A concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2017 and setting forth the appropriate budgetary levels for fiscal years 2018 through 2026.

Mr. President, with the permission of the chairman, I would like to ask unanimous consent to speak as in morning business for up to 20 minutes.

I have no objection to that.

Mr. President, this is the 152nd time I have come to the floor for my ``Time to Wake Up'' speech, warning about the perilous effects of climate change. I am going to continue this in the new Congress, continuing to present the latest and most compelling scientific evidence of the changes that are coming our way driven by carbon pollution.

Nobody should take my word for it. I urge my colleagues to listen to their own home State's climatologists, their own home State's university researchers, their own home State's public health officials, and their own constituents who are out there fighting to protect their communities from the changes that are already happening right before their eyes.

In Rhode Island, we have a lot of fishermen, just as Louisiana has, Mr. President. The president of the Rhode Island Commercial Fishermen's Association is Chris Brown. Just this past week, he was the subject of a New York Times article. ``Climate change is going to make it hard on some of those species that are not particularly fond of warm or warming waters,'' he told the Times. ``We used to come right here''--where he was on his boat, The Proud Mary--``and catch two, three, four thousand pounds a day, sometimes 10.'' But the whiting, the fish he was after, have moved north to cooler waters.

The Times reports that two-thirds of marine species off the northeast coast have moved from their traditional ranges into deeper and cooler water.

John Manderson is a biologist at NOAA's northeast fisheries science center, and he told the Times in that article that public policy needs to keep pace with the rapidly changing oceans, where species are shifting northward in response to warming 10 times as quickly as they do on the land. ``Our ideas of property rights and laws are purely land-based,'' he said, ``but the ocean is all about flux and turbulence and movement.''

In Rhode Island, fishermen are getting clobbered by that flux.

Captain Dave Monti is a member of the Rhode Island Marine Fisheries Council. He wrote in the Providence Journal this week:

I often think about the fish and how important it is to

grow them to abundance so there are more fish for all to

catch and eat. . . . In 2017 we need a fish-first agenda, or

someday there may be no fish left to catch. Climate change,

acidification, overfishing by world nations, and changing

federal strategies could make it the worst of times for fish

in 2017. . . . We need to make an effort to understand what

is happening to the environment and the fish, and then take

that second step of communicating it to others to affect

policy.

That is what I am being asked.

The Providence Journal also recently wrote about how in Rhode Island the sea is moving higher and farther inland, as it is in Louisiana, which is the State losing ground fastest to the ocean of all the 50. They reported on StormTools, a program developed by Rhode Island's Coastal Resources Management Council director Grover Fugate and University of Rhode Island emeritus professor of ocean engineering Malcolm Spaulding. StormTools provides 3D maps of the potential flooding damage along Rhode Island's coast. The Journal described the project as ``one of the most sophisticated models developed anywhere to project future damage from storm surges and sea level rise.'' And we are taking the results seriously.

The Journal quoted William DePasquale, who is the director of planning in one of our cities, Warwick, RI. He said, ``When I saw some of those scenarios, my jaw hit the ground.'' That is what we are looking at, and Warwick is now using those maps to prepare for the future.

The Providence Journal has also recently written about Matunuck Beach in South Kingstown. Town manager Stephen Alfred warns that if the sea takes out Matunuck Beach Road, 240 homes will be totally cut off, without a water supply or access to emergency services.

The article features Kevin Finnegan, who owns the Ocean Mist, a renowned local establishment. The Journal said:

The Ocean Mist has occupied the same spot under different

names since Prohibition ended in 1933. But the ocean has

moved. Where once beach bathers had to plan a trek across

sand to reach the water from the Mist, waves now flood the

supports holding up the tavern's deck.

Finnegan and the town of North Kingstown are scrambling to build seawalls. Engineer Bill Ladd, who works for Finnegan and who the Providence Journal reports had his first beer at the Ocean Mist back when the drinking age was 18, estimates that the two walls may only buy Matunuck Beach 20 or 30 more years against the oncoming ocean. That is because, as The Independent--a local newspaper in the southern part of Rhode Island--reported in December, about 4 feet of Matunuck Beach is eroding every year. According to Director Fugate of the CRMC, that erosion will more than double by the end of the century. Rhode Island is not a big State. We cannot afford to have this much reclaimed by the ocean.

The Independent article quotes North Kingstown Town Council president Kerry McKay, who says that climate change threatens the property values of his community's coastal homes, which is a significant portion of the town's revenue base.

He said historical values ``will have to change'' as

coastal concerns rise, and residents ``have to be more

receptive'' to redoing building infrastructure, such as

through elevating houses.

He also said that homes ``may not be there'' in 20 years, resulting in a ``major revenue loss.''

Another Providence Journal article last week featured Tanner Steeves, a

wildlife biologist with the Rhode Island Department of Environmental Management, which has to tear up roads and parking lots along the Sakonnet River as the seas rise. The Journal writes:

As the barrier beach just south of Sapowet Point has

narrowed--losing nearly 100 feet since 1939--the salt marsh

on the other side has become more susceptible to flooding.

The Independent made Rhode Island's case for climate action in a December editorial. They said:

The signs are clear, if not immediately visible to most.

There are the well-documented, widely publicized shifts

with global import, such as the loss of polar ice and the

growing frequency of extreme weather events. Locally, there

are changes in the ecology of Narragansett Bay, and locations

at which the effects of a rising sea level--sometimes subtle,

sometimes less so--may be plainly seen. . . . But we

encourage all Rhode Islanders, from coastal communities and

beyond, to remain attuned to the situation--in terms of both

what the sea is telling us and what is being proposed to

prepare for coming changes. The stakes are enormously high,

and the broadest possible effort is required to meet the

challenge.

That is the message to me from Rhode Island. That is why I give these speeches.

As I continue to push for honest debate on this issue in Congress, I also tour around the country to see folks on the ground in other States. I have now been to 15 States. In the closing months of 2016, I hit Texas and Pennsylvania.

In Texas, I joined Representative Elliott Naishtat, the advocacy group Public Citizen Texas, and Texas environmental advocates at a public event in Austin to call out Congressman Lamar Smith, Republican chairman of the House Science, Space, and Technology Committee, for his abuse of congressional power to harass public officials and climate scientists, including subpoenas demanding that States attorneys general divulge their investigative materials relating to their inquiries into ExxonMobil's potentially fraudulent climate misinformation. The committee is also harassing the Union of Concerned Scientists, 350.org, Greenpeace, and various university scientists because they are exposing Exxon for years of misleading the public on its understanding of climate change. Texans are taking notice. The San Antonio Express-News, which had previously always endorsed Congressman Smith for reelection, decided not to endorse him in this latest election cycle. The paper cited his ``bullying on the issue of climate change'' as behavior that ``should concern all Americans.''

I joined a panel discussion with leading scientists from Texas universities to discuss their research into climate change in Texas. The panel included Dr. John Anderson from Rice University, Dr. Andrew Dessler from Texas A&M University, Drs. Charles Jackson and Kerry Cook from the University of Texas at Austin, and Dr. Katherine Hayhoe from Texas Tech University. They had a unified voice on the dangers of climate change.

Dr. Hayhoe said Texans are seeing changes all around them.

We get hit by drought. We get hit by heat. We get hit by

storms. We get hit by sea level rise. And we're starting to

see those impacts today. . . . Texas is really at the

forefront of this problem.

Dr. Anderson of Rice agreed that the Texas climate is already changing. He said:

Accelerated sea-level rise is real, not a prediction. Its

causes are known--thermal expansion of the oceans and melting

of glaciers and ice sheets--and it is causing unprecedented

change along the Texas coast.

Dr. Dessler from Texas A&M laid out what he called ``the fundamental and rock-solid aspects of climate science: humans are loading the atmosphere with carbon, this is warming the climate, and this future warming is a huge risk to our society and the environment. We should insist that our elected representatives rely on this sound science when formulating policy.''

I returned to Austin in November to speak to the Association of Public and Land-grant Universities. President David Dooley of the University of Rhode Island had invited me to join a panel that he moderated with, among others, Dr. John Nielsen-Gammon, Texas State climatologist and professor at Texas A&M University.

The bottom line was simple: Climate change is real, and the scientists at our universities will be increasingly forced to defend good science, academic freedom, and climate action. University leadership will have to defend their scientists against the onslaught of FOIA requests and personal attacks that are the modus operandi for climate deniers and against the phony science fronts propped up by the fossil fuel industry to spread calculated misinformation. The American scientific community faces a real threat from that operation.

On to Pennsylvania, I had the opportunity to spend a day traveling with my friend and colleague Bob Casey around southeastern Pennsylvania getting a firsthand look at the effects of climate change and hearing about the work Pennsylvanians are doing to address it. At the University of Pennsylvania's Morris Arboretum, leaders from Children's Hospital of Philadelphia's Community Asthma Prevention Program, Moms Clean Air Force, Physicians for Social Responsibility, and other groups talked about kids with asthma and other conditions that worsen when temperatures and pollution levels are high.

In Malvern, we toured the LEED platinum North American headquarters of Saint-Gobain, the world's largest building materials company. The company is demonstrating that green building materials and technologies can be married with stylish design to produce stunning results. With operations in Rhode Island, Pennsylvania, and around the globe, Saint- Gobain is developing innovative technologies to reduce pollution, generate clean energy, and improve air quality for millions of people.

From there, we visited the John Heinz National Wildlife Refuge, which is the Nation's first urban wildlife refuge and Pennsylvania's largest freshwater tidal wetland. Lamar Gore, the refuge manager, showed us how the refuge is at risk from the saltwater pushed in by rising sea levels. The refuge is adjacent to the Philadelphia International Airport, along the Delaware River.

As you can see from these graphics reproduced from the New York Times, at 5 feet of sea level rise, some of the city goes underwater and the refuge is in real trouble. Water encroaches upon the Philadelphia airport. At 12 feet of sea level rise, 6 percent of the city--including the refuge, airport, and parts of downtown Philly--is underwater. Projections that parts of Philadelphia will one day be uninhabitable due to sea level rise are one of the major drivers for forward-looking climate mitigation and adaptation policies of Philadelphia's Office of Sustainability. Senator Casey and I met with them too.

Being in Pennsylvania gave me a chance to connect with Dr. Robert Brulle of Drexel University. He is the scholar who documented the intricate propaganda web of fossil fuel industry-funded climate denial, connecting over 100 organizations, from trade associations, to conservative think tanks, to plain old phony front groups. The purpose of this climate denial apparatus is, to quote Dr. Brulle, ``a deliberate and organized effort to misdirect the public discussion and distort the public's understanding of climate.''

I will wrap up with a special thank-you to one of the folks who helped organize my Texas trip: Tom Smith, who has been director of Public Citizen of Texas for more than 30 years. Known by his friends and colleagues as Smitty and known for his signature straw hat, over his career he has testified more than 1,000 times before the Texas Legislature and Congress--Mr. Uphill Struggle indeed. He was successful, though, and central in creating the Texas Emissions Reduction Program, which led to wide-scale deployment of solar and wind across Texas. A true environmental champion, Smitty retires this year.

I ask unanimous consent to have printed in the Record a recent tribute from the Texas Tribune entitled: ``Analysis: `Smitty,' a Texas Lobbyist for the Small Fry, Retiring after 31 years.''

Mr. President, in the article, he is quoted as saying: ``The thing that I learned time after time, story after story, is that people standing up does make a difference. It does change policy.''

Good words to end the speech by. Thank you, Smitty.

Mr. President, I ask unanimous consent that the time during quorum calls be charged equally to both sides.

Mr. President, I suggest the absence of a quorum.

Mr. President, I rise to join my colleagues in raising the alarm about the possible impact for all of us in America and, in particular, for my constituents in my home State of Delaware should we indeed as a body proceed with barreling forward and repealing the Affordable Care Act without a plan to replace it, as seems to be the intention of the majority.

When I was first elected to the Senate back in 2010, the Affordable Care Act wasn't even a year old. Yet Republicans were already trying to repeal it, without offering any comprehensive plan with which to replace it. Now, more than 6 years and 60 repeal attempts later, it is truly disheartening to see that when it comes to plans for the American health care system, seemingly nothing has changed. Instead of working across the aisle to find constructive fixes to this Affordable Care Act that could win bipartisan support, instead of finding new ways to invest in infrastructure or strengthen American manufacturing or coming together to respond to the Russian attack on American democracy or even waiting a week to take this upcoming vote so we Senators can give our full focus to vetting the President-elect's Cabinet nominees, instead of pursuing any of these priorities, it seems we are once again spending--even wasting--the American people's time to fulfill a misguided and, in my view, mean-spirited promise to repeal the Affordable Care Act at all costs, without a clear plan to replace it. Sadly, in that sense, nothing has changed since I first came here in 2010, not so for the American people, as plenty has changed for them and for my home State of Delaware.

