Floor Statements

Mr. President, let me associate myself with the remarks of the Senator from Massachusetts. There is a lot of work we need to do this week; she is right. There are healthcare crises right around the corner for millions of kids and families that we could be working on solving right now. As the Senator knows, both Connecticut and Massachusetts are still being wrecked by an opioid crisis--one that in my State is getting worse by the year, not better. We could be working together on that. We have brothers and sisters all throughout the United States who are right now in crisis because of devastating storms that have hit. We could be working together on trying to provide a meaningful response, and we aren't. Yet, again, we are back now talking about TrumpCare redux. This is version 10, version 11. I think there have been three versions already this week. This one is really the most dangerous version yet.

CBO just released a scaled-down analysis, noting that there was no way they would be able to provide a full analysis given the compressed schedule, given the need to pass this by the end of this week because of Republicans' desire to make sure that not a single Democrat is included in the negotiation. They gave us some hints as to what their score would say once it was fully completed.

Federal spending on Medicaid would be reduced by $1 trillion over the course of this decade. There is simply no way to rip $1 trillion out of the Medicaid system--the Medicaid system, by the way, as all my colleagues know, that provides insurance to the disabled, to children, and to the elderly--without millions of people losing access to healthcare, people who have nowhere else to go.

CBO unsurprisingly says that the number of people with comprehensive health insurance would be reduced by millions, and they predict that States would allow insurers to set premiums on the basis of an individuals' health status. None of that is news to people who have read this piece of legislation.

I want to talk for a second about why CBO comes to those conclusions and why this is the most dangerous version of the bill yet.

In this bill is a massive reordering of the American healthcare system. The healthcare exchanges, which right now insure millions of Americans across the country, are essentially eliminated under this bill because the whole reason they existed was to funnel tax credits that are attached to individuals based on their income to help them buy insurance. Those tax credits go away under this proposal; thus, the exchanges go away.

Medicare as an entitlement is ended by this bill. No longer will you as an individual have a payment from the Federal Government attached to you because of your income or your health status or your disability. States will now get a block sum of money to do essentially what they wish, which may or may not cover the same number of people today covered under Medicaid.

While proponents of this bill are trying to contend that it still protects people with preexisting conditions, no one is buying it, no one is believing it, because on the face of the text, it does not. It is important to explain why that is.

While technically it is up to the States as to whether they protect people with preexisting conditions, under this new version, States can just sign a form that allows them to permit insurers to price based on medical acuity again--meaning charge sick people more. They will have to exercise that option under this version of TrumpCare. They will be forced to exercise that option because what is also eliminated by this version of TrumpCare is the requirement that healthy individuals buy insurance. You cannot require insurance companies to charge sick people the same as healthy people if you don't provide incentives for healthy people to sign up. There is no incentive, at least under the latest version of the bill that I read; thus, anybody who has taken a semester's worth of education on insurance practice will tell you that States will be faced with two choices: one, reimpose their own individual mandate--and I am going to guarantee you that based on the vitriol that has been launched against the individual mandate from Republicans in this Chamber and the House of Representatives over the past 6 years, most States will probably not take on their Republican Senators and congressional delegation by passing their individual mandate--or they will be forced to drop the protection for people with preexisting conditions.

CBO and JCT anticipate that many States--I would argue the majority of States--will have to drop that protection for people with preexisting conditions because they will not pass an individual mandate; thus, rates will skyrocket for sick people or anybody who has ever been sick, making insurance unaccessible for Americans who have had a cancer diagnosis or an addiction diagnosis or a mental illness diagnosis.

This bill is a massive reorientation of the American healthcare system, the elimination of Medicaid as we know it, the end of the healthcare insurance exchanges, the end of the tax credits to help people buy healthcare insurance, and the end of the mandatory national protections for people against abusive insurance practices. We are potentially going to vote on this later this week without a CBO score-- with one hearing, with no markups.

I don't care how mad my Republican friends were about how the Affordable Care Act was passed. That was done in an open process, with dozens of hearings, with markups in every committee, with 30 days of debate on the floor of the U.S. Senate, with hundreds of Republican amendments that were offered and adopted as part of the affordable healthcare act, with over a year of public input and debate about the pros and cons of the proposal.

None of that is happening on Graham-Cassidy. This is being rushed through in the dead of night, with no time for Americans to review it, no time for Members of this body to look at it, and no ability for any Senator in the Democratic Party to be able to have any input into the final product. This is nothing like what happened on the Affordable Care Act. No matter how mad you are that in the end you couldn't vote for it, Republicans had plenty of opportunity to have a say. The American people had plenty of opportunity to take a look at it. That is not happening with Graham-Cassidy.

Because there is no CBO score, we have to rely on outside independent groups to size up the potential disaster of this bill. The Center for American Progress--which admittedly is a left-leaning organization but is one of the few that have taken the time to take a look at the text and what it will mean--came to the conclusion that 32 million people would lose coverage. The Commonwealth Fund, which is not a political organization, which is an independent, nonpartisan healthcare think tank, essentially came to the same conclusion, saying that after 2026, 32 million people would lose coverage. The Commonwealth Fund says that 15 to 18 million people could become uninsured by 2019.

I have had this chart up here for 3 or 4 months, and I have had to adjust it over and over again because it started out with 23 million people losing insurance as we analyzed the first Republican repeal bill. Then, when the new version came in, you can see I had to write in 22 million people because the amended version that we were going to vote on right before the break was 1 million better. I had to redo my chart based upon this analysis of Graham-Cassidy, resulting in 32 million people losing insurance. Thirty-two million people. It is hard to understand how many people--32 million people will be losing insurance over the course of 10 years. That is the total population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, South Dakota, West Virginia. We had to cross out Rhode Island, but then we had to add Mississippi, Arkansas, Vermont, Wyoming, and Utah.

Forgive me; I had to do my own artist's rendering of these States because the data is coming in so fast and the vote is coming so quickly, I didn't have time to have this chart made up again.

That is 32 million people. Think about that. Over 10 years, the equivalent population of all of these States--what is that? 17 States, 19 States--all losing healthcare at the same time. That is a humanitarian catastrophe, and nobody knows it because this bill is being pushed through without any debate, without any CBO score. That is what could happen if this passes.

It is no surprise that basically everybody in the American healthcare system opposes this piece of legislation. The proponents cannot find a single verifier inside the medical community for this piece of legislation.

This morning, I heard Senator Graham say: Well, that is to be expected. You know, we are making a big reform, and anytime you are making a big reform, the status quo players aren't going to like the result.

Well, that is a little unfair because the status quo for groups like the American Heart Association or the Juvenile Diabetes Research Foundation or the American Cancer Society--the status quo for them is that their members--people who have cancer or juvenile diabetes or heart disease--don't go bankrupt any longer because they can't afford insurance. So, yes, they are kind of upset that 32 million people are going to lose insurance--many of their members--and that we are going to go back to the day in which if you are sick, if you have cancer, in most States, you can be charged more. So, yes, people are protective of the status quo--the part of the status quo that makes sure that sick people or people who have ever been sick don't lose insurance.

I think it is actually worthwhile for just a second--bear with me--to give a quick sense as to how many people in the medical community oppose this bill. Here is just a beginning list: the AARP, the School Superintendents Association, America's Health Insurance Plans, the ALS Association, America's Essential Hospitals, America's pediatric dentists, the American Academy of Pediatrics, the American Academy of Family Physicians, the American Association on Health and Disability, the American Cancer Society, the American Dental Association, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Diabetes Association, the American Federation of Teachers, the American Heart Association, the American Hospital Association, the American Lung Association, the American Osteopathic Association, the American Medical Association, the American Public Health Association, the American Psychiatric Association, the American Psychological Association, the Arthritis Foundation, the Big Cities Health Coalition, Blue Cross Blue Shield, the Children's Hospital Association, the Center for Medicare Advocacy, the Cystic Fibrosis Foundation, the Endocrine Society, Family Voices, the Federation of American Hospitals, the HIV Medicine Association, the Human Rights Campaign, the Juvenile Diabetes Research Foundation, the Leukemia and Lymphoma Society, the Lutheran Services in America, Main Street Alliance, March of Dimes, the Medicare Rights Center, the National Association of County and City Health Officials, the National Association of School Nurses, the National Alliance of State & Territorial AIDS Directors, the National Coalition for Cancer Survivorship, the National Health Council, the National Multiple Sclerosis Society, the National Organization for Rare Diseases, the National Partnership for Women and Families, Planned Parenthood, the Arc Connecticut, the Arc of the United States, the Trust for America's Health, and 47 religious organizations representing various denominations, including American Muslim Health Professionals, Alliance of Baptists, Methodist Federation for Social Action, the National Council of Jewish Women, the Presbyterian Church of the United States, the United Church of Christ, and the United Methodist Church.

That is the tip of the iceberg. You are not really in good company if you are supportive of this bill when every single medical association, every single patient advocacy organization, every single hospital association, every single insurer thinks that you are wrong. You would like to think there might be a couple of these groups who would think it was a good thing to pass a bill that uninsures potentially 32 million--maybe 25 million, maybe 22 million--and jeopardizes preexisting protections for millions of Americans.

What is so bonkers about this is that we were this close to getting a bipartisan agreement. It is not as if there wasn't another path. I sit on the HELP Committee. I had half a dozen conversations with Senator Alexander and Senator Murray. I know we were 80 percent of the way there on passing a bipartisan package of reforms--at least out of the HELP Committee--that would have kept what was working in the Affordable Care Act and tried to fix what wasn't working.

I saw Leader McConnell's tweet from earlier today in which he said that Senate Democrats have two thoughts on how to fix ObamaCare--one, do nothing; two, a fully government-run system that would take away even more of their decisions.

That is not true. That is not true, and everybody here knows that it is not true. Why? Because Senate Democrats were sitting down and talking with Senate Republicans. We were at the table just a week ago, trying to come up with a package of reforms. So to say that the Democrats want only a single-payer healthcare system or what we have today is not true, and everybody knows that is not true.

I am certainly raw at the fact that Republicans walked away from that negotiating table when we were so close. I do not think that was in the best traditions of the U.S. Senate, but I am ready to sit back down at the table. I know that Patty Murray is ready to sit back down at the table if this process blows up, as every previous attempt at repealing the Affordable Care Act with a thoughtless alternative has blown up.

My constituents are not happy with the American healthcare system. They like a lot of the things the Affordable Care Act did, but they acknowledge there are still lots of problems that need to be solved. Amongst those constituents in my State who like what the Affordable Care Act has done but who still want to see changes are Isabelle and Rylan.

Isabelle first wrote about her son to my office 2 days after the last election. This is Rylan, who was born with a congenital heart defect. He looked healthy when he was born. He and Isabelle had been scheduled for discharge from the hospital when Rylan went in for some routine testing, but he never came back. His parents kind of knew something was up, but when the doctors arrived back in their room, they told Isabelle and her husband that Rylan needed to be rushed to the hospital for emergency surgery because his body was not getting enough oxygen, and there was something wrong with his heart. He was diagnosed with several severe heart defects, and he required emergency open heart surgery.

The first thing Isabelle thought was: How are we going to pay for this? Does insurance cover it?

She found out, much to her relief, that insurance did cover it, because insurance was required to cover things like hospitalizations under the Affordable Care Act and that they would not lose coverage, because no matter how big the bills got, the Affordable Care

Act prohibited insurance companies from cutting her off.

Isabelle has been a warrior in preserving those protections in the Affordable Care Act, and I just want to leave you with an email that she sent me this week.

She writes that she is exhausted and that she is so tired of having to fight over and over and over again for Rylan. She feels that no matter what she tries to do, this repeal is going to happen, regardless of Rylan's story, and that they are just going to be casualties of this political imperative to repeal the Affordable Care Act.

In 3 weeks, Rylan is going to be going up to Boston for his big cardiac and neuro checkup. She wishes that their biggest fight were to keep him healthy and alive, but it is not. They are engaged in a political fight to try to stop the protections, which keep him alive and keep this family solvent, from being stolen from them.

This is not a game to Isabelle and to Rylan. This is not about politics. This is about this little boy's life. I am going to tell you that my State cannot hold this together if you cut Federal funding for healthcare by 50 percent to Connecticut, as this bill would do--maybe more. What we are hearing is that money is going to be stolen from States that have implemented the Affordable Care Act in order to be delivered to the States of Senators who have not yet committed to the bill on the Republican side. We cannot hold it together for Rylan in Connecticut if you take away half of our Federal healthcare funding, if you take away the tax credits that help people buy insurance, if you take away the Medicaid that helps insure these kids--if you let insurers go back to the days in which they discriminated against these kids. It is not a game to Isabelle.

She writes:

Every time the repeal comes up (what is it--the third time

or more), I feel sick with anxiety. How quickly the rug will

be pulled from under us. How quickly the bricks will begin to

fall.

We are ready to work with you. We are ready to sit down, once again, and try to work something out that gets Democrats and Republicans together on this and that does what the American people want us to do-- keep what works in the Affordable Care Act and improve what does not work. Please give this up. You are ruining the lives of these families who, in addition to having to save their children's lives, are having to become full-time political activists to stop this from happening. We can do this together. We can deliver peace of mind to these families. It is not too late.

I yield the floor.

Madam President, before the Senator leaves the floor, I just want to probe him for a moment on this question of process.

Listen, this is an affront to the Senate--a bill that reorders one- fifth of the U.S. economy and that is being delivered to us days or weeks before we are to vote on it.

The Senator may have covered this, and if he did, he may just reiterate it for me.

My understanding is that there is not going to be a CBO score before this bill is before us. For the folks who do not know what that means, that means that everyone who votes on this bill will have no clue as to how many people will lose insurance, how high premiums will go, or how much money their States will lose. I do not think that we have ever, ever voted on a bill of this scope and size without having an analysis from the CBO. My understanding is that, today, when you list or rank the affronts on the process involved in the debate over Graham-Cassidy, at the top of that list will be the fact that we are not going to see a CBO score.

Madam President, if I may ask the Senator a follow-up question, we are in a different position today because, when we were taking these votes a month ago, there was only the faint talk of a bipartisan process to try to keep what works in the Affordable Care Act and fix what is not working.

It is another assault on the process, in my mind, and I ask for the Senator's thoughts on it. Literally, as we speak, Republicans and Democrats are talking to each other about the bipartisan bill that Americans in every State are begging for. Apparently, if this bill is going to be brought before the Senate, then that whole process was a fraud. It was a ruse to distract Democrats into thinking that there might be a bipartisan fix. It was pulling one over on the American public to give the impression that, maybe, Republicans were interested in a bipartisan compromise.

Right now, there is a process playing out, and if this bill comes up for debate with no CBO score, then, that bipartisan process, which was really hopeful for a lot of Americans, I assume just falls apart; right?

