Floor Statements

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, there are two things Americans need to know about this Republican healthcare plan. The first is that it is going to make insurance more expensive, and the second is that it is going to make it harder to get healthcare in the first place. That is the bottom line of this bill: higher costs for less care--and all for a tax cut for the rich. That is what we are doing.

We are taking about $800 billion worth of revenue, eviscerating it, eliminating it. Those tax revenues were basically tax increases passed under the Affordable Care Act. They were tax increases on the wealthiest among us. What we are doing is getting rid of all those tax increases in order to cut Medicaid. That is what this bill does. That is not what Americans had in mind when they said on a bipartisan basis, on a majority basis--when they asked Congress to fix healthcare. When you read the fine print, you see that it gets worse every moment, and you realize how bad this plan is.

The Senate version did something extraordinary: It actually moved to the right. And that is a real legislative achievement. Look at Medicaid. This is a program that helps one out of every five Americans, two out of every five children in the United States. It helps one out of every two families who have a newborn baby. And it covers three out of every four long-term nursing home residents.

This program literally saves lives--nursing home patients; people struggling with opioid addiction; people who are working two jobs but still don't make enough to cover their own healthcare insurance--but with this bill, Medicaid as we know it will be destroyed, all so that people at the top of the food chain can pay less in taxes.

This bill actually has a certain symmetry to it. There are at least $800 billion worth of cuts to Medicaid--probably more but at least $800 billion--and it just so happens that there are also around $800 billion worth of tax cuts for the wealthy. So insurance executives will be OK. Don't worry about them. What we should worry about is women who need Medicaid for maternal health services. We should worry about seniors and people with disabilities.

Activists for disability rights are appropriately freaked out about this bill. People in wheelchairs protested outside of a Senate office earlier today,

and some of them said that they would literally die if this bill passes. It was an intense protest. And we hope everybody is OK, but it is intense because these are intense issues.

These are personal issues. These are healthcare issues. People are worried--not about some abstract public policy or political debate; they are worried about their own lives. And they are not wrong. Because of Medicaid, people now have access to physical therapy and immunizations. They can see a counselor for mental health problems and opioid addiction. They can afford the medication they need instead of relying on free samples from clinics. Medicaid has changed everything for them.

This is not just good for patients, it is also good for taxpayers. By giving preventive care, we save money. And if TrumpCare becomes law, those services will go away, thanks to $800 billion in cuts.

This bill also lets insurance companies opt out of covering essential health benefits. I want to be very clear about this. This is a term of art. It is a piece of jargon. I am going to go slowly here and not assume that if you are not in politics, you would understand what an essential health benefit is.

Basically, if you are getting a healthcare plan, there are 10 things that, under Federal law, a healthcare plan has to cover. It just makes sense. I will list them. They are ambulatory patient services; emergency services, so ER visits; hospitalization--if you have to stay overnight in the hospital, it has to be covered in your healthcare plan; maternity and newborn care; mental health and substance abuse services, including behavioral health treatment; prescription drugs; rehab; laboratory services; preventive wellness and wellness services; chronic disease management; and pediatric services.

So I want you to imagine a world where you can get an insurance plan--a so-called insurance plan--but under the law, they can tell you: By the way, we don't cover hospitalization. By the way, we have this great insurance plan, but if you need any prescription drugs, those are out-of-pocket--not a copay; you have to pay all of it. By the way, we will give you an insurance plan, but if you have mental illness, you are on your own. By the way, if you get pregnant, we don't cover that.

It is a healthcare plan, which is why we have a statute, a Federal law, that says ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehab, lab services, preventive and wellness services, and pediatric services have to be covered. Otherwise, it is not insurance. Every one of these benefits is covered full stop under the current law, but what the proposal does is it eviscerates essential health benefits.

I don't know what the CBO is going to say, because they got rid of the individual mandate, and it is going to be unclear. There is a real possibility that there will actually be an increase in the number of people who are covered, but that coverage is going to be nonsense. Can you imagine having a health insurance plan that doesn't cover maternity care? Can you imagine--especially nowadays, when half the time when you go to the doctor, they give you a prescription--so you go to the doctor, and they say you need this, and you say OK, and then you have to pay out-of-pocket? What is the point of insurance if none of the things you need are covered by the insurance? That is what this bill does.

I am also worried about the distractions in this bill. It defunds Planned Parenthood and doesn't provide nearly enough for opioid addiction programs. I want to be clear about what I mean by ``distraction.'' It is my supposition--I don't know for sure that these things were intentionally either omitted from the bill or put in the bill to allow some of my Republican colleagues to get well legislatively. What do I mean by that? Opioid treatment was tens of billions of dollars in the House version. They brought it down to less than $1 billion. That puts somebody on this side of the aisle in a position to say: Even though I am for $800 billion of Medicaid cuts, which will eviscerate opioid treatment across the country, I am going to introduce an amendment and we are going to increase opioid treatment. Once we get a ``yes'' vote, well, you know, I was really concerned, but with my amendment, we have more money for opioid treatment.

Don't fall for that trick. It is a trick. The way to fund opioid treatment is to fund opioid treatment. Medicaid is both the best way to do it clinically and the best way to do it fiscally. So I am afraid they intentionally left that out so somebody can go in and be the hero on the other side, while not actually solving the problem--likewise with Planned Parenthood. The way you fund opioid treatment is through Medicaid.

We had 13 men working in secret without input from any women or Democrats or experts or advocates.

Part of the thing about healthcare, as the President says, is nobody knew it was so complicated. But you really need hearings. You really need to understand how all of the parts of a system interact with each other. Let me give an example. You cut Medicaid, and somebody who is Medicaid-eligible but also a veteran--you don't know for sure whether, if Medicaid services are not available, they are going to go back into the VA system and cost the VA system more money. If you cut preventive treatment, you don't know if you are going to end up having to pay on the back end with more ER services. So the reason you have hearings is you have to have some rather technical expertise in the room to say: Hey, if you do this, this might happen. If do you that, this might happen. If you do this, we are not quite sure what might happen.