More than 20 million Americans now have gained access to high-quality health insurance across our whole country, including 38,000 more Delawareans. Now, 38,000 is not a big number of people, but in my little State of 900,000, 38,000 more people who couldn't get access to health insurance before and can now is a big deal. Across the whole country, the rate of uninsured Americans is at a record low of just 11 percent, and in Delaware fewer than 8 percent, and this is well down below pre-ACA levels.

Let me focus on what I think is the biggest, broadest, and most important benefit of the Affordable Care Act, not just those tens of thousands in my State who have gotten coverage on the exchanges, but in my little State of 900,000, 560,000 Delawareans get their health insurance through their employer, as the vast majority of Americans do. For those half a million or more Delawareans, they have gained lifetime improvements to the quality of the health insurance they have through the ACA: no discrimination against preexisting conditions, young people can stay on their parents' health insurance until they turn 26, free preventive care, no lifetime limits on coverage and recovery, and a requirement that insurance companies spend 80 cents of every dollar on health care versus overhead. These five key consumer protections have been the center of the best of what the Affordable Care Act has delivered to Delawareans and Americans. Americans no longer have to make the phone calls they used to make to their Senators, their Congressmen, their local representatives, pleading that they could somehow find access to quality and affordable coverage. These reforms have made a real and tangible impact on Americans across the country.

I have also come to this floor, on a number of occasions over many years, and recognized the challenges of the Affordable Care Act, the ways in my home State that it has fallen short of our hopes and goals when it was initially passed, and I have offered, with an open hand, to work across the aisle

to find vehicles to repair and improve elements of it that haven't worked as had been hoped.

Before I turn to that, though, let us focus for a few minutes on hearing the stories of Delawareans who have reached out to me because at the end of the day, my passionate defense of the Affordable Care Act is rooted in individuals I have met and heard from, people whose lives have been changed by access to quality, affordable, accessible health care.

As Republicans move us forward to a repeal vote, it is my hope that they will listen to these and other stories and think about what possible alternative pathway there might be that would save the opportunity for them to have access to decent, quality health care.

I grew up in this tiny town of about 1,500 called Hockessin, DE, and Nicole is also from Hockessin. She reached out to me to tell me her 2- year-old daughter has cystic fibrosis. She spends at least an hour every day administering her daughter's breathing treatments and at least $5,000 a month. Her medications aren't cheap. Nicole is confident that without the Affordable Care Act, she would have exceeded her annual cap on medical expenses well before the end of each year.

Nicole makes it pretty clear to me that without the consumer protections put in place by so-called ObamaCare--the ACA--she would have one of three choices, choices tragically faced by many Delawareans and Americans before the Affordable Care Act. One, hope she somehow qualifies for Medicaid, which she probably doesn't because she is hard- working enough and successful enough that her income makes her ineligible for Medicaid. Option No. 2, go into deep debt to pay for her daughter's needed and lifesaving treatment. Option No. 3, stop giving her daughter some of the medication she depends on and just hope and pray that she will not suffer needlessly. That is all assuming that her daughter's cystic fibrosis was not a preexisting condition, preventing her from getting any insurance at all.

Let me review that because Nicole's story starkly outlines the reality that millions of Americans could face if we continue barreling down this misguided path of repealing the Affordable Care Act wholesale without coming together around a plan for replacement. That reality for so many sick Americans or Americans with sick children is this: First, hope you don't get sick. If that fails and you don't qualify for some other form of government assistance, either go into debt or try to get by without health care. That is it. That is what it was before the Affordable Care Act, and following its repeal, that may sadly be what it is again.

Over the last few weeks, I have heard many other stories, and I will cover a few quickly, if I may. Kim, from Wilmington, DE, is a thyroid cancer survivor who was able to get insurance because her cancer is no longer considered a preexisting condition. Will her ability to access affordable, quality health care be repealed?

There is Sue from Frankford, DE, whose husband got sick a decade ago--desperately sick--and hasn't been able to work since. They are retired but not quite eligible for Medicare. Yet, despite his illness, they have been able to find coverage now on the individual market. Will repeal of the Affordable Care Act deny Sue and her husband access to quality health insurance?

There is Carla from Odessa, DE, whose son was able to stay on her health insurance when his employer didn't cover it. Not only that, but Carla's sister--a self-employed gardener with a 40-year history of insulin-dependent diabetes, also known as a preexisting condition, was able to get health insurance when she tragically divorced at age 63 and lost coverage through her husband's employer.

There is Matthew from Wilmington, whose son was diagnosed with brain cancer. The year before his son's diagnosis, Matthew and his family were on a non-ACA-compliant health insurance plan. As Matthew wrote me, ``Our family was all young and healthy, and we thought this plan was right for us. Then, my 11-year-old got sick right out of the blue. It can happen to anyone at any time.''

Matthew is right. Illness can strike any one of us at any time--and not just the flu, not just a cold, but tragic, expensive, terminal illnesses can strike any family in America at any time.

Just listen to the story of Kerry from Wilmington, DE, a massage therapist who considers the Affordable Care Act, as she puts it, ``nothing short of miraculous.'' Here is why. Kerry signed up for health insurance in 2014 thanks to the subsidies, the tax credits provided through the Affordable Care Act. She had long had nagging abdominal and lower back pain. She didn't think much of it considering she had no family history of terrible diseases and had never even had a stitch before. Fast forward to January of 2015, when a routine diagnostic procedure covered by her new health insurance revealed that Kerry had stage III colon cancer. She had surgery a week later, followed by 6 months of chemotherapy, and ended up facing no out-of- pocket expenses besides her annual deductible. Kerry's cancer has now been in remission since September of 2015, and as she writes, ``The ACA came along at the last possible moment to save my life. I am certain that without it, I would have just continued to live and work with the discomfort and try to self-treat until the cancer was so advanced it could not have been successfully treated.''

I have many more, but stories like Kerry's and Matthew's and Carla's and Sue's and Kim's have been pouring into the inboxes of my colleagues in States around the country.

My Democratic colleagues and I know, and have known since the day it was signed into law, that the ACA is not perfect. I have talked to small businesses that want to offer health insurance for their employees but have struggled to find affordable options in Delaware. I have met plenty of Delawareans whose deductibles or premiums are higher than they would like to see, and I have heard from economists and budget forecasters who know our country's fiscal health depends on doing even more to control health care costs.

That is exactly why 2 years ago I came to this floor with a simple, commonsense request of my Republican colleagues: work with us to make the Affordable Care Act better. A colleague, a physician from the State of Louisiana, happened to be listening that day, and we have had a number of constructive and positive conversations since. Sadly, despite many attempts over many years, I so far have been unable to find a Republican partner willing to actually cosponsor meaningful, constructive fixes to the law.

In my view, and as I said 2 years ago, no conversation about the Affordable Care Act and how to improve it can be complete without reconciling the reality of the millions of Americans it has helped and the many others for whom it has fallen short.

I have sought to address the affordability of health care coverage for all families. I have cosponsored bills to increase tax credits to make it more affordable for small businesses, looked for ways to make sure there is more competition in the marketplace, especially in small States like Delaware, and pursued commonsense regulatory reforms and cost-containment efforts to further slow the growth in health care costs. For years, my colleagues and I have asked our Republican friends to put aside their rhetoric and focus on pursuing bipartisan fixes like these.

Today, the bottom line is still this: I know the Affordable Care Act has helped millions of Americans just like the Delawareans whose stories I have read. Kerry, Carla, Matthew, Sue, and Kim today live healthier, safer, and more secure lives.

Let's take a look at the alternative. There is no single proposed plan. There are dozens of bills in the House and Senate that would do lots of different things, but it would be very hard to predict with precision what the alternative really is. We know what repeal will do. As of today, the alternative--let's call it TrumpCare--is nothing more than a wholesale repeal with no clear plan to replace.

TrumpCare, a simple repeal, by one estimate would kick 26 million Americans--more than 50,000 Delawareans--off their health insurance. Even for those who don't lose their insurance, those hundreds of thousands of Delawareans who get their insurance through their employer, it would be much lower quality because it would

remove all the consumer protections that we have all come to embrace. It would give a nearly $350 billion tax cut to the wealthiest 1 percent of our country and a nearly $250 billion tax cut to big corporations. While tax cuts have their day and their reason, pushing aside all of that revenue with no plan for how to replace the Affordable Care Act and how to pay for it will become a desperate and dangerous move. TrumpCare, a simple repeal of the Affordable Care Act, would cut 3 million jobs and trigger negative economic impacts well beyond the health care sector by creating profound uncertainty. Lastly, it would burden State and local governments, which would lose nearly $50 billion in tax revenue.

That is the reality. Describing a repeal of the Affordable Care Act as anything other than the injection of wild uncertainty into our daily lives, into the health insurance and health care markets is just not square. That is the reality. Describing it any other way is political rhetoric, and that is, sadly, what this debate is about. It is repeal without replace.

Matthew from Wilmington, whose 11-year-old son was diagnosed unexpectedly with brain cancer, concluded his note to me with one last thought. He wrote of his son: ``He's my hero and I will fight for him and all others who continue to suffer similarly every day.''

Thank you, Matthew. Thank you for sharing your story and continuing the fight. I promise you and all the Delawareans who have reached out to me to do my level best to stand with you and fight for you every step of the way every day until we find a better path together.

I yield the floor.

Madam President, in 2010 the American people were promised a number of things, but among

those things was affordable, accessible, and quality health care. They were promised that if they liked their health care plans, if they liked their insurance, they could keep those insurance policies. They were promised a system that could get more folks covered at lower costs.

Instead, unfortunately, the Affordable Care Act has failed us and has failed to keep its promises. Canceled policies, elimination of certain plans, difficulties in identifying new plans, massive premium increases, sky-high deductibles, and limited options for doctors have really become a new standard for many American families.

At the end of last year, I completed another round of 105 townhall meetings in our State. There are 105 counties in Kansas. On occasion-- it is pretty rare but on occasion someone will say: The Affordable Care Act was helpful to me and my family. My response to that is: I am glad, but surely we can come up with a proposal--a plan--that isn't so damaging to so many other people for the benefits that you claim you have acquired under the Affordable Care Act. Surely, we can come up with a plan that doesn't increase premiums, increase deductibles, increase copayments, eliminate plans, reduce the choice of the physician you see, and reduce your ability to keep the health care plan that you like. Because I am opposed to the Affordable Care Act does not mean I am opposed to trying to make sure Americans have better options and more affordable care.

I have also visited all 127 hospitals in our State. I have had conversations with the chief financial officer, the CEO, the trustees, the doctors, the nurses, and almost without exception the conversation is about how bad debt expenses increase, the ability for their patients--people who are admitted to the hospital--to pay their bills is less, not more, and that is because they can't afford the copayments and deductibles.

Unfortunately, ObamaCare--the Affordable Care Act--has taken away the freedom to make health care decisions from Americans, from us as individuals, and given way too much authority to the Federal Government. Kansans continue to ask me to help them get back to their former health care plans, to find a better way to do this, a plan that is more affordable with better coverage.

Over the last 6 years, I have advocated for a number of changes to our health care plan to help American families. Even before President Obama was President, we were talking about what we ought to do.

I had ideas of what we could do to improve the chances that people across Kansas and around the country would have a better opportunity to provide health care insurance for themselves and their family members. I am proud of some of the successes we have had in recent time.

I am a member of the Senate Appropriations Committee and a supporter of funding for NIH, or the National Institutes of Health. This is research that is essential to saving and improving lives, growing our economy, and maintaining America's role as a global leader, but, most importantly, it saves lives and improves health care. In addition, it saves money--the cost of health care--if we can find the cure and treatment for cancer, for diabetes, for Alzheimer's. One of the ways we can help reduce the cost of health care and make it more affordable is to make certain that we make the necessary investments in finding those cures and treatments.

