Upholding America's Nuclear Commitments Act of 2017

Will the Senator yield for a question?

Mr. President, can I ask the Senator from Connecticut a question?

Thank you very much.

The Senator's charts plainly showed who benefits from the Republican bill that we saw in the House. The CBO, as he pointed out, plainly demonstrates that 23 million Americans will lose healthcare. I have heard him talk about this on other issues--how we as Americans are far more connected than we realize and that while one family might suffer from lack of health insurance--like the folks he talked about in the beginning of his remarks--the reality is that when that child doesn't get the healthcare they deserve, when they don't achieve in life the great potential they might have, others suffer as well. You see this as you travel to European countries. They have vastly more people insured, vastly more investments in childhood education and childhood healthcare.

I am wondering if the Senator can extrapolate for me for a moment that this isn't just about individual families who are vulnerable. It is really all Americans, who suffer when other Americans are not getting the benefit of healthcare in this country.

If I can ask the Senator from Connecticut one more question--that interrelatedness is a part of a larger system. We all benefit from these systems. My colleague mentioned hospitals, and whether it is my family who gets injured and is rushed to a hospital or a wealthy family or a poor family, those hospitals are a critical part of the healthcare system.

I was mayor of a city, and I imagine my experience is similar to that of the Senator from Connecticut. Our hospitals before the Affordable Care Act were having a really difficult time because so many of those costs at the most expensive point--when a disease had become so much more acute--were being pushed into hospital emergency rooms. My State was having a very difficult time with the costs of that charity care. They literally had tough choices. They weren't going to close their doors when somebody went into diabetic shock or someone had an asthma attack or some of those diseases were not treated at an earlier stage.

I am wondering if the Senator can help explain, in terms of Connecticut's perspective, why this has an impact on all of us in terms of the systemic healthcare systems that sustain our communities.

That brings up one more issue, if the Senator will indulge me, because I just visited his State. As I was talking to a lot of his members--being from New Jersey, there might be a small rivalry between our two northeastern States. A couple of folks came up to me and got in my face in a polite and joking way about how our Constitution was formed. They talked about the Connecticut Compromise. As you well know, this was a compromise that allowed our Republic to form, understanding they would have two bodies, the House and Senate. Every State would have two Members representing it. In many ways, the Founders of our country, coming out of this, viewed this body very differently than the other body.

Now, the other body, you served in. I am hoping maybe you can shine some light. I have been here 3\1/2\ years. You had experience as a House Member and as a Senator. You said something some people at home might dismiss as hyperbolic partisanship, but I have been here 3\1/2\ years, and I have seen this body change. What frustrates me is that when I was here for a brief period of time and Democrats were in the majority, I heard Republicans talk about regular order, how urgent regular order is. When we are in charge, we will have regular order. The leader spoke publicly about this thing called ``regular order.'' The House operates on majority rule. Our Founders saw that as a very different body than this, which is in many ways talked about as a different rhythm--a different way of doing things. In fact, one Senator over here can have a lot of power within this system, sometimes to the frustration of folks, to slow things down.

You made the claim about this being broken. This is a perfect example of it--this idea that this would be the body, on such a big issue, that would have a chance to be deliberative and to focus on this. I think you are right. We have seen this body, in the very short period of time I have been here, begin to undermine not just things that happened under the Obama administration but to undermine traditions that go back decades, if not more than a century.

I wonder if, being that State, as I was told, so critical to our Constitution, you could give some light on why you really are substantively, factually saying that this is probably one of the low moments of the Senate in the way that this process is being done.

They might have been born in New Jersey.

I thank Senator Murphy for giving me those few moments.

I wonder if the Chair would recognize me to give a few remarks myself.

Thank you very much, Mr. President.

I want to pick up on that conversation that we were having, in which Senator Murphy laid plain on his charts about larger issues with this bill. I want to get back to the point he was just talking about and that I observed here in the Senate for about 3\1/2\ years, and that is the functioning of this body. I love history. I am one of these guys who doesn't read any fiction any more. I love reading about this country, about its past leaders, about great moments in history.

What is interesting about this body is that, being someone who has the privilege to stand on this floor--quite literally, given to me by the State that I love, New Jersey--I walk on this floor and I feel a sense of history every time I am here. It has been 3\1/2\ years, and it hasn't lost its ``wow'' factor for me that I get to stand on this floor. I have to say that I love my State, and in my campaigning, I don't think the issue that I am New Jersey's first Black Senator came up that much. New Jerseyans wanted to know: Would I come down here and fight for them? I was aware of the history of being the fourth African American popularly elected in the history of this body. I came down here as a student of many of the great moments in time on this floor and many of the records that were set.

I think some of those records are really germane to this moment right now. The longest filibuster on this floor is where one Senator could actually grind the workings of the Senate down to a crawl because of Senate rules and Senate traditions. In this case, it is something I wasn't even alive for, but something that, to me, is frustrating. But it is a moment of history that shows what regular order is. It slows down this body.

A filibuster takes 60 votes to overcome. So here was this moment. It was

actually almost exactly 60 years ago. That was the 1957 Civil Rights Act. It was Strom Thurmond who gave this long filibuster, trying to block something that--yes, indeed--was going to have societal impacts on this country--the 1957 Civil Rights Act. This is one illustration of how, when monumental pieces of legislation come to this floor, the history of this body and the traditions of this body are to slow things down, to have a process, to have rules--especially for things that are so monumental. In this case, it was the 1957 Civil Rights Act-- something on which we look back in the past and say: Wow, it took them a long time to get there, but it demonstrates what this body's rules have been about for a long time.

Let me go with another record that I mentioned earlier tonight, but it shows, again, that when monumental pieces of legislation are coming, this is a body that looks closely, takes its time, is deliberative, and has a time-honored process. That is the other record set by the longest consecutive session in Senate history. It was a debate about truly one of the more important things in our society, which is issues of war and peace. The longest consecutive session in the Senate history of debate and of deliberation--open and public, not just for the Nation to see but for the world to see--was a debate during the First World War about whether to arm merchant ships. It brought about tremendous consternation, tremendous debate, as we did the lead up to the First World War. What is interesting is, if you think about the forming of our country in that debate--again, the Constitutional Convention was public, open, transparent--issues were debated. One of the fundamental reasons for organizing our government was seen as the protection of the American people, the ideals of a common defense, and the public welfare. These were the things, literally, put into the preamble of our Constitution, about what this government is about--that these are the most important ideals. In fact, we herald some of these ideals. They have become part of our civic gospel. Everyone knows when they hear the words ``liberty and justice for all'' that they are part of our civic gospel.

Part of that gospel, as well--in the core center of our country--is that this is a nation about life, liberty, and the pursuit of happiness. As to that word ``life,'' this government, this Republic is affirming the ideals of life. It is only understandable when we are debating epic pieces of legislation that will go to affect the lives of tens of millions of Americans.

I was in the children's hospital today. Families in peril, families in crisis were talking about the lives of their children. I have seen it happen, unfortunately, to neighbors and people of my community. When the lives of their children are at stake or threatened or afflicted with disease, it puts so many things in perspective.

So here we have legislation speeding its way to the Senate floor that goes to the fundamental ideals of this Nation. Will we be a country that has a system of healthcare that affirms life?

When we are talking about records in the Senate, it is no coincidence to me that one of the longest times that there was a consecutive session in Senate history for debate--no coincidence to me--was about war and peace. It was the rush, as some people saw it then, toward war in World War I. What is fascinating is that folks should know that the second longest consecutive session in Senate history was about healthcare. It was in 2010. It was over the Affordable Care Act, a bill that the full Senate spent 25 consecutive days considering, 160 hours. Those 160 hours in session does not include hundreds more hours in committee hearings, in meetings. All that took place in the development of a bill that came to this floor and set a record about being the second longest debate.

It is perfectly justifiable that the bill should have taken so much time, so much focus--that the world's greatest deliberative body would deliberate, would do its job. As for that piece of legislation, don't believe the lie; it wasn't rushed through here. It didn't get the express train through the Senate. It set records for discussion, deliberation, debate, and a process that included comments, input, thoughts, and testimony from Americans across the country--not just red States, not just blue States, but of all Americans. It was justifiable. It was absolutely justifiable.

I wasn't here. I was at home in Newark. I was mayor of the city.

This debate went on and on and on, and it captured the attention of the Nation. It was something I had never seen before and I haven't seen since. The President of the United States then, Barack Obama--this to me was stunning; it caught my attention--was on national TV cameras. Sure, it was C-SPAN--not what I turn to first when I am home relaxing on my couch. But the President of the United States invited Congress in--Republicans, some of the smartest minds. I have served here 3\1/2\ years now. Some of the smartest minds I have met in this country are here in the Senate on the Republican side. He invited the Congress in to discuss and debate with him on live TV healthcare. I don't know if Reagan did that. I don't know if Bill Clinton did that. I can't remember that they did. So here was something that was done fully in the light, vetted, debated, deliberated, discussed in open air.

