Floor Statements

Mr. President, I intend to offer a motion to commit the reconciliation bill to the Finance Committee with instructions to report the bill back to the Senate within 3 days, not counting any day on which the Senate is not in session, with changes that would strike any provision that would eliminate, limit access to, or reduce the affordability of pediatric dental services by repeal all or part of the Patient Protection and Affordable Care Act, ACA, or otherwise negatively impact children's access to coverage or such services.

I am offering this motion because the Finance Committee should review the implications of depriving millions of children of access to dental care. An estimated one of five children aged 5 to 11 years and one of seven adolescents aged 12 to 19 years in the U.S. have at least one untreated decayed tooth. Consequently, tooth decay has led to 51 million school hours lost annually, and related dental disease can cost billions to our healthcare infrastructure. Early childhood cavities and related oral health complications also disproportionately affect low- income families and minority communities.

The ACA has expanded access to dental services nationwide by designating pediatric dental services as one of the essential health benefits. Expanding access to affordable dental benefits is essential to securing the health and well-being of our children. Many have heard me speak before about the tragic loss of Deamonte Driver, a 12-year-old Prince George's County resident, in 2007. Deamonte's death was particularly heartbreaking because it was entirely preventable. What started out as a toothache turned into a severe brain infection that could have been prevented by an $80 extraction.

We cannot let what happen to Deamonte happen again.

I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Mr. President, I intend to offer a motion to commit the reconciliation bill to the Finance Committee with instructions to report the bill back to the Senate within 3 days, not counting any day on which the Senate is not in session, with changes that would eliminate or reduce access to affordable preventive services that are currently offered without copayment or cost-sharing under the Patient Protection and Affordable Care Act, ACA, including blood pressure screening, colorectal screening, breast cancer screening, cervical cancer screening and domestic and interpersonal violence screening and counseling.

I am offering this motion because the Finance Committee should review the implications of reducing access to affordable preventative services to millions of Americans. A key provision of the ACA is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among Americans each year and account for 75 percent of the Nation's health spending. Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions.

I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Mr. President, I intend to offer a motion to commit the reconciliation bill to the Finance Committee with instructions to report the bill back to the Senate within 3 days, not counting any day on which the Senate is not in session, with changes that would strike any provision that would eliminate, limit access to, or reduce the affordability of health services for homeless individuals.

I am offering this motion because the Finance Committee should review the implications of depriving millions of children of access to dental care. On any single night, over 500,000 people experience homelessness. On any single night over 50,000 of these individuals are homeless veterans. Many individuals experiencing homelessness have significant healthcare needs and may suffer from mental health conditions, substance use disorders, and chronic diseases like diabetes, asthma, and hypertension. Without access to health services, individuals tend to use hospitals and emergency departments at high rates, driving up overall healthcare costs. The Patient Protection and Affordable Care Act, ACA, has greatly decreased the uninsured rate among homeless individuals, leading to better health outcomes, and creating stability in the individual's life. Health centers that treat the poor and homeless in States that expanded Medicaid report that 80 or 90 percent of their patients are now covered by insurance.

I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Mr. President, I intend to offer a motion to commit the reconciliation bill to the Finance Committee with instructions to report the bill back to the Senate within 3 days, not counting any day on which the Senate is not in session, with changes that would strike any provisions that would eliminate or reduce access to mental health services and substance abuse treatments.

I am offering this motion because the Finance Committee should review the implications of reducing access to mental health services and substance use treatment to millions of Americans. An estimated 43.6 million Americans ages 18 and up experience some form of mental health condition, and over 20 million adults have a substance use disorder. Of these, over 8 million have both a mental health condition and a substance use disorder. That Patient Protection and Affordable Care Act, ACA, has been vital to giving these individuals access to affordable treatment options where they had none before.

I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Mr. President, I yield myself 3 minutes.

I first thank Senator Corker, Senator Crapo, Senator Brown, Senator Schumer, and Senator McConnell for their help in getting us to this moment. This is an important moment for our country, and I am very proud of what we were able to accomplish.

The legislation we are about to vote on will give the United States the strongest possible hand to stand up against the aggression of Russia. Russia attacked us and our democratic institutions; Russia invaded the sovereignty of other countries, including Ukraine and Georgia; Russia is participating in war crimes in Syria, and this legislation will give the United States the strongest possible hand in taking action against Russia.

Mandatory sanctions are included in this legislation with regard to the energy sector, the financial sector, the intelligence and defense sectors--not only with primary sanctions but with secondary sanctions. This legislation provides for a democracy fund, working with Europe, to protect ourselves against Russia's attacks. This legislation provides a review process so the President, on his own, cannot eliminate sanctions. He must come to Congress. As President Obama had to in regard to the Iran sanctions, the President would have to come to Congress in regard to sanction relief against Russia.

This is a tough bill to stand up to what Russia has done and requires mandatory action. There are so many people to thank in regard to this. Of course, we also have the Iran sanctions. I thank Senator Menendez, on our side, particularly on the Iran sanctions issues. We are taking actions against Iran for their nonnuclear violations, their support of terrorists, their ballistic missile violations, their support of the arms embargo, human rights violations.

What we do here is totally consistent with the JCPOA. The bills are very consistent with what passed this Chamber 98 to 2. We maintained the integrity of the Iran and Russia provisions consistent with what was done in our committees.

In regard to North Korea, I know we all want to take actions against North Korea. The provisions added by the House are consistent with what we think are appropriate for North Korea.

This is an important moment for our country. I really do want to thank all involved. I know Senator Corker, Senator Brown, and Senator Crapo would agree with me: I really thank our dedicated staff. We could not have done this without our staff. They worked 24/7 for the last 7 weeks to get this done. As a result of their action, the United States is going to be in a better position dealing with Russia when this legislation is enacted, and I am proud to be part of that.

I reserve the remainder of my time.

May I have a moment?

First, I want to join in thanking Senator McCain and Senator Graham for their work. We started in January on this legislation--their legislation. How we drafted it is intact here, and I thank Senator McCain and Senator Graham.

The leader on the Iran sanctions, going back many, many Congresses, has been Senator Menendez. In introducing him, I want to thank him for his leadership on Iran and, also, these other bills. I look forward to his comments.

Mr. President, I wish to commend Dr. Joseph T. ``Tim'' Arcano, technical director for Naval Surface Warfare Center, NSWC, Carderock Division, who is retiring after a lifetime

of service to the U.S. Navy, our Federal Government, and the scientific community.

Tim Arcano has dedicated his professional life to serving our country, first in the military and later as a civil servant. His knowledge of ships and the oceans they sail and nuclear safety and capabilities has been developed through his education and in his myriad positions throughout the Navy and our Federal Government. Two of Dr. Arcano's academic degrees were earned in my us, home State, where he attended the U.S. Naval Academy, and later earned his Ph.D. at the University of Maryland. In addition, he holds an Ocean Engineer degree and a masters in mechanical engineering from the Massachusetts Institute of Technology, MIT.

Dr. Arcano's first career was in our military, where he served for 30 years in both Active and Reserve service. As technical director and ship design manager for the Virginia-Class Submarine Program, as technical authority for advanced submarines at Naval Sea System Command, NAVSEA, and as a program manager at the Defense Nuclear Facilities Safety Board, Dr. Arcano developed an understanding and expertise that few can match. Those skills were further utilized in five Reserve commands.

Dr. Arcano's dedication to our country continued after his transition from Active service to the Reserves in 1992 and his later retirement from the Navy as captain in June of 2008. He served as deputy chief of Nuclear Safety at the United States Department of Energy and as the director of the Office of Ocean Exploration and Research at the National Oceanic and Atmospheric Administration. During that time, he returned to the Naval Academy to hold the Corbin A. McNeill Endowed Chair in Naval Engineering, where he created a course on engineering of submersible systems.

Dr. Arcano came to NSWC Carderock in May of 2013, bringing his wealth of experience as he took the helm of a campus of over 3,000 employees. His impact has been magnified by his commitment to STEM education and developing the next generation of scientific leaders. Under Dr. Arcano's leadership, employees at NSWC Carderock have mentored countless high school and college interns, even reaching to our youngest developing scientists by leading elementary students in FIRST Robotics clubs. Dr. Arcano ``walks the walk'' himself, giving greatly of his own time by taking interns under his wing to offer advice and helping them chart their path, wherever that might lead.

As part of his encouragement of STEM education, Dr. Arcano and NSWC Carderock have continued to host the International Human Powered Submarine Races. Teams from not just corporations and research centers, but from universities and even high schools come from around the world to race their independently built one- or two-person submarines through a course at the historic David Taylor Model Basin at Carderock. For 2 years, these competitors learn about hydrodynamic design, propulsion, underwater life support, materials science, and other scientific principles in creating their own designs for these vehicles. The lessons learned, both in science and engineering and in collaborating on a team project, help to fuel their enthusiasm for careers in science and technology.

Dr. Arcano's career reflects his selflessness, his unparalleled leadership capabilities, and his devotion to our country. He commands the respect and admiration of all who have had the privilege to know and work with him. His leadership will be greatly missed, but he has left a legacy of scientific leadership that will continue to develop through the principles and practice that he exercised every day. We are deeply grateful for his devotion to our national security, to naval science, and to America's future generations.

I offer the thanks of a grateful nation to Dr. Arcano and, by extension, to his family--his wife, Brenda, their daughter, Heather, and sons, Greg, Joseph, and Tyler--for as we all know, the support of family is critical. I am honored and pleased to recognize Dr. Tim Arcano for his outstanding career in public service and wish him all the best in his future pursuits.

Mr. President, I have listened very carefully to the majority leader and his requests that we come forward and bring amendments to the floor--all of our ideas about how we can improve our healthcare system so that this would be an opportunity through budget reconciliation for us to deal with those issues.

I asked my staff to prepare amendments in order to protect the Medicaid system from cuts. I asked my staff to prepare amendments to protect the essential health benefits that are in the Affordable Care Act because it is important that we preserve those benefits, whether it is mental health and addiction services or one that is particularly important to Maryland; that is, pediatric dental. In Maryland, we all recall the loss of a 12-year-old not too many years ago because he couldn't get dental care--Deamonte Driver.

I asked my staff to take a look at preparing amendments to protect minority health and health disparities because the Affordable Care Act made tremendous advancements in trying to close that gap on the disparities in minority health and health disparities. I asked my staff to take a look at the tax provisions because we want to make sure that we are not giving tax cuts to wealthy people at the expense of cutting the Medicaid system. I asked them to look at this in a lot of different ways.

Listening to the majority leader, I also have introduced legislation that I will talk about that could build on the Affordable Care Act, and I was wondering what bill I should amend? What is the bill that we are considering? It is not the bill that Senator McConnell brought forward because that bill was defeated. It is not the repeal--and we are starting with a blank slate--because that was defeated. I don't believe it is the House bill because that has been discredited, called a mean bill by the President, as well as by Members of this body, who said it has no chance of passing. So my dilemma is that I don't know what I should be amending.