Last year, I supported, and this Senate and Congress passed, the 21st Century Cures Act. This takes us in additional directions in the way of finding those cures for life-altering diseases and, in the process, helps us to save our families' dollars. We have also worked hard to try to maintain the funding for Federal programs and agencies that work with universities and medical schools to train and recruit medical professionals who then go on to serve particularly in medically underserved areas. It is very typical of your State and mine, Madam President, in which we are experiencing the constant shortage of the necessary professionals to provide the necessary health care.

While this is progress, with a new Congress, a new year, and a new administration, we now have a tremendous opportunity to provide real substantive reform to our health care system. I mentioned the conversations I have had in townhall meetings. In addition to the health care side of the Affordable Care Act and the problems it has created for affordable and accessible health care, we have also had the challenges on the economic side--the job creation side--that the Affordable Care Act has unfortunately caused--the conversation about whether or not to expand a business, whether or not to exceed the 50- employee threshold. Those aspects of the Affordable Care Act are very damaging and need to be addressed and cured as well.

As we as a Senate, we as a Congress, and we as a country look for a replacement strategy, for something different--significantly different than the Affordable Care Act--we ought to focus on the practical reforms that embrace increased flexibility and allow American men and women to decide what is right for them and their individual family health care needs.

As we take this matter up in Congress, I wish to again put forth some specific ideas I have offered over the years as a blueprint for reform that we should try to put in place.

First, we should maintain preexisting condition protections for those with continuous coverage. Individuals with debilitating diseases and chronic conditions who have purchased health care should be reassured that their coverage will not be stripped in any future health care changes to our system.

Second, we can increase coverage by enabling Americans to shop for plans from coast to coast, no matter what State they live in. This will lower the premiums by spurring greater competition in the insurance market.

Third, we should extend tax savings to those who purchase health care coverage, regardless of their employment. To assist low-income Americans, we can offer tax credits to help them obtain the private insurance of their choice. We also can expand access to care by supporting community health centers and other primary care access points.

Fourth, instead of limiting the choice of plans, let's give small businesses and organizations the ability to pool together in order to offer health insurance at lower premiums, similar to corporations and labor unions. We also need to make it possible for health insurance to travel with workers when they move from one job to another job throughout their careers.

Fifth, we ought to increase the incentives available to individuals to save now for their future and for long-term care needs by empowering them to utilize health savings accounts and other incentive plans. Doing so enables individuals to take ownership in their health, and that is important as well.

Sixth, we need not accept the idea that costs for currently available medical treatments will inevitably rise. Instead, let's continue to support those things that bring down the cost of health care by finding cures and treatments, as I mentioned, with the National Institutes of Health. Advancing lifesaving medical research and spurring innovation can help us accomplish health care savings, reducing the financial burden for those with diseases and their family members who care for them.

Seventh, we need to address shortages in our medical workforce by promoting education and programs at our universities and our medical schools that train physicians, nurses, and other health care officials and encourage them to practice in underserved areas through scholarship and loan repayment programs. Kansas is an example, as is your State, Madam President, where those rural areas and, additionally, those core centers of our cities lack so often the necessary health care providers.

Eighth, in order to curb the preventable costs that often occur through unnecessary emergency room visits and untreated symptoms of disease, we should provide coverage to low-income Americans, despite their limited financial means, in a financially sustainable way that ends up saving money in the long run. For all of us, the best reduction in health care costs is wellness, fitness, diet, and nutrition. That also means early preventive care. It means early diagnosis, and we make certain that Americans have access to that diagnosis and that early treatment. Ensuring access to quality care with a focus on preventive health is an effective way to limit high-cost health visits that place burdens on hospitals,

physicians, our economy, and our health care system as a whole.

Lastly, we can reform our medical liability system and reduce frivolous lawsuits that result in inflated premiums and the practice of defensive medicine, where doctors order every possible test out of fear of potential lawsuit. Doing so can save tens of billions of dollars each year and make health care more affordable for more people.

The bureaucracy that goes with the providing of health care needs to be simplified. I have often looked behind the desk when I go see my family physician and wonder what all the people who are working there are doing. So much of it is not about patient care but navigating the system by which your health care bill, at least in part, gets paid. There is all the variety of insurance forms. I know this in my life-- the ability to understand that insurance document that arrives in the mail and sits on our kitchen table waiting for my wife or me to figure out what this means. I have seen this with my own parents when they were living--the amount of documents, paperwork, and forms and checks for $13.19 that arrived in my dad's mailbox and trying to figure out with my parents: What does that mean? Why am I getting this?

So much cost savings and so much anxiety and angst could be eliminated if we had a system that was much more uniform in its presentation, simplifying the way in which our health care bill gets paid by our insurance provider, by Medicare, by Medicaid, or out of our own pocket. I would defy most Americans to be able, unfortunately, to understand what is the stuff that comes in the mail and what it means to them.

As we move forward with trying to replace and improve access of Americans to health care--to affordable health care--I believe there are reforms that will provide us with a good blueprint for how to start helping Kansans and all Americans across the country who have suffered under the deficiencies and the costs and the damage that comes from ObamaCare.

I look forward to working with my colleagues--Republicans and Democrats--to find solutions to take advantage of this opportunity that we have. The American people--many American people, most American people--are hurting under this law, and they have spoken clearly numerous times. It is time for us to bring to them the changes that improve their lives by improving their health care, by improving their health, and by making sure that no American is worried about whether or not the necessary health care that they need or their family member needs is outside of their reach.

I yield.

I thank the Senator from Delaware, and I appreciate his comments. He did walk in just as I was talking about that particular issue of a series of things that I believe would improve the cost and affordability of health care. I thank the Senator for sharing his experience in Delaware and elsewhere and use that as an opportunity to indicate that the cost savings that comes from that kind of reform is a positive, but we also want to make sure those who, through no fault of their own, are actually harmed are made whole to the best of our ability that this can be accomplished.

Finally, I would use this as an opportunity to point out that this Senate ought to work in a way in which the ideas of all 100 Members are considered in a respectful way as we try to find solutions to the access and affordability of health care.

Again, I thank you for the time on the floor.

Madam President, I would welcome a membership on the Finance Committee, but I don't have one at this stage or with my time in the Senate. Under either circumstance--membership on the Finance Committee or here in the entire Senate--I look forward to working with my friend and colleague, the diligent Senator from Delaware.

I yield my time.

Mr. President, I ask unanimous consent that all time be considered time on the resolution.

Mr. President, I ask unanimous consent that during the periods of a quorum call, the time be equally divided between the two sides.

I suggest the absence of a quorum.

Madam President, I ask unanimous consent that at 2:45 p.m. today, the Senate vote in relation to amendment No. 8.

I yield the floor.

Madam President, today I have been listening to the diatribes against the repeal resolution we are working on, and I think some things need to be answered.

The Republicans are not trying to throw 30 million people off of their insurance. What we have seen over the time of ObamaCare is that there were 30 million people who were uninsured when we started that debate, and today there are 30 million people who are uninsured. Now it is a different 30 million people. The 30 million people who couldn't get insurance have insurance, and we want them to have insurance. And the 30 million people who are now off insurance used to have insurance, but they can no longer afford it. There has been a huge increase in the cost of health care. That is not how it was supposed to be. The prices were supposed to come down.

Yesterday we took the first step in fulfilling the promise of repealing ObamaCare, which will pave the way for real health care reforms to strengthen the doctor-patient relationships, expand choices, lower health care costs, and improve access to quality, affordable, innovative health care.

As I discussed yesterday, while Republicans will start by repealing ObamaCare immediately, we will ensure a stable transition in which those with insurance will not lose access to health care coverage. This will allow us to move step by step to a new set of reforms, listening carefully to the advice of millions of Americans affected and making sure we proceed wisely, doing no harm.

There is a common misconception that some of my friends across the aisle have promoted. It is the idea that ObamaCare was a success and that repeal will be tearing down a functioning program. That is not true. ObamaCare has put our health insurance markets on the brink of collapse in many parts of the country. And what Republicans face now is an imperative to do something that the Democrats couldn't bring themselves to do when they had control, and that is to fix the problems they created.

ObamaCare became the epitome of a sacred cow for them, and any changes, as you can see, unless done by Executive action, were out of the question.

Interestingly, President Obama recently admitted in October 2016 at Miami Dade College that the law has real problems and that, in his words, ``There are going to be people who are hurt by premium increases or a lack of competition and choice.'' That is the President of the United States talking about ObamaCare. In that same speech, he went on to call these issues ``growing pains.'' I think that is a troubling

blind spot about this law that he and many of my Democratic colleagues share. Millions are facing impossibly high health insurance premiums for plans they may not even want to have. Costs are going up, and they can't afford it. Somehow these casualties of ObamaCare don't deserve relief, apparently; they are just written off as growing pains by the authors of the law.

My colleagues will recall ObamaCare architect Jonathan Gruber, who was paid in a number of different ways, who was famously exposed in 2014 for stating, amongst other things, that while crafting this bill, he believed that ``the lack of transparency is a huge political advantage'' and that it ``was written in a tortured way to make sure the CBO did not score the mandate as taxes.'' Mr. Gruber may have succeeded in masking the consequences of ObamaCare to obtain passage, but there is no way to hide the results.

A recent poll by the Gallup organization showed that more Americans continue to disapprove--53 percent--than approve--42 percent--of the law and that a majority of Americans want to see the law changed. Let me highlight that point again. A majority of Americans want to see ObamaCare either changed or replaced altogether. In fact, since passage of ObamaCare in 2010, there has never been a majority of Americans supporting the law. A quick glance around the Nation quickly explains why. For more and more Americans, there is only a single insurer from which they can select health plans, a monopoly. In fact, on Federal exchanges, one in five consumers will only be able to select plans from a single insurer. Many residents across the country only have one choice of health insurer. That is including my home State of Wyoming as well as the entire State of Alaska.

What does this lack of competition mean? Prices are surging for hard- working families who now have to choose between unreasonable insurance rates or an unreasonable fine. That doesn't even include the deductible problem we have. That doesn't even include the additional taxes and prices people are paying as a result of other things that are built into the law, which I will go into later--not in this speech.

The irony of a Democrat-led effort to help resulting in the creation of a lose-lose proposition for families ran true to voters in the most recent election when they voted for change. In Wyoming, some families would be forced to pay more than 30 percent of their total income on premiums to obtain health care coverage, which often includes deductibles of over $1,000. One family faced premiums of more than $1,600 per month. That is one family, $1,600 a month. As an alternative, their tax penalty for not carrying coverage was only $1,700 for the whole year. So guess what they did. They paid the fine because they couldn't afford the insurance premium. They could also see no way that they were going to be able to get a benefit from that.

For those lucky enough to be able to afford insurance, particularly in the individual market, under the new health law, premiums are expected to increase faster in 2017 than in previous years. Some States will see insurance premiums rise by as much as 53 percent. I think that makes it truly an emergency.

After discussing the why, it is important to talk about how we are going to do this. Passing the repeal resolution we are currently debating today will allow Republicans to use the budget reconciliation process to untangle the country from this unworkable, unpopular, and unaffordable law. This is the exact same procedure congressional Democrats and President Obama used to secure passage of portions of ObamaCare. Let me say that again. This is the exact same procedure congressional Democrats and President Obama used to secure passage of portions of ObamaCare.

After Congress passes this repeal resolution, it can then move forward on reconciliation legislation that will provide for the repeal of ObamaCare and pave the way for real health care reforms. I think Members are looking forward to an open and serious debate about the future of America's health and its health care system and the importance of restoring the trust of hard-working taxpayers. I think that is something both sides can agree on, and that is what will happen.

This resolution we are debating does two things. It recognizes the point in the budget we are at considering the points of order and things that happened up to this point in time. We are just recognizing that is where this budget is. It still keeps in place the points of order to maintain some control over our spending, but the significant part is the repeal part. That is where we institute the reconciliation, and all that is, is an instruction to two committees on the Senate side and two committees on the House side. The two on the Senate side were the Finance Committee--they are the ones who deal with all of the taxes and the finance and the Medicare and the Medicaid, and they need to save $1 billion over 10 years. That is peanuts around here. They will do much better than that, I am certain. And then the HELP Committee-- Health, Education, Labor, and Pensions--also has an instruction to save $1 billion. That is it.

