health centers if the medicaid programs were cut. i had a chance to visit with mosaic which deals with behavioral health in baltimore and they were concerned if we ee limited the benefits of mental health and addiction what impact that would have on care. there was a consistent message in each of the places i met with in regards to whether we would able to maintain coverage. that under the affordable care act we expanded coverage by tens of millions and whether that would be compromised in the legislation considered in the united states senate. we talked about whether there would be a weakness in the benefits that would be covered. i mentioned mental health and addiction and there was a discussion with regards to obstetrics and how it would affect women to the pediatric dental care, which is a particular concern in maryland. they also raised many issues concerning discrimination in health care that was present before the affordable care act and whether these conditions would be returning. a young father told me a story about how his daughter was born prematurely and it was in the -- and was in the neonatal intensive care unit. when his daughter was 4 years old, she had reached her limit and if we would be returning to the predatory type practice that's were present before the affordable car act, whether we would be returning to preexisting conditions oroing that indirectly through what benefits would be covered. that was expressed at several- several- -- several of my health care meetings. i mentioned the concerns that the elderly expressed, the discrimination of the near elderly if we go to a five to one, which those 50 to 60 years of age paying five times more than younger people were paying. the one message i wanted to leave my colleagues -- there was a strong interest that we work together, democrats and republicans, because we all acknowledge that the affordable care act can be made better. we don't want to repeal it. we want to improve it. before we left before the july 4th break, i introduced legislation that deals with some of these issues. the legislation would improve competition by putting the so-called public option in the exchanges so we would know there would be at least one government option without any additional break over private insurance companies to guarantee more competition in the marketplace. i also included in my legislation the deal with, i think, the two major problems that we have under the affordable care act. for some people the insurance premiums are too high. why? well, i asked care first, who is the major health payer in maryland, the uncertainty as to whether president trump will share the cost sharing issues and my legislation makes it clear those funds will be made available as it was anticipated under the affordable care act. i provide predictable subsidies for lower-income families so we can help bring down the costs of premiums in that marketplace and reimpose the reinsurance program so we can spread the risk so insurance companies know they have a more predictable risk when they set their premiums. all of this would make a difference carefirst, said if you do that and enforce the individual mandate we could increase the premium by 50%. i hope to work with democrats and republicans to deal with the problem that has been brought to our attention on higher premiums. and then to deal with health care costs generally. more and more people talk to me about bringing down the costs of prescription drugs. it is outrageous americans pay twice what canadians pay. why don't we have a competitive marketplace, have rebates, and allow for better pricing. my legislation would do that and there is bipartisan support for that. lastly, the deal with more integrated care. i was at mosaic, they have an integrated care model. if you come into their community health center, they'll treat whatever your problems are. they are not going to say, come in one day we'll deal with diabetes and the next day we'll deal with high blood pressure. let's deal with the whole patient. my bottom line is this -- no, i'm not going to support weakening the affordable care act. i'm not going to support legislation that would diminish those who currently have coverage or the quality of their coverage, but let's work together, democrats and republicans, to deal with the real problems of bringing down costs in our health care system. everybody benefits by that. and to make sure there's more competition in our exchanges and that's there better premium support for those who cannot afford their premiums. if we do that, i think we really are carrying out what people in maryland were asking me to do during this recess, and that is, don't go back on the progress we made on the affordable care act. let's build on that and make health care more affordable and deal with more competition on the premium costs. with that, mr. president, i would yield the floor. the presiding officer: the senator from florida. mr. rubio: mr. president, i have, since the year 2014, come to the senate floor on numerous occasions, perhaps more than i had hoped to, to discuss the developing situation in the nation of venezuela. the reason i have taken such an interest is because of the i impact it has first and foremost on my home state of florida. we are blessed in florida and my hometown of miami and south florida to have a vibrant and diverse community of people from across the world and those from the western hemisphere. some of those include people from venezuela. some who live there part of the year