I expect we will get to see another bill somewhere along the process with virtually no notice and no opportunity to read and no opportunity to amend, but the majority leader says I am going to have that opportunity. Yet we don't know what the bill is that I am supposed to be addressing my amendments to.

We know that all the bills we have seen today--every single one from the Republicans--have been scored by the Congressional Budget Office as to tens of millions of Americans losing their insurance coverage--tens of millions. I understand it is about 33 million if we just repeal the Affordable Care Act, 22 million if we use the type of replacement that the majority leader was suggesting. All of those move in the wrong direction.

We also know that in every one of these proposals to date, insurance premiums are going to go up, not down.

That is one thing I have heard from my constituents. They would like to see us bring down the growth rate of health insurance costs and healthcare, not increase it. So, yes, I would like to be able to offer amendments, but I don't know what to offer amendments to.

I also am concerned when I see that every one of the bills that have been suggested by the Republicans would reverse the protections that we put in law against the wrong practices--the discriminatory practices-- of insurance companies. I have talked to many of my constituents who tell me that if we reimpose caps, either yearly or lifetime--they have the circumstance where their child was born with a disability and that cap would have been expended within a matter of months--they would be left without insurance coverage. They tell me about how preexisting conditions could be jeopardized. All of us have some form of preexisting condition, and, on a lot of these plans that are being suggested where you could choose the type of coverage you want, insurance companies are not going to offer the benefits you need. People who have challenges are going to be most discriminated against. So I don't quite understand how I can offer amendments and we could have a vote on the floor when we don't know what we are trying to amend.

I must state that there is a common theme here, and we know it. We know that there is now talk that the majority leader might bring up, sometime during this process, what has been called in the press a ``skinny'' bill. I call it a slow death of the Affordable Care Act, and, in fact, I am afraid it might be a fast death of the Affordable Care Act because, if the reports are accurate, one of the provisions that the majority leader is looking to bring in as the final bill that we would vote on would eliminate the requirement that companies have to provide insurance coverage to their employees and individuals must have coverage.

Now that seems innocent enough, except for the tens of millions who are going to lose their insurance coverage--people who are working for companies that decide to terminate their policies, healthy people who decide not to buy insurance policies. I believe you are going to find that there still will be tens of millions of people losing their insurance coverage, and that is unacceptable. But it goes beyond that. That proposal will also increase premium costs by a very large percent. Why?

Think about this for a moment. If you don't have to buy insurance and you are young and healthy, are you going to buy insurance or not? Many will say no until they need the insurance, and then they will buy the insurance. Actuaries tell us that without the requirement to have insurance, the insurance pools will contain a very high percentage of adverse risks--people at higher risk--and when that happens, the purpose of insurance to spread the risk is no longer done. It means premiums will go up dramatically. That doesn't help the people who are going to need it.

What you also find when you eliminate this requirement is that people get what we call job locked. They may have a company that provides health benefits, but now they may have to leave that company. But if they want to leave that company and start a job or go to another job that doesn't have insurance, they are locked into where they work. All of that adds to anxiety, adds to lack of coverage, adds to people who don't have health insurance, adds to people not getting adequate healthcare, adds to bankruptcies, adds to the problems that we addressed with the Affordable Care Act.

But there is another explanation here. Maybe this is just a shell bill that is going to go back--hopefully, as the Republicans believe, but I hope it does not happen--to the House, and then we will put in the Medicaid cuts and the tax relief and all the other things that are not in the bill. This is just a shell to get us back to one of the bills that couldn't get the votes here on the floor, where tens of millions of people will lose their insurance coverage, premiums will go up, and insurance company arbitrary and discriminatory practices will return.

Every one of these proposals--every single one--moves us in the wrong direction in healthcare. We recognize that we can improve our healthcare system. I am for improving our healthcare system. I think we can work together--Democrats and Republicans--to improve our healthcare system.

So here is my request: Vote for the Casey motion. Why? For two reasons. One, I would hope that on this anniversary of the ADA, or the Americans with Disabilities Act, we would want to do no harm to those with disabilities in our healthcare system and they would have adequate coverage. I was in a celebration over the weekend in Baltimore City with the disabilities community. We celebrated one of the great victories in America, the Americans with Disabilities Act--a bipartisan bill, with Democrats and Republicans coming together in a proud moment, in the best traditions of the Senate, to say that people with disabilities will be treated fairly in America. On this day we should adopt the Casey motion on the issue of protecting people with disabilities.

But there is a second issue here.

Mr. President, I ask unanimous consent to speak for 2 additional minutes.

I will try to conclude my remarks. On this day that we are celebrating the anniversary of the Americans with Disabilities Act, let's do right by that. There is a second part to the Casey motion that sends it back to committee so we can use the regular process, as Senator McCain talked about yesterday. Let's have the committee hearings, as Senator Alexander talked about. Let's have the committee markups and work together. I introduced legislation that would bring down the cost of healthcare and lower the rate of increase of individual premiums. I do that by suggesting more competition in the individual marketplace, by having a public option, by providing stronger subsidies to lower income families, by making sure that cost- sharing is in fact paid for so we don't have that uncertainty, with the reinsurance that Senator Carper was talking about to deal with the overall cost of healthcare, by dealing with prescription drug costs, and by dealing with coordinated care so that we can deal with the whole patient rather than their individual disease.

All of those issues would improve the Affordable Care Act, but before we get there, we have to get off of this train. We have to stop this disastrous course. I am going to do everything in my power to make sure that, as to the bill we have, whenever it comes forward, we stop it right here, and then work together, Democrats and Republicans, to improve our healthcare system, not to take away insurance coverage and increase costs for so many Americans.

With that, I yield the floor.

Madam President, I intend to offer a motion to commit the reconciliation bill to the Finance Committee with instructions to report the bill back to the Senate within 3 days, not counting any day on which the Senate is not in session, with changes eliminating provisions that would weaken access to essential health benefits, reduce access to affordable preventive services, and undermine the prohibition of annual and lifetime limits and caps on out-of-pocket expenditures for health insurance plans.

I am offering this motion because the reconciliation bill affects tens of millions of Americans who gained health coverage under the Patient Protection and Affordable Care Act, ACA. The reconciliation bill allows insurers to eliminate coverage of essential health benefits. Insurance companies could exclude essential benefits like maternity care, substance use disorder treatment, mental healthcare, prescription drugs, and hospitalization--the very services people buy insurance to obtain. Before the ACA, one-third of individual market health plans did not cover substance use disorder services, nearly one- fifth of those plans did not cover mental health, and only nine States required all insurers on the individual market to cover maternity care.

Allowing States to waive essential health benefits would also allow insurance companies to reinstate annual and lifetime caps. This means that a premature baby could exceed its lifetime limit within its first few months of life or that a cancer patient could hit an annual cap just a couple of months into treatment.

Before the ACA, too many people and families were hurt physically and financially because they could not afford access to healthcare. They didn't get the tests they needed. Perhaps they did not catch a preventable disease early enough--so the treatment costs skyrocketed. We saw too many families go through bankruptcy because they could not afford the healthcare that they needed. We saw too many people literally cutting their prescription pills in half, hoping to stretch out their medicine because they could not afford more, even though they knew they were compromising their health. We cannot go back to this cruel, dreadful situation.

The following Senators support my motion to commit: Senators Carper, Brown, Blumenthal, Warren, Nelson, Van Hollen, Duckworth, and Stabenow. I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Madam President, I intend to offer a motion to commit the reconciliation bill to the Senate Health, Education, Labor & Pensions, HELP, Committee with instructions to report the bill back to the Senate within 3 days, not counting any day on which the Senate is not in session, with changes that would eliminate provisions in the bill that would increase health disparities among certain populations, including disparities on the basis of race and ethnicity, socioeconomic status, gender, religion, disability status, geographic location, and sexual identity and orientation.

I am offering this motion because communities of color and disenfranchised communities have faced significant barriers to accessing affordable health coverage, and these barriers have contributed to health disparities, which are evident in higher rates of diabetes, heart disease, hepatitis B, HIV/AIDS and infant mortality, among other conditions. The Patient Protection and Affordable Care Act's vital coverage reforms, which include Medicaid expansion, cost sharing reductions, eliminating annual and lifetime limits, and creating coverage options for individuals with preexisting conditions, has led to sharp declines in the uninsured rates for minorities and low-income populations. With the implementation of the major ACA coverage provisions in 2014, the uninsured rate dropped dramatically and continued to fall in 2015. In 2015, the nonelderly uninsured rate was 10.5 percent, the lowest rate in decades, with the most dramatic changes seen among low-income Latino Americans, African Americans, and Asian Americans.

Minorities now make up more than 35 percent of the American population, and that number is expected to rise in the future. Every community across this great Nation deserves optimal health. A person's ethnic or racial background should never determine the length or quality of his or her life. We must work to bridge health equity across communities, ensure that all Americans have access to affordable, high- quality healthcare, and continue our efforts to eliminate health disparities.

The following Senators support my motion to commit: Senators Booker, Hirono, Brown, Carper, Stabenow, Markey, Blumenthal, Van Hollen, and Nelson. I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Madam President, I intend to offer a motion to commit the reconciliation bill to the Finance Committee with instructions to report the bill back to the Senate within 3 days, not counting any day on which the Senate is not in session, with changes that would eliminate provisions that hand out tax breaks to large corporations and the most affluent Americans while the bill makes cuts to Medicaid, which serves millions of our most needy Americans, including the elderly poor and poor children.

I am offering this motion because the Finance Committee should review the implications of depriving millions of Americans, including children, veterans, individuals with disabilities, and older people, of their health insurance while at the same time providing large tax breaks to the richest Americans and biggest corporations. H.R. 1628 offsets those tax breaks by voraciously cutting the Medicaid Program. Republicans are using the Medicaid Program as a pay-for for these large tax breaks. As a result, the Republican bill harms far more people than it will help. Former President John F. Kennedy said, ``To govern is to choose.'' The Republicans have made a cruel choice, and I object to it.

The following Senators support my motion to commit: Senators Harris, Van Hollen, Casey, Udall, Coons, Markey, Booker, and Leahy. I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Madam President, first, let me thank the Democratic leader for his statement on a better deal for all Americans.

I had a chance over the weekend to travel throughout my State, and I heard over and over again the people of Maryland talking about what we need to do on a better deal. I had an interesting forum on healthcare, and Marylanders want a better deal on healthcare. They want to make sure healthcare is affordable, that they can get access to quality care, and they can make sure we maintain the highest quality healthcare.

What they don't want to see is us moving in the wrong direction. I heard over and over again their concerns about what is happening with the consideration of the bill the Republican leadership is anticipating having a vote on later this week. That bill would proceed on legislation that would eliminate healthcare coverage for, at least, 22 million Americans, maybe as high as 33 million Americans. I must tell you that is not a better deal for Americans on their healthcare needs. We could do much better moving in the opposite direction and making healthcare more affordable, not cutting people out of healthcare insurance.