This isn't a debate over what the changes are going to be to ObamaCare; this is a debate about whether we are going to give two committees, which have jurisdiction over this situation, the ability to consider it and bring us something. It has to conform with the budget requirements, and that is going to save some money. That is why we have a very low threshold, each of them saving $1 billion. That is the time when we will have the debate on what is happening with health care. If somebody wants to raise the threshold of the $1 billion for each of the two committees, that would be perhaps acceptable--unnecessary but perhaps acceptable. If somebody wants to change the budget, we are going to have an actual chance to change the budget right after we finish this process because there is a budget for 2018. We are already a third of the way through 2017, and there are no spending bills approved. That is wrong, but that is what this budget reflects. That is where we are at this point in time on our spending. Hopefully, we will do well on the new budget and come up with a plan that is going to pull the United States out of the hole that we are in on our deficit spending, which results in huge debt.

I would like to make that distinction. Deficit is our overspending. Debt is the amount that we owe that we have to pay interest on--like pouring money down a hole--and that interest rate is going up. We get to make decisions on about $1 trillion each year, and the interest rate right now spends $200 billion right now by itself--that is at about 1 percent. If it goes to 5 percent, which is the norm for the United States, that would be $1 trillion dollars. That is the amount we get to make decisions on. What shape will our country would be in if we have to spend $1 trillion dollars on interest and that is all we have to make decisions on?

We have to do something. Health care is affecting more people in this country than anything else. So we will start immediately. We normally have a recess that would begin from the time we reorganize until the time the President is sworn in, but Republicans recognize that this is an emergency. This is something that needs to be taken care of. So we are going to stay around and get it solved.

We are going to do the processes we have to do. This is the first of the processes. There is another more important step, which has to be the actual savings part in order to do the reconciliation, and we are going to do that.

We will hear all kinds of stories of ways that people have been helped by health care, and we will hear stories about how people have been hurt by this health care. We need to fix it for both of them.

So I think Members are looking forward to an open and serious debate--I hope, a serious debate--about the future of America's health care system and the importance of restoring the trust of the hardworking taxpayers. I hope that is something we can both agree on.

Thank you. I yield the floor.

Mr. President, I ask unanimous consent that at 2:45 p.m. there be 2 minutes of debate, equally divided in the usual form, prior to the vote in relation to Kaine amendment No. 8.

I yield the floor.

Amendment No. 8

Mr. President, this amendment is corrosive to the privilege of the budget resolution, meaning that it is outside the scope of what is appropriate for a budget resolution. Any inappropriate amendment could be fatal to the privilege of this resolution, which would destroy our efforts to repeal ObamaCare. In other words, a vote in favor of this amendment is a vote against repealing ObamaCare.

In addition, this amendment is not germane to this budget resolution. This budget resolution is much more focused than a typical budget resolution. The Congressional Budget Act requires that the amendment to a budget resolution be germane. Since this amendment does not meet the standard required by budget law, a point of order would lie. As such, I raise a point of order under section 305(b)(2) of the Congressional Budget Act of 1974.

Mr. President, I call up amendment No. 1 and ask unanimous consent that it be reported by number.

Mr. President, would the Senator mind if it comes off of the resolution time?

Mr. President, I want to talk specifically for a few minutes about mental health care and about an amendment that I will be offering this evening. But I do want to start off by stepping back for a moment and indicating that, from my perspective, I know those of us on the Democratic side of the aisle understand that we have work to do together to continue to bring down costs for health care and, in some areas where there is not enough competition, in fact, to create that competition. Affordable health care is the goal for all of us. I have concerns in looking at my small business community that we continue to do things that support them. That is different than what we are being asked to vote on here.

What we are being asked to vote on is a repeal of health reform that touches every American and all of the patient protections that we put in place that have moved total control from insurance companies to people with insurance so that we can't quit a job if we get sick. If you have a preexisting condition, are a diabetic, or have heart disease or you had some other challenge or your child has, you know that you will have confidence that you will continue to be able to find insurance and see your doctor. There are all of the provisions that are here--young people up to age 26, all of the efforts that we put in place to make sure that you have the confidence and the ability to know that you have insurance. We need to ensure that if someone has cancer, they are not going to be capped with the amount of care they can get.

Yesterday in the capitol in Lansing, MI, there were physicians and pediatricians working with cancer patients, with children and their families, who were talking about the fact that, because of the Affordable Care Act and taking off the caps on the amount and kinds of treatment that children with cancer can get, literally, lives have been saved. Parents are now looking at this body and the Congress as a whole and the new President and are saying: Why in the world would we want to go back to a situation where people can't get the level of care, the quality of care, or, in some cases, the care at all for themselves or their families?

So we are proposing that, rather than repealing health reform, which unravels the entire health care system because part of it is Medicare, part of it is prescription drugs going back up--it weakens the Medicare system, and it weakens the Medicaid system, where most of the dollars are going to seniors in nursing homes. It creates a situation where someone who is working very hard at a minimum-wage job and hasn't been able to have insurance because their employer didn't provide it can now have the assurance that they can care for themselves and their families and see a doctor without using the emergency room for regular treatment, which, of course, is the most expensive way to get health care and drives the costs up. What is being proposed is that we unravel all of it and literally create chaos in the system. We are for affordable health care, and we are willing to work with anybody at any time. I, certainly, will be ready and willing to do that. But I reject the idea that we are going to repeal and unravel the entire health care system and create chaos for families, businesses, and communities. There are many communities where the hospital system is the major employer in the community. Health care is one-sixth of the entire economy and is going to be impacted by this.

I want to specifically speak about the importance of accessible and affordable mental health services and what we have been able to achieve with protections established by the Affordable Care Act that ensure people can receive care. We have come a long way since over 50 years ago when President John F. Kennedy signed the Community Mental Health Act and put down a marker about the importance of treating health issues above the neck as well as below the neck. Comprehensive health care should affect every organ, every part of the body, every kind of disease. We have made major steps in that direction. We have a long way to go to get the comprehensive care we need in the community, but we have made major steps forward, including bipartisan efforts here related to the Cures Act, as well as the efforts that Senator Roy Blunt and I have been working on to make sure the payments for providing services in the community are the same for mental health and substance abuse services as well as physical health. So we have made steps forward, but the reality is that repealing the Affordable Care Act will take us backwards in a major way.

I have introduced, along with colleagues who are also champions on this issue--Senators Cardin, Murphy, Durbin, and a number of other Democratic colleagues--an amendment that would help to prevent passage of any legislation that would reduce or eliminate services and access to mental health care. This is an amendment that should not even be necessary, particularly given the fact that we have worked in a bipartisan way on other pieces of legislation to move forward.

I don't know why we would ever pass something that reduces or eliminates access to mental health or substance abuse services such as opioid treatment. Why in the world would this body come together and jeopardize work we have already done, essentially ripping it apart? The repeal of the Affordable Care Act and the cuts to the Medicaid Program do exactly that.

Why is this important? Well, nearly one in five adults in our country has a mental illness. About 4 percent of adults have serious mental illness. Unfortunately, even now, with work we have been doing, we still have over 60

percent of people who don't receive the full treatment they need. We should be working together on that, not taking away the access to treatment that people already have.

This touches all of us in one way or another. I think all of us--our families, our friends--know someone. In my case it is very personal. I grew up with a loving, wonderful father who became ill when I was in elementary school. He was misdiagnosed and mistreated for years, and finally was accurately diagnosed as being bipolar, meaning he had a chemical imbalance in the brain. So contrary to other people who may have a sugar imbalance and they take their insulin because they are diabetic or they may have some other chemical change or imbalance where they can get treatment that has been covered under health insurance, if it is a chemical imbalance in their brain, up until the Affordable Care Act, it was not required to be covered under health insurance. It was not required, even though we passed policies stating that there should be mental health parity. For the first time, in the Affordable Care Act, we said in every definition that, when we talked about health care, it would include behavioral health, mental health, and substance abuse. As a member of the Finance Committee, that was a top priority for me. I indicated to the chairman at the time that I would not support any health care reform that did not define essential health care benefits as including mental health and substance abuse services. We know that definitions drive every new system, and we were successful in making sure that, in every part of health reform, we defined health care in a comprehensive way for the first time.

Mental health used to be considered a preexisting condition--not any more. Health insurance companies can no longer deny you coverage or raise your rates because you need mental health treatment. My dad struggled with that throughout his life. When he was finally diagnosed correctly and got the medications and the help that he needed, he never went back into the hospital again. I have seen what happens when someone doesn't get the help they need and when they do and the challenges to the families as well, and I am committed to making sure that services and treatment are available for every family.

Americans now have coverage for preventive services like depression screenings with no cost-share. You can see your doctor to get help without breaking the bank. Mental health and substance abuse are also now guaranteed benefits, as I mentioned before. They are covered as essential health care benefits. Why in the world would we not want to do that? Why would we say we want people to have access to health care, but it depends on what part of the body your disease is in?

That makes absolutely no sense. The Affordable Care Act makes sure that our law defines comprehensive health care from your head to your toes. It is the right thing to do.

These are all commonsense reforms, and we cannot afford to roll this back. A Harvard Medical School and New York University study released just this morning shows that if the ACA were repealed, 1.2 million Americans with serious mental disorders and 2.8 million Americans with substance abuse disorders would lose some or all of their coverage. This is 4 million people losing treatment that is allowing them to get help, move on with their lives, and be productive citizens as we all want to be and as we all want to have available to our family members.

Think of all the millions more who could again be in a situation of not being able to afford insurance once relabeled with a preexisting condition. The opioid treatment gap--the gap between the number of people who seek services and those who can find or afford--would increase by 50 percent if the ACA is repealed. There would be 50 percent more people unable to find or afford services.

We just had major debate on the floor and passed grant funding to help with this very serious issue. But why in the world should we say for a critical part of health care affecting every family, one out of five Americans, that it will be only around grants and not a part of our comprehensive health care system?

What happens now? The grant runs out: Gosh, I am so sorry you are sick. I am so sorry that you need to see a therapist or that you need medications. I am so sorry the grant ran out.

I don't think we would do that to somebody who had a heart attack: I am so sorry you have had a heart attack. You need surgery, but the grant ran out.

But with mental health illness, that is what happens every day. That is what happens.

Frankly, it is outrageous that we don't have a comprehensive health care system that is completely treating and responding in every way and reimbursing physicians and nurses for all of the different kinds of treatments, services, and medical help they provide.

We have put into law in the ACA that insurance companies cannot discriminate, you cannot have larger copays, you cannot have caps on services, you cannot have larger premiums--and this is a fundamental baseline right that we have placed into law as it relates to access to mental health and substance abuse services. To see that ripped away from Americans across the country is unbelievable to me. It is totally unacceptable.

The amendment we are offering would create a budget point of order against any legislation that comes to this floor that reduces access to mental health services for children, for adults, for seniors in this country. I would hope that all of us could join together and state through our votes that we understand how important these services are and what a difference they have made. Right now, repeal of the ACA means 4 million people will lose those services, not counting all of the others that would be blocked because of future access problems and preexisting conditions and caps on services and all of those patient protections that go away.

I hope that we will join together in a bipartisan way, as we have done on bills such as the Cures Act and others, to say we understand this is the fundamental piece. It starts with mental health parity. To me it is incredibly hypocritical to talk about these issues and want to provide grant funding when the fundamental question of whether mental health and substance abuse services covered under your insurance are ripped away, which is what will happen with the repeal of the Affordable Care Act.

I urge my colleagues to support our amendment.

Mr. President, I yield the floor.

Mr. President, I want to thank the junior Senator from Connecticut for his leadership on ACA. Since we arrived in the Senate together, he has been stalwart, not just on the many benefits of ACA but specifically on mental health and the benefits and the destigmatization of mental health care in the context of ACA.

It wasn't so long ago that people wouldn't step up and say: I need help. I need mental health care. But now I think it is broadly accepted on both sides of the aisle, partly because of Chris Murphy's leadership, that mental health is health and that just as if you tweak your shoulder or need something with your lungs or have a crick in your neck, if you have some mental health issues, you need to get them taken care of.

The plan to repeal the Affordable Care Act with no replacement reminds me of a car I used to have. It was an OK car. I remember I bought it in 2006. It was a 2005, but it was new--one of those in the back of the lot. I got it for $2,500 less than MSRP. It was a station wagon. It was ugly. It was purple, and I just sort of rode it into the ground. I kept driving it. I didn't take great care of it. I have gotten better about taking care of my cars. At the time I just rode it and rode it. The AC busted, and I didn't fix it. There was a fender bender, and I didn't fix that. The car was OK. It needed some TLC, but it got me around. What if I had taken this car to Jiffy Lube in Honolulu just to get a little tuneup and left it, and then I came back an hour later and it had been dismantled? That is what the Republicans are doing with the Affordable Care Act. Instead of fixing what is wrong and keeping what is working, they are going to destroy the American health care system.

