Floor Statements

Mr. President, I rise to speak to the repeal and replace effort that is before us, and the challenge has been how to do so. Senator McConnell has recently introduced a bill, and as we pore over it, there is much to like, but quite likely, there will be some Senators who will still express reservations as to whether this amendment adequately fulfills President Trump's campaign pledges--those pledges specifically to continue coverage, care for those with preexisting conditions, eliminate mandates, and lower premiums.

If more is required, Senator Lindsey Graham and I have actually come up with an amendment that we will add to the bill being offered. It doesn't replace it but, rather, it adds to it. In it, we return to conservative solutions that devolve power back to States and rely upon the States to, in turn, devolve power to the patient.

So what does this bill do? What we do basically is take the dollars that the Federal Government would give to a State under ObamaCare and we give those same dollars in the form of a block grant. We allow the State to then administer the money in its best way to, one, give patients the power, and two, fulfill President Trump's pledges.

We think this works. It is a 10th Amendment solution in which that which is not specifically given to the Federal Government is, in turn, given to the State. Let the States decide what they want to do. Some object. They say: Oh my gosh. A conservative State may do something that we don't think--whoever is speaking--it should be allowed to do. Another might say: Well, I don't think a liberal State should be allowed to do that. Under our bill, we devolve to the State, so a blue State can do a blue thing and a red State can do a red thing. Let's let our States be the laboratories of democracy that teach each other the best way in which to insure others. But we say it will be the State that has the power and not the Federal Government.

If you oppose this approach, it means you would trust a Washington bureaucrat more to address the needs of your State than you would trust the people of your own State.

We would still have those protections which would allow folks to get the adequate coverage they need. There would still be--for example, preexisting conditions will be covered, fulfilling President Trump's pledge to that end. We would fulfill what I call the Jimmy Kimmel test--that everybody who is ill or has a loved one who is ill would have adequate resources to have that person's illness addressed.

We have a precedent as to how this is done. Congress, I am told, when it addressed the Temporary Assistance for Needy Families Program, gave the dollars necessary, with flexibility to the States. Although at the time the solution was criticized as giving too much money to the States, since, the Federal Government has not had to put in more money. Because of the flexibility, the States have been able to use the dollars allocated in such a way as to meet the needs of the population.

So what could a State do with these dollars?

It could help those patients who are at higher risk or higher cost purchase

the coverage they need, perhaps in a reinsurance or in an invisible high-risk pool that would allow premiums to be lowered for those individuals and for all.

It could maintain status quo. Those folks getting tax credits instead could have these dollars fund their purchase of insurance. It could be used together with Senator Cruz's amendment, which would allow a health savings account to be used to purchase health insurance. The individual could set up such an account, the State could fund it, and then these dollars could then be used to purchase insurance. I like that, personally. That particular provision was in the Cassidy-Collins bill, the Patient Freedom Act, and it dovetails very nicely with block- granting these dollars back to the States to care for someone.

It could directly contract with providers to provide assistance to a specific population. So imagine you have an Indian reservation--or if not an Indian reservation, which might be covered under another source of funding, another fairly isolated population that does not have access to healthcare, the State could say: OK, we are going to come in and provide providers specifically for that population.

Alaska may adopt this because they have 700,000 people stretched over a land mass almost as big as the lower 48, and that might be a solution Alaska comes up with, but the point being, the solution would be specific for that State. Unlike ObamaCare, in which, out of Washington, DC, Washington bureaucrats dictate that the same approach be taken across the Nation no matter how different the States are, in this, the money is given to the State, and the State is asked to provide for their citizens in a way specific for the needs of that State.

We think the Graham-Cassidy amendment returning power to States and to patients is a conservative solution which ultimately gives the patient more power. I will repeat. This does not replace that bill which is being offered by Senator McConnell. It would be an amendment to that. And if it turns out that some Senators feel as if that particular bill is not adequate to fulfill President Trump's campaign promises, we think this amendment could take the bill the rest of the way.

Mr. President, I yield the floor.

I suggest the absence of a quorum.

Mr. President, today I would like to acknowledge and honor Camp Beauregard on its 100th year of service. Named after famed Louisiana General Pierre Gustav Toutant Beauregard, Camp Beauregard is a U.S. Army installation operated by the Louisiana National Guard. For the past century, Camp Beauregard has hosted hundreds of thousands of soldiers training for combat missions all across the world and has served the State and local communities.

The site that eventually became Camp Beauregard was constructed in the late 1850s as a military academy. Following the Civil War, the school was relocated to Baton Rouge and renamed Louisiana State University. In the early 1900s, the site became the permanent camp for the Louisiana State National Guard's annual training exercises. The site officially became Camp Beauregard in 1917 as the United States entered World War I. Over 44,000 soldiers trained at Camp Beauregard before the end of the First World War, and hundreds of thousands of men trained at Camp Beauregard during the Second World War.

Camp Beauregard is currently the largest National Guard post in Louisiana and is essential to the Louisiana National Guard's efforts to serve the United States, Louisiana, and local communities. Not only does Camp Beauregard serve as a training ground for soldiers preparing for overseas combat operations, the camp also plays a vital role during major weather events and hosts competitions and family

events. For 100 years, Camp Beauregard has served Louisianans and Americans alike.

I and my fellow Louisianans are proud of Camp Beauregard's accomplishments and the positive impact the training there has had on our State, our Nation, and across the world. I would like to thank those currently at Camp Beauregards as well as all those who have served our country there, and congratulate them for 100 years of service and patriotism.

Mr. President, I am also here to comment, as Senator Cornyn has, on the state of play, if you will, and the repeal and replacement of ObamaCare. I think sometimes the American people feel like collateral damage as Republicans and Democrats go back and forth as to what is the best policy.

I am a physician, a doctor who worked in a public hospital for the uninsured for decades before I went into politics. I guess from my perspective, the primary thing is not Republican versus Democrat, but that patient who is struggling to pay her bills, her premiums, or the fellow who can't afford medicine. What are we doing for them?

There is a gentleman who went on my Facebook page--again, cutting through this kind of political noise. This is Brian from Covington, LA:

My family plan is $1,700 a month, me, my wife and 2

children. The ACA has brought me to my knees. I hope we can

get something done. The middle class is dwindling away. Can

everyone just come together and figure this out?

If that is not a plaintive plea of someone who is drowning under the cost of premiums for insurance, which he knows he has and, as a responsible father and husband, he will work to pay for--nonetheless, he says that he is being crushed by these high premiums.

The American people need relief. We have to lower those premiums. I have always said, though, that whatever we do must pass the Jimmy Kimmel test; that is, to say that if Brian's wife or children or he himself has a terrible illness, there will be adequate coverage to pay for the care their family would need for that member of their family with that terrible disease. It kind of brings us to where we are now-- two aspects to what we are considering.

By the way, when folks say that we are redoing one-sixth of the economy, that is not true. The Affordable Care Act, ObamaCare, again, attempted to address one-sixth of the economy that is healthcare. We are focused on the individual market, which is about 4 percent of those insured, and Medicaid. We are not touching Medicare. We are not touching the employer-sponsored insurance market. It is important to realize that this is not as comprehensive as the Affordable Care Act. It is something far more focused.

Let's first talk about Medicaid. I am very concerned about what has been proposed for Medicaid, but also concerned about current law regarding Medicaid. Under the Medicaid expansion in the Affordable Care Act, States got 100 percent of all the cost of the patients enrolled for the first 4 to 5 years. As you might expect, States were quite generous in their payments for these patients as they contracted with Medicaid-managed care companies to care for them, so much so that those folks enrolled in Medicaid expansion. Taxpayers are paying 50 percent more than taxpayers are paying for those in traditional Medicaid. And States enrolled roughly 20 million people in the Medicaid expansion program. The combination of enrolling so many people in the Medicaid expansion program and paying 50 percent more than for traditional Medicaid means that when States finally have to foot 10 percent of the bill, which they will by 2020--when States have to finally foot that 10 percent of the bill, they cannot afford that 10 percent.

Unfortunately, under the Affordable Care Act, State taxpayers will not be able to pay what in California is $2.2 billion extra per year as the State's 10-percent share. Similarly in Louisiana, my State, our taxpayers--me, my colleagues, my friends, my neighbors--would be on the hook for $310 million per year. Our State is having a budget crisis because we can't afford $300 million. Now it is a $310 million recurring bill every year.