Madam President, I thank the Senator. I know it is late, and I thank him for staying on the floor for a few moments.

You do not know what it is going to do to your own constituents. We do not have a CBO score telling us how many people will lose coverage, how high rates will go, what will happen to Medicaid. It is also another bill that has been written behind closed doors. Senator Cassidy and Senator Graham may have spent some time in thinking about what this legislation does, but virtually no one else has been let into the room. Patients have not been in that room. Doctors have not been in that room. Hospitals have not been in that room. Do you know why I am pretty confident of that? It is because all of the groups that represent those populations oppose this legislation.

Potentially, we are going to vote next week on a healthcare bill that massively, massively reorders the American healthcare system and that is opposed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association. Those are the physician groups.

By the way, it is kind of hard to know for these groups whether they are for it or against it, as there is no CBO analysis of this, but the patient groups have weighed in. Basically, every group that represents patients who are sick in this country is begging this Congress not to pass this bill.

Also included is the ALS Association, the Cancer Society, the American Diabetes Association, the Heart Association, the Lung Association, the Arthritis Foundation, the Cystic Fibrosis Foundation, the Juvenile Diagnosis Research Fund, the Lutheran Services of America, the March of Dimes, the National Health Council, the National Multiple Sclerosis Society, the National Organization of Rare Diseases.

How do you pass a bill that has no CBO score, that has had no hearings, that is opposed by every single group that Republicans welcome into their office every year representing people with serious diseases?

There have been some really mean healthcare proposals, but Graham- Cassidy is the meanest version of TrumpCare yet. Let me walk you through why I say that.

Again, we don't have the numbers so we don't have a CBO analysis of how many million people are going to lose access to healthcare, but let me guarantee you it will be in the millions, likely in the tens of millions.

The bill radically--radically--trims the amount of money States will get in order to insure the population that has been insured by the Affordable Care Act. What this bill does is shrink the amount of money we are spending, then redistributes it out to States, and it will simply not be enough--not nearly enough money--in order to cover the 20 million people who have insurance today because of the Affordable Care Act; many of those through Medicaid, others through the healthcare exchanges.

An early analysis by an outside group that is trying to help us understand what this means suggests that for my little State of Connecticut, it will be a $4 billion reduction in healthcare dollars from the Federal Government to

the State of Connecticut. We are a State that doesn't have a $20 billion annual budget. Four billion dollars means that we will either have to kick hundreds of thousands of people off of healthcare or we will have to dramatically raise people's taxes.

So all of the reductions in insurance are in this bill. We will just have millions of people losing access to health insurance under this bill.

The specific, targeted harm to women is in this bill. Planned Parenthood is one of the country's biggest providers of primary care and preventive healthcare services to women. I get that many Republicans have a problem with Planned Parenthood because they also provide abortion services, but the majority of their work is, in fact, providing basic preventive healthcare to women in this country.

My wife, when she was a low-income twenty-something, could only afford to get her healthcare through Planned Parenthood. That is where she went for her preventive healthcare, for her wellness checkups, and there are millions of women just like her. This bill is particularly cruel and particularly mean to all of the women in this country who, without access to a Planned Parenthood clinic, may not be able to get quality, affordable, preventive healthcare.

This bill is perhaps the meanest, though, to individuals who are sick or individuals who have been sick because at least in prior versions of TrumpCare that came before this body, there was at least a meager attempt to try to preserve protections for people with preexisting conditions. It wasn't workable, but at least there was a face-saving gesture by Republicans and by the Trump administration to try to at least claim there was language to protect people with preexisting conditions.

Senator Cruz stood on this floor a few years ago during his long overnight filibuster. I sat in the chair listening to him explain how everyone knows, including him, that you cannot protect people with preexisting conditions without requiring, in some way, shape, or form, that healthy people buy coverage. Why is that? Let me walk you through it for a minute because it is not hard to understand, but it is really important to understand because people don't like the individual mandate. They are not going to understand that. Nobody likes to be required to do something, but you cannot protect people with preexisting conditions if you don't require people to buy insurance.

The logic goes like this. If you say to insurance companies that you cannot charge people who are sick more than people who are not sick, if you say to an insurance company that you cannot charge someone with cancer more than someone who is healthy and you don't require that healthy people buy insurance, then what does the rational individual do? The rational individual, in that case, says: Why would I buy health insurance while I am healthy? If I will not be charged anything more for it when I become sick, then there is no rational economic reason for me to be covered when I am healthy.

So what insurance companies tell you--what every insurance expert tells you is, if you require insurance companies to charge the same between sick people and healthy people, then healthy people will not buy insurance. If I were advising someone, I am not sure I would tell them to buy insurance if they didn't have to until they were sick. So the pools get so skewed with sick people and no healthy people that rates dramatically rise for everyone. Some estimates suggest that the rate increases would be 20 percent per year, compounding year after year after year.

In the last version of this bill, Republicans knew that so they included a version of the individual mandate in their bill. Now, it wasn't the same mandate, but it was a mandate nonetheless. The mandate under the Affordable Care Act says that if you don't buy insurance, you will pay a fee on your taxes.

What the Republican bill said--the version of TrumpCare that came very close to getting a vote on this floor--is that if you go without insurance, you will pay a penalty when you try to get back on. The timing of the penalty was just different. Under the Affordable Care Act, you pay it when you lose insurance. Under the first version of TrumpCare, you would pay the penalty when you try to get back on insurance. It is a mandate. It is a penalty. It is just in a different place.

Republicans did that because they knew that was the only way to require States or give States the option to continue to require insurance companies to treat sick people the same as healthy people.

So why am I talking about this? Because in Graham-Cassidy, the individual mandate is totally gone--gone--replaced with nothing. Thus, even though it says that States, if they wanted to, could preserve protections for people with preexisting conditions, States did not do that because the Federal Government does not require healthy people to have insurance. If you think that States are going to reimpose an individual mandate, A, there will be some real question as to whether they can do that, and, B, they will not. They will not because that issue has become, thanks to my Republican friends, so politically toxic around the country.

You will be left with massive discriminatory treatment of people with preexisting conditions, and nowhere for them to go because Medicaid is obliterated under this bill. Medicaid dollars get lumped into all the rest of the money. It gets sent to States, and then Medicaid dollars are capped going forward--intentionally capped--at a number that is well below what the general rate of increase in the Medicaid Program is. There is intentionality to the underfunding of Medicaid here.

Now, the old bill would have taken, I think, 15 million people off of the rolls of Medicaid. I think I am getting that number right, and we will never know what this number is before the vote happens. It is likely around the same number because this bill treats Medicaid in roughly the same way, in terms of capping the amount of money States get.

The formula by which States get this money is so wildly complicated that no one could understand it between now and next week. I would challenge any Republican, other than Bill Cassidy and Lindsey Graham, to come down and give us an explanation as to how this formula works. It is the most bizarre Rube Goldberg scheme you could ever imagine, but in it is a dramatic reduction in Medicaid payments to the State over time.

So think about this little boy Deacon. Deacon is 10 years old, and he lives in Ohio. I am just looking here at a picture of him clutching a Pokemon character. I know what Pokemon character this is. It is Pikachu. I know that because I have a 9-year-old who is the same age as Deacon, but, for the grace of God, my 9-year-old is not going through what Deacon the 10-year-old is going through.

I will just read a little bit about Deacon. He loves playing baseball, playing video games, volunteering at animal shelters. He loves being a patient champion for children's hospitals, spending time with his friends and family, being a big brother, raising money and awareness for heart disease and defects.

Now, my 9-year-old doesn't enjoy raising awareness for heart disease and defects. The reason Deacon enjoys doing that is because he has a condition called hypoplastic left heart syndrome. That is combined with asthma and acid reflux. It essentially means Deacon has half a heart. We have whole hearts. Deacon has half a heart.

Right now, everything is controlled for Deacon by medications. He has had six heart surgeries to get to the point of stability. His heart will fail--not may fail. His heart will fail. He will go into heart failure, requiring a heart transplant. That is Deacon's future. The heart cannot last on the two-chamber system that Deacon's surgeons put into place.

Affordable, quality insurance means everything to Deacon. Strep throat could be a death sentence for him. Any little virus that gets into him and goes into his bloodstream, that is it--game over for 10- year-old Deacon.

His parent writes:

My child is alive because he has Medicaid. That allowed for

him to have the doctors, the surgeons, and the care he has

always needed. Deacon had 6 heart surgeries before 3 years of

age. He has continued medications as well as regular doctors

checkups as he needs them. Because of his diagnosis, he even

has a specialist for simple things like dental care. If he

had not had Medicaid coverage, there is no way I could have

afforded his care. By his first surgery at 10 days, he was

over the million dollar mark. I would have lost our house

easily, quickly. I am a single mom. Medicaid helps keep my

son alive and healthy, and it has given me my best friend to

love and watch grow up.

Medicaid helps a boy live a normal life. Where we would have never thought that it would be possible, Medicaid lets a boy with half a heart be on a baseball team with his friends, a best friend.

This is not hyperbole. This isn't a game. It is not about scoring political points just because you made a promise that you were going to repeal the Affordable Care Act in the first year that you had control of this body. This is about this little boy who lives in a State that had the wisdom, on a bipartisan basis, to expand Medicaid.

Ohio would be one of the biggest losers under this bill--a massive withdrawal of billions of dollars away from Ohio's healthcare system, simply to fulfill a political promise Republicans made.

We are not making this up. We are not trying to tug your heartstrings just for our own political purposes. Kids are going to die if they don't have access to healthcare. If 20 million people lose insurance, as may be the case under this legislation, thousands of people will not be able to survive. That is $1 million of care. I can guarantee you that this single parent's home is not worth $1 million. At some point you just stop being able to provide the care necessary to keep people alive.

Republicans are treating this like it is a game, talking about taking a vote next week when no one in this country has looked at this legislation. Not a single townhall has been held in which your constituents can weigh in. No Member of this body will have looked at an analysis by the Congressional Budget Office to know what its impact is. This bill will be rammed through in the dead of night, I guarantee you, without any input from people like Deacon and his family.

This is the meanest version of TrumpCare yet, in part because of what is in it, in part because of the butchered process, but in part because Deacon's family will not get to come down here and talk to you about it because you are going to rush it through next week, if reports are to be believed.

What a great trick Republicans will have pulled on this country. Everyone said that the repeal bill was dead, that we were going to move on to a bipartisan process in the HELP Committee, that the Senate was going to move on to another issue of tax reform. What a great head fake that would be if it were all a lie, if it were all a ruse just to be able to give cover for Republicans to quietly muster support for another devastating assault on America's healthcare while Democrats were looking hopefully at a bipartisan process playing out in the HELP Committee that was never intended to result in an outcome.

I hope that is not the case. I really do. I have put enormous faith and trust in Senator Alexander. Admittedly, I gave him a very hard time over the course of the first 6 months of this year because I could not understand what the point was of being on the HELP Committee if we weren't going to debate a reordering of one-fifth of the economy: the healthcare system. Why be a member of the HELP Committee if the biggest reform to the healthcare system during my tenure in the Senate wasn't going to be debated in the HELP Committee? I thought that was an abomination.

I have been very pleased that in the last 2 weeks Senator Alexander has convened a bipartisan process, which I have invested in. I have shown up to all of those hearings. I have talked to him over and over again on the floor of the Senate and in these committee meetings. I have offered constructive suggestions about how we can come up with a bipartisan fix to the parts of the Affordable Care Act that aren't working as well, while maintaining the parts that are working. As I sit here today, I hope and I pray this wasn't all one big ruse to distract me and the Democratic Members of the Senate while Republicans quietly worked on building support for the meanest version of TrumpCare yet. That would be a deceit, and I hope it is not going to be the case.

This isn't a game. People are going to be really, terribly, badly hurt if this bill becomes law. I don't even know what the effects will be because we don't have the analysis. We don't have a score. I can guess. But I have never been part of anything like this in my 20 years of public service. I have never seen a group of public officials so hell-bent on achieving a political goal as to throw out decades of precedent on how this body has normally worked on major pieces of legislation, shown such casual disregard for good, old-fashioned nonpartisan analysis as is happening if this bill comes to the floor without a CBO score.

We can do something together. We can continue the work of the HELP Committee to pass a truly bipartisan product that admittedly would just be a start, that could involve real compromise on both sides. Republicans could compromise by saying: We know we need to have some stability in these healthcare exchanges, and, thus, we are going to make sure that President Trump can't take away payments from insurers or threaten to take them away on a month-to-month basis. Democrats can recognize that Republicans want flexibility in these exchanges--want the ability for States to do a little bit more innovation, whether it be with benefit design or reinsurance pools. We can both give, and we can get a product that would build trust between both sides, that might allow us to do something bigger later on.

I have no idea whether Deacon's family is Republican or Democrat. I have no idea whether his single mother--who is so deeply fearful today of what Republicans are about to do to her and her child, her best friend, her 10-year-old son--voted for Donald Trump or voted for Hillary Clinton. When it hits you--when that heart defect or that schizophrenia or that heroin addiction or that lung cancer strikes you, it doesn't discriminate as to whether you are a Democrat or Republican. It hits you hard no matter who you voted for.

That is why, when we go back home--I know what Republicans hear because I hear it in Connecticut. They want us to work together. They are sick and tired of healthcare being a political football that just gets tossed from one party to the other. We used it to bludgeon Republicans, and Republicans used it to bludgeon us, and we used it to bludgeon you, back and forth, and back and forth.

We are on the verge of passing a bill, getting a bill out of the HELP Committee that might begin to end the use of healthcare as a simple political bludgeon. That is what our constituents want. We are not going to have time to get any public polling on this because no one is going to be able to understand it by next week, but I will guarantee you, it will poll at the same rate that previous versions of TrumpCare have polled--in the teens and the twenties, with base Trump voters being the only folks who support it. That is because people have gotten hip to what is in here. They don't actually think it is a good idea to take healthcare away from tens of millions of Americans, but they also don't like the fact that this has been done behind closed doors. This has been done with Republicans only. They want this debate to occur in the open.

Whether they are Republican or Democrat, they want both sides to be a part of it, and we are closer to that reality than ever before. Pulling the rug out from under the bipartisan process is not the meanest or cruelest part, but it is pretty high on the list.

Think about Deacon. Think about the tens of thousands of little boys and girls like Deacon who live in your State. Don't do this to the people of America. Don't do this to the U.S. Senate. Don't break this place beyond recognition by ramming this through without any process or without any CBO score next week. Let this bipartisan process play out. Let us build some good faith together. That is what the American people want, and that is what the American healthcare system needs.

I yield the floor.

