Medical Innovation Act of 2015

Mr. President, as we just heard, the House has sent over legislation they have moved through that body that would allow for export of LNG. As we speak, in the Energy and Natural Resources Committee downstairs, the committee is considering a bipartisan LNG measure. Five Republicans and five Democrats are coming together with an LNG export proposal that they have not only worked with the administration on, but the administration is actually carrying out, without the law being in place. Certainly we are getting to a place with our LNG and our natural gas opportunities where there are good, substantive developments being made in our laws and in how we can provide for not only certainty through the regulatory process-- efficiency, expediency--but assurance to the public--to families, to businesses, to manufacturers--that pricing issues will be addressed and the opportunity for jobs in this country is put first and foremost. So I think there is good news going on today.

There is further good news as we begin the glidepath toward passage of the Keystone XL Pipeline. We have had a host of measures come before us in the form of some 35 amendments that we have considered as a body over the course of these several weeks. I think it has been good debate. I think it has been a good process. We are now getting to the final closeout.

Amendment No. 80, as Further Modified

Some very important issues have been raised in this debate. I wish to thank Senator Vitter for bringing the very important issue of revenue sharing to the attention of the Senate. He offered an amendment that has been before us for consideration. He has been very steadfast in ensuring that there is a continued commitment to America's energy security and increasing offshore energy production.

The American energy revolution has provided us with high-paying jobs for millions of workers. It has led to lower gas prices. It has provided a real stimulus to the pocketbooks of just about every American. It is fundamentally changing our role on the international stage, which is so important.

The amendment Senator Vitter has offered to the underlying bill, which would increase access to our offshore energy resources and provide revenue sharing for coastal producing States, is a very important one. Again, I thank him for that.

One of my top priorities as chairman of the Energy and Natural Resources Committee is to help ensure the exploration and the development of Alaska's Outer Continental Shelf--OCS--which holds an estimated 236 billion barrels of offshore oil and 132 trillion cubic feet of offshore natural gas. This is clearly an amazing resource base. It is going to take a while--more than a decade--to develop, but it will provide substantial government revenues for generations to come.

With the benefits that come with this resource development, there are also impacts. There will be impacts both to the State of Alaska and to coastal communities. It will require major investment in new infrastructure, whether it be ports or pipelines or roads. That just comes with this kind of resource production.

I look forward to working with Senator Vitter to address the revenue sharing not only for my State but for the gulf States and other States that host energy development off of their coastline in legislation that the energy committee will consider later this year.

I appreciate the continued support of my colleague from Louisiana and for providing a fair share of the revenue from offshore oil and gas activity to the States that are most affected. His State most clearly has experienced the benefits of offshore activity. I have seen this for myself when I have gone down to visit.

He is also working hard to ensure that others enjoy those benefits as well. Again, we are having a great debate over energy policy. We are seeing many good amendments with ideas that could be included in future bills, and I certainly look forward to working on revenue sharing with my colleagues from Louisiana, Senator Vitter and Senator Cassidy, and with other Members of the Senate as we go forward in this Congress.

I will now yield to my colleague from Louisiana for any comments he may choose to make.

Mr. President, I thank my colleague from Louisiana.

I do think this is an area where those of us from coastal States can sit down together to truly map out a proposal that is fair and equitable, truly taking advantage of the benefits of accessing our offshore resources while recognizing those States that bear the responsibility of these production and development activities should share in some of the benefit there as well. I am looking forward to working with him as well as members of the Energy and Natural Resources Committee.

At this time I ask unanimous consent that the votes on the Barrasso amendment No. 245 and the Cardin amendment No. 124 occur after the disposition of the Udall amendment No. 77, with all other provisions of the previous order remaining in effect, and there be 2 minutes equally divided before the vote on the Daines amendment.

Just for Members' information, we will be prepared very shortly to commence votes. The good news for Members is the list of amendments that we had scheduled prior to the lunchtime has actually been winnowed down somewhat. Some Members, such as we have just seen from the Senator from Louisiana, have chosen to withdraw. We may be in a position to take some by voice. We will be having votes commencing here very quickly. But the good news is there will be fewer than there were when we started out this morning.

Mr. President, we are just about ready to begin our votes. Again, it was a very productive day processing amendments yesterday, and we have some good provisions included in the bill. We were able to adopt by voice the provision of the Senator from Maine to better coordinate energy retrofitting assistance for schools. That was good for us. I think we have been available to reach agreement on several of the measures that will allow the process to go quickly this morning.

I am certainly prepared to yield back any time here so we can commence with the voting, although I want to recognize my ranking member and partner in this weeks-long effort if she wants to make any comments before the vote.

Mr. President, I believe Senator Daines is still in the Energy and Natural Resources Committee so I will attempt to speak on his behalf in support of his amendment.

Reauthorizing the LWCF is something that I have said we plan to take up in the energy committee. We are going to make it a priority. But I agree

the sense-of-the-Senate, in order to ensure that this program can be an effective tool for management structural improvements to the program, is going to be needed.

For example, I know the LWCF has been used to acquire inholdings in existing national parks, our national forests, and wildlife refuges. Acquiring inholdings can improve management. We should do more of these kinds of targeted land acquisitions.

Another structural change I know some are interested in making is setting aside some of the LWCF funding to address the maintenance backlog facing our Federal land management agencies. We have combined maintenance backlogs, as much as $22 billion, according to CRS reports. We have issues. We have to do that.

I will support the Daines amendment.

I ask for the yeas and nays.

I move to reconsider the vote.

Madam President, I would suggest that legislative proposals such as reauthorizing the LWCF should be considered under regular order, beginning with hearings in the Energy and Natural Resources Committee. Obviously, this is an issue in which many of us are interested. We have just had a measure before this which spoke to some of the proposed policy changes that might be considered.

So whether we are seeking to reauthorize permanently or considering different set-asides of funds that come in for different programs, I would like to think we could do it through regular order. But I certainly understand where the Senator from North Carolina is coming from, and I look forward to working with him.

Madam President, I move to reconsider the vote.

Madam President, this amendment is an issue that Congress has considered many times over the past 16 years, but we declined to impose a renewable electricity standard.

We called it several different names. We called it a renewable portfolio standard. Then it moved to renewable electricity standard. It was later rebranded the clean energy standard. Now it is back to the RES. But this latest proposal that 25 percent of electricity supplied by a retail provider be generated by certain renewable resources by 2025 is really no different than the EPA's move to impose a 30-percent reduction in greenhouse gases from existing powerplants by 2030 under this proposed CPP regulation.