In my State of Maryland, in 2018 alone, 221,000 people in my State would lose coverage under the proposals the Republican leadership is suggesting, including 4,200 veterans, 164,000 people in the Medicaid system, and 62,000 people in the individual marketplace. That is going to hurt. These are people today who have healthcare coverage who would lose their healthcare coverage. It would hurt our seniors in the coverage they get under the Medicaid system for long-term care. It would hurt those who are working to try to end this opioid drug addiction issue.

Under the current law, mental health, behavioral health, and drug addiction is covered under the essential health benefits. It is covered under private insurance. It is covered under the Medicaid system. That is in danger of being lost under the legislation being considered.

I heard from public health and law enforcement over the weekend how that would move our community in the wrong direction if those bills were considered.

I also heard from the majority leader that all he wants to do is get on this bill, and then we can offer amendments. Well, that is not accurate. You can't offer any amendments you want on a bill that is under reconciliation instructions, and we certainly aren't

going to get a fair shot at trying to make this bill a better bill under the restrictions we are operating under: We had no committee hearings. We had no committee markups. That is not the way legislation should be considered.

The other issue I heard about from people in Maryland--I think you will hear this from people around the country--is they want to bring down the cost of their healthcare coverage. They want to bring down the cost of their healthcare. They want to reduce the high growth rate in healthcare costs in this country. Yet the Senate Republican bill increases the average premium by as much as $1,700 in Maryland by 2020 and preserves what we call the age tax--a 5-to-1 difference.

So if you happen to be 55 years of age, you are going to pay a lot more than that in increases in your health insurance premiums. That is not what people in Maryland want to see. That is not what people in this country want to see. They are concerned that we should be building on the Affordable Care Act to bring down the cost of their premium increases, not to increase it by that dramatic amount of money.

The increase in deductibles in Maryland could be as high as $3,300 for a person making $42,000 per year and $5,600 for a person making about $18,000 a year. Those are increases in deductibles. They can't afford that. The concerns we have--people like the Affordable Care Act, and they want us to improve it. They want us to improve it. They don't want us to add to their costs, and the bill the majority leader is asking us to consider would have people in Maryland and around the country paying more--not less, which they want.

The people in Maryland and around this country like the consumer protections we have under the Affordable Care Act. They like the idea that there is no annual cap or lifetime cap. I had several people who came up to me to tell me about their own personal circumstances. One father explained to me that his child was born with serious issues and that they reached their cap within a matter of months. Without the protection in the Affordable Care Act, they would have had no other insurance coverage. Yet, under the bill being considered by the Republican leadership, that family could lose that protection because you could see the imposition of caps.

All of us know of people who are very concerned about preexisting conditions. The bill that is being considered under the Republican leadership weakens those protections against discrimination of preexisting conditions.

Let me just remind my colleagues of what we saw before the Affordable Care Act in discriminatory practices by private insurance companies. We had reined much of that in under the Affordable Care Act. All of that could be lost if we proceed on legislation--and move it forward--that doesn't provide the consumer protections, allows the elimination of caps, allows discriminatory practices in regard to preexisting conditions, restricts the amount of money going into the Medicaid system so our States are forced basically to cut back on the Medicaid system. We lose the expanded coverage--the Congressional Budget Office has already told us that--and we go back to the days of job lock. I want to talk about that for one moment because I think this is one of the untold stories. We haven't had a lot of discussion on the floor.

If you go in the wrong direction and you do what the Republican leadership is talking about doing and repeal the Affordable Care Act and either repeal and later replace or replace it now with a program that will eliminate a lot of coverage and once again eliminate these consumer protections we have in health insurance, what you do is people get locked into employment. They are afraid to leave their job because they have insurance that covers their family--they have a spouse with cancer or they have a child with a major disability. Yes, they would like to do what this country is best known for, and that is set out with an entrepreneurial spirit, start a company or go and take risks, but they can't do it because they know they are jeopardizing their family's healthcare because they can't get the type of insurance they need to cover their risks. That is called job lock and that works against the growth of our economy.

There are so many reasons to be concerned about what the majority leader is asking us to do--to proceed on this bill that all the options we have seen will cost tens of millions of people their coverage, take away a lot of the consumer protections we have seen in the law, and discriminate against our elderly, discriminate against minorities and women. That would be returning to our old healthcare system. No, that is not the right way to do it.

I am frequently asked: Well, what should we do? The Affordable Care Act, doesn't it have problems? Doesn't it need to be fixed?

The Affordable Care Act has done a lot of good. It has given people coverage who never had coverage before. It has reined in the discriminatory practices of health insurance companies. It has made a dramatic improvement on dealing with minority health and health disparities. It has provided essential health benefits so we deal with mental health and addiction. It has done a lot of really good things, but, yes, we could improve it. There has never been a major law passed without us going back and revisiting.

Why haven't Democrats been part of this process? Well, we could not get engaged in this process because the way this bill came to the floor, it didn't come through the Health, Education, Labor, and Pensions Committee, it didn't come in through the Finance Committee, the two committees of jurisdiction that deal with the healthcare system in this country. Instead, it came in through the majority leader using the rule XIV process to bring out a reconciliation bill that can be jammed through, with limited time and no open amendment process, from the point of view that amendments have to be germane to the reconciliation instructions so we don't have an opportunity to fix this bill.

We weren't part of the process to develop the bill. You are not giving an opportunity for the democratic system to work. There was no on-ramp for Democrats to get engaged in the process.

About 2 weeks ago--maybe 3 weeks ago now--I filed legislation and sent letters to my Republican colleagues telling them: I want to work with you. I do. I have worked with Republicans in the Finance Committee on healthcare bills. We have gotten some good things done. Democrats and Republicans want to work together, so let's work together.

The legislation I filed dealt with the two major problems that I hear about, as I travel throughout Maryland, regarding what we need to fix on the Affordable Care Act and how we can make it better.

Problem No. 1, we need more stability and competition within the individual marketplace. Yes, we have seen large proposed increases in premiums in the individual marketplace--not in the group plans where most Americans have their insurance but in the individual marketplace. Why? Because we don't have enough people who have signed up in the exchanges. Younger, healthier people, because there really hasn't been a penalty imposed, have chosen not to join. They will say: Look, we will join if we have a need.

We have also found that with President Trump indicating he may not fund the cost-sharing provisions that go directly to the insurance carriers that keep the premiums low and the deductibles and copays low, this also has a lot of insurance companies nervous. As a result, the premium increases are larger than what we had anticipated. We need to do something about it.

How can we keep those premium increases at a more reasonable growth rate rather than what we have seen? One way we could do it is a proposal that, I believe, has bipartisan support; that is, deal with what is known as reinsurance. Reinsurance is a way we spread the risk over a greater group of people, therefore dealing with those high-risk pools in a way in which their premium costs are much more affordable.

Another way we can do it is by Congress mandating that the President fund the cost-sharing with the insurance carriers so we don't have the threat that they are going to pull out those funds that are used to keep copays and deductibles low.

Another way we can do it is to increase our support for those who are of

modest income and the funds they have to lay out for their premiums because we know you can make a good salary, but because of the cost of healthcare, if you don't have an employer providing part of those benefits, it is very hard for you to be able to afford that without some help. We can do all of that.

Another thing we could do is bring more competition into the individual marketplace. We have had those who have suggested a Medicare for all. We have had those who have suggested Medicare for the near elderly--the 55 to 65 age group or something similar to that. We have others who have suggested that we have a public option under the exchanges. All those, to me, make sense because it just brings in more competition. There is no additional government cost here because they are not subsidized any differently than any other insurance plan, but it gives more options, more choice, more competition, and therefore more stability in the individual marketplace. We could do all that and all that can help.

The other thing we really need to deal with is to deal with the overall cost of healthcare. Here, again, Democrats and Republicans have had ideas. Why don't we take on the pharmaceutical industry? Why do Americans pay twice what Canadians pay for the same medicines that are manufactured here in the United States? Why don't we have rebates in the Medicare system like the rebates we have in the Medicaid system? Why don't we organize our purchasing power in a larger pool so we can get greater discounts for the government taxpayers? All those things will bring down the cost of prescription medicines. The President has talked about it. Democrats and Republicans have talked about it. It is time we act.

We have acted in several areas to try to deal with more value-based reimbursements in our healthcare system, recognizing we should treat the person, not the particular disease. Many people have more than one ailment, and they have to go back to the doctor multiple times. Why don't we have a more coordinated, integrated care model?

I talked on the floor about 2 weeks ago about the coordinated care model between Sheppard Pratt Hospital in Baltimore and Mosaic, which deals with behavioral health issues and how they deal with it in an integrated, coordinated care model, which saves money. It saves money. There are fewer tests, more timely interventions.

How can we use telemedicine? They are using telepsychiatry. How can we use that to bring down the cost of care? When I am asked in my district, asked in my State as to what I can do--where is my plan, and how can we fix the Affordable Care Act--my answer is quite simple: I am proud of the progress we have made under the Affordable Care Act. I invite Democrats and Republicans through our committees to work together to improve it. Yes, we can improve it. We can provide more stability in the individual marketplace. We can bring down the high annual growth we have seen in premiums in the individual marketplace. We can continue to bring down the growth rate of healthcare costs by working together on some of these commonsense approaches in order to deal with healthcare in America. All of this I think we can do, with Democrats and Republicans working together. But the first order of business--and I urge my colleagues--the first order of business is to stop this process of trying to jam a repeal of the Affordable Care Act and a replacement that would cost tens of millions of people in this country their health coverage and would move in the wrong direction on how we should improve healthcare in America. Let's get that off the table.

Let's reject this motion to proceed that the majority leader is talking about voting on later this week. Let's do what Senator Alexander, the chairman of the Health, Education, Labor, and Pensions Committee has suggested. Let's have hearings in our committees. Let's work together, and let's bring legislation that stabilizes the Affordable Care Act and deals with the two major problems that the people in this country are talking about; that is, bringing down the growth rate of premium costs and bringing down the overall growth rate of healthcare costs in America. I believe we can do both by working together. There are suggestions I have made, and I am sure other Members have. Let's work on those. Let's work together and get it done. Let's do what is in the best interest of the people in this country.

I yield the floor.

Mr. President, a few weeks ago, I joined Senators Barrasso, Capito, Klobuchar, Boozman, and Baldwin in introducing S. 1514, the Hunting Heritage and Environmental Legacy Preservation-- HELP--for Wildlife Act.

This bill represents a more than $100 million annual Federal investment in the protecting the bay. The bill has several provisions, one of which reauthorizes the programs at the heart of restoring and maintaining the health of the Chesapeake Bay watershed. S. 1514 reauthorizes the U.S. Environmental Protection Agency's, EPA, Chesapeake Bay Program through 2022 at $90 million per year, which is more than the program has ever been funded in its history. This unique regional partnership, managed by EPA through the Chesapeake Bay Program office in Annapolis, helps program partners collaborate to achieve the goals of the voluntary, bipartisan Chesapeake Bay agreement. Because this program expired in 2005, reauthorizing the program is critical to secure necessary appropriations and reject the Trump administration's proposal to eliminate the program.

