Floor Statements

Mr. President, today I wish to honor a champion for Detroit and for Michigan, Mike Ilitch. Everyone from Michigan knows his life story: the son of Macedonian immigrants, he founded Little Caesars Pizza, one of the largest pizza chains in the world, and rebuilt both the Detroit Tigers and the Detroit Red Wings into world class, winning franchises. He led the Red Wings to four Stanley Cups and brought the Tigers to the World Series twice.

The story of Mike Ilitch is the story of never doing anything halfway. He embodies the American dream: he served as a marine, built a business empire, and had an eye for perfection that led him to incredible success.

For him though, it wasn't enough to be satisfied with success in business or

sports; it was all about giving back. He said it himself: ``I was raised in Detroit. I came from zero. This community helped make me. It's nice to give something back.''

He loved Detroit and worked to revitalize the city while maintaining its cultural history. His company, Olympia Entertainment, purchased the Fox Theater and restored it in 1988. He built Comerica Park, home to the Tigers. His recent $40 million donation to the Wayne State University School of Business will help build their state-of-the-art facility on Woodward Avenue, next to the new home of the Red Wings and the Pistons, Little Caesars Arena.

Detroit is better off because of the work that he did. And the people of Detroit are better off because of his work. From his philanthropic organization that has given to those in need and the program he started through Little Caesars that helps honorably discharged veterans get employed, Mike Ilitch gave people a chance to succeed and to thrive.

Mike will be sorely missed by all of us. His legacy is shared by his loving wife of over 61 years, Marian, and his seven children, but it is also shared by everyone in Michigan and all of those who love Detroit. Thank you.

Thank you very much, Mr. President.

The decisions made by the next Secretary of Health and Human Services will affect all of us, and that is why we are here. That is why we have spent so much time and will continue to talk about the issues. This is not personal with the individual, this is about everyone in our country and how they are impacted by the ideas and the policies of this individual as well as the person who has nominated him.

This particular individual has a very clear record as to what he believes should happen as it relates to Medicare and Medicaid, and our entire health care system. More than 100 million people rely on programs like Medicare--seniors, people with disabilities on Medicare. With Medicaid, the majority of money spent through the Medicaid health care system goes to seniors in nursing homes. That is where the majority of dollars go, long-term care for seniors. So Congressman Price's ideas, his proposals, the things he has pushed in the House matter because they show us what he believes should happen to Medicaid and to Medicare.

We need to make sure the next Health and Human Services Secretary will fight for the health care of families in Michigan--at least I need to be sure. That is where my vote goes, based on what is best for families in Michigan. That is what is best for our communities, rural communities, where the hospital, like where I grew up in Clare, was the largest employer in the community, greatly affected and impacted by what happens to Medicare and Medicaid funding. If the hospital is not there, chances are the doctors aren't there either or the nurses. Our larger communities are where, obviously, our hospitals are critically important as well.

So when we look at communities and hospitals and doctors, families, children, seniors, and the broad economy--and, by the way, one-sixth of the whole economy in our country is connected to health care