I would encourage Members to oppose this amendment.

Further, I would note to colleagues that we are very close to finishing up these amendments. If we move quickly, if we stay on the floor and stick to 10-minute votes, we can finish them all before lunch. I think that would be good, but it is going to require the cooperation of all Members.

With that, I ask for the yeas and nays.

Madam President, this is an amendment Senator Barrasso and Senator Cardin have been working on together. This amendment provides that the Federal Government must consult with the relevant Indian nations before modifying or breaking any trust or treaty obligation. This obligation is already required by Executive order. The Federal Government has been fulfilling its government-to-government consultation responsibilities on the Keystone XL Pipeline project for over 6 years.

I think it is important for colleagues to recognize that this amendment does not create any new law; it is merely an additional guarantee that the Federal Government will live up to its existing obligations to consult with the Indian nations, which is a matter I think we should all be able to agree on.

This is an issue Senator Barrasso has been working on with the Senator from Maryland, and they have indicated that they will accept a voice vote on this amendment.

Amendment No. 245, as Modified

I ask unanimous consent that Barrasso amendment No. 245 be modified with the changes at the desk.

I ask unanimous consent that the 60-vote affirmative threshold be vitiated, and I urge its adoption by voice vote.

Mr. President, we are here today because the Keystone Pipeline border crossing permit has been pending for years. There are no shortcuts at play.

The Booker amendment, drafted as a savings clause, would withhold the approval the bill seeks to confer if there are any new circumstances, new information relevant to environmental concerns. That is the whole point here.

The Keystone administrative record is already thousands of pages long. We have had 6 years of dos and redos. If this amendment is adopted, it begs the question as to whether there will ever be a decision.

I think the obvious strategy of pipeline opponents is to drag out the approval process until everybody gives up on it; everyone walks away. That is certainly not the intent of those of us who support this bipartisan bill. We don't want to see an endless round of further considerations. I think the majority here in the Senate believes it is time to move forward. Let's not have continued delays.

I urge a rejection of this amendment.

I ask for the yeas and nays.

Mr. President, I move to reconsider the vote.

Mr. President, I call for the regular order with respect to the Boxer amendment No. 130.

It is my understanding that Senator Boxer is willing to forgo a rollcall vote, but she would like to speak to her amendment.

I turn to Senator Boxer.

Mr. President, I think it is clear that the good Senator from California and I disagree on whether the Keystone XL Pipeline should proceed. It is apparent that we disagree on the reach of the section on permits as currently in the bill and also, more specifically, the substitute amendment we are discussing.

I am willing to agree that the permits which have already been issued should not be affected. That was the intent of the provision within the substitute. I am going to be voicing my opposition through a loud ``nay'' and would encourage my colleagues to do the same.

With that, I ask for the yeas and nays.

I withdraw my request.

I would suggest that this amendment is designed to further delay this pipeline. It requires that a study be done by all Federal agencies with even a smidgen of review authority to determine whether increased greenhouse gas emissions are likely to contribute to an increase in more extreme weather events. It doesn't specify that the increased greenhouse gases that are under study are only related to the pipeline project. So, for instance, the President's deal to allow an increase in greenhouse gas emissions until 2030--if it caused the impacts listed in this amendment, it would stop the pipeline. That is not what we want to do.

I am going to be urging my colleagues to vote no.

Mr. President, I will be opposing this amendment. I believe it is unnecessary. We already debated and dispensed with this just last week. We voted for the sense of the Senate amendment which called for a loophole within the oilspill liability trust fund to be closed. We set us on a path to work with the House on that. That amendment is now part of this bill.

I thank the Senator from Massachusetts for his support in making sure we did adopt that. I think most of us believe this loophole should be closed, and I am confident that we will close it well before the Keystone XL Pipeline goes into operation.

We have to remember, my friends, that before any oil flows through this pipeline which can be put into the oilspill liability trust fund, it has to be built. That is what this bill before us does. I want to make sure that we address this with the House. We will do so.

I urge a ``no'' vote on this amendment.

Mr. President, I am very pleased that we are at this point after three solid weeks of debate. The Presiding Officer introduced this bill on January 8, 2015, and it is now January 29. After weeks of good, solid debate, we have officially passed our bipartisan bill to approve the Keystone XL Pipeline.

This legislation was not only important to pass so we could add more jobs, have energy security, and good trade relationships with our neighbor in Canada, but also we were able to return to what we call regular order in the Chamber. The Senate has been given the title of the world's most deliberative body. I think it is fair to say that in recent years we have not really worn that title very well. We have not been able to engage in the deliberation and debate that I think Members of the Senate and the public at large expect.

What we have seen over these past few weeks was a return to regular order where a Member is free to call up an amendment, have it debated, and have it fall or succeed based on a process that has been long established in this Chamber. That is a good thing to see.

Boy, did we have our share of ideas. By last count, I believe there were close to 250 amendments that Members had offered from both sides of the aisle. That is a lot of ideas. There was a lot of pent-up demand, if you will, on energy-related legislation.

All in all, we voted on just over 40 amendments. I believe the final count was 41 amendments. We made a lot out of the statement that we have surpassed--with just this one bill in 1 month--all of the recorded votes that we had throughout 2014. In fact, we surpassed it with nearly three times more votes than we had in all of 2014.

Senator Cantwell and I have been here in the well during this last vote, and we have received thanks from Members who said: Thank you for getting us to this point. We appreciate that. Good job.

But I think we all recognize there were some points of very clear tension around here, and that is just part of the process. Fortunately, cooler heads prevailed, and we were able to come back together. We were able to get the process moving forward and keep this bipartisan coalition in tact.

I will just point out to the Members that with the help of the ranking member on the energy committee--with the exception of one night--we did it all during daylight hours. Not to get real personal around here, but we have gotten into a habit in recent years of not taking up votes until just about the dinnertime hour. I don't know about the rest of you, but when I call the family in for dinner, we kind of expect it is dinnertime.

I am pleased that we were able to work with everyone's schedule and move through amendments in a fashion that was reasonable and structured. Yesterday was not exactly convenient with the numbers that we processed, but we did it. So I appreciate the great level of cooperation we have had. It is not easy to start out a new Congress in a new majority as the manager of the first bill brought to the floor, but I had a lot of phenomenal help.