But the idea that 13 men with very little expertise in healthcare policy--they are not unintelligent, they are not unqualified to be public policy makers, but the whole thing about being in the Senate is that, for the most part, we are supposed to be, as they say--Jack or Jane--Jack of all trades, master of none. We are supposed to be pretty good at receiving information, kind of distilling it, asking the right kinds of questions, listening to our constituents, and then crystallizing all of that into a bill.

The problem with this process is they did about one-third of that. They talked to each other, and they talked to Republican lobbyists, but they didn't talk to the people back home. They didn't talk to people who run community health centers. They didn't talk to mental health advocates.

We have people who come from Hawaii and across the country who advocate for every specific disease treatment and disease research. These people usually are touched personally by their issues. They come in, and most of us receive them and talk to them and think about how to get them more funding or more reimbursements through NIH or CDC or the Department of Defense or wherever we can find resources for them.

That is the process of being in a legislative context if you are not personally an expert on healthcare policy. If you do it in the dark of night, if you do it literally without any women, if you do it literally without any people from the other party, you are going to get a bad product. They knew they were going to get a bad product, but they made a judgment. They made a judgment.

They decided that the longer this bill sees the light of day, the lower the chances it has of passing, and I think they are right. I mean, if this thing is subjected to real sunshine, it will just wither. That is just a fact. This is why they didn't have any hearings in the House, this is why they are not only not having any hearings in the Senate, but they are going to allow for I think it is 20 hours of debate under this silly vote-arama procedure.

What they will do is, I think, yield back a lot of their time. What does that mean? That means 20 hours will become 10 hours because they don't want to defend their bill.

They are absolutely happy to trash the Affordable Care Act and say it has a series of problems and all the rest of it. You know what, the Affordable Care Act has a series of problems. No doubt about it. I will tell you it is way better than this. I will also tell you it is way better than the situation we had before the act was passed.

The No. 1 cause of bankruptcy in the United States was getting sick. Think about that. Before this act, people

would not be just afraid for themselves when they got sick, when something catastrophic happened to them, either a chronic disease or something that imperiled their lives or an accident, but you would have dual anxieties, right? You wondered whether you were going to be OK, but you also wondered whether you were going to be able to make it financially.

So we are sort of beyond that, and now we have a law that has been on the books that does need fixing. I know the Presiding Officer and the Senator from Missouri, who is waiting to speak, would be pleased-- really would be pleased to participate in a bipartisan process.

I think about the chairman of the Health, Education, Labor, and Pensions Committee, one of the best statesmen in the U.S. Senate, Lamar Alexander, a Republican with whom I disagree on a lot, but he and Patty Murray did a bill on public education that got--I don't know--84 votes or something. Liberal Patty Murray and conservative Lamar Alexander did a deal. Orrin Hatch, President pro tempore of the Senate, is someone who worked with my predecessor, who worked with Teddy Kennedy, who did bills and did deals.

So I understand we are kind of in this squabble about whether there is good faith or there was good faith. Our view of this is you went into the reconciliation process before even, in any serious way, pursuing bipartisan legislation. You decided you wanted 51 votes, not 60 votes, and that was sort of poisonous fruit from the tree. Fine. That is our view. Your view is that you serially tried to reach out to us, and we have rebuffed your overtures. I have my view; the Republicans have their view.

Right now, you are about to walk one-sixth of the American economy off a cliff, and you are also about to harm tens of millions of individuals in all of our home States--not Republicans or Democrats or Greens or Independents or Libertarians or people who don't vote or whoever it may be, but people are going to really be hurt by this bill. People are really going to be hurt by this bill.

Forgetting the politics, I think we have an opportunity to avert the harm. If this bill does come crashing down, then I think we have an opportunity to work together on healthcare. I, for one, pledge that if we are in a position to sit down on a bipartisan basis and come up with improvements to the existing statute, I will be the first person to say yes to that kind of process. It is not too late. All we need are three Republicans to say: Let's slow down. Let's have a hearing. Let's work with Democrats. Let's do this the right way.

I yield the floor.

Mr. President, the Senate recently passed the Department of Veterans Affairs Accountability and Whistleblower Protection Act. This legislation is intended to improve the VA by strengthening the process of holding nonperforming VA employees accountable, but it does this by removing certain due process protections that are currently in place to protect VA employees from unlawful discrimination or retaliation. Dr. David Shulkin, the Secretary of Veterans Affairs, asked for this authority to reform the personnel system, and the Senate obliged his request.

In Hawaii we have a much different and more pressing problem that this legislation does not address, and that is the challenge we face with recruitment and retention of VA leaders and filling vacant positions at the VA.

Nowhere is this challenge more evident than in the VA's yearlong search to recruit a new executive director for the Pacific Island Health Care System in Honolulu. During this time, six executive directors from six different VA healthcare systems on the mainland rotated through Hawaii on an interim basis. The VA said that its search dragged on for so long because it faced a shortage of individuals with the right skills to fill these medical director positions, but that is no excuse. The VA should have been doing more to develop a pool of qualified people to fill vacant medical director positions. Failure to find long-term, stable leadership undermines accountability not only at the highest level, but across the entire healthcare system.

I am also bothered by the decision to rotate medical directors in from other healthcare systems, even on an interim basis. This stopgap measure failed to ensure the proper leadership required to provide long-term direction for the Pacific Island Health Care System and to make sure that there was someone to hold accountable for the delivery of services to the more than 120,000 veterans that the VA is responsible for in the Pacific. Those veterans and their families deserve better.

Leadership recruitment is not the only staffing issue we face. In its September 2016 report on the Pacific Island Health Care System, the VA's Office of the Inspector General specifically noted that recruitment and retention of staff is an ongoing challenge across our neighbor islands, in large part due to cost of living, distance, and physical isolation. At the time of its report, the OIG noted that there were 75 unfilled positions at community-based outpatient clinics across Hawaii. These are vacant positions at clinics that directly affect veterans' access to healthcare.

