Floor Statements

Mr. President, I rise today to talk about the urgent need for action on the Children's Health Insurance Program and other vital safety net programs.

On September 30 of this year, 3 weeks ago, funding for the Children's Health Insurance Program, or CHIP, expired, and funding for community health centers also expired, as did funding for the National Health Service Corps. These three cornerstone programs provide essential health services to hundreds of thousands of my constituents and to millions of people across the country.

Although these programs have historically secured strong bipartisan support and, ostensibly, still do today, the Republican majority has not moved these bills forward toward passage, and it is really time to act.

My home State of Minnesota is one of the first States to exhaust its funding for its Children's Health Insurance Program, or CHIP, a program that covers 125,000 low-income children and 1,700 pregnant women.

While the Federal Government has provided some emergency stop-gap funding, that, too, is slated to run out by the end of November. Minnesota has a long tradition of insuring coverage to vulnerable populations. So coverage for low-income children will continue, no matter what. However, over the next few weeks, if CHIP funding is not reauthorized, the State will have to decide whether it will take extraordinary measures and incur significant financial losses to continue providing coverage for vital services, like prenatal and postnatal care for the pregnant women, whose coverage is currently funded by CHIP. This is a terrible

choice that States shouldn't have to make, and it doesn't have to be that way.

Minnesota is not alone. Five other States and the District of Columbia will see their funding dry up by December, and 25 more States will exhaust their funding by early next year.

Pretty soon, thousands of families could receive notices informing them that their coverage will be terminated. Imagine for a second what that moment would feel like. You have a son or a daughter with a serious medical condition, and, perhaps, they are even in the hospital. You find out that their health insurance is going to be cut off because the Republican-controlled Congress couldn't get its act together to continue funding for a bipartisan program that has been in existence for decades. I would be livid. That is why we have to act now.

For most of this year, the Republican majority has been consumed with destructive and counterproductive debates focused on repealing ObamaCare. They have done little else. That meant that not only did we blow past the funding deadline for the Children's Health Insurance Program, but we also blew through the funding deadlines for community health centers and the National Health Service Corps program. Now this critical reauthorization is on hold because Republicans can't agree on how to pay for it. This comes just a week after Republicans in the Senate endorsed the budget to increase the debt by up to $1.5 trillion over 10 years for tax cuts that will largely benefit the wealthiest Americans. In fact, the Tax Policy Center estimates that 80 percent of benefits of the Republican tax plan would go to the top 1 percent of income earners in this country.

This is truly a case of the absurd. When it comes to providing healthcare for needy children and keeping Americans healthy, Republicans are saying they can't do it unless it is paid for, and, often, that means making cuts to other safety net programs in which vulnerable individuals rely. But when it comes to tax cuts for the wealthy, which costs many, many, many, many times more than the cost of providing children with health insurance, my Republican colleagues are perfectly happy to do that without demands for offsets and, instead, adding costs to the debt. This is not responsible budgeting, and it is not just kids that stand to lose under this type of budgeting approach. Let me tell you about the other programs at risk in my State of Minnesota.

In Minnesota, there are more than 70 community health center clinics that receive a total of $27 million in funding to care for the uninsured and the underinsured in the State. If this funding is not reauthorized soon, these community health centers and the patients they serve are going to experience serious losses and not just financial losses.

Take, for example, Sawtooth Mountain Clinic, which provides care to some of the most isolated and rural counties up in the northeastern corner of my State, in the Arrowhead. Sawtooth reports that it would lose up to $1 million, which would force them to cut back on staff and services, having a drastic ripple effect across the entire community.

The CEO of the clinic in Grand Marais explains:

We are the only clinic and providers in all of Cook

County--

Parenthetically, that is a big county--

and also one of the only providers serving the Grand Portage

band.

That is the band of the Chippewa or Ojibwe.

Since 1965, Congress has provided this stable and

critically important funding that supports our isolated and

rural communities. Congress needs to do its work and needs to

act now.

Similarly, without funding for the National Health Service Corps-- this is what the program does. It provides financial support and loan repayment for clinicians who practice in underserved areas. I know the Presiding Officer must be interested in that, as Alaska has some underserved areas and needs providers to serve in those areas. Many providers, including those in greater Minnesota, will not be able to recruit or hire new staff.

In a recent news article, the chief executive of a Minneapolis-based network of clinics stated that the National Health Service Corps Loan Repayment Program offered him a unique bargaining chip against the larger health systems. Without this program, he believes he wouldn't be able to successfully compete for providers.

Look, I recognize how we got here and where the time and energy has been spent over the last few months, and I am proud that we were able to abide by the will of the people and successfully stop the effort to repeal the ACA and strip healthcare from millions of people. I would hope that we would recognize that we have here historically bipartisan legislation to reauthorize funding for children's health insurance coverage and other safety net programs. It is incumbent upon us to act, and act now. We have to reauthorize these programs so that Minnesotans and millions of the families across the country are not unnecessarily and unfairly harmed as a result of our inaction.

In the same news story I referred to earlier, the CEO of NorthPoint Health & Wellness, another safety net clinic in Minnesota, stated:

There is a high degree of anxiety for staff and for some of

our patients. . . . I think Congress understands that we are

vital to the safety net and they have to continue to support

the community health centers.

Let's work together to pass this legislation so we don't let these clinics and the patients they serve down. It is time to act, and time to act now.

Thank you very much, Mr. President.

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

Mr. President, I rise to talk about the recent terrorist attack in Somalia.

On October 14, a truck filled with explosives detonated in a crowded district in Mogadishu--Somalia's capital. The blast was especially devastating because the truck blew up next to a fuel tanker, causing a massive fireball and leveling structures, including the nearby Safari Hotel, which collapsed and trapped many people under its rubble. According to Somali authorities, the target of the attack may have been the city's international airport which also houses many Embassies.

This is the worst terrorist attack in Somalia's history. Three hundred fifty-eight people were killed, hundreds have been injured, and dozens are still missing.

As a Minnesota Senator, I represent the largest Somali-American population in the Nation. For Minnesota, this wasn't just a massive attack overseas. It affected every one of my estimated 74,000 Somali- American constituents.

Among those killed is Ahmed Eyow. He was from Bloomington, MN. He had attended Normandale Community College and Metropolitan State University. He left behind his wife and three children.

Another Somali-American who was killed in the blast was Mohamoud Elmi. He had lived in Ohio and had moved back to Somalia about 2 years ago. He was a young man with a bright future, working at the Ministry of Humanitarian Affairs and Disaster Management in Somalia.

There was Abukar Mohamed. He lived in Virginia before moving back to Somalia, where he worked in the Ministry of Commerce and Industry. He was killed along with his wife, Shadiye Hassan. They left behind seven children who are between the ages of 3 and 20.

Hundreds of others perished in that heinous attack. They all have their own stories. They left behind their wives, their husbands, their children, their friends, their parents.

Somalia is one of the most, if not the most, fragile nations on Earth. It has been an incredibly difficult country to

govern ever since the civil war tore the country apart in 1991. It suffers from the massive displacement of people, hundreds of thousands of refugees, lack of sufficient public services, and warring factions and clans. To make matters worse, a severe drought has ravaged Somalia, leaving 6 million people--half of the nation's population--facing food shortages. The combination of instability, lack of security, and shortage of goods and services has enabled terrorist groups like al- Shabaab--widely believed to be the culprit in this attack--to gain a foothold in Somalia.

We have to have a comprehensive strategy to help the people of Somalia. One component of that strategy is to help Somalis root out terrorism. The Government of Somalia has announced its intent to step up the fight against al-Shabaab. The United States has and will continue to aid those efforts, as will the African Union Mission in Somalia--a multinational peacekeeping force that is supported by the United States.

At the same time, we have to erode and eliminate the conditions that enable terrorist groups to thrive. That means redoubling our efforts to help stabilize fragile nations. That means supporting good governance, reducing extreme inequality, and helping marginalized, disenfranchised individuals who are preyed upon time and again by terrorist recruiters.

It is more important than ever that we fully fund our international programs that support these efforts, for humanitarian and security reasons. Unfortunately, the administration's 2018 budget proposal does the opposite. It includes a 30-percent cut to programs that seek to bring stability, rule of law, and humanitarian assistance to places that need it the most. The administration's budget is making the world, and us, less safe. And I want to urge the President to rethink his approach to foreign aid.