I wish to take a brief moment to thank those who have provided counsel and assistance to us. This is kind of like the Academy Awards for the first bill coming through the Senate.

I would like to recognize my staff on the Energy and Natural Resources Committee who have done a fabulous job with every part of this process: My staff director, Karen Billups, Pat McCormick, Kellie Donnelly, Colin Hayes, Lucy Murfitt, Tristan Abbey, Kate Williams, Robert Dillon, Chelsea Thompson, Chuck Kleeschulte, Cathy Cahill, Chris Kearney, Mike Pawlowski, Chester Carson, Mike Tadeo, Isaac Edwards, Jason Huffnagle, and Brian Hughes, on the Energy and Natural Resources Committee and on my personal staff as well. Our interns on the Energy and Natural Resources Committee, Samin Peirovi and Will Treadwell, also did a great job assisting my staff, including putting together binders, making sure we had the current amendments and the modifications that were in front of them. So they did a great job as well.

I also want to thank the members of the natural resources team in the Senate Office of the Legislative Counsel. These folks are kind of the unsung heroes. These are the ones who helped prepare the more than 240 amendments that were offered to this bill. We never see these folks, but they are churning out amendments as quickly as we can move ideas to them. Gary Endicott, Heather Burnham, Christina Jacquet, Michelle Johnson-Weider, Deanna Edwards, and Heather Lowell.

It is absolutely not possible to do what we did in moving this measure through--or any measure--without recognizing the work our floor staff does for us. I wish to thank Laura Dove and the entire cloakroom staff, including Robert Duncan and Chris Tuck. The Parliamentarians and the clerks really worked hard.

Also I wish to recognize on the Democratic side of the aisle Gary and--everybody has just done a phenomenal job and we so appreciate it.

I truly must say the opportunity to start with this first bill and to be working with my ranking member, Maria Cantwell, on this effort, knowing that she was just getting her staff in line as we moved to this bill--the staff director on the ranking side I don't even think had officially been brought on--and it was full on. They have done extraordinary work, working with us.

I want to recognize Angela Becker-Dippmann and Sam Fowler and all the rest of the team because they were extraordinary.

I also want to recognize Barbara Boxer and her staff as well. There was so much that needed to be coordinated.

I thank my ranking member for her patience, for her partnership, and for really the very good-faith efforts she has made as we have worked to get this bill to a conclusion, and offer a continued gesture of wanting to work together with her. I want her to know that I will be with her this weekend rooting for the Seahawks at the Super Bowl. So yet one more area of her operation, but a grand thanks to my ranking member and my partner on this bill.

With that, I thank the Chair and I yield the floor to Senator Cantwell.

Madam President, I wish to thank the Senator from Washington for her comments. I think it is clear that we have a great deal of work in front of us, but I think we also have a better idea of where some of that common ground may be as a result of the discussions this past month. So I am looking forward to advancing an energy initiative through the committee and, hopefully, through the full process, that will speak to the attributes of affordability, abundance, a clean energy supply, diverse and secure. We have a lot of work to do.

In the comments I made, I thanked a lot of people, but I think it is important to recognize that the Senator from Washington and I would not have been able to do the job we did--managing this bill on the floor, working with other Members, working with staff on the floor and our respective staffs--if there had not been a very clear and a conscious decision that management of what was going to happen on the Senate floor was going to be a little bit different, that there would be an opportunity for debate, and some have described free-wheeling debate. What is free-wheeling debate? I think we have just kind of defined it here with the Keystone XL Pipeline. I don't know whether that is going to be the course for everything going forward, but this was a pledge that the majority leader Senator McConnell made when he became the majority leader. I think we have seen that play out in a process that has been respectful, where at the end of the discussion we can still agree to disagree on the bill itself, but the process that has gotten us through final passage has been one that, again, was respectful and did allow for full and civil discourse. I think that is what the Senate should be all about and I am proud to have been a part of it.

With that, I know my good friend from North Dakota, the prime sponsor of this bill, is waiting to speak and I congratulate him for a phenomenal job. He and his staff--I should have mentioned his staff. Ryan and the others

who have been working behind the Senator from North Dakota have been doing a great job. Senator Hoeven has been articulate, persistent, and really has done a phenomenal job moving this through the process.

I congratulate the Senator from North Dakota, and I yield to him.

The following Senator is necessarily absent: the Senator from Florida (Mr. Rubio).

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Amendment No. 77

The following Senators are necessarily absent: the Senator from Utah (Mr. Lee) and the Senator from Florida (Mr. Rubio).

Madam President, let me say to the Senator from Alaska and the Senator from North Dakota, congratulations, and tell them how much I admire and appreciate their tenacity. The 114th Congress had a lot to prove. Mainly what we had to prove is we weren't like the 113th Congress that was completely dysfunctional, particularly the Senate.

I have to say to our good friend, the Presiding Officer, it wasn't the House. It was the Senate that was dysfunctional. The House passed a lot of legislation that came to die in the Senate because the then- majority leader made the decision he wasn't going to move it. It is a new day in the Senate. While I am sure the bill managers would tell us it wasn't easy, we actually have an accomplishment thanks to the leadership of the Senator from Alaska and the Senator from North Dakota, and thanks to an awful lot of people. That is progress.

I hope the first efforts we have made by being able to pass legislation--hopefully the House will concur, the Senate, and the President--we will have done our job. What the President decides to do is about him doing his job, but we can't fail to do our jobs just because he refuses to do his job.

In fact, when he has announced for seven different pieces of legislation he is going to veto them, the easiest thing for us to do would be to curl up in a fetal position and say we give up, we are not even going try. We haven't done that. Again, I think this is a great accomplishment.

I would say to my friends, the Senator from Alaska, the Senator from North Dakota, and others who have gotten us here today, well done.

President Obama's 2016 Budget

Madam President, I would like to turn to another topic. That seems as though it is a metaphor for life in the Senate. We finished one important piece of legislation, and we turn the page to the next topic. I would like to talk about the budget.

Next Monday the President is expected to release his 2016 budget. Budgets are a time when you talk about and deal with your priorities. This budget will reflect the President's priorities, I am sure. I hope one of those priorities is to put the country on a more sustainable path. But one of the things I am very glad about is that for the first time the President, in a long time, is actually going to propose his budget on time. The President missed so many previous deadlines over the years that people hardly ever notice anymore--but that is good, the President releasing his budget on time.