I worry that removing important due process protections for VA employees will only make this problem worse, because, where there are already issues in physician recruitment and retention, the VA could compete through the promise of a stable job, in an environment free from unlawful discrimination or retaliation. Knowing that those protections are in place is not only helpful to attracting recruits, but it is helpful to promoting a culture free of inequity and intimidation because people know they will be held to account for their actions. That kind of culture is critical to recruitment and retention because the last thing the VA wants is hard-working employees to search for

jobs that offer better working conditions elsewhere.

At our recent subcommittee hearing on military construction and veteran affairs appropriations, Secretary Shulkin acknowledged that the VA has seen cases of documented whistleblower retaliation, and that is important, because it means that Secretary Shulkin is going to have to be vigilant so that this new legislation is not abused. In his mind, he is not seeking this legislation so that the VA can fire employees without any reason or to allow supervisors to abuse them, and I hope that is how this plays out in practice across the country, but there is going to be more risk for a workforce of 360,000 that is decentralized, where decisions are made locally, and so we will be vigilant with him and will hold Secretary Shulkin accountable for any wrongdoing.

We are still left grappling with the challenge of recruitment and retention, and unfortunately, this legislation does not address it, and it may make addressing it even harder. With nearly 50,000 vacant positions across the VA workforce, Congress needs to get a handle on this issue because these vacancies risk undermining the delivery of services and care to our veterans who rely on the VA. We can and need to do better by them.

Thank you.

Madam President, I have a parliamentary inquiry. I have information that indicates that approximately 300 amendments were considered and that of those amendments, 161 amendments offered by Republican members of the committee were adopted during the consideration of S. 1679. Is that correct?

Madam President, I ask unanimous consent that Calendar No. 120, H.R. 1628, be referred to the Committee on Finance for the purpose of conducting a public hearing.

Mr. President, we Democrats are here on the floor to take a stand against a bill that is a disaster for our Nation's healthcare-- Medicaid patients, families with loved ones in nursing homes, people who struggle with opioid addiction, women who rely on Planned Parenthood, and people who work in the healthcare industry. We stand with them and for them tonight, but we also stand for the American public, who is being left in the dark about what TrumpCare will mean for them.

This is not the normal order of Senate business. The Republicans are going about this in a way that is so procedurally flawed that it is an embarrassment to democracy itself. They are hiding this bill. They are hiding this bill because people will be outraged when they find out what is in it.

That is why a Republican aide said that they are not releasing the bill--because ``we aren't stupid.'' Think about what that statement means. First, it means that they have a bill. Second, it means that they think it is political suicide to make the bill public. So they are bypassing the normal and necessary process that is needed to make good legislation.

The way you make legislation is to allow the Sun to shine in, and that starts with hearings. Every legislative body in the country--from a school board to a county council--has hearings because we have figured out over the centuries--for all of our flaws--that you need hearings, not just to placate the masses but to figure out whether your legislation is any good or not.

Republicans have not held a single hearing on TrumpCare. No one who knows anything about healthcare is allowed to say anything about this bill because they are not even allowed to see it, but anyone who has ever tried to understand the American healthcare system knows that it is complicated. The President said so himself. You need expert testimony, public input, and time to talk to your home State. That is the way you get a good product, but Republicans have totally bypassed the two committees that exist in order to consider legislation like this.

Think about it. Under normal circumstances, this legislation would be in the Finance and HELP Committees' jurisdictions. There would be hearings, and there would be a markup, but that is not the process that is being used. There is no markup. There are no committee hearings. It is just 13 dudes, and they are rushing to pass a bill without

women, without Democrats, and without input from the American people. Here is the order of the people who get to see the healthcare bill: 13 men in secret, Republican lobbyists, POLITICO, Republicans, Democrats, and, then, the American people.

This is shameful. This is a violation of the way democracy itself should work. When they are done, the product will be the fruit from the poisonous tree. It will not be good because the process that will have produced it will have been so flawed.

There are many, many Americans who do not support this bill, and I am going to highlight just three groups who stand to lose.

First, you have people who are going to pay more for insurance, lose their insurance altogether, or lose the ability to choose their providers. Families will not be able to afford nursing home care for their loved ones or to pay the hospital bills for a parent after she has had a heart attack. Americans who have preexisting conditions will struggle to buy insurance because insurance companies will be able to charge more for conditions like diabetes or cancer or asthma. Women will be blocked from getting annual checkups or cancer screenings at their local Planned Parenthood clinics. All of these people stand to lose if the bill moves forward.

Second, you have people whose jobs may be at risk. Healthcare makes up about one-sixth of the American economy, and it does not exist in a vacuum. It is an industry that impacts millions of workers, and you can bet that those jobs will be affected by this bill. One study found that TrumpCare will take away nearly 1 million jobs by the year 2026. We are supposed to be helping American workers, not taking away their jobs or making it harder for them to get healthcare.

Finally, this bill hurts the working poor. These are the people who will struggle even more under TrumpCare, and I do not know why we would punish them. Why would we leave them with nowhere to turn? I know that millions of Americans feel the same way that I do. They care deeply about the poor, the vulnerable, and the sick among us, because they have made news in standing up for their neighbors.

One woman named Jessie went to a town hall to make her voice heard on TrumpCare, and I want to read what she said:

It is my understanding the ACA mandate requires everybody

to have insurance because the healthy people pull up the sick

people, right? And as a Christian, my whole philosophy on

life is pull up the unfortunate. So the individual mandate,

that's what it does. The healthy people pull up the sick. If

we take those people and put them in high-risk insurance

pools, they're costlier and there's less coverage for them.

That's the way it's been in the past, and that's the way it

will be again. So we are effectively punishing our sickest

people.

Look, we may not agree on policy, but I hope we can agree on the process. So what will it take? What will it take for this process to be restored and for TrumpCare to be considered in the way that it ought to be considered?