I try very hard not to be too apocryphal with my language. I try very hard not to be too nasty and too partisan on this floor, but this is factual. They are going to destroy the American health care system. That is what repeal and replace is all about. They are going to remove a law from the books and come up with something terrific in a few months or a few years, but they are also going to keep the stuff you like.

Here is the first thing that everybody across the country needs to know about this process. It is not on the level. There is no way around it. This is just not on the level. Anybody who has spent any time thinking about health care policy knows that covering people with preexisting conditions like cancer, mental illness, and diabetes is a popular thing to do. It is the right thing to do. People also know that the only way to do that is to create a risk pool that includes healthy people. If you are going to insure folks, you can't just be paying out for the expensive cases; you also have to be bringing in revenue and not paying out, so you need young people in the risk pool. You need professionals in the risk pool. You need nonsick people in the risk pool. That is how this all works. Everybody understands that.

Everybody who is working on this in good faith understands that you need to create a risk pool in order to cover more people. So they know that if they eliminate the individual mandate, they eliminate the benefit, but they are stuck with a promise they made to repeal this law totally, root and branch--not to improve upon the law.

Just remember that it was an article of faith that we couldn't make even the most modest improvements to this law at any point in the last 6 or 7 years; that if you did so, you ran afoul of Republican orthodoxy. It is not that they wanted to fix the law. It is that they had told everybody it was so bad--partly because it was ObamaCare--that there was nothing good in it; there was nothing worth preserving about the Affordable Care Act.

Now they are into repeal and replace. They are stuck with the promise they made to repeal this law totally, and they know people are about to be very, very angry because President Obama is the President only for another 10 days, and people are not going to accept the premise that we are going to rip health care out from under you, but don't you hate health care because it is called ObamaCare? That is an argument that may have worked 3, 4, or 5 years ago, but with a new President-elect and a new Congress, we have an obligation to have a better strategy than that.

Republicans do not have a replacement plan. If they had one, they would be adopting it shortly. It has been 7 years. It has been 7 years, and we haven't seen any legislative language--none. They have no plan at all for American health care other than to cause immediate harm and to try to blame it on the law that they are repealing.

There are only a few ways this could end up. I will give you a couple of them. First there could be the equivalent of a health care cliff, which is similar to what we have done with our fiscal situation where they have to periodically shovel money at the problem

and bail out the insurance companies. What will happen is they are basically eviscerating the revenue that provides the subsidies for individuals, but they are going to realize: Hey, these subsidies are quite popular, but we just eliminated the revenue. We don't want to increase taxes so let's borrow money and keep shoveling money at the insurance companies or they may make minor reforms in the ACA and call it a replacement. That would be great. I do not see that they are on this path right now or they are really going to repeal the law and take health care coverage away from millions of Americans. This is completely irresponsible.

So what happens when they repeal ACA? Twenty-two million people will have their health care coverage ripped away from them, more than 22 million men, women, and children. For those of you who still have coverage, I want you to know that this impacts you too. If you have a preexisting condition as common as diabetes or high blood pressure or mental health issues or cancer or Crohn's disease or Lupus or in a lot of instances pregnancy is a preexisting condition, you are not going to be able to keep your coverage.

If you are a woman, you are likely going to lose access to preventive health care services like birth control. If you live in a rural area-- everybody in rural America should understand this.

There is this thought that there are rural States and nonrural States. Every State is both a rural State and a nonrural State. I know the Presiding Officer has an urban area and plenty of rural areas. I have one of the densest cities in the United States, and then I have far-flung, very small towns that are old plantations. Everybody in the Senate represents rural America in some form or fashion.

If you live in a rural area, chances are that your local hospital will lose millions of dollars in funding, which will force many rural hospitals to turn away patients and close their doors. This is not an exaggeration. I encourage every Republican Member of the Senate, Member of the House, citizen out there to ask their health care leaders in rural hospitals what is about to happen. They are in a panic.

Let's be totally clear about what this means. You lose rural hospital money and you lose rural hospitals. For a lot of small towns, from Hawaii to the Dakotas, to the Carolinas, and everywhere in between, the rural hospital is the economic center of the community. It is often by far the largest employer. I want you to understand, if a rural community loses its rural hospital, a lot of the working-age folks leave. They move to a more urban area.

What happens is, the elderly citizens also have to leave because if you need access to emergency services but you are nowhere near any of that care, you are going to have to go too. So there is not a single thing we can do in the Congress that would harm rural communities quicker than what is being done this week by the Republicans.

I want to be really clear about how much harm is about to be done to rural communities, not just rural health care providers, not just nurses and doctors and technicians and admins and janitors and everybody who works at those rural hospitals.

That is important because in a lot of instances, that is the economic driver of a small town. It is also about, people start to make choices with their own life and with their own planning, especially as they get older, and they think to themselves: How do I stay close to health care? If that rural hospital goes away, that rural town goes away.

We have seen it in Hawaii. That is why we fight for Molokai Community Hospital. That is why we fight for Lanai Community Hospital. That is why we fight for Waianae Coast Comprehensive Treatment Center. That is why everybody fights so hard for their community rural hospitals-- because it is the center of a community, not just economically, but without it, you basically have no community.

All of this will cause the entire insurance market to unravel, raising costs for everyone. This means families are going to pay more for prescription drugs, pay more on their premiums, and pay more for out-of-pocket costs.

So if the Republicans are still unfazed by the health impacts of the repeal I just outlined, and have been outlining for the last 4 or 5 hours, over the last 3 or 4 days, there is another reason to be extremely cautious about what is about to happen. As we know, the vehicle for this is a budget resolution, right? They are trying to characterize this as, no, it is not a budget resolution.

The only reason they are doing it as a budget vehicle is so they can do reconciliation. What does that mean? That means they only need 51 votes, where otherwise they would need 60 votes, but this is a budget. If it were not a budget, they would not be subject to the 51-vote threshold. This is the Federal budget. This Federal budget increases the deficit by trillions of dollars.

This Federal budget increases the deficit by trillions of dollars-- not trillions of dollars at a flat line with the previous Federal budget, this is trillions of dollars more than last year's Federal budget.

So if you are a fiscal hawk, gosh, you must be swallowing hard over the next couple of days. This must be a bitter pill to swallow because on the one hand, boy, do you hate ObamaCare. On the other hand, boy, do you hate running up the national deficit--not the debt, deficit--by trillions of dollars. This is insane. This deficit--what we are doing to the debt and deficit in the next 2 or 3 days makes everything that we have done in the last 3 or 4 years pale in comparison.

If you are a fiscal hawk, I cannot see how you get to yes on this. You cannot vote to increase the national debt by trillions of dollars and then still call yourself a fiscal hawk. So we have a choice in front of us. Do we build on the progress of the Affordable Care Act or do we strip millions of Americans of their health care coverage, leave those with preexisting conditions out in the cold, and raise the national debt?

We know ACA has its flaws. No one ever said it was perfect. Let us be clear. Every major piece of legislation, every signature piece of legislation that this body has ever passed has been flawed in some way. What do we do when we are a functioning world's greatest deliberative body? We iterate it. We work on a bipartisan basis to fix it. That is what we should do.

The benefits of ACA are undeniable. That is what we should be debating, improvements to the ACA, not an implosion. So let's keep our eye on the ball and remember what our common goal is: giving every American the opportunity to get quality, affordable health care they deserve.

I yield the floor.

That is the first time the Senate has ever ended with that one.

Mr. President, once again, congratulations on your election. I haven't gotten a chance to talk with the Presiding Officer in detail about his path to the U.S. Senate, but I have had a chance to talk to a lot of my colleagues about how they got here, and I think we can all agree it is not often a real pleasant experience. You get your name dragged through the mud. You get called all sorts of names. You have to call lots of friends and strangers and ask them for money. It is no walk in the park to run for political office or to put your name out there and be the subject of both praise and a lot of ridicule.

It is not surprising the reason that people do this. The reason that the 100 of us have decided to run for office and to put ourselves out there in the public spotlight is because we deeply care about our neighbors, about the people who live in our States. We are doing this job, to a man and woman, because we want to make life better for people; in particular, people who have been just thrown big curveballs by life.

I grew up in a pretty economically secure house, but I understand a lot of kids don't have that opportunity, and I feel like both Republicans and Democrats are here because we want to lift those kids up. I have had a pretty healthy life, a few bumps and bruises along the way, but I feel like both Republicans and Democrats are here because we get that other people aren't as fortunate. They got sick. They got diagnosed with something terrible. Our role should be to try to help get them some cures or some treatments.

We are here not because we think it is fun to run elections, we are not here because we like the look of our name on the door, we are here because we care desperately about people. I think this is what Senator King was getting at in his remarks. All of the tabloids and the TV news shows, they spend 80 percent of their time focusing on politics, and we end up chasing our tail off in here because if the daily political rags and the cable news shows are talking about politics, then maybe we should be talking and thinking about politics as well, but that is not why we decided to do this. We decided to run for the Senate because we care about people.

Why we are here tonight is pretty simple. Ultimately, the repeal of the Affordable Care Act, with no replacement, with no plan for what comes next, will hurt millions of real people in very real ways. In the end, I don't believe that my Republican colleagues want to cast a vote that will do that.

This tall guy right here is Josh Scussell. He lives in Connecticut. He is from Guilford. He is standing next to his bone marrow donor and her boyfriend. This is Josh's wife. Josh was diagnosed with stage IV non-Hodgkin's lymphoma in 2012.

Here is what Josh says. He will tell you the unvarnished truth. Josh says: ``The ACA is entirely responsible for me still being alive.''

He relapsed after an additional diagnosis before he turned 26, and the only way he was able to get insurance was because of the Affordable Care Act, which allowed him to stay on his mother's insurance up until he turned 26. During the course of his treatments, he underwent stem cell transplants, which could be up to $200,000 each. Because of those transplants, he needed ongoing weekly treatments at a cost of $10,000 per treatment.

He recalled how he was getting his first stem cell transplant and he was in the hospital during the Supreme Court deliberations on the Affordable Care Act. He said, ``I was in a hospital bed watching the TV, when the Supreme Court approved the ACA, and just the feeling I had in my body was a feeling that I had never experienced before because I knew that I was going to be taken care of.''

Josh is in remission. In a few more years of being cancer-free, the doctors tell him he might be out of the woods. He says, ``I'm more fearful for other people in my position. . . . Because there's no way I would have been able to afford any of those treatments'' if it wasn't for the Affordable Care Act.

This little guy, his name is Rylan. This is his mother Isabelle. Rylan was born with a congenital heart defect. One day he had to be rushed to Connecticut Children's Medical Center for emergency open- heart surgery to keep him alive. Isabelle says that she never really thought about health insurance. She knew she had it, but she didn't really think about it until Rylan went for that emergency surgery. She thought: Oh, no, is our insurance going to cover it? Will they cover all the treatments he needs going forward now that he will have had a preexisting condition? She found out that the Affordable Care Act protected her because it eliminated a common practice of insurance companies to cap the amount of coverage you get in any one given year or over the course of your lifetime.

Isabelle tells it plainly. She says:

Without the Affordable Care Act, we would have never been

able to afford the care for Rylan. We would have had to make

awful decisions--decisions about whether we kept our house,

kept our car, whether we could still afford to work.

It was the Affordable Care Act that protected her and her family.

Finally, this is John. John is a hero in my book. John was born with cystic fibrosis. John tells the story about how health care is the most important thing to him in the world. It is more important than salary. It is more important than his job. It is more important than friends. He struggles every day to live. The only way he lives is that he is able to take medications that allow him to continue to breathe and that allow his lungs to continue to function amidst this crippling disease and diagnosis.

John is on the Affordable Care Act, and John will tell you, just as plainly as Josh and Isabelle, that without the Affordable Care Act, he would die--not 2 years from now, not 3 years from now. John would die within a matter of weeks because without his medications, he cannot live.

It is not hyperbole to suggest that the absence of the Affordable Care Act is a matter of life and death. John will tell you that without the Affordable Care Act, he doesn't have insurance. Without insurance, he cannot afford the medications to keep him alive. Without the medications to keep him alive, John disappears from this Earth.