S. 1514 also reauthorizes the Chesapeake Bay gateways and watertrails network and the Chesapeake Bay Gateways Grants Assistance Program, which provides $6 million per year throughout the watershed in technical and financial assistance to State, community, and nongovernmental partners to increase access to the Chesapeake Bay and its tributaries. The bill also reauthorizes the National Fish and Wildlife Foundation, NFWF, until 2023. As the Nation's largest conservation grant-maker, NFWF has been instrumental in completing conservation projects in Maryland and around the Chesapeake Bay. In 2016, the State received nearly $5 million in funding for projects protecting and restoring habitat for fish and wildlife.

S. 1514 also reauthorizes the North American Wetlands Conservation Act, NAWCA, which provides grants to increase and protect wetlands which not only provide habitat for wildlife, but also reduce the severity of flooding and coastal erosion, and improve water quality. In the 2014 to 2015 grant period alone, Maryland received $1 million from the NAWCA program, which was leveraged with nearly $3 million in additional contributions by outside partners to protect 1,600 acres of wetlands in the State.

The bill reauthorizes the Neotropical Migratory Bird Conservation Act for another 5 years and authorizes $6.5 million to be spent each year on conservation projects that protect more than 350 different species of birds which summer in the United States and winter in the tropical regions. Twenty-one different State birds are neotropical migrants, including Maryland's famous and beloved Baltimore Oriole.

S. 1514 codifies the National Fish Habitat Partnership, a collaboration between public agencies, private citizens, and nonprofits for promoting fish conservation. America is home to more than 3,000 species of fish, and 22 percent of the stream miles in this country are at high or very high risk of current habitat degradation. Over the past few years, $175,000 in funds from this program were used in Maryland to rehabilitate three different streams, funding which was 27 matched by $843,000 from private investors. The partnership estimates that the improved habitat in the three streams for brook trout provided a total socio/economic impact of $9.2 million.

I am proud that S. 1514 contains so many provisions to help the Chesapeake Bay and the State of Maryland.

I would like to speak for a minute about the importance of reauthorizing these programs and the ``power of the purse.'' As my colleagues in the Senate well know, the ``power of the purse'' is the two-step process of authorizing and appropriating. Authorizing legislation can establish, continue, or change programs and activities, and it signals to the appropriators that they should fund these programs. The budget process is not complete until the appropriations process provides the actual funding for the activities and programs established through the authorization process.

Office of Management and Budget Director Mick Mulvaney has said that President Donald Trump is sending a deliberate message to Congress about spending money on unauthorized programs. With the President putting an emphasis on boosting defense spending without adding to the deficit, administration officials are looking closely at expired authorizations. By reauthorizing these programs, we are sending our own clear message back: these programs matter to our constituents and to us.

Mr. Mulvaney said lawmakers too often ignore the ``regular order'' process of approving a budget, authorizing specific programs, and then appropriating the money for those programs. ``We actually spend a lot of money in the federal government on programs that aren't authorized at all,'' he said. ``Either they used to be authorized and they lapsed, or they were never authorized in the first place. They simply were appropriated without any authorization. It's the wrong way to do it.''

Because of President Trump and Director Mulvaney's position, it is more important than ever that the essential programs contained in S. 1514 be reauthorized.

None of these reauthorizations are more important to Maryland than EPA's Chesapeake Bay Program. In 1987, Congress ratified the Chesapeake Bay Program, a voluntary partnership among the watershed States and the EPA, under the Clean Water Act. The 1987 legislation supported cleanup efforts with a program of grants and scientific research. In 2000, Congress directed the EPA to ``ensure that management plans are developed and implementation is begun'' to meet the goals of the Chesapeake Bay Agreement. In June 2014, the Governors of the six States in the watershed signed a new voluntary Chesapeake Bay watershed agreement to work in partnership with the Federal Government through the Chesapeake Bay Program. The watershed agreement has ten goals to improve water quality in local rivers and streams and the Chesapeake Bay by 2025.

The program office is housed within the EPA, which provides staff and funding. Primary funding for the program comes from State governments. Federal funding was first authorized at $40 million annually from fiscal year 2001 to fiscal year 2005 to fund environmental studies and grants that support restoration activities in the Chesapeake Bay. Congress has appropriated funds for the Program since the authorization for appropriations expired in fiscal year 2005. In fiscal year 2017, for instance, Congress appropriated $73 million for the program. The President's fiscal year 2018 budget eliminates funding for the program and cuts other programs that also benefit the bay across several Federal agency partners' budgets.

A healthy bay means a healthy economy, and this recovery cannot be accomplished without a strong Federal commitment. At a time when we have seen nutrient levels dropping and water quality improving, I am deeply disappointed President Trump is intent on turning the clock back to a time when a swath of the Chesapeake Bay in mid-summer was a hypoxic low-oxygen zone or ``dead zone''.

The most recent State of the Bay report, issued biannually by the Chesapeake Bay Foundation, evaluates the progressing and overall health of the Bay for 2014 to 2016. The Chesapeake Bay's health was given a grade of C-minus, a slight improvement from the previous State of the Bay report in 2014. This progress is due largely to the continued implementation of the Chesapeake Clean Water Blueprint. This improvement, though modest, was hard-won. It is the result of countless hours of grueling work by State and Federal public servants and nonprofit workers, as well as citizens' actions across the watershed. A grade of C-minus is hardly an acceptable endpoint. To reach an A, which would represent a saved and comprehensively healthy Bay, we will need redouble and accelerate our efforts. I am determined to pass on a vibrant and healthy Chesapeake Bay to the next generation, for the sake of public health and the local economies that depend on a clean and bountiful bay. This is all the more reason that we need to reauthorize the Chesapeake Bay Program and make sure that it is fully funded in this year's appropriations bill.

Many Marylanders and national wildlife organizations are happy about the HELP for Wildlife Act. The Choose Clean Water Coalition and Blue Water Baltimore have issued statements of support. The Chesapeake Bay Foundation will testify in support of this bill next week in a legislative hearing the Environment and Public Works Committee is holding. The National Wildlife Federation's Collin O'Mara said the bill ``represents a great bipartisan effort to conserve America's outdoor heritage for hunters, anglers, campers, hikers, and wildlife enthusiasts, while helping to restore America's wildlife populations.'' The Theodore Roosevelt Conservation Partnership said the bill is ``the strongest legislative package of sportsmen's priorities in years.''

As S. 1514 moves out of the Environment and Public Works Committee and to the Senate floor in the coming weeks, I urge my colleagues to support this bill that is critical not only to the Chesapeake Bay and the State of Maryland, but to conservation efforts in every State across the Nation.

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

Mr. President, I take this time to share with my colleagues the experiences I had in the State of Maryland during our most recent work period and shortly before that, when I took the opportunity to meet with different groups with regard to the healthcare debate.

I had a townhall meeting this past week at Atrium Village, which is a senior living place in Baltimore County. We had a robust discussion primarily with seniors, but not just seniors, about their concerns as to whether the changes in the healthcare law would affect their ability in the Medicare system as well as relating to long-term care and Medicaid.

A little bit earlier than that, I had a townhall meeting at one of our local hospitals where we had a chance to talk with lots of people. It was an open townhall meeting, and a lot of people from the community showed up. They expressed their concerns about what would happen under the changes being suggested in healthcare on coverage and quality of coverage, and we had a very robust discussion.

I also had a chance to meet with leaders of the faith community as we talked about our responsibility to make sure healthcare is a right and not a privilege in the United States.

I met with the leaders of the community health centers in Park West, in Baltimore City, to talk about the impact on the viability of health centers if the Medicaid Programs were cut.

I had a chance to visit with Mosaic Behavioral Health Center, which deals with behavioral health in Baltimore, and their concern is, if we eliminate the essential health benefits of mental health and addiction, what impact that would have on access to care.

There was a consistent message from each of the places I met with, with regard to whether we would be able to maintain coverage--under the Affordable Care Act, we expanded coverage by tens of millions--and whether that coverage would be compromised under the legislation being considered in the Senate.

We also had a chance to talk about whether there would be a weakness in what benefits would be covered. I already mentioned mental health and addiction. There were also concerns expressed about reductions of benefits regarding obstetrics and how it would affect women, and pediatric dental care, which is a particular concern in Maryland after the tragic death of Deamonte Driver.

They also raised many issues concerning discrimination in healthcare that was present before the Affordable Care Act and whether these conditions would be returning. A young father told me a story about how his daughter was born prematurely and, as a result, the baby was in the neonatal intensive care unit for 4 months. When his daughter was 4 months old, she had reached her lifetime limit of what the insurer would pay for healthcare if we returned to lifetime limits. Whether we would be returning to the predatory-type practices of the insurance companies that were present before the Affordable Care Act and whether we would be returning to preexisting conditions or doing that indirectly through what benefits would be covered--that was expressed at several of my healthcare meetings.

I already mentioned the concerns that the elderly expressed, including the discrimination of the near elderly, if we go to a 5-to-1 ratio on health premiums, so that those who are 60 or 62 years of age paying five times higher premiums than younger people are paying. All of that was brought out during my townhall meetings.

The one message I just wanted to leave with my colleagues is that there was a strong interest that we work together--Democrats and Republicans--because we all acknowledge that the Affordable Care Act can be made better. We don't want to repeal it. We want to improve it.

Before we left for the July 4th break, I introduced legislation that deals with some of these issues. The legislation would improve competition by putting the so-called public option in the exchanges so that we know there would be at least one governmental option without subsidies, without any additional breaks over private insurance companies, to guarantee more competition in the marketplace.

I also included in my legislation a solution to deal with the two major problems that we have under the Affordable Care Act. For some people, the insurance premiums are too high. Why? Well, I asked CareFirst, which is the major health insurer in Maryland, about the uncertainty as to whether President Trump is going to fund the cost- sharing issues. My legislation makes it clear that those funds will be made available, as was anticipated under the Affordable Care Act.

I also provide predictable subsidies for lower income families, up to 400 percent of poverty, so that we can help bring down the cost of premiums in that marketplace, and we reimpose the reinsurance program so that we can spread the risk so the insurance companies know that they have a more predictable risk when they set their premiums.

All of this would make a big difference. CareFirst said that, in the individual marketplace in Maryland, if you do that and endorse the individual mandate, we could reduce our premium increases by 50 percent.

So I am trying to work, I hope with Democrats and Republicans, to deal with the problems that have been brought to our attention on higher premiums and then to deal with healthcare costs generally.

More and more people talk to me about bringing down the costs of prescription drugs. It is outrageous that Americans pay twice what our friends in Canada pay for the same medicines that are manufactured here in the United States. So why don't we have a more competitive marketplace? Why don't we have the rebates that we have in the Medicaid and the Medicare systems, and why don't we allow for more collective bargaining for prices in the pharmaceutical industry? My legislation would do that, and I know there is bipartisan support for that.