My colleagues, Senators John McCain and Tim Kaine, put it this way in a recent op-ed they coauthored, saying:

Today, 80 percent of our assistance provides relief and

promotes stability in conflict zones and states on the verge

of collapse. There are U.S. Agency for International

Development programs in many of the countries most plagued by

terrorism, including Afghanistan, Pakistan, Nigeria, Mali,

Yemen and Somalia. We're saving lives and creating partners

to help address the instability that produces the threats our

military risks life and limb to fight.

In conclusion, I urge my colleagues and the American people to not forget about the terrible tragedy in Somalia. I urge everyone to keep Somali victims and other victims of terror acts throughout the world in their thoughts and prayers.

The world needs to know that the United States will continue to support Somalia and other nations that are fighting those who are wreaking havoc on their nations. But we have to remember that we will all be more successful when we combine military efforts with diplomatic and humanitarian ones. While we cannot bring back those who perished, if we focus on rooting out the conditions that give rise to terrorism, we can have a shot at averting the next one.

Thank you.

I suggest the absence of a quorum.

Mr. President, I ask unanimous consent that my health policy fellow, Laura Knudtson, be granted floor privileges for the remainder of this Congress.

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

Mr. President, I rise to talk about the devastation in Puerto Rico and the U.S. Virgin Islands and the need to rebuild the electric grid in a more resilient and sustainable way.

Over the last few months, communities around the country have been devastated by natural disasters. We have had terrible hurricanes in Texas, Florida, Puerto Rico, and the U.S. Virgin Islands, as well as tragic wildfires across the West. These communities need immediate help, and that is why the disaster supplemental appropriations bill we passed yesterday is so important. I am glad this bill provides nearly $19 billion to replenish FEMA's emergency disaster accounts that help communities start to rebuild, but it is just a downpayment. As we know, it will take a lot more Federal assistance.

One thing we need to focus on is the electric grid. Hurricanes Harvey, Irma, and Maria demonstrated the risks the electric grid faces from extreme weather. The communities hardest hit in Texas and Florida underwent days--sometimes much longer--without any power, and when this happens, it is a serious risk to the safety and health of everyone in the area.

Now, American citizens in Puerto Rico and the U.S. Virgin Islands are facing a major humanitarian crisis, and the Federal Government needs to do everything it can to assist.

More than a month after Hurricane Maria hit, only 25 percent of Puerto Rico has access to electricity, and it will take many months to get power back to those communities. That is completely unacceptable. Without electricity, pumping stations can't supply drinking water to households. In fact, 25 percent of the island still lacks access to potable water. Without electricity, wastewater treatment facilities can't operate, which means raw sewage is contaminating rivers and streams. Without electricity, cell towers cease to function, making communication with first responders difficult. Without a stable electric grid, hospitals have to rely on backup power to keep lifesaving equipment working. That backup power is often diesel generators that require fuel, which is in short supply.

Given the dire situation, it is no surprise that we have already seen tens of thousands of Puerto Ricans leave the island, with nearly 60,000 arriving in Florida alone.

The majority of the transmission and distribution lines were destroyed in Puerto Rico and the U.S. Virgin Islands. We need to rebuild them, and I think we can all agree they should be rebuilt to withstand the next disaster. So let's rebuild the electric grid in a more resilient and sustainable way that reduces future threats and future costs. I have been talking with my Republican colleagues and members of the administration, and everyone agrees this is a good idea. That is why I want to work with my colleagues on both sides of the aisle to include language in the next supplemental disaster aid package that does exactly this.

I am talking about investing in a more modern and more decentralized

grid so that not everyone is relying on a handful of powerplants that can go down. Decentralized energy resources operating in microgrids are more likely to remain functioning during and after storms. There are many instances of distributed energy keeping important facilities online after natural disasters, including the Texas Medical Center, which is the largest medical complex in the world, which has a combined heat and power plant that kept running during Hurricane Harvey. That is because during extreme weather, these technologies can go into island mode or operate independent of the grid.

Puerto Rico and the Virgin Islands have some of the highest electricity prices in the United States, and that is because they rely on oil, coal, and gas that must be shipped from the mainland. While these islands do not have fossil fuels, do you know what they do have? Lots of Sun. And the rapidly declining costs of distributed clean energy technologies such as solar, wind, energy efficiency, and battery storage, in many instances make them more affordable than existing power generation, which means these clean energy technologies could help reduce prices.

These investments will also save money in the long run. In 2005, the National Institute of Building Sciences completed a study for FEMA that found that every dollar invested in disaster preparedness and resilience saves $4 in future avoided losses. We know we are going to see more hurricanes and extreme weather events, so let's rebuild in such a way that impacts are not as severe the next time around. Let's protect people and save taxpayer money.

That is my message: Let's protect people, and let's all save taxpayer money and do the thing that makes sense.

Thank you.

I suggest the absence of a quorum.

Mr. President, I rise to discuss the Consumer Financial Protection Bureau's recently finalized rule to limit the use of predispute, forced arbitration clauses in contracts for financial services and products. I strongly oppose the Congressional Review Act resolution to dismantle this vital consumer protection.

Forced arbitration clauses force individuals to sign away their right to go to court as a condition of buying a product or a service, and they allow corporate America to take advantage of a shadow justice system that is inherently biased toward the corporation and offers no meaningful appeals process. To put it bluntly, these clauses serve one purpose and one purpose alone, to help make sure the giant corporations still come out on top if they have wronged consumers.

Thankfully, we started to make some progress in addressing forced arbitration. Five years ago, the Consumer Financial Protection Bureau began an intensive study of forced arbitration clauses in consumer financial services contracts for things like credit cards, savings accounts, and private student loans. The study confirmed that forced arbitration stacks the deck against consumers and in favor of powerful corporations. Of the 341 reviewed cases of forced arbitration in which consumers made claims against financial institutions, the CFPB found that consumers obtained relief in just 32 disputes. That is 32 out of 341--9 percent of the time.

By contrast, of the 244 cases of forced arbitration in which companies made claims against their customers, the companies obtained relief in 227 of them or 93 percent of the time. For the consumers who did obtain relief, the CFPB found they won far less than they had claimed, while the companies that obtained relief recovered nearly the entirety of their claim.

The study also demonstrated how giant financial institutions have learned to pair forced arbitration clauses with class action bans to shutter the courtroom doors on groups of individuals with small claims. Once blocked from going to court as a class, most people drop their claims entirely because they lack the financial means or will to fight a corporation in arbitration as an individual, where outcomes are seemingly predetermined in favor of the corporation.

Although millions of financial consumers are covered by forced arbitration clauses and class action waivers, the CFPB found, on average, that only 25 consumers with claims of less than $1,000 pursue arbitration annually. Think about it. That is just license for corporations to rip you off $20, $30 at a time. It is license.

Finally, forced arbitration is shrouded in secrecy, which shortchanges current and prospective customers of information that may affect their financial decisions. Between confidentiality requirements contained in many forced

arbitration agreements and the secretive nature of the arbitration proceeding itself, financial institutions use force arbitration agreements to shield themselves from accountability to the courts and to the public eye.

Let's take the Wells Fargo scandal. Just last year, the public was shocked to learn that over the course of 5 years, Wells Fargo employees had been incentivized to open millions of sham accounts in the names of Wells Fargo customers, including over 31,000 in my State of Minnesota. Then the bank charged the customers for those accounts without their permission. One reason this fraudulent practice was able to continue for so many years is because Wells Fargo's customer account agreement included and continues to include, yes, a forced arbitration clause.

When customers discovered and attempted to sue Wells Fargo for the sham accounts, the company forced them into arbitration, having successfully argued that any dispute arising from the sham account was covered by the arbitration clause in the agreement for the real account.

Let me say that again. Wells Fargo successfully argued that any dispute arising from the sham account was covered by the arbitration clause in the agreement for the real account. That is what we are voting on here.

If these claims--some of which date back to 2013--had been able to proceed to court rather than in private, forced arbitration, other Wells Fargo customers would have been alerted to the wrongdoing and may have been able to save themselves and thousands of others from being ripped off and prevented damage to their credit. That really matters to people. A bad credit score can mean the difference between getting a mortgage and not getting a mortgage, getting a car loan or not, or even getting a job or not

Fortunately, a few months ago, the CFPB issued a rule to ban financial institutions from preventing their customers from banding together to seek justice in a public court of law. This is good news for consumers who have been scammed by payday lenders, debt relief companies, or big banks like Wells Fargo; it is good news for our servicemembers and veterans who wish to vindicate their rights under the Servicemembers Civil Relief Act; and it is good news for small businesses, community banks, and credit unions that have been forced to compete with powerful corporations that are pocketing billions in stolen money from consumers.