These are real people. I care about them because I know them, and I have had the chance to meet John and Isabelle and Josh. But you have these people in your State as well. My Republican colleagues have just as many of them. Some of the biggest numbers of enrollment in the Affordable Care Act aren't in States represented by Democrats; they are in States represented by Republicans. And this mythology that the Affordable Care Act hasn't worked or that it is in some death spiral is just political rhetoric. It is not true.

This is an AP fact check story from today, I believe. Here is the beginning of it. It says:

President-elect Donald Trump says that President Barack

Obama's health care law ``will fall of its own weight.''

House speaker Paul Ryan says the law is ``in what the

actuaries call a death spiral.''

And Senate Majority Leader Mitch McConnell says that ``by

nearly any measure, ObamaCare has failed.''

The AP says:

The problem with all these claims: They are exaggerated, if

not downright false.

The Affordable Care Act has not failed for the 20 million Americans who have insurance now because of it. The Affordable Care Act has not failed for the millions more who are paying less because insurance companies can no longer discriminate against them if they have a preexisting condition. The Affordable Care Act has not failed for seniors all across this country who are on Medicare and are paying less for prescription drugs.

There is no doubt that the Affordable Care Act isn't perfect. Medicare wasn't perfect when it was passed. We amended it 18 different times. The Affordable Care Act needs to be amended and perfected, as well, but if you really care about people instead of political headlines, then the prescription here is simple: Stop. Take a step back. Don't

lurch the entire health care economy into chaos when you don't have to.

I am pretty sure that Donald Trump is going to be President for the next 2 years. I am pretty sure that Republicans are going to control the Senate and the House of Representatives for the next 24 months. You have time. You don't need to prove some point to the political talk show hosts and the conservative radio commentators. You can step back and rescue these real people from the fate that you are about to subject them to by--instead of engaging in a partisan repeal with no replacement for what comes next--reaching out across the aisle and working with Democrats to try to fix this law.

I have been here the last 6 years. I was part of the passage of this law when I was in the House of Representatives. I have listened to my colleagues say, literally tens of thousands of times in Washington and across the country, that their priority was to repeal and replace this law. I watched on TV our President-elect say in response to a question about the process for health care repeal going forward:

No, we are going to do it simultaneously [repeal and

replace the law]. It'll be just fine. We are not going to

have, like, a two-day period and we are not going to have a

two-year period where there is nothing. It will be repealed

and replaced.

There will not be a 2-day period in between repeal and replace. And that is what I heard from my Republican colleagues: Put your vote where your mouth has been because the alternative is a death spiral.

The Associated Press calls the mistruths out and says: No, the Affordable Care Act is not in a death spiral. But those same health care economists who are quoted in that story will tell you that if you repeal this bill without any replacement for what happens next, that is what creates the death spiral. Why? Because when you put a clock ticking on the life of the Affordable Care Act, then a couple of things happen. First, people who need some procedure done rush into those exchanges and they drive up the actuarial cost, and insurers just look at themselves and say: Why would you hang around for that? And they bolt. So the Affordable Care Act falls apart if you telegraph to people that you have only 1 year or 2 years left.

You don't have to do this. You don't have to visit that kind of harm on real people. I know that is not why Republicans ran for office. I know we have philosophical differences on how to get health care to people, about how to insure more people, but let us sit down and figure out a middle ground so we can save the lives of all these people who are relying on us.

What we are doing right now is extraordinary. This is absolutely extraordinary. We were sworn in less than a week ago. The new President has not even been inaugurated. There isn't even a conceptual plan for what will replace the Affordable Care Act, and we are rushing forward with repeal. There is an enthusiasm to this cruelty that is hard to understand.

I hope that some of the Republicans who just in the last 24 hours have called for a delay in this debate are heard by Republican leadership. I know that Democrats will continue to be on this floor to make this case. I guess I am still optimistic enough about what is still a pretty broken town that, in the end, my Republican friends aren't so cold-hearted, aren't so barbaric as to take away insurance from people like those we have been talking about here today when there is an alternative, when there is another way, when there is no political imperative to do this kind of damage to people right now.

I yield the floor.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I come to the floor with a lot of other folks to talk about the health care in this country. I think one of the goals we all share--and maybe we are not sure how to get there--is how to make sure that everybody who needs access to health care has it, that it is affordable, and that they get reasonably good quality, whoever they are and wherever they come from.

When I was a naval flight officer, we used to fly a lot of missions out of Japan during the Cold War. I have a special interest in Japan, and I like the folks there. They are pretty remarkable in what they have achieved over the years. One of the things they have achieved over the years is providing pretty good health care for a fairly modest amount of money.

We started working on the Affordable Care Act 7 or 8 years ago. One of the things I learned about Japan was that they were spending 8 percent of their gross domestic product for health care in their country. We were spending 18 percent. As it turns out, they were getting better results. They had lower rates of infant mortality and higher rates of longevity. People lived longer. Newborns died less frequently than we did. On top of all that, in Japan they covered everybody. Everybody was covered for health care. We had about 40 million people--over 40 million people at the time--whose health care coverage was to get into an emergency room of a hospital, try to get in line, and get someone's attention.

I know how smart the Japanese are, but I don't think they can be that smart and we can be that dumb. That is sort of where we were 6, 7 years ago. So we said: What are we going to do about it?

I think almost every President--maybe since Truman--had a goal of making sure everybody in this country had access to health care. A lot of folks talked about it and maybe tried to do something. The first time we had a serious effort to do that was during the Clinton administration, not led by President Bill Clinton but led by First Lady Hillary Clinton. What she came up with and worked on was something called HillaryCare.

The Republicans came up with an alternative to HillaryCare introduced by the Republican Senator from Rhode Island, John Chafee--a really good guy, a very able guy. I actually served with his son Lincoln in the Senate. But in 1993, 1994, when most people focused on HillaryCare, John Chafee introduced legislation with 20 or so Republican cosponsors. A couple of them are still here, I think. Senator Orrin Hatch was one of them, and Senator Chuck Grassley of Iowa was one of them--maybe a couple of Democrats, as well. But 20 to 25 Senators, mostly Republican, cosponsored the Chafee legislation.

This chart mentions the Chafee bill and what was included in the Chafee legislation. One of the things included was the individual mandate--basically, that everybody had to get coverage.

Second was the employer mandate, which basically said that employers had to provide health care coverage for their employees--maybe not for everyone, maybe not for the smallest businesses--but getting employers to meet what Senator Chafee and other Senators thought were the employers' obligations, their responsibilities.

In the Chafee legislation there was a ban on preexisting conditions.

In the Chafee legislation there were subsidies for purchasing insurance. Purchasing it where? Purchasing it in State exchanges. The idea of creating large purchasing pools--there were folks who didn't have health care coverage who could get their health care coverage in a large purchasing pool. If their income was low or relatively low, they would be eligible for tax credits to buy down the cost of their health care coverage. They would get theirs from the exchanges and the purchasing pools.

Those were all ideas in Senator Chafee's legislation in 1993. Do you know what? I am a Democrat and probably shouldn't say this, but I thought they all made sense.

The legislation didn't go anywhere. In the end, HillaryCare didn't go anywhere. But long before we had serious debate on the Affordable Care Act, people were talking about the same thing.

You go over here--RomneyCare in 2006. Individual mandate: Got it. Employer mandate: Got it. Ban on preexisting conditions? Yes. Subsidies for purchasing insurance? Yes. Establish State purchasing groups? Yes. Those are all in RomneyCare.

I have always given Governor Romney credit for the idea of the individual mandate, but apparently that was wrong. It was in Senator Chafee's legislation as well. Governor Romney took the handoff, if you will, from Senator John Chafee and introduced what they call RomneyCare in Massachusetts. It was introduced in 2006.

When it first was introduced, they had real good success in getting people covered. It was successful in terms of getting people covered. Where they were not so successful initially was affordability. They had to work on affordability. Part of the problem there was it took a while for the healthier, younger people who did not think they needed health care coverage because they were young and invincible. It took a while for them to start.

They said: The fine keeps going up year after year after year. Maybe I should get some health care coverage and not pay the fine. Ultimately, I think RomneyCare did a much better job on affordability.

If you take those five key provisions, the individual mandate, employer mandate, ban on preexisting conditions, subsidies for purchasing insurance, and establishing the State exchanges--key provisions in the Chafee bill--they are in RomneyCare. Believe it or not, they are in the Affordable Care Act.

I know some of our Republican friends think that nobody listened to them when we wrote the Affordable Care Act. Actually, these are your ideas. These are your ideas. Some of the provisions or aspects of the Affordable Care Act that our friends across the aisle have been most critical of are things that were originally their idea--originally their idea.

Then we changed this thing. Senator Sanders who has joined us on the floor. We added to that. We expanded Medicaid. We said to States--we didn't make them expand Medicaid, but we said: If you do, the Federal Government will pay the lion's share of the increased costs in Medicaid. I think initially maybe 24 States signed up and said: We will do that, including the District of Columbia. Later on, another seven or so, eight States--I think Indiana is one of those that decided, under then-Governor Pence, to expand Medicaid up to about roughly 135 percent of poverty from maybe closer to 100 percent of poverty for most States.

That is a little bit of a good history lesson. I think we have another chart we can look at. It is a pie chart. Sylvia Matthews Burwell came by--the Secretary of Health and Human Services came by a month or two ago and talked to our Democratic Senate caucus. One of the things she said to us that I thought was especially informative was she talked about this pie chart.

What she said is: Think of this pie chart. It includes about 300 million Americans who get health care, at least those who get some kind of health care other than emergency room. She told us that roughly half of the people, a little bit more than half of the 300 million people among the Americans who are getting health care--a little over half, 57 percent--get their coverage through employer coverage. The employers provide that as a condition of employment. Another roughly 22 percent-- that is this area, sort of the brown area--is Medicaid and

the S-CHIP program, the Children's Health Insurance Program, a bipartisan idea. Bill Roth worked on that, the Clintons, and others. I even worked on it as Governor. About 15 percent--this area right here, the green--is Medicare. Then down here you have the individual markets, the marketplaces, and so forth.

There are roughly 5 or 6 percent down here where people are getting their coverage. A lot of the attention, a lot of the criticism of the delivery of health care in the last 6 or 7 years by our friends on the other side has been down here with the marketplaces, the exchanges. Those were their ideas.

One of the nice things the Affordable Care Act has done--not many people know this--but the Medicare trust fund, which is in danger of running out of money, the life of that trust fund has been extended by 12 years because of the Affordable Care Act. The Medicaid pieces have been--the Secretary of Health and Human Services, Sylvia Matthews Burwell, has negotiated with a number of Governors to try to give them the opportunity to sort of customize their Medicaid programs.

I think maybe in Indiana they wanted to have a small copay for the people who participated in Medicare. That is what they got. So it is not all one size fits all, but there is some differentiation between Medicaid. Now we have roughly two-thirds of the States that have signed up for Medicaid expansion.

So that is just a little visual. Do we have another chart here? The question is, Who gets hurt by repealing the Affordable Care Act? If we just repeal the Affordable Care Act, and we don't replace it at the same time we repeal it or change it, a lot of people will get hurt, including a lot of people who are in the exchanges and getting health care coverage maybe for the first time in a long time, and actually folks who are not in the exchanges, people who get their health care coverage in all kinds of ways, including employer provided, Medicare, and Medicaid, or privately purchased.

We don't need the kind of uncertainty, the lack of predictability that would be created by repeal without having a very clear picture of what we are going to replace it with at the same time--not a year from now, not 2 years, not 3 years, not 4 years from now but at the same time. That is what we ought to do.

I will close with this. I note one of my colleagues from a big State up to the northeast of us has a few things he wants to say. I welcome hearing him.

My dad used to say to my sister and me when we were kids growing up, a little younger than our pages--we would do some bone-headed stunt, and he would say to my sister and me: Just use some common sense. That is what he would say. Just use some common sense. He said it a lot. We must not have had much.

Well, just repealing the Affordable Care Act and not having something to replace it with immediately that provides coverage just as good-- affordable, comprehensive coverage--that would not be very good common sense. We can do better than that. We can do better.

I hope our Republican friends, with this rush to judgment to repeal and replace 2 or 3 or 4 years down the line, can come around and say: No, that does not make much sense. I hope they will listen to some of their colleagues and some of the rest of us who say: If we are going to repeal the Affordable Care Act, let's know what we are going to replace it with, and make sure we do that on day one.

With that, I am happy to yield the floor to my friend from Vermont.

Mr. President, I would just say, I had the pleasure of sitting here listening to the Senator from Connecticut talk about his concerns about repealing ObamaCare, and I would say it strikes me that their posture is that we sold the American people a lemon, and we insist they keep it.