Lastly, we deal with more integrated care. I mentioned Mosaic, a behavioral health facility in Baltimore City. They have an integrated care model. If you come into their community health center, they will treat whatever your problems are. They are not going to say: Well, come in one day and we will deal with diabetes, and the next day we will deal with high blood pressure. Let's deal with the whole patient in a coordinated and integrated care model, and that would help save on costs.

My bottom line is this. No, I am not going to support weakening the Affordable Care Act. I am not going to support legislation that would diminish those who currently have coverage or the quality of their coverage. Let's work together--Democrats and Republicans--to deal with the real problems of bringing down costs in our healthcare system-- everybody benefits from that--and to make sure there is more competition in our exchanges and to make sure there is better premium support for those who cannot afford their premiums. If we do that, then, I really think we would be carrying out what the people of Maryland were asking me to do during the recess; that is, not to go back on the progress we have made under the Affordable Care Act. Let's build on that. Let's make healthcare more affordable, and let's deal with more competition on the premium costs.

With that, I yield the floor.

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

Mr. President, I come to the floor to speak about the rise of a failed state, Venezuela, and the manmade tragedy President Maduro has imposed on his citizens.

For 3 months, Venezuelans have taken to the streets in daily protests. They are speaking out against their country's economic collapse, against widespread food shortages, the disintegration of their medical system, against endemic corruption, and against a government that denies them their human rights and fundamental freedoms.

Appallingly, President Maduro has responded to the protests by unleashing his National Guard. As a recent Washington Post article stated, ``Mr. Maduro and the corrupt clique around him are hanging on by the brute force of tear gas, water cannons, mass arrests, and shootings by snipers.''

Since April, Venezuela's increasingly unstable crisis has left over 75 dead, thousands jailed, and thousands more injured. Yet, instead of listening to his people's legitimate demands and mitigating this tragedy, President Maduro is attempting to rewrite the Constitution, despite widespread opposition. Additionally, he declared this week that ``what couldn't be done with votes would be done with weapons.''

This is our hemisphere. This is a hemisphere that prides itself in democratic states, and here is the President of Venezuela saying he doesn't care what the voters say. With Maduro threatening to use arms against his people, one can only imagine the bloodshed and abuses will continue unabated.

Despite these threats, protests endure because Venezuelans see no alternatives. They have no other recourse against standing in lines for endless hours to scour the empty shelves at their markets. They have no other way to channel their sorrow over the spike in maternal and infant mortality rates in hospitals that lack supplies to treat the most basic diseases. They have no other way to express their outrage at the military profiting from corruption in food procurement contracts, even while children increasingly suffer the ravages of malnutrition.

Parallel to the protests, chaos is becoming commonplace. In the past 72 hours, the National Guard troops have stormed the National Assembly and assaulted opposition legislators. They came into the Parliament and assaulted the opposition. The supreme court has stripped the attorney general, Luisa Ortega, of her authorities for her criticism of President Maduro.

We have seen lootings and the burning of government buildings. Alarmingly, a rogue police officer commandeered a helicopter and launched grenades and small arms fire while flying over the supreme court. These incidents from just the last 3 days should make it clear to all we are now dealing with a failed state in our own hemisphere.

As this crisis cripples Venezuela, I call on all sides to refrain from violence. I also want to recognize that the current situation is the product of 18 years of systematic efforts to dismantle Venezuela's democratic institutions.

Since coming to power, President Maduro--like Hugo Chavez before him--has filled the ranks of government with loyalists who have led the economy to hyperinflation and the brink of default. State oil companies like PDVSA, the country's only source of revenue, has been purged of its expertise. In a truly devastating blow to democracy and the rule of law, the judiciary has been entirely sapped of its independence so it now functions as a political appendage of the executive branch.

In the 18 months since the opposition coalition won control of the National Assembly--and I must tell you there was hope when we saw the voters in Venezuela enacted a new government in their Parliament--the supreme court has overturned every piece of legislation passed, gave itself authority to approve the national budget, and in April temporarily usurped the rest of the legislature's authorities, completely reversing the will of the people.

Additionally, as Venezuela's civilian and military justice systems have become accomplices to persecution and torture, the number of political prisoners has soared. Leopoldo Lopez, Judge Afiuni, Daniel Ceballos--these are just some of the more well-known names among the more than 350 political prisoners recognized by Venezuelan human rights NGO Foro Penal. These are people who are in prison as a result of their political beliefs.

It is no surprise the decay of judicial independence has led to an alarming rise in corruption and impunity. It is now a stated fact that senior officials have syphoned billions out of Venezuela and are engaged in the illegal drug trade.

In response, the United States has designated a dozen people under the Kingpin sanctions, including Vice President Tareck El Aissami. Interior Minister Reverol was indicted in the United States last year for drug trafficking. Even Maduro's nephews were convicted in the United States on drug charges.

The sum of these trend lines is truly disturbing. Today, Venezuela is a failed state, where authoritarian leaders profit from links to corruption and drug trafficking, while the Venezuelan people are subject to precarious humanitarian conditions and human rights abuses. Against this backdrop, we require little explanation why more than 18,000 Venezuelans sought asylum in the United States last year.

We are all concerned about the flight of people at risk. What is happening in Venezuela directly impacts people trying to seek safety coming into the United States. If all this wasn't enough, in late 2016, Venezuelan State oil company PDVSA used its U.S. subsidiary Citgo as collateral to secure a loan from Rosneft, a company that is controlled by the Russian Government and is currently under U.S. sanctions. The result is, the Russian Government holds at least 49.9 percent of Citgo's mortgage and could come into control of critical U.S. energy infrastructure, including refineries, terminals, and a large network of pipelines. This should

concern every Member of the U.S. Senate.

So the question for the United States and the international community is, How do we respond? What do we do? We cannot let this circumstance continue.

Thankfully, supported by a growing diplomatic coalition that includes Mexico, Brazil, Costa Rica, Peru, Canada, and the United States, the Secretary General of the Organization of American States, Luis Almagro, is marshalling international pressure. Mr. Almagro has called on President Maduro to heed the demands of his citizens, free political prisoners, permit the delivery of humanitarian assistance, commit to a timetable for overdue elections, and restore the authority of the National Assembly.

However, despite Mr. Almagro's leadership, the results of last week's meeting of Foreign Ministers was a stunning failure to reach consensus on a hemisphere response. Appallingly, eight countries refused to vote their conscience, among them Haiti, the Dominican Republic, Ecuador, El Salvador, Trinidad, and Suriname. They did not use the power under the OAS to recognize that Venezuela today is not living up to its charter commitment to be a democratic state. There is a process at the OAS to take action. They were unable to do that--a major setback.

As efforts at the OAS continue, all must remain clear that there are no alternative facts when it comes to Venezuela, there is just a manmade tragedy that demands collective action.

While providing full support for multilateral diplomacy, the United States must also lead. In May, I introduced bipartisan legislation to address the multifaceted crisis in Venezuela. My bill will authorize humanitarian assistance and require the State Department to coordinate an international approach to humanitarian challenges. The legislation will also provide strong congressional backing for OAS efforts, as well as funding for international election observers and civil society groups working to defend human rights and democratic values.

Given the rising instability in Venezuela, the bill would codify two lines of targeted sanctions against Venezuelan officials involved in corruption and undermining democratic governance--the very authorities the administration used to rightly sanction members of the Venezuelan supreme court last month.

Congress should act, as we have done in so many other places where we show congressional leadership to make it clear that this type of activity will not be allowed to continue and that Congress will take a strong position to give appropriate authority to sanction those individuals who are responsible.

Finally, the bill would require the State Department and U.S. intelligence community to prepare a report on the role of Venezuelan officials in corruption and drug trafficking.

As the instability in Venezuela grows, every day we decide not to act only makes the crisis worse. I urge my colleagues to work with legislation I have filed. Let's work with the Congress and the President to make it clear to the Venezuelan people they are not alone, and we will not tolerate a country in our hemisphere to become a failed state.

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

Mr. President, today I wish to recognize LGBTQ Pride Month, a time to openly acknowledge and celebrate the contributions lesbian, gay, bisexual, transgender, and queer or questioning individuals have made to our Country and the progress they have made over the years toward equality and civil rights.

Pride, equality, freedom--these values are at the core of Pride Month for LGBTQ individuals and families in Maryland and across the United States. Every American deserves the same freedoms, the same opportunities and the same protections under the law to love whom they love.

Respect, dignity, hope--LGBTQ Americans have helped drive the innovation and bold ideas that make America exceptional. They have stood sentry in our military, made scientific advances, created jobs from Main Street to Wall Street, made all of America laugh and cry, and so much more. LGBTQ individuals have enriched our communities and made us a stronger nation.

Fear, apprehension, caution--those of us who defend civil rights every day understand that these are discouraging and uncertain times. It pains me to say the full admission of lesbian, gay, bisexual, transgender, and queer or questioning individuals into society has yet to be granted. The open expression of one's sexual orientation and gender identity has been--and oftentimes still is--wrought with discrimination and hardship.

Despite the highs of Windsor and Obergefell, the LGBTQ community feels the pain of the senseless shooting at Pulse nightclub 1 year ago, blatant discrimination in States like North Carolina, and the incomprehensible abandonment of transgender students in schools, and the decades of injustice that reach back far beyond Stonewall. The results of last year's Presidential election brought an unwanted chill to the winds of momentum that had swept through the LGBTQ community. Insensitive language from the current administration adds an ominous cloud over the potential for future progress.

To all of my lesbian, gay, bisexual, transgender, and queer or questioning sisters and brothers, I say this: You are not alone. I support you. I will fight alongside you. We will not allow extremism to take away the inherent rights afforded to each and every one of us. Equality and liberty will prevail over any who would use hate and bigotry to frighten or intimidate others.

I have joined with nearly half of the U.S. Senate as a sponsor of the Equality Act, S. 1006, historic, comprehensive Federal legislation that would ensure full Federal nondiscrimination equality for LGBTQ individuals by adding sexual orientation and gender identity to other protected classes, such as race or religion, in existing Federal laws. Despite major advances in equality for LGBTQ Americans, including nationwide marriage equality, the majority of States still do not have explicit LGBTQ nondiscrimination protection laws. The Equality Act would fill in the gap by explicitly banning discrimination in a host of areas, including employment, housing, public

accommodations, jury service, access to credit, and Federal funding.

When the White House broke more than a decade of tradition by failing to recognize June as LGBTQ Pride Month, I joined my colleagues in picking up the mantle by introducing the first-ever Senate resolution recognizing June as LGBTQ Pride Month. The resolution notes major milestones in the fight for equal treatment of LGBTQ Americans and resolves to continue efforts to achieve full equality for LGBTQ individuals.

As we build a new future of equality for all, despite the current headwinds, it is important that we learn from our Nation's past and use it as a source of strength and a teachable moment for those unaware of the history the LGBTQ community and what our Nation has been through. It is my firm hope that we are not seeing a redux of a McCarthy-like rise in political-driven discrimination.