Let's be very clear about what the rule doesn't do because I think there has been some misinformation put out there. The rule is not about banning arbitration altogether, and the rule does not prevent a consumer from pursuing arbitration if he or she wants to, assuming the corporation also wants to go to arbitration. Instead, the rule simply takes the ``forced'' out of ``forced arbitration'' and gives the consumers a real choice again to pursue a claim of wrongdoing in arbitration or band together with similarly harmed consumers to seek justice in a public court of law.

Now the big banks and financial institutions--including Equifax, the massive credit bureau that put 143 million Americans' private information at risk--are trying to kill the rule, and they are far too close to getting their way.

As long as I have been in the Senate, I have been fighting to end forced arbitration. I have always said my efforts are about reopening the courtroom doors because they should never have been closed in the first place.

I urge my colleagues on both sides of the aisle to see the CFPB's rule for exactly what it is, a commonsense way to restore transparency and accountability in our Nation's financial system and to level the field between Wall Street and consumers. We must allow the CFPB to move forward in implementing this critical consumer protection.

I ask you to please join me in showing strong support for the CFPB's rule, knowing what is in the rule, knowing what this is about, and then opposing the special interests that are attempting to take this rule away.

Thank you.

I yield the floor to the Senator from Connecticut.

Mr. President, I rise today to remember and celebrate the life of my friend, Senator Paul Wellstone.

Paul led a lot of fights in the Senate on behalf of working families and those without a voice. He didn't back down even when a fight seemed unwinnable. He told voters exactly what he believed even when it wasn't popular. It was by taking such positions that Minnesotans, whether they agreed with him or not, always knew where he stood.

In the final days of the 2002 campaign, he told Minnesotans:

I don't represent the big oil companies, I don't represent

the big pharmaceutical companies . . . they already have

great representation in Washington. It's the rest of the

people that need it. I represent the people of Minnesota.

But Paul also knew full well that standing up to powerful interests could have steep political costs. His career in the Senate was bookended by votes on going to war in Iraq. Both of his votes were unpopular, but Paul stood on principle, not on politics. His maiden speech, the first speech he gave as a Senator, was in opposition to the first Gulf war, and one of the last Senate votes he cast was against the second war in Iraq.

He was facing a tough reelection challenge at the time of his vote, and he knew it might cost him his seat, and he told friends so. But to have voted otherwise, he said, would have violated the principles that guided his career. So he voted his conscience and put political considerations aside, just as he did throughout his time in public office.

Then, just 11 days before election day, his plane went down, taking not only Paul and Sheila, his wife, but their daughter Marcia, campaign staffers Tom Lapic, Mary McEvoy, and Will McLaughlin, as well as pilots Richard Conry and Michael Guess.

Since coming to the Senate, I have learned how well regarded Paul was around the Capitol, not only by Senators from both sides of the aisle but also by Capitol police officers, whom he knew by name, and the elevator operators, for whom he always made time.

Paul's legislative work continues to make a profound difference in the lives of millions of Americans. Among his accomplishments are his pioneering efforts, along with Republican Senator Pete Domenici of New Mexico, on mental health parity, which ensures that copays and deductibles for addiction and mental health services are on par with payments for other medical services. The law was jointly named for Paul and Senator Domenici, and it passed in late 2008, 6 years after Paul's death.

After I was seated in 2009, one of the first things I did was to work with Paul's son David on getting the final rules written to implement Wellstone-Domenici. That work inspired me to later push for investments in school mental health services, to help students and their families who need those services.

Paul also led the David-and-Goliath effort to stop bankruptcy legislation that favored big banks and credit card companies over working families. Despite going up against a wide range of special interests with huge lobbying power and lots of money, he successfully held off passage of the bill during his lifetime.

He also took on special interests when he stood against oil drilling in the Arctic National Wildlife Refuge. He believed, like I do, that the long-term consequences of endangering the home of indigenous people and a pristine habitat for wildlife far outweighed ``a short-term speculative supply of oil that will not . . . help consumers.'' Because of Paul and others in the Senate, the Wildlife Refuge, at least for now, remains pristine.

Paul also had an amazing and special relationship with Sheila, who became an important partner in his Senate work. She became a leading advocate for survivors of domestic violence, spending years raising awareness about the issue and the need to address its causes. Former Senator and Vice President Joe Biden said Sheila deserves as much credit as any lawmaker for passage of the landmark Violence Against Women Act. Since the law's enactment, incidents of domestic violence have been reduced significantly. It was a landmark achievement.

My constituents remember Paul fondly. They leave notes and mementos for him at the quiet memorial site honoring him just off of Highway 53, near Eveleth, MN. They leave them for his wife Sheila, too, and for the others who died with them exactly 15 years ago tomorrow, when their plane tragically crashed just miles from the Eveleth-Virginia Municipal Airport.

I have been to the memorial site, and I have seen how deeply and personally Paul touched people in Minnesota and across the country. He inspired them not only as a U.S. Senator for 12 years but also as a Carleton College professor who encouraged a generation of students to take action in their communities. He did so as a fiery organizer who stood up for Minnesota farmers and for working families and insisted on giving them a voice and a seat at the table. He never lost the tenacious spirit that led him to be a collegiate wrestling champion--he is in the college wrestling hall of fame--and he brought that same approach to standing up for Minnesotans. He stood strong against injustice, even when it

twice meant being arrested. It wasn't because he wanted to break the law, but because he thought it was necessary to bring about change for the better.

He also had a special way of connecting with people. Former Senator Tom Harkin said at a memorial service for Paul that he ``made a miner up in the Iron Range know he was as important . . . as the president of the United States.'' That is how Paul voted in the Senate, too, putting ordinary Minnesotans ahead of politics, money, and influence.

The last time I saw Paul was at a 2002 campaign event in St. Paul, just weeks before he died. He was locked in a bitter struggle for reelection. Despite being in a grueling fight for his political life, the first thing he said to me was, ``How's your mom?'' That was Paul.

I had just come from my mom's nursing home in Minneapolis, where she had a picture of Paul on her wall that said: ``Phoebe, keep fighting.'' She wasn't doing very well. I told Paul that she had dementia--some sporadic dementia--and that day I couldn't have a conversation with her. He put his hand on my shoulder and said: ``Touch means so much. Touch means so much.''

The next day, I went to the nursing home, and I took my mom out into the garden, in a wheelchair. She was having a bad day again, but I put my arm around her as we sat. It was a beautiful day. I don't know if it meant anything to her, but it sure meant everything to me.

Paul's life and his work meant a lot to me too. His examples as a tireless, passionate champion for working families, for veterans, for farmers, and for those who simply needed a voice have inspired my own time in the Senate. I keep Paul's picture and his Senate name plate in my office behind me as a reminder at my desk every day. Every day I serve, I think back to Paul's words. This is what Paul said:

Politics is not about power. Politics is not about money.

Politics is not about winning for the sake of winning.

Politics is about the improvement of people's lives.

While Paul isn't here with us today, his legacy lives on in so many ways. It lives on in the generations of students and activists he trained and inspired in Minnesota. It lives on in the policies he fought for here in the Senate, for access to mental health care, for a clean environment, and for making sure that working families get a fair shot. It lives on in the countless lives that he touched, like mine and my mom's.

Paul made us all better, and I hope his legacy will continue to inspire us well into the future.

Mr. President, in May, Jimmy Kimmel shared the story of his newborn son Billy, who was born with a life-threatening condition that required open-heart surgery. Kimmel said that he was fortunate to have had good health coverage and was able to pay for the care that his son needed, something he believed every American deserved.

A few weeks later, as efforts to repeal ObamaCare were gaining steam, Senator Bill Cassidy explained that the bar he believed any healthcare bill had to clear to get his vote was what he called the Jimmy Kimmel test. He said: ``Will a child born with congenital heart disease be able to get everything she or he would need in the first year of life?''

When Kimmel interviewed Senator Cassidy a few days later, Kimmel explained the test this way: ``No family should be denied medical care, emergency or otherwise, because they can't afford it.'' Well, I am here to report that this latest version of TrumpCare, offered by none other than Senator Cassidy himself, fails the Jimmy Kimmel test miserably.