Mr. President, first let me lend my support to efforts to bring amendments before the floor later today or later this week with respect to strengthening our Nation's ``Buy American'' laws. This has been a cause that I have been working on for almost my entire career in the U.S. Congress, and it is about time we start making sure that when we are spending billions of dollars for the U.S. military, we prioritize American companies so that we don't allow for those dollars to flow overseas when we have companies in Connecticut, North Carolina, and Illinois that can do the work. This is important, and I hope we take some votes on these measures that I think will draw bipartisan support either this week or next.

I do rise, though, to lend my voice, as well, to the amendment being offered by Senator Paul. Let me stipulate that this is an extraordinary amendment to sunset an authorization of military force that currently provides the legal authorization for our continuing military efforts to take out al-Qaida as they try to plan attacks against the United States and our allies. It is time for extraordinary measures because we have simply not done our constitutional duty in declaring and authorizing war.

I would argue, as many of my colleagues do, that no matter how necessary it is for the United States to take the fight to ISIS, as we have in Iraq and Syria and other places around the world, that is not currently authorized by the U.S. Congress, and it is a fairly extraordinary leap of statutory interpretation to think that an authorization to attack al-Qaida, the perpetrators of the attacks on 9/ 11, allows you then to conduct a global war with almost no limits against this new enemy.

To me, if we don't reauthorize military action against ISIS, perhaps against other foes that we confront, then I am not sure the Congress will ever again authorize war. Why? It is a lot harder to authorize military action today than it was a century ago or 50 years ago. We aren't marching conventional armies across a field against one another. We aren't signing neat peace treaties that provide a clear end to hostilities. The enemy is shadowy and diffuse and perpetual, and victory now is harder to define than ever before. It is very easy for the U.S. Congress to just step back and say that authorizing military force is too hard. It is too difficult, so we outsource it to the executive branch to decide who we fight, where we fight, when we fight, and how we fight. That is not what the Founding Fathers imagined, and, in fact, there is very good reason to vest in the Congress the sole authority to declare war. If I thought that we were going to do this without the sunsetting of the existing AUMFs, then I wouldn't support this extraordinary measure. I have been here long enough to know that it is far too easy and convenient for this Congress to allow for an Executive, whether it be a Republican or Democratic Executive, to define the parameters of war and to name new enemies who have not been before this body for debate.

So I think it is time for us to sunset these authorizations, and I do think that with that pressure, we will be able to come up with a new authorization that gives our military and our Executive what they need in order to continue the fight against groups like ISIS, while protecting the interests of our constituents, who, frankly, by and large, no matter what State they are from, do not want the President of the United States--this or any other--to have an unchecked ability to bring the fight to anyone, anywhere around the globe.

I will just state, take a look at the way in which the President suggested he was authorized to take action against the Assad regime as evidence of how unending the current interpretation can be. The justification for that action was because it was next to action being taken against ISIS, which was authorized because ISIS has some familial relationship to al-Qaida. That is three or four steps removed from any debate this body has ever had. That is not what the Founding Fathers intended.

I am going to support Senator Paul's amendment. I will then vigorously work with my colleagues to try to craft an authorization that gets the job done. It is about time.

I yield the floor.

Mr. President, today I wish to recognize Spencer M. Houldin of Roxbury, CT, as he nears the end of his term as the 112th chairman of the Independent Insurance Agents & Brokers of America, also known as the Big I. Spencer was installed as chairman of the Big I in September 2016, becoming the youngest person to serve as chairman in the association's 120-year history. Throughout his term, even when he and I disagreed, Spencer was always a thoughtful and dedicated advocate for independent insurance agents.

Prior to becoming the chairman, Spencer often served as a leader in the independent agency system. He chaired the Big I national Government Affairs Committee in 2009 and served as the president of the Connecticut Big I association in 2004. In these leadership positions, Spencer consistently promoted an environment where independent agents, in both Connecticut and across the country, could both thrive in their business and represent their customers with the highest quality of care.

Spencer has consistently served his community in Connecticut. He resides in Roxbury, CT, with his wife, Carol, and two sons, Chandler and Carter. Spencer is president of Ericson Insurance Services in Washington Depot, CT, where he has 25 years of experience as a personal insurance advisor, working alongside his brother Peter. He currently sits on the board of the Western Connecticut Health Network, which is comprised of Danbury Hospital, Norwalk Hospital, and New Milford Hospital. He has been involved with the health network in various capacities over the past 20 years. He recently cochaired a $72 million capital campaign for Danbury and New Milford Hospitals. In July 2017, Litchfield Magazine named Spencer one of Litchfield County, Connecticut's 25 most influential people.

Today, I am pleased to join Spencer's colleagues from across Connecticut and

the Nation in congratulating him as he finishes his term as chairman of the Big I.

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

Thank you, Mr. President.

We are starting to hear rumors of what is in the so-called skinny bill, and it is not skinny. It is humongous. It is filled with all sorts of conservative priorities, whether it be--these are rumors--the end to the individual mandate, the elimination that insurance companies are required to include certain coverages, the denial of funding to Planned Parenthood. This is not a bill that is designed to go to conference. This is a bill that is designed to become law.

I just want to put all of the pieces together for folks what we are hearing tonight, because you are hearing, if you are following this all across America, different pieces of news emerging from different parts of this city. Let me try to put it together for you for a minute.

First, you are seeing this skinny bill get fatter and fatter, which all of a sudden looks like a piece of legislation that is not designed to go to conference. It looks like a piece of legislation designed to become law.

It is healthcare arson. It sets the insurance markets on fire. It immediately takes insurance from 16 million people and drives rates up by 20 percent on a compounding basis. This is insanity.

It is getting bigger and bigger, which makes you wonder, wait a second, is this about going to conference or becoming law? Then we got another piece of information. The White House doesn't support the conference. The White House likes the skinny bill and wants it to become law. Then we got another piece of information. The House of Representatives tomorrow morning will declare what is called martial law. That is a procedural move that will allow the House to pass the bill that comes from the Senate as quickly as possible. This isn't going to conference, this is becoming law. Then the icing on the cake is the most curious piece of news: a statement from the Speaker of the House in which he says, not ``we will go to conference,'' he says, ``I am willing to go to conference.''

Why ``I am willing to go to conference'' and not ``we will go to conference''? Well, maybe you got the clarification from his spokesman who said: ``Conference committee is one option under consideration, and something we are taking steps to prepare for should we choose that route, after first discussing with the members of our conference.''

Can you see what is happening here? Can you see what is happening here? This is a bill that is being sold as just a procedural step to get to conference, but everything else that is happening around it suggests this is becoming law. Even if I am not right, let's also be clear about the process. Even if there is a conference, how on Earth is the conference going to come to a conclusion that the Senate could not? Right? You are going to introduce the Freedom Caucus to the U.S. Senate and think you are going to get more functionality and not less functionality? Even if you get to that conference, it will last for a couple days, maybe a couple weeks. They will come to no conclusion, and then guess what. The skinny bill, which is not so skinny any longer, is there for the U.S. House of Representatives to pass and put into law. All the while, the President of the United States is cheering that on. That is the signal he gave you. The President of the United States does not support a conference. He supports a bill that we are going to have unveiled later tonight and passed. He supports that bill going into law.

So even if you get to conference, with the President chiding the conference to give us and pass the Senate bill, which is available to the House for passage, that is what the outcome will be.

So for our Senate friends who want assurances that this bill will not become law, you are getting exactly the opposite tonight.

With that, I yield the floor to the Senator from Minnesota.

Mr. President, this process is an embarrassment. This is nuclear-grade bonkers what is happening here tonight.

We are about to reorder one-fifth of the American healthcare system, and we are going to have 2 hours to review a bill which, at first blush, stands essentially as healthcare system arson.

This bill is lighting the American healthcare system on fire with intentionality. To use the word ``freedom'' at its center--there is freedom in this bill. There is the freedom to go bankrupt, there is the freedom to get sick and not be able to find a doctor, and there is freedom in this bill to die early. That is not hyperbole. That is what happens when, overnight, 16 million people lose insurance.

Don't tell us that is because people all of a sudden will not be mandated to buy it. This is a vicious cycle that happens. When you get rid of the mandate, every insurance company will tell you that rates skyrocket because you are not getting rid of the provision that requires insurance companies to price sick people the same as healthy people. CBO says that rates go up immediately by 20 percent and then 20 percent after that and then 20 percent after that. So all of a sudden you can't have the individual mandate because nobody can afford to buy the product.

There is a lot of freedom in this bill, it is just not the kind of freedom we all thought was at the heart of this reform measure. This is real life. It is not a game.

I know lots of Members on the Republican side are voting for this because they have some promise that even though this bill is terrible-- and everybody admits it doesn't solve any problems--it will get to a forum in which the problems can be truly solved. That is gamesmanship. That is not senatorial. That is not what this place was supposed to be. This was supposed to be the great deliberative body where we solved big problems, and this bill surrenders to the House of Representatives.

Let's just be honest about what is going to happen when this bill gets to the House. Maybe there will be a conference committee, but it will not resolve any of the problems which have been inherent in the Republican conference here in the Senate. In fact, those problems will get worse because you will inject the Freedom Caucus into a Republican conference here that alone wasn't able to come to a conclusion. They will argue for a couple weeks, maybe a month, and then the House will decide to proceed with a vote on this bill.

There is nothing in the rules that locks this bill into the conference committee once it is there. The House can pick it up out of that conference committee and move it to a vote--and they will do that because none of the problems that were solved here will be solved there.

We have seen this happen before. Remember the budget stalemate in which this hammer of sequestration was created, and the supercommittee was supposed to solve all the problems the House and the Senate couldn't? They didn't, and now we are stuck with sequestration-- something nobody thought would happen. This is the same thing.

This will not be a hammer sufficient enough to solve the dysfunction which has always been present in this process. Thus, the conference will be doomed, and this bill will become law--raising rates for everyone, locking millions of people out of the system of insurance, with no answer for the parents of those disabled kids who have been begging to get into Senators' offices. This isn't a game. This is real life. If this bill becomes law, real people will be hurt.

We are begging our colleagues to vote for the motion to commit. Take us at our word. We want to work with you. We acknowledge there are still problems that need to be solved, though we maintain there are parts of the Affordable Care Act that are working. What if we owned the problem and the solution together? What if this wasn't a perpetual political football? There is still time for us to work this out together if you support us and vote for the motion to commit.

This process is an embarrassment to the U.S. Senate. This isn't why we all came here--and don't delude yourself into thinking that this bill you are voting on will not become law. There is a very good chance that it will, and the end result will be absolute devastation and humanitarian catastrophe visited upon this country.

It doesn't have to be this way.

I yield the floor.

Mr. President, will the Senator yield for a question?

Maybe this time would be better used if you allowed us to ask you some questions about the bill.

Mr. President, no one should normalize what is happening on this Senate floor right now. We are all waiting for the white smoke to come out of Republican leadership offices so that the millions and millions of very scared people in my State will be able to see what is about to happen to their lives.

This isn't a game. People's lives are at stake. People's health is at stake. Yet, because this debate is now devoid of policy and substance and seemingly just about delivering a political victory to Republicans, we wait and we wait and we wait.

People are scared. All over the Capitol today there are parents of children with disabilities, many of whom rely on Medicaid in order to keep their children alive. I have spent a lot of time with them over the course of the last 6 months because, to them, the measure of a civilization is how it treats the most vulnerable, and their kids, with these deep disabilities, are among the most vulnerable. For much of the last 6 months I have seen anger in their eyes--anger that Congress would choose to hurt their kids or to force their family to go bankrupt.

Yesterday, I saw something new in their eyes. I saw fear. I saw deep, debilitating fear because they sense that we are on the precipice of doing something that they didn't think was possible--a piece of legislation passing the Senate and the House that would deliberately and intentionally hurt their children.

There is no way around it. It is not hyperbole. The House bill that we are debating right now guts Medicaid to the point where 15 million people--the most vulnerable Americans--would lose access to healthcare.

I know it is very hard for people in this Chamber to understand because we all have really good healthcare. But when you have an expensive disease or your child has an expensive disease and you lose insurance, you can't pay for it. You can sell your house, you can sell your car, and you can exhaust your savings. For some families, that will cover 6 months' worth of expenses for their sick child. At some point, the patient dies if they don't have access to healthcare.

So people are scared. They are really scared. They are scared not just at the consequences of the House bill eventually passing, but they are also scared at the casualness with which this debate seems to treat their plight.

There are rumors now that, at the end of this process, we are going to vote on what has been described as a stripped-down, gutted version of the original Republican healthcare bill. It might have one or two provisions in it--maybe the elimination of the individual mandate, maybe the elimination of a few taxes. The intent would be to essentially punt the more comprehensive debate about what our healthcare system is going to look like to a conference committee.

I want to talk about that for a few moments and what the consequences of that are. First, I want to talk about what the consequences are, if that end result is achieved, for the Senate. Why do my colleagues choose to run for the Senate if they are prepared to surrender the biggest policy decision they will likely face to the House of Representatives? Why go through all the trouble of running, of raising all the money, of getting all the votes to become a Senator if you aren't prepared to actually render an opinion and pass a bill on the biggest priority issue facing this country right now--the future of the American healthcare system?

Republicans have been unable to come up with a bill that can get 50 votes. Why? Because they refuse to engage with Democrats. Now the solution

is to punt by passing a stripped-down version of the bill, handing all power to the House of Representatives, surrendering to the House of Representatives. What is the point of being a U.S. Senator if you aren't actually going to make policy, if you are just going to hand over the keys of policymaking to the House of Representatives? This is the U.S. Senate.

I disagreed with Senator McCain's vote yesterday, but I heard the speech he gave to us that this should be the place in which we make the big, tough decisions about the future of the American economy. The Senate will put an ``out of business'' sign on the outside of this Chamber if we pass a scaled-down version of this bill that admits we can't come to a conclusion.

What is the point of being a Senator if you just hand this debate over to the House of Representatives? By the way, that is what will happen. If the Senate goes to conference with the House of Representatives and there is only one bill in that conference--and that is what will happen if a stripped-down version of this bill goes into conference and the House has a comprehensive reform bill--the House bill will be the only one in the conference committee, and the House bill will become law. The House bill will survive. It may have some small cosmetic amendments to it, but all of the power will be given to the House of Representatives in those negotiations because there is only one idea that will be present.

Let's go back for a moment and remember what was in that House bill that so many of my Republican colleagues told me was deeply objectionable to them and would never get a vote on the Senate floor. Twenty-three million people will lose insurance. Rates will go up by 15 to 20 percent. People with preexisting conditions in most States likely will lose all protections available to them. Insurance plans will not have to cover maternity care, mental illness, or addiction any longer. Medicaid will be gone as we know it. My small State, with an $8 billion Medicaid Program, will have a $3 billion cut. Children will lose their ability to stay alive because they lose their healthcare insurance. Seniors in nursing homes will be put out on the street. That is not hyperbole. That is real. That is what happens when you kick 23 million people off of insurance.