The hearing numbers are incredible. I have been here 3\1/2\ years, and I have never seen anything like it. In the Senate's so-called HELP Committee--Health, Education, Labor, and Pensions--they held 14 bipartisan roundtables, 13 bipartisan hearings, 20 bipartisan walkthroughs, and they considered 300 amendments. This is the thing I didn't know until I got to the Senate because of all the rhetoric on 24-hour cable news. This wasn't a purely Democratic bill. They actually accepted over 160 amendments from Republicans. The stories I have heard from people on both sides of the aisle is that they were bending over backward trying to pick up one Republican vote, so they incurred and took on amendments that actually shaped the bill, Republican ideas onto this healthcare bill, 160 amendments. But stop, that is only in the HELP Committee.

In the Senate Finance Committee, they held 17 bipartisan roundtables, they held summits and hearings, 13 member meetings and walkthroughs, 38 meetings and negotiations, bipartisan. They held a markup. I have been to lots of markups. I have never seen them last or scarcely can think of times they have lasted for more than a day, but they held, in the Finance Committee, a 7-day markup on the bill. That 7-day markup--talk about records--that 7-day markup was the longest markup on a bill in 20 years. That was the process.

A bill affecting that fundamental American ideal that this Nation-- founded like no other, not a theocracy, not a monarchy. It is the oldest constitutional democracy on the planet Earth that affirmed ideals that put into the ether of Earth, for the first time, this Constitution, talking about life, liberty, and the pursuit of happiness. This healthcare bill involved such debate and discussion and the Nation participated. Policy experts, market experts, medical professionals, health nonprofits, insurers, hospitals, Americans all got to put forward their input, their ideas. Sure, all of them were not accepted, but everything went into the mix.

This should be shocking to the consciousness of all people of good conscience who aren't reflexively partisan, but look at the history of this country, a history that is proud, a history that should be shameful about how things got done in matters of war and peace, in matters of foreign policy and domestic, in matters like integration and civil rights that made it possible for me to stand on the Senate floor. There was a process, and somehow in the last 3\1/2\ years--in the name of what? A vicious brand of partisanship that somehow undercuts not just the voice of Democrats, not just the voice of policy experts, not just the voice of hospital experts, not just the voice of medical professionals--it doesn't just undercut their involvement in the process, but it is an insult to the history and the traditions of this body.

This was not the constitutional intent that something as important as healthcare should be done in a back room where a small handful of Senators are trying to hammer out amongst themselves a piece of legislation that is going to affect tens of millions of Americans and change our economy and change our communities. There is honor in this place that isn't

on TV. There are good folks on both sides of the aisle. I have gotten to know them. I consider folks my friends. I know their hearts. This does not sit well the way this is being handled. I know it.

This is one of those moments of history that somebody just needs to raise their hand and say: You know what. I might even like that bill that comes out of that back room. I may like that bill that was hammered out by 12 Republicans, but this process is wrong. It is an insult to our history. I wouldn't want this done to me.

This is the moment. It is a test. History will look back and see what this body did at this moment in history. I fear we are going to fail the test.

What is even more painful than that, for me, is not just the sadness or the anguish I feel about a body contorting its traditions, breaking its way, what even hurts me more than that is what they are going to be pushing through. We saw it in the House.

Instead of this body coming together--and literally there is agreement on this. All of us believe the Affordable Care Act needs to be improved. I have had it in conversations, formal and informal, that we could build upon the Affordable Care Act. We could correct for its deficiencies, and we could build upon its extraordinary successes.

I see those extraordinary successes in my State. I have Republicans and Democrats who are now fearful about the consequences should a bill like the House Republican healthcare bill be made law. There are folks who fear for their families, fear for their children, who don't want to go back to the Nation we had before, where the No. 1 reason for bankruptcy was not being able to afford your medical bills, where people with preexisting conditions were denied insurance, when mental healthcare wasn't in parity with physical healthcare. I can go through all the things I have seen make a huge difference in New Jersey in communities, rural and urban, for Americans.

I want to highlight some of those right now, some of those questions that people are asking at home about what happens if a bill like the House bill becomes law, if they take that bill here in the Senate and push it through, send it back to the House this bill that subverted process, inclusion and debate and deliberation, and go to that process called reconciliation. There are questions that are being asked.

Here is one: What happens to a mother who is pregnant with, say, her second child who suddenly loses Medicaid coverage? Now, understand, a very large percentage of the children born in the United States of America are born covered by Medicaid, which we already see in this House bill is being gutted, which is the biggest rollback in the safety net in our country in my lifetime and more.

What happens to that mother who is pregnant with her second child and loses her Medicaid coverage and her prenatal care? If she loses her prenatal care along with it, what happens to that American citizen? What happens to that baby?

Well, we know that according to the U.S. Department of Health and Human Services, babies born to mothers who receive no prenatal care are five times more likely to die than those whose mothers did receive prenatal care. Tragically, women without prenatal care are three to four times more likely to suffer maternal mortality--that means dying in childbirth--than women with prenatal care, and these rates significantly increase for women of color.

What happens to the tens of thousands of mothers who may lose access to maternity services, and what happens to the already dismal infant mortality rate and maternal mortality rates in our country if this plan goes through? That is a legitimate question. The data is clear. You restrict access to prenatal care, you endanger children, Americans, and you endanger mothers.

Let's keep asking those questions. What happens to the healthcare worker who works 60 hours a week taking care of others but loses their own healthcare coverage and then is unable to afford getting screened themselves, preventive screenings for cancer--let's say ovarian cancer. What happens to them? We don't have to imagine what happens when millions of Americans forgo preventive screenings. We have factual data on what happens should access to those preventive screenings--like what happened with the House healthcare bill--what would happen.

The American Cancer Society tells us clearly that inadequate health coverage is a barrier to preventive care, early detection, and optimal treatment. They find, for example, that patients with stage II colorectal cancer who have it detected have higher survival rates. In fact, they point out that people with stage II colorectal cancer with adequate health insurance have better survival rates than people with stage I colorectal cancer who have no health coverage. In other words, the American Cancer Society shows that access leads to survival and denial leads to higher rates of death.

A recent cancer study found that ``the number of Americans whose cancers were diagnosed at the earliest stage when it was most likely to be cured increased after ObamaCare went into effect, and more citizens had access to health coverage.'' You take away the expanded coverage that was founded through ObamaCare, you decrease preventive screenings, you decrease early detention and, as indicated by the American Cancer Society, death rates go up.

Another question, in general: What happens to cancer rates in America when these gains are reversed? What happens when these gains are reversed? What happens to the father of two who is diagnosed with a rare cancer who can't afford the additional estimated $82,000? His cancer treatment goes up if this bill, like the Republican House bill, passes. That is what is estimated--$82,000 is what his cancer treatments would go up. What happens when he can't afford that care, when he is forced to choose between his family's home, for example, and treating his cancer?

Well, this is what we know. These are the facts that from 2010 to 2016, personal bankruptcy filings have dropped close to 50 percent in the United States of America. One of the collateral benefits of ObamaCare is there was a 50-percent drop in personal bankruptcy filings, with experts agreeing that the Affordable Care Act played an important role in this significant decrease.

A group of economists has estimated that the House Republican bill would cost the average enrollee more than $1,500 more per year than the current system. This is despite the fact the surveys have found that the majority of Americans have less than $1,000 in savings, with one study finding that 63 percent of Americans don't have the savings to cover a $500 emergency.

Remember what Senator Murphy showed? That is a bill that gives massive tax cuts to the wealthiest of Americans, shifting the cost burden so the average enrollee now under this bill is going to see a $1,500-more-per-year payment when the average American doesn't have the savings to cover about a $500 emergency.

Another question that folks are asking is, What happens to the family whose child with a disability loses their access to home and support services--the physical and speech therapy they receive through Medicaid--if the Republican plan goes forward?

I was in a hospital today with such parents telling me about children who--the only way they got the coverage was because of the expanded Medicaid. Now what happens under the Republican plan? We know that Medicaid is a critical lifeline for people and families with disabilities, providing access to services such as rehabilitative therapy to help children meet developmental goals.

One of the incredible young women, girls, I met today--because of developmental therapy, she went from not being able to walk to now continuing to do the things that her normal teenage peers and her twin sister are able to do.

We know that today, 15 percent of kids are growing up with developmental disabilities. In New Jersey, 1 in 41 children lives with autism. But this plan that was passed in the House threatens to make it more difficult for children with disabilities to receive the care they need, to go to school, and to live healthy lives. Losing coverage could mean the difference between a child with a disability achieving a developmental milestone or falling further behind. Unfortunately, in the Republican bill that passed the House,

that is exactly what will happen if it should become law.

If that bill passes, what will happen to older Americans who qualify for Medicare but still need access to critical health services? We know that insurance companies would likely be allowed to charge older Americans much higher premiums under the Republican plan. Remember, it used to be capped. The cost for older Americans used to be capped. It is now being estimated that Americans between the ages 55 and 64 would pay some of the highest increases. That increase would be $5,200 more per year. Standard & Poor's actually estimated that premiums for a 64- year-old could increase by 30 percent under the Republican bill that passed the House.

The Congressional Budget Office noted in their report on the House Republican health care plan that ``although the agencies expect that the legislation would increase the number of uninsured broadly, the increase would be disproportionately large among older people with lower incomes, particularly people between 50 and 64 years of age with incomes of less than 200 percent of the Federal poverty level.'' Think about that for a second. Executives of insurance companies, pharma companies--the richest will get tax breaks into the hundreds of thousands of dollars, but the poorest folks, the elderly in our community, according to the CBO, would see their costs go up considerably.