The answer is actually very straightforward. We need three Republicans. It only takes three Republicans, and you can be a person who hates the Affordable Care Act or has mixed feelings about the Affordable Care Act or anywhere in between. It only takes three Republicans in the U.S. Senate to restore the U.S. Senate itself--to restore the hearing process, to restore public confidence, and to restore bipartisanship.

All we need are three Republican Senators to say: I will not vote for anything if there hasn't been a public hearing. I will not vote for anything that is being jammed down Americans' throats. I will not vote for anything without being able to go back home and figure out how it will impact my State's hospitals.

This is not an unreasonable task. We are just asking for three Republicans to say: Let's be a Senate again. Let's restore order and transparency and do things the right way because that is the only way this bill will not be a total disaster.

I yield the floor.

Mr. President, I want to give a status report on this bill. Right now, we think it is with the 13 men who are working on it in secret; they will show it to Republican lobbyists, and then they will send it over to the CBO for a score, and eventually the American public and the Senate will be able to see the bill.

We will have a process called vote-arama, which is mostly nonsense, and there will be lots of opportunities to offer amendments, but let's be clear about what happens at the end of vote-arama. The leader will offer an amendment in the nature of a substitute. So what does that mean? That means all of the amendments that were adopted along the way get taken out, with one 51-vote margin, and all of that vote-arama was for show because Mitch McConnell will put his bill on the floor that was negotiated in secret with those 13 people.

If there was any question that our democracy is being rolled over by Senate Republicans, I want you to think about these 13 men. They are drafting a bill without any input from women, from Democrats, from experts, and by working in secret they are cutting out about 250 million people who are from the 40 States who aren't represented among those 13 men. You can bet that those 40 States have unique healthcare needs and unique healthcare laws. And without the right language, the bill could throw healthcare in each of those States or any of those States into total chaos.

They have also cut out Senators on the Health, Education, Labor, and Pensions Committee and the Finance Committee, even though these committees are actually constructed for the purpose of working on legislation like this. They know how to get things done like this. There are members of the HELP Committee and the Finance Committee who are among the experts on this issue, yet they don't get a chance to even see the bill. These Senators have jurisdiction over this legislation, but they are being left out. This is just not the way it is supposed to work.

We need transparency. We need bipartisanship. But now the Republicans will try to tell us that the hearings are bypassed all the time. That is not true. In fact, this body will hold a hearing on almost anything. In 2017 alone, the Senate has had hearings on hot tub safety, self- driving cars, a treaty for outer space, multimodal shipping, the maritime administration, and dozens of other issues. Look, those are actually not to be trivialized. It is important for the Senate to have hearings. It is important for subcommittees to do their work. But nobody can tell me that hot tub safety, self-driving cars, a treaty for outer space, multimodal shipping, and the maritime administration are more important than one-sixth of the American economy. It is a joke.

We are talking about one-sixth of the American economy, about millions of jobs, and about people with life-threatening diseases and life-changing medical bills, so we know how important hearings are to do legislation. When the Senate took up the ACA, there were almost 100 hearings. Think about that: 100 hearings versus 0. There were roundtables and walk-throughs held by the two committees. We considered hundreds of amendments and accepted

more than 150 amendments from Republicans. But, for this bill, no markup, no transparency, no bipartisanship--just 13 men meeting in secret outside of the regular process.

The only thing that has changed is now the market is under siege, but the market is under siege because of the Republican administration. They are purposefully creating uncertainty. That is not a rhetorical flourish; they are saying they are doing that. President Trump actually said he wanted to create uncertainty in the healthcare market in order to create leverage with Democrats.

Think about how unusual that is. Think about how offensive that is. It is perfectly appropriate for one party to try to generate leverage in a negotiation against the other. That is part of politics, either in an election context or in the public policy context. But the way that this President and Tom Price are trying to generate leverage is by raising healthcare premiums in order to force Democrats to buckle. That is unheard of. It really is unheard of. And it hurts everybody across the country to create this uncertainty.

It is bad enough that the Republicans are trying to take healthcare away from 23 million people--from nursing home patients and their families, from women who are pregnant or fighting breast cancer, from sons and daughters and moms and dads who struggle with opioids. But to add insult to injury, they are going to jam it down your throat. You don't get to read what it is about before it passes or hear from doctors or nurses or experts about how it will affect you.

So why are they working on this bill in secret? The answer is very simple. The bill stinks. They are ashamed of it. The bill itself is an embarrassment. The process is an embarrassment. They have said so themselves. No matter how you look at this, this bill is a disaster for people and their families. It will be a disaster for anyone who relies on Medicaid, which will be cut by at least $800 billion, and Medicaid is a safety net for people who need care but can't afford it.

Look at nursing home care. Medicaid covers three out of every four long-stay nursing home residents. My wife's grandmother was in a nursing home and just passed away, had great care, and wouldn't have been able to get the care she needed were it not for Medicaid. This is not an uncommon story--millions of Americans across the country of all income levels. People think of Medicaid as for people who are not financially in a position to get care in any given moment. That is true. It does take care of the poor. But it also takes care of nursing home care for people who worked all their lives and just don't have enough. It is $9,000 a month in the State of Hawaii for nursing home care. It is more than that for hospice care. We all know that nobody escapes end-of-life care. Rich or poor, left or right, red, blue, purple, nobody escapes this part of your life, and everybody needs help. There might be a few people who save up enough cash money to be able to shell out $10,000 a month for that kind of care, but for the rest of us, Medicaid is that lifeline.

There are actually some Republicans who don't want to cut Medicaid. They have seen how the program improves people's lives. Arkansas and Kentucky, for example, expanded Medicaid. These States have seen big jumps in the number of the people who now have their own doctor or have gotten a checkup in the past year, people who are now more likely to say they are in excellent health. But under TrumpCare, we will be back to the bad old days.

This bill is also a disaster for older people, who will be hit with what the AARP is calling an age tax. This will get a little wonky--not as wonky as that referred to by my colleague who spoke about 5 minutes ago but a little wonky. Right now, companies are not allowed to charge any more than three times as much for an older person as a younger person. Three times is the cap. But TrumpCare will increase that rate to five times. So what happens is every year, as you get older, your insurance costs will go up and up and up. That is why they call it an age tax. In other words, many seniors will see premium increases that can cost them thousands of dollars more each year at a time when people are already struggling to find money to pay for healthcare.