While I am happy to see he will finally meet his statutory deadline in submitting his annual budget, what I am interested in seeing is what he has in the budget, to see if he is willing to meet the challenges of our day by drafting a serious budget, including realistic priorities. That also means making tough decisions, but that is where budgets are so helpful.

I am an optimistic person, but if the President's State of the Union rhetoric is any indication as to what we will see next week, I am concerned the budget will be loaded with more taxes, more spending, and more debt. That certainly isn't a sustainable path forward for the country, but last year the President's 2015 budget would have raised taxes by more than $1 trillion

and increased our national debt by trillions more and his budget would have never balanced.

I can't think of anything worse during a time of slow economic growth than layering on $1 trillion of additional taxes on the people we are depending upon to create jobs and make the investment to get the economy growing again and get America back to work.

Here is another sort of sleight of hand the President has been using lately. He has been talking a little bit about deficits. Deficits, as we all know, is the difference between the money that comes in and the money that is paid out on an annual basis. The debt is a different topic. That is the long-term debt. Actually, it is the accumulated deficits which represent the biggest challenge.

The President likes to say that, well, the deficit has come down-- which is true--but primarily the reason for that is because of a huge tax increase he embraced a couple of years ago along with the sequester or discretionary spending caps that were in the Budget Control Act of 2011. The combination of higher taxes the President sought and got and the spending restraint that essentially was championed on this side of the aisle resulted in lower annual deficits.

But the fact is we are still spending money we don't have. As the distinguished chairman of the Budget Committee likes to say, we are still overspending. We are still spending money we don't have as long as we have any deficit. But deficits will not hold up for long as a reliable red herring. Factors contributing to lower deficits will soon change. Spending on ObamaCare and other broken entitlements will only ramp up from here. On the President's current trajectory, it is only a matter of time before those annual deficits start building again and adding even more to our national debt.

What the President is hoping is that they will be distracted by his happy talk about lower annual defenses, and we will not pay attention to the looming elephant in the room, which is our national debt which has grown more than $7 trillion in the 6 years he has been in office. More than $1 trillion a year. The national debt is $18 trillion and counting. It is set to explode over the long term.

I realize most of us can't possibly conceive of what $18 trillion is, but if we consider the fact we have 320 million people in America and we have an $18.1 trillion national debt, each one of us--from the oldest American, most senior American, to the baby who was just born-- owes $56,500 in debt.

Earlier this week the Congressional Budget Office released its annual Budget and Economic Outlook which provides an updated economic forecast for the current fiscal year and for 10 subsequent years. According to the Congressional Budget Office, under current law the national debt is expected to grow more than $9 trillion in the next 10 years. The President added $7 trillion during the 6 years he has been in office. If we don't do something quickly, we are on a trajectory to add $9 trillion more over the next 10 years.

The Congressional Budget Office's report also shows that in 5 years the Federal Government will spend more than $500 billion in interest on the debt alone and $827 billion in 10 years.

Here is the ticking timebomb if you think about it. Because of slow economic growth globally, a lot of the Federal Reserve Banks essentially for the United States and other countries have done the best they can to keep interest rates low. In America they are next to zero. All we need to do is look at the return on our savings accounts to see what a meager interest rate is being offered by the bank or credit union on our savings. That is because of Federal Reserve policy. That is true of central banks throughout the world. But inevitably over time those interest rates are unsustainable, so they are going to start ticking back up. When they go from roughly zero to 4 percent or 5 percent, the amount of money we will have to pay on the current $18.1 trillion in debt and on the additional debt that will be added over the next 10 years--unless we get hold of this problem--is going to crowd out our ability to do everything from protecting the most vulnerable in our society through our safety net programs to jeopardizing our national defense which is something we can't outsource to somebody else. This is something only the Federal Government can do.

We had an office holder in Texas a few years ago who talked about the Yellow Pages test. It always resonated with me. She used to say government should not be doing things that we can find in the Yellow Pages because that means the private sector is doing it. But the one thing you won't find in the Yellow Pages is national security, and so our ability to protect our way of life and our future is going to be jeopardized by this debt. That is why Admiral Mullen--former Chairman of the Joint Chiefs of Staff a few years ago--shocked all of us when he was asked ``What is the single largest threat to our national security?'' and he said ``The debt.'' That got a lot of us going to the books trying to figure out what he was talking about, and what he was talking about is what I have been referring to here.

Let me repeat that second part again. In 2025 we will be spending $827 billion in interest on our debt alone. We won't be paying down the principal; we will just be paying interest on the debt by 2025--$827 billion. That would be the third largest line item in the Federal budget, just behind Medicare and Social Security.

The Director of the Congressional Budget Office, Doug Elmendorf, has been testifying on findings from this report. On Tuesday, before the House Budget Committee, Dr. Elmendorf stated that ``such large and growing federal debt would have serious negative consequences.'' He is exactly right. When we have to basically take up available credit to finance our national debt, that leaves less credit available to the private sector to make investments that will actually create jobs. It acts like a wet blanket on economic growth. Nothing but fiscal uncertainty and crisis will come from our debt continuing to spiral out of control.

The bottom line is this: Under President Obama the Federal Government has spent the past several years raising taxes. It has increased regulations. It is driving our national debt to unprecedented levels, and we have a growth rate which reflects that.

I know the President was celebrating. He was almost spiking the football at the State of the Union, saying: Well, we had a 5-percent spurt of growth in the gross domestic product last quarter.

Well, that is great, but all of the projections show that for the next year, because of all of the factors I have mentioned, growth is going to continue to bounce along the bottom at a rate of roughly 2 to 2.2 percent. That is not enough growth to get the economy moving again to create the jobs to create the prosperity and lift our economy needs to get Americans back to work.

In my opinion, the President's policies over the last year have actually made it more difficult for businesses to hire workers and for families to plan for the future. I would argue that his policies have introduced enormous uncertainty into our health care system, our tax system, and our financial system.

What our country needs now is the same thing which we have needed all along but which we haven't had over the past 6 years. We need genuine Presidential leadership, the type of leadership that is required to restore Americans' confidence in the future and to ensure better opportunities for the next generations and beyond. We don't need Presidential leadership that leads us into more debt, less opportunity, and a more dismal future.