One thing that is not said is that Medicaid expansion in its current format is not sustainable. We have to do something--again, to preserve benefits for that patient. We have to take care of that patient, but we have to make it sustainable, both for the Federal taxpayer and the State taxpayer. By the way, whoever is watching this is both a Federal and State taxpayer. You are getting caught both ways.

Let me speak a little bit about the process. If you want to speak about Medicaid, we just laid it out. Let's speak a little about the process, as much has been said about it. I don't care for how the process transpired, but I certainly understand Leader McConnell's concerns that Democrats would not collaborate. I find that a sorry state of affairs.

What do I mean by that? Susan Collins and I, and four other Republican Senators, put forward a bill that would allow Democratic States to continue in the status quo--to get the money they would have ordinarily received under the Affordable Care Act and to continue a system--as much as they desire to have--for the whole Nation.

The minority leader, Chuck Schumer, condemned our bill before we filed it, meaning before he had a chance to read it. Without reading our bill, he condemned it, even though his State of New York would have been allowed to continue in the program that they are currently in and receive the dollars to support that program. He condemned the bill before he read it, even though it would have allowed his State to continue in the status quo.

Similarly, we approached other Senators--10, at least, on my part. None would help us with our bill, even though their State could have continued in its current status quo, receiving the income it currently receives. That tells me that even a good faith effort to reach across the aisle was not going to get cooperation. That is too bad, and that is why, I think, there is kind of a political back-and-forth in which the patient--the American like Brian, struggling to support and cover his family--gets lost in the crossfire. A goodwill bill, designed for States to do that which they wish to do, would not even be considered by the other side.

I have always pointed out that if even two Democrats had walked into Mitch McConnell's office and said ``We will work with you to pass a bill,'' they could have gotten far many more things for their State than saying ``No, we have not been invited to the party; therefore, we will not participate.'' I say that as an observation, not as a criticism, but also as an explanation to the American people of how we have ended up in this position.

Now, as to the bill that will be before us, I have not seen the written language. I reserve judgment until I have seen that, but I will say that there are some things I like. If our desire, again, is to take that patient, the American citizen, and make sure his needs or her needs are met--a family such as Brian described here who cannot afford their current premiums--there are things in this bill which will lower those premiums. There is the so-called cost-sharing reduction payments for the next couple of years that would continue to provide certainty to the insurance companies so that when they market insurance on the individual market, there would be certainty. They would be able to know those dollars are coming from the Federal taxpayer to support folks for the next couple of years, and they could lower their premiums accordingly.

There will be a so-called State Stability Fund that going forward, States

could use to create what was called the invisible high-risk pool--a reinsurance program, if you will--so that if you are a patient on dialysis, a patient with cancer, very expensive to care for, you would continue to get the care you require, but everyone else in that insurance market has their premiums lowered because there is a little bit of help for those folks with those higher cost conditions. By that, we lower premiums.

President Trump, when he was running for President, said he wanted to continue coverage, care for those with preexisting conditions, eliminate the ObamaCare mandates, and lower premiums. What I have seen or, at least, heard is we are on the path to fulfilling President Trump's pledge. Now, again, reserving judgment until I have seen written language, I will say that what I have seen so far keeps the patient as the focus, would address someone like Brian, the needs of his family, the needs of their pocketbook as well as their health, and build a basis so that going forward, States would have the ability to innovate, to find a system that works best for them.

On behalf of those patients, I hope that we as a Senate--whatever our party--are successful. I hope going forward we, as a Senate, no matter what our party, put the patient as the focal point, hoping that our combined efforts--again, no matter what our party--will address her needs or his needs, both financially and particularly for their health.

I yield the floor.

I suggest the absence of a quorum.

Mr. President, one of the things we are debating right now is, What is the future of the Affordable Care Act or, I should say, healthcare in the United States? One thing we can all agree to is that the individual market under the Affordable Care Act--or ObamaCare, as it is commonly called--is not doing well.

I will put up this Facebook post from a constituent in Louisiana named Brian. He wrote in to say:

My family plan is $1,700 a month. Me, my wife, and 2

children. The ACA has brought me to my knees.

He doesn't say this, but we know that, most likely, his family deductible is $13,000.

I hope we can get something done. . . . The middle class is

dwindling away. Can everyone just come together and figure

this out?

So his family is putting out $20,000 a year for insurance. They most likely have a $13,000 family deductible. They have two children, a young family, $33,000 of out-of-pocket expenses before they would see significant benefit from their policy. Clearly, we have a problem.

When he was campaigning, Candidate Trump recognized this, and he said over and over that his contract with the voters was to maintain coverage, lower premiums, address and care for those with preexisting conditions, and to eliminate the ObamaCare mandates. This, if you will, was his contract with the voters--a pretty good contract. I think it is something both parties can get behind.

Candidate Trump and then President-elect Trump doubled down on this just before taking the oath of office, saying: ``People covered under the law''--meaning the law that he would support to replace the Affordable Care Act--``can expect to have great healthcare. It will be in a much simplified form. Much less expensive and much better.''

Indeed, the President of the United States seemed, again, to renew this commitment this past week at a lunch with 15 Senators at the White House, once more saying how we have to have a law that lowers premiums and cares for those with preexisting conditions.

That is the baseline. Some would argue, has President Trump committed himself to some right that previously did not exist that all Americans would have healthcare?

I am a physician, a doctor. I worked in a public hospital for the uninsured for so long. I can tell you, Congress created a right to healthcare when it passed the Emergency Medical Treatment and Labor Act. I think President Clinton was the one who signed it into law. This said that anyone--whether they were a U.S. citizen or not--could come to an emergency room and receive all the care they needed, and if they could not pay, they would still receive care.

Whenever somebody says ``My gosh, folks don't have a right to healthcare,'' I note that when I was in the emergency room at 2 o'clock in the morning, as long as those emergency door rooms were open, there were people coming through. They would have congestive heart failure, COPD, diabetes out of control, gunshot wounds, or vomiting blood. They could be schizophrenic or a drug overdose. As long as

that patient or those patients came through the door, we treated them, and someone paid.

I would say that it is the fiscally conservative way that if Congress is going to say ``My gosh, everybody has a right to healthcare,'' then we should come up with a considered way to pay for it, as opposed to forcing the hospital to shift the cost of this care to other sources-- principally, by the way, small businesses paying higher premiums for their employees, higher rates to pay for the uninsured. The fiscally conservative way is ``Let's address these needs.''

As a physician, I will also say that the best business practice ways to address somebody with chronic health conditions is to actually manage the disease. If you have a diabetic who doesn't have insurance, she may come to the hospital once a month with diabetes out of control. You have to start an IV and put her in the hospital, perhaps overnight, sometimes in the hospital for longer. This can cost thousands of dollars. Contrast this with having that patient with a primary care physician so that you can manage her disease. Not only is her health better, but you spend a lot less money.

In fact, the wisest corporations in our country now consider the health of their employees as a cost center. What can we do to have the best outcomes at the lowest price? This is the most fiscally conservative way. I think that is the approach we should take as a country.

This brings us to the next point. How do we achieve that which President Trump suggested, which was that we would maintain coverage, lower premiums, care for those with preexisting conditions, and eliminate mandates in a way that we could achieve it? Some folks say that you cannot achieve this. I disagree with this.

The way to achieve it is to embrace each of President Trump's goals. Susan Collins and four other Senators and I have put forward a bill called the Patient Freedom Act. In the Patient Freedom Act, the approach we take is to first maintain the coverage President Trump spoke of, but we do it by eliminating mandates. We give the States the options of doing something called automatic enrollment. It means it is easy to be enrolled.

On our income taxes, for example, Republicans have always said: We want to make it easy to pay your taxes--not 16 pages of forms that you have to fill out with a CPA and an attorney but, rather, something you can do on one page. We need to make enrollment in insurance easy.

The second thing--if you can expand the enrollment, we can take from what we know works, which is on Medicare. When someone turns 65, he or she is automatically on Medicare. They don't have to fill out a bunch of forms online. Rather, they are just on Medicare. They get a card. Here is your Medicare card. You are in unless you don't want to be.

If you don't want to be, we make it easy to get out. You just call up and say: I don't want to be on Medicare. And you are not. It turns out that 99 percent of Americans like this simple approach, and they stay on Medicare.