For this reason, I was taken back a bit at the confirmation hearings of Rex Tillerson and Nikki Haley, who are now serving as America's top diplomats, that neither of them would say the phrase ``LGBTQ.'' Following that peculiarity, it has been widely reported that the Trump administration has scrubbed LGBTQ content from various Federal Government websites--in some cases changing the agency's official nondiscrimination policy.

Juxtaposed with the Obama administration that lit up the White House in rainbow lights during Pride month and backed up those concrete actions of support, this attempt to erase LGBTQ individuals from government was disturbing. I was alarmed because I knew that it had been tried before during the McCarthy era. It had a damaging effect on U.S. foreign policy back then, and it cannot be repeated.

In what came to be known as the Lavender Scare, according to the State Department's Bureau of Diplomatic Security, employees were forced out on the ostensible grounds that their real or perceived sexual orientation rendered them vulnerable to blackmail, prone to getting caught in ``honey traps,'' and a general security risk. Many more individuals were prevented from joining the State Department due to a screening process that was put in place to prevent those who ``seemed like they might be gay or lesbian'' from being hired.

David Johnson's ``The Lavender Scare: The Cold War Persecution of Gays and Lesbians in the Federal Government,'' University of Chicago Press, 2006, the definitive academic study of the issue, found that at least 1,000 people were dismissed from the U.S. Department of State alone for alleged homosexuality during the 1950s and well into the 1960s before the ``scare'' ran its course.

The Senate bears a special measure of responsibility for the Lavender Scare, as the State Department's actions were in part in response to congressional investigations into ``sex perversion of federal employees,'' reports on the employments of ``moral perverts by Government Agencies,'' and hearings or pressure placed on the Department through the appropriations process.

Last year, in my role as ranking member of the Senate Committee on Foreign Relations, I urged then-Secretary of State John Kerry to shine a spotlight on this dark period in American diplomatic history by issuing the first-ever public apology for the Department of State's targeting due to perceived sexual orientation.

This month, I introduced new legislation called the Lavender Offense Victim Exoneration Act of 2017, or the LOVE Act. Similar to what was enacted for the men and women of our military, who also were forced to hide their real self to the world, the LOVE Act would make amends and help right the wrongs that were leveled against our U.S. diplomats during this un-American and unacceptable episode in our history. The Lavender Scare is a painful but little-known chapter in American history, and even though times have thankfully changed in so many ways for the LGBT community, we must have the courage of our conviction to recognize wrong, apologize, and move forward with common sense and compassion whenever it is required.

A few have asked me, Why now? Why do we need to relive past transgressions when there are ``more important things to do''? The answer is clear: The current administration may work to avoid using the words lesbian, gay, bisexual, or transgender, but Congress should take firm action to show LGBTQ Americans that their valuable contributions to our country--today or 60-plus years ago--are very real and they are recognized. We cannot and should not turn our backs on the individuals who sacrificed so much for the benefit of the American people. We cannot and will not turn back the clock on the hard-fought civil rights of the LGBTQ community.

The theme of the 2017 Baltimore Pride celebration is ``Pride Unleashed,'' a commitment to ``work boldly and to live freely.'' I can think of no better mantra for LGBTQ Marylanders and allies as we fight side by side to protect civil rights and celebrate the strength of our diversity.

I implore you and all of our colleagues to join the fight for LGBTQ equality. The administration also should take firm action to show LGBTQ Americans that their valuable contributions to our country are recognized and appreciated. It is the responsibility of each and every citizen to root out systemic intolerance. Inclusion and diversity are some of our Nation's greatest strengths; yet these values are now in peril. We cannot and will not turn back the clock on hard-fought civil rights for the LGBTQ community.

Mr. President, I want to thank Senator Wyden for his leadership on this issue and so many issues, his position as the ranking Democrat on the Senate Finance Committee. He serves this body very well, and he has done that today in outlining the flaw of the healthcare bill that was presented a week ago by the Republican leadership and what it would do to our healthcare system.

I want to acknowledge that I am very proud that I was in the Congress when we passed the Affordable Care Act. Today, millions of Americans have coverage who didn't have coverage prior to the enactment of the Affordable Care Act. I am also proud about the quality of that coverage. That coverage has guaranteed benefits so that individuals know they will be covered for their needs--no preexisting conditions, no caps. It is affordable, and we made sure it was affordable to the people of this Nation.

I have listened to the debate from some of my Republican colleagues about how the Affordable Care Act is collapsing under its own weight. Nothing could be further from the truth. The problems we are experiencing with high increases in the individual marketplace are caused in part by the actions of the Trump administration to try to undermine the Affordable Care Act.

Let me give an example in my own State of Maryland, where CareFirst-- the largest carrier in the individual marketplace--sought about a 50- percent increase in individual rates, and they were very direct. At least half of that increase is as a result of the uncertainty of the Trump administration putting the cost-sharing payments into the budget. That raises the premiums for all of those individuals in the individual marketplace. There is also the uncertainty as to whether the Trump administration is going to enforce the requirement that people buy insurance, which means only the people who have higher risks are likely to buy the insurance, raising the price for those who want to buy insurance.

When we talk about the fact that there are increased costs beyond what we think are reasonable, recognize that it is the actions of the Trump administration that are causing a large part of that premium increase, which brings me to the bill that was unveiled last week by the Republican leadership. It moves us in the wrong direction in trying to fix the problems. It does that because it decimates the Medicaid Program. The largest expansion of coverage has been in the Medicaid Program.

This bill will significantly cut back--CBO has scored that a total of 22 million individuals who have insurance today will lose their coverage, but it does more than that. It does that for what reason? Not to make healthcare more affordable--it does that in order to give tax cuts to the very wealthy.

I am glad that we now have a little cooling-off period. We are not going to come back to the bill for about another 10 days, it looks like.

I want my colleagues to know that as proud as I am of the Affordable Care Act, I acknowledge that we can make it better. I hope Democrats and Republicans will work together to move in the right direction on improving the Affordable Care Act. Let me give some examples.

We know there is a high cost on the premiums, a higher increase than we would like. Why don't we join together to make sure there is predictable cost sharing provided to the companies that are in the individual marketplace? That would remove the uncertainty and reduce the premiums significantly in the individual marketplace. Why don't we work together, Democrats and Republicans, to increase the subsidies we provide to low- and middle-income families so that the premiums will be more affordable? We intended to do that under the Affordable Care Act, but after we got the cost scoring, we had to trim that back. Let's work together, Democrats and Republicans. Those two changes alone would deal with the concern that in the individual marketplace, we are seeing large premium increases. Together, we can solve that problem.

Why don't we work for more competition? I have heard my colleagues talk about the fact that some of the insurance companies are leaving, and some are mainly because of the uncertainty as to whether they are going to get their rightful payments for cost sharing. We can do something about that.

Why don't we, Democrats and Republicans, come together and say that there should be a public option with no public subsidy, so it is a level playing field of competition? That way, we are guaranteeing to every market in the country that there will be coverage for the people in your community. That encourages more competition. That gives stability in the marketplace. We could do that together.

Then, Democrats and Republicans, let's work together to bring down the

overall cost of healthcare in this country. We made proposals that--why are we paying more for prescription drugs, twice as much as our Canadian friends? Because they have an organized market, and they negotiate as an organized market. Why don't we come together and say: Let's take the entire market that we have for the government paying prescription drugs and have one negotiation? That would significantly bring down the cost of prescription medicine.

Why don't we build on efforts that we have done for collaborative healthcare, for value-based reimbursement? That would significantly reduce the cost. We have seen that in mental health and addiction. We could see the same savings in kidney care and in diabetes and heart disease.

There are ways we can improve the Affordable Care Act. Democrats are ready to work with Republicans to get that done. What we will not do is make this current system worse. We are not going to cut the Medicaid Program in order to provide tax cuts to the wealthy. Join us in improving the law to make premiums more affordable in the individual marketplace, to bring more competition into the program, and to drive down the overall cost of healthcare in this country. That is what Democrats stand for, and we are ready to work with Republicans today in order to get that done. I would encourage our colleagues to work together, and let's improve the healthcare system.

I yield to my friend from Oregon.

Senator Wyden is exactly right. I have met with the largest insurer in Maryland. I have gone over their rate requests for this year. They told me directly that the largest amount of their premium increase request is based upon the uncertainty.

They don't know whether the cost sharing is going to be put in the budget, and they have to make their decisions on rates now. Not knowing that, they have to cover themselves, and they are asking for a rate increase under the concern that the cost sharing may not be in the payment.

That was not only envisioned, we thought it was mandated in the Affordable Care Act. Now the President is talking about: Well, maybe I am not going to put it in. And we see some of his other activities. So if you are an insurance company and you are answerable to your board of directors and you know that this payment is how you are able to get low deductibles and copays, but you are not sure you are going to get the Federal payment, and you know that your customers are going to want the low cost sharing, you have to charge a higher premium just to cover yourself. That is exactly what was done in Maryland.

If the President of the United States had said that money is going to go into the program because that is what Congress intended, we would have had significantly lower rates in Maryland in the individual marketplace. Predictability is critically important.

I will be glad to yield to my friend from Delaware.

Madam President, first I want to thank Senator Markey for his comments. I share his concerns. I agree with what he has said about the risk factors of the bill that was announced this morning by the Republican leader and what it could do to millions of people around this country and what it will do to coverage for hundreds of thousands of people in my State of Maryland who will lose coverage and just about every Marylander whose healthcare will be impacted if this bill were to become law.

I want to start by saying that I think this is a shameful moment for the Senate--the Senate, whose traditions have made it be known as the most deliberative body in the world; the Senate, which has been known as a body that

allows for robust debate and benefits from the views of all 100 Members, where each of us has opportunities to get our voices heard. That tradition has been badly damaged by what the majority leader has done in bringing a bill that affects one-sixth of the economy of our country to the floor of the Senate without the deliberation by our committees and without transparency to the American people.

When I got to the Senate, I worked hard to get on the Senate Finance Committee. I did that because the jurisdiction of the Senate Finance Committee contains areas that I have devoted a good part of my public career to, including issues of taxation and issues concerning social programs in our State. But it also included healthcare, an area that I worked on when I was first in the Maryland State legislature. I wanted to be on the committee that had a role in developing the health policy of this Nation. I thought I could add to that debate with my experience, and I wanted to make sure that the people of Maryland had a voice as we developed healthcare policy in America.

That role is being denied by what the Republican leader is doing in bringing this bill to the floor without the benefit of hearings. Let me just repeat that. There has not been one hearing held on the legislation being brought forward by the majority leader. There hasn't been one committee markup of the bill.

Now, let me explain to the general public what a markup is. It is when the committees that have expertise on a bill--in this case, it would be the Senate Health, Education, Labor, and Pensions Committee and the Senate Finance Committee--have had a chance to bring the public in to get their views on the legislation, have had the committee staff go through it and explain all of the aspects to the members of the committee, with an opportunity for us to offer amendments to improve the bill, and then, ultimately, taking a vote on the recommendation to the full Senate. That is the regular order, but it is particularly the regular order on complex pieces of legislation.