and some made it their permanent home. they have contributed greatly to our economy, culture, and to our lives. it is through their eyes that i have witnessed the tragedy that has unfolded in that nation over the last five years. venezuela is one of the richest countries in the world. blessed with natural resources that god has blessed that nation with. the largest crude oil reserves on the planet. it is larger than the united states and canada combined, as an example. educated people -- highly educated people, capable, and a long tradition of democracy. venezuela has one of the oldest traditions of democracy in the western hem hemisphere. this is a tragedy not only for venezuela, it is a tragedy for the hemisphere and ultimately for the world. we look at some of the great causes that the world is facing and think about what they could be contributing. but the last five to ten years, particularly the last five, have largely been taken up by internal strife. my interest at the end of the day of venezuela has never been the removal of power, but the restoration of the democratic order so that the people of venezuela can choose their path forward. if you look at the history of of the western hemisphere. most of the nations inhe western hemisphere were governed by dictators and few in our hemisphere had a role to play in choosing their leaders. today, but for an exception of a handful of places, particularly in cuba, almost all the people in their region get to choose their leaders. that has been the story of venezuela until recently. sometimes they choose leaders that agree with america and sometimes they do not, but they choose their leaders and in the end we know that democracies very rarely start wars because their people do not tolerate it and democracy always seeks stability and prosperity because their people demand it and they get rid of leaders that don't deliver it. our goal, my goal in particular, has consistently been the restoration of the democratic order and the dignity of all people, particularly in venezuela. and so it's sad to see what's happening because i think it's fair to say that the situation today in venezuela is worse than it has been at any point since 2014. we saw about a week ago the horrifying images of armed thugs storming the national domestic the democratically elected national assembly and attacking members of that assembly. it would be equivalent of protesters storming the capitol doors and attacking senators and congressmen. we saw images of uniformed personnel, some of which basically are the equivalent of our capitol police, roughing up the very members of that assembly that they are supposed to be protecting. we have seen the images in the streets of protests, of national guard troops firing on people with tear gas an rubber bullets and in some instances with guns and we've seen these irregular groups going after people on the street and, by the way in fairness, we have seen violence on both sides of it, although the vast majority of people are in the opposition, the enormous majority seek a peaceful resolution to this. any time you put people in the street, chaos happens. if you think do not only about the protesters, but their family on the other side of it. those holding up the shields, they have sisters, brothers, wives, loved ones on the other side of that barricade deeply dividing this proud nation with an incredible history of contributions that it has made. and it's now reached what i believe is a tipping point. later this month, venezuela's government -- i should say executive branch under its current president -- has scheduleled an unconstitutional assembly. it violates the very constitution of the country, not to mention in a the supreme court has already canceled the democratic order, this adds to that. and i just say this with deep sadness is that as that goes forward, i think it fundamentally changes this permanently. i had occasion earlier this morning to speak to the president on this topic for a few minutes. he expressed his continued dissatisfaction with the course of events and i think it should be abundantly clear to everyone that this government in the united states is prepared to take on additional significant measures if, in fact, that constituent assembly moves forward at the end of this month, basically all -- all but admitting to the world what we already know and that is the democratic order in venezuela has ended. i do believe there is still a path forward -- a path forward that doesn't involve vengeance, that involves reconciliation, a bath forward to designed to restore the democratic order. i believe deeply all of my colleagues here in the senate and the congress and that the

Related Keywords

Alabama , United States , Nevada , Alaska , Vermont , Brazil , China , Delaware , California , West Virginia , Klamath Falls , Oregon , Iowa , Togo , Cuba , South Korea , Wallstreet , Colorado , Baltimore , Maryland , Miami , Florida , New York , Canada , Japan , Tampa , North Carolina , Germany , Texas , Baltimore County , Iran , Washington , Kentucky , Loudoun County , Virginia , Indiana , San Antonio , Cincinnati , Ohio , United Kingdom , Maine , Baker City , Idaho , China Sea , Brunei General , Brunei , Petersburg , Sankt Peterburg , Russia , Town Hall , North Korea , Venezuela , Italy , Iowans , Americans , America , Floridians , Nevadans , Korea , Britain , Canadians , Floridian , American , David Nye , Regina Herbert , Mitch Mcconnell , Obama Whitehouse , David C Nye , Brian Michael , Mick Mulvaney ,