Our position is that ObamaCare has been a failure. It has been a grand--in terms of scale--experiment, a national experiment that has failed.

Yesterday I talked about the fact that my constituents are writing me and telling me that their premiums, in many instances, have doubled, and their deductible has gotten to the point that they are effectively self-insured so their insurance does them virtually no good.

We will vote to repeal ObamaCare, but obviously we are not going to leave people hanging out to dry. We are going to make sure they have coverage that they choose and that they can afford. I welcome the assistance of our colleagues on both sides of the aisle to try to craft a bipartisan reform.

The biggest failure of ObamaCare was the fact that when our Democratic friends had 60 votes in the Senate and they had President Obama in the White House and a majority in the House, they jammed it down the throats of the American people. That is really why ObamaCare is unsustainable--because it was purely a partisan political exercise. We need to start over by repealing ObamaCare and then reforming our health care system so people can buy the coverage they want at a price they can afford. We are going to work very carefully to make sure the transition is thought out, methodical, and very carefully done.

Nominations

Soon, Mr. President, we will be considering and confirming men and women nominated by the President-elect to fill leadership roles throughout the administration. This is crucial to ensuring a smooth transition from one President to another, and it is important to make sure the next President has the people and resources he needs to help lead our country.

I have had some of the reporters in the hallway say: How in the world can you process so many nominees at the same time, so quickly?

I said: It is the tyranny of the calendar. We are going to have a new President on January 20, and wouldn't you want--for example, the President's CIA Director choice, the Attorney General, the Secretary of Defense, the head of the Department of Homeland Security, the Director of National Intelligence--wouldn't you want all of those key national security positions filled as soon as possible in case some of our adversaries decide to take advantage of this transition to try to threaten the United States?

It makes sense to me that we would work in an orderly sort of way with our colleagues across the aisle to make this transition a smooth one from President Obama to President Trump. President Obama has said that is what he is working to do, and you would think it would make sense for us to be a part of the solution and not a part of the problem.

Holding up confirmations just for delay's sake is irresponsible and it is dangerous. As I speak, there is a hearing going on on the foreign cyber threats in the Senate Armed Services Committee. People are justifiably concerned about what our adversaries are doing in cyber space. But it is not related to just cyber space, it is related to nuclear threats from countries such as North Korea, obviously the ongoing humanitarian crisis and civil war going on in Syria and elsewhere, the threats from Russia not only in cyber space but also to our NATO allies in Europe, and I could go on and on talking about Iran and its nuclear aspirations, its ballistic missile capability.

This is a dangerous world we are living in, and why in the world would we want to make it even more dangerous just to let our colleagues delay for delay's sake President-Elect Trump getting to fill his Cabinet, particularly these important national security offices? The truth is, when it comes to wanting what is best for America, we are all on the same team. We should all want what is best for our country. It doesn't do our Democratic colleagues a bit of good to delay the inevitable because, thanks to former Democratic leader Harry Reid and the so-called nuclear option that changed the Senate confirmation rules, we know that President-Elect Trump's Cabinet members will be confirmed. It is going to happen because it takes 51 votes. Just delaying for delay's sake out of partisan pique really doesn't do anything to accomplish any goal but, rather, makes our country more dangerous and denies the President-elect the Cabinet he has chosen.

When President-Elect Obama was nominated to office, we acted very quickly. In fact, on the day he was inaugurated--January 20, 2009-- seven of his Cabinet members were confirmed. We were not happy about the outcome of the election on this side of the aisle. We wished a different electoral outcome had occurred. But once the voters had spoken, we accepted their verdict, and we worked cooperatively to see a smooth transition from the Bush administration to the Obama administration. I believe it is our duty to do that. Nearly all of President Obama's Cabinet-level nominees were confirmed within the span of 2 weeks. We came together, understood that the people had spoken, and we went to work to cooperate in good faith, not necessarily because we were happy about the outcome but because it is our responsibility to do so.

Then there are some of the statements from some of our colleagues across the aisle that they now appear to be walking away from. In the spring of 2015, Senator Stabenow, the senior Senator from Michigan, said: ``When a President wins an election, they have the right to have their team.'' She said that on April 20, 2015. I hope that not only the Senator from Michigan but her other colleagues remember that position they took then and simply reciprocate in good faith during this transition.

Senator Stabenow is right, by the way. No matter which side you are on, we know that the voters have spoken. As President-elect, he has the authority to surround himself with those he sees fit to advise him and help him as he serves our country.

For some of our colleagues to suggest that keeping the President understaffed is somehow in the best interest of the American people is palpably false. It is ridiculous. I mentioned the national security nominations the President-elect has indicated. One of those first ones was Senator Sessions, our colleague here in the Senate, the junior Senator from Alabama, to serve as Attorney General of the United States. The Attorney General is not only the head of the Department of Justice and has an important law enforcement role, the Attorney General also has a very important anti-terrorism national security portfolio as well. So it is very important that people like Senator Sessions, the Attorney General nominee, be put in place on a timely basis for the safety of our community.

Talking about the nomination of Attorney General Loretta Lynch not even 2 years ago, the senior Senator from Vermont urged a quick confirmation, saying: ``Confirming the top law enforcement position should be an urgent priority of the Senate.'' And he is right.

As the minority party is now considering the political strategy of obstruction, delay, and stall tactics, what has changed except that your preferred candidate did not win and our preferred candidate did win? That is the only thing that has changed.

Another nominee the Senate will consider is the President-elect's choice to fill the Supreme Court vacancy left by the death of Justice Scalia. Last year, after the death of Justice Scalia, we promised the American people that the next President, whether it was a Republican or a Democrat, would nominate the successor to Justice Scalia. We didn't say we would only vote to confirm a Republican President's nominees; we said that the American people had a right to a voice in who would make that choice, recognizing that the next Justice on the Supreme Court could serve 25 or 30 years.

Here we are 15 days before the President-elect is sworn in to the White House and the minority leader is already threatening to deny the voices and the vote of the American people from last November by blocking any nominee indefinitely.

As shocking as it sounds, on Tuesday night, just hours after the 115th Congress was sworn in, Senator Schumer, the Democratic leader, was asked in an interview on MSNBC if he would ``do his best to keep the seat open.'' He answered with one word: ``Absolutely.'' Despite months of calling for a full Supreme Court, all nine members, even using the hashtag ``We need nine,'' the Democratic leader is now threatening indefinite obstruction.

Republicans were clear with the American people: We would respect their voice in whom they wanted to pick the next Supreme Court Justice, whether it was a Democrat or Republican in the White House, and we would move forward with that nominee in the new Congress.

I hope our Democratic friends don't slow-walk President-Elect Trump's nominees. It is one thing to obstruct, but it becomes an even bigger problem when they intentionally try to keep President Trump from doing the job the voters have given him the responsibility to do.

The American people made clear in November that they are done with

business as usual here in Washington, DC. Frankly, I don't think it was a robust endorsement of either one of the political parties. We got an unconventional President-elect, and I think the American people expect him to shake this place up, and I think he will. We intend to work with him to make sure there is a positive outcome for the American people. I don't think they are interested in political stunts or delay for delay's sake, nor do they want us to return to the dysfunctional do- nothing Congress of the past. They want results, and they want a path forward toward a brighter future for themselves and their families.

Let's not keep from President Trump the men and women he has chosen to work alongside him. That would only make us less safe, our economy more fragile, and the government less efficient. After all, we are paying the bills as taxpayers. Why would we want a less efficient or less effective government? In short, it will not serve the interests of the American people well.

I know we are ready on this side of the aisle to roll up our sleeves and get to work. As I have learned through hard experience, the only time anything ever gets accomplished in the Senate is when we work together. I am not talking about people sacrificing their principles. We ought to fight like cats and dogs when it comes to our basic principles. There are a lot of things that are outside of the realm of principles where we can find common ground and work together and build consensus. I think we ought to take advantage of this historic opportunity to do just that, starting with confirming the President's Cabinet and letting them get to work to help his administration as soon as possible.

I yield the floor.

Mr. President, I rise with my colleagues, and I am thrilled to be here with them, to save our health care and to try to convince our colleagues that a repeal of the Affordable Care Act would be health care malpractice, and because health care is one-sixth of the American economy, it would be economic malpractice as well.

What I thought I would do basically is just tell two stories. I am going to tell a Virginia story from before the passage of the Affordable Care Act, and I am going to tell a Virginia story since the passage of the act.

I was first elected to statewide office in 2001, and I became the Lieutenant Governor of Virginia. Shortly after, I started to attend, on a fairly regular basis, a most amazing annual event. It is called the Remote Area Medical clinic in Wise County, VA. It is in the heart of Appalachia, in a community on the border of Kentucky where my wife's family is from. This was an annual medical clinic that was set up by some Catholic nuns who were driving a van around trying to offer medical care to people who didn't have it, and they decided they would recruit volunteers. They would set up at a dusty county fairground, the Virginia-Kentucky fairground in Wise, VA, and open the doors on Saturday to people who didn't have health care. It had been going for many years when I first went as Lieutenant Governor. I had heard so much about it, and I was anxious to go see it.

Here is what I saw when I first went there. People start to come on about Tuesday of the week when it is going to open on Friday, and they come in groups of three or four families, and then they come in groups of ten or dozens, and then hundreds, and then thousands, to this dusty county fairground in late July--hot in Southwestern Virginia. They gather so that on Friday morning, at about 7 o'clock when it opens, they have gotten a number, they know where they are in the line, and sometime over the course of Friday and Saturday, they will be able to see a doctor, in some instances for the first time in their lives. There are doctors, dentists, medical students, the Lions Club volunteers to give vision screenings, hundreds of volunteers, and thousands of people seeking medical care.

The first year I went to this, I was overwhelmed at the magnitude of the philanthropic spirit of the volunteers, and I was also overwhelmed at the depth of the need. Something made it more palpable by walking around the parking lot to see where people had come from.

This is a community that is on the border of Virginia and Kentucky so I wasn't surprised to see Virginia license plates and Kentucky license plates. It is kind of near West Virginia so I wasn't surprised to see West Virginia license plates. It is near Tennessee. I saw Tennessee license plates. I saw North Carolina license plates. What struck me as I went through the parking lot was to see license plates from Georgia and license plates from Alabama and license plates from as far away as Oklahoma.

We are the richest Nation on Earth. We are the most compassionate Nation on Earth. Yet, in order to get medical care, people would get in their cars and drive for days, and then camp for days, for the chance to see a doctor or a dentist.

It reminded me that first year, and it reminds me still, of the way health care was delivered in the poor country of Honduras where I served as a missionary in 1980 and 1981. There wasn't really a health care network. Occasionally, missionaries or others would set up a clinic in a mountain community once a year--maybe less than that--and people would gather, and that was the way we were delivering health care in a successful State, in the most compassionate and wealthiest Nation on Earth. It is just not right. It is just not right.

The RAM clinic still goes on. It hasn't gone away, but I will tell my colleagues what has happened since the passage of the Affordable Care Act. The percentage of Americans without health insurance has dropped from over 16 percent to about 8 percent. It has almost been cut in half, and the uninsurance rate in this country is at its nearly lowest percentage since we have been able to record that number. That means there is less of a need for the RAM clinics because more people can have a medical home and can seek care. That decline has also been significant because in Virginia, we were about 14 percent uninsured in 2010, and that number has now come down to about 9 percent.

So that first story--the story of this RAM clinic, pre-Affordable Care Act, with one in six Americans not having health insurance--we have done a good thing as a Congress to provide access to dramatically reduce that number.

Let me tell my colleagues a second story. The second story is just about a family, a story in a letter that I received just a few days ago. It is a different aspect of the Affordable Care Act. It is not so much about the reduction in the uninsured, but it is about more peace of mind and security for the majority of Americans who do have health insurance.

Dear Senator Kaine,

As a Senator, you have been charged with an immense task.

Your constituents rely on you to work on our behalf to uphold

and protect the freedoms we enjoy as Virginians and

Americans. We also rely on you to safeguard the legislation

that exists to keep our family and so many of our friends and

neighbors healthy and safe.

When I graduated from the University of Virginia, I was

fortunate to enter a career through which I received

excellent benefits. I taught second grade and kindergarten in

both Chesterfield and Albemarle Counties. My health insurance

was comprehensive and affordable. I didn't know how good I

had it.