Over the past few weeks, there have been two ongoing conversations about the future of healthcare in the United States. The first has been conducted in an open, bipartisan manner in the Senate Health, Education, Labor, and Pensions Committee in full accord with the traditions of this body. In the HELP Committee, Republicans and Democrats alike have been talking with Governors, insurance commissioners, and other experts on ways to address concerns of States and consumers by stabilizing the individual market and lowering premium costs. That is how the Senate is supposed to work, and the bill that emerges from that process will be one that makes things better, not worse. It will create certainty. It will bring down costs for consumers. It is a bill that any Senator should be proud to vote for.

The second conversation is a model of how things shouldn't work. It has occurred behind closed doors between Senate Republicans and party operatives. It is not about making the system work; it is about passing something--anything that can be said to repeal and replace the Affordable Care Act, and along the way, it destroys the Medicaid Program as we know it. As many of us have argued before, this conversation is an affront to the traditions of this body and, more importantly, to the will of the American people.

I urge my Republican colleagues to oppose the Graham-Cassidy bill-- the newest iteration of TrumpCare--which will rip healthcare coverage from tens of millions of people, create higher

costs for consumers, and ensure the destabilization of the individual health insurance market.

While I have worked closely with Senators Cassidy and Graham on other bills, and I respect them, I have grave concerns with this legislation.

First, the bill undermines protections for people with preexisting conditions.

States could apply for waivers that would allow them to charge people more based on their health status, age, or any other factor other than race or ethnicity. This means premiums would be higher just for being older or sicker or having had an illness in the past. In other words, there would be no protection for people with preexisting conditions.

Additionally, States can also seek waivers to remove the ACA's essential health benefit requirements, which mandate that insurers that are offering plans on the exchanges include coverage for vital services, such as prescription drugs, maternity care, mental health, and substance use disorder services.

While the bill technically requires States to describe--just simply describe--how they will ``maintain access to adequate and affordable health coverage for individuals with preexisting conditions,'' there is no definition of what that means, and there are no enforcement mechanisms. Insurers would still be able to charge people with preexisting conditions more for their care or exclude services altogether. Under this plan, millions of people with preexisting conditions could face much higher costs, if they can get coverage at all. Again, this bill rips away protections for people with preexisting conditions.

Second, the bill would undoubtedly reverse the significant coverage gains we have seen in recent years and drive up the number of Americans without health insurance.

The Graham-Cassidy proposal eliminates the ACA's premium subsidies, eliminates the Medicaid expansion, eliminates cost-sharing reduction payments, and more. Instead of funding these critical aspects of the ACA, the bill would return some but not all of this funding to the States in the form of block grants, which are authorized in this bill from 2020 to 2026.

The bill also proposes to dramatically reduce funds for States that have expanded Medicaid and have successfully enrolled more adults in ACA exchanges--States like Minnesota. Instead of incentivizing success, the bill will reward failure, initially increasing funds for States that refuse to expand Medicaid and have done little to encourage enrollment. But even these States lose out in the end. In fact, the funding stops completely after 2026, resulting in enormous losses for every State, and even prior to 2026, the Center on Budget and Policy Priorities estimates, most States will receive significantly less funding from the Federal Government under this block grant than they do under current law. Minnesota could lose $2.7 billion. Other Senators who have expressed various levels of concern with this legislation could see their States lose significant sums. Those include Arizona, which would lose $1.6 billion; Alaska, $255 million; Maine, $115 million; Colorado, $823 million; and the list goes on. Healthcare isn't free. These shortfalls will mean that families don't get the services they need.

On top of all that, the Graham-Cassidy proposal caps and cuts Medicaid--a program that provides coverage to seniors, families with children, and people with disabilities. In Minnesota alone, that is 1.2 million people facing cuts to their benefits or losing coverage altogether.

I believe many of us truly want to help our constituents access the care they need. As I have said before, the ACA is far from perfect, but it has resulted in significant improvements in millions of people's lives.

I have heard from countless Minnesotans who have literally had their lives or the life of a loved one saved by the ACA--the same way that Billy Kimmel's life was saved by the treatment he was able to receive at the beginning of his life. Take Leanna, for example. Leanna's 3- year-old son, Henry, has been diagnosed with acute lymphoblastic leukemia. His treatment will last until April of 2018. He often needs round-the-clock care to manage his nausea, vomiting, pain, and sleepless nights--a 3-year-old.

Henry's immune system is so compromised that he is not supposed to go to daycare, so Leanna left her job to care for him. Leanna and Henry are supported by her spouse, but they couldn't pay for Henry's treatment on one salary.

Leanna says:

It is because of the ACA that Henry gets proper healthcare.

Henry can get therapy and the things he needs to maintain his

health and work towards beating cancer. Henry is still with

us because of the ACA.

Let me say that again: Three-year-old Henry is still with us because of the ACA.

Consider Maria's story. Maria enrolled in Minnesota's Medicaid Program after finishing her graduate degree and while looking for full- time employment. Maria was grateful for the coverage because she needed access to treatments for her endometriosis, which was diagnosed a few years prior while she had insurance through her employer.

Soon, Maria found her dream job, but it came with a catch: no health insurance. Days before she was set to move and start work, she decided to go in for one last big checkup. The results were unnerving. At the age of 35, Maria was diagnosed with bilateral breast cancer. Maria had to give up her job offer and aggressively pursue treatment for the cancer.

Fortunately, because Minnesota had expanded Medicaid, all of Maria's treatments were covered, and lucky for her, they worked. Maria's cancer is in remission. Maria said: ``The Medicaid expansion of the ACA literally saved my life.'' She told me that anyone could find themselves on Medicaid. She said: ``Without that comprehensive, affordable, accessible health insurance, I wouldn't be here.''

But now that all of these programs are in jeopardy, my constituents are generally scared. They have come to me in tears, explaining that if the Affordable Care Act is repealed or if draconian changes and cuts to Medicaid go through, they don't know how they will care for their elderly parents, keep their rural hospital open, or afford treatments they or their children need.

I believe it is legislative malpractice to pass partisan legislation that would undermine this progress, people's economic security, and their livelihood, all to achieve a destructive political end--to do it without holding thorough hearings in the committees of jurisdiction, without hearing from experts, and without a complete assessment from the Congressional Budget Office on how this legislation would affect the American people.

I urge my Republican colleagues to once again abandon their efforts to ram through dangerous legislation that would fundamentally restructure our healthcare system. This new iteration of TrumpCare fails the Jimmy Kimmel test. It is the result of a horrible process that is not worthy of this body.

We have a better option. Over the past few weeks, Chairman Alexander and Ranking Member Murray have held four bipartisan hearings on individual health insurance market reforms and are working to forge a legislative compromise to reduce premiums for consumers. We have heard from Governors, we have heard from insurance commissioners, and we have heard from experts--all of whom span the ideological spectrum. This is what regular order looks like, and this is the way the Senate is supposed to work.

I have worked with all of my colleagues on this committee in good faith, and I am proud of what we have been able to accomplish so far, but all of that work is in jeopardy because of a destructive, partisan, last-ditch effort to repeal the Affordable Care Act and end the Medicaid Program as we know it.

Do not shortchange those important legislative developments. Do not shortchange the American people. Think of the millions of children and families who need our help right now. Oppose TrumpCare, and, instead, let's work to improve care, lower costs, and ensure access to healthcare when people need it the most. It is within our reach.

I suggest the absence of a quorum.

Mr. President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record.

Thank you, Madam President.

Madam President, I rise this evening to speak in opposition to the Republican plan to dismantle our healthcare system. Their effort to repeal the Affordable Care Act and gut Medicaid would put the health, as well as the financial security of millions of Americans, at risk.

Let me tell you how this would affect Minnesotans such as Annie and her 5-year-old son Carter. Carter has autism spectrum disorder and relies on Medicaid to help cover necessary therapy services. When Carter was 2, he did not talk, make eye contact, or interact with anyone. But now, because of the treatment he receives under Medicaid, Carter speaks full sentences and is entering kindergarten. Annie explains how none of that would be possible without Medicaid. If Republicans succeed in imposing drastic cuts to Medicaid, which is what they want to do, and States are forced to cut back services, Annie and her family would not be able to afford the therapy that Carter needs to thrive.

Think about that. Think about what that does to one life. Think about the other millions that would be affected in such a negative, tragic way.