That bill or some version of it would emerge from the conference committee because the Senate would have defaulted to it by going to conference with nothing. But that is just the long-term consequence. The short-term consequence is that this scaled-down bill reportedly will include an elimination of the individual mandate. Insurance markets will fall apart.

Everybody here knows, whether you are a Republican or a Democrat, that the only way you guarantee that people get priced the same if they are sick or not sick is to require people to buy insurance when they are not sick. In fact, the Republicans know that because in their bill that they wrote behind closed doors, they included an individual mandate. They did. It was designed in a different way. They said that if you don't buy insurance, you will be penalized by being locked out of the insurance market for 6 months. But they had a penalty for people who don't buy insurance, just like the Affordable Care Act has a penalty. Republicans and Democrats understand that in order for the insurance markets to work as they are regulated today, you need to encourage people to buy insurance when they are healthy and penalize them if they don't. The Republican bill does that, just like the Affordable Care Act does that.

If you pass a bill that removes that mandate, then every insurance adjuster, every actuary who works for a major healthcare insurance company, will tell you that the markets will crater because individuals won't buy insurance until they get sick, knowing that they can't be charged any more. Healthy people will not buy insurance. Rates will go up. Insurers will flee the markets. The entire thing collapses.

That is the short-term consequence of telegraphing to the insurance companies that you are getting rid of the individual mandate. Even if that is not the final result, that telegraph signal, at a point where insurers are already rethinking the markets because of the sabotage campaign that President Trump has undertaken, would be catastrophic.

This is not a game. These stakes are big. The casualness with which people are approaching this debate is scaring the life out of people in my State, out of parents of kids with disabilities and folks who are dealing with sickness and illness all across this country.

It is not too late. We don't have a communicable disease. We aren't going to physically harm Republicans if they come talk to us. It is time to abandon this Republican-only approach and come work with Democrats. Let's jointly own the problems that still exist in the healthcare system and jointly own the solution. People are scared of what is happening in the Senate today, and there is a different way.

I yield the floor.

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

Mr. President, I was really glad to be on the floor to hear the remarks of my great friend Senator Kaine.

It is gut-check time in the U.S. Senate. The legislation we are going to consider tomorrow would hurt a lot of people in ways I think that are very hard to fathom. One of our colleagues said: I didn't come here to hurt people.

Everybody came here with designs on how to make their community, their State, their Nation a better place, and we are on the verge of taking a vote on a bill that objectively will rain a level of devastation down on this country that is really hard to fathom.

I can't match Senator Kaine's eloquence talking about the personal stakes here. We take for granted the fact that as employees of the U.S. Senate, we get a health benefit that makes sure that if we do fall ill or if our children fall ill, we will not have to think about whether we have the money to be able to afford treatment, but that is not how it is for all of those families who lined up in Virginia to receive care. That is not how it is for those who come to a similar event in Connecticut that is targeted just for dental services but has a line that begins the night before and is oversubscribed before the event begins the next morning.

That is not how it was for the millions of American families who used to go bankrupt because, when faced between a choice of personal financial ruin and the death of a child or a loved one, they chose financial ruin. Until you have been faced with that choice, I don't think there is any way to understand it. It certainly is a choice no one in this Chamber will ever have to make.

In Connecticut, the Burger family made that choice. Before the Affordable Care Act was passed, in the 2-week period of time where Mr. Burger didn't have healthcare insurance, their son was diagnosed with cancer, and when he got on his new plan, it was a preexisting condition so it wasn't covered, and the Burger family lost everything. They went through their savings account. They lost their house. They went bankrupt. They were one of thousands and thousands of families who made that choice. That rarely happens any longer. The number of personal bankruptcies in this country has been cut in half because of the Affordable Care Act.

The Affordable Care Act hasn't made healthcare magically affordable for everyone, but it has meant that people don't have to make that choice any longer. The scope of the pain we are talking about, if any of the three versions of this bill get the vote, is really hard to fathom. Under the original version of the bill, 23 million people would lose insurance.

I amended this chart when a series of changes were made at the last minute that CBO scored to reduce that number to 22 million, but this is the entire population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, South Dakota and West Virginia, all losing healthcare at the same time, and the majority of that happens in the first year. So of the 22 million, 14 or 15 million of those people lose insurance next year. The scope of that devastation--12 months from now, 15 million less people having insurance, 15 million more people showing up in emergency rooms to get care--is something I don't think any of my colleagues really can get their head wrapped around.

For all the times President Trump said the Affordable Care Act is dead, that ObamaCare is in a death spiral, that is not true. It is a lie. It is a lie because the Congressional Budget Office says the death spiral only occurs if you pass any of the versions of the legislation we are considering; that if the Affordable Care Act stays in place, 28 million people will not have insurance--which is far too many--but if one of these bills go into effect, at the end of 10 years, we will have 50 million people without insurance.

A new report from the Kaiser Family Foundation found that the ACA markets are not collapsing despite what the White House says--despite the lies they perpetuate. Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. ``Insurer financial results show no sign of a market collapse.'' That is the Kaiser Family Foundation's finding which mirrors the finding of CBO.

The collapse in our insurance market only happens if one of these bills pass, and it is not just the number of people who lose healthcare. The folks we should care most about--the people who are making just enough money so they don't qualify for Federal programs but not enough money that they can save for retirement and pay for their kids' college bills and do all the things you need to do in order to lead a respectable life--those people are going to be hurt worst by this bill.

If you are a 64-year-old getting ready for Medicare coverage, you are making $56,000 a year, you are going to pay 170 percent more under this bill just in your premiums, never mind the extra money you are going to pay in copays and deductibles.

The CBO says that if these bills are passed, a single policyholder who purchases a plan at a 58-percent actuarial value in 2026 would have a deductible of roughly $13,000 for medical and drug expenses combined, which is absolutely unaffordable.

By every metric, whether it be the amount of money that you pay or the number of people who do not have healthcare coverage, the CBO answers this question: Who gets hurt under the GOP healthcare plan? Pretty clearly, everybody, unless you are an insurance company, a drug company, or rich. If you are affluent and you can afford your own healthcare, you will be fine. If you are an insurance company or a drug company, you are going to get a big tax cut out of this. But everyone else will get hurt and get hurt really badly.

I have watched my Republican friends process this information. I have watched them, largely, stay silent. The Democrats are the only people on the floor of the Senate these days who are talking about healthcare. Most of my Republican friends are not willing to come down and defend any of these products, but those who have been have shifted their rationale.

Republicans who have been willing to come down and defend their plan concede that millions and millions of people will lose insurance, and they concede that rates will go up for most Americans. So they cling to one last value that underpins the Republicans' healthcare plan. In their words, that value is freedom--the freedom not to be insured. The Republicans suggest that you should not really worry about 32 million people losing insurance because those people really did not want insurance and now they will be free not to have it. That is just not what the CBO says. The CBO says that millions and millions of these people who will lose insurance desperately want it; they are just not going to be able to afford it.

It is also not true that the bill grants that kind of freedom. Insurance is compulsory under the Republican healthcare plan just like it is under the Democratic plan. It is just compulsory in a different way. The Republican plan says that as a penalty for not having insurance, you will be banned from purchasing insurance for 6 months. The Affordable Care Act says that if you do not purchase insurance, you will get a penalty on your tax form. Either way, it is a penalty.

Yet a new wrinkle has been thrown into this debate because last week it was ruled that, in a reconciliation, the Republicans cannot include this penalty provision. Without it, the entire

bill falls apart. Markets would collapse.

For all of the Republicans' talk about the freedom not to purchase insurance, they included a requirement in their bill that people buy insurance. They know they had to because they know that without it, the entire insurance market would collapse. Why is that? If you require insurance companies to charge the same thing for sick people as for non-sick people, then you have to encourage people who are not sick to buy insurance. If you do not, folks will just wait until they are sick to buy insurance, and the only people who will have insurance will be the people who have acute conditions. That will make insurance itself unaffordable, and insurers will stop offering products, or they will jack up rates to the point that it will be totally unaffordable for everyone.

In the Affordable Care Act, that is what led to the individual mandate. In the Republican healthcare bill, that is what led to this provision that locks you out of insurance for 6 months. But that has been ruled veritable. That has been ruled essentially out of order under reconciliation.

The Republicans are going to be faced with a choice if they are able to get on this bill. They will either remove that provision and guarantee the collapse of the entire insurance market in this country or they will have to strengthen that penalty in order for it to be allowed under reconciliation, but that will essentially rob the last rhetorical argument that the Republicans had in favor of this bill. They cannot argue that it provides more people with insurance. They cannot argue that it helps with cost. They cannot claim that it increases quality. They know that. The only thing left that they could argue is that it allows some people to go without insurance if they do not want it. In truth, their bill does not do that, and the rules of the Senate are going to require that they increase that penalty even more if they want any plausible, workable version of this bill to survive.

It leaves us in a place in which there is no argument to do this. It does not advance values that Republicans hold dear, like personal freedom, it does not improve people's healthcare experiences, and it does not increase the number of people who have healthcare insurance.

It really does beg the question: Why are we doing this? Did anybody come to the Senate with the desire to hurt this many people?

If I had told my Republican colleagues 4 years ago that their ACA replacement plan was going to drive up the number of people without insurance by 32 million and increase rates by 20 percent in year 1, would you have believed it? No. For 6 years, I took my Republican colleagues at their word. I did not agree with them that we should repeal the Affordable Care Act, but at least I thought they had the same goals in mind as we did--more people having access to the healthcare system and costs being controlled for as many people as possible. It is now clear that we do not. The Republicans are about to vote on a bill that will inflict unthinkable amounts of pain on this country. Who gets hurt under the GOP health plan? Everybody.

I said this on the floor last week, and I will just say it again to close--that it does not have to be this way. We have accepted for so long that healthcare is a political ping-pong ball that gets tossed from one side to the other every 5 or 10 years.

Why is it so inconceivable that Democrats and Republicans could not sit down together and try to work out keeping the parts of the Affordable Care Act that are working and improving the parts that are not? Why couldn't the Democrats understand that the Republicans want flexibility of benefit design and give Republicans something on that if you understood that we want some certainty of these marketplaces? We do not want President Trump to be able to sabotage and undermine these markets. Why can't there be a compromise and a deal there?

There is still time. If this vote fails tomorrow, there is still the ability for us to come together, because in the end, there is the story Senator Kaine told about rural Virginia. Everybody here knows that story. Everybody here knows there is enormous work still to be done, and nobody out there is believing the lies about this bill, this wonderful healthcare plan President Trump is promising. Everybody in this country hates this bill. It has a 15-percent approval rate. These folks know there is virtually no one who is helped by this bill other than insurance companies, drug companies, and people who are very affluent and fortunate enough to be healthy.

We do not have a communicable disease on our side of the aisle. We are not going to physically hurt you if you get in a room with us. We actually do deeply desire to improve the healthcare system. You have just got to give us a chance.

I yield the floor.

Mr. President, I thank the Senator from Georgia for the recognition.

Colleagues, the new CBO score is out on, I guess, version 4.5 or 5.5--it is hard to keep track of the bill to repeal the Affordable Care Act--and nothing has changed. This proposal, which is a moral and intellectual dumpster fire, is still a disaster.

Here is what the CBO says about the bill that is currently being reworked behind closed doors by my Republican colleagues. The CBO says that, immediately, 15 million people would lose coverage by next year. That is a humanitarian catastrophe. It is something this country has never witnessed before--that number of people losing coverage in that short a period of time. Our emergency rooms would be overwhelmed as they would be unable to deal with the scope of that kind of humanitarian need. Ultimately, the number would rise to 22 million at the end of the 10-year window. We know it will be far bigger than that in the second 10 years because that is when the worst of the Medicaid cuts will happen, but 22 million is a lot of folks. It is no different than in the previous version, which was 23 million, or in the House's bill, which somehow got a majority vote in that place despite 24 million people losing health insurance, according to the CBO.

Today, 90 percent of Americans are covered by health insurance. The CBO says that number will go all the way down to 82 percent. I have heard my friend Senator Cornyn complain on this floor year after year that the ACA still leaves millions of Americans uncovered. This would make it even worse.

When you get down to look at what happens to individual Americans, it gets even more frightening. Let me give an example of how this bill would dramatically increase premiums on individuals who are currently insured through the private market.

A lot of the coverage losses happen because of this assault on Medicaid, but lots of folks who have private coverage would not be able to afford it any longer. If you are a 64-year-old who is making, let's say, $55,000, that is over three times the Federal poverty level. In a lot of places, you can live on $56,000. Today, that individual is paying about a $6,700 premium. Under the Republican healthcare bill, that individual would be paying $18,000 in premiums. That is an increase of 170 percent. That is just one individual.

The bottom line is that, if you are older and you are less wealthy, you are going to be paying a whole lot more under this proposal.

Despite all of the guarantees made by Republicans and this President that under their plan, costs would go down, that deductibles would go down and premiums would go down, the CBO says the exact opposite. It says that, especially if you are sort of middle-income and are 50 or older, your premiums will go up dramatically.

This is a terrible bill. It does not solve a single problem that the Republicans said they were trying to fix. More people lose insurance, costs go up, and quality does not get better. This is a terrible piece of legislation.

We are at this very frightening time in the negotiations when changes are being made to this bill not to improve policy but to try to win individual votes. That is what is happening as we speak. Behind closed doors, small changes are being made to this bill to try to win the votes of individual Senators, giving them specific amounts of money for their State, and their State alone, in order to win their vote. That is shameful, and it is no way to reorder one-fifth of the American economy. We are talking about 20 percent of the U.S. economy. And changes are being made to this bill right now that have nothing to do with good healthcare, that have only to do with winning individual votes to try to get to 50, because Republicans refuse to work with Democrats--refuse to work with us. So instead of building a product that could get big bipartisan support, Republicans are now down to a handful of their Members and are trying to find ways to deliver amounts of money to those Members' States in order to win their vote.

There is a special fund in the latest version of the bill for insurance companies in Alaska that was not in the previous version of the bill. Now, all of these provisions get written in a way that if you are an average, ordinary American who decides to take a couple of hours of your time to read the bill, you would never know that it was a specific fund for Alaska because it doesn't say ``Alaska.'' It sets up a whole bunch of requirements that a State has to meet to get this special fund for insurance companies, and only one State fits that description, and it is Alaska.

There is a change in this bill from previous law that addresses States that were late Medicaid expanders, States that expanded into the new Medicaid population allowed for under the Affordable Care Act but did it late in the process. The previous version didn't give those States credit when establishing the baseline for the new Medicaid reductions, but miraculously this new bill has a specific provision to allow for two States that were late Medicaid expanders to be able to get billions of additional dollars sent to their State. Those States are Alaska and Louisiana--two States.

