Training the Next Generation of Primary Care Doctors Act of 2019

Mr. President, all across our country--in Vermont, in Illinois, in California--all across this country, people are asking a very simple question. That question is, How does it happen that in the midst of the extraordinary wealth that exists in our country--how does it happen that so many people continue to hurt financially and struggle desperately to keep their heads above water economically?

Today, despite unemployment being relatively low, some 40 million Americans continue to live in poverty. We don't talk about poverty very much here in the Senate, but we have 40 million Americans living in poverty. Many of them are struggling to adequately feed their kids. Many of them are forced to go, despite working, to emergency food shelters just to stay alive.

Despite the United States having a GDP--gross domestic product--of more than $20 trillion, we in this country embarrassingly continue to have the highest rate of childhood poverty of almost any major country on Earth. We don't talk about that either. Children are obviously the future of America, and we continue to have one of the highest rates of childhood poverty of any major country, and that includes 29 percent of African-American children who live in poverty.

How does it happen that in a so-called booming economy--and we hear from President Trump every other day about how the economy is booming-- the bottom 40 percent of our population does not have $400 in cash in order to address a financial emergency? Think about that. The bottom 40 percent--almost half of Americans--don't have $400 in their pocket, in the bank to address a financial emergency. Maybe the car breaks down, maybe the kid gets sick, maybe one loses one's job, maybe one undergoes a divorce; something happens, and 40 percent of the American people don't have $400 in the bank to address that crisis.

In other words, today--and we saw this in the recent government shutdown; today in America, many, many millions of families live paycheck to paycheck in order to survive. That should not be happening in the wealthiest country on Earth, and it is time we begin to talk about that. It is not good enough to talk about a so-called booming economy, forgetting about tens of millions of families who are not seeing that booming economy but, in fact, are living under incredible financial stress.

How does it happen that, in the so-called booming economy, tens of millions of American workers today are working for wages that are so low they cannot afford the escalating cost of housing? Some of them are spending 40, 50 percent of their limited incomes on housing. For many of these people, there is no health insurance available; the idea of a vacation for the family is something not even to be thought about; and the idea of being able to send one's kids to college is something that is also not on the table. By the

way, many of these individuals are working two or three jobs, 50, 60, 70 hours a week, just to survive.

This, again, is the wealthiest country in the history of the world. Yet 30 million Americans today, as we speak, have zero health insurance--no health insurance at all; 41 million people are underinsured--which means their deductibles and their copayments are so high that even though they have insurance, they still can't afford to go to the doctor, and one out of five Americans today cannot afford the prescription drugs their doctors prescribe.

In my view--a view I have held for a very, very long time, and it is a view shared by people not only in this country in wide numbers, but all over the world--healthcare is a human right, not a privilege. Whether you are rich or whether you are poor, you have the right to go to a doctor when you get sick, and you have the right to know that if you end up in a hospital, you are not going to go bankrupt or suffer from financial distress.

We are an aging population--no great secret there. We are an aging population. In this Congress, instead of dealing with government shutdowns precipitated by the President, we should be talking about how we respond to the reality of an aging population. Yet what we don't talk about is that about half of older Americans--half of older Americans, those 55 and older--have no retirement savings and no idea about how they will retire with dignity.

Think about what that means. Somebody is 60 years of age, they are coming to the end of their work-life, and they have no money--or virtually no money--in the bank. Maybe all they are going to get is Social Security. They turn on the TV, and they hear folks around here talking about cutting Social Security. Talk about why people in this country are angry and why they are stressed out.

Here is the bottom line. We are the wealthiest country on Earth. In fact, we are the wealthiest country in the history of the world, but despite that wealth, a significant percentage of our population--our children, our elderly people, our working men and women--struggle each and every day to keep their heads above water economically. Not only are they struggling, I think the pain they are feeling has to do with the worry they have about the future for their kids because they know, as many of us know, that unless we make some bold changes in our economy, the younger generation today will have a lower standard of living than their parents.

Imagine that--a so-called booming economy, yet we are looking at a situation where the younger generation may well have a lower standard of living than their parents.

I want to also say a word about another reality that currently exists. While so many of our people are struggling, while so many of our children are living in poverty, while 20 percent of folks on Social Security are trying to live on less than $13,000 a year, there is another pervasive reality in American society today; that is, the people on top--the very wealthiest people in this country--have never had it better, and the gap between the very, very rich--I am not just talking about the rich; I am talking about the very, very rich--is growing wider.