We could expand coverage and make it simple, still eliminating mandates by giving States the option to say to their residents, you are in unless you are out. We are going to make it simple.

If you are eligible for this credit, you would get the credit. And unless you call us up and say that you don't want it, you would be enrolled in an insurance program.

In this way, we care for those with preexisting conditions. How is that the case? If you have a few sick people in the insurance pool, then the only people whom you can spread that risk among are the few and the sick in the pool. Every year they pay higher and higher premiums.

On the other hand, if you can expand the risk pool to include all the young ``healthies''--the folks who think themselves immortal, who on an average year may only have $500 or $800 worth of healthcare expenses-- if you can incorporate all of them in your risk pool, then the expense of the few and the sick is spread out over the many and the healthy. Instead of premiums rising because of one person's illness, premiums hardly budge because the cost of that care is spread over so many.

We call it a risk pool for a reason. If you take a cup of water and you pour it in a large swimming pool, the level of that swimming pool does not change because that big pool absorbs the water. If you take a cup of water and you pour it in a smaller cup of water, it overflows.

We need to make it where it is the former situation--where we have a big risk pool with lots of young, healthy people with whom we can share that risk over the many and not the few. In this way, we can lower premiums.

It was modeled that if we did automatic enrollment in my State, still maintain the enrollment of the older and the sicker who are already in, we would lower premiums by 20 percent. That is the power of giving the States the option to make it simpler for people to be enrolled in their insurance.

The conservative way to approach our healthcare reform is to recognize that President Trump's contract with the voter on the campaign trail is the pathway to achieving his goals. As we do that in a fiscally conservative way, we recognize that we should not move this cost of care off to small businesses. We should go ahead and pay for it. It is fiscally conservative to manage these patients' illnesses, as opposed to have them going to an emergency room every so often for emergency room care.

Lastly, we have to say that if we embrace Republican ideas of making it simpler to be in a plan, as opposed to more complicated, we are more likely to have that risk pool that is inclusive of many who are healthy, not just a few who are sick.

I look forward to replacing the Affordable Care Act--the un- Affordable Care Act as it has become--with something that embraces conservative principles and fulfills President Trump's campaign pledges.

I yield the floor.

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

Mr. President, this morning, an unbalanced individual carried out a cowardly attack, not only against Members and staff of this Congress but against democratic institutions. This terrorist--and he is a terrorist--desired to destroy our democratic institutions. We as a country cannot allow this to happen. If anything, this must strengthen our resolve to do what is right for our country and for each other. We cannot let this shooter defeat good.

I have known Steve Scalise for decades. I served with Steve in the Louisiana Senate, then in the U.S. House of Representatives. I called his wife Jennifer and will be available to help his family in any way I can.

Steve is a man of good character. He loves the United States and Louisiana, loves the LSU Tigers, which, of course, is our mutual affection as well. It is a privilege to serve with someone who cares so deeply about the people whom we are both honored to represent. My prayers are with Steve, Jennifer, and their children.

We also think of Zack Barth, Matt Mika, Agent David Bailey, and Agent Crystal Griner. We think of them, are gratified that they were able to receive medical treatment quickly, and ask that everyone join in keeping them and their families in our prayers as well. To all of them--we want them to know that we in the United States and in Louisiana support them.

I specifically commend the Capitol Police for all they do, and, again, Agents Bailey and Griner for their bravery and quick actions to protect those in danger. We are blessed by the service of the Capitol Police and fortunate they were there to prevent this attack from being even more tragic.

Where do we go from here? Frankly, we as a country need to come together to try and reinject civility into our political rhetoric. We can disagree on policy. It is that disagreement and our ability to discuss and debate these differences that makes democracies successful.

The key word here is ``debate.'' There is a difference between debate and attacking the motives and good faith of another. Debates are healthy, productive, and you respect those in opposition. You discuss ideas, not perceived intentions. When respect and good faith in the intentions of the other are lost, though, perhaps it does more to hurt than to heal.

We as individuals need to look at how we use rhetoric--rhetoric that can cause someone who is unbalanced to commit an act of violence, as we saw this morning. Anyone saying things to vilify another or portray them as evil, we have to recognize that can drive some, again, to acts of violence. Let's do what we can to move this country to the era of respectful debate.

Now let me end where I began. We cannot let political terrorism win. We must stand firm in support of our democracy and democratic institutions. We must carry on, not letting evil triumph. We do that by recognizing that we are all, first, children of God, then all Americans. We come together, stand united, doing that which is best for our country and for each other.

I yield the floor.

I suggest the absence of a quorum.

Mr. President, I thank my colleague from New York for yielding, as well as for the tremendous work she and our staffs have done together on the Flood Insurance Affordability and Sustainability Act of 2017.

There is a capriciousness of flooding which makes the National Flood Insurance Program so important. You can have a mountaintop village next to a dry gulch. If there is a sudden flash flood, folks who have lived there 100 years suddenly find their 100-year-old homes destroyed. The NFIP helps rebuild the lives of those who are so affected.

The Flood Insurance Program is critical, not just to that mountaintop village but, by extension, our entire country. The economic impact of flooding extends far beyond real estate transactions to the fundamental vitality of communities and the workforce that operates our ports, develops and refines our domestic energy, and produces our seafood and agriculture for global consumption. It just makes sense.

Most towns started on the coast and on riverways because that is how goods were transported, and the history of these waterside communities is what makes them, one, economically vital, but, two, also makes them susceptible to flooding. I will note that the Presiding Officer's State of Pennsylvania, I believe, has among the most incidents of flooding in our country--principally because there are so many riverine systems. There is a valley with a river. If the water rises quickly, that riverside community is flooded. Look at my State of Louisiana. It relies on an accessible and affordable flood insurance program, but that benefits the country.

Louisiana is the No. 1 producer of offshore oil and gas, producing over 15 percent of our Nation's domestic energy supply. That is 15 percent of our Nation's domestic energy supply. It is home to the second largest refining capacity in petrochemical industry. The Gulf of Mexico is home to 11 of the top 20 U.S. ports by cargo volume, and we have one of the largest seafood industries in the world. After Hurricane Katrina, when our port facilities were affected and the farmers in the Upper Missouri suddenly could not get their crop to international markets, it shows the importance of our ports for our entire economy.

The National Flood Insurance Program allows folks in my State to participate in a working coast that gets that energy inland and gets those products in the international market, and this is what provides the value-added contribution to our domestic economy. Since the creation of the National Flood Insurance Program, people in Louisiana paid over $5 billion in flood insurance premiums, but, unfortunately, we have suffered some of the greatest losses after Hurricanes Katrina, Rita, Gustov, Isaac, and the flooding of the great Louisiana floods of last March and August.

While the NFIP has a deficit of $24 billion--according to FEMA's premium and payout data--the NFIP would have had a surplus if we remove the 2005 loss year, including the losses incurred after Superstorm Sandy. I will also note that New Orleans flooded because federally built floodwalls designed to protect those businesses and families were constructed in a faulty way. This has been recognized, and their failure is what led to the expense. I am not here to say that NFIP doesn't need reforms--it needs reforms--but to underscore the fact that the program has worked for many years despite its failings. We need to reauthorize the NFIP and use the opportunity to improve the program, make it more affordable, transferring more risk to the private sector at a lower cost, increase investment mitigation, modernizing flood mapping to produce greater accuracy, and improve the transparency and accountability of all the participants that operate and administer the program.

There are a number of constituencies interested in long-term reauthorization of NFIP. Senator Gillibrand and I know that the issue of flooding crosses party and geographical lines. We wanted to set the right bipartisan tone as Congress begins to debate the issue by introducing our bill, the Flood Insurance Affordability and Sustainability Act. We hope the legislation will contribute to the ongoing discussion and work the committees of jurisdiction are conducting as we move toward reauthorization of the NFIP and with the needed reforms that enhance affordability and sustainability of the program.

Senator Gillibrand and her staff are passionate advocates for an affordable and sustainable flood insurance program. I am glad to work with her on this issue. We have listened to many stakeholders: bankers, realtors, homebuilders, flood plain managers, insurers, reinsurers, mapping experts, local government officials, financial experts and, most importantly, homeowners who work on our working coast and who have so much invested in making sure they can live and raise their families in a way which has protection from the capriciousness of flooding.