The New Jersey Hospital Association noted that ``under current law, a 64-year-old making $26,500 a year will pay an average of $1,700 in annual premiums.'' Under the AHCA--the Republican plan in the House-- that same individual making just above minimum wage will pay, under their plan, between $13,600 and $16,100 in premiums. That is the increase for older Americans, working Americans. That is the increase.

We know that as more older Americans lose their health coverage and in turn enter Medicare in worse health, our entire Medicare system is made weaker and less solvent.

If this bill passes, what happens to older Americans who have already spent their life savings in nursing homes? We know that right now for elder Americans in nursing homes, Medicaid actually covers the cost of two out of three of those individuals.

I will quote from a piece that ran just this past weekend in the New York Times: ``Roughly one in three people now turning 65 will require nursing home care at some point during his or her life.''

Over three-quarters of long stay nursing home residents will eventually be covered by Medicaid.

Many American voters think Medicaid is only for low-income adults and their children, for people who aren't ``like them.'' But Medicaid is not somebody else's insurance; it is an insurance for all of our mothers and fathers and eventually for ourselves.

I continue the quote:

Mr. Trump and the Republicans would lower spending on the

frailest and most vulnerable people in our healthcare system.

They would like most Americans to believe that these cuts

will not affect them, only their ``undeserving neighbors,''

but that hides the truth that draconian cuts to Medicaid

affect all of our families. They are a direct attack on our

elderly or disabled and are dangerous.

I want to wrap up with this concluding thought: We know right now that we are at a turning point in our country, that the process that has made this deliberative body known throughout the land, throughout humanity--that this deliberative body is about to alter its tradition and have a bill that affects tens of millions of Americans done and crafted in a back room without public input and rushed to this floor. That is what the process is right now.

As Martin Luther King said in a speech to the medical community for human rights in 1966, ``Of all the forms of inequality, injustice in health care is the most shocking and inhumane.''

This bill will perpetuate injustice in our Nation. It will further the gulf between the haves and have-nots. But it does not just target the vulnerable, the elderly, the poor; it targets all of us. It targets our character as a country, our highest ideals, the very core of many, if not all, of our States. The least of these. The least of these.

We cannot allow this legislation that will so hurt our country to be crafted in darkness behind closed doors. It subverts a mighty tradition of the world's most deliberative body to be rushed through and cause so much damage to so many Americans and indeed the very soul of our country.

Mr. President, I yield the floor.

Mr. President, pending before the U.S. Senate is the nomination of Mick Mulvaney, a Congressman who is seeking to be the Director of the Office of Management and Budget.

If you were to ask the people of America about the Cabinet positions filled by the President, the one they probably would miss is the Office of Management and Budget. It turns out to be one of the more important positions, but it is not as well known historically as Treasury Secretary, Secretary of State, and Attorney General. It is an important job. It is one of the most consequential jobs because the Director of the Office of Management and Budget is responsible for preparing the President's budget, setting the priorities of the Federal budget, and overseeing the performance of Federal agencies. It is a big and challenging job.

Many other nominees for positions in the Cabinet are well known and have been debated on the floor of the Senate. Today I come to say a few words about the record of this Congressman, Mick Mulvaney, who is seeking this directorship of the Office of Management and Budget. It is a very interesting record.

It is not unusual for Members of the House and the Senate to have unusual positions on issues. I guess each one of us has something we believe intensely that other people question. When it comes to Congressman Mulvaney, there is a long litany of positions he has taken that are far out of the mainstream of either political party. Yet President Donald Trump decided this is the man, this is the person he wanted to head up his budgeting effort. This is the person he wants to set the priorities for spending in the United States of America during his Presidency.

If you look at the record of Mick Mulvaney, you will find that he has had an eagerness to dictate large and draconian cuts across the Federal Government in some of our most important and most cherished programs. Let me tell you about a few that highlight his record in Congress. Each one of these that I will speak to, if advanced by the Director of the Office of Management and Budget, would have far-reaching consequences on families and individuals across the United States, not only in the operation of government but also in the effectiveness of our Federal workforce.

To start with--and this, I think, is the right place to start-- Congressman Mulvaney, who seeks the position of Director of the Office Management and Budget, has repeatedly led efforts to shut down the Federal Government. When Mr. Mulvaney and the Republicans succeeded in shutting down the government for 16 days in 2013, it cost the American economy $20 billion. Do you remember that?

Rush Limbaugh got on his radio show and said: If they shut down the government, no one will even notice.

Guess what, Mr. Limbaugh. They noticed.

All across America, working families paid the price for that foolish political act of shutting down the government. The real cost of the government shutdown is not just measured in dollars. The real cost is in hardships unnecessarily created, hardships for Federal employees who didn't receive their checks on a timely basis, hardships for people struggling to survive in America, who relied on programs like food stamps. We call them SNAP benefits now. They had their food in jeopardy and endangered because Congressman Mulvaney and his friends thought that a display of political power--shutting down the government--was the right recipe for America.

These government shutdowns delayed 2 million Federal workers from receiving their checks, real people with real families to feed. Congressman Mulvaney doesn't seem to care about these real-world consequences of a shutdown. Instead, he called the shutdown of the Federal Government ``good policy.'' Those are his words: ``good policy.''

Then, when we finally reached an agreement to reopen the government, he was one of the few Members of the House to vote against the compromise in reopening the government.

In recent years, he has repeated his calls. He is willing to shut down the government of the United States of America to defund Planned Parenthood. This man wants to craft our national budget, and he would shut down the government over one provision in that budget? That is what he said.

Time and again, he has taken extreme positions on the Federal budget. We have a standing tradition in the House and the Senate. Since not one of us can predict when the next natural disaster is going to occur, we try to help one another.

I have voted for funds during the course of my congressional career for disasters in probably every State in the union. Do you know why? Because I knew the day would come--and it did, several times during my tenure in the House and Senate--when there would be a natural disaster in my State, and we needed a helping hand, emergency disaster assistance. That is a tradition which has been around Congress--I can go back almost centuries to see it in past history.

Listen to what Congressman Mulvaney did. He tried to block emergency disaster assistance to States that desperately needed the help of the Federal Government in their recovery efforts. He offered a poison pill amendment to the Hurricane Sandy relief package that would have required across-the-board cuts in military spending--military spending--to pay for disaster relief from Hurricane Sandy. Then he went further and said: Not just military spending, I want cuts in entitlement programs--Medicare, Medicaid. Let's cut the healthcare assistance for Americans to pay for that disaster. That is his idea of social justice.

Despite President Trump's campaign promises to rebuild the Nation's crumbling infrastructure, Congressman Mick Mulvaney has taken an extraordinary and extreme view. He wants to eliminate Federal funding for transportation projects. He cosponsored a bill that would slash the Federal gas tax. That is how we pay for repairing Federal roads and mass transit across America. He isn't interested in fixing the highway trust fund solvency problems. His solution is to bankrupt it.

This is the man who wants to write the budget for America? His extreme ideology would threaten billions of dollars that my State receives in Federal transportation funds. We put money into the Federal highway trust fund,

too, every time we buy a gallon of gas in Illinois. He would cut back on the resources coming back to my State and others to repair the very roads we drive on.

He has consistently supported across-the-board cuts for the Department of Defense, regardless of those affected. Just a few minutes ago, Senator John McCain, the senior Senator from Arizona, came to the floor to announce that because of Congressman Mulvaney's positions on cuts in the military, he--Senator McCain--would oppose the appointment of Mulvaney as head of OMB. Senator McCain said that it is a rare day when he comes out against a Presidential nominee of his own party. But he thinks Mulvaney's record is worrisome, and I couldn't agree more. The positions that Congressman Mulvaney has taken are reckless and would jeopardize the economic security of working families and put our Nation and economy at risk.

Possibly one of the most troubling positions that Congressman Mulvaney has taken is the fact that he is opposed to the Federal Government spending funds for medical research. Last year when Congress was deliberating how to combat the Zika virus, Representative Mulvaney wrote this on his Facebook page: ``Do we really need government-funded research at all?''

Let's think about that for a moment. Do we really need government- funded medical research in the United States? Do we need the National Institutes of Health, the Department of Defense, and the Veterans' Administration investing in trying to find new cures for diseases?

Government-funded research in the Department of Defense has produced fascinating insights into the biology of breast cancer that have greatly impacted the treatment of that disease and saved lives in America. Look at the revolutionary Department of Defense-funded work that led to the development of the innovative drug Herceptin. Government-funded research, which Congressman Mulvaney does not believe we should do, at the National Institutes of Health has accomplished the following. It has cut the U.S. cancer death rate by 11 percent in women and 19 percent in men. And Congressman Mulvaney says: Do we really need to do that? Is that important? I would guess that his family, like every family in America, has a story to tell about cancer--what it has meant, the devastation it has created, the deaths that have resulted.

But Congressman Mulvaney doesn't get it. He just doesn't understand anything as basic as investing in medical research to save lives. HIV/ AIDS is no longer a death sentence in America. I saw Magic Johnson just a few weeks ago at a farewell party for President Obama. I remembered the day in the House of Representatives when I was told that he had AIDS. We assumed he would die in just a short period of time. But that was over 25 years ago. He has survived because of research that was done at the National Institutes of Health, and he is not alone. There are thousands just like him.