Here is the simple truth, a truth that we virtually never talk about here in the Senate, a truth that is not heard much in the corporate media; that is, the United States of America today has the most unequal distribution of wealth and income of almost any major country on Earth, and that level of inequality is worse today than at any time since the 1920s, the so-called Gilded Age of American society.

Today, if you can believe it, the three wealthiest people in this country--three--own more wealth than the bottom half of America, 160 million people. Let me repeat that. The three wealthiest people in this country own more wealth than the bottom half of America, 160 million people. Today, the top one-tenth of 1 percent--not 1 percent; one-tenth of 1 percent--own almost as much wealth as the bottom 90 percent. Today, and since the Wall Street crash in 2008, about 46 percent of all new income goes to the top 1 percent. Roughly speaking, half of all new income goes to the bottom 99 percent, and half goes to the top 1 percent, and our great task here in the U.S. Senate is to keep the government open while Trump tries to shut it down. Maybe, just maybe, we should be talking about those issues. Maybe, just maybe, we should be talking about an economy that works for all of us, not just the people on top.

Today, the top 25 hedge fund managers on Wall Street--25 hedge fund managers--earn nearly double the income of all 140,000 kindergarten teachers in America.

What all of the psychologists tell us is that the most important years of a human being's development are 0 to 4. Those are the most impressionable years in terms of how we develop intellectually and emotionally, and our childcare workers, our kindergarten teachers play a very important role. Does anybody think it makes sense that you have 25 hedge fund managers on Wall Street who, today, earn nearly double what 140,000 of our kindergarten teachers make? By the way, public teachers in America are falling further and further behind other occupations.

Having stated that reality--the fact that the middle class is struggling and the fact that the people on top are doing phenomenally well--I think it is fair to ask what the views are of the Republican leadership here in the Senate--Republicans control the Senate--and what our Republican President, President Trump, is proposing to address these massive levels of injustice and inequality. Three people own more wealth than the bottom half of America. What does the President and what does Leader McConnell have to say about that? The sad truth is that the Republican leadership today wants to make an embarrassingly bad situation even worse.

After passing a $1 trillion tax giveaway for the top 1 percent and large corporations last year, Republican leadership is coming back and saying: Hey, we only gave 83 percent of the tax benefits to the 1 percent. That is not good enough. That is not good enough. We have to do even better for our billionaires and corporate sponsors.

This time, the Republican leadership and the President want a tax break of hundreds of billions of dollars that would go exclusively to the wealthiest of the wealthy. I am not talking about the wealthy; I am talking about the wealthiest of the wealthy--the top one-tenth of 1 percent, the wealthiest 1,700 families in America.

We have 127 million families in our country--a population of some 320 million people. As I have indicated, many of these families are struggling. Many of these families are hurting. Today, many of these families are wondering how they are going to pay their rent, pay their mortgage, keep their lights on. Yet the legislation to repeal the estate tax that Senator McConnell and President Trump are proposing would benefit less than the top one-tenth of 1 percent of them--99.9 percent would see no tax reduction from the legislation.

Can anyone actually imagine bringing forward a piece of legislation that does not help the bottom 99.9 percent? Can you imagine that? The middle class are struggling. The gap between the rich and the poor is growing wider. There are 30 million people without health insurance. Our infrastructure is crumbling. And they come forward with a piece of legislation that is designed to protect and benefit the top one-tenth of 1 percent. The legislation would be of no benefit to 99.9 percent of the people of this country.

I think it is clear that when the people of this country look at Congress and say ``Those folks in Washington are not representing me. They are representing their wealthy campaign contributors. They are representing the billionaire class,'' there can be no clearer example of that reality than this proposed legislation.

Once again, with all of the economic problems, all of the inequality we face, imagine legislation that comes forward from the Republican leadership and the President that benefits the top one-tenth of 1 percent--the 1,700 wealthiest families in this country.

It is no secret that our infrastructure--our roads and our bridges, water systems, airports, wastewater plants--is crumbling all over this country. All over this country, there are major infrastructural problems. But I hear over and over again: We don't have the

funding to rebuild our crumbling infrastructure and put millions of Americans to work at good-paying jobs rebuilding that infrastructure. We just don't have the money.