I thank my colleague from New York, as well as Senator Capito, for her contribution to this legislation and process.

Mr. President, I thank my colleague from New York for yielding, as well as for the tremendous work she and our staffs have done together on the Flood Insurance Affordability and Sustainability Act of 2017.

There is a capriciousness of flooding which makes the National Flood Insurance Program so important. You can have a mountaintop village next to a dry gulch. If there is a sudden flash flood, folks who have lived there 100 years suddenly find their 100-year-old homes destroyed. The NFIP helps rebuild the lives of those who are so affected.

The Flood Insurance Program is critical, not just to that mountaintop village but, by extension, our entire country. The economic impact of flooding extends far beyond real estate transactions to the fundamental vitality of communities and the workforce that operates our ports, develops and refines our domestic energy, and produces our seafood and agriculture for global consumption. It just makes sense.

Most towns started on the coast and on riverways because that is how goods were transported, and the history of these waterside communities is what makes them, one, economically vital, but, two, also makes them susceptible to flooding. I will note that the Presiding Officer's State of Pennsylvania, I believe, has among the most incidents of flooding in our country--principally because there are so many riverine systems. There is a valley with a river. If the water rises quickly, that riverside community is flooded. Look at my State of Louisiana. It relies on an accessible and affordable flood insurance program, but that benefits the country.

Louisiana is the No. 1 producer of offshore oil and gas, producing over 15 percent of our Nation's domestic energy supply. That is 15 percent of our Nation's domestic energy supply. It is home to the second largest refining capacity in petrochemical industry. The Gulf of Mexico is home to 11 of the top 20 U.S. ports by cargo volume, and we have one of the largest seafood industries in the world. After Hurricane Katrina, when our port facilities were affected and the farmers in the Upper Missouri suddenly could not get their crop to international markets, it shows the importance of our ports for our entire economy.

The National Flood Insurance Program allows folks in my State to participate in a working coast that gets that energy inland and gets those products in the international market, and this is what provides the value-added contribution to our domestic economy. Since the creation of the National Flood Insurance Program, people in Louisiana paid over $5 billion in flood insurance premiums, but, unfortunately, we have suffered some of the greatest losses after Hurricanes Katrina, Rita, Gustov, Isaac, and the flooding of the great Louisiana floods of last March and August.

While the NFIP has a deficit of $24 billion--according to FEMA's premium and payout data--the NFIP would have had a surplus if we remove the 2005 loss year, including the losses incurred after Superstorm Sandy. I will also note that New Orleans flooded because federally built floodwalls designed to protect those businesses and families were constructed in a faulty way. This has been recognized, and their failure is what led to the expense. I am not here to say that NFIP doesn't need reforms--it needs reforms--but to underscore the fact that the program has worked for many years despite its failings. We need to reauthorize the NFIP and use the opportunity to improve the program, make it more affordable, transferring more risk to the private sector at a lower cost, increase investment mitigation, modernizing flood mapping to produce greater accuracy, and improve the transparency and accountability of all the participants that operate and administer the program.

There are a number of constituencies interested in long-term reauthorization of NFIP. Senator Gillibrand and I know that the issue of flooding crosses party and geographical lines. We wanted to set the right bipartisan tone as Congress begins to debate the issue by introducing our bill, the Flood Insurance Affordability and Sustainability Act. We hope the legislation will contribute to the ongoing discussion and work the committees of jurisdiction are conducting as we move toward reauthorization of the NFIP and with the needed reforms that enhance affordability and sustainability of the program.

Senator Gillibrand and her staff are passionate advocates for an affordable and sustainable flood insurance program. I am glad to work with her on this issue. We have listened to many stakeholders: bankers, realtors, homebuilders, flood plain managers, insurers, reinsurers, mapping experts, local government officials, financial experts and, most importantly, homeowners who work on our working coast and who have so much invested in making sure they can live and raise their families in a way which has protection from the capriciousness of flooding.

I thank my colleague from New York, as well as Senator Capito, for her contribution to this legislation and process.

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

Mr. President, I am here to speak about a topic which, wherever I go, people speak about--the replacement of the Affordable Care Act or ObamaCare, as people call it. Clearly, we need action.

I had a Facebook post maybe a week or two ago from Brian in Covington, LA. He said: My family plan is $1,700. The quote goes on to say how his family cannot afford that $1,700.

Rates are going up, which I have said time and time again. My friend back in Baton Rouge, he and his wife are 60, 61. The quote for their insurance last year was $39,000--for 1 year. That is clearly not affordable. This is not just in Louisiana; it is in Washington, DC, it is in California, it is across our Nation where individual market quotes are going up that they cannot support.

Most recently, Connecticut insurers--there are two--are proposing rate increases that are 15.2 percent and 33.8 percent, on average, respectively. They are quoting 22 percent over 2017. In Maryland, some insurers are going to raise rates as much as 59 percent for those individual plans.

I am a physician. I learned a couple of things in my 20 or 30 years of practice. One, to lower costs, the patient must have the power; and, two, the insurance must be affordable; and, three, that the insurance they receive must be adequate. President Trump totally got this. On the campaign trail, President Trump said time and again--what I call his contract with the voter. He wanted folks to maintain coverage with lower premiums, care for those with preexisting conditions, and eliminating mandates. I think President Trump just knew it. I shorthand this, if you will, saying, if we focus on lowering premiums and making sure it passes the Jimmy Kimmel test. The late-night comedian, when his child was born with a terrible heart problem, immediately got the care that child needed. So if we can have insurance that passes the Jimmy Kimmel test--lowering premiums, taking care of the rest of President Trump's goals, then I think we can accomplish it. We need to talk to experts, actuaries, those who

design insurance plans, to make sure we come up with something.

There is something else the President said that I want to focus on. This is just before he took the oath of office. He said people covered under the law--meaning the Republican replacement--can expect to have great healthcare. ``It will be much simplified.'' One of the complaints about the Affordable Care Act is it is so complicated. Even online, 16 pages online, with your W-2, if you don't get it, you get booted out. The President said we must have a much simpler way of going about this--much less expensive and much better.

What could this look like? Let me propose some conservative solutions that could be in a Republican plan that would achieve the President's goal. First, the patient has to have the power. In my 30 years of practice, I found that if the patient has the power, the system lines up to serve her. One example is price transparency. If we can put in that a provider has to publish the provider's price, so the patient getting the blood test knows the cost of the blood test at that moment and can compare it to someone down the street, we will lower cost.

One example just came up in a newspaper out of New Orleans. Nola.com is their website. A woman went in and got blood tests. She received a bill weeks later and her bill was for $324. She found she could have gotten the same blood test for $34 right down the street. A woman from Texas came up. She said she heard me speak of price transparency--the power of negotiating, if you will. The doctor ordered an MRI on her son's shoulder. She called up the different places where she could have it done and she got a price of $667. On my Facebook page is a little video of her speaking: I got it for $667. Then I remembered what you said: If you pay cash, you get a discount. I called them back. I said, if I pay cash, will you give me a lower price? They said: Pay us cash, we will cut that $667 to $400. The patient had the power. So she ended up paying far less for the procedure the doctor ordered. That is one conservative solution, give the patient the power.

Secondly, let States innovate. We need to take all of this power that ObamaCare brought to Washington, DC, and push it back out to the States. If we do that, we are going to accomplish something. Let's just acknowledge that there are 700,000 people or so in Alaska. If you took a map of the State of Alaska and put it over the lower 48, it would stretch from roughly Georgia to the Pacific Ocean. Washington, DC, has almost the same population as Alaska, and you can walk across the city in a morning. Clearly, you need different solutions for an area you can walk across and an area you cannot fly across in the same time that you would walk across Washington, DC. We have to return power back to the patients. We have to engage doctors and patients so those patients with complex conditions get their healthcare managed. I use the example of a diabetic. She perhaps developed childhood diabetes, and now she is 35 years old. If a doctor is managing her condition, she works, stays at home, her complications are minimal, and her life is much better. If her condition is not managed, she comes to the emergency room three times a month with diabetes out of control. That just shoots a hole in the bucket of fiscal responsibility and also in her health. Instead of working, keeping a family, she is coming to the hospital, getting care through the emergency room, which she cannot afford to pay for, and that cost is shifted to everyone else. That is not the way to manage that. We need to engage doctors with patients.