When I was a kid, polio was something every mother and father were frightened of. What in the world was happening? How could your child be infected with polio and end up being crippled for life? Our Republican leader here, Mitch McConnell, went through that in his childhood and has talked about that episode in his life and how devastating it was. He has had a full life since then, but he has overcome the problems of that disease. I remember as a kid in grade school, when they announced that our government research had come up with a vaccine that would protect kids from polio. That, to me, was a breakthrough, and one that I welcomed and our family welcomed.

Congressman Mulvaney questions whether or not medical research should continue, even in the light of the achievements in eradicating polio and small pox and other diseases in our country. These advances didn't just magically happen because of the miracle of the marketplace. They occurred because of sustained taxpayer investment in Federal medical research.

I will tell you this. If he wants to make a referendum in the Senate or the House on medical research a part of his budget debate, I welcome the challenge. I believe that Members of both political parties would stand up for medical research, despite Congressman Mulvaney's extreme positions.

So when someone asks if we really need government-funded medical research, the answer on behalf of cancer patients who are beating the disease, on behalf of HIV/AIDS patients who are living longer and normal lives, on behalf of all those families hoping and praying that some Federal researcher will come up with a breakthrough for Alzheimer's, for autism, or Parkinson's or diabetes--the answer, Congressman Mulvaney, is unequivocally, yes. America needs to invest in medical research. And the fact that you would question it really raises the question of your judgment.

Let me tell you another thing that he is for, which I think is the single most irresponsible budgetary position he has taken. He has been an opponent of raising the country's debt ceiling.

What is the debt ceiling? That is America's mortgage. That is the amount of debt we incur as a nation. It is a mortgage that is incurred for things that we have already spent money on. So when we come and vote for $600 billion for the Department of Defense and the intelligence agencies and we don't have enough money coming in taxes to pay for it, we have to extend America's mortgage to cover it. Congressman Mulvaney says that is the wrong thing to do--extending the debt ceiling of this country. While running for Congress, Congressman Mulvaney, who now wants to manage our Nation's budget, pledged he would never ever vote to raise the country's debt ceiling. He voted against it four different times.

In 2011, when we were just about to breach the debt limit and default on our national debt for the first time in the history of our country, Mulvaney was a leading voice in support of default. He called it a ``fabricated crisis,'' and accused both parties of ``fear mongering.''

I am not sure what is more disturbing--Mr. Mulvaney's willingness to default on our country's obligations, the full faith and credit of the United States, or his lack of appreciation for the devastating economic consequences which would follow. I can tell you what is at risk with that kind of reckless attitude toward our Nation's debt. What is at risk are the savings and investments and retirement accounts of ordinary Americans across the Nation. Mr. Mulvaney may be willing to gamble the full faith and credit of the United States; I am not. Forcing the Federal Government to default on the Nation's debt would harm the economy and affect the government's ability to make payments to Social Security and Medicare recipients, military personnel, veterans, Federal employees, defense contractors, State governments, and to the bondholders of the United States, here and overseas.

We would lose our credibility if Mr. Mulvaney had his way and allowed us to default on our national debt. We should not ever consider confirming an OMB Director who has repeatedly risked the economic security of our Nation to score political, rhetorical points.

Throughout his campaign, President Trump promised to protect Medicare and Social Security and make decisions that would ``benefit American workers and American families.'' That is a quote. However, instead of making good on the promise, President Trump has chosen a man to head the Office of Management and Budget who has led calls for devastating cuts to Federal programs that millions of Americans rely on every day.

Mr. Mulvaney has said he wants to ``end Medicare as we know it,'' and he has called Social Security a ``Ponzi scheme.'' He has called for raising the retirement age for Social Security to 70, from the 67 that it currently is. Well, 3 more years at work may not mean much to a Member of Congress, because we sit down a lot in these comfortable chairs and people bring us things when we need them. But 3 more years of working before you qualify for Social Security means something to a waitress, whose hips and ankles and knees have been bothering her for years, but she has no choice but to get up every morning, go to work, carry those trays, and try to bring enough money home to help a family. It means something to someone who works in a coal mine--I guarantee you that--3 more years at work, exposing yourself to the lung diseases and other things

that might come with the job. It means something to a truckdriver, spending days and nights on the road. It means something to people who have to move freight around. It is the kind of thing that means a lot to ordinary working people. It clearly doesn't mean anything to Congressman Mulvaney. Three more years working, as far as he is concerned, is an acceptable alternative.

He wants to privatize Medicare and turn Medicare back into the loving arms of private health insurance companies, and let's see what seniors end up experiencing. Almost 60 million Americans now rely on Medicare. In Congressman Mulvaney's point of view, the guarantee of Medicare would end. This is the man President Trump has chosen to head the budget for the United States of America. Mulvaney has called repeatedly for cuts to Social Security, Medicare, and Medicaid, including a ``cut, cap, and balance'' budget, which would cut each of these programs by 25 percent. When you say the word Medicaid, people have an image in their mind: Oh, that is health insurance for poor people. And that is generally correct, although it also covers disabled Americans. But do you know who the major recipients of Medicaid are in America? The largest single group of people receiving help from Medicaid are children--children in poor, low-income families who get medical care through Medicaid. The biggest expenditure for Medicaid is not children though. The biggest expenditure is for the elderly Americans who are living largely at institutional settings, in these care homes, nursing homes. Medicaid keeps them in that place with adequate medical care. So now comes Congressman Mulvaney and says: Let's just cut those by 25 percent. There is one good way to reduce Federal spending.

Really? So that means fewer immunizations for children. What does it mean for your mother or your grandmother in the nursing home when it is announced that we don't have enough money to cover the cost to keep her here in a good, safe, positive environment? For Congressman Mulvaney, it is just numbers on paper. For real families across America, it is the reality of life.

Much like our new Secretary of Health and Human Services, Congressman Price, Representative Mulvaney wants to dramatically undermine the Medicare Program for our Nation's seniors. Let's look at what Medicare has meant to our country since it was created in 1965. Before Medicare, only 51 percent of Americans 65 and older had health care coverage. Nearly 30 percent lived in poverty. Today, 98 percent of seniors have health care, and less than 10 percent live below the poverty line. Has Medicare work? You bet it has. It has provided health insurance for seniors, and it has given people dignity and independence in their senior years--something that everyone should value. And, incidentally, the life expectancy of Americans has grown by 5 years since we created Medicare. It is working. Medicare helps seniors, helps their families, and it helps America. But Congressman Mulvaney doesn't get it.

This man has been chosen by President Trump to write the budget of America. Why is Congressman Mulvaney so hell-bent on ending a program like Medicare that 98 percent of our Nation's seniors depend on? Well, I can tell you, if his comments on Medicare scare you, on Medicaid he is even worse. This program, combined with the Children's Health Insurance Program, ensures health coverage for 70 million Americans. One out of every five nationwide depend on Medicaid. It helps low- income families, pregnant women, children, and those with disabilities. Currently, if you qualify for Medicaid, you are guaranteed to get health coverage. Congressman Mulvaney thinks he has a better idea. He wants to change that.

Congressman Mulvaney wants to significantly cut the Federal funding for Medicaid and leave States to fend for themselves when it comes to caring for these 70 million Americans. Faced with less Federal funding, States would be forced to find ways to cut spending and save money. They might start Medicaid waiting lists or impose work requirements or slash benefits. At the end of the day, the result would be catastrophic.

I just spent the last weekend in Southern Illinois. We had a roundtable down there to talk about the impact of the repeal of the Affordable Care Act. These hospital administrators from smalltown hospitals came in to tell me that losing Medicaid reimbursement could force them to dramatically cut their workforce and maybe even face closure. Here is Congressman Mulvaney suggesting: Let's just do that across America. I wonder where he lives. I wonder if there are any small towns or rural areas near him. I wonder if he values those hospitals the way the people living in communities that I represent value them. These are not only lifelines for people who desperately need timely, professional medical care, but they are the source of the best jobs in the community. Congressman Mulvaney could care less: Let's just keep cutting on Medicaid and see what happens.

What will happen will be devastating.

Mr. Mulvaney isn't content with just throwing seniors off Medicare and low-income families off Medicaid. He wants to punish women by taking away their healthcare providers and inserting his own decisions into their medical decisions. Mr. Mulvaney has repeatedly attempted to defund Planned Parenthood health centers, which provide women and men with important cancer screenings, family planning, STD testing, and other important health care services.

The laws of the United States of America provide that not one penny can be given to Planned Parenthood for abortion services--not one penny under the law. Most people, if asked what percentage of the Planned Parenthood budget is actually spent on abortion services would get it wrong. The actual number is 3 percent. Ninety-seven percent of what Planned Parenthood does, in terms of family planning, cancer screening, STD screening, has no relation directly to abortion services, and that is compensated, but abortion services are not under the law. Congressman Mulvaney could care less. He would close down the sources of family planning in small towns and communities around America.

The concerns I have laid out today are just a few that I have about this nomination. The millions of hard-working Americans who believed President Trump's campaign promises, and as a champion for the most vulnerable, deserve far better than Congressman Mulvaney.

There are real problems facing this Nation. Far too many people are struggling, and there is a lot of work to do. We cannot afford to risk our economic recovery, the retirement plans and savings of working Americans, the health of our children, the kind of care we want for our mothers and grandmothers--we cannot afford to risk them by appointing OMB Director Mick Mulvaney.