There is a new provision in the latest version of the bill that makes a very curious change to the way in which DISH payments are sent to States--that is the Disproportionate Share Hospital Program that helps hospitals pay for the costs for people without insurance. Not coincidentally, it is a change that was advocated by one Senator from one State: Florida. The change will disproportionately benefit the State of Florida, and it is now in the new version.

These are not changes that help the American healthcare system. They are not changes that benefit my State or

the State of the majority of Members here. Some of these changes don't benefit 98 of us; they only benefit 2 of us. And they are in this version of the bill in order to win votes, not to make good policy.

We heard word this morning of a new fund that was invented in the middle of the night last evening that would supposedly help States that are Medicaid expansion States transition their citizens who are currently on Medicaid to the private market. Now there are reports that it is a $200 billion fund, and that is a lot of money. It sounds like a lot of money, and it is a lot of money, but it would represent 17 percent of the funds that are being cut to States, and it would only be a temporary bandaid on a much bigger problem. Why? Because CBO says definitively that the subsidies in this bill for people who want to buy private insurance are so meager that virtually no one who is kicked off of Medicaid will be able to afford those new premiums. That is why the numbers are so sweeping in their scale--22 million people losing healthcare insurance.

So even if you get a little bit of money to help a group of individuals in a handful of States transition, when that money runs out--and it will--they are back in the same place. All they are doing is temporarily postponing the enormity of the pain that gets delivered. And once again, this provision being delivered to only States with Medicaid expansion populations is being targeted in order to win votes, not in order to improve the entirety of the healthcare system.

Senator Corker called out his colleagues today. He said that he was willing to vote for the motion to proceed, but he was growing increasingly uncomfortable with a bill that was increasingly--I think his word was ``incoherent.'' That is what happens when you get to the point where you have a deeply unpopular bill that everybody in the country hates and you need to put amounts of money in it to get a handful of additional votes. It becomes incoherent. And this was an incoherent bill to begin with. It is hard to make this bill more incoherent, but that is what is happening when these individual funds are being set up for Alaska, Louisiana, and Florida.

We could solve all of this if Republicans decided to work with Democrats. If we set aside the big tax cuts for the wealthy and the pillorying of the Medicaid Program, if we try to fix the real problems Americans face today, we could do it on a bipartisan way. And wouldn't that be great.

I get it that there is enormous political advantage for Democrats to sit on the sidelines and watch Republicans vote for a bill that has a 15-percent approval rating, just like there was political advantage for Republicans to sit on the sidelines and not do anything to help Democrats provide insurance to 20 million more Americans. Healthcare is a very thorny political issue, but it doesn't have to be that way. We could sit down together and own this problem and the solution together, and we could end healthcare being a permanent political cudgel that just gets used every 5 to 10 years by one side to beat the other side over the head.

We are Senators too. We got elected just like our Republican friends did. Why won't Republicans let Democrats into the room, especially after this bill has failed over and over again to get 50 votes from Republicans? We don't have a communicable disease. We aren't going to physically hurt you if you let us into that room. We are not lying when we say we have a desire to compromise.

Democrats aren't going to walk into a negotiating room and demand a single-payer healthcare system. We understand that we are going to have to give Republicans some of what they want; maybe that is flexibility in the benefit design that is offered on these exchanges. But Republicans are going to have to give Democrats some of what we want, which is the end to this madness--an administration that is trying to sabotage our healthcare system and destroy the healthcare our citizens get. But that could be a compromise. It is not illegal to meet with us. There are 48 of us; there are not 12 of us. My constituents in Connecticut deserve to have a voice in how one-fifth of the American economy is going to be transformed.

I know a lot of my Republican friends want to do this. I have talked with Republican Senators who say: Well, when this process falls apart, we want to work with you. It is falling apart, because the only way Republicans are going to get the 50 votes is by making these shameful changes--specific funding streams for specific States in order to get a handful of votes--and that is not how this place should work. Maybe that is how things happened here 100 years ago, but it is not how things should happen today.

So once again I will beg my Republican colleagues to stop this partisan closed-door exercise and come and work with Democrats. We can do this together. We can own it together. We will have plenty of other stuff left to fight about if we find a way to agree on a path forward for America's healthcare system.

Mr. President, I yield the floor.

Mr. President, I have had the good fortune of being in both the House and the Senate during the period of passage and implementation of the Affordable Care Act and now the debate over repeal, and I have heard consistently from my Republican colleagues two things. One is that they did not think the Affordable Care Act was the right approach to fixing the problems of America's healthcare system. There were 60-some odd times that the House or the Senate voted to repeal all or parts of the Affordable Care Act. The second thing I heard consistently over that period of time, dating from 2009, is that the Republicans were prepared to offer a replacement to the Affordable Care Act that would be better, that would be an improvement over the Affordable Care Act--indeed, over the status of the American healthcare system when the Affordable Care Act was passed. The ground has shifted mightily since then.

The Congressional Budget Office tells us that, under the Republican plan either passed in the House or in the Senate, a humanitarian catastrophe will result in this country. Tens of millions of people would lose their healthcare. That is not what Republicans said their replacement would do. They said their replacement would be better than the Affordable Care Act.

The CBO says that rates will go up immediately by 20 percent on almost everybody. Then, after that, if you are young and healthy, rates will probably go down, but for everybody else, the amount of money you have to pay in premiums, copays, and deductibles will go up. There is nothing in the Republicans' bill about cost--nothing that addresses the underlying issues with an American healthcare system that, procedure by procedure, costs twice as much as in most other countries--and nothing about quality. There is not a single provision in the bill that encourages higher quality.

As we get ready for Republican repeal bill 3.0 or 4.0--whatever this next version will be that will be released secretly to Republicans tomorrow--I think it is just worth reminding everybody what Republicans said would happen. I will just use our President's words. I understand that many of my Republican colleagues here do not ascribe to all of the beliefs and statements of our President, but he is the leader of the Republican Party. All of my colleagues did support him, and they stood with him in the House of Representatives, arm in arm, when they passed the Republican House's repeal and replacement bill.

President Trump wrote this:

I was the first and only potential GOP candidate to state

there will be no cuts to Social Security, Medicare, and

Medicaid. Huckabee copied me.

So no cuts to Medicaid was the promise. Yet the bill that the President has endorsed and is trying to help Leader McConnell push through the Senate involves debilitating cuts to Medicaid--$700 billion to $800 billion worth of cuts to Medicaid--resulting in millions of people being pushed off of that benefit. The cut to the State of Connecticut would be $3 billion. We are a tiny State. Our Medicaid Program is somewhere in the neighborhood of $8 billion. We would lose $3 billion of that. The promise was that we would not cut Medicaid. This bill cuts Medicaid.

President Trump wrote:

If our healthcare plan is approved, you will see real

healthcare, and premiums will start tumbling down. ObamaCare

is in a death spiral!

There is always one long sentence and then one very short sentence.

Here are the two claims: ``Premiums will start tumbling down.'' That has been the promise, and that has been a consistent promise--that costs will go down if the Affordable Care Act is repealed and replaced with a Republican plan. The CBO debunks this from beginning to end. It says that premiums will go up. They will start tumbling upwards immediately at rates of 20 percent. If you are older or if you have any history of preexisting conditions, your premiums will continue to go up. The danger, of course, is in thinking

that the only thing that you pay in the healthcare system is premiums. I could pretty easily construct a healthcare reform proposal in which your premium would go dramatically down. How would I do that? I would just shift all of the payments onto deductibles, onto copays, and I would give you nothing with regard to the actuarial benefit of the plan. It is easy to get premiums to go down if you do not care about what you are actually covering and the size of your deductibles and the size of your copays.

Then, ``ObamaCare is in a death spiral!'' The CBO debunks that as well. The CBO says that, if you leave the Affordable Care Act in place over the course of the next 10 years, 2 or 3 million people will lose healthcare insurance. If you pass the Republicans' healthcare bill, that is where the death spiral occurs. There are 23 million people who will lose insurance if you pass the Republicans' bill, but 2 to 3 million people will lose insurance if you do not pass it.

Again, President Trump writes:

Healthcare plan is on its way. Will have much lower

premiums and deductibles--

Here, he is making a commitment on deductibles. Once again, the Congressional Budget Office says that premiums will go up and deductibles will go up, especially for individuals who are older or individuals with preexisting conditions--

while at the same time taking care of pre-existing

conditions!

This bill does not take care of people with preexisting conditions. Why? Because it allows for any State to allow insurance companies to get out from the minimum benefits requirement. If you have cancer, technically, the Senate Republicans' bill says that you cannot be charged more, but you may not be able to find a plan that covers cancer treatments. So that is not protecting people with preexisting conditions. The CBO says this specifically. It says that, especially for people with preexisting mental illness and preexisting addiction, they will be priced out of the marketplace because they will not find plans that cover their illnesses. You cannot just protect people with preexisting conditions by saying that insurance plans have to cover them. You actually have to require insurance plans to offer the medical benefit they need.

Once again:

Our healthcare plan will lower premiums and deductibles--

and be great healthcare!

Insurance companies are fleeing ObamaCare--it is dead.

I have already covered the part about premiums and deductibles, but let's remember that insurance companies were not fleeing ObamaCare until President Trump was sworn into office. The period of open enrollment covered a period prior to his inauguration and a period after his inauguration. Before President Trump's inauguration, open enrollment was on pace to enroll a record number of Americans in exchange plans and Medicaid plans--record enrollment. Enrollment fell off a cliff after President Trump was sworn into office and signed an Executive order that told all of his agencies to unwind the Affordable Care Act. People listened to President Trump, who said that he was going to kill the Affordable Care Act, and they stopped signing up for those plans.

It got worse when he refused to pay insurance companies. Right now, the President will not commit to paying cost-sharing subsidies to insurance companies more than 30 days ahead of time. He stopped enforcing the individual mandate, and it is no surprise that insurance companies are saying they do not want to participate in these exchanges because the President is trying to kill them. He has made it very clear from day one.

I have had the benefit of being on the floor a number of times with Senator Barrasso, who often came down to the floor, following my remarks, during the period of the implementation of the Affordable Care Act. I heard him talk about the fact that there will be freedom for Americans to have or not to have insurance if this piece of legislation is passed. It is a wonderful idea that people will be free to not be able to afford insurance. The reality is that, yes, some individuals buy insurance today because they are compelled to by the individual mandate, but there is a reason for that. If you do not compel people to buy insurance who are healthy, then you cannot protect people who are sick.

I sat where the Presiding Officer is during Senator Cruz's 24-hour filibuster. In the middle of that filibuster, he said exactly that. Senator Cruz, in the middle of the his filibuster, said that we all understand that you have to have the individual mandate in order to prohibit companies from charging higher premiums for people who are sick, and my Republican colleagues know that because they kept the individual mandate in their bill.

So this nonsense about no one's being required to buy insurance is belied by the text of the legislation we are considering. There is a mandate in this bill. There is a penalty in this bill. It is just a far meaner and crueler penalty than was included in the Affordable Care Act.

What do I mean by that?

So the Affordable Care Act doesn't mandate that you buy insurance in the sense that if you don't buy it, you will be locked up in jail; it says that if you don't buy insurance, you will pay a penalty on your income tax. If you don't buy insurance, there will be a penalty.

That is exactly what the Republican Senate bill says. It says that if you don't buy insurance, you will incur a penalty. In their bill, the penalty is that you will be locked out of buying insurance for 6 months. If you are sick, or even, frankly, if you are healthy and you need to go see a doctor for something, you will have to pay for that out of your pocket for those 6 months. If you are sick, and you have a serious condition and you are legally refused healthcare because of this legislation, the consequences could be dire, but whatever the scope of the consequences, it is still a penalty, just like there was a penalty in the bill that the Democrats supported and passed in 2009 and 2010.

So it is just not true to say that now Americans have the freedom not to have healthcare. You don't because you are going to be penalized if you let your health insurance lapse. If you don't make payments for a couple months, you are locked out of the insurance market. That is just a different kind of penalty than the one that is in our bill.

The truth is that while I admit there are some people who buy insurance today because they fear that penalty, it is necessary, as Republicans realize, in order to make sure the markets don't spiral out of control, because if you say that you can't charge people with preexisting conditions more and you don't require healthy people to buy insurance, then why would any healthy person buy insurance? They will just wait until they are sick because they know that once they are sick and need very expensive care, they can't be charged any more for it.

The nature of insurance is that people who have the good fortune to be healthy or to be free of accident or natural disaster subsidize individuals who are not so fortunate--who are sick, who do have an accident occur to their home or who are subject to a natural disaster. That is how insurance works.

Republicans realize that because they put a penalty in their bill, but for as many people who buy insurance because they are forced to, most people buy insurance because they want it because they recognize it is better to have insurance in the case that they or a loved one gets sick, and that is whom we are talking about here. Of the 23 million who lose insurance, according to CBO, under the Republican bill, millions and millions of those are those people who want insurance but will not be able to get it because they are priced out by the Republican bill. I can see there will be some people who will make that choice, but there will be millions more who had insurance today who will not be able to get it moving forward.

As Republicans finish up this latest round of secret negotiations, I just want to make sure we are on the same page about what this bill does. It mandates that you buy insurance, just in a different way. It has a penalty just like the Affordable Care Act has a penalty.

I want to make sure we remember what Republicans stated as their goals for this replacement. The goals were that the system would be better, but by every single metric, this proposal will result in worse healthcare for people. Less people will have insurance. Rates

will go up for everyone except for young, healthy people. Costs will continue to spiral out of control, and no additional measures will be taken to make quality better. Every single problem that Republicans address in the existing healthcare system gets worse.

Senator Barrasso complains mercilessly about these exchanges. CBO says the exchanges will shed even more people. The costs will go even higher. Senator Cornyn regularly tweets out that the Affordable Care Act still left 28 million people uninsured, but this bill you are debating will double the number of people who don't have insurance.

For all of my Republican colleagues who rightly come to the floor and talk about the fact that the cost is too high for individuals in our system, there is not a single provision in this bill that deals with the actual cost of the service, of the procedure, of the visit, of the surgery.

I am deeply worried that this next version of the Republican repeal and replace bill will result in premiums going up by 15 percent and only 17 million Americans losing healthcare and it will be declared a victory, but that is not what Republicans promised. They promised to repeal the Affordable Care Act and replace it with something that is better, not something that is less bad than the original version of the replacement plan they introduced.

I think the reason that to many people it appears this bill is falling apart is because when my colleagues went home this weekend, they heard an earful from their constituents--from real folks who will be affected by this piece of legislation.

Alison is 28 years old. She is from Milford, CT. She was in my office this week. She came to DC this week, she and her boyfriend, I think--I don't want to ascribe an engagement to them that is not true; I think her boyfriend. They came down here this week. They were supposed to be on vacation this week, and they decided to spend some of their vacation coming to Washington so Alison could tell her story to Members of Congress.