I don't think there is a Member of this body who would say that this is not a complex field when we are dealing with healthcare--one-sixth of our economy. But the process that was used denied the people of Maryland and the people of this Nation the opportunity to have their voices heard through their elected representatives. It is a shameful moment.

Now, I know this has been done before on the floor, but I will just repeat it one more time. Compare this to how the Affordable Care Act was passed by the Senate. We had transparency, opportunities for the public to have input. We had hearings--many, many hearings that took place. My staff tells me there were 50 hearings or roundtable discussions or walk-throughs. We had 26 consecutive days of Senate debate. There were hundreds of amendments offered by both Democrats and Republicans that were adopted on the bill before the bill reached the floor of the Senate. That all took place before we started the debate on the bill.

You cannot justify this process. This is an abuse by the majority, and it will affect the functioning of the Senate.

There are concerns about what this bill will do. The process is terrible. The impact on the Senate is terrible. But the real tragedy here is the impact, if this bill were to become law, it would have on healthcare in America.

So let me talk a little bit about my State of Maryland. It has been projected under this bill that those who will not have insurance coverage will go back basically to what it was prior to the passage of the Affordable Care Act; that is, a little over 400,000 Marylanders are at risk of losing basic health coverage. Now, it is going to affect everyone with insurance in Maryland, and I will get to that in a moment. But as many as 400,000 people are in jeopardy of losing their insurance because of what is done with regard to the alliances and the Medicaid Program itself. Many more will lose quality coverage.

Senator Markey talked about preexisting conditions. You claim that there is protection for preexisting conditions, but it does not guarantee that the services will be provided because the States are given tremendous discretion as to what would be required as essential benefits within the healthcare plans. So if someone has a mental illness or someone has a drug addiction, is there a guaranteed coverage that that person would be able to get services? If that person has a preexisting condition, it may very well not be covered because of the absence of essential health benefits.

Let me just give you another example of what could happen under this bill, and this is a real example on gender discrimination. Obstetrics coverage is critical for a childbearing woman. Now, if that becomes an optional coverage because of the State plans and discretion that it is given, obviously only those women who are planning to have children will take that coverage. Why would someone who doesn't need that coverage take the coverage? What are the consequences of allowing that type of choice? It is very clear.

Younger women are going to pay a lot more for their health insurance than they otherwise would. Is that fair? I think not. I think not. That is the consequence of the type of changes that are being made in the Affordable Care Act.

I was very instrumental in making sure that we had full coverage for pediatric dental. Why? Well, unfortunately, in my State in 2007--the year I first started in the Senate--we had a youngster, Deamonte Driver, who lived not far from here, who died because of an untreated tooth decay. It became abscessed and went into his brain. He had to go through a couple of surgeries, and he lost his life. What was needed was $80 of dental care. He couldn't get access to it because there was no coverage for it. He had no access to that care. He lost his life and, of course, the healthcare system had to pay a lot of money when it only needed to spend $80 to keep him healthy.

Well, we took care of that and fixed that with the essential benefits now, including pediatric dental. Is that protected under the Republican bill? The answer is unclear--probably not. It is up to the States. It may be different in one State versus another. We don't have the protection.

Then we get to the affordability issue for Marylanders to be able to afford to have health insurance. Under this bill, there will be discrimination on those that are older. They are going to have to pay more for their health insurance. Is that right? No, it is not right. I heard the majority leader this morning give examples of how the Affordable Care Act is in danger, and he cited high premium increases. One of the States he quoted was the State of Maryland, and it was very misleading the way he did that. He was talking about the individual marketplace, and he was talking about one segment of that. What he didn't tell you is that CareFirst, the insurance company that is proposing that rate increase, indicated that at least half of that increase is the result of action taken by the Trump administration, because the Trump administration has not made it clear whether they will fund the cost-sharing provisions, which keep the costs down and affordable in the individual marketplace. That is a self-inflicted increase in premiums by the Trump administration.

There is a second issue that CareFirst mentioned, and that is the President's insistence on not enforcing the individual mandate, and, by the way, that is in the Republican bill. It means that younger, healthier people will choose not to have health insurance. Now, if they happen to ride a motorcycle and wrap themselves around a tree and get flown to the Shock Trauma Center in Baltimore and we are going to treat him, guess who is going to pay the bill? All of us are going to pay the bill through uncompensated care. It is going to raise my insurance policy and everybody's insurance policy. That person should have had insurance, but that person thought he or she didn't need that insurance. So they didn't take out the policy.

You find that those who will take out the insurance policies are the higher risks because they know they need the insurance. So those with high-risk issues will be in the pool raising the costs and that is why CareFirst has a higher ask, because they know it is less likely that healthier people will be in the pool than projected under the original Affordable Care Act. Why? Because of President Trump.

So when the leader says that the Affordable Care Act is falling apart, the

Affordable Care Act is strong, but it has been made vulnerable by the actions of the Trump administration, and the provisions in this bill will make it even weaker.

Now, 1.2 million Marylanders are in our Maryland Medical Assistance Program, or Medicaid Program. Many of these people are working families. Many of these people are our seniors who need long-term care and are in the Medicaid Program because it pays for their long-term care expenses. Many of these people are veterans or returning warriors who are under the Medicaid Program.

Under the Republican-released bill, they may make it a gentler slope before we get to the full impact of the Medicaid reductions, but the Medicaid reductions, if I understand correctly, are even more severe than under the House-passed bill.

Now, I could speak for Maryland. I know our legislature. Our legislature is going to try to do what is right, but they have limited resources in order to try to meet the needs that are out there. It is just not right to say that we are passing these problems on to the States when the States don't have the fiscal capacity to deal with them. Who gets hurt? The 1.2 million Marylanders who rely upon the Medicaid Program and all Marylanders who don't want to see what we call cost shifting, when someone who doesn't have health insurance ends up in our emergency room and doesn't pay the bill and everyone else pays those bills.

So why are we doing this? What is the reason we have gone through this pain? I have heard my colleagues talk about it, and it is absolutely true. The Republicans need to make room for the tax cut. They are pretty clear about it. Close to $1 trillion in tax cuts is what they need to do. Who benefits from tax cuts? The wealthy, those who have access to healthcare. Who pays for the tax cuts? Those who are the most vulnerable in our community. That is just wrong.

My staff has put together a lot of individual letters that have been sent to us. I don't even need to go through them. I can tell the Presiding Officer just the experiences I have had walking on the streets to Baltimore or, quite frankly, walking anywhere, including here in Washington.

When people come up to me and say: Senator Cardin, keep up the fight. Do you know what is going to happen if that healthcare bill becomes law? We have done some tests and we have certain genes, we are in a high-risk pool for cancer. We are not going to be able to get coverage if you let insurance companies go back to the practices they had before the passage of the Affordable Care Act.

People say that if they didn't have the insurance they now think they are going to lose, they would have to go through personal bankruptcy. That is not a hypothetical. Before the passage of the Affordable Care Act, unpaid medical bills was the leading cause of bankruptcy. Are we going to go back to those days?

I talked to a parent who has a child with a disability--and to think what the cost of that child is going to be in the healthcare system. They don't possibly have the means to be able to afford that if they didn't have access to healthcare coverage without discrimination. You leave these discretions to how the insurance companies will respond with their businesses, they are going to figure out a way so a family who has a disabled child will not have adequate coverage. That is what is at risk. Senator Markey is right--healthcare should be a right, not a privilege, and we are moving in the wrong direction.

In Maryland, we have hospitals that are located throughout our State to meet the needs of the people of Maryland. We have hospitals that are located in areas where they have a lot of elderly and a lot of poor people, but because of the way we deal with our hospital reimbursements, we don't have cost shifting. We can have what is known as an all-payer rate, where whoever goes into the hospital, they pay the same rate so a hospital can locate in an inner city or poorer neighborhood. If you increase the cost sharing for people who don't have insurance, hospital facilities will not locate in those communities, adding to the costs of everyone's healthcare.

One of the great benefits, one of the great achievements of the Affordable Care Act, is that we now have facilities that are more conveniently located to people in this country, whether they live in a rural area or urban setting. Some are healthcare centers and some are health clinics, but they are more conveniently located because more people have third-party coverage and have insurance in order to pay those bills.

So I read with interest that certain segments of the advocacy community are going to be given certain concessions in this bill, and they think they are going to be OK. One is, I understand--and I am not sure what this term means, and maybe someone can explain it to me-- medically complex children. These are children, I assume, who have special needs.

If I understand the bill correctly, there is going to be a carve-out in the Medicaid system so that these complex cases will be, at least for a period of time, reimbursed. Where are they going to get care?

Right now they are getting care, in many cases, in a school-based health clinic that is going to be closed under the Republican bill that is out here because it is not qualified to receive reimbursement. The expansion of our qualified health centers under the Affordable Care Act is going to be in deep jeopardy. I met with the CEOs of our qualified health centers where we have expanded to deal with pediatric care, dental care, and mental health. That is in jeopardy of being contracted if you don't have the reimbursements from the people who live in that community that we have under the Medicaid expansion. That is in jeopardy. So don't believe you are protecting any vulnerable population when you don't provide the structure in which you can have reasonable reimbursements so that doctors, hospitals, and clinics can locate in communities and be treated fairly under our reimbursement structure.

I am deeply disappointed. I am deeply disappointed with what we have done to this great institution on this, such an important subject. I am deeply concerned, about the impact this is going to have on the people of Maryland and our Nation, and I will join my colleagues in doing everything I possibly can, during the limited opportunities we have only on the floor of the Senate, not in our committees--to do everything I can to protect the interests of the people of Maryland and our Nation so healthcare can be a right and not a privilege.

With that, I yield the floor.

Mr. President, I rise today to introduce a resolution to mark World Refugee Day, and to address the ongoing displacement crisis across the globe. War, conflict and persecution have forced millions of people to leave their homes, creating more refugees, asylum seekers and internally displaced people than at any other time in history. Today, there are more than 65 million displaced men, women, and children worldwide, the highest level ever recorded in history. To put this number into perspective--if the global displaced population were a country, it would be the 21st largest country, more populated than the United Kingdom.

The global displacement trends we are witnessing now, due to conflict, severe human rights abuses, and climate change, are not going away. U.S. leadership in responding to these crises, whether it is the immense suffering of refugees from South Sudan or the plight of the internally-displaced in Syria and Iraq, is critical. How we respond--or whether we respond at all--will undoubtedly shape the landscape and the lives of future generations for years to come.

The United States has a long and proud history of providing safe harbor to the world's most vulnerable refugees--women and children, survivors of torture and other violence, and those with severe medical conditions. This included after World War II and after the fall of Saigon, when we resettled hundreds of thousands of refugees.