Another conservative solution is we need more competition between insurers so there is not just one insurance company in the market that can therefore set prices but rather we have multiple. So if we give the patient the power by giving the patient a tax credit that she can use to purchase the insurance she wishes to have, that will create competition as more insurers enter the market. If we have that competition--those market forces--prices come down.

When the President said we have to make things simpler, I think that also includes how we enroll people in insurance. We figured that out on Medicare. Under Medicare, if someone turns 65, they are on Medicare. It could not be simpler. They get a letter. They are on Medicare. If they don't want to, they can call: Hey, I don't want to be on Medicare. But as a rule, they are on Medicare.

Fortune 500 companies have figured out the same thing. In order to enroll people into retirement plans they say: Listen, you are in the 401(k) plan unless you choose not to be. That makes it simpler to get a 95-percent enrollment in retirement plans. Now, you could say: Hey, listen, you have to fill out a bunch of forms. If you don't fill out these forms, you are not going to be enrolled. But that would not work for Medicare. It would not work for 401(k)s. It has not worked under ObamaCare.

We need to take those same sort of solutions we have found for both Medicare and enrolling people in their retirement and do it for the Republican alternative.

The Republican alternative would say: We make it easy to enroll. You are in unless you are out. So if you are eligible for a tax credit, you would receive it. You would then have the insurance. If you were passive about it, you would have a default policy. But if you are active, you could do more with it. But by doing so, you actually increase the number of people insured.

Now, when you increase the pool of those insured, you lower premiums. We had Blue Cross look at our proposal to make it easy to enroll: You are in unless you are out. That would lower premiums by 20 percent, just by expanding the number of those who are insured--20 percent.

So when President Trump says he wants to continue coverage, caring for those with preexisting conditions without mandates and lowering premiums, doing this feature where you are in unless you call us and tell us you don't want to be and making it simple achieves all four goals.

We would increase coverage. By that, we would lower premiums, taking care of those with preexisting conditions. Now, again, it is using the mechanism that is already used in Medicare and in Fortune 500 companies, making it easy to enroll. There are some who don't want to give States the options. They don't want to give patients the options. They don't want to make it simple to enroll. They want to replace, if you will, the tyranny of ObamaCare--where all of this power is taken to Washington, DC, and States and people were told what they had to do-- with a different sort of tyranny, telling States what they can't do.

I think we ought to give as much power to the States, as much latitude to the patients to come up with the solutions that work for them. That is the conservative way to go.

But I will say, in speaking with conservatives, that I very much invite our Democratic colleagues to come to the table. There are some of my Democratic colleagues who have said they just want Republicans to work through this, thinking that it might be a political train wreck that would work to their advantage. But in those States there are Americans whose premiums are becoming unaffordable.

I mentioned earlier that in Connecticut premiums are rising 15 and 34 percent this year. In Oregon, it is as high as 22 percent, and Maryland is as high as 60 percent.

Now, who cares if the person is a Democrat or a Republican? If her premium is increasing 60 percent, she cannot afford it. So I challenge my Democratic colleagues to get off the sidelines and engage. Try to do something not for political purposes but for the purpose of that person who is at home struggling to pay the bills and deciding that she can no longer afford insurance, but, perhaps unbeknown to her, she has a cancer brewing inside her. Just when she decides she can no longer afford coverage because premiums have risen 60 percent, that is when her cancer is discovered.

We have to address this. It will take us on either side of the aisle--both Democrats and Republicans--to work together. I will finish with a quote from a fellow from Covington, Brian, on my Facebook page. He said that his family plan is $1,700 a month, for him, his wife, and his two children. The ACA, the Affordable Care Act, or ObamaCare, has brought him to his knees. I hope we can get something done. The middle class is dwindling away. Can everyone just come together and figure this out?

This is a cry for help. It is a challenge to Republicans and Democrats to come up with a plan that is not a red plan or a blue plan but an American plan to address his needs, his wife's needs, and those similar to him across the country.

Mr. President, I ask unanimous consent that Patrick Flanigan, an intern in Senator Kennedy's office, be granted floor privileges for the remainder of the day.

Mr. President, I thank the Senator from Colorado for his kind words.

I rise to speak about our Republican effort to repeal and replace the Affordable Care Act. I always kind of chuckle when I say the ``Affordable Care Act,'' as I have a friend back home whose quote for his insurance was $39,000 for 1 year. That is the un-Affordable Care Act.

A family member from San Francisco whose policy was $20,000 for 1 year had a $6,000 deductible for each person. I think her husband actually voted for Bernie Sanders, but she is like: The heck with this because I cannot afford it.

Then there is another fellow here in Washington, DC, who is an insurance consultant. If anybody can get a good deal, an insurance consultant should be able to. He says:

My family premium is $24,000 a year with a family

deductible of $13,000. We will pay $37,000 before we receive

benefit from our insurance policy.

That is unsustainable.

President Trump saw that during the campaign. He said over and over again--kind of his four pledges, if you will--that he wished to maintain coverage, lower premiums, get rid of those mandates that Americans hate in ObamaCare, and care for those with preexisting conditions. This is what he said over and over. It is a great pledge.

He actually said something else as well: He said he wanted to make healthcare easy. Now we have an approach to do this. Some people call it auto enrollment, but I call it making it easy. In this way, we can increase coverage and achieve the goals of President Trump's to lower the premiums. We are using something that is already used in Medicare and 401(k) plans. Again, we make it easy to enroll. Let me elaborate on this.

People argue that we have to have a mandate because without a mandate, people will lose coverage, and if people lose coverage, only the sick enroll and healthcare expenses increase. I think the Senate actually has an opportunity to do something better. We can make it easy. Under this, we can imagine that someone is eligible to be enrolled in our program unless he calls us up and says he does not want to be.

This is what we do in Medicare. When we--when I, when you, when any of us--turn 65, we are automatically enrolled in Medicare. I turned 65, and I am on Medicare. It is not a mandate. I can call them up and say that I do not want to. You have never heard anybody complain about it. It is just called making it easy.

Similarly, when a Fortune 500 company puts in a 401(k) plan, it has learned that if it asks somebody to sign all of the forms, and they can opt into its 401(k) retirement plan, it gets about 65 percent participation, but if they say: You are in unless you call us up and tell us you do not want to be--if they make it totally easy, they get 95 percent participation in that 401(k) program.

We know both from Medicare and from business that if you make enrollment easy, you have 95 percent participation. Now, that is so good in the setting of this because if we have all of those enrolled who are eligible to join the ObamaCare replace plan, we make that insurance pool large.

We call it a pool for a reason. If you pour a cup of water into an ocean, it does nothing to the level of the ocean. Similarly, if you have one person who is ill who is in a big pool of otherwise healthy people, it does nothing to the expense because the expense of that one person's illness is spread over many. So by making enrollment easy-- fulfilling President Trump's pledge--just like the ocean with one cup of water, that one person who is sick, the expense spread out over many, the impact on any one person's premium is nil.

By the way, there is a lot of conservative support for this sort of concept. First let me just say that coverage is important. If we pretend that people having coverage is not important, it is just not true. I am a physician. I can tell my colleagues there are many conversations I have had where someone who was poorly insured or uninsured might need some critical medicine or critical procedure and we had to work, scramble, do everything we could to get her the coverage she needed to have sometimes a lifesaving procedure.

Rich Lowry is a conservative columnist for the National Review. He had a column saying that the worst argument against replacing the Affordable Care Act is that coverage is not important. Coverage is important.

If we go on toward this kind of concept--make healthcare enrollment easy; you are in unless you are out--Jim Capretta, Joe Antos, and Stuart Butler have all spoken about using this concept. Nina Owcharenko and Bob Moffit of the Heritage Foundation wrote in Senator John McCain's Presidential plan in 2008 that it would be accompanied by a system of automatic enrollment of health insurance, either at the workplace--and then they go on. But they were praising the Presidential candidate's--but now Senator John McCain's--employment of let's make it easy to enroll.

By the way, President Trump kind of emphasized this. Just before he was inaugurated on January 15, he gave an interview to the Washington Post and he was talking about his proposed healthcare law. We have already mentioned the components that he said were in it. He wanted all covered, caring for those with preexisting conditions, getting rid of the mandates, and lowering premiums, but he added this: People under his law ``can expect to have great healthcare. It will be in a much more simplified form. Much less expensive, and much better.''