This is also a disaster for patients who don't want to lose their healthcare provider. Right now, an estimated one in five women goes to Planned Parenthood clinics. I understand we have different views about reproductive choice. I understand that. But we also understand--when we are talking on the level about Planned Parenthood and when we are talking about Federal funding for Planned Parenthood, everybody who pays any bit of attention to this understands what Planned Parenthood does for women across the country--again, conservative women, progressive women; Planned Parenthood doesn't care. Planned Parenthood is not using Federal funding for abortion. We all know that by now. It is cancer screenings, and it is quality healthcare and birth control.

People talk about giving more choices for healthcare and saving taxpayers' money, but the CBO estimates that defunding Planned Parenthood will take away options for nearly 400,000 women across the country and will cost taxpayers more than $130 million.

It is also a disaster for those struggling with opioid addiction. This bill will take away treatment for mental health and addiction, leaving hundreds of thousands of people fighting opioid addiction without adequate health insurance. We saw the statistics that opioid addiction, I believe, is killing more people annually than HIV/AIDS killed at its apex. I believe it has either surpassed or is comparable, in terms of cause of death, with car accidents. This is one of the leading killers in the country, and Medicaid is the program that funds opioid addiction for most of the people who get help.

This bill is also a disaster for patients with preexisting conditions because it means we will be going back to the dark days when insurance companies could charge you more for having a preexisting condition.

I have heard from people back home in Hawaii who are terrified of what this could mean for their health. One woman wrote that she is in the middle of a fight for her life against breast cancer, and she is scared that under TrumpCare, she will lose her insurance, that she will have to stop her treatments and could lose her life. A husband wrote to me that his wife has stage IV breast cancer. She has had every possible treatment and surgery imaginable to extend her life, but without the guarantee of affordable coverage for all, her fight will quickly come to an end. She is 29.

Even people without serious medical conditions will be affected by this preexisting condition's nonsense. We know that because before the Affordable Care Act became law, insurance companies were able to discriminate based on what they determined to be a preexisting condition.

One woman in Hawaii told me that in the days before the Affordable Care Act, she was rejected by insurance companies because she had back pain at one point in her life. The pain never came back, and she never needed treatment again. She was young and healthy, but the insurance company wouldn't give her insurance.

We cannot accept the end of nationwide protections for people with preexisting conditions. We cannot accept high premiums or so-called high-risk pools that have historically failed in giving people the coverage they need and deserve. We don't have to do it this way.

We don't have the majority, and this is being done under a process called reconciliation, which means that you don't need a filibuster- proof majority; you just need 51 votes. So if you are proud of your bill--we have Senator Hatch, chairman of the Finance Committee and one of the most respected Republicans in the country, actually. We have Senator Alexander, chairman of the Health, Education, Labor, and Pensions Committee. Both have a long history of being able to do deals--Orrin Hatch with Teddy Kennedy and my predecessor, Dan Inouye; Lamar Alexander with just about everybody--Chuck Schumer, Patty Murray. These are conservative Members of the Senate. There is no doubt about their Republican credentials. But they are also people who are capable of crafting legislation in the right way. I have no doubt they like their gavels. I have no doubt they like chairing hearings. I have no doubt they have the personal, intellectual, emotional, and political

stamina to go through a process which may take more than a couple of days.

I will tell you, this is the world's greatest deliberative body--it is--and these are a bunch of impressive people I serve with in the Senate. But without a hearing, you get a garbage product. You get a bill that just stinks, that staffers say they are keeping secret because ``we're not stupid.'' They are so embarrassed at this product that they are keeping it secret, because they know the moment this thing gets posted, everybody from everybody's home State--and not just Democratic States and not just purple States, but every home State is going to say: My community health center is going to get shut down. My opioid treatment center is going to get shut down. My hospital may no longer exist.

They know this bill stinks.

There is a simple solution. All we need is three Republicans to say: Let the Senate be the Senate. The House did whatever the House was going to do.

There was a weird White House Rose Garden signing ceremony without a bill even being enacted. It was the most bizarre thing I have ever seen, where everybody was congratulating each other for inflicting pain on the American people.

But the Senate has to be the Senate here, and what that means is that we have to be that cooling saucer. We have to actually slow down and have a deliberative process. All we need is three Members of the Senate on the Republican side to say a very simple thing. They can be as critical of ObamaCare as they want, they can be as partisan against us as they want, but all they have to say is this: I am not voting for a bill that doesn't get a hearing. I am not voting for a bill that doesn't get a hearing. Let this thing see the light of day.

I yield the floor.

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

Mr. President, before I move into my remarks, I would like to say welcome back to the Senator from North Carolina. We are happy to see him hale and hardy.

I was worried until I saw your little internet video and you looked fine. It is nice to see you. We welcome you back to the Senate floor-- and looking more energetic than the rest of us, in any case. So happy to have you back, Senator Tillis.

Mr. President, I thank Mr. Franken for his leadership on this issue. He is a person who understands the content industry and has been a fierce defender of people's ability to view content online, people's ability to express themselves online, and understands that a fair and open media marketplace is central to our democracy.

I want to address one assertion that was made by the proponents of repealing net neutrality; that is, that somehow the investment climate under net neutrality was harmed. They say there is some reason to believe that under net neutrality, the investment climate was diminished, but the Internet Association published research today that addressed this very issue, and their findings show that since 2015, when the rules went into place, telecommunications investment has actually increased. ISPs and their consumers are enjoying historically low production costs and innovation has increased. Free Press also published a report on this question earlier this week, and they found that investment in broadband by publicly traded companies actually went up after net neutrality went into place. Here is what the research director at the Free Press had to say: ``If investment is the FCC's preferred metric, then there is only one possible conclusion--net neutrality and Title II are a smashing success.''