There is also Mari and Chrysann, both from Moorhead, MN. Moorhead is in northwestern Minnesota, right across the river from Fargo. Mari took care of her aging mother in her home as long as she could, but when Chrysann's health began to decline, Mari helped her mom move to a nursing home where she could access the higher level of care she needed.

Mari and her husband work full time and still have children at home. I visited the nursing home where Mari spoke, and she got emotional when she told me that if it were not for Medicaid, her family would not have any other way to pay for her mother's care. She does not know how she would care for her mom or what would happen to her.

Chrysann, Mari's mom, is worried too. She spoke at this roundtable at the nursing home. She is worried about how the Republican plan will affect her own future and those of others who are in similar situations in nursing homes. Sixty-four percent of Americans in nursing homes have their care paid for by Medicaid. Chrysann told me this

plan is not about taking care of people but simply about ``survival of the fittest.''

Is that really the healthcare system we support in the United States of America--the survival of the fittest?

How about Chuck? Chuck is the CEO of Perham Health. It is a rural hospital that is doing really innovative work in Northwest Minnesota. It is kind of central, north. It is in rural Minnesota, not unlike the rural areas in the Presiding Officer's State.

Chuck told me: ``Cutting Medicaid as drastically as they are proposing will force us to cut staff in areas that are actually saving the system money today.''

These cuts would affect nurses who run the hospital's medical homes, community paramedics, and other staff who are helping to keep people out of the Emergency Department, reduce readmissions, and keep people healthy overall. This is part of the innovation they are doing there. This is part of the innovation that Minnesota leads the Nation in.

Perham Health is one of the largest employers in town so taking away jobs does not just impact the patients and the hospital, it affects the community and rural economy. Cutting jobs and getting rid of successful reforms just does not make sense, and this would be repeated over and over and over again in rural America.

Again, the question is, Why are Republicans pursuing such a reckless and irresponsible strategy?

All of the bills they have proposed thus far will increase patient costs, including premiums and out-of-pocket costs, will increase the number of uninsured Americans, and will rip apart our healthcare safety net. These are not the changes Americans want. In fact, this is the opposite of what Americans want and are asking for.

Now, over the last day, we have heard a lot more about another path Republicans may pursue--a scaled-back plan that eliminates a handful of the ACA provisions, including the employer mandate and individual mandate. While these two changes may be politically expedient, they would, according to the Congressional Budget Office, drive up premiums and cause millions of Americans to become uninsured.

What is more, as the New York Times points out, this plan does nothing to address the criticisms Leader McConnell, President Trump, and their allies continue to lodge against the Affordable Care Act. For example, this approach does nothing to improve competition and choice in the individual market and, in fact, injects far more uncertainty into individual health insurance markets, which are already rattled by the administration's deliberate efforts to sabotage them.

Should this plan pass the Senate, it will surely get much worse when the differences between the plan and the House bill are reconciled in the conference committee. According to news reports, a number of my Republican colleagues are arguing that passing this scaled-back version of repeal is really just a means to get to conference, where Members can further negotiate the House and Senate repeal and replace bills. In fact, some are even suggesting that the provisions in the House-passed bill would be a guidepost for negotiations.

I think all of us remember how awful, far-reaching, and--according to President Trump--mean the House-passed bill is. What is more, we can see the worst provisions of the Better Care Reconciliation Act resurface in the conference committee, which is the Senate repeal and replace bill that was defeated on a bipartisan basis.

Overall, pursuing this path is dangerous, given the tremendous number of unknowns. Not only would this half-baked--that is being generous-- quarter-baked, scaled-back version of the ACA repeal destabilize health insurance markets, but it would also serve as a vehicle for Republicans to take up the most controversial measures included in the defeated BCRA and the House-passed bill.

Why on Earth would we support that?

Frankly, it is also delusional to believe that a small group of House and Senate leaders can craft a workable solution in a matter of days or weeks. They have had 7 years to come up with an alternative. They do not have one so how can we expect them to, all of a sudden, come up with a viable plan that affects one-sixth of our economy?

Look, this whole process has been and continues to be irresponsible. In fact, this is one of the most irresponsible policymaking processes I have seen in my time in the U.S. Senate. What we should do is just what Senator McCain called for in his speech yesterday, which is to pursue regular order, work together--Republicans and Democrats--and seek out compromise. If we reject this wrongheaded effort, then I and many of my colleagues are ready and committed to work in a bipartisan way on reforms that will expand coverage, lower costs, and improve care.

Let's have bipartisan hearings on the individual market, on drug prices, and more. Let's call in nonpartisan expert witnesses. Let's have meaningful committee and floor debates. Let's fix what needs fixing in the Affordable Care Act. Annie, Carter, Mari, Chrysann, Chuck, and millions of other Americans need us to do just that.

To my colleagues on the other side of the aisle, please, stand up to the bullying, stand up to the lies, and work with us to improve people's lives, not make them worse. Paul Wellstone said that politics is not about winning, that it is not about power, that it is not about money. Politics is about working to improve people's lives, and that is what we should be doing. You owe it to your constituents. You owe it to yourselves.

Thank you.

I yield the floor.

Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senators Shaheen and Blumenthal.

Madam President, I intend to offer the following motion to H.R. 1628, and I ask that it be printed in the Record. The motion is supported by Senator Blumenthal.

Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senator Udall.

Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record.

Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senators Baldwin, Casey, Coons, and Blumenthal.

Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senators Baldwin, Duckworth, Reed, Carper, Blumenthal, Brown, Warren, Stabenow, Booker, Udall, Feinstein, Shaheen, Coons, Nelson, and Van Hollen.

Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senators Cantwell and Klobuchar.

Mr. President, I rise to talk about the effort by Republicans in the majority to rip apart our healthcare system and jeopardize the protections for people with preexisting conditions and to throw millions of people off their health insurance.

Now, it is deeply troubling at this point that with less than 24 hours until the expected vote, we don't even know which version of repeal the Republicans hope to pass. Do Republicans support the Better Care Reconciliation Act--the bill that according to the Congressional Budget Office, would cause 22 million more Americans to become uninsured, which would drive up healthcare costs and dismantle the Medicaid Program? Do they support the Cruz amendment, which would bring back junk insurance plans that offer virtually no protection and drive up out-of-pocket costs for vital services or will they rally behind their backup option, a plan to repeal the Affordable Care Act and replace it with nothing--that is, nothing--an approach that would add 32 million more Americans to the ranks of the uninsured and cause average premiums in the nongroup market to double or will it be something else entirely? We don't know.

This is reckless. This is irresponsible. The American people deserve better.

Let's be clear. A vote for the motion to proceed is a vote to move forward with conceivably any one of these bills, and all of these bills are terrible. They jeopardize lifesaving care and treatment for millions of American families, especially those with preexisting conditions. They tear apart our safety net and give tax breaks to powerful corporations.

Let me remind my Republican colleagues that a vote in support of the motion to proceed will have real-world consequences for your constituents who may lose their health insurance. Perhaps these are people you have met; people, many of whom may be losing sleep out of justified fear that their children or their parents, their loved ones or they themselves are at risk of losing their healthcare.

I have talked to so many people in my State about these dangerous proposals. There is Kristi. Kristi is a young farmer in Greater Minnesota whose husband and two kids relied on Medicaid to access care when their farm was struggling.

There is Sandy, whose mom is in a nursing home and who doesn't know how she will pay for the round-the-clock care her mother needs if Medicaid, which covers more than 6 in 10 nursing home residents nationwide, scales back coverage.

Then, this is Sheri, who said that if it weren't for Medicaid, her son Brandon, who has cerebral palsy and hydrocephalus, probably wouldn't be here. I met Brandon. I think he is 18 or 19. He was born 15 weeks early, in Minneapolis, about a pound and a half. They took him to the Mayo Clinic in Rochester. The Mayo Clinic said: We can't handle him, so they sent him back to Minneapolis to Gillette Children's Hospital, which could. They told Brandon's parents: He is going to require $1 million in care the first day to save his life.

Brandon has had, I think, 37, 38 surgeries. He spoke at a meeting we had on Medicaid a couple of weeks ago in Minnesota, and he stood--he had a walker. He had just gotten an A-minus in his first college course. He was actually, in a way, the last person in the room I was worried about because his resilience--this guy, this kid is going to be amazing. I don't think he would be here if we didn't have the kind of Medicaid we have and the kind of Medicaid my colleagues on the other side of the aisle are talking about limiting in a way that will affect so many people I have met across my State.