When she was 9 years old, she was diagnosed with a rare liver disease. At the time, she and her family were told that they would need to find a liver transplant in roughly 10 years or she wouldn't survive.

At the start of her sophomore year at Sacred Heart University in Connecticut, she was starting to have symptoms of a condition that results from a buildup of ammonia in her brain. She was having a hard time concentrating, abdominal pain, nose bleeds, nausea, vomiting, and joint pain. Her doctor said it was time for her to get that transplant, that she was at that critical moment when she needed it.

Unfortunately, none of her family or 8 other candidates--friends, I think, of the family--were a match. So in desperation, her parents wrote an email and just sent it out to people who lived in Trumbull and in the Sacred Heart University community. From that email, an anonymous young man stepped forward. He was tested and determined to be a match. The surgery was a success. When she walked on stage to receive her diploma from Sacred Heart University, she was joined by that anonymous donor, and her fellow graduates gave her a standing ovation.

Now, her family was lucky because she had insurance through her father. She is, because of the Affordable Care Act, allowed to do that, at the time being under 26 years old. Her insurance paid for virtually everything that was necessary, but, she says, had my dad not had the healthcare benefits he did, I know my family would not be in the place we are today because my parents would have lost everything they worked so hard for. There was no way we could have afforded to pay for all of those burdens.

Today she worries that if this bill is passed, she, as a young woman with a preexisting condition, will be destined to a life of discrimination because she may not be able to find a plan that covers her condition because of the withdrawal of protection with respect to the minimum benefits requirements. Even in Connecticut, she is vulnerable to that withdrawal of protection, not because Connecticut is likely to allow insurance plans to offer coverage that doesn't include the minimum benefits but because if you work for a big company, and even if you are housed in Connecticut, if that company anchors their plan in a State that does strip away the insurance protections, then you lose the protections even as a resident of Connecticut.

Alison is now a nurse in the neonatal intensive care unit at Yale University Children's Hospital. She is contributing in a big way to our State and to the healthcare system. Yet she is living in fear of this legislation being passed. So she took some of her vacation to come to Washington to share her story with us.

I am with Senator Collins. I think the Republicans should scrap this garbage piece of legislation. I hope they understand our offer is sincere--it is not political--that Democrats do want to sit down with Republicans and try to provide some reasonable fix to what still ails our healthcare system.

I will end with this thought: It doesn't have to be like this. Healthcare does not have to be a political football that is just tossed from one side to the other every 10 years. That is what has been happening here for my entire political lifetime. I was elected to Congress in 2006, in part because of the tempest of popular frustration with the way in which Republicans passed the 2003 Medicare Modernization Act, which included the new prescription drug benefit that Democrats saw--and sold--as a giveaway to the drug and insurance industries. Democrats used healthcare as a political cudgel to bludgeon Republicans after the 2003 Medicare Modernization Act. Its implementation was very rocky, just as the implementation of the Affordable Care Act was. The Democrats used it against Republicans.

In 2009, it was the Republicans' turn to bludgeon Democrats. Democrats lost a lot of seats in 2010, in part because Republicans used the passage of the Affordable Care Act to politically harm Democrats. Now, once again, it is the Democrats' turn to politically bludgeon Republicans.

Whether this bill passes or not, the fact that Republicans have walked out on a plank with a partisan piece of legislation that takes insurance from 23 million people across the country and, as every poll shows, is widely unpopular will be a political liability for Republicans.

What if we decided to stop tossing healthcare back and forth? What if we decided to jointly own one-fifth of our economy? What if we decided to sit down and give a little bit, from our side to yours, from your side to ours? What if I said that I understood you cared about flexibility in these marketplaces, that I understood your desire for more flexibility for Governors and State legislatures under Medicaid? What if you said you understood our interest in providing long-term stability in these marketplaces, that you understood our desire to try to get at some of the costs of the actual services and devices and prescription drugs that are sold? What if we sat down and fixed the things that aren't working, kept the things that are working, and held hands together and said that we are going to jointly own the American healthcare system?

It would leave plenty of things to fight over. There would still be no shortage of disagreements that we could run elections on. Whether it be immigration or taxes or minimum wage, there will still be lots of things we could disagree on, but for as long as I have been in politics, this issue has just been thrown back and forth, to hurt Democrats, to hurt Republicans. In the process, we have injected so much uncertainty into the healthcare system and into the economy at large, that we make it impossible for private sector reform to take hold.

Hospitals and healthcare providers have been doing really innovative things since the Affordable Care Act went into effect because they got a signal from the Federal Government that we wanted them to start building big coordinated systems of care, that we were going to reward outcomes rather than volume. So they started making all of these big changes, and then, about a year ago, they stopped because Republicans said they were going to blow up that model and pass something new. We frustrated innovation because we telegraphed that healthcare policy is just going to ping-pong back and forth between left and right. We hurt ourselves politically, we frustrate the

private sector innovation, and get no benefit to us on the economy.

My offer, and I think the offer from most of my colleagues, is sincere. If my Republican friends do choose to throw away this piece of legislation because it doesn't comport with the goals that Republicans have long said were at the heart of their effort to repeal this bill, there is an important bipartisan conversation about keeping what is working in our healthcare system and admitting together that there are big things that aren't working and fixing them together.

I yield the floor.

I suggest the absence of a quorum.

Mr. President, I want to pick up where my colleague from Hawaii left off. There is a wonderful analogy that President Obama used after the 2016 election. As you could imagine, Democrats were pretty dejected the day after, and President Obama put it pretty simply. He said: Listen, just remember, these elections are intramural scrimmages. We put on temporary pinnies, Republicans and Democrats, but in the end, we all belong to the same team. We are all Americans.

Elections and legislative fights are temporary skirmishes before we recognize and realize our greater identity, which is that we have this commonality. Clearly, that is not what the American people see here. They think our primary identity is our partisan identity, and there is a lot of days in which we give them fodder for that belief.

It really is amazing, when it comes down to it, that when you think about the healthcare system, we do have the same goals in mind. There are actually lots of other issues on which we don't have the same goal. Republicans want to go left, and we want to go right. Republicans want to go right, and we want to go left. On healthcare, we actually all want to get to the same place: More people have access to health insurance, the cost of that insurance is less than it is today, and the quality of the care people get is better. It is funny because underneath that, it is just mechanics. It is not actually ideology. It is a decision as to which lever you press and which you don't.

I get that a lot of my Republican colleagues don't think we are sincere when we say: If you put this monstrosity of a bill aside, we will work with you to do something better. But it is sincere. We don't want to blow up Medicaid. We are not with you on that. We don't want to pass along big tax breaks, only going to the very wealthy. But we get that you want some more flexibility for States. We get that you want maybe an additional plan offered on the exchanges that doesn't have all the bells and whistles the existing plans do. But you get that we want stability in the exchanges. We want some certainty in the markets going forward.

There is an important conversation to be had here. Our hope is that, with this CBO score, maybe it will be the straw that breaks the camel's back, that will cause our Republican colleagues to give up this nonsensical approach to healthcare reform and work with us.

I am going to repeat some of the ground that has already been covered here in the next few minutes, but I want to go over some of the highlights of this CBO report.

Senator Schatz previewed this, but it is hard to get your head wrapped around what it means for 22 million people to lose insurance.

This is an old chart from the CBO score on the House bill that held that under their approach, 23 million people would lose insurance. I X'd that out. We now have 22 million people who would lose insurance under the Senate approach. That is the entire combined population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, West Virginia, and South Dakota. All that happened between the House Bill and the Senate bill is that the people of Rhode Island got saved. I X'd out Rhode Island because Rhode Island has about 1 million people. About 1 million more people will have insurance under the Senate bill, but that is humanitarian catastrophe. That is a big deal, to have that many people lose insurance.

I know that is not what you set out to do. I know the Republicans didn't set out to do this, in part because I listened to Senator Cornyn come down and complain on the Senate floor relentlessly that the Affordable Care Act still left a whole bunch of people without insurance. In fact, he sent out a tweet today highlighting that the CBO does confirm that if current law continues, there will still be a lot of people without insurance. He left out the fact that the CBO says that under the Republican bill, 22 million more people will lose insurance, but that is a whole lot of people.

By the way, in the first year, CBO says 15 million people will lose insurance. Fifteen million people is the entire population of 13 States. That happens next year. Emergency rooms in this country cannot in 12 months absorb 15 million people losing insurance.

For all the folks who say that the ACA is in a death spiral, CBO says you are wrong. Very flatly, CBO says that if existing law remains, even without any improvements, the number of people without insurance effectively remains static. Yes, at the end, if you make no improvements, you will go from 26 million people not having insurance to 28 million people not having insurance.

CBO says--I had to change this because it used to be 51 million under the House bill. CBO now says 49 million people will lose insurance if you actually pass the bill the Senate is going to consider this week. The death spiral happens if we pass the Republican healthcare proposal. That is not a death spiral; that is stability. It is not an optimal result, 28 million people not having insurance, but it is far preferable to 49 million people not having insurance. I understand that Republicans will quibble with CBO and say that maybe they didn't get it exactly right. Even if they were 50 percent wrong, that is still over 10 million people losing insurance. By the way, just for good measure, CBO was right in their estimates of the percentage of Americans who would have insurance under the Affordable Care Act. Inside of their estimate--the details worked out differently--but they said that by 2016, 89 percent of Americans would have health insurance, up from 83 percent prior to the passage of the Affordable Care Act. Guess how many people have health insurance today: 89 percent of Americans, 89 to 90 percent of Americans.

We all agree that premiums should go down. If we are going to pass something, the result should be that premiums go down. Here is what CBO says: Premiums go up and not by a little bit. They go up by 20 percent in the first year. Admittedly, I am painting a partial picture here. That is 2018. After that, CBO says for certain populations in this country, premiums will go down, but it is largely for the young, the healthy, and the wealthy.

CBO says that you will have massive premium increases for older Americans. For lower income Americans who are in that age bracket of 50 to 64, premium increases will go up by at least two times, up to four times.

CBO also says that if you are lower income, you are not going to buy insurance because you can't afford it. It doesn't even matter what your premiums are because they will be so high, you can't afford them. Premiums go up for everybody off the bat--and for lots of vulnerable people after that.

So who gets hurt? Everybody, except for the folks who are getting tax cuts. If you are an insurance company, a drug company, or you are super rich--maybe that is an unfair term--people making $200,000 or more a year get tax cuts, but most of the tax cuts go to the super rich. People making over $1 million a year will do fine. If you are an insurance company, a drug company, or you are very wealthy, you get a great deal out of this piece of legislation, but pretty much everybody else gets very badly hurt.

Today, one of our Republican colleagues said this to a reporter--I won't give you a name. One of our Republican Senate colleagues, when he was asked about the Republican healthcare proposal, said: ``I am not sure what it does. I just know it's better than ObamaCare.'' That is about as perfect an encapsulation of the Republican positioning on this bill as I can imagine, because if you did know what it did--if my Republican colleagues did get deep into the CBO report, it doesn't solve a single problem in the American healthcare system. There are big problems, such as 26 million people still don't have insurance. This bill makes it worse.

People are paying too much for insurance, especially those folks who are making middle incomes who are just outside of qualifying for the Medicaid subsidies. This bill makes it worse. Almost every problem is made worse by this piece of legislation. I guess that is sort of what a lot of Americans wonder--if our Republican colleagues do know what is in this bill. ``I am not sure what it does. I just know that it's better than ObamaCare.''

This solves one problem for Republicans. It is a political problem. Republicans have said for the last 8 years that they are going to repeal the Affordable Care Act. My Republican friends promised it in every corner of this country, at every opportunity they had, and this does solve that political problem. If you pass this bill, you can successfully claim that you have repealed the Affordable Care Act, but that is the only problem it solves. It makes almost every other problem in this system worse.

The number of people without insurance goes up. Premiums, especially for the poor, the vulnerable, go up. There is nothing in this bill that addresses the cost of healthcare, of drugs, of devices, of procedures. There is nothing in this bill that talks about the quality of healthcare. Every problem--virtually every problem in the healthcare system gets worse.

I will just end by reiterating the offer that Senator Schatz made. I think you have a lot of people of very good will who want to work with Republicans and are sincere about it. I will be part of whatever group gets put together if this bill falls apart this week.

I held an emergency hearing in New Haven, CT, on Monday, just to try to explain to people what was in the Republican Senate proposal and to get people's feedback. It was hard to sit through. It was 2\1/2\ hours of some really scared folks.

I will be honest with the Presiding Officer. Most of the people who came had disabled kids. Most of the people who came had disabled kids who were on or relied on Medicaid, and they were just scared to death about what was going to happen to their children. But they also talked about the problems that still exist in the healthcare system--the fact that drugs are too expensive. Many of them pay too much for healthcare. They wanted those problems solved, and they wanted us to work with Republicans on it.

Senator Schatz was right. If we did it together, we would own it together. It would stop being a political football. While that would be a secondary benefit to the actual good that would come from a bipartisan piece of legislation that actually addresses the issues in the underlying healthcare system, it would be a pretty remarkable good that is possible because we have the same goals in mind. We both want the same things. It is just, in the end, putting aside this bill that makes all of those problems worse and, instead, sitting down together and deciding which levers we want to push to make things better.

I yield the floor.

Mr. President, I thank my friend from Hawaii for convening us here tonight.

This isn't theoretical. This isn't about numbers. This is about real people. We know them. They exist throughout our States.

I have told this story a few times before on the floor of the Senate. When I think about the progress that has been made over the course of the last 6 years, I think about Betty Burger. Betty is a woman who lives in Meriden, CT. Betty and her husband did everything we asked them to do. They were morally upstanding citizens, contributed to their community, had full employment, raised good kids.

Her husband switched jobs. He switched jobs, and he had a 1-week, maybe a 2-week period of time in between those two jobs. As luck--or lack of it--would have it, during that brief intermission between employment, their son was diagnosed with cancer. The cancer then became a preexisting condition, which meant her husband's new employer would not cover the son as part of a family plan. The cancer progressed and progressed and progressed, and this family, the Burgers, had no means to keep up with the payments.

Their story, unfortunately, is not foreign to folks who have heard from constituents who have gone bankrupt because of healthcare costs. The Burgers lost everything. The Burgers first went through their savings, then they went into their son's college account, then they sold their car, then they sold their house. They lost everything they had trying to make sure they had healthcare for their son simply because he got diagnosed with cancer during the one tiny interim between their family's insurance coverage. That preexisting condition doomed that family. There but for the grace of God--that could be us. That could happen to any one of us.