Our schoolteachers are underpaid, but we don't have the money to provide attractive salaries in order to get the best and the brightest to do the most important work in this country; that is, teaching our young people.

Today, we have veterans--people who put their lives on the line-- sleeping on the streets, but we don't have the money to house them.

Families in America cannot afford childcare, and public schools are underfunded.

We don't have the money to address those crises, but somehow we do have hundreds of billions of dollars available to provide tax breaks for the top one-tenth of 1 percent.

We apparently have enough money to provide the Walton family--the wealthiest family in America, the folks who own Walmart, the people who pay their own employees starvation wages--by repealing the estate tax, as Senator McConnell and President Trump would like to do, we have enough money to provide the Walton family, the wealthiest family in America, with a tax break of up to $63 billion. Veterans sleep out on the street, teachers are underpaid, and 30 million Americans have no health insurance. We can't address those issues, but we do have legislation that would provide up to $63 billion in tax breaks for one family.

We have, apparently, enough money available to provide the Koch brothers--a family who spent some $400 million during the midterm election to help elect Republican candidates; the Koch brothers, one of the wealthiest, most politically active families in America--we have enough money to provide them with up to a $39 billion tax break.

Under this legislation, we can provide a tax break of up to $27 billion to the Mars candy bar family and up to a $13.4 billion tax break to the Cox cable family.

In other words, at a time of massive needs in this country, we don't have enough money available to protect working families and the middle class, but we certainly have more money than we know what to do with in order to give incredible tax breaks to the richest people in this country.

The estate tax that we are going to be proposing does not give massive tax breaks to the wealthiest people in this country--quite the contrary. It says to those people that at a time of massive income and wealth inequality, instead of repealing the estate tax, we must substantially increase this tax on the multimillionaires and billionaires of this country and in doing that, not only come up with much needed revenue to address the needs of working families but also to reduce wealth inequality in America.

That is why this week I will be introducing legislation for an estate tax bill that would do exactly the opposite of what my Republican colleagues propose to do. Let me briefly explain what is in the legislation I am offering.

Under my bill, anytime someone inherits an estate in America of $3.5 million or less, that person will not pay one penny in estate taxes. They will get to keep that inheritance tax-free. That population includes 99.8 percent of the American people. The legislation I am proposing would not raise taxes by a penny on 99.8 percent of the American population.

If you are in the top two-tenths of 1 percent of the population--the population that inherits over $3.5 million--your taxes will, in fact, be going up, and they should be going up.

My legislation establishes a 45-percent tax on the value of an estate between $3.5 million and $10 million, a 50-percent tax on the value of an estate between $10 million and $50 million, a 55-percent tax on the value of an estate in excess of $50 million, and a 77-percent tax on the value of an estate above $1 billion. In other words, this bill begins to create a progressive tax system in America, which is based on ability to pay.

I know some may think otherwise, but the truth is, this is not a radical idea. From 1941 through 1976, the top estate tax rate was, in fact, 77 percent on estate values above $50 million. Back to 1976, the top estate tax rate was 77 percent.

This bill would also close tax loopholes that have allowed billionaire families, such as the Waltons, to pass fortunes from one generation to the next without paying their fair share of taxes.

Under this legislation, the families of all 588 billionaires in our country, who have a combined net worth of over $3 trillion, would pay up to $2.2 trillion in estate taxes.

Let me make a confession here. This idea, this approach, was not developed by Bernie Sanders. It is not a new idea. More than a century ago, a good Republican President named Teddy Roosevelt fought for the creation of a progressive estate tax to reduce the enormous concentration of wealth that existed during the Gilded Age.

What is really quite remarkable is that what Teddy Roosevelt talked about over 100 years ago during the Gilded Age of the 1920s, when little children were working in factories and fields and the wealthiest people were enjoying incredible wealth and luxury--the idea Teddy Roosevelt proposed then is as relevant today as it was back then. Let me quote what Teddy Roosevelt said more than 100 years ago:

The absence of effective state, and, especially, national

restraint upon unfair money-getting has tended to create a

small class of enormously wealthy and economically powerful

men, whose chief object is to hold and increase their power.