I like that: simplified.

Under ObamaCare, we have like 16 pages online that people have to fill out with all their W-2s with them in order to find out if they are eligible. The patients I saw in a hospital for the uninsured where median income may have been $16,000, people lived in perhaps public housing, they took public transportation to the public library in order to log on because they did not have a home computer, much less internet. That is not simple. That is why enrollment numbers are lower for lower incomes. We make it easy.

Let me just emphasize one more time: If we can get that bigger pool of people, premiums fall. So for my family member in San Francisco who can't afford that premium, if we get that pool bigger, premiums fall. Similarly for the insurance consultant here or my friends back home in Louisiana, if we can make that pool bigger by making enrollment easier, their premiums will fall.

I will just say that I call myself a kitchen table conservative. All those conservative families who voted for Donald Trump, who sit down at their kitchen table and they know they can't afford a $20,000 premium and already they are struggling with their car note, their house note; they have given up sending their kids to a private school; they are doing whatever they can to make ends meet. Under the un-Affordable Care Act, they are required to pay so much. When they heard President Trump say that he would lower their premiums, they saw that as a lifeline for their family budget. Their vote for President Trump was a cry for help: Help us with insurance premiums we cannot afford.

Now, as a kitchen table conservative myself, to those families who voted for Republican candidates over the last several elections but who absolutely know they need help with their health insurance, we have a solution for them.

But let me pause for a second. You don't have to be a conservative to care for this solution. In fact, people on the left have actually endorsed this concept as well.

I will end by saying this. As we come up with a replacement plan for the Affordable Care Act, it will not be a Republican solution and it will not be a Democratic solution. At its best, it will be an American solution--an American solution for that family at the kitchen table, struggling to pay their premiums, who can't do so now but know that they need coverage. In so doing, if we can fulfill President Trump's campaign pledges to cover all, caring for those with preexisting conditions, eliminating mandates, and lowering premiums by making enrollment easy through something called auto enrollment, we will have done our job.

Mr. President, I yield the floor.

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

Mr. President, obviously, a big problem before the country right now is, What do we do about rising healthcare premiums?

What we know under the Affordable Care Act--or the un-Affordable Care Act--or ObamaCare, as some call it, is that premiums are rising more and more. One of President Trump's campaign pledges was that premiums would come down and, actually, come down with, as he said in one place, beautiful coverage--that it is actually good coverage and premiums are lower. So let's kind of set the stage.

I just got a message on my Facebook page. I will read it. By the way, anybody can post on our Facebook page these sorts of stories, if they are interested in them.

Brian from Louisiana sent a message saying: My family plan is $1700 a month for me, my wife, and two children--so roughly about $20,000 a year. The ACA, or the Affordable Care Act, has brought me to my knees. I hope you can get something done as my credit cards are all maxed out. And 80 percent of my friends are in the same situation. The middle class is dwindling away. Can everyone just come together and figure this out?

Think about this: $1,700 a month. He did not write this, but what would be standard for this sort of policy is a $13,000 family deductible.

I say that because I have an acquaintance in San Francisco. San Francisco is so expensive for housing, transportation, and food, and the premium for their young family is $20,000 a year, with each family member with their own separate $6,000 deductible. This is under the un- Affordable Care Act, as I call it, or the Affordable Care Act, as others do.

A friend of mine back in Baton Rouge, whom I have quoted many times, put this on my Facebook page because people would not believe it: He and his wife, 60 and 61, their quote for their insurance last year was $39,000. Their quote for their insurance was $39,000.

Then I spoke to a fellow who is an insurance consultant here in Washington, DC--an insurance consultant. If anyone can get their premiums down, it would be he. For his family, their premium is $24,000 a year with a $13,000 family deductible. If they get in a car wreck, their family will be out $37,000 before the insurance kicks in. Who can afford this? We must do something better.

When President Trump ran for office, President Trump clearly recognized this. On the campaign trail, he said over and over that he wished to lower premiums. It is the President's genius, if you will, that he knew how to do so. You do so by expanding the risk pool. He said he wanted to continue coverage for all.

He gets away from the ObamaCare mandates, which people hate. The American people don't like being told what to do.

He also said he would care for those with preexisting conditions. This is how it works. When you cover many, you have a bigger risk pool. Those with preexisting conditions have the cost of their illness spread out over the many. So premiums come down for all.

My hat is off to the President for coming up with that. In fact, 5 days before he was sworn in, he echoed this, because one way to lower premiums is to give poor coverage. One way to lower premiums is to give folks such terrible coverage that it doesn't cost anything. On the other hand, it doesn't cover anything. The President seems to know this.

Five days before he was inaugurated, he said to the Washington Post about people covered under his replacement for ObamaCare:

[They] can expect to have great healthcare. It will be in a

much simplified form. Much less expensive and much better.

We're going to have insurance for everybody. There was a

philosophy in some circles that if you can't pay for it, you

don't get it. That's not going to happen with us.

I am a physician, a doctor. Again, I admire President Trump's insights. As a physician, I know that whoever wants healthcare gets healthcare. Twenty or so years ago, Congress said that if you walk into an emergency room, the emergency room has to take care of you. It doesn't matter if you are an American citizen. It doesn't matter how much it costs. The hospital has to take care of you.

I told folks when I was practicing--it would be the middle of the night--that as long as that emergency room was open--and it was open 24/7--in through the door came folks vomiting blood, heart failure patients, folks with drug overdoses, schizophrenics, diabetics, asthmatics--you name it. They came through that door, and we cared for them all--and somebody paid.

President Trump understands that even if you say you can't afford it, everybody is going to be treated. That is our current system, and that is not going to happen under his watch.

We mentioned that one way to lower premiums is to give poor coverage. I think everyone knows, or many people know, of Mr. Kimmel, the late night comedian who pointed out that when his child was born, instead of celebrating and handing the baby to the mother so the mother could kiss and the father, Mr. Kimmel, could cuddle the baby, the nurses and the doctors looked at the baby and immediately recognized that something was wrong. They recognized that this child was blue. He didn't have oxygen, and if something wasn't done immediately, this child would die.

Folks criticized Mr. Kimmel for being emotional. I totally get it. Instead of cuddling, you are signing a release waiver so your child can be transferred across the city of Los Angeles for emergency surgery. In his emotion, he asked that all children--and I would expand to all Americans--have the ability to get that sort of emergency care done.

Again, the President was about that. I came up with what I called the Kimmel test. Again, it echoes President Trump's contract with the American voter--that we would protect those with preexisting conditions, that we lower premiums, but as we lower premiums, we make sure that the coverage is adequate.

The Kimmel test, making sure there is adequate coverage while lowering premiums and caring for those with preexisting conditions, is so compatible with what President Trump said, because Americans need lower premiums.

Let me echo that one more time. We need to lower premiums. The President's approach, the contract he made with the voters on the campaign trail, is the right approach. You get a bigger risk pool, lots of younger people, so those who are older and sicker have the cost of their care spread out among the many.

We have a plan, the Cassidy-Collins plan, or the Patient Freedom Act, which I introduced with Senator Susan Collins and four other Senators. We have a way to go about it. One way to get young, healthy folks involved is to do something that we do on Medicare. If you are eligible, you are enrolled unless you call up and say you don't want to be. That is what we do with Medicare. By the way, that is what Fortune 500 companies do with their employees for 401(k) plans, and it works really well.

Ninety-five percent of employees are likely to participate in a 401(k), and they love it. As to people on Medicare, 99 percent stay on Medicare, and 1 percent call up and say: I don't want it. Usually they have better coverage someplace else. As a rule, no one feels coerced because they all know they can call up and say: I don't want it; I don't get it. As it turns out, most do.

The plan we have taken with Cassidy-Collins, in our attempt to fulfill President Trump's contract with the American voter, is that we allow a State to automatically enroll for this, and you would be in. The credit you receive would be sufficient to pay for the annual premium.

If you don't want it, call up. Make it easy. Get out of here. I don't want it.

As a rule, we think folks would be in. By doing this, you expand that risk pool so those old and sicker, those with preexisting conditions, can have their conditions cared for, but we fulfill President Trump's campaign pledge. We also lowered those premiums.