It is my hope that the President's budget will be exactly what it should be and exactly what the American people deserve; that is, a responsible blueprint for robust, economic growth. There are not a lot of problems that face our country that couldn't be addressed in large part by robust economic growth. Our economy would grow. Revenues to the Federal Treasury would grow, thus reducing our deficits and giving us a better opportunity to address our debt. More Americans would be working again instead of the lowest percentage of people in the workforce in the past 30 years. That is what they call the labor participation rate.

I hope the President's budget will get behind some of these progrowth policies, such as progrowth tax reform--something we are eager to work with

the President on--and support serious efforts to save Social Security and Medicare. The dirty little secret in Washington is that if we don't do anything to save Medicare and Social Security, they are going to fall off the fiscal cliff. So doing nothing is not an option, but we need a bipartisan commitment to save Social Security and Medicare.

I hope the President's budget will be a balanced one and finally offer a long-term plan for controlling our national debt. If it is not, well, we are not going to depend on the President alone; we are going to do our job in the Senate and the House and pass a responsible budget. If the President does not propose one, we will show the American people what one looks like because we cannot let the President continue to lead us down this path of unsustainable debt and a darker future for American people.

Madam President, I ask unanimous consent that I take a few minutes to debate the next amendment and save a little bit of time at the end by withdrawing the amendment.

Madam President, as we consider both the Barrasso and Cardin amendments, I wish to remind my colleagues of the unique history the United States has with Indian nations. This history includes over 300

treaties that were negotiated with individual tribes and nations which remain in effect today.

For over two centuries our Nation disregarded the concerns of tribal nations with respect to expansion and development that affected their communities. This often included abrogating treaty rights and disregarding trust obligations this country has to Indian nations and individual Indians. But this is no longer how we work with Indian nations in our country. We now have laws and Executive orders requiring deliberate and meaningful consultation on any actions taken by the Federal Government that affect tribal interests. We have also signed on to the United Nations Declaration Rights of Indigenous Peoples, which states that the rights of indigenous peoples cannot be abrogated without their free and informed consent.

I want to make it crystal clear that nothing in this bill is meant to abrogate the rights of any Indian nation or any individual Indian. So while I believe we could say more to affirm these policies in this bill, I am happy that at a minimum, Senator Barrasso's amendment guarantees that Indian nations continue to have a voice through meaningful consultation on this project.

It has been necessary to have this discussion because the Great Plains Tribal Chairman's Association does not believe that the consultation required is occurring with respect to KXL. It is helpful to remind the executive branch agencies involved in this process just what their obligations are. I would like to quote from a letter the association recently sent to Interior Secretary Jewell, which states in part:

As our Trustee, DOI has a specific duty to insure that its

comments and positions on this National Interest

Determination accurately reflect the very real potential

impacts that this Project may have on our historical Tribal

homelands, sacred sites, cultural resources and water rights,

all of which are protected by applicable federal law and our

Treaties with the United States. While many of our Tribes

have submitted comments on this document, the State

Department's unwillingness to sit down with us on a

government to government basis to discuss our concerns has

led us to question whether that Department really respects

our legal roles as elected officials of federally recognized

sovereign tribes. These concerns are so serious that the

Standing Rock Sioux Tribe, the Cheyenne River Sioux Tribe,

the Rosebud Sioux Tribe, and the Yankton Sioux Tribe have all

become party interveners in the South Dakota Public Utility

Commission's proceedings challenging its 2010 action permit

for this project.

Madam Secretary, we know that you have many important

demands on your schedule, but meaningful government to

government consultation, especially on matters of this

importance, is assured to us by President Obama's Tribal

Consultation policy of November 5, 2009, as well as by

Executive Order 13175. President Clinton issued that

Executive Order to ``establish regular and meaningful

consultation and collaboration with tribal officials in the

development of Federal policies that have tribal implications

[and] to strengthen the United States government-to-

government relationship with Indian tribes''. President Obama

re-committed federal agencies to this duty through a

Memorandum for the Heads of Executive Departments and

Agencies issued on November 5, 2009, in which he declared:

``My Administration is committed to regular and meaningful

consultation and collaboration with tribal officials in

policy decisions that have tribal implications including, as

an initial step, through a complete and consistent

implementation of Executive Order 13175''. To prepare final

DOI comments on a document of this magnitude without

affording us the opportunity for a meaningful face to face/

government to government meeting is a flagrant violation of

President Obama's directive in 2009 and of the commitments

President Obama has made to us as recently as last December.

Now, what is meant by the term ``consultation''? When the world community of nations, including the United States, worked with Indigenous Peoples over a 15-year period to develop the United Nations Declaration on the Rights of Indigenous Peoples, they used the consultative standard of ``free, prior and informed consent'' in Article 11, 2: which reads: ``States shall provide redress through effective mechanisms, which may include restitution, developed in conjunction with indigenous peoples, with respect to their cultural, intellectual, religious and spiritual property taken without their free, prior and informed consent or in violation of their laws, traditions and customs.''

This language was necessary because the Federal Government and the States once ran roughshod over the rights of Native peoples and simply took and used land and other property of Native nations and persons, and there was a need to make sure that this would not happen in the future. In the late 1800s and early 1900s, Native peoples were confined to reservations and could not leave without permission of the Federal Indian agent. Even in the 1950s and 1960s, Native delegations to Washington were not supposed to go to Capitol Hill without checking in at the Bureau of Indian Affairs, BIA. Native people tell me that they used to think BIA stood for ``boss Indians around.'' Out of this sorry past have come new policies that give true meaning to the nation-to- nation relationship. Key to this relationship is ongoing consultation that is meaningful and worthy of trust, and agreements that are made are transparent and consensual.

There are many laws mandating consultation with Indian tribes and persons, regarding areas on tribal, individual trust and original lands, among them the American Indian Religious Freedom Act, the Archaeological Resources Protection Act, the Native American Graves Protection & Repatriation Act, and the National Historic Preservation Act. Unless the consultation required under these and other statutes is open and based on informed consent, it is not meaningful and cannot lead to a good end. When we refer to consultation in the modern era, we do not mean some sleight of hand; rather, we intend fair, good faith dealings that honor the high standards of the United States' treaty and trust relationship with the Native peoples.