Here is the point. The internet is not broken. There are parts of the economy that are not working well. We struggle with manufacturing. We need to invest in infrastructure. We have a trade imbalance. We have a higher education system that is not working for everybody. We need to do more work in these areas, but the part of our economy that is working great for consumers, for entrepreneurs, for the private sector, for engaged citizens is the internet itself. Tomorrow, the FCC is going to endeavor to break it.

Before I hand it over to someone who has been working on these issues for many years, I want to point out that nobody would have anticipated that the Affordable Care Act would still be on the books because of unprecedented online and inperson organizing.

The FCC has a very unique process where there is going to be a 3- month public comment period. The statute actually allows the public to go and weigh in on what they think. The last time this happened when net neutrality principles were being established, 3.8 million people commented. So far, before they even take their first formal action, there are 1.6 million people who have already commented. My guess is, by the time tomorrow is

done--maybe the next day--we will be well into the 2 to 3 million comment range, and they still have 3 months to go. Understand the power in our democracy still resides with the people. Somebody who has been working in the trenches on this issue and many consumer issues for a very long time is my great colleague, the senior Senator from Connecticut, and I will yield to him as I realize I think I am standing at his dais.

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

Mr. President, Scott Pruitt, Mike Flynn, Betsy DeVos-- there is a pattern here. This administration keeps choosing people who seem like the wrong fit to run their agency, and now we are about to add Jay Clayton to the list.

He is different in a lot of ways. I met with him. He is a good person. He is a sensible person desiring to be a public servant, and he is a very smart lawyer. But he is not the right candidate to lead the SEC because it is on the frontlines of making sure that Wall Street follows the rules. And that is the No. 1 issue here because Mr. Clayton has too many ties to the industry that he would be in charge of overseeing.

Wall Street is full of his friends and business contacts, and there is nothing wrong with that, generally. We need lawyers in the securities industry. We need honorable people who help companies to do an IPO, but that doesn't mean that individual is appropriate to be in charge of the SEC and in charge of reining in Wall Street. That causes the problem.

I do not question Mr. Clayton's integrity. I have no doubt that he is a good person. But how can we say that the best person to hold Wall Street in check is someone with strong ties to the big banks, someone who has built his career there, who very well may go back to his old law firm in a few years?

I talked with Mr. Clayton at his confirmation hearing about whether he would go back to Wall Street after his time at the SEC ended, and he said he couldn't rule it out. That is just one of several concerns that I have. If we look at Mr. Clayton's statements about the SEC, it is clear that he is not the right person to be the cop on the Wall Street beat.

He has talked about ``monitoring'' the financial sector; that is the word he used--``monitoring.'' But the United States does not need someone to ``monitor'' Wall Street. We need someone who will aggressively enforce the rules, to make sure we don't have a repeat of 2008, when the big banks made so many bad and reckless decisions that our economy failed.

We have a very short memory in Washington about what happened to our country less than 10 years ago, but the rest of the country remembers. There are far too many communities still working to recover from the great recession.

Now is not the time to walk back the small steps toward progress we have made in protecting the economy from bad actors on Wall Street. But I am afraid this is what could happen under this administration, including if Mr. Clayton should be confirmed.

In his confirmation hearing, he said he wants to lighten the penalties companies face when they get into trouble with the SEC, and that is not something I can support. We cannot expect big banks and investment firms to play by the rules when they know they can pay a small fine and keep behaving badly as a cost of doing business. Regulation and enforcement has a cost, but that cost is meant to put the burden on the actors who are causing the problem

instead of allowing the burden to fall on the rest of us--to fall on American families.

The cost is there, one way or the other. The question is, Who should pay it?

Even if the Senate disagrees on enforcement and regulation, I hope we can agree that conflicts of interest have gone too far. This administration has diminished the meaning of public service in the context of conflicts of interest. Instead of looking out for conflicts of interest, it has leaned into them. Instead of protecting the country from corruption, it is putting our country in real danger. And at some point, it is up to the Senate to be a Senate--to do something. We have to decide where to draw the line. How long do we let this go on?

I am a ``no'' on Mr. Clayton's nomination. I urge all Senators who care about ending conflicts of interest and putting a tough cop on the Wall Street beat to join me and vote no on this nomination.

Mr. President, I yield the floor.

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

Madam President, when our country was founded, corporations were on the minds of no one. They are not mentioned in the Constitution or the Bill of Rights, and when the topic finally came up to the Supreme Court, Chief Justice John Marshall called corporations a ``mere creature of the law.''

People have certain unalienable rights. Corporations do not. We established corporate personhood so that companies could raise capital and enter into contracts, but nobody ever thought that this term that was used--``personhood''--actually meant that corporations were people. They are not. It is not complicated. Corporations do not eat. They do not sleep. They do not worry about their children or their elderly parents. They do not get sick. They do not retire, and they do not have complex motivations. In fact, under the law, they have only one motivation, which is to maximize profits.

Any logical person knows that corporations are not people, but in Judge Gorsuch's America, they are.

There is no doubt that he is a very smart person, but he, actually, had a hand in creating this theory that corporations have the same rights as human beings--that they are, in fact, people. We are supposed to pretend that this premise is not insane, but it is crazy, and it is hurting our democracy. For the past several decades, we have increasingly limited people's rights in favor of corporate rights.

Now Republicans want us to confirm a judge who says that corporations have religious rights. Judge Gorsuch was a part of the Hobby Lobby decision that went before the Supreme Court, in which the Tenth Circuit decided that corporate personhood extends to First Amendment religious rights, and because the corporation itself--not just the people who own it--has been granted those rights by judges like Neil Gorsuch, the rights of corporations now usurp the health and the rights of American citizens. That is the problem with Judge Gorsuch's worldview.

It is not just that he is a conservative; it is that he actually thinks that corporate entities have the very same rights as American citizens--rights, by the way, that do not come with the same responsibilities that we all have as American citizens. Yet this judge wants to confer more rights onto corporations when we are already past the tipping point as a society when corporations have more power than people.