Ultimately, to lower the cost of insurance, you have to lower the cost of healthcare. Cassidy-Collins does that with some conservative approaches that even liberals will like. One way is that we put in what is called price transparency. You would know the price. A mother would know the price of a procedure--an x-ray, a blood test--before she gets it for her daughter, as opposed to finding out 6 months later when she gets the final bill.

Let me give one example. We have all seen those urgent care centers. Some are run by hospitals. Typically, a visit there will cost you $500 to $1,500. Others are run by a group of physicians, or maybe a small business decides to set up an urgent care center. The same visit might cost you as little as $75 to $150. The patient doesn't know that until she gets the bill.

One door has exactly the same appearance and exactly the same type of facility with the same capabilities. In one door and it can cost $500 to $1,500, and in the other door and it can cost $75 to $150, and the patient never knows.

I think we can lower the cost of healthcare by giving the patient the power of knowing what is the price of healthcare.

Think of it. You walk up to a French restaurant in a city you are not familiar with, and you look at the menu posted on the door. You see the prices of the food. Oh, the food is pretty good, but look how expensive it is. Let me go down the street. You go down the street. The food looks good, and it is less expensive.

The power of price informs the patient of what is the best deal for both our health and for our pocketbook. One way we can lower the cost of health insurance is by lowering the cost of healthcare. There are other ways of doing so as well.

Let me return once more to what I said earlier. Americans need lower premiums. President Trump, during the campaign--his contract with the voter, I think, is the right approach to get there.

I will summarize with this. He said he wanted to maintain coverage for those who have insurance, lower premiums, that preexisting conditions would be cared for, and eliminate the ObamaCare mandates. If we fulfill President Trump's goals--and these are goals that folks on the right and left can get behind. By the way, if we do get behind them, premiums will be lower. If we can fulfill President Trump's campaign contract with the American voter, we will lower those premiums, and we will do so by achieving these other great goals.

I yield back.

I suggest the absence of a quorum.

Mr. President, it is fair to say that Americans are sick of partisanship when it comes to issues of greatest concern. They are asking, if you will, that we in the Senate put party behind us--behind the needs of the people. This is especially true when we are speaking of those issues of greatest importance, and I would argue that the replacement of the Affordable Care Act is one of those issues of greatest importance.

Whatever the excuse, no Senator of either party should sit on the sidelines. This is such an important issue that every Senator, whatever her or his personal views, should be engaged.

We know President Trump's principles, if you will. He laid them out time and again on the campaign trail. He wants to maintain coverage, lower premiums, care for those with preexisting conditions, and eliminate the ObamaCare mandates upon individuals and businesses.

At his inauguration speech, he spoke of the forgotten man and of the forgotten woman. In fact, we can see that just before his inauguration, he emphasized that with what he said during the campaign:

We're going to have insurance for everyone. There's a

philosophy in some circles that if you can't pay for it, you

don't get it. That is not going to happen to us.

He also emphasized the quality of the care, saying that people covered under the law that he would propose to replace can expect to have great healthcare. ``It will be in a much simplified form. Much less expensive, much better,'' he said to the Washington Post just before he was sworn in. These are his principles.

When he was sworn in and gave his inaugural address, speaking of the forgotten man and the forgotten woman, I cannot help but think that he was influenced as he went through counties seeing folks with terrible tales of their child dying from opioid addiction or their spouse unable to afford insurance under ObamaCare.

I will point out that there is a huge dimension to this that we sometimes forget, but we should not. Senator Jerry Moran from Kansas made the point that healthcare is like no other issue. It is an issue which touches us most personally. I think President Trump saw that on the campaign trail. He saw the parent of an adult child with mental illness, and she could not get a psychiatric bed for her child. We know the fate of that child if he does not have the care he needs. He will end up either in a homeless shelter, a jail cell, or the morgue. That is the human dimension to this, and that is why we need to help President Trump fulfill his pledge.

Voters understand what we are speaking of; they understand the importance of it. But let me speak just a little bit more to the politics of this because we cannot separate what we do here in Washington, DC, from politics.

There are researchers from Princeton who recently published a report. If you look at White males and females between 18 and 54 who lack a college education, their life span is decreasing. Now, for Hispanics, African Americans, and other minorities, it is improving, but for this group, it is decreasing.

I have seen data which shows that in the population centers of the United States in which this phenomenon is being most seen--these Whites from age 18 to 54, noncollege educated, their life span is decreasing-- the counties in which this effect is most seen were most likely to vote for Donald Trump. Think about the politics of this. The politics are that a group of folks who understand that their life is materially and physically declining, with higher rates of suicide, addiction, liver disease, and other chronic illness, ending in premature death, voted significantly more for the President who swore that he would remember them, who spoke of the forgotten man and the forgotten woman. His pledge to them was a lifeline. Their vote for him was a cry for help.

This is not just a human dimension; there is a political dimension leading to a policy necessity.

Let's stop for a second. There is a key issue of cost. We understand that the Affordable Care Act was too expensive. We can save money. But let's not fool ourselves; it is still going to cost. We can save the $150 billion or so that the House suggested we have to save. We know the rules the Senate has to address to save at least that much money. On the other hand, we know that Congress has mandated people can get care; therefore, if Congress mandates that folks get care, then Congress should help provide the means by which to pay for it.

There are some who think, oh, my gosh, Congress does not need to provide for the money for care, and everything will be good. I am a physician. I have been in the emergency room at 2 in the morning, and at 2 in the morning, when those emergency room doors are open, whoever comes in is treated. She may have heart failure, he may have a drug overdose, they might be a schizophrenic, or they might be somebody vomiting blood. Each one of them receives all the care that he or she needs to stabilize their emergency condition. And if they have to be hospitalized--think of a car wreck with multiple traumas--and they are in the hospital for 4 months, they still get that care because Congress mandates that. But, if Congress does not provide the means to pay for it, the cost of that care is shifted not to government; the cost of that care is shifted to the privately insured. All of those getting their insurance through their employer begin to pay higher premiums-- much higher premiums. Somebody pays. And if we do not fulfill our obligation, after mandating that those patients get cared for--we, being Congress--then society pays, and society is the person struggling to make ends meet and now finds out from her employer that her premium has increased 20, 30, sometimes 50 percent--all because of the cost- shifting that occurs.

It is not just the group market. Under ObamaCare, we can see that in the individual market, premiums have skyrocketed. It is not that the Affordable Care Act is working so well. Last week I communicated with someone who lives in San Francisco, and she and her young family are paying $20,000 a year for a premium, $6,000 deductibles; none of them is sick, none of them will meet their deductibles, but living in a very expensive city, having to struggle to pay their mortgage, groceries, and transportation, now they have to come up with $20,000 to pay for their healthcare. That is all because of the Affordable Care Act.

Then I spoke with a person in Washington, DC, and someone in Washington DC--that person who is a consultant on insurance issues, knows insurance backward and forward, says that for his family, the premium is $24,000 a year, with a $13,000 family deductible. The insurance expert says: I will be out $37,000 in a single year before my insurance kicks in. Families cannot afford that.

I will finish up lastly with a story from Louisiana. Folks never believe this because it seems too crazy, but I put it on my Facebook page. There is a couple back home, 60 and 61. They were quoted a premium of $39,000 for a premium of one year, with a deductible on top of that--$39,000. We can see that in the individual market, the Affordable Care Act is not working, it is becoming the un-Affordable Care Act. We have to address this.

But let me say, we have to address it whether we are a Democrat or a Republican. We must respond to the cries for help coming from those folks suffering from addiction, mental illness, heart failure, or any other chronic disease for which they do not have coverage, but also to the cries for help from middle-class families who cannot afford these premiums, and if they don't sacrifice something in the budget to pay for it, under the Affordable Care Act, they will be fined.

Let's return to the political side. The political side is that I have voters back home asking why Republican Senators

are not helping a Republican President fulfill his pledge--a pledge to all voters--but one that certain Republican voters specifically took to heart; that is, to fulfill his pledge of caring for those with preexisting conditions, continuing coverage, lowering premiums, and eliminating mandates.

If you are a Democratic Senator, the forgotten woman and the forgotten man is in your State too. I can promise you, even if you are not a Republican but you are a Democrat, you have an opioid crisis in your State. So if we are now looking at addressing Medicaid expansion or the affordability of the individual market, and you are a Democratic Senator and you decide to sit on the sideline--if you are a voter in that State, you should be asking why.