After years in the classroom, I put my career on hold while

I stayed at home with our children. We were so lucky to have

been in a position to be able to make that choice. I know

that being able to rely on a single income is not a reality

for many Virginians. We enrolled in a private health

insurance plan through my husband's company, a small business

based out of Richmond, Virginia.

Our new plan came at a higher cost than my excellent

public-school teachers' insurance, but it was comprehensive

and it allowed my husband and me, and especially our

children, access to outstanding health care. Just this past

year, my husband, who was by then a part-owner in the

company, left his position to open his own Financial Advisory

firm. It was a move that was made easier because we had the

option of enrolling in a health insurance plan through the

Affordable Care Act, which we did in July of 2016.

In addition to well checkups, sick visits, prescriptions

for antibiotics, and vaccinations, we rely on our health

insurance made affordable through ``ObamaCare'' to, quite

literally, save our children's lives.

Our oldest son is ``medically complex.'' He was diagnosed

with multiple and severe food allergies when he was just 10

months old. Though he was initially highly reactive to over

13 foods, with the help of a vigilant pediatric allergist,

multiple blood draws, tens of skin prick tests, and four in-

office, hours-long oral food challenges, my son can now

safely eat all foods except for nuts, peanuts, milk, and

shellfish. Still, we pay a premium for life-saving

prescriptions that we hope he'll never need: Epi-pens. He

needs one at school and one that travels with him from home

to extracurricular activities. Even after insurance, we pay

nearly $1,000 each year for these prescriptions.

In addition to his pediatrician and allergist, we have been

to a psychologist for his anxiety and a cardiologist for a

detected heart murmur. More recently, after his pediatrician

became concerned about his stagnation on his growth chart, my

nine-year old has been subjected to more blood draws, weight

checks, countless hemoglobin level checks, and a consultation

with a gastroenterologist. Next week he will undergo an

endoscopy and a colonoscopy to, hopefully, diagnose a

treatable condition that, once known and treated, will enable

him to get back on that weight chart and thriving.

Because of our health insurance, we have the peace of mind

of being able to afford these doctors' visits, lab work, and

medical procedures for our son. Our medical insurance through

the Affordable Care Act allows us access to the best medical

care and professionals in our area.

Please do what is right for our family. Please do what is

right for your constituents. Please do what is right for our

country. Please save the Affordable Care Act.

Thank you for taking the time to read one little piece of

our family's story.

Sarah Harris, Crozet, VA.

My first story was about people who didn't have health insurance. My second story is about people who do have

health insurance, but the health insurance is now affordable and comprehensive. My second story about the Harris family is also about something else important. Her husband was able to leave a job with health benefits to start his own company, which we want to encourage in this country. We want to encourage entrepreneurs. We want to encourage innovators. Before the Affordable Care Act, somebody like Mr. Harris couldn't leave his job and start a company because he wouldn't have been able to buy insurance that would have covered a child with a preexisting condition. Imagine being a parent with a dream, like so many have, of starting your own business, and realizing you could not achieve that dream and you would have to put it on hold because if you changed your job, you would not be able to get health insurance for your child.

I gave a speech about this on the floor last week. I will just conclude and say this. Health insurance is to provide a protection for you when you are ill or injured, but that is not all it is about because if you are a parent, even if your child is healthy, but you do not have health insurance, you go to bed at night wondering what is going to happen to my family if my child gets sick tomorrow or if I am in an accident tomorrow. Who is going to be there? How is my family going to be taken care of?

So what the Affordable Care Act is about is, as Sarah Harris said, peace of mind. It is about coverage, but it is also about the peace of mind that you need as a parent to know that your child will be protected if you are ill or if your child is injured. That is what the Affordable Care Act has done for the Harris family of Crozet, VA. That is what it has done for tens of millions of Americans.

The Urban Institute indicated that if the Affordable Care Act is repealed without a replacement, or even a delayed replacement, it could cause 30 million Americans to lose their health insurance--and 30 million Americans is the combined population of 19 States in this country. This is not a game. This is very, very serious, life and death, that we are grappling with in this body. My strong hope is that our colleagues will join together and decide that we want to fix and improve the health care system of our Nation but not break it.

Mr. President, I yield the floor.

Madam President, I hear my Democratic colleagues praising ObamaCare. I had to smile yesterday. I heard a colleague talking about how ObamaCare was addressing high pharmaceutical costs. I had to start laughing--and kind of a bitter laugh. Tell that to a senior who is paying $6,000 for her medicine, which before ObamaCare passed was a fraction of that.

We hear how great it is that ObamaCare has given so many people coverage. Say how great that coverage is to someone who has a $6,000 deductible--a $6,000 deductible--who does not have $400 in her checking account. There is a friend of mine--people don't believe it so I put it on my Facebook page. He got his quote for him and his wife. They are 60 and 61 years of age. Their premium for 1 year was $39,000, each of them with $6,000 deductibles. Again, it is on my Facebook page because otherwise no one would have believed me.

So when people speak about the affordable health care act, I have to laugh. If this is affordable, what would be unaffordable? We can clearly do better than this.

I begin this speech by calling into question my Democratic colleague's defense of ObamaCare, but we can have common ground. I applauded and still applaud the goals of those who support the Affordable Care Act. They wish to have coverage for all. Now, that is important. For over 30 years, I have worked as a physician in a hospital for the uninsured. My medical practice has been geared toward bringing coverage, to bringing care to those who otherwise would not have it.

As I look at this issue, I have to thank them for their motivation but have to recognize that the Affordable Care Act has not achieved that in a way which most Americans find affordable. The other thing about ObamaCare is that it coerces Americans. It takes power from patients and States and gives it to Washington, DC, coercing the individual with mandates and penalties, taking away her right to choose. That is not where the American people wish to be.

I would like to believe Republicans and Democrats can find common ground. I have introduced a replacement plan that would give States the power. I am willing to concede, the minority leader believes that ObamaCare is working just fine in his State of New York. In my plan, we repeal ObamaCare on a Federal level, but if a State like California or New York thinks ObamaCare is working for them, God bless them.

Under my plan, a State legislature would have the right to stay on ObamaCare. So here Congress would pass the legislation giving States the choice, and the State would either have the option we advance, which I think is superior--but when Republicans say that you can keep your health insurance if you wish, and we mean it, we mean it. If a State decided they wished to stay on ObamaCare, they could or if a State truly decides they want to have nothing at all to do with any of this, they can totally opt away from the Medicaid expansion, from any help for others in their State to purchase insurance, period.

I think this recognizes that if the minority leader wants to claim it is working in New York, they can keep it, but clearly ObamaCare is not working in some other States. We can talk about Arizona, where briefly a county did not have a single insurance company providing insurance and where premiums increased by as much as 100 percent. We can look at Louisiana, my State, where that quote I gave earlier--a fellow and his wife, $39,000 for 1 year's premium.

Clearly, ObamaCare markets are failing there. So let's repeal ObamaCare, give the States the power, allowing them to choose the system that will work for them. Now, health care cost is important. Under our bill, we make health care more affordable by giving the patient the choice, the power, if you will, of price transparency. Under ObamaCare, we have seen prices rise out of control. A lack of price transparency keeps providers from having to compete which takes away the consumer's power of choice.

You can see this power of choice price transparency. Fifteen years ago, LASIK surgery cost $1,000 an eye or $875 an eye, with more for astigmatism. Now you can drive down the street and you see a billboard--a billboard--that says: LASIK surgery $275 an eye. So over a period of time, when everything has increased, LASIK surgery has come down--the power of price transparency.

Another example I like to use is of a woman, a physician, went for her mammogram. She wanted to pay cash. They talked her out of it. No. No. No. We don't even know what to charge you.

OK. I won't pay cash.

They billed her insurance company. She later found that if she had paid cash for her mammogram, it would have cost her $90. As it turns out, they billed the insurance company $500. Her deductible was $100. She was actually out $10 because they billed her insurance company. She should have known that price going into it.

One more example. If a doctor orders a CT scan, the cash price, according to an LA Times article a few years ago in the Los Angeles Basin, varied from $250 to $2,500. Unless you are an investigative reporter for the LA Times, able to call up and get that cash price, you otherwise would not know. I guess maybe it sometimes helps to have another example. Would anyone buy a car if they did not know the price of the car beforehand? Yet that is routinely done with health care.

Under the legislation I and Senator Collins have introduced in the Senate, and I and Pete Sessions have introduced in the House of Representatives, people will know what the cash price is. I have found, working in a hospital for the uninsured, that when you the give the patient the information and power they need to know to make the better decisions, you get better outcomes.

By the way, we have been told that Republicans don't have a plan. The plans I am speaking of now are drafted in legislative language-- legislative language, again, that would repeal ObamaCare, put in price transparency, and return decisionmaking power to the patient. We should repeal the individual mandate, repeal the employer mandate, prevent the Federal Government, the long arm of the Federal Government from reaching into someone's household, forcing them to do something they don't wish to do.

There should be an alternative. Under both the World's Greatest Health Care Plan--the bill I introduced with Pete Sessions--or the Patient Freedom Act that I have Susan Collins as a cosponsor, we take all of the money a State would receive had they done the Medicaid expansion and those eligible to be signed up for the ObamaCare exchanges, and we give that money to the State to allow them to give tax credits to those who are eligible.

These tax credits could only be used for health insurance. If the patient did nothing, she would have a health savings account, catastrophic policy with a pharmacy benefit. She could use the health savings account as first-dollar coverage.

Now, under ObamaCare, $6,000 deductible. Under our plan, the patient has first-dollar coverage, so if her daughter has an earache and she takes her daughter to the urgent care center, she can cover that visit with a health savings account that would be funded with this credit. They also have catastrophic major medical coverage, so if they get in that car wreck, take them to the emergency room, sky-high pricing, they are protected from medical bankruptcy.

Under our replacement plan, we also give States the option to say that if someone in our State is eligible, they are automatically enrolled. I smile when I say that covers two populations, the person who may live under a park bench and does not have his life together to otherwise do it, and the other population would be my 22-year-old son and those like him, those young folks who never think they are going to get ill so they never sign up for insurance. Without them being in the pool, we end up with a sicker pool. That is what has happened with ObamaCare.

By the way, it would be easy to imagine you could end up with 95 percent enrollment of those eligible should the State decide to go this way. The timeframe for our replacement would be simple. In year one, say 2017 Congress

passes the enabling legislation, which in year 2018 allows the State to choose between these three options; in 2019, the State would implement the option it chooses; and by the end of 2019, we have made the transition from repeal to replace, to implementation.

Folks ask: Would I lose my coverage? I am a physician. I am going to give my perspective: a patient I might see who has breast cancer. She does not like ObamaCare. She voted for Donald Trump, but she is on the bubble financially. She is not sure she can afford coverage, but she has breast cancer. As bad as ObamaCare is, at least she is getting some care.

Now she is having to put out all this money first, but still she is getting some care. If we keep her in the prism through which we look at this problem so that in the transition from ObamaCare to better coverage she continues to have her therapy, so at the end of this, not only does she have better coverage, but she has health and recovery from breast cancer, we have done our job. That is our Republican goal, to keep our prism as that woman who is vulnerable from a sickness she has now. In our transition, she does not lose coverage; she merely moves to better coverage.

I introduced the Patient Freedom Act with 12 Senate cosponsors in 2015 and then again teamed up with Representative Pete Sessions in 2016 to introduce the World's Greatest Health Care Plan. That is truly its name. Tom Price, our soon-to-be HHS Secretary, first introduced his Empowering Patients First Act to the House of Representatives in 2014. Speaker Paul Ryan, Representative Fred Upton, Senators Richard Burr, and Orrin Hatch have also outlined plans for comprehensive health care reform.

All of these plans create a new system that returns power of choice to patients and to States. Simple provisions as I have described such as health savings accounts, instituting free market values, if we put them into a replacement plan now, we will quickly have an effect upon millions. Republicans have worked hard to lay the groundwork to repeal and replace ObamaCare.

President-elect Trump has said he wants repeal and replace to happen at the same time. He promised both. We should fulfill both promises. Our majority leader has said we can do a better job as Republicans covering more people. We have the principles, the ideas, and the plans ready to go so let's put them to use. We owe it to the American people to carry out that replacement now with a smooth transition so the insured population can grow without anyone losing coverage in the process.

Republicans are committed to creating and passing effective health care legislation to replace ObamaCare and to bring real coverage to all Americans. Now is the time to do so.

Madam President, I yield the floor.