The prime need is to change the conditions which enable these

men to accumulate power. Therefore, I believe in a graduated

inheritance tax on big fortunes, properly safeguarded against

evasion and increasing rapidly in amount with the size of the

estate.

That was Teddy Roosevelt over 100 years ago. What Roosevelt said then is absolutely true for today.

From a moral and an economic perspective, our Nation will not thrive when so few people have so much wealth and power and so many people have so little wealth and power. This wealth and income inequality is not only unjust and unfair; the truth is, it is a real threat to our economy and our democracy.

We need a tax system in this country that tells the billionaire class that they are going to have to pay their fair share of taxes so that we do not have 30 million people without health insurance, so that we do not have young people graduating college $50,000, $100,000 in debt, so that we do not have an infrastructure that is crumbling, and so that we do not see our great country moving toward an oligarchic form of society where a handful of families enjoy incredible wealth and power at the expense of everybody else.

In my view, the fairest way to reduce wealth inequality, to invest in the middle class and working families of our country, and to preserve our democracy is to enact a progressive estate tax on the inherited wealth of multimillionaires and billionaires. That is exactly what I will be proposing.

Mr. President, I rise today to reintroduce legislation that will finally put an end to the separation of families at our southern border. I have believed from the outset that the administration was wrong to pursue a zero tolerance policy of family separation, which is cruel and detrimental to children and parents alike.

The President claimed to end this policy in June by executive order, but we have learned that the practice of separating families continues today. In fact, the separations may have been broader in scope than we previously knew.

Last year, the American people were rightly horrified when thousands of children, including babies and toddlers, were taken from their parents, to be separated for weeks and months. Dozens of these children spent days and weeks in cages with nothing but thin mats and aluminum blankets.

In response, people from all walks of life--Republicans, Democrats, clergy, the medical community, business leaders, labor organizers-- stood up and

said, ``enough is enough.'' Average Americans spoke out, marched, and called their members of Congress pleading for us to stand up to the President and demand he reverse his policy.

But we still may not know the full scope of the harm that was caused. We still do not know just how many families were torn apart as a result of the zero tolerance policy.

Litigation has identified over 2,700 children who were separated from their parents by DHS, including nearly 100 children under the age of 5. However, in January the Inspector General for Health and Human Services found that ``this number does not represent the full scope of family separations.'' Indeed thousands--thousands--more children may have been separated from their parents in 2017, before the start of the accounting period required by the court.

We have also learned in recent weeks that this crisis is not over. Families are still being separated from one another.

In June, the Trump administration issued an executive order that ended the ``zero tolerance'' family separation policy. Despite that order, the practice of family separation did not end.

Instead, the Inspector General for Health and Human Services reported that separations are ongoing with little oversight or accountability. In fact, at least 118 children were separated from their parents between June 2018, when the executive order was issued, and early November.

These family separations could not have happened if Republicans had joined me and all Senate Democrats to pass the Keep Families Together Act last Congress. The Keep Families Together Act prohibits Border Patrol from separating children from their parents or legal guardians, without good cause.

Good cause is defined with a focus on the best interest of the child, and cannot be based on the parent's migration or crossing of the border. No separation can be made without consulting a child welfare specialist, and all presumptions are made in favor of family unity, including unity of siblings.

The Keep Families Together Act includes vital oversight mechanisms that will ensure that every child separated under the zero tolerance policy is accounted for. These include a requirement for DHS to publish transparent guidance on separations, as well as annual reporting requirements and a requirement for a GAO report on criminal prosecution of asylum seekers.

These are basic protections for children that should not be controversial. Parents who try to protect their children from violence and poverty abroad, should not be punished by having those children ripped from their arms. Children should not be subjected to severe trauma in the interest of deterring migration.

Instead, families should be kept together and given a fair chance to present their cases for asylum. The Keep Families Together Act will provide these fundamental necessities and protect children from further harm. We have a fresh start in a new Congress. It is time to make these vital protections a reality.

Mr. President, I am pleased to reintroduce the ``Santa Ana River Wash Plan Land Exchange Act.'' This legislation would help implement a consensus-driven regional land management plan by directing the Bureau of Land Management to exchange land with the San Bernardino Valley Water Conservation District in San Bernardino, California.