Let's face it. Speaking of my Democratic colleagues, many of you do not like President Trump. Some of you hate President Trump. Some of you like him, but you have to pretend that you hate him. Even though this is President Trump's pledge, this is not about President Trump. This about the voters--the patients, the people in our States who either cannot afford their insurance or who have an addiction or some mental illness or some other critical mental healthcare need that, if this ObamaCare replacement is not done well, will leave them far worse off.

I have heard some of the excuses from my Democratic colleagues as to why they cannot participate. They say: Oh, we are using the word ``repeal'' or, oh, we are not going through a normal committee process--oh, this, or oh, that. I concede it all. Who cares? If you are a voter right now, and your child is addicted to opioids, do you really care that there is a semantic issue regarding whether or not we are saying ``repeal'' or ``repair''? Do you really care that after 8 years of hearings, we don't have a few more hearings? Do you even understand the difference between reconciliation versus normal process? I would say no, because the principal thing that concerns you is that your child is desperate for help and you are not sure that the help will continue.

So I say to my Democratic colleagues: Whatever the excuse, ignore the excuse, and please engage.

Let me finish where I started. I think the average American right now wants every Senator, whether Republican or Democrat, to help President Trump fulfill his pledge to maintain coverage, lower premiums, and care for those with preexisting conditions, without mandates. Every Senator should listen to the American people as they ask us to put patients over party, to put the American people over partisanship.

Mr. President, I ask unanimous consent that the time during quorum calls until 12:30 p.m. today be equally divided.

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

Mr. President, before us as the Senate right now, aside from issues Mr. Blumenthal referred to, is the repeal and replacement of the Affordable Care Act.

I am a physician, and I have been practicing in hospitals for the uninsured for the last 25 years. I would like to in one sense say that gives me special standing to speak about this issue, but in reality, it does not.

Senator Moran from Kansas spoke up the other day at our lunch. He said that healthcare is like no other issue. He spoke of a friend of his approaching him at church with tears rolling down her face. Her mother had a preexisting condition, and she was so concerned that we get this right.

I don't need to say I have special standing, being a physician. We all have special standing from living, having families and friends who--sooner or later, healthcare will affect the family.

The Affordable Care Act for many is not working. Premiums are going sky high.

Two or 3 days ago, I had communication with someone from San Francisco. Her young family has a $20,000-a-year premium, a $6,000 deductible for each member of the family--in San Francisco, already paying so much for housing, food, and transportation, and $20,000 on top of that for a family of relatively modest income.

Then I spoke to someone in Washington, DC. His family's premium is $24,000; they have a $13,000 deductible. He said: I am out $37,000 before my insurance kicks in. I reassured him that his colonoscopy would be for free. I don't think he thought that funny.

Then a friend of mine who last year in Louisiana--his quote for a policy for himself and his wife, 60 and 61, was $39,000 for 1 year-- $39,000 for 1 year--with a deductible.

Now we are being told there will be premium increases this coming year. In Connecticut, they just announced they are going to be 15 to 35 percent higher. In my own State, I have been told they may approach 30 to 40 percent higher, although that is not definite.

The reality is that premiums have become unaffordable. President Trump campaigned on this. There were four things he told the American people. He said he wanted to cover all, care for those with preexisting conditions, eliminate the Affordable Care Act mandates that people hate so much, and lower premiums.

I would like to say I think it is part of President Trump's intuitive genius. Whatever you say about the fellow, he certainly has an intuition sometimes about how things work. Of course, the way you would lower premiums is that you would cover all, and by covering all, you expand the risk pool, which then lowers premiums for those with preexisting conditions but keeps them lower for the rest of us.

Folks ask how you can do that without mandates, and I say you can do it through the mechanism of the Cassidy-Collins plan, the Patient Freedom Act, which is to say you have an auto-enrollment feature.

By the way, here is President Trump. He said it many times, but here he is in the Washington Post on January 15, 2017, just before he takes the oath of office:

``We're going to have insurance for everybody,'' Trump

said. ``There was a philosophy in some circles that if you

can't pay for it, you don't get it. That's not going to

happen with us.''

You cannot have a stronger statement from a fellow who is about to rise to be inaugurated and gives a speech in which he speaks passionately about the forgotten man and the forgotten woman. President Trump pledged to remember them.

The question is, How do you lower premiums? How do you fulfill President Trump's goals?

There are several ways to lower premiums. I just described one, where you fulfill the other parts of his contract with the voter, which is you cover all, and by doing so, you increase the size of the risk pool, and therefore you lower premiums. There is another mechanism. You can put in price transparency and do other things to lower the cost of medical care, which in turn lowers the cost of healthcare premiums. But there is one way which is not so good. One way that you can lower cost is to have a crummy policy that hardly covers anything. You think you are getting a deal in the front end because premiums are low, and then you or someone in your family gets sick, and it is not such a great deal after all.

I was asked about this on a Sunday morning show and spontaneously came up with something called the Kimmel test. Jimmy Kimmel, the late- night comedian, spoke of his son being born. We can all imagine--this happened 2 weeks ago--his child was born. I suspect somebody is videoing it. It is going to be a moment of celebration. As the child emerges and everybody wants to lean forward and hand the child to the mother and the father to hold and cuddle, instead, the doctor and the nurse notice that the child is blue--``blue'' meaning he is not getting enough oxygen. It is quickly realized that something is profoundly wrong. Instead of mother and father hugging and bonding with the child, they are pushed to the side. They hear a code blue call, which means this child will die if something is not done immediately.

I was not there, but I have been in similar situations.

They are being asked to sign forms which would allow this child-- their child whom they have not yet held--to be transported by helicopter across Los Angeles to have emergency surgery that day and being told that if they do not sign this form, that child will die.

Now, Jimmy Kimmel pointed out that he is a millionaire, he could afford it, but he also pointed out: Others, not so much.

I think that brings us back to what President Trump said. President Trump said:

``We're going to have insurance for everybody. There was a

philosophy in some circles that if you can't pay for it, you

don't get it. That's not going to happen with us.''

The Jimmy Kimmel test: We will protect those with preexisting conditions, but we will do it by lowering premiums and not by giving crummy coverage but, rather, by having adequate coverage. So if our approach passes the Kimmel test, then we feel it is a way to go.

Now, how do we go from here?

We can recognize that premiums are too high for middle-class families. They can no longer afford it, and that is before the premium increases, which are about to occur.

I will also say that as to the way the Affordable Care Act was passed--not blaming or praising anyone--that only one party was engaged is not the path forward. History says that any time there is significant social legislation that has an enduring effect in the United States, both parties engage.

I want this to change. I would challenge my Democratic colleagues to become engaged. Some have said: Oh, my gosh, Republicans are doing this through reconciliation; isn't that terrible?

I would say it presents opportunity. We don't need 12 Democrats; we don't need 8 Democrats. We could have three Democrats or four Democrats. Anyone who cares enough about the people in their State and their premiums, which are rising 20 to 40 percent a year, will put aside all the pressure from a political base and say: The people of my State are more important than the political pressure I may feel. They will step forward to influence the final product.

We know that if folks come in from the other side of the aisle, we will have a different product than if it is only among Republicans. If Republicans had participated in the passage of the Affordable Care Act, we would have had something perhaps a little different than the Affordable Care Act.

I am not pointing fingers. I am just observing that it would only take three or four Democrats to break ranks, to step across the aisle, and to ask for what they would need. This is not: You come to us, and you don't get it--no. We have a meeting of the minds so that we can come to the policy that fulfills President Trump's pledge--his pledge to cover all, caring for those with preexisting conditions, eliminating mandates, and lowering premiums.

We have an incredible opportunity before us to bring relief to those middle-class couples struggling with premiums that they can no longer afford and deductibles that they will never meet. If they don't meet and can't afford them and if they do not purchase the insurance, they are being fined and are accumulating resentment toward Washington because they are stuck with this. We can address that issue and at the same time fulfill President Trump's pledge that all will have coverage.

Some said you can't get it if you can't pay, but that is not going to be the case with us. It will provide them that coverage with something that passes the Kimmel test. I look forward to working with our Senate to come to this solution.

I yield back.

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