I will close my remarks simply by including excerpts from just two recent judicial decisions regarding the nature of Federal-tribal consultation. First, from the U.S. District Court for the Southern District of California ruling in the case of Quechan Tribe v. United States Department of the Interior, et al (December 15, 2010), citing the National Historic Preservation Act: ``The consultation requirement is not an empty formality; rather, it `must recognize the government- to-government relationship between the Federal Government and Indian tribes' and is to be `conducted in a manner sensitive to the concerns and needs of the Indian tribe.' ''

Second, from the case of Comanche Nation, et al v. USA, et al (September 23, 2008), involving the Army's failure to consult with the Comanche Nation regarding a sacred place, Medicine Bluff, the U.S. District Court for the Western District of Oklahoma found that the National Historic Protection Act, NHPA:

. . . requires an agency to make a reasonable and good faith

effort to identify historic properties that may be impacted,

and to identify . . . issues in connection with such

potential impact. . . . The reasonable and good faith efforts

requirement extends to consultation with Native American

tribes which may attach religious and cultural significance

to potentially affected property . . . It has been said that,

in a general sense, the NHPA requires agencies to `stop,

look, and listen' before commencing actions which could

impact historic or culturally significant properties. . . .

The evidence submitted during the preliminary injunction

hearing substantially demonstrates Defendants' actions were

contrary to the letter and the spirit of the NHPA and its

implementing regulations. . . . Defendants virtually ignored

the concerns regarding the viewscape up to the Bluffs from

the southern approach. . . . Contrary to the direction of the

Ft. Sill Garrison Commander . . . to `get with the tribes'

about their viewscape issues, that same day the Section 106

letter was sent out without a reference to Medicine Bluffs

and without mentioning the potential impact on viewscapes.

Instead, the details of the TSC project were buried in

technical attachments, and the consulting parties were left

to ferret out for themselves the adverse impact on viewscapes

then known by Defendants to exist. . . . Moreover, the

requirement of good faith consultation suggests that the

consulted Native American tribes would have considered it

important to know, and therefore should have been told, that

the TSC warehouse was the tip of the iceberg regarding plans

to build within the southern approach to the Bluffs. . . . In

reality, the area in question is also slated for construction

of a DRMO facility (which will occupy about 20 acres),

construction of a fire station, and a widening of Randolph

Road on its north side. Had this cumulative impact been

disclosed to the area tribes, their initial reaction may well

have been different. As it was, the Comanche Nation began

complaining in earnest in the fall of 2007 and early 2008.

These protests, asserted after the close of the 30-day

comment period announced in the August 10, 2007 Section 106

letter, were brushed off by defendants as untimely. Having

concluded that they technically complied with the Section 106

process, Defendants decided to proceed with the TSC project

despite the mounting objections from the Comanche Nation. . .

. it has been said that the NHPA requires an agency to `stop,

look and listen' Coliseum Square Ass'n, Inc., 465 F.3d at

225; the evidence in the present case suggests that

Defendants merely paused, glanced, and turned a deaf ear to

warnings of adverse impact. Thus, Defendants' efforts fell

short of the reasonable and good faith efforts required by

the law. Where a plaintiff shows that an agency failed to

comply with the NHPA requirements, injunctive relief may

issue.

The bottom line is that for over two centuries, our Nation disregarded the concerns of tribal nations with respect to projects affecting tribal communities. We now have laws and executive orders requiring deliberate and meaningful consultation on any actions taken by the Federal Government that affect tribal interests. This certainly applies to the Keystone pipeline.

I want to thank Senator Barrasso for working with us on the amendment we just approved that makes it very clear that the consultation obligations must be adhered to. I also want to thank Senator Heinrich, Senator Tester, and Senator Cantwell for their incredible help on this issue so we could get a compromise.

The work that Senator Barrasso and I have done in consultation with other Members, with the amendments that have been filed, to try to find common ground exemplifies what I hope we would do more of here in the Senate: finding common ground.

So I am pleased we were able to adopt the Barrasso amendment.

Amendment No. 124 Withdrawn

With that, I ask unanimous consent to withdraw my amendment.

Madam President, I will be brief, but I would like my colleagues' attention because we have an opportunity today to take a program that functions well, that this body designed, funded from royalties off of exploration of energy, that has never been fully funded at what the statute said we would do, and every so often it comes up for reauthorization. That is sort of stupid.

What this amendment does is it makes permanent the Land and Water Conservation Fund. I say to my friends and colleagues, if you want to change the makeup of the fund--what it does, how it works--that still exists, but let's not have the debate as to whether this is going to continue. Let's continue it permanently, and let's make sure that what they do in their work, where they leverage a few Federal dollars with a lot of private dollars, not to acquire massive amounts of lands or create parks but to put adjoining lands together that stops encroachment on some very sensitive areas--this is a smart investment, and it is an investment we make off of the production of energy in this country.

I urge my colleagues to support amendment No. 92.

I yield the floor.

Mr. President, I am pleased to talk about an issue that as Senator Alexander said is near and dear to my heart; that is, ensuring that America's patients have access to the most cutting-edge medical products in as timely a manner as possible. I look forward to the partnership that Chairman Alexander and I have in what I think is one of the most crucial studies and processes we will go through in this session of Congress.

Many of my colleagues know that holding the National Institutes of Health and the Food and Drug Administration accountable for their work on behalf of America's patients is not a new area of focus for either one of us. After I was first elected to serve in the House of Representatives, I was tasked with modernizing the Food and Drug Administration, a Federal agency that controls 25 cents of every $1 of our economy. This work culminated in the Food and Drug Administration Modernization Act of 1977, FDAMA, a total revamp of that agency.

FDAMA sought to ensure that the FDA had the tools it needed to keep pace with modern scientific advances. We modernized the agency in a way that supported regulating in the least burdensome manner, while ensuring that innovative products would reach patients in as timely a manner as possible. As many of my colleagues remember, these reforms were adopted at a critical point in the fight against the HIV/AIDS epidemic. But while we have made great strides in certain areas, FDAMA's tools haven't been fully leveraged, and the challenges of keeping pace with the cutting-edge technologies have only increased.

Today the timely and predictable review of medical products is key to promoting and protecting the public health, just as it was 18 years ago. But the agency's mission and responsibilities have expanded dramatically over that same period of time. The size and the scope of the FDA as an organization has never been more complex than it is today. By its own admission, FDA has struggled to regulate the most cutting-edge medical products at the same time our understanding of medicine and the ability to target treatments to individualized patients has never been greater. The growth of the agency and its responsibilities presents serious management challenges.