I have no choice but to oppose Mick Mulvaney's nomination for Director of the Office of Management and Budget.

Mr. President, Mick Mulvaney is a founder of the House Freedom Caucus, which has made repeal of the Affordable Care Act--without a replacement--one of their main causes. This is not about good policy or the real consequences for people around the country. This is about ideology.

Mr. Mulvaney wants to rip health insurance away from nearly 30 million people and deny people the important consumer protections they have come to depend upon. He would once again allow insurers to impose pre-existing condition exclusions and discriminate based on gender and cut off coverage when someone gets sick and needs it most.

His answer to fixing our health care system is ``free-market competition'' and ``crackdown on frivolous lawsuits. Those might make good talking points, but they will not stabilize our insurance market and help people in need.

The Illinois Hospital Association estimates that Republican plans to repeal the Affordable Care Act will result in the loss of up to 95,000 jobs in Illinois--in hospitals, doctor's offices, construction, real estate, and beyond.

Over the last month, I have been going around my State, meeting with hospitals and providers, talking to them about what repeal would mean. They are worried.

You see, Illinois hospitals and health systems generate nearly $90 billion in the State and local economies each year, and 1 in 10 jobs in Illinois is in

health care. Hospitals are vitally important to our State's economy and vitally important to patients in need.

Don't just take my word for it, Franklin Hospital CEO, Jim Johnson told me:

In our community, at the time that the hospital in West

Frankfort closed, we [Franklin Hospital in Benton] managed to

stay open . . . they're just eaten up that they don't have a

hospital anymore. It's incredible what the loss of a hospital

can do to a small community. And I'm down there talking to

those guys every day because naturally I like them to use our

hospital . . . but those conversations, it has just torn this

community apart.

In Illinois and nationwide, rural hospitals would be particularly hurt by Mr. Mulvaney and Republicans' prescription for chaos.

In Illinois, 62 of our 102 counties are rural. We have 51 Critical Access Hospitals, which are the hubs of their communities. Rural hospitals typically are more reliant on Medicaid and Medicare, and have tighter operating margins.

So what has the ACA meant for them? In States that expanded Medicaid, like Illinois, rural hospitals have seen greater financial stability thanks to the decrease in uncompensated care--or charity care--costs.

Thanks to the Affordable Care Act, the uninsured rate in rural communities has dropped by nearly 40 percent. This is not only great for those individuals obtaining insurance, it is also great for the rural hospitals who are now getting paid for the health services they provide.

Community Health & Emergency Services CEO Fred Bernstein told me:

You can look at Cairo as the ghost of the future. Because

there is not much left that we have to lose . . . We've lost

the only grocery store, and the only drug store in Cairo. If

this Affordable Care Act thing isn't resolved and if we go to

block grant in the Medicaid program, there's not going to be

any resolution to those problems down there. We are not going

to be able to stay open. At least 72-74 percent of my

patients depend upon Medicaid . . . Without the expansions of

Medicaid that we've already seen, and without some of the

subsidies that those who can get some insurance will get to

keep that insurance, there's not going to be the ability to

afford any care for most of the people we serve.

Since 2009, the number of rural hospitals in Illinois operating in the red has decreased by 46 percent. Put another way, 16 rural hospitals in Illinois are now on much more solid financial footing thanks to the ACA.

I yield the floor.

Mr. President, I thank my friend from Hawaii for convening us here tonight.

This isn't theoretical. This isn't about numbers. This is about real people. We know them. They exist throughout our States.

I have told this story a few times before on the floor of the Senate. When I think about the progress that has been made over the course of the last 6 years, I think about Betty Burger. Betty is a woman who lives in Meriden, CT. Betty and her husband did everything we asked them to do. They were morally upstanding citizens, contributed to their community, had full employment, raised good kids.

Her husband switched jobs. He switched jobs, and he had a 1-week, maybe a 2-week period of time in between those two jobs. As luck--or lack of it--would have it, during that brief intermission between employment, their son was diagnosed with cancer. The cancer then became a preexisting condition, which meant her husband's new employer would not cover the son as part of a family plan. The cancer progressed and progressed and progressed, and this family, the Burgers, had no means to keep up with the payments.

Their story, unfortunately, is not foreign to folks who have heard from constituents who have gone bankrupt because of healthcare costs. The Burgers lost everything. The Burgers first went through their savings, then they went into their son's college account, then they sold their car, then they sold their house. They lost everything they had trying to make sure they had healthcare for their son simply because he got diagnosed with cancer during the one tiny interim between their family's insurance coverage. That preexisting condition doomed that family. There but for the grace of God--that could be us. That could happen to any one of us.

Yet, today, medical bankruptcy is, frankly, a thing of the past. Why? Well, it is not because healthcare costs any less; it is because we said we are not going to allow insurance companies to deny coverage to someone because they have a cancer diagnosis. In fact, we are not going to allow insurance companies to charge you more just because you are sick. Guess what. People have been able to keep their college savings account. They have been able to keep their car. They have been able to keep their house even if they get sick. That is what this bill has meant. Twenty million more people are insured, yes, but the number of personal bankruptcies in this country has plummeted by 50 percent, almost entirely because there aren't Burgers any longer. There aren't people who had to live through what the Burger family had to live through.

That is what this is about. This is about real people who are going to go through miserable, terrible experiences because of the bill Senate Republicans are just days away from putting onto the floor.

I know my colleagues have covered this exhaustively, but I just want to show visually what CBO says the House bill does.

I know it is in vogue for the President and Republicans to say that ObamaCare is in a death spiral, but that is not what CBO says. CBO says that if you keep the Affordable Healthcare Act and actually implement it rather than undermine it, rather than sabotage it, as the President of the United States is today, the number of people who don't have health insurance will remain fairly stable from 2017 to 2026. It is about 28 million people. But if you enact the American Health Care Act, the bill that passed through the House, that number goes almost immediately from about 26 million up to 40 million. Right about 14 million people lose insurance right off the bat. Like within a heartbeat of passing this bill, about 14 million people will lose insurance, and then, over time, it grows to 51 million people. That is not the affordable healthcare act in a death spiral. That is market stability. This is a death spiral. The death spiral starts upon passage of the act being secretly negotiated today.

I get it that 23 million is kind of a hard number to get your head wrapped around. What does 23 million people really mean? These numbers are so huge. So here is what 23 million people is. It is the entire population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, South Dakota, and let's just throw in West Virginia. That is what 23 million people is. That is a humanitarian catastrophe.

Remember, 23 million people is what you get to at the end of 10 years, but 14 million people lose it right off the bat. There is no way for our healthcare system to provide coverage to 14 million people who had insurance one day and then don't have it the next. By the way, they tend to be the sickest people because that is who is going to lose healthcare first.

Why are we doing this? Why would you choose to inflict this kind of pain on people? Why would you ask to run for Congress in order to put this kind of hurt on the American public?

Here is the answer. I wish this weren't the answer. I wish there were a different answer, but here is the answer. Twenty-three million people lose health insurance, and the cost of that is about $800 billion of money out of the healthcare system. It is not coincidence that that then gets transferred into 650 or so odd-billion dollars in tax breaks for the pharmaceutical companies, the insurance companies, and for really, really rich people. It is not just by accident that it worked out that the amount of money you took from poor people and from middle- class people and from sick people is the exact amount of money you are transferring to the pharmaceutical industry, the insurance industry, and rich people.

Here is another way of looking at it. Here is where the tax cuts go: The lowest quintile, the second quintile, the middle quintile, even the fourth quintile don't get a lot of money out of this tax break. It is the top quintile, the top 20 percent of income earners who get an average tax cut of $2,700.

Here is the big benefit: The top 1 percent of income earners--a $37,000 tax cut out of this bill. The top 1 percent of income earners get a $37,000 tax cut from this bill. Let me say that again: 23 million people lose healthcare so that the top 1 percent of income earners get a $37,000 tax cut. Who runs for Congress to do that? What constituency is asking for the U.S. Congress to pass a bill that takes health insurance from all sorts of working Americans, people who are playing by the rules--people like the Burgers--in order to pass a tax cut for the super wealthy?

I don't know what is happening behind those closed doors. I don't know

exactly what they are talking about, but I am going to guarantee you that it is not fundamentally different than what the House bill did, which is what I am describing here. There are still massive numbers of people losing healthcare, rich people getting a tax cut, and lots of folks getting hurt. Why? Just because Republicans made a political promise to do this.

I know I have other colleagues who want to talk. Let me turn for a moment to this process because the process does matter. The majority is breaking the Senate. They are breaking the Senate. Don't think this will not be how this works if you are in the minority. The fact is, we acknowledge that there is a lot that is still very wrong with the American healthcare system. Our constituents command us to try to make those things better. We would love nothing more than to sit down with the Republicans and try to figure out how we can come together on a path forward to make this healthcare system better. I know you don't believe us, but you didn't even try.

I am not sure we believed you at the beginning of 2009 when you said: We want to help people get insurance. We watched Republicans have control of the Presidency and the House and the time Senate for a long time without a lot of progress being made, but Democrats tried.

Democrats spent a whole year sitting down with the Republicans, trying to figure out if there was common ground--holding committee processes, exhaustive hearings. There were 30 days of Senate debate on the floor. I get it; in the end Republicans didn't support that package. I get that Republicans can lay blame at the feet of Democrats for not crafting something that could win Republican support. I understand how that argument works.