We are in the absurd position of asking: How far are these corporate rights going to extend? They have been given First Amendment rights. They have been given Fourth Amendment rights. Do they get the right to vote next? Do they get the right to keep and bear arms? How many more constitutional rights are we going to give to corporations before we say that enough is enough? We are already well beyond the point at which corporate interests beat out the individual, whether it is at the polls or in the workplace.

There are a lot of other things about Judge Gorsuch's worldview that I object to, but, at my core, I think I might be able to get around some of those things in knowing that the Constitution requires the Senate to advise and consent, not agree with. Yet his worldview regarding corporations as people embodies everything that is going wrong with our country and with the Court. By the way, it is probably fair to say that almost every nominee whom we have seen this year embodies this worldview.

Time and again, Democrats in the Senate have raised the alarm about this administration's nominees, and we have been overruled. What is the result? You have Cabinet Secretaries destroying American diplomacy. You have Secretaries trying to ban Muslims from entering the United States. You have an EPA Administrator, Scott Pruitt, leaving a dangerous product on the market that has been proven by his own scientists to hurt children. Why? Because they prioritize corporate rights over people's rights.

The problem is this: Cabinet Secretaries come and go; Supreme Court

Justices do not. Let me put it this way: This administration's Cabinet is like a date. It is a really bad date, but at least it comes to an end. A Supreme Court Justice on the other hand is not a bad date; it is a marriage. It is a lifetime appointment that will have an impact on generations of Americans.

The fact that he is out of the mainstream is absolutely essential for us to consider. The fact that he thinks corporations are people is, in my mind, disqualifying--so disqualifying that I will vote no on cloture, and I will vote no on final confirmation if it comes to that, which brings me to the question of cloture.

When the Senate votes on cloture, the question before the Senate is, Is it the sense of the Senate that debate should be brought to a close?

For the Supreme Court nominee, we have rules, and those rules say that you need 60 Senators to end debate--not 59, not 51, not 57. There are 59 Senators who do not get to decide when to end debate; 60 do. If you cannot get 60 votes to end debate, you do not have cloture.

After 2013, there is only one position--one appointed position that retains that 60-vote threshold, and that is the U.S. Supreme Court. That is for a very straightforward reason. It is that we have decided as a body that the Supreme Court needs to have bipartisan support; that if a person cannot get 60 votes, you change the nominee, you do not change the rules.

We have decided that this position--this institution, the Court itself, the highest Court in the land--should be beyond our partisan disputes and differences. That is the foundation of the U.S. Senate. It is the way this place works. Without this rule, the reality will be grim. Without this rule, if you are a Member of the minority party, the President's nominees don't have to listen to you, meet with you, think about you. Without this rule, advice and consent is rendered meaningless for whichever party is out of power.

I have been here now 5 years, about 4\1/2\ years. Even in my short time here, the door swings both ways in Washington. Remember that today, this week, for the Republicans it might feel satisfying to use power maximally, to use the greatest authority possible under the U.S. Constitution, but without this rule, the Senate itself will be undermined by its own Members. I have never seen any legislative body endeavor to diminish its own authority, and that is what is going to happen this week.

We can argue about how we got here. Was it in 1987 when the Senate rejected Robert Bork? Was it in 2013 when Leader Reid responded to historic obstructionism by eliminating most filibusters on nominees? Was it last year when Merrick Garland was not even given a hearing? We all have our talking points. At the end of the day, both sides own some of this mess. I am a Democrat. I think it is 80/20. Republicans will think it is 80/20 on the other side. The general public may think it is 60/40 or 50/50. I am not sure that matters anymore. The question of who is at fault is not the most important question. The question is, What do we do next? Will the Senate undermine its own authority and strengthen the power of partisanship?

I would say this to my Republican colleagues: Think about what you are going to do next. Think about what this is going to mean the next time you are in the minority party, because it will not be Senators Duckworth and Cortez Masto who can't even get a meeting with a Supreme Court nominee, it will be you.

This is about the future of the Senate and the Supreme Court. The nuclear option will mean nominees for the Supreme Court will not have to meet with or consider minority opinions. It will mean that the Senate's habit of being slow--sometimes maddeningly so, but we know it is in the best interests of the country--will go away for this appointment. That tradition allows the center to hold, and it will be undermined.

To my Republican colleagues, I am not asking you not to do this. I am asking you to take your time. In the world's greatest deliberative body, there is no reason to rush this decision. I am asking you to wait. I am asking you to take a few weeks before you decide to change the Senate forever. Take your time. This is probably one of the most consequential decisions you are going to make in the U.S. Senate because it is about the Senate itself. This is worth talking about. This is worth deliberating over. It is worth thinking over. Go home. Talk to your constituents. If you want to do this, you can do this anytime you want. You can do this the Monday we get back from our spring work period. For goodness' sake, there is no reason not to think about it for a little bit longer.

All we need are three Members of the Republican Party to go to their leader, publicly or privately, and say: We are not with you on nuclear yet; give us some time to try to save this important aspect of the Senate. Otherwise, you will make both the Supreme Court and the world's greatest deliberative body more extreme and more divided, and I believe you will regret it.

I yield the floor.

Mr. President, what is the purpose of the Senate? The authors of the Constitution laid the foundation of the Senate without really knowing what it would look like once it was standing. They knew it would rival and restrain the House of Representatives. After all, the Senate has a higher age requirement, Members serve 6-year terms, and they have to represent not just a district but an entire State. But it was clear from the beginning of the formation of the Senate that it would take time before the purpose of this body was truly realized.

For several decades in our Nation's history, it was the House of Representatives--not the Senate--that hosted the great debates and introduced major legislation. It wasn't until the Nation began to splinter in the shadow of slavery that the Senate came into its own. While the rules of the Senate gave us its basic structure, it was the Members of the Senate--the people who made up this body--who had to stand up and lead. We remember them today as lions

of the Senate: Daniel Webster, John Calhoun, and Henry Clay. This body owes its status to them and their leadership because they began to define the Senate in a way that no one had before.