Before I continue, I would like to thank Senators Lisa Murkowski and Maria Cantwell, as well as their staffs, for their hard work to move this bill forward last Congress. With their assistance, this legislation passed out of the Senate Energy and Natural Resources Committee in August 2018 and was included in a bipartisan public lands package.

I thank Senator Murkowski for introducing a bipartisan lands package bill this Congress and including this legislation in it. I look forward to working once again with Senator Murkowski, as well as the newly designated Ranking Member, Senator Manchin, to maintain our momentum and pass this bill as quickly as possible.

I also would like to express my gratitude to Representative Paul Cook and his staff for their continuing work and collaboration on this legislation. Lastly, I welcome working with Representative Cook and Representative Aguilar who are cosponsoring companion legislation in the House of Representatives. Lastly, I thank Senator Harris for cosponsoring this legislation.

This bill is an excellent example of how smart, sustainable, land planning can be accomplished through interagency cooperation. Federal and State agencies, private industry, and municipalities representing mining, flood control, water supply, wildlife conservation, and other interests all came to the table to develop a land management plan that accounts for the array of land uses in this area.

The land exchange facilitated by this bill is broadly supported, including by: County of San Bernardino, City of Redlands, City of Highland, San Bernardino Water Conservation District, San Bernardino Valley Municipal Water District, East Valley Water District, Endangered Habitats League, CEMEX Construction Materials Pacific, Robertson's Ready Mix, Inland Action.

This diverse group of entities formed the ``Wash Committee'' in 1993 to address mining and land management in the upper Santa Ana River wash area.

I applaud the Committee, along with federal, state and local stakeholders, for working together to develop a strategy for comprehensive land management planning for the area. This group has shown that through cooperation, it is possible to both protect the environment and support local business and community interests.

The land exchange between the San Bernardino Water Conservation District and the Bureau of Land Management will consolidate open space for conservation purposes and optimize the efficiency of mining operations and water conservation efforts.

The exchange will also set aside new land for conservation purposes near land already managed by BLM.

This bill will lead to increased habitat protection, groundwater recharge, and public access while allowing for the continued use of land and mineral resources.

I look forward to working with my colleagues to pass the ``Santa Ana River Wash Plan Land Exchange Act'' as soon as possible.

Thank you Mr. President, I yield the floor.

Thank you, Mr. President.

Today I rise on the 3-year anniversary of the tragic death of a constituent of mine, Sarah Root. On January 31, 2016, the same day as her college graduation, Sarah was killed in nearby Omaha, NE, by an illegal immigrant named Edwin Mejia. He was drag racing with a blood alcohol level more than three times the legal limit.

Despite requests by local law enforcement, Immigration and Customs Enforcement failed to detain Mejia because of a nonsensical policy that allows ICE to use discretion when determining whether to detain an illegal immigrant. He posted bond, he was released, and 3 years later remains a fugitive. It has been 3 years, and he is still a fugitive, denying Sarah's loved ones any sense of closure or justice.

As a mom, I can't fathom the grief her family and friends continue to feel after such a devastating loss. My own daughter is approaching the age at which Sarah was killed.

Just 21 years old, Sarah was bright, she was gifted, she was full of life and ready to take on the world. What a talented young lady.

She had just graduated from Bellevue University with a 4.0 GPA. She was dedicated to her community, and she wanted to pursue a career in criminal justice. Sarah had her whole future ahead of her, but her opportunity to make her mark on the world was taken away from her. Her life was tragically cut short. Yet even in death, Sarah touched the lives of others. Sarah saved six different individuals through her organ donation.

Sadly, what happened to Sarah Root is not an isolated incident.

We have seen this story play out time and again in the 3 years since Sarah's killing--innocent lives taken by criminals who entered the United States illegally through a porous border. Crimes committed by those here illegally are truly among the most heartbreaking and senseless, and that is because these crimes are completely preventable, as the perpetrators should not be in the United States in the first place.

Although nothing can bring Sarah back to her family, we can ensure that ICE never makes this same mistake again. That is why I rise today and, again, join with my colleagues from Iowa and Nebraska, including the Presiding Officer; thank you again for joining in this legislation. We are introducing Sarah's Law again in honor of Sarah Root.

Sarah's Law would require that ICE take custody of a person who is in the country illegally and who is charged with a crime that seriously injures another person. Sarah's Law would also require better victim notification and amend the law to require that the Federal Government take custody of anyone who enters the United States legally but violated the terms of their immigration status or had their visa revoked and is later charged with a crime that resulted in the death or harm of another person.