Yet, today, medical bankruptcy is, frankly, a thing of the past. Why? Well, it is not because healthcare costs any less; it is because we said we are not going to allow insurance companies to deny coverage to someone because they have a cancer diagnosis. In fact, we are not going to allow insurance companies to charge you more just because you are sick. Guess what. People have been able to keep their college savings account. They have been able to keep their car. They have been able to keep their house even if they get sick. That is what this bill has meant. Twenty million more people are insured, yes, but the number of personal bankruptcies in this country has plummeted by 50 percent, almost entirely because there aren't Burgers any longer. There aren't people who had to live through what the Burger family had to live through.

That is what this is about. This is about real people who are going to go through miserable, terrible experiences because of the bill Senate Republicans are just days away from putting onto the floor.

I know my colleagues have covered this exhaustively, but I just want to show visually what CBO says the House bill does.

I know it is in vogue for the President and Republicans to say that ObamaCare is in a death spiral, but that is not what CBO says. CBO says that if you keep the Affordable Healthcare Act and actually implement it rather than undermine it, rather than sabotage it, as the President of the United States is today, the number of people who don't have health insurance will remain fairly stable from 2017 to 2026. It is about 28 million people. But if you enact the American Health Care Act, the bill that passed through the House, that number goes almost immediately from about 26 million up to 40 million. Right about 14 million people lose insurance right off the bat. Like within a heartbeat of passing this bill, about 14 million people will lose insurance, and then, over time, it grows to 51 million people. That is not the affordable healthcare act in a death spiral. That is market stability. This is a death spiral. The death spiral starts upon passage of the act being secretly negotiated today.

I get it that 23 million is kind of a hard number to get your head wrapped around. What does 23 million people really mean? These numbers are so huge. So here is what 23 million people is. It is the entire population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, South Dakota, and let's just throw in West Virginia. That is what 23 million people is. That is a humanitarian catastrophe.

Remember, 23 million people is what you get to at the end of 10 years, but 14 million people lose it right off the bat. There is no way for our healthcare system to provide coverage to 14 million people who had insurance one day and then don't have it the next. By the way, they tend to be the sickest people because that is who is going to lose healthcare first.

Why are we doing this? Why would you choose to inflict this kind of pain on people? Why would you ask to run for Congress in order to put this kind of hurt on the American public?

Here is the answer. I wish this weren't the answer. I wish there were a different answer, but here is the answer. Twenty-three million people lose health insurance, and the cost of that is about $800 billion of money out of the healthcare system. It is not coincidence that that then gets transferred into 650 or so odd-billion dollars in tax breaks for the pharmaceutical companies, the insurance companies, and for really, really rich people. It is not just by accident that it worked out that the amount of money you took from poor people and from middle- class people and from sick people is the exact amount of money you are transferring to the pharmaceutical industry, the insurance industry, and rich people.

Here is another way of looking at it. Here is where the tax cuts go: The lowest quintile, the second quintile, the middle quintile, even the fourth quintile don't get a lot of money out of this tax break. It is the top quintile, the top 20 percent of income earners who get an average tax cut of $2,700.

Here is the big benefit: The top 1 percent of income earners--a $37,000 tax cut out of this bill. The top 1 percent of income earners get a $37,000 tax cut from this bill. Let me say that again: 23 million people lose healthcare so that the top 1 percent of income earners get a $37,000 tax cut. Who runs for Congress to do that? What constituency is asking for the U.S. Congress to pass a bill that takes health insurance from all sorts of working Americans, people who are playing by the rules--people like the Burgers--in order to pass a tax cut for the super wealthy?

I don't know what is happening behind those closed doors. I don't know

exactly what they are talking about, but I am going to guarantee you that it is not fundamentally different than what the House bill did, which is what I am describing here. There are still massive numbers of people losing healthcare, rich people getting a tax cut, and lots of folks getting hurt. Why? Just because Republicans made a political promise to do this.

I know I have other colleagues who want to talk. Let me turn for a moment to this process because the process does matter. The majority is breaking the Senate. They are breaking the Senate. Don't think this will not be how this works if you are in the minority. The fact is, we acknowledge that there is a lot that is still very wrong with the American healthcare system. Our constituents command us to try to make those things better. We would love nothing more than to sit down with the Republicans and try to figure out how we can come together on a path forward to make this healthcare system better. I know you don't believe us, but you didn't even try.

I am not sure we believed you at the beginning of 2009 when you said: We want to help people get insurance. We watched Republicans have control of the Presidency and the House and the time Senate for a long time without a lot of progress being made, but Democrats tried.

Democrats spent a whole year sitting down with the Republicans, trying to figure out if there was common ground--holding committee processes, exhaustive hearings. There were 30 days of Senate debate on the floor. I get it; in the end Republicans didn't support that package. I get that Republicans can lay blame at the feet of Democrats for not crafting something that could win Republican support. I understand how that argument works.

The fact is that when Democrats were in the majority, they tried. They opened up the committee process. They let everyone in the public see the debate we were having. Why? Because it is a big deal.

We are talking about one-fifth to one-sixth of the American economy. If you are talking about reordering that biggest segment of the U.S. economy, if you are talking about millions of people benefiting or losing, that shouldn't happen behind closed doors.

My constituents, even though they are represented by Democrats, have no fewer rights than the citizens of Iowa or the citizens of Texas who are represented by Republicans. Why are my constituents not allowed to see the details of what is about to happen to their lives? Why are only a select group of Americans able to have a voice inside that room? Why are the people of Connecticut going to get 3 minutes to look at this bill once it hits the Senate floor? My constituents are Americans, just as the constituents in Republican States are Americans. They deserve to know what is about to happen to them.

You are breaking the Senate. It will not get put back together that easily. These are tough questions. They are partisan questions, but it doesn't mean there is not an obligation to try to find common ground. If you can't find common ground, don't bury the proceedings behind closed doors where nobody can see it.

People hate this bill. They hate this bill. They hate it in part because they don't trust the process. When they see this balance--tax breaks for pharma, insurance, and rich people--and then losing coverage, they want to know why they lose and why super rich people win, but they can't get answers because it is all happening behind closed doors.

It is not too late. I will just end there. Senator Schatz said it right: It is not too late. My Republican colleagues can reject this and say: Let's start over. Let's sit down and see if there are some Democrats who want to work on stabilizing these exchanges, seeing if there is some middle ground, being able to build a bipartisan consensus when it comes to the future of the healthcare system.

It is not too late. I think you are going hear that consistently from my colleagues this evening.

I yield the floor.

I have yielded the floor, but I will happily engage in a colloquy.

I think we all got a gut punch earlier today. We received news that the young man who just returned from North Korea, after being abused and tortured there, had passed. If you read the statement from his family, it was hard to read. You couldn't help but read that without feeling your heart drop into your stomach. Why? Because this was a young man with such promise ahead of him, who had that future robbed from him.

I didn't know him. My colleague didn't know him. The people in my State who were similarly affected didn't know him, yet they felt something.

I think the reason this bill is so wildly unpopular is that people are going to die. The fact is, if people don't get coverage for addiction, if folks who are mentally ill don't get to see a doctor, they aren't going to survive. Even those who have enough money to be able to pay for the premium increases in this bill--they know there is something a little evil in wanting to do this to people.

As my colleague remarked, even if you are not amongst the 23 million people who lose insurance, the CBO also says your rates are going up because when those people don't get health insurance, they show up somewhere else in the system. They show up at the emergency rooms. They get much more expensive care. That cost gets passed on to the rest of us.

Even if you are lucky enough not to be amongst the 23 million, you are going to be personally, financially affected by this. The CBO says that everyone's rates will go up by 15 to 20 percent. Even if it is not the money you care about, we are all connected, and nobody should want this to happen to people. We are all weaker if we pass a piece of legislation that ends up hurting people in such a real, meaningful, and devastating way.

I think it is important to understand what the law says. The

law says there is only one healthcare provider that by law has to treat every single person who comes in the door; they can't turn away individuals based upon their ability to pay. That is the emergency room.

What we also know is that the emergency room is the place you get the most expensive care. By the time you get there, you are often in crisis. The care you receive in the emergency room is expensive, and then all of the care you need afterward is expensive as well.

I always remember a woman from Connecticut who lost her Medicaid coverage. In losing her Medicaid coverage, she didn't end up being able to see a doctor for an infection she had in her foot. It was hurting her for a long time, that infection. She didn't have Medicaid any longer, so she just decided to let it hurt. She popped some Tylenol and hoped it would go away. One day it was so painful that she went to the emergency room, and it was too late. It was too late. Her foot had become so badly infected that she had to have that foot--that leg below her knee--amputated.

She had no insurance, so we all picked up the cost of that, but she had her life altered in a way that is hard for us to fathom, and there is not a single winner in that scenario because, obviously, her entire life is changed because of that.

It is not as if we had saved any money in treating her so shabbily because we ended up having to cover all of those costs. That is one story. If you think about what the House bill does, it repeats that story millions of times over. It is morally bankrupt, but it is also fiscally imprudent and foolish.

There is, right outside this Chamber, a picture of the authors of the Connecticut Compromise, two of the Connecticut delegates to the Constitutional Convention.

I appreciate that shout out to Connecticut. You are right. The idea of the House is that it is supposed to respond, perhaps, more quickly to the temporary passions of the public, which is ironic, given that the passion of the public today is in deep opposition to this piece of legislation. Unfortunately, the House is responding to the passions of one very small portion of the public, which is the extreme Republican base, which maybe is the only remaining segment of this country that supports the American Health Care Act.

This place is supposed to be able to step back and look at the long term and look at the long view. That is why we have 6-year terms, so we don't do something that may feel good in the moment politically but has devastating impacts over the course of time. That is exactly what this debate is about. It is about a massive reordering of one-fifth of our economy that has just enormous consequences over time, when these people who lose insurance start to feel the effects of that as they bleed through their savings over 5 or 10 years and go bankrupt at the back end of that time period.

So this is a place where both parties should be able to sit down and talk about what this really means for folks. I thought Senator Schatz put it well. When you don't engage in regular order, not only do you do things that are very partisan and political, but you also do things that don't make sense.

One of the things that regular order brings is the ability to talk to experts. We all sit on committees, and those committees bring experts to the table to tell us what the impact of legislation is. There has been no committee process on this bill. We haven't had a single committee meeting. We had one hearing in the HELP committee upon which I sit.

So as Senator Schatz said, the result is a product that is garbage-- that, logistically, does not work because neither the House nor the Senate engaged in the kind of deliberation that would get you to the facts. Yes, this place is supposed to work differently, but also you are supposed to use the committee process to make sure that you are not passing something that just makes sense politically but makes sense from a policy standpoint as well.

Mr. President, while my friend's remarks on the motives of Democrats are fresh in people's minds, let me address this directly. There is a new President today, but there is a different policy, and that is what this resolution is about. Let me be very clear about what we are talking about today.

Senator Graham would have you believe that we are about to vote on the entirety of the $110 billion in arms sales that was proposed--that was unveiled--by President Trump during his visit to Saudi Arabia. That is not the case. We are voting today on $500 million of that $110 billion sale. You can still be friends with Saudi Arabia and sell it $109.5 billion worth of arms rather than $110 billion worth of arms. The specific set of arms that we are talking about--precision-guided munitions that are going to be used to perpetuate the Saudi bombing campaign in Yemen--was the specific set of weapons that the Obama administration refused to transfer to the Saudis at the end of 2016. We did not take a vote on this in 2016. We took a vote on a different arms sale.

It is not simply that there is a new President and that Democrats are objecting to the arms sale that President Trump is moving forward with. It is that we have a new policy. This specific set of munitions that President Trump is asking us to consent to is one that President Obama would not sell. The policy is different, not just the personnel. Let's talk about why the policy is different.

What is happening today in Yemen is a humanitarian catastrophe of epic proportions. There are four famines that exist in the world today. One of them is in Yemen, and only one of those four is caused, in part, by the United States. The United States supports the Saudi-led bombing campaign that has had the effect of causing a humanitarian nightmare to play out in that country such that 8 million people right now in Yemen are in starvation or are on the brink of starvation. Last week, we received word that 100,000 people in Yemen now have cholera. Cholera? All of this is directly a result of the civil war.

The reason that the Obama administration decided not to transfer the precision-guided munitions to the Saudis is that the Saudis were using the weapons we were giving them in order to deliberately target humanitarian infrastructure and civilian infrastructure inside Yemen. The Saudis have made it pretty clear that time is on their side, that they can wait out the Yemeni population and drive it to the negotiating table. They suggest that this humanitarian catastrophe, ultimately, accrues to their benefit because it eventually will push the Houthis into supporting a better deal than they would have otherwise for the Saudis.

Let me give you some direct evidence of how this bombing campaign is leading to the humanitarian crisis.

This cholera outbreak, which has been covered in the news, began, in part, because the Saudi airstrikes were targeting water treatment facilities inside Sanaa. This is independent reporting from relief agencies that operate on the ground inside Yemen that tell us that the Saudi bombing campaign that has targeted civilian infrastructure--in this case, water treatment facilities--has led to the cholera outbreak.

It continues. The bombing campaign that is leading to this catastrophe continues. The reason the Obama administration would not sell them this specific set of arms is that it did not have confidence that the arms would be used to hit purely military targets.

What we are asking for is to hold off on selling these precision- guided munitions until we get some clear promise--some clear assurance--from the Saudis that they are going to use these munitions only for military purposes and that they are going to start taking steps--real steps, tangible steps--to address the humanitarian crisis.

Senator Young has been very articulate on the things that the Saudis are doing to stop--to halt--to slow the flow of relief supplies into Yemen today. There are some proactive things the Saudis could do, which they are not, that could save millions of lives inside Yemen today.

More broadly, I think this is an important moment for U.S. policy in the Middle East. The Saudis are our friends. They are an important, stabilizing presence in the Middle East. They have helped to broker a kind of detente between Sunni nations and Israel, our sacred ally. They cooperate with us on counterterrorism measures. They share intelligence with us. Clearly, we have an important economic relationship, but they are an imperfect partner.

This body should have a debate as to whether it is in the national security interests of the United States to get drawn more deeply into the set of proxy wars that is playing out in the region between the Sunnis and the Shia. That proxy battle plays out in Yemen; it plays out in Syria; and it plays out in other ways in places like Lebanon. Just because you have a friend does not mean that you have to back every single one of your friend's fights. If my friend asks me to hand him a rock to throw at the neighborhood kids, I am not going to do it, but if he wants me to help him stand up to the neighborhood bully, then maybe I will be there for him. Even with your friends you decide what fights you join them in and what fights you don't.

In Yemen, it is not just I who is making the argument that the civil war is accruing to the detriment of U.S. national security interests; it is a broad swath of foreign policy experts and Middle East experts in this city and across this country and across the globe. Why? It is that this civil war is radicalizing the Yemeni people against the United States. They do not perceive this bombing campaign that is killing thousands of civilians as a Saudi bombing campaign. They perceive it as a U.S.-Saudi bombing campaign.