Our report, as the chairman said, entitled ``Innovation for Healthier Americans: Identifying Opportunities for Meaningful Reform to Our Nation's Medical Product Discovery and Development,'' takes a hard look at the current status quo and poses targeted questions that can help inform how we do things better. We need to identify how we can improve our policies to promote more efficient and effective medical product development and review processes to cut down on total time it takes for these lifesaving products to actually reach America's patients.

We have seen how regulatory burden and uncertainty results in innovation going overseas, while America's patients wait for the FDA to catch up. The day-to-day actions and in many cases inaction at the agency has a profound effect on our Nation's patients and our health care.

It also directly impacts our economy, as FDA-regulated products account for about 25 cents of every $1 spent by American consumers. The importance of holding the agency accountable for its actions and inactions--all the way from the frontline reviewers to the Commissioner--has never been more important than now.

This is what the current landscape tells us:

No. 1, it costs too much to bring medical products through the development pipeline to patients. There is no disputing that the costs to bring medical products through the development pipeline have grown over time.

No. 2, as science and technology advance, the discovery and development process takes longer for medical products to make their ways to patients. We need to look at the total real time it takes for medical products to reach a patient, not only the time of FDA review.

In 2004, FDA's Critical Path Report warned that:

Today's revolution in biomedical science has raised new

hope for the prevention, treatment, and cure of severe

illnesses. However, there is a growing concern that many of

the new basic science discoveries made in recent years may

not quickly yield more effective, more affordable, and safe

medical products for patients. This is because the current

medical product development path is becoming increasingly

challenging, inefficient, and costly.

More than a decade later, these challenges continue to confront us. We must find a way to embrace our advances and to cut down on the total time it takes medical products to reach an American patient. Our report asks for feedback, as the chairman said, on how we do that.

No. 3, FDA's responsibilities have grown to include many activities unrelated to the core function of regulating medical devices to advance the public health. Today there are more than 12,000 employees at the Food and Drug Administration. This growth has exacerbated the management challenges of the agency, and the question is, How do we ensure that FDA is equipped to fulfill its mission?

No. 4, the disparity in scientific knowledge at FDA and the fast pace of biological innovation are slowing and in some cases stifling innovation in American medicine. To ensure that medical product innovation continues to benefit America's patients, our report asks how we could better leverage the regulatory science initiatives to ensure that the novel medical products are reaching America's patients in that timely fashion.

No. 5, we know that a working FDA is essential to be continuing biomedical innovation in the United States and maintaining America's global leadership in medical innovation. Therefore, we ask for feedback on how Congress and the FDA can work to align public policy and regulation to support biomedical research as a vibrant and healthy component of the U.S. economy.

We have a unique opportunity this Congress to take a hard look at what is and is not working and advance solutions that will ultimately ensure that the NIH and the FDA serve America's patients better. We have an opportunity to focus on these issues without a crisis demanding action, such as the unfortunate meningitis outbreak in 2012.

The drug and medical device user fee negotiations have not yet begun. I should add that these negotiations should not begin until everyone has the data to inform how well the agency is currently meeting what was agreed to in the last round of negotiations. It makes no sense to me why anyone would rush to engage in a negotiation before they have the data to know what they are getting or what they are currently paying for.

It is my hope that looking at these issues without the pressure of an eminent, expiring, user fee reauthorization will help to facilitate candid dialogue among all stakeholders about where we are, where we need to go on behalf of America's patients.

While we do not have these pressures upon us today, we do bring an urgency to this work because of what is at stake. These issues impact every single one of our constituents and every single American, but they affect not only our patients but our economy and our global competitiveness.

Our goal is simple, to align public policies to support accelerated medical innovation and patient access to medicines and medical technologies, because when we advance innovation, we help America's patients be able to access the most cutting-edge, lifesaving medical devices, and products in as timely a fashion as possible.

We foster and facilitate the next generation of cutting-edge products which, in turn, help to ensure America's continued standing as the world leader of innovation.

This is good for our innovators, it is good for our patients, and it is good for North Carolina.

Dr. Paul Howard of the Manhattan Institute's Center for Medical Progress was right when he pointed out that innovation is not an option, it is a national imperative. Innovation is central to addressing our Nation's unsustainable health care costs. It is also central to improving the treatments, outcomes, and ultimately the quality of life for the American people.

Former FDA Commissioner Andrew von Eschenbach was kind enough to pen the foreword of this report. The chairman has already alluded to some of his statements, but in that foreword he writes:

Government policy can either inhibit or accelerate the next

revolution in science and technology. The time has come to

examine whether our nation has the right public policies in

place to realize the full promise of discovery, development,

and delivery of 21st century medicine.

Toward that end, I really do look forward to working with my good friend Chairman Alexander, with our ranking member, Senator Murray, and with all the members of the HELP Committee as we begin this important process of ensuring that the National Institutes of Health and the Food and Drug Administration work as well as they can for patients today and, more importantly, into the future.

I thank the chairman for the opportunity to work with him on this issue. It won't be an easy road, but it is one we are committed to tackling. I urge those who might have input for the purposes of this study and this initiative to please visit the HELP Web site and submit feedback to [email protected]. I am glad to see we have put that in place.

I say to my colleagues on both sides of the aisle, health care doesn't distinguish between parties. Health care requires us to come together and to put policies in place that drive innovation and drive quality outcomes. If we can do that, we might set a new pathway for how we cure disease, for how we bring down health care costs, and for how Americans look forward to a generation that grows up with less genetically transmitted diseases.

With that, I yield the floor.

I suggest the absence of a quorum.

Mr. President, I ask unanimous consent to speak for up to 15 minutes, and that following me, the Senator from North Carolina be recognized for up to 15 minutes.

Mr. President, I am advised by the highly competent floor staff that Senators Nelson and Collins will be worked in to be able to speak shortly after we have because I know they both are hoping to do that.

Amendments Nos. 67, 98, 103, 174, 102, and 55 Withdrawn

I ask unanimous consent that the following amendments be withdrawn: Sullivan No. 67, Murkowski No. 98, Flake No. 103, Merkley No. 174, Tillis No. 102, and Peters No. 55.

The Senator from North Carolina, Senator Burr, and I are here to speak about an important and exciting development that is about to occur in our Health, Education, Labor, and Pensions Committee. What we are talking about and we will describe in our remarks today is a report entitled ``Innovation for Healthier Americans'' which will launch a bipartisan effort to look at how Congress can help to get cutting-edge treatments, drugs, and devices to America's patients more quickly while still preserving this Nation's gold standard for safety and quality. This report and the actions we hope to take will affect virtually every American.