This is one of those votes that will go down in history. It is one of those votes that all of us will be answering for wherever we go for the rest of our lives.

The former Republican Senator from Minnesota, David Durenberger, outlined some of the reasons Senators should not vote for this consequential legislation in an excellent op-ed, a piece he wrote, and it was in USA TODAY today. Senator Durenberger--again, a Republican from Minnesota and someone whom I talk to a lot about healthcare--wrote this piece, saying resist the bullying, don't vote for a mystery healthcare bill.

I ask unanimous consent to have printed in the Record Senator Durenberger's op-ed.

Mr. President, there aren't many votes like this in a Senator's career so let's just lay this out. If you support the vote tomorrow, the following are some of the specific consequences that could follow and in many cases would follow.

First, it is a vote that would open debate on bills that would undermine protections for people with preexisting conditions. This could happen in one of two ways. This vote could open debate on the potential Cruz amendment, which would allow insurance companies, as long as they offer ACA-compliant plans on the exchanges, to also sell bare-bones, skimpy plans outside of the exchanges, with almost no consumer protections. Under this amendment, insurers would be allowed to deny coverage and charge higher rates to women, older adults, and individuals with preexisting conditions. To my Republican colleagues, I ask: Do you know someone who is pregnant? Do you know someone who has diabetes? Asthma? Depression? Cancer? Multiple sclerosis? Substance use disorders? Arthritis? Dementia? Sleep apnea? Parkinson's? All of these people could be denied coverage under the Cruz amendment, just as they were prior to the ACA.

The Cruz amendment will also bring back annual and lifetime limits, coverage exclusions, and more.

When I was campaigning in 2008, and I would go around Minnesota-- cafes, VFW halls, bars--there would be a flyer up for a family who had gone bankrupt for someone who had gotten sick. This would bring back those annual limits, those lifetime limits. Do we really want to go back to that?

The Cruz amendment is intended to deceive. The amendment is designed to make people think it would lower premiums since it would allow insurers to offer stripped-down plans that don't comply with the ACA's consumer protections, but what it actually does is skyrocket the price of insurance for people with preexisting conditions like epilepsy, Crohn's disease, and stroke, while eviscerating the quality of insurance for those who don't yet need, or know they need, such coverage.

In fact, America's Health Insurance Plans, which is the national political advocacy and trade association of companies that sell health insurance to Americans, and the BlueCross BlueShield Association have said this proposal is ``simply unworkable in any form and would undermine protections for those with preexisting medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market.''

The fact is, these high-deductible, bare-bones plans are a dangerous rip-off, and many people will not even realize what garbage insurance they have until it is too late.

Here is the thing. Even if the Cruz amendment were removed from the bill, the Better Care Reconciliation Act would still undermine protections for people with preexisting conditions. That is because the bill would allow, and even incentivize, States to waive ACA protections like the guarantee of coverage for basic essential health benefits.

If you are allowed to offer plans that don't cover basic services like mental health, prescription drugs, and maternity care, then you have a backdoor channel to charge people who need those services more than those who don't. Not only that, States that seek waivers and end the guarantee of essential health benefits bring us right back into the world of annual and lifetime limits--a world where your care would end not because your doctor said so but because the insurance company would stop paying for it. This could be true even for people who get their health insurance through their employer. In fact, even if you work in a State that hasn't taken this waiver, your employer could have gotten their health insurance from a State that had.

In short, with or without the Cruz amendment, the Better Care Reconciliation Act breaks President Trump's promise to protect people with preexisting conditions.

Second, yes, tomorrow is a vote to end Medicaid as we know it. Medicaid is a lifeline, providing health insurance and access to care for more than 70 million Americans. That is about one in every five Americans. It includes seniors, pregnant women, people with disabilities, families with children.

Senator Klobuchar was right about this being a lottery. Any of us can be in an accident. Any of us can be diagnosed at any time. Any of us can have a child who is diagnosed at any time with something unexpected.

Healthcare really should be a right. I don't understand people who say: I am healthy. My kids are healthy. Why should I suffer? I am the victim here. Nothing has happened to me. Why should we have a system where I am paying for people with preexisting conditions?

Really? Is that the attitude my Republican colleagues are taking? Because that seems to be the logic.

Medicaid had been a bedrock of our healthcare system since 1965. It was and is a Federal promise made to States and to all Americans over 50 years ago. And most of all, Medicaid works. But the Better Care Reconciliation Act would gut it. It would end the program's coverage guarantee, leaving States to either roll back coverage or slash other vital programs in order to meet their citizens' needs.

Finally, a vote to support the motion to proceed to this bill is a vote to drive up people's total healthcare costs. The Republicans' plans decrease or eliminate the ACA's tax credits, which help people afford their insurance--that was part of the construct--and it dramatically hikes premiums for older Americans, although ones younger than I--I am now 66, but from 50 to 64. It drives up deductibles and other out-of-pocket costs that many people have to pay in order to receive care.

Americans don't like these proposals. In fact, new polling shows that only 17 percent of Americans think they and their families will be better off under the Republican plans. That is 17 percent.

What Americans want is for Republicans and Democrats to work together to build on and improve the Affordable Care Act. So why do my Republican colleagues continue to push forward on these terrible bills? It doesn't have to be this way. There is another option. This body can reject the wrongheaded and ill-thought-out proposals and allow for an open, bipartisan process under regular order where we can work together and do the things the American people actually sent us here to do-- expand coverage, lower costs, and improve care. We should have bipartisan hearings where we hear from nonpartisan expert witnesses about the challenges facing the Affordable Care Act so we can work together to fix what isn't working in the ACA.

What we do know from the last few years is that coverage matters. This is important. Coverage matters. Just having coverage matters. Healthcare isn't really about these big, heroic emergencies. A person's health is about some of those events, but what it is really about is having coverage and getting continuous care throughout your life.

Rigorous studies have shown that for every 300 to 800 adults who get coverage, 1 life is saved per year. Research summarized by Atul Gawande and his colleagues in a recent New England Journal of Medicine piece finds that health coverage expansions have improved people's access to care, improved their financial security, meaning fewer bankruptcies and medical bills sent to collections, improved chronic disease care and outcomes, improved self-reported health, and more. Overall, health insurance has been shown to help Americans live longer, healthier lives. Now is not the time to roll back our progress.

I urge my Republican colleagues to think about what a vote for proceeding on this terrible legislation would mean for the American people.

Paul Wellstone said that politics isn't about winning; it isn't about money; it isn't about power; it is about improving people's lives. Our constituents sent us here to improve their lives. So I urge my Republican colleagues to vote no. Let's work together to fix what needs to be fixed in the Affordable Care Act and do all we can to

make sure people have access to affordable, high-quality healthcare when they need it.

Mr. President, I yield the floor to the Senator from New Hampshire.

Mr. President, I rise also in opposition to the nomination of John Kenneth Bush. Mr. Bush, who has been nominated to serve as a judge on the Sixth Circuit Court of Appeals, has the dubious distinction of having anonymously written scores of blog posts that aren't just offensive--which, believe me, they are--but that call into question the nominee's ability to be a fair and impartial arbiter of the law, which is the job of a judge, especially a circuit court judge. In my view, the nominee's lengthy record of inflammatory and intemperate writings stands as evidence that Mr. Bush falls far short of the high standards that the Senate should demand of nominees to the Federal bench.

Over the course of nearly 10 years, Mr. Bush wrote under the pseudonym ``G. Morris.'' He wrote under a pseudonym on a political blog operated by his wife, where he published hundreds of incendiary posts.

Let me be absolutely clear. Being politically active or expressing political opinions is not a disqualifying characteristic in a judicial nominee--at least, not in my view. But as I said during Mr. Bush's hearing, it is important for the Senate, in attempting to determine whether a nominee is qualified to serve as a Federal judge, to assess that nominee's judgment as a judge--to assess his or her judgement--and that is what I would like the President and all our Members to consider.