Just get your intelligence briefing, and look at the difference in the amount of space that AQAP controls today versus what it controlled before the civil war began. AQAP, which is the arm of al-Qaida that has the most capability to hit the United States, has grown exponentially in terms of the territory it controls. ISIS has grown as well. These extremist groups take advantage of the civil war, and if our priority in the region is really about defeating these organizations, then this civil war is not helping in that effort. Civilians are dying; extremist groups are growing; and the Yemeni population is being radicalized against us.

To exacerbate matters, the Trump administration has walked away from the political process. Secretary Kerry was actively involved in trying to bring the Houthis and the Saudi-backed government together. He got close to an agreement, but it fell apart. This administration has not restarted that process. For those who want to throw more arms into this contest, I think it is hard to believe that, ultimately, it will lead to any cease-fire or any peaceful transition to a new government if the United States is totally absent from the negotiating table as we are today.

This is not about objecting to the entirety of the sale, and this is not about delivering a broader message to the Saudis. This is about saying that this specific conflict in Yemen is not going well and is hurting the United States. Until we get some real assurances from the Saudis that they are going to pay attention to the ``no strike'' list, until we get some commitments from the Saudis that they are going to let relief supplies flow into Yemen to address the famine and address the cholera outbreak, then let's press pause on this small slice of this arms sale.

I am proud to join with Senator Paul and others, and I hope that my colleagues will see fit to support it when we vote in about an hour and a half.

I suggest the absence of a quorum.

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

Mr. President, I come to the floor very briefly to make what, I hope, is a reasonable recommendation to my colleagues on both sides.

We are due to vote later today on moving forward on a piece of legislation that I support. Last week, we voted out of the Foreign Relations Committee a new sanctions bill against the Iranian regime for its continued movement toward a ballistic missile program that, ultimately, could threaten the security of the Middle East and could threaten the security of our sacred ally in the region, Israel. It also speaks to Iran's continued problematic human rights record and its support for terrorism in the region.

We should move forward on this piece of legislation, but I would recommend that we not do so today. There is reason to have this debate, but given the terrorist attack that occurred in Iran, given the fact that today we know that there are 12 dead and 40 wounded in 2 very coordinated attacks, my worry is that, literally, at the moment of grieving in Iran, this resolution would look as directed not at the regime, as it is, but at the Iranian people. It would seem intemperate and, ultimately, do more damage than good.

This is an important resolution to debate. We can find the time to get this done, but given the unfortunate timing--obviously, not intentional in our moving this forward this week--given the attacks that just occurred and for which ISIS has claimed responsibility, I would hope that we could find a way

to move this to another time. I think it is really important because, ultimately, it is in the United States' national security interest for the Iranian people to get their way, who are, broadly speaking, Western-oriented and who, broadly speaking, want a democratic, internationalist future.

In everything we do, we need to make it clear that we have deep disagreements with the Iranian regime--its rhetoric toward Israel, its inflaming of tensions, its funding of proxy wars in the region--and that our beef is not with the people of Iran. From time to time, that is a difficult distinction to make, but it is a very important distinction to make. By choosing to postpone this debate and this vote to another time, I think we will send an important message to the Iranian people that we want to give them the time to grieve and that we want to give them the time to understand the scope of this attack.

I do not think it comes at much of a cost or loss to us. It is important to remember that when we were attacked on September 11, there were vigils held throughout Iran. The regime itself was not sponsoring those, but the Iranian people did stand up and, in substantial numbers, displayed a common cause with the people of this country--again, another sign that this disagreement is not with the people of Iran but with the regime.

Despite my having some reservations about this piece of legislation-- I do not endorse it wholeheartedly, but I am a supporter of it and will vote for it when it comes to the floor of the Senate--I would hope that the leadership on both sides of the aisle might find a path so as to give the people of Iran some grieving space, to make sure that we are not sending the wrong message with this vote this afternoon, and to find some time later this summer to take up a very, very important issue.

I yield the floor.

I suggest the absence of a quorum.

Madam President, I rise to speak on the same subject as my friend from Texas.

Listen, Democrats are ready to talk to Republicans about improving our healthcare system, but we aren't going to engage in a debate that presupposes that the end result is going to be millions of people losing care and rates going up for everybody in order to fund a tax cut for the wealthy. That is the plan Donald Trump and the Republicans are pushing.

So my Republican friend is right: Democrats are not interested in having a discussion about how many people are going to lose coverage. We are not interested in having a discussion about how high the rate increases are going to be. We are not interested in having a discussion about big tax breaks for millionaires, billionaires, insurance companies, and drug companies.

Let's be honest. If Republicans were serious about working with Democrats, we wouldn't be using an arcane Senate rule which allows them to push through a bill with 50 votes. If Republicans really wanted to work with Democrats on healthcare reform, they would do it through normal business. If Republicans were really serious about working with Democrats on healthcare reform, they would be going through regular order and going through the committee process.

Whatever we want to think about the Affordable Care Act, it went through the committee process. I think 160 Republican amendments were accepted in the Health, Education, Labor, and Pensions Committee in 2009. The Finance Committee held multiple meetings. The bill was on the floor of the Senate for a month. Republicans are jamming this bill through--no committee process, no committee meetings, no committee markups, no open-floor process.

Even Senator Corker called out his own party and said that this is no way to rewrite one-sixth of the American economy--13 male Republican Senators, behind closed doors, in secret.

Democrats are desperate to work with Republicans on fixing what is wrong with our healthcare system. Not every problem has been fixed, but we are not going to start with 17 million people losing healthcare or rates going up by 20 percent. And we want to do it in a way that is transparent to the American public, where everybody can see.

On the second point my friend from Texas raised--this idea that CBO got the numbers wrong when they estimated how many people would be insured by the Affordable Care Act in 2009--as he mentioned, they weren't off by that much, but to the extent they were off, there is a simple reason for it: CBO did not take into account that Republican States would seek to undermine the Affordable Care Act in every conceivable way possible. CBO gave Republican Governors and State legislatures the benefit of the doubt that once this law was passed, once it was presenting an avenue to insurance for millions of people across the country, both parties would seek to implement it. That is not what happened. Republican States refused to set up State-based exchanges. Republicans brought lawsuit after lawsuit to try to stop the Affordable Care Act from going forward. Republicans, in control of the House and the Senate, jammed through legislation that reduced the risk insurance provided to insurance companies. CBO did not estimate that Republicans would wage a 6-year-long campaign to undermine and undo the Affordable Care Act.

In States that implemented the act, such as Connecticut, numbers met or beat expectations. In States that didn't

implement the Affordable Care Act, sought to undermine it, numbers didn't meet the expectations.

Then comes President Trump, who openly telegraphs his desire to undermine the Affordable Care Act, cuts off all of the advertising, tells the IRS to stop enforcing the law, bleeds out payments to insurance companies one month at a time, teasing that this will be the last month they get their money.

Finally, on this question of a gun to the head of consumers--I guess that is a reference to the provision of the Affordable Care Act that says: If you don't buy insurance, then you will pay a penalty. That is absolutely part of the Affordable Care Act. Why? Because if you want protection for people with preexisting conditions, then you have to have a mandate that people buy insurance, or else people just won't buy insurance until they are really sick, knowing they can't be charged more.

Actuarially, the protection for people with preexisting conditions only works with the individual mandate. I remember Senator Cruz, during his marathon filibuster, admitting that. Republicans and Democrats know that. That is why the American Health Care Act, which just came out of the House of Representatives, includes an individual mandate. So let's not pretend like this is a partisan issue.

The rightwing American Health Care Act that came out of the House of Representatives 2 weeks ago includes an individual mandate--it is in there--because they know the same thing: If they want to preserve any modicum of protection for people with preexisting conditions, they have to require people to buy insurance. They just put the mandate in a different place. In the Affordable Care Act, the penalty kicks in if you don't buy insurance. In the House bill, the penalty kicks in after you have lost insurance and you try to sign up again. It is the same mandate, the same penalty, just a slightly different timetable for payment.

Here is what TrumpCare does: higher costs, less care, tax cuts for the rich.

I want to talk about the CBO score that came out last night--not major adjustments from the first CBO score, but there are some important amendments that they make. But the bottom line is that if you care about costs, there are going to be higher costs. That is what CBO says. There is a 20-percent increase in cost the first year, 5 percent in the next year for good measure. There is less care--I mean significantly less care--23 million people. Big improvement--24 million people lost care in the first House bill; 23 million people lose care in the second House bill. And all of this is done in order to pass along tax cuts to the wealthy. We are talking about $662 billion of tax cuts for the wealthy.

Here is what CBO says: Premiums are projected to rise 20 percent in 2018. So our Republican friends who came down to this floor for 6 years and said we need to repeal the Affordable Care Act because costs are too high just passed a bill in the House of Representatives that CBO guarantees will raise premiums by 20 percent in 2018.

And it got a lot worse. CBO says that if you are an individual with a preexisting condition and you live in a State that takes advantage of one of these waivers, the premiums, frankly, don't even matter to you because you won't be able to afford the catastrophic high cost associated with your illness.

If you are an older American, especially an older American living on Social Security, then you are targeted by the American Health Care Act. A 64-year-old making $26,000--and I have a lot of 64-year-olds in Connecticut making $26,000, and I bet a lot of my colleagues here who live in lower cost and lower income States have even more of this population--today you are paying about $1,700 a year for healthcare. That is what your premium is after taxes. Under the American Health Care Act, your premium would go up to $21,000 a year. You are making $26,000, and your premium goes up to $21,000. You would receive about $5,000 in tax credits, but in the end, you would be paying $16,000 in healthcare premiums.

Now, obviously you wouldn't be paying $16,000 in insurance premiums because you couldn't afford healthcare if you still want to pay your rent and you still want to pay your gas bill and you still want a few groceries.

The reason why massive numbers of people lose insurance is because 20 percent is just the average; for some people, premiums will go up 700 to 800 percent, especially if you are older or if you are lower income.

Here is what CBO says will happen if the Affordable Care Act stays: The number of uninsured will go up a little bit. It will tick up to about 28 million. But for all my colleagues on the Republican side who have been claiming that the Affordable Care Act is in a ``death spiral,'' CBO tells you that you are wrong. You are wrong. They state clearly that the marketplaces will remain stable. Now, again, they may not be counting on the kind of sabotage President Trump is engaged in. If President Trump continues to destabilize the markets, maybe this number will be wrong. But if you had an administration that was attempting to enforce and implement the Affordable Care Act, you would get about the same number of people who are uninsured.

Here is what happens if you pass the American Health Care Act: The number goes immediately up to over 40 million uninsured and peaks after 10 years at 51 million people.

Senator Cornyn said: Listen, we still have 30 million people who don't have insurance; let's try to solve that problem. But CBO says that the House bill doesn't solve the problem. It turns a problem of 28 million Americans without health insurance into a humanitarian catastrophe--more people uninsured at the end of this than were uninsured before the Affordable Care Act passed.

So I guess what Senator Cornyn is saying is that whatever product emerges from these secret meetings will insure more people and that CBO will verify that. That is something on which we can work together. Let me guarantee, that won't be the case.

To give a sense of how many people 23 million is, because I know that is kind of a hard number to get your head wrapped around, this is the number of people who lose insurance under the House bill, according to CBO. CBO's new numbers just came out last night. That is the equivalent population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, Nevada, New Hampshire, New Mexico, South Dakota, Rhode Island, North Dakota, and West Virginia. When we put up this chart a couple months ago, I think there was one additional State. So by moving from 24 million losing insurance to 23 million people losing insurance, one State came off this list. But that is the equivalent population of how many folks lose healthcare in this country. That is why I call it a humanitarian catastrophe.

Then let's just think about what CBO says about who benefits. Here are 23 million people who lose insurance--and that is a pretty simple formula. The bill takes insurance from 23 million people in order to pass along a $173 billion tax break for the pharmaceutical industry and the insurance industry and a $230 billion tax break for very rich people. Some of it will go to people making above $200,000 a year, but most of it will go to people making over $1 million or $1 billion a year. The numbers actually work out pretty squarely. The cuts to healthcare in the bill roughly work out to be about the same amount in tax cuts for the wealthy.

By the way, there is another chart here that is a great one. There is another chart that shows who benefits when we look at the tax breaks. If you make under $200,000 a year, you get zero benefit from the American Health Care Act. Every single dime of the tax cuts for individuals or families goes to those making over $200,000 a year. How about that--a $230 billion tax break, and not a dime of it goes to people making under $200,000 a year. So this bill was a nightmare before the CBO score, and it is even more of a nightmare today.

Let me point out one more important thing that CBO says about this bill. Inside this bill, in a new amendment that allowed it to pass the House of Representatives, is a provision that allows States to get waivers from the essential healthcare benefits requirement that insurance actually provide you coverage for healthcare and the community rating requirement that you spread out the costs of healthcare across the entire population of people who are insured.

What CBO says is that about one-sixth of the population--that is equivalent to about 25 States and Washington, DC--who might obtain waivers, including both the essential benefits requirement and the community rating benefit--that would result in insurance markets coming apart at the beginning of 2020.

CBO states that ``less healthy people would face extremely high premiums, despite the additional funding that would be available'' under the bill to reduce premiums. CBO says specifically: ``In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services.''

Let me put a finer point on this. The legislative jujitsu that Republicans did in the House to get this thing passed involved eliminating the requirement that people with preexisting conditions be protected from premium increases, combined with a high-risk pool that would have a bunch of money in it to help reduce premiums for those people.

CBO tells you essentially that those high-risk pools are a fraud. CBO says there is not enough money in the high-risk pools in order to provide any meaningful benefit for people with preexisting conditions. In particular, they say, women going through pregnancy, families going through pregnancy, and individuals with mental health and substance abuse will see thousands of dollars in additional costs because the money in the risk pools cannot cover the cost of that care.

We have an opioid epidemic raging throughout this country, and the House just passed a bill that will increase costs for people suffering from substance abuse by thousands of dollars. We can do better. Republicans can emerge from these secret meetings, set aside their plan to ram through this vote with no committee process through reconciliation, and we can start talking about what to preserve in the Affordable Care Act and what we need to change. That is what Americans want us to do.

The majority of Americans do not want this bill repealed. The majority of Americans today support the Affordable Care Act. Yes, that number is different than what it was a few years ago. Maybe that is because, faced with this benefit, faced with these insurance protections being eliminated, Americans are rallying to the defense of the Affordable Care Act. That doesn't mean Democrats don't believe we can make some commonsense amendments, but it does mean we are not willing to participate in a process that presupposes that the outcome will be less people being insured, costs getting higher in order to finance tax breaks for the very wealthy and for insurance companies and drug companies.

Republicans should come out from behind closed doors, work with Democrats. CBO tells you a humanitarian catastrophe is coming if you don't.

I yield the floor.