At the same time, we take the security of our citizens seriously. That is the reason the United States has the most rigorous refugee screening process in the world, involving the Department of Defense, Department of State, Department of Homeland Security, Federal Bureau of Investigation, and National Counter Terrorism Center. The process includes biometric checks, medical screenings, forensic testing of documents, DNA testing for family reunification cases, and in-person interviews with highly trained homeland security officials.

The U.S. Refugee Resettlement program has been and should remain open to those of all nationalities and religions who face persecution. The Trump Administration's proposals that would have the U.S. State Department disqualify refugees from protection based on their nationality or religion fly in the face of the very principles this Nation was built upon. They also contradict the legacy of leadership our country has historically demonstrated, and dishonor our shared humanity.

It is clear, however, that the Trump Administration is determined to undermine longstanding American tradition and values, and in doing so they weaken our National security. As we all know, one of President Trump's first executive orders sought to drastically reduce the number of refugees entering the United States and turn away refugees from Iran, Libya, Somalia, Sudan, Syria, and Yemen. This un-American policy, rooted in fear not fact, cannot be tolerated. We collectively must reject the misplaced notion that some refugees are more deserving of protection than others.

Again and again, the Federal courts are signaling to the White House a real need for the President to immediately rescind his discriminatory executive order targeting Muslim refugees and travelers. Even while stayed by the courts, President Trump's executive orders have made America less safe, damaged our relationships with our allies, and harmed countless numbers of law-abiding citizens, travelers, and their families. America is a compassionate nation steeped with a history of welcoming immigrants and refugees.

I was proud to join Members of Congress who filed legal briefs in opposition to the President's discriminatory executive orders, along with HIAS in Silver Spring, Maryland, whose motto is to ``welcome the stranger'' and ``protect the refugee.'' Recently the U.S. Court of Appeals for the Fourth Circuit provided a valuable check and balance on the President's authority. The court correctly pointed out that the President's most recent Executive Order ``speaks with vague words of national security, but in context drips with religious intolerance, animus, and discrimination'' which violates the Establishment Clause of the First Amendment. No American president is above the law.

Turning away refugees--whether they are from Syria or Somalia, Burma or Iraq, whether they are Muslims or Christians, Hindus or Jews--means turning our backs on the international humanitarian system and the mechanisms of stability and security that are the bedrocks of international order. Refugees remain powerful ambassadors of the American Dream and our Nation's founding principles of equal opportunity, religious freedom, and liberty and justice for all.

The Trump Administration again revealed its determination to erode American leadership with the release of its Fiscal Year 2018 Budget request. Their FY18 budget represents a wholesale repudiation of U.S. global leadership on virtually every critical matter, including humanitarian assistance and protection of the most vulnerable populations. The President's budget called for a 44 percent cut in humanitarian assistance--a truly horrifying reduction made even more appalling given the level of global need. According to a group of leading NGOs, the human cost of these cuts could be staggering. The proposed 18 percent cut to the Migration and Refugee Assistance account could result in over 3.5 million refugees and internally displaced persons not receiving assistance globally, including about 1 million in the Middle East and 1.1 million in Africa.

The United States has been a beacon of hope for so many around the world for centuries, and it is imperative that we remain so for others in this century, and beyond. We need to be unified on this and the United States must lead by example. It is a universal human desire to live in peace and security and to create a better life for our families and loved ones. We must do our part to facilitate that. We need to keep our doors--and our hearts--open to those who so desperately need safe harbor.

S. Res. 195

Whereas World Refugee Day is an opportunity to acknowledge

the courage, strength, and determination of women, men, and

children forced to flee their homes due to conflict,

violence, and persecution;

Whereas according to the United Nations High Commissioner

for Refugees (referred to in this Resolution as ``UNHCR'')--

(1) there are more than 65,600,000 displaced people

worldwide, the highest level ever recorded, including nearly

22,500,000 refugees, more than 40,300,000 internally

displaced people, and 2,800,000 people seeking asylum;

(2) children account for 51 percent of the global refugee

population, millions of whom are unable to access basic

services, including education;

(3) 10,300,000 people were newly displaced due to conflict

or persecution in 2016;

(4) more than 5,500,000 refugees have fled Syria since the

start of the conflict, and more than 6,300,000 people are

displaced inside Syria;

(5) since January 2014, more than 3,000,000 Iraqis fleeing

violence have been internally displaced, and 257,000 refugees

have fled to neighboring countries;

(6) South Sudan has the world's fastest-growing refugee

crisis, which is now the largest refugee crisis in Africa,

with more than 1,800,000 refugees, including 1,000,000

children;

(7) increasing violence in Guatemala, El Salvador, and

Honduras has led to a growing number of unaccompanied child

refugees, who are particularly vulnerable to sexual violence,

human trafficking, and kidnapping; and

(8) ongoing conflict, violence, and persecution have

resulted in the displacement of millions in Ukraine,

Colombia, and the Central African Republic;

Whereas 84 percent of the world's refugees are hosted in

developing regions, with more than 28 percent hosted in the

world's least developed countries;

Whereas refugees who are women and children are often at

greater risk of violence, human trafficking, exploitation,

and gender-based violence;

Whereas the United States resettlement program is a life-

saving solution critical to global humanitarian efforts,

which reflects American values, strengthens global security,

and alleviates the burden placed on front-line host

countries;

Whereas refugees are the most vetted travelers to enter the

United States and are subject to extensive screening checks,

including in person interviews, biometric data checks, and

multiple interagency checks;

Whereas refugees contribute to their communities by

starting businesses, paying taxes, and sharing their cultural

traditions; and

Whereas refugees contribute more than they consume in

state-funded services, including schooling and health care:

Now, therefore, be it

Resolved, That the Senate--

(1) reaffirms the bipartisan commitment of the United

States to promote the safety, health, and well-being of the

millions of refugees;

(2) recognizes those individuals who have risked their

lives working individually and for nongovernmental

organizations and international agencies, such as UNHCR, to

provide life-saving assistance and protection for people

displaced by conflict around the world;

(3) underscores the importance of the United States Refugee

Resettlement Program as a critical tool for United States

global leadership;

(4) calls upon the United States Government--

(A) to continue providing robust funding for refugee

protection overseas and resettlement in the United States;

(B) to uphold its international leadership role in

responding to displacement crises with humanitarian

assistance and protection of the most vulnerable populations;

and

(C) to alleviate the burden on refugee host countries

through humanitarian and development support while

maintaining the

United States' long-standing tradition of resettling the most

vulnerable refugees regardless of their country of origin or

religious beliefs;

(5) reaffirms the goals of World Refugee Day; and

(6) reiterates the strong commitment of the United States

to seek to protect the millions of refugees who live without

material, social, or legal protections.

Well, first, to Senator Corker. There is a reason Members want to serve on the Senate Foreign Relations Committee. We had a long list of Members who wanted to join our committee in this Congress. Quite frankly, I think the reason they want to join is not only the challenges we have globally but the fact that this is a committee that works bipartisanly and respects the views of every single Member, both Democratic and Republican, on the Senate Foreign Relations Committee.

The bill we have before us reflects that--in the best tradition of the U.S. Senate and the Senate Foreign Relations Committee. That is due, in large part, because of the talent, leadership, and commitment of our chairman. I thank Senator Corker for allowing us to reach this very important moment in the U.S. Senate, to be able to vote on a bill that is consequential for America's national security.

I believe this is the first major bill we have had on the floor of the U.S. Senate, the first bill we have had amendments to, and I concur in the Senator's observations that our leaders allowed us to let the process work in the best traditions of the U.S. Senate.

It is difficult for many of us to explain how the Senate operates at times. It really is difficult, but it is a body which respects the rights of each Member, and they have certain abilities to slow things down or bring us to a stop, and the process doesn't work the way it is supposed to work, but this bill has been handled very quickly on a major subject because we respected the rights of every single Member of the U.S. Senate. It doesn't mean we reach total agreement. We didn't, but we have a bill that accomplishes three very important things:

First, it stands up to the aggression of Russia and Iran. Yes, we have been talking about this--and I am glad Senator McCain is on the floor. Senator McCain has been one of the most ardent crusaders to point out the risk factors of Russia to our national security and that of our allies.

I started with Senator McCain in January. We sat down, and he informed me why we had to do certain things and make it very clear and not have any ambiguity because Russia would run right through that ambiguity. Thanks to that initial leadership, we have those provisions in the underlying bill. There will be no ambiguity as to what Congress is saying in regard to Russia's behavior.

I also acknowledge we have a review process in here. Senator Graham brought that to our attention very early in the process in January so Congress can insert itself.

Mr. President, I ask unanimous consent for 2 additional minutes.

That review process will give Congress the right role to review executive actions so we are stronger, working together. It also gives the President a stronger hand in negotiating with Mr. Putin and Russia because Congress has said: You must accomplish certain objectives, such as getting Russia's aggression to end in Ukraine or get Russia to stop supporting war crimes in Syria, to stop interfering with our democratic election systems. That is what we say, and we are very clear about that.

Then we take the third step, which I think is very important; that is, provide the wherewithal of U.S. leadership, working with our European allies, to protect our democratic institutions.

All of that is included in the bill that we are going to have a chance to vote on in a few minutes, and I want to thank all who were involved. I am going to include staff who worked so hard on this.

They were here 24/7 putting this bill together--Damian Murphy, in my office; Margaret Taylor; and Jessica Lewis, Dana Stroul, Lowell Schwartz, Sean Bartlett, Chris Barr, John Ryan, Leslie Bull, Danny Ricchetti, as well as Todd Womack, Rob Strayer, David Kinzler, and Ben Purser.

They were extraordinary in helping us reach this day.

Madam President, I ask for the yeas and nays.

Mr. President, April was National Minority Health Month. I point that out because I have worked with many of my colleagues in order to advance minority health.

We have done some very important things in recent years that I am very proud of, and many of those are included in the Affordable Care Act. I know that Senator Carper and Senator Blumenthal will be on the floor; Senator Carper is here now. They have been instrumental in advancing quality healthcare for all Americans, but we do recognize that we have a special role in regard to historic discrimination on minority health. I was pleased that the Affordable Care Act included the National Institute on Minority Health and Health Disparities so that we could have a focal point at NIH to deal with the historic problems and have a game plan to advance that.

I was also pleased that the Affordable Care Act provided coverage for minorities in greater numbers because when we looked at the number of uninsured, the number of minorities were a much higher percentage than the general population of uninsured. When we looked at inadequate coverage, we saw the same numbers. So we have made advancements.

In April, historically, I had filed a resolution in order to acknowledge the progress we made and to continue our commitment to make sure that all Americans have access to affordable, quality healthcare and that we do not discriminate. That resolution had always cleared without any difficulty until 2017. For reasons I cannot explain, there were Republican objections, and we were not able to adopt the resolution commemorating minority health month.

Mr. President, I ask unanimous consent that the text of that resolution be printed in the Record.

I thank Senators Menendez, Blumenthal, Brown, Hirono, Markey, Klobuchar, Van Hollen, Booker, Peters, Duckworth, and Carper for their help in regard to minority health and the resolution.