The fact is that when Democrats were in the majority, they tried. They opened up the committee process. They let everyone in the public see the debate we were having. Why? Because it is a big deal.

We are talking about one-fifth to one-sixth of the American economy. If you are talking about reordering that biggest segment of the U.S. economy, if you are talking about millions of people benefiting or losing, that shouldn't happen behind closed doors.

My constituents, even though they are represented by Democrats, have no fewer rights than the citizens of Iowa or the citizens of Texas who are represented by Republicans. Why are my constituents not allowed to see the details of what is about to happen to their lives? Why are only a select group of Americans able to have a voice inside that room? Why are the people of Connecticut going to get 3 minutes to look at this bill once it hits the Senate floor? My constituents are Americans, just as the constituents in Republican States are Americans. They deserve to know what is about to happen to them.

You are breaking the Senate. It will not get put back together that easily. These are tough questions. They are partisan questions, but it doesn't mean there is not an obligation to try to find common ground. If you can't find common ground, don't bury the proceedings behind closed doors where nobody can see it.

People hate this bill. They hate this bill. They hate it in part because they don't trust the process. When they see this balance--tax breaks for pharma, insurance, and rich people--and then losing coverage, they want to know why they lose and why super rich people win, but they can't get answers because it is all happening behind closed doors.

It is not too late. I will just end there. Senator Schatz said it right: It is not too late. My Republican colleagues can reject this and say: Let's start over. Let's sit down and see if there are some Democrats who want to work on stabilizing these exchanges, seeing if there is some middle ground, being able to build a bipartisan consensus when it comes to the future of the healthcare system.

It is not too late. I think you are going hear that consistently from my colleagues this evening.

I yield the floor.

I have yielded the floor, but I will happily engage in a colloquy.

I think we all got a gut punch earlier today. We received news that the young man who just returned from North Korea, after being abused and tortured there, had passed. If you read the statement from his family, it was hard to read. You couldn't help but read that without feeling your heart drop into your stomach. Why? Because this was a young man with such promise ahead of him, who had that future robbed from him.

I didn't know him. My colleague didn't know him. The people in my State who were similarly affected didn't know him, yet they felt something.

I think the reason this bill is so wildly unpopular is that people are going to die. The fact is, if people don't get coverage for addiction, if folks who are mentally ill don't get to see a doctor, they aren't going to survive. Even those who have enough money to be able to pay for the premium increases in this bill--they know there is something a little evil in wanting to do this to people.

As my colleague remarked, even if you are not amongst the 23 million people who lose insurance, the CBO also says your rates are going up because when those people don't get health insurance, they show up somewhere else in the system. They show up at the emergency rooms. They get much more expensive care. That cost gets passed on to the rest of us.

Even if you are lucky enough not to be amongst the 23 million, you are going to be personally, financially affected by this. The CBO says that everyone's rates will go up by 15 to 20 percent. Even if it is not the money you care about, we are all connected, and nobody should want this to happen to people. We are all weaker if we pass a piece of legislation that ends up hurting people in such a real, meaningful, and devastating way.

I think it is important to understand what the law says. The

law says there is only one healthcare provider that by law has to treat every single person who comes in the door; they can't turn away individuals based upon their ability to pay. That is the emergency room.

What we also know is that the emergency room is the place you get the most expensive care. By the time you get there, you are often in crisis. The care you receive in the emergency room is expensive, and then all of the care you need afterward is expensive as well.

I always remember a woman from Connecticut who lost her Medicaid coverage. In losing her Medicaid coverage, she didn't end up being able to see a doctor for an infection she had in her foot. It was hurting her for a long time, that infection. She didn't have Medicaid any longer, so she just decided to let it hurt. She popped some Tylenol and hoped it would go away. One day it was so painful that she went to the emergency room, and it was too late. It was too late. Her foot had become so badly infected that she had to have that foot--that leg below her knee--amputated.

She had no insurance, so we all picked up the cost of that, but she had her life altered in a way that is hard for us to fathom, and there is not a single winner in that scenario because, obviously, her entire life is changed because of that.

It is not as if we had saved any money in treating her so shabbily because we ended up having to cover all of those costs. That is one story. If you think about what the House bill does, it repeats that story millions of times over. It is morally bankrupt, but it is also fiscally imprudent and foolish.

There is, right outside this Chamber, a picture of the authors of the Connecticut Compromise, two of the Connecticut delegates to the Constitutional Convention.

I appreciate that shout out to Connecticut. You are right. The idea of the House is that it is supposed to respond, perhaps, more quickly to the temporary passions of the public, which is ironic, given that the passion of the public today is in deep opposition to this piece of legislation. Unfortunately, the House is responding to the passions of one very small portion of the public, which is the extreme Republican base, which maybe is the only remaining segment of this country that supports the American Health Care Act.

This place is supposed to be able to step back and look at the long term and look at the long view. That is why we have 6-year terms, so we don't do something that may feel good in the moment politically but has devastating impacts over the course of time. That is exactly what this debate is about. It is about a massive reordering of one-fifth of our economy that has just enormous consequences over time, when these people who lose insurance start to feel the effects of that as they bleed through their savings over 5 or 10 years and go bankrupt at the back end of that time period.

So this is a place where both parties should be able to sit down and talk about what this really means for folks. I thought Senator Schatz put it well. When you don't engage in regular order, not only do you do things that are very partisan and political, but you also do things that don't make sense.

One of the things that regular order brings is the ability to talk to experts. We all sit on committees, and those committees bring experts to the table to tell us what the impact of legislation is. There has been no committee process on this bill. We haven't had a single committee meeting. We had one hearing in the HELP committee upon which I sit.

So as Senator Schatz said, the result is a product that is garbage-- that, logistically, does not work because neither the House nor the Senate engaged in the kind of deliberation that would get you to the facts. Yes, this place is supposed to work differently, but also you are supposed to use the committee process to make sure that you are not passing something that just makes sense politically but makes sense from a policy standpoint as well.

Mr. President, I get letters and emails every day from families begging me not to let Republicans in Congress tear up healthcare in this country. People aren't writing because they find themselves with a lot of extra time on their hands. They are not writing because they are professional activists or political organizers. They are not writing because they like writing letters and emails. They are writing because they are scared. They set aside all the other things they need to do in their day--the sink full of dishes, the load of laundry, the overflowing inbox--and they steal some time to write these letters.

They write these letters because they are terrified--terrified down to their bones that if they don't speak out, their family is going to lose their healthcare coverage, their children will be shut out from care, their elderly parents will lose the assistance they need to pay for nursing home care, their own insurance costs will be going up, and their financial security could be hanging by a thread.

A lot of people write letters and send emails, and a lot of people make calls too. Every week since the Republicans started their cruel effort to take away healthcare from tens of millions of people in this country, my office has been getting phone calls from worried constituents.

Last week, something changed. We went from our regular quota of calls about this terrible Republican healthcare bill to an avalanche of voice mails and phones ringing off the hook.

Since last week, I have gotten more than a thousand phone calls from people who are pleading with me to do whatever I can to stop Republicans who are going forward with their brutal plans. People are literally in tears on the phone. They are scared, and they are angry. They are calling because they know that 13 Senate Republicans--13 men-- are locked away in a secret room, behind closed doors, writing a secret plan to trade their health insurance for tax cuts that will go to the wealthiest Americans in this country.

The bill the Republicans are negotiating behind closed doors isn't a healthcare bill. It is a tax cut for billionaires bill, and it is paid for by cutting healthcare for tens of millions of other Americans.

The Republican healthcare bill has $663 billion in tax cuts in it-- $663 billion in tax cuts for the richest people in this country and for wealthy corporations, tax cuts that would blow a giant hole in the American budget.

The Republicans didn't let that slow them down. They kept their eye on the prize. For the Republicans, the most important thing about this healthcare bill is the tax cuts for the rich. They decided to cut Medicaid by $834 billion in the same bill so they can pay for their tax cuts.

This is a straight-up trade. The Senate Republicans say that Americans should cut health insurance for little babies or for seniors in nursing homes or for people getting treatment for opioid addiction-- all so that millionaires and billionaires can get their tax cuts.

That is not a healthcare bill. That is a statement of values. And it says that tax cuts for a handful of millionaires and billionaires are more important than healthcare for millions of hard-working Americans and their families. There is only one word for what the Senate Republicans are doing with this bill--``shameful.'' It is shameful.

The Republicans negotiate in secret, behind closed doors. They refuse to let anyone see the bill. They will not tell anyone what is in it.

Senator McCaskill asked Chairman Hatch on the Finance Committee if he would hold a hearing on the bill, and he said no. Senator Murray asked Chairman Alexander on the HELP Committee if he would hold a hearing on the bill, and he said no, no plans to do so--no, no hearings, no reviews, no public look at what the Republicans are up to.

What is going on here? I will tell you what is going on. Senate Republicans don't dare let the people back home see this bill. They don't dare let voters see this bill. Instead, they have decided to try to ram this bill through with no hearings, no public discussion, and get it signed into law.

They hope, once that is done, people will not see much point in learning about the details and holding Republicans accountable. They hope that if they can do a quick vote, everyone else will just give up.