In the hundreds upon hundreds of posts that Mr. Bush anonymously published on his wife's blog, Mr. Bush did not demonstrate what any Member of this body would characterize as good judgment. It was far from it. During his hearing, I questioned the nominee about a series of posts in which he seemed to fixate on President Obama's Kenyan heritage. In one post, Mr. Bush discussed an article that suggested a reporter was detained by the Kenyan Government because he was investigating ``Barack Obama's connections in the country'' and that authorities had locked up the reporter in order to prevent him from publishing what he discovered. The article Mr. Bush quoted from and linked to was published on World Net Daily, a website known for peddling conspiracy theories, bogus claims, and White nationalism. In fact, World Net Daily is widely known for trafficking in birtherism-- the widely debunked and racist belief that President Obama was not born in this country. Nonetheless, Mr. Bush presented the World Net Daily article as fact. This is a guy who has been nominated to be a circuit court judge calling a World Net Daily article fact.

So during his confirmation hearing, I asked Mr. Bush--and I asked him over and over again--how he decided which sources to rely upon in his writings and how he determined a particular source was credible. In my view, whether a nominee is capable of discerning real news from fake news or blogs that traffic in conspiracy theories from legitimate journalism directly speaks to the nominee's judgment. Again, the job is judge. Really now, World Net Daily?

Whether and how a nominee evaluates the credibility of a claim or a source of information provides a window into how he might approach the factual record in a case, for example. That is what judges do. But Mr. Bush couldn't answer my question. Instead, he said: ``As a blogger, I was finding things that were in the news that were of note, I thought.'' In response to a written question I posed, Mr. Bush said that rather than perform original research to support his claims, he instead ``relied upon readily available sources on the internet.'' That would be the prestigious internet. Really? Really? From a nominee for the circuit court?

This begs the question: How did Mr. Bush find these articles? Does the nominee consume a steady diet of disinformation and conspiracy theories? I asked him that question in writing. Mr. Bush responded that he did not remember how he came upon those sources and that, in fact, aside from the articles he quoted, he did not recall reading any articles from those sources, despite the fact that he linked to and quoted liberally from conspiracy-minded websites many, many times in his writings.

Despite Mr. Bush's claims that he can't remember how it was that World Net Daily found its way onto his computer screen and despite his claim that he can't recall how he discovered and then later cited the writings of a birther conspiracy theorist, I suspect that in Mr. Bush's case, the simplest explanation is probably the right one. I suspect the reason Mr. Bush quoted from sources like World Net Daily so frequently is that Mr. Bush frequented those sources, that he frequently read the material they published, and I suspect he enjoyed it. That is just a suspicion based on my judgment.

The fact that a man who anonymously wrote inflammatory and offensive blog posts and who consumed information from sources that routinely publish lies and racially insensitive material could be confirmed to a lifetime appointment on one of the U.S. courts of appeals should shock the conscience of each and every Member of the Senate, no matter what your politics are.

I have served on the Judiciary Committee for 8 years, and during that time I have had the opportunity to evaluate countless judicial nominees. I understand that each Senator has his or her own way of determining whether a nominee should be confirmed. Some Senators prefer nominees who embrace a judicial philosophy of originalism or strict constructionism, others reject that view. For some Senators, a nominee's view of the Second Amendment or Roe v. Wade serves as a litmus test.

Setting aside the usual yardsticks by which we measure judicial nominees, Mr. Bush should strike each and every

Member of this body as manifestly unqualified, by any measure. Through his writings alone--and I urge all of my colleagues simply to look at his writings on his blog or on his wife's blog that he wrote with a pseudonym. They are awful. They are disgraceful.

Please, I beg my colleagues, read these and say to yourself: Are these writings the writings of a man--no matter what his leanings are in terms of how constitutional law should be decided, what his philosophy is, whether conservative, progressive, or liberal--how we can confirm someone to the circuit court, to a Federal judgeship for life, who writes anonymously these awful, incendiary things, relying on sources that are known for spreading hatred and linking to them. I don't think we have been here before. I don't think we have been here before.

I would beg my colleagues, before you cast this vote--I believe you could not justify to your constituents, that you could not justify to your family--please read these blog posts by this nominee and check your conscience--not at the door, check it. This is one of those incredibly unusual circumstances where somebody comes before us who, I believe, is uniquely unqualified for the job.

Thank you.

Thank you, Mr. President.

I thank my vice chairman of the Indian Affairs Committee, and I thank the Presiding Officer, who chairs the committee. I am honored to serve under both of them.

I rise to discuss the devastating effects the various Republican healthcare proposals that have been made would have on Indian Country.

Republicans are now considering a straight repeal of the Affordable Care Act, with no replacement. This policy, like others that have come before it, would have a devastating effect on Native communities. Today, I want to describe some of the healthcare challenges that these communities face, how the Affordable Care Act has helped to address some of those challenges, and how repealing the Affordable Care Act would undermine these gains and further jeopardize healthcare for an already vulnerable population.

I have served on the Indian Affairs Committee for the past 8 years, and I am continually shocked by what I hear almost every week from Tribal leaders and other witnesses about the challenges that face Native communities. One of the biggest challenges is that the Federal Government consistently falls short of its responsibilities to Indian communities. There is a lack of attention to the concerns of Native communities. There is a dysfunctional bureaucracy and a Congress that doesn't adequately fund Indian programs, and this can create a vicious cycle. When programs don't have adequate funding, they don't work as they should.

Some of my colleagues who have failed to provide Indian Country with the funding they need point to the resulting program inefficacies as justification for continuing to cut and underfund critical programs. That just doesn't make sense to me. Healthcare has fallen prey to this vicious cycle even though the Federal Government has a trust responsibility to provide healthcare to Tribes and to their members.

Medicaid and the Indian Health Service are both part of this trust responsibility. Over the years, the Indian Health Service has suffered from lack of resources, poor staffing, and other challenges. The vice chairman was right: ``Don't get sick after June'' is unfortunately something we hear over and over again, and it is said with some irony but also hurt in Indian Country because the funding runs out then.

These challenges mean that many in Indian Country, particularly those living in remote areas, don't have reliable access to the medical care they need on a timely basis. This is healthcare that was promised by treaty and by our Constitution.

Prior to the ACA, funding shortages meant that IHS was only able to provide people with the most basic services, so a lot of the care that people needed was simply not available. For example, prior to the passage of the Affordable Care Act, the Indian Health Service could not afford to provide vital services, including women's health screenings, like mammograms, or basic diabetes care. If you suffered from diabetes, you often had to wait until dialysis was required or limb amputation was needed before being able to receive care. That is just unconscionable. That is terrible. What is more, American Indians and Alaska Natives were more likely to be uninsured than non-Native populations, which meant that many people who needed care that wasn't covered by the IHS simply went without.

The ACA helped change all of this for the better. First, the ACA gave States the option to expand their Medicaid Programs to include low- income adults without dependent children. Thanks to Medicaid expansion, 11 million Americans, including more than 290,000 American Indians and Alaska Natives, were able to get health insurance. The ACA's Medicaid expansion made it possible for an estimated 60 percent of uninsured American Indians and Alaska Natives to qualify for healthcare coverage.

This expansion, coupled with other Medicaid policy reforms, such as those that simplified the enrollment process, helped increase the total number of people covered under the program. In fact, IHS reported earlier this year that 42 percent of patients receiving services--of those who receive the services--did so because they had coverage through Medicaid. That is what the Indian Health Service said. Forty- two percent of those who received healthcare services did so because they are covered by Medicaid. In Grand Portage, which is a beautiful spot on the

northeastern corner of Minnesota, this meant that well over 20 more band members, many of them children, received coverage. We know from a recent report out of Georgetown University that, nationwide, 54 percent of children in American Indian and Alaska Native families were enrolled in Medicaid in 2015, compared to 39 percent of all children.

This program has been a vital source of coverage, and, with health insurance coverage, people have finally been able to access the healthcare they need. That is what healthcare is really about. Healthcare is about having coverage so that you have routine visits for primary care. So if you are diabetic, you have routine visits. It is not about the emergency heroic event; healthcare is about the constancy of care. That is what improves people's health. That is what improves their lives.

Another way the ACA helped improve healthcare for Native populations was by transitioning the IHS to be the payer of last resort. By establishing that Medicare, Medicaid, and private insurance would be the primary payers, the ACA ensured that there was more money going to provide a wider range of services that people needed, while simultaneously reducing the financial burden on the IHS.

Yet there is more that we need to do to strengthen the Affordable Care Act and improve rates of coverage and access within Native communities. For example, we need to do more to address workforce shortages and lack of competition in insurance markets in rural areas. The Presiding Officer knows that. Also, it is imperative that we tackle the opioid epidemic in Indian Country. But recent Republican efforts to repeal the Affordable Care Act will do nothing to address these outstanding needs and would undermine the recent health and coverage gains Tribal communities have been able to achieve. I know the last bill had money targeted at opioid treatment, but it wasn't anywhere near what will be taken away when the Medicaid expansion and cuts to Medicaid are figured in.