I am especially glad today to be here with the Senator from North Carolina. While there are a number of Senators on this body who worked hard on these issues--which in our government are usually dealt with by the Food and Drug Administration and by the National Institutes of Health--no one has been more effective, no one has worked harder, and no one has had more foresight and vision on these issues than Richard Burr, the Senator from North Carolina. The report today is substantially his work product, and he will be deeply involved in the next year as we work with Senator Murray, our Democratic friends, and with President Obama to try to bring this to a result.

In 2013, Dr. Francis Collins, Director of the National Institutes of Health, wrote the following:

Drugs exist for only about 250 of the more than 4,400

conditions with defined molecular causes. And it takes far

too long and far too much money to get a new drug into our

medicine cabinets. This is an old problem that cries out for

new and creative solutions.

Since Dr. Collins said that, the number of conditions with defined molecular causes has increased now to about 5,390, yet the number of new drugs approved has not kept pace with these discoveries.

The President of the United States has recognized this problem. In his State of the Union message a few days ago, President Obama said this:

21st century businesses will rely on American science,

technology, research and development. I want the country that

eliminated polio and mapped the human genome to lead a new

era of medicine--one that delivers the right treatment at the

right time. In some patients with cystic fibrosis, this

approach has reversed a disease once thought unstoppable.

The President said:

Tonight, I'm launching a new Precision Medicine Initiative

to bring us closer to curing diseases like cancer and

diabetes--and to give all of us access to the personalized

information we need to keep ourselves and our families

healthier.

Senator Murray and I had breakfast yesterday with Secretary Burwell and talked with her about the President's statement and about Secretary

Burwell's own desire to help implement that initiative.

Today Senator Burr and I released a report titled ``Innovation for Healthier Americans.''

Next, Senator Murray--who is ranking member of the Committee on Health, Education, Labor, and Pensions--and I will start examining the issues in this report and other issues raised in comments, through a bipartisan HELP Committee staff working group.

I emphasize that we are going to be working together, Democrats and Republicans. We are going to be working with Secretary Burwell, we are going to be working with the President of the United States, and we are going to be on a parallel track with the House of Representatives, where Chairman Upton and his team have been working for several months on what they call 21st century cures. In our committee in the Senate we will begin hearings in March.

We are releasing the report today in order to ask for comments. Surely we missed something in the report. If someone who is listening or reading it may have an idea or solution, we would like to know about that. We have opened an email account just to hear from those outside of Washington, DC, that is: [email protected].

Improving medical device and drug development is not a new topic for the HELP Committee. Legislation was passed in 1997 and different legislation was passed in 2012 to try to get at the same goal of speeding delivery of drugs and devices while ensuring they are still safe. Our goal will be to give bipartisan legislation to the President this year.

It is encouraging to have the House, the Senate, and the President working on such an important common goal that affects virtually every American during the same Congress. That greatly increases our likelihood of securing a result.

We want to improve and modernize how drugs and medical devices are discovered, developed, and approved. We will examine the work of the National Institutes of Health, which funds and enables much of the research that leads to medical breakthroughs and the Food and Drug Administration which regulates all the medical products we come in contact with.

As I mentioned, this work will touch the life of almost every single American--from a very ill patient who has run out of treatment options and is counting on the most cutting-edge drug to an active child with asthma who is hoping to run faster and farther with the aid of a new drug.

Today our scientists and researchers are making discoveries at a pace that our development process is not equipped to match. Patients wait while treatments languish in laboratories, going through our drawn out, inefficient, and outrageously expensive development process.

FDA Commissioner Dr. Margaret Hamburg has acknowledged that ``we are left relying on the 20th century approaches for the review, approval and oversight of the treatments and cures of the 21st century.''

There is no time to waste in solving this problem. The mapping of the human genome opened a whole new world of individualized medicine in which a person's genetic makeup can drive the doctor's plan for disease prevention, diagnosis, and treatment.

In the words of Andrew von Eschenbach, the former Commissioner of the FDA and Director of the National Cancer Institute:

We stand on the cusp of a revolution in health care.

Advances in molecular medicine will allow us to develop

powerful new treatments that can cure or even prevent

diseases like Alzheimer's and cancer. Tomorrow's high-tech

cures can also slash health-care costs and eliminate

ineffective treatments. What will it take to realize the

potential of the new medicine?

Today's report is the first step of our initiative. It seeks to answer the questions: What today is driving innovation? What barriers are standing in the way? What can we improve?

The report has five main themes:

No. 1, it costs too much to bring medical products to patients; No. 2, as science and technology advance, the discovery and development process takes too long; No. 3, the Food and Drug Administration's responsibilities have grown to include many unrelated to regulating medical products; No. 4, science outside the FDA is moving at a faster pace than ever; No. 5, an effective FDA is essential to maintain the U.S. leadership in biomedical innovation.

Some of the report's key findings include that complex medical devices approved in the U.S. were available to patients in Europe on average four years earlier than in the U.S., and increased competition for NIH grants may be discouraging researchers from proposing risky projects. Further, the average cost to develop a drug is disputed-some say $1 billion, some say $2 billion, some more-but all agree it is rising, and unpredictable and inconsistent development requirement standards in the FDA review process drive product developers to design clinical trials that are unnecessarily expansive.

Since World War II, the U.S. has dominated the biomedical industry space. Even 20 years ago, studies suggested that the U.S. share of global biomedical research funding was as high as 70-80 percent.

However, from 2007 to 2012, the U.S. share of research and development declined from about 51 percent to 45 percent. While the U.S. continued to lead the world in public sector investment during this time, private sector investment shrank by almost $13 billion and largely reallocated to Asia.

This is a chance to step back and look at where we are and how all the different reauthorizations have added up. We need to ensure that legislative efforts over the last 30 years are helping and not getting in the way of having the best treatment and technology available for the right patient at the right time. Our goal is simple but ambitious-- to work in a bipartisan way with members of the HELP Committee to make sure policies support medical innovation and patient access to important medicines and medical technologies.

I ask unanimous consent to have printed in the Record the copy of the executive summary from the report that Senator Burr and I are releasing today.

I look forward to the remarks from the Senator from North Carolina. As I have said, no Senator has done more on either side of the aisle in this area of helping us think about creative new ways to move treatments, medical devices, and drugs through our safety process into the medicine cabinets and into the hands of patients who desperately need them.

I yield the floor.