I have news for Senate Republicans. That is not going to happen. Senate Republicans may not want to hear from families who are worried about losing their insurance coverage in the middle of a battle with breast cancer. They may not have time for stories about premature babies who need Medicaid so they can get lifesaving care. And maybe they don't want to hear about the grandparents with Alzheimer's who could get kicked out of nursing homes.

Senate Republicans may not want to hear from these people, but I have a message for these Senate Republicans. We don't care how long we have to stand up here. We don't care how many times you try to dodge the question about what is in your secret healthcare bill. Democrats are here to keep demanding that you show us this bill, and we are going to keep insisting that you account for its shameful contents.

I know you would prefer to take the phone off the hook so you don't have to hear it ring, and I know you would like to pretend that there aren't families in your State who would be hurt by this bill, but I am going to take some time to read you a handful of the letters I have been receiving about exactly what is at stake in this debate about healthcare. These families deserve to be heard.

A few months ago I received a letter from Jenny in Worthington, MA. She wrote to me about how she and her husband got good healthcare coverage through the Affordable Care Act and how Medicaid was there when they needed it most, when Jenny was diagnosed with breast cancer.

A few days after President Trump's inauguration, Jenny's son Liam wrote a letter to the President. Liam asked President Trump not to take away his mother's healthcare. I don't know if President Trump ever read that letter, but I am going to read it right now into the Congressional Record.

Dear President Trump,

My name is Liam Barry, and I am ten years old. My mother

has been very ill. Thanks to the ACA, my mother has been able

to have the care and medication she needs. If you repeal the

ACA, my mother will not be able to get the care she needs. I

know there are millions of kids in the same situation as me.

Please think of them when you read this.

Sincerely,

Liam Barry

Thank you for speaking out, Liam. We are fighting for your mom, and we are fighting for you.

Kristine from Cambridge also wrote to me about her fight against cancer. She wrote:

I ask that you and fellow Senators PLEASE fight for the

Affordable Care Act. I am a cancer survivor. When I was 28

years old, I got the news no one ever wants to hear, ``You

have cancer.'' Luckily, for me, I had a job that had

wonderful insurance, and I was able to get medication,

surgeries, and treatment to win the fight--and to not go

broke doing so.

However, I know many young people and old people and

children who would not be here today if it was not for ACA. I

know people who are still fighting their battles with cancer.

They are frightened and losing hope, not because of cancer,

but because they don't know whether they will be able to

continue to get the treatments necessary to stay in the

fight.

I am now 30 years old, and have my whole life in front of

me. Because of what [President] Trump is proposing, I am now

afraid that if I lose my job or if I wish to change jobs, I

might not be able to get the necessary coverage, because I no

longer qualify.

I really didn't think this is what I would be worried about

two years ago after having been through 8 rounds of chemo, 20

rounds of radiation and surgery to clear me of this disease.

Please, I ask that you fight for us. Fight for those who

are in the chemo chair right now, at this very moment, who

are miserable, bald and bloated. Fight for the cancer warrior

who is now crying with worry because she doesn't know, come a

month from now, if she will be able to continue to receive

the life-saving treatment she is entitled to!

That is why we are here tonight. We are fighting for you, Kristine. We are in this fight. Thank you for speaking out about your own fight against cancer and for others who are currently battling cancer and worried about the future of their healthcare.

I also heard from Sarah, who lives in Shrewsbury, MA, and who wrote to me about her concerns that the Republican healthcare bill would endanger coverage of birth control and access to services at Planned Parenthood. Sarah wrote to me this past weekend, while I was out dancing in the Boston Pride parade.

As I type this you are at Boston Pride, which I would have

loved to be at to support my friends, but, due to my

endometriosis pain, here I sit.

I am extremely concerned about the GOP plan to reduce or

strip away insurance coverage for birth control. As a 21-

year-old woman suffering from endometriosis, a very common

disease among young women, I know firsthand that birth

control does more than just prevent pregnancy--in fact, for

many, it is the only treatment for them.

In 10 days I will be undergoing endometriosis surgery, and

for the past 6 months since I've been diagnosed until the

surgery, birth control was the only thing enabling me to

stand up straight most days. Even while taking oral

contraceptives, there were many days I was unable to get out

of bed (today being one).

I am so lucky to have access to an amazing endo specialist

at Brigham & Women's Hospital, and to have access to the

medication and surgery that I need. But every time I groan

about having to go to an appointment, I think about how many

women are suffering from the same debilitating pain, but

without the resources to overcome it. Many women rely on

Planned Parenthood not just for abortions, but to provide

them with the medicine that will enable them to stand up

straight in spite of the pain they deal with every day.

Endometriosis doesn't discriminate, and it cannot be cured,

only treated. Until endometriosis becomes a prominent focus

of medical research, which I feel it should be, we must

protect the right to be treated for it, which means

protecting insurance coverage of birth control, and

protecting Planned Parenthood.

I know that you are a warrior for women's rights, and you

are the patron saint of Planned Parenthood. I know these are

issues you fight for, and I cannot even begin to thank you

enough for all you have done thus far. I hope that by adding

my voice and my personal story, I can fuel your fire and

somehow be a small part in protecting my fellow females and

my fellow endometriosis sufferers (1 in 10 women in the US).

Thank you for fighting for us. Thank you from the bottom of

my heart.

Sarah, thank you for writing, and thank you for fighting. We are going to fight to save your coverage, and next year I expect to see you on the parade route at Pride.

I also heard from Dr. Hemal Sampat, who is a doctor at MGH in Boston. He wrote in with his personal story, and I want to read parts of his letter.

I actually grew up in a low-income family myself. My

parents immigrated to the U.S. My mother is brilliant but

only had a 7th grade education because my grandfather

couldn't afford to send her to school. My father is college-

educated, but struggled frequently with unemployment. My

older brother has multiple disabilities. He's blind and

brain-damaged from a stroke during childhood, epileptic,

intellectually disabled, and has a transplanted kidney. I am

fortunate enough to have been healthy my entire life.

For most of my life, my family was on Medicaid, as well as

other forms of public assistance. . . . My brother,

additionally, due to his kidney disease, got Medicare as

well, but Medicaid was always his secondary insurance. He

sees multiple different specialists and has done very well

over these years.

In spite of us having multiple financial struggles, we

never had to worry about his healthcare being paid for. His

transplant from childhood lasted 19 years, and then about 10

years ago he was transplanted again and has done well with

that.

My parents still live in the same house I grew up in, in

Maryland. Right now, they're cared for by Medicare and

Medicaid. My brother lives with them, receives SSI, and his

health needs are met by Medicare and Medicaid. Although none

of his chronic medical conditions can be cured, they are all

well taken care of.

In the meantime, I grew up healthy, was able to attend

Georgetown through need-based financial aid, was able to get

into medical school at the University of Maryland and pay for

it using Federal student loans (which I'm repaying through

the Public Service Loan Forgiveness program), got into a

dual-specialty residency of Internal Medicine and Pediatrics

at Penn State, and am now working at Harvard and MGH.

My family's story goes to show that Medicaid is about

helping families that struggle, about helping children with

complex medical needs, and about how providing for the good

health of a family can achieve positive outcomes for the

long-term future.

Today, Dr. Sampat works at Harvard at MGH. He makes sure his patients on Medicaid get excellent care. He told me about one of his patients who came in to urgent care in Chelsea. This little girl wasn't even 2 years old yet and was wheezing and had a fever. Here is what the doctor said:

This child and her mother were on Medicaid through

MassHealth. [As] I asked questions, I found out more about

this mother. She was working two to three jobs in order to

make ends meet. Her daughter was in daycare during the day

and then [the] grandmother took care of [the little girl]

most evenings. This mom took care of her daughter on the rare

days she had off and clearly loved and cared for her

daughter.

This young girl's wheezing was probably some of the

earliest signs of what will become asthma. [Her] mom has

asthma, too, and it runs in their family. Asthma is a

completely controllable illness with medication, but it

requires monitoring by a doctor and access to medication.

Because the child has Medicaid, I feel much more confident

that, in spite of how much the mother is struggling

financially, the child has a good shot at growing up healthy.

Without Medicaid, this child could live a life in poor health

from a treatable condition.

These are some of the people the Senate Republicans want to kick to the curb so they can deliver a big tax cut for millionaires and billionaires--a 10-year-old kid with a sick mom, a cancer survivor, a woman with endometriosis, a boy kept healthy by Medicaid so he could grow up to become a doctor at one of the best hospitals in this country and help a little girl with asthma.

Senate Republicans are willing to tear away health insurance from these families to deliver tax cuts for their buddies, but we are not going to let that happen. We can't let that happen. You are fighting back, we are fighting back, and we will keep right on fighting.

I yield the floor.

Mr. President, I want to give a status report on this bill. Right now, we think it is with the 13 men who are working on it in secret; they will show it to Republican lobbyists, and then they will send it over to the CBO for a score, and eventually the American public and the Senate will be able to see the bill.

We will have a process called vote-arama, which is mostly nonsense, and there will be lots of opportunities to offer amendments, but let's be clear about what happens at the end of vote-arama. The leader will offer an amendment in the nature of a substitute. So what does that mean? That means all of the amendments that were adopted along the way get taken out, with one 51-vote margin, and all of that vote-arama was for show because Mitch McConnell will put his bill on the floor that was negotiated in secret with those 13 people.