Over time, this place became one that valued bipartisanship, deliberation, and compromise. It has become a Chamber that balances the right to debate with demands for action.

In some of the toughest moments in our history, the Members of the Senate have used this body to lead, particularly when the President has faltered.

Take President Nixon. The Watergate scandal had weakened the Presidency in ways that do-nothing Presidents never had. But the Senate, led by a Member of the President's own party, didn't stand by and watch the void, unmoved. They filled the vacuum for the good of the country.

It is this kind of history that has shaped the Senate into what it is today, a body that examines, considers, and protects.

Senator Byrd, the longest serving Senator in U.S. history once said: ``The Senate is a source of wisdom and judgment--both on the actions of the lower house and on the executive.''

That is what the Senate is for. That is our purpose. We achieve that purpose through customs and traditions; through members who serve 6- year terms and represent whole States; through rules that force bipartisanship, deliberation, and compromise.

Now the majority leader has placed one of those rules on the chopping block because they can't get to 60. He can't find the 60 votes needed to end debate on the President's nomination to the Supreme Court.

We shouldn't be surprised to find ourselves here because, after all, back in February, President Trump told the majority leader to change the rules if he had to. Now, as this administration closes in on its first 100 days without passing a single piece of major legislation, the Senate majority leader is ready to fulfill the President's request and change the rule, instead of changing the nominee.

The question I have for this body is this: Should we change the rules in order to give the President a win before spring break? Should we be weakening the Senate at a time when the executive branch is so weak? Isn't it our obligation to assert ourselves into this void, instead of receding from responsibility?

I can think of no instance in the history of any great legislative body in which a legislature decides to diminish its own power. This is beyond strange in the world's greatest deliberative body, in the world's most powerful legislative Chamber. For what good reason would we give up our own prerogatives?

This administration has been ineffective. Now the Senate majority leader is suggesting that the Senate respond to this executive weakness by weakening ourselves. This is wrong. The purpose of the Senate is achieved through bipartisanship, deliberation, and compromise. The 60- vote threshold for Supreme Court nominees preserves these ideals. Changing this rule will make it harder to get there.

Look at the House of Representatives. Look at the way the House Intelligence Committee has dissolved so quickly into partisanship, unable to do its job.

Look at the country. Look at the campaign last year. We are a country divided. Polarization is at an all-time high. Now is not the time to crush a cornerstone of the Senate's foundation.

I don't think this is inevitable. This is not unstoppable. This is up to all of us. It is up to the Members of the Senate to decide if we are going to damage the world's greatest deliberative body at a time when the country needs us the most.

The Senate has always been defined by its Members. The rules, the customs, and the traditions--they help. But at the end of the day, it is the Members of the Senate--like Calhoun, Webster, Clay, Kennedy, Inouye, Hatch, McCain--who make the Senate relevant and necessary.

We are going to find out who we are, as Senators. I would ask that at a minimum, the Senate take its time on this decision. Don't rush. That is not who we are. That is not how we get to the best decisions. This is about the future of the Senate and the future of the Court. The nuclear option will mean nominees for the Supreme Court won't have to even meet with the minority party to be confirmed. It will mean that the Senate's habit of being slow--sometimes maddeningly slow--will go away. That tradition that allows the center to hold--not just in this Chamber but across the country--will be undermined.

So to my Republican colleagues, please take a few weeks before you decide to change the Senate forever. Take your time here. This is probably one of the most serious decisions that you are ever going to make as a Senator because it is about the Senate itself. This is worth talking about. This is worth deliberating over. It is worth thinking over.

Go home and talk to your constituents. If you want to do this, you have the votes. You can do this three Mondays from now, anytime you want. But for goodness sake, there is no harm in thinking about it. All we need are three members of the Republican Party to go to the majority leader--either publicly or privately--and say: Give us some time to find another way to do this. Otherwise, you will make the Supreme Court, this place, and this country more extreme and more divided. You will answer this difficult moment in history by weakening one of the last bastions of bipartisanship, and I believe you will regret it.

I yield the floor.

I suggest the absence of a quorum.

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

Mr. President, distance or delays should never be the reason that veterans don't get the healthcare they need, but that is exactly what is happening to veterans across the country. That is why the Veterans Choice

Program was started--so that thousands of veterans and their families can get the care they deserve when and where they need it. Instead of traveling long distances or waiting months on a list, veterans can use the Choice Program to get the healthcare they need in their own communities.

As the ranking member of the Military Construction and Veterans Affairs Appropriations Subcommittee, I want to give a little perspective on what would happen to our veterans if we don't pass the bipartisan Veterans Choice Program Improvement Act.

Now, I know that the Choice Program is not funded through my subcommittee, but what we do today has an impact on the VA as a whole. If the Veterans Choice Program Improvement Act does not pass, the funding we appropriated to the VA will expire before it has all been used. It is not a small amount of funding. It is $1 billion, and the VA does not have $1 billion elsewhere in the budget to make up for this loss.

In other words, if we don't pass this bill, it is going to be a disaster for veterans because all of the veterans who use this program for their healthcare are going to have to go back to the VA. That means the wait times that everybody was complaining about over the last couple of years will grow longer and longer and longer, and especially in rural America, where access to care is such a challenge, it will get worse and worse.

To manage the increase in patient load, the VA will have to scramble to find funding that can take away from other VA programs, including hospital maintenance and medical equipment. That is what is going to happen if we don't pass this bill. This is an urgent matter for veterans across the country. Whether you are a participant in the VA Choice Program or you go to a traditional VA clinic or hospital, one way or another, this is going to impact you.

Now, I know the Choice Program isn't perfect, but this temporary extension, coupled with the improvements in the system contained in the bill, gives Congress the time we need to develop a long-term, comprehensive solution. And while we are working on a solution, let's not punish veterans by cutting off $1 billion toward a program that is designed to improve services for people who have served our country.

So I hope we can come together to find a way to pass this bill. Our veterans are counting on us.

I yield the floor.

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

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