The Republicans' proposals would hurt Indian communities in a number of important ways.

First, they would cause tens of millions of people, including many American Indians and Alaska Natives, to lose coverage, with between 15 million and 18 million Americans losing coverage immediately. For example, Republican plans would end the Medicaid expansion, as I have said, which has been central to providing health coverage to many in Native communities.

Second, they would jeopardize the sustainability and stability of the individual market, while giving huge tax breaks to powerful corporate interests.

Finally, they would increase premiums and reduce subsidies that low- income people receive to help pay for their healthcare, which would put private health coverage out of reach for so many.

Efforts to repeal the Affordable Care Act are just bad for Native communities and bad for the country as a whole.

As many of my colleagues know well, American Indians and Alaska Natives are twice as likely, as compared to non-Hispanic Whites, to be overweight, obese, diagnosed with diabetes, and experience hopelessness and depression. In Minnesota, American Indian women are also more likely than Whites to be diagnosed with maternal opiate dependency during pregnancy, and more children are born opioid dependent. Reducing coverage and driving up healthcare costs is the last thing these communities need.

Indian Tribes in Minnesota and in North Dakota and in all of our States are grappling with challenging and complex healthcare needs. They need our help. They don't need legislation that is hastily put together for ideological reasons. They don't need policies that undercut their care and livelihood.

I believe we need to work together across partisan lines. I really hope that is what we are going to do.

The Republican healthcare plans that have been put forward so far break the Federal Government's trust responsibility and undermine the very programs that are helping Indian communities. That is what I sincerely believe.

I urge my colleagues to reject Republican efforts to repeal the Affordable Care Act and instead work with us on a bipartisan basis, in regular order, with hearings before our committees, to strengthen care options for our Native communities and for all Americans. I believe we can do that, and I believe we can work together. It is just the right thing to do.

Thank you, Mr. President.

I yield to the vice chairman of the Indian Affairs Committee, the Senator from New Mexico.

Thank you, Mr. President.

I rise to talk about the effort to repeal and replace the Affordable Care Act. Before I begin, I thank Senator Hirono for sharing her story and for leading us all here in the discussion tonight.

I thank the Presiding Officer who has been listening, and I appreciate that. I really do.

In recent days, we have finally gotten to see the plan that 13 Republican Senators have been working on in secret and behind closed doors. I really thought the Senate bill would be better. I thought it would be better than the House version that was passed. Even Senator Burr said of the House bill that it was ``dead on arrival'' in the Senate, but, unfortunately, the Senate plan is just as bad.

The nonpartisan Congressional Budget Office announced just today that, under the Senate plan, 22 million more Americans would be uninsured. That has consequences. Perhaps worst of all--and partly because this causes the reduction in the number of Americans who would be covered--the bill ends the Medicaid expansion and cuts the

funding for the Medicaid Program by nearly $800 billion--a program that has been a vital part of our social fabric since 1965.

This bill--and I do not like to say this--is mean. The President said that of the House bill. I do not like to characterize something that way, but it is mean and would have far-reaching effects for millions of Americans across the country.

This past weekend, I hosted a healthcare forum in Burnsville, MN. It is a suburb that is south of Minneapolis, of the Twin Cities. It was on the importance of Medicaid and how the Republican plan's devastating cuts would affect Minnesotans. Over 230 people showed up to share their stories about how Medicaid changed their lives, and it was very moving.

I think it is really important to tell this in terms of people, not in terms of numbers, although the numbers are pretty stark. Brandon and his mom spoke, Brandon and Sheri. They are both from Burnsville.

Brandon was born 15 weeks premature. He weighed just 1 pound 13\1/2\ ounces. He was so small that his parents' wedding rings could slide on his arm. He was also born with cerebral palsy and hydrocephalus, which is a condition that causes fluid to collect in Brandon's brain, which results in brain damage.

Brandon, who is now 17, got up with a walker at the event. He told me that he was taken immediately to the Mayo Clinic in Rochester. He was born in the Twin Cities, but Mayo said that his case was too complicated to handle, so they sent him back to the Twin Cities, to Gillette, which is a children's hospital. It is a great children's hospital, a great hospital. Within 24 hours of his birth, the hospital told Brandon's parents that his costs were already over $1 million--a terrifying addendum to what must have been a harrowing, harrowing experience.

Over the years, Brandon has needed 38 surgeries--surgery to reduce the fluid in his brain. He has a shunt. He has had surgeries to straighten out his legs. He has had eye surgeries and more. He has also needed extensive physical therapy, occupational therapy, speech therapy, and across his lifetime, he has needed other interventions to help him do basic tasks, like eat and now walk. He could not turn over. He could not do the things that babies do, that we parents and grandparents relish in every day.

But guess what. He is thriving. In fact, he just passed his first college course at Dakota County Technical College. He proudly told me and the rest of us that he received an A-minus, and he hopes someday to get a job at Gillette, the Gillette Children's Specialty Healthcare, which is the very place that provided him with the unique and high- quality care that he has needed over the years. All of this has been possible because Brandon and his family were able to get health insurance through Medicaid.

Sheri, Brandon's mom, said: ``If we didn't have Medicaid, Brandon probably wouldn't be here''--meaning at our forum--``and he wouldn't be doing as well as he's doing.''

Brandon similarly noted:

Kids with special needs are referred to as ``special

needs,'' and I like to think I'm pretty special. I also like

to think our needs are also special depending on the kind of

care we need and that's what Medicaid provides.

I really believe that all of us here tonight must do all we can to protect these kids and protect their families and everyone who relies on Medicaid, and I sincerely believe that means we have to defeat this bill.

My colleague Senator Hirono stated last week: ``We are all one diagnosis away from a serious illness.'' That is the case. Do you know what else? We are also just one accident away from a life-changing injury.

Another Minnesotan, Deborah, shared her story with my office. She described for me a car crash and the subsequent traumatic brain injury that she survived in 2012.

She explained:

It was just another day. I was on my way to work. I lost

control of my SUV after sliding on a patch of ice and slammed

into a concrete median.

Her whole life changed at that moment. She had to relearn basic tasks--reading, walking, talking, and eating--but all of it was possible because of the home- and community-based services she was able to receive through Medicaid.

She said:

Without the services funded by Medicaid, my goal of

returning to paid employment would be impossible. I honestly

worry that proposed changes to the Medicaid program could

significantly diminish my overall health outcomes and even

leave me facing long-term homelessness.

As my colleagues and people at home who are watching this debate well know, this week could prove to be an extremely consequential week in the history of this country. The decisions we make--the 100 of us--over the next few days could literally mean life or death for many Americans. Lives are on the line.

Tomorrow, I will give a speech that is more about the data, and we have heard about some of that, but there is a study in the New England Journal of Medicine that came out this week that reads that Medicaid-- having the insurance--improves people's lives and that--this is not precise--for every 300 to 800 who will lose healthcare, who would lose Medicaid, there will be a premature death.

This is a study that is going to be summarized in the New Yorker, in an article by Atul Gawande, that the effect of having insurance is not about dramatic emergencies. This is especially about things like diabetes and heart illness and cancer--the day-to-day. It is about having access. Because you have insurance for care, it improves the health of people, and it extends mortality. This is real stuff. What we are doing is really serious.

I strongly urge my Republican colleagues to talk with their constituents about the bill that was drafted. Again, it was behind closed doors, and many of my Republican colleagues did not see it until last week. I urge them to talk to their constituents about the consequences this bill would have for seniors, for children, and parents who have Medicaid coverage.

Talk to the people who would see their healthcare costs rise. Talk to the families who may lose their health insurance. People are afraid.

I am a cochair of the World Health Caucus. I go all around my State. I talk to roundtables at rural hospitals and nursing homes. These are the parts of my State that voted for Donald Trump. During the campaign, Donald Trump said that he would not cut Medicaid. These are people who are scared, whose elderly parents stay home because Medicaid pays for their home healthcare, and they are afraid because that will go away. Both she and her husband work--this was a woman in Herman, MN--and they do not know what they will do.

Please, listen to your constituents. You need to do the right thing and vote no on this bill for their sake--for the sake of your constituents.

I yield the floor.