President Trump implemented parts of Sarah's Law through an Executive order in 2017, and I commend him for that. It included directing the Secretary of Homeland Security to prioritize the removal of criminals who are here illegally. The Executive order also establishes an office to implement notification requirements of Sarah's Law.

Despite provisions of Sarah's Law being put into place by President Trump's order, it is critical that the Senate take up this legislation in order to codify these enforcement priorities so that any future administration cannot remove these provisions. No family should ever have to endure such a tragedy, especially one that could have been prevented. The fact remains that Sarah's killer would not have been in our country if it weren't for our country's broken immigration system.

Sarah's Law is commonsense reform. It recognizes the simple fact that all criminals should be held accountable for their actions. How much more commonsense can this be, folks? Hold criminals accountable. We should not allow them simply to slip back into the shadows.

I recognize that the immigration debate has become a political football. We see that every day here in Washington, DC, but the security of our borders and enforcement of our immigration laws is not a game. We must honor the lives of these innocent victims and do better. We must work to stop future crimes.

I look forward to continuing to work with my colleagues to fulfill the promise I made to Sarah's loving parents, Michelle Root and Scott Root. I will do everything I can to ensure that not one more parent has to go through what the Roots have faced--the loss of their daughter and the promise of justice.

Madam President, I thank you for joining me on this legislation. It means a lot to this family and many others.

Mr. President, I rise to introduce legislation with my colleague Senator Casey that would reauthorize the only federally funded programs that are specifically designed to develop a health provider workforce to care for our older Americans. The Geriatrics Workforce Improvement Act would reauthorize the Geriatrics Workforce Enhancement Program and also reinstate the Geriatrics Academic Career Award Program.

The number of Americans aged 65 and older is growing rapidly. In my State of Maine, we are reaching an aging milestone faster than are other States. By 2020, the number of Maine seniors is projected to exceed the number of Maine children. This is 15 years ahead of the nationally projected date of 2035, at which point the number of Americans aged 65 and older will outnumber those under the age of 18 for the first time in our Nation's history.

The United States is facing a critical shortage of geriatric health professionals and direct service workers to support our aging population. Today, we need 20,000 geriatricians. However, fewer than 7,300 of our Nation's nearly 1 million physicians are board certified as geriatricians. By 2030, we will need 30,000 geriatricians and even more geriatric health professionals and direct service workers. To achieve this goal, we will need to train 1,600 geriatric specialists per year over the next 12 years.

For the State of Maine, with an aging population of more than a quarter million Mainers over the age of 65 and with only 40 geriatricians, there is an acute need to quickly train more geriatric health professionals and direct service workers to meet the growing demand. The University of New England, College of Osteopathic Medicine has joined the University of Maine this year in proposing the ``Aging Maine Transformation Collaborative.'' I was pleased to lend my support to this collaboration earlier this year. If funded, AgingME would become our State's first Geriatric Workforce Enhancement Program and would bring with it much needed assistance to communities and families throughout our State.

Nationwide, our bill would reauthorize this workforce enhancement program at $45 million per year over the next 5 years and would reinstate the Geriatrics Academic Career Award Program at $6 million per year. Together, these programs would train the current workforce and family caregivers while simultaneously developing a cadre of emerging leaders in geriatric education in a variety of disciplines. By doing both, we will ensure that older Americans will be cared for, for decades to come, by a healthcare workforce that will be specifically trained to meet their unique and complex healthcare challenges. This training of using the most efficient and effective methods for older adults will result in improved care while reducing unnecessary costs.

I am pleased to say that our legislation is supported by the leading organizations in gerontology and geriatrics, including the Eldercare Workforce Alliance, the American Geriatrics Society, the Alzheimer's Impact Movement, and the National Association of Geriatric Education Centers.

I ask unanimous consent that these letters of support be printed in the Record.

Mr. President, I urge all of my colleagues to support this bipartisan bill that would ensure geriatric education for our current workforce while it would optimize resources to bolster academic careers in geriatrics and help to attract the best and the brightest into this field. Together, these programs would develop exactly the kind of highly qualified workforce that we need to care for Americans as our Nation grows older.

I thank the Presiding Officer.