If there was any question that our democracy is being rolled over by Senate Republicans, I want you to think about these 13 men. They are drafting a bill without any input from women, from Democrats, from experts, and by working in secret they are cutting out about 250 million people who are from the 40 States who aren't represented among those 13 men. You can bet that those 40 States have unique healthcare needs and unique healthcare laws. And without the right language, the bill could throw healthcare in each of those States or any of those States into total chaos.

They have also cut out Senators on the Health, Education, Labor, and Pensions Committee and the Finance Committee, even though these committees are actually constructed for the purpose of working on legislation like this. They know how to get things done like this. There are members of the HELP Committee and the Finance Committee who are among the experts on this issue, yet they don't get a chance to even see the bill. These Senators have jurisdiction over this legislation, but they are being left out. This is just not the way it is supposed to work.

We need transparency. We need bipartisanship. But now the Republicans will try to tell us that the hearings are bypassed all the time. That is not true. In fact, this body will hold a hearing on almost anything. In 2017 alone, the Senate has had hearings on hot tub safety, self- driving cars, a treaty for outer space, multimodal shipping, the maritime administration, and dozens of other issues. Look, those are actually not to be trivialized. It is important for the Senate to have hearings. It is important for subcommittees to do their work. But nobody can tell me that hot tub safety, self-driving cars, a treaty for outer space, multimodal shipping, and the maritime administration are more important than one-sixth of the American economy. It is a joke.

We are talking about one-sixth of the American economy, about millions of jobs, and about people with life-threatening diseases and life-changing medical bills, so we know how important hearings are to do legislation. When the Senate took up the ACA, there were almost 100 hearings. Think about that: 100 hearings versus 0. There were roundtables and walk-throughs held by the two committees. We considered hundreds of amendments and accepted

more than 150 amendments from Republicans. But, for this bill, no markup, no transparency, no bipartisanship--just 13 men meeting in secret outside of the regular process.

The only thing that has changed is now the market is under siege, but the market is under siege because of the Republican administration. They are purposefully creating uncertainty. That is not a rhetorical flourish; they are saying they are doing that. President Trump actually said he wanted to create uncertainty in the healthcare market in order to create leverage with Democrats.

Think about how unusual that is. Think about how offensive that is. It is perfectly appropriate for one party to try to generate leverage in a negotiation against the other. That is part of politics, either in an election context or in the public policy context. But the way that this President and Tom Price are trying to generate leverage is by raising healthcare premiums in order to force Democrats to buckle. That is unheard of. It really is unheard of. And it hurts everybody across the country to create this uncertainty.

It is bad enough that the Republicans are trying to take healthcare away from 23 million people--from nursing home patients and their families, from women who are pregnant or fighting breast cancer, from sons and daughters and moms and dads who struggle with opioids. But to add insult to injury, they are going to jam it down your throat. You don't get to read what it is about before it passes or hear from doctors or nurses or experts about how it will affect you.

So why are they working on this bill in secret? The answer is very simple. The bill stinks. They are ashamed of it. The bill itself is an embarrassment. The process is an embarrassment. They have said so themselves. No matter how you look at this, this bill is a disaster for people and their families. It will be a disaster for anyone who relies on Medicaid, which will be cut by at least $800 billion, and Medicaid is a safety net for people who need care but can't afford it.

Look at nursing home care. Medicaid covers three out of every four long-stay nursing home residents. My wife's grandmother was in a nursing home and just passed away, had great care, and wouldn't have been able to get the care she needed were it not for Medicaid. This is not an uncommon story--millions of Americans across the country of all income levels. People think of Medicaid as for people who are not financially in a position to get care in any given moment. That is true. It does take care of the poor. But it also takes care of nursing home care for people who worked all their lives and just don't have enough. It is $9,000 a month in the State of Hawaii for nursing home care. It is more than that for hospice care. We all know that nobody escapes end-of-life care. Rich or poor, left or right, red, blue, purple, nobody escapes this part of your life, and everybody needs help. There might be a few people who save up enough cash money to be able to shell out $10,000 a month for that kind of care, but for the rest of us, Medicaid is that lifeline.

There are actually some Republicans who don't want to cut Medicaid. They have seen how the program improves people's lives. Arkansas and Kentucky, for example, expanded Medicaid. These States have seen big jumps in the number of the people who now have their own doctor or have gotten a checkup in the past year, people who are now more likely to say they are in excellent health. But under TrumpCare, we will be back to the bad old days.

This bill is also a disaster for older people, who will be hit with what the AARP is calling an age tax. This will get a little wonky--not as wonky as that referred to by my colleague who spoke about 5 minutes ago but a little wonky. Right now, companies are not allowed to charge any more than three times as much for an older person as a younger person. Three times is the cap. But TrumpCare will increase that rate to five times. So what happens is every year, as you get older, your insurance costs will go up and up and up. That is why they call it an age tax. In other words, many seniors will see premium increases that can cost them thousands of dollars more each year at a time when people are already struggling to find money to pay for healthcare.

This is also a disaster for patients who don't want to lose their healthcare provider. Right now, an estimated one in five women goes to Planned Parenthood clinics. I understand we have different views about reproductive choice. I understand that. But we also understand--when we are talking on the level about Planned Parenthood and when we are talking about Federal funding for Planned Parenthood, everybody who pays any bit of attention to this understands what Planned Parenthood does for women across the country--again, conservative women, progressive women; Planned Parenthood doesn't care. Planned Parenthood is not using Federal funding for abortion. We all know that by now. It is cancer screenings, and it is quality healthcare and birth control.

People talk about giving more choices for healthcare and saving taxpayers' money, but the CBO estimates that defunding Planned Parenthood will take away options for nearly 400,000 women across the country and will cost taxpayers more than $130 million.

It is also a disaster for those struggling with opioid addiction. This bill will take away treatment for mental health and addiction, leaving hundreds of thousands of people fighting opioid addiction without adequate health insurance. We saw the statistics that opioid addiction, I believe, is killing more people annually than HIV/AIDS killed at its apex. I believe it has either surpassed or is comparable, in terms of cause of death, with car accidents. This is one of the leading killers in the country, and Medicaid is the program that funds opioid addiction for most of the people who get help.

This bill is also a disaster for patients with preexisting conditions because it means we will be going back to the dark days when insurance companies could charge you more for having a preexisting condition.

I have heard from people back home in Hawaii who are terrified of what this could mean for their health. One woman wrote that she is in the middle of a fight for her life against breast cancer, and she is scared that under TrumpCare, she will lose her insurance, that she will have to stop her treatments and could lose her life. A husband wrote to me that his wife has stage IV breast cancer. She has had every possible treatment and surgery imaginable to extend her life, but without the guarantee of affordable coverage for all, her fight will quickly come to an end. She is 29.

Even people without serious medical conditions will be affected by this preexisting condition's nonsense. We know that because before the Affordable Care Act became law, insurance companies were able to discriminate based on what they determined to be a preexisting condition.

One woman in Hawaii told me that in the days before the Affordable Care Act, she was rejected by insurance companies because she had back pain at one point in her life. The pain never came back, and she never needed treatment again. She was young and healthy, but the insurance company wouldn't give her insurance.

We cannot accept the end of nationwide protections for people with preexisting conditions. We cannot accept high premiums or so-called high-risk pools that have historically failed in giving people the coverage they need and deserve. We don't have to do it this way.

We don't have the majority, and this is being done under a process called reconciliation, which means that you don't need a filibuster- proof majority; you just need 51 votes. So if you are proud of your bill--we have Senator Hatch, chairman of the Finance Committee and one of the most respected Republicans in the country, actually. We have Senator Alexander, chairman of the Health, Education, Labor, and Pensions Committee. Both have a long history of being able to do deals--Orrin Hatch with Teddy Kennedy and my predecessor, Dan Inouye; Lamar Alexander with just about everybody--Chuck Schumer, Patty Murray. These are conservative Members of the Senate. There is no doubt about their Republican credentials. But they are also people who are capable of crafting legislation in the right way. I have no doubt they like their gavels. I have no doubt they like chairing hearings. I have no doubt they have the personal, intellectual, emotional, and political

stamina to go through a process which may take more than a couple of days.

I will tell you, this is the world's greatest deliberative body--it is--and these are a bunch of impressive people I serve with in the Senate. But without a hearing, you get a garbage product. You get a bill that just stinks, that staffers say they are keeping secret because ``we're not stupid.'' They are so embarrassed at this product that they are keeping it secret, because they know the moment this thing gets posted, everybody from everybody's home State--and not just Democratic States and not just purple States, but every home State is going to say: My community health center is going to get shut down. My opioid treatment center is going to get shut down. My hospital may no longer exist.

They know this bill stinks.

There is a simple solution. All we need is three Republicans to say: Let the Senate be the Senate. The House did whatever the House was going to do.

There was a weird White House Rose Garden signing ceremony without a bill even being enacted. It was the most bizarre thing I have ever seen, where everybody was congratulating each other for inflicting pain on the American people.

But the Senate has to be the Senate here, and what that means is that we have to be that cooling saucer. We have to actually slow down and have a deliberative process. All we need is three Members of the Senate on the Republican side to say a very simple thing. They can be as critical of ObamaCare as they want, they can be as partisan against us as they want, but all they have to say is this: I am not voting for a bill that doesn't get a hearing. I am not voting for a bill that doesn't get a hearing. Let this thing see the light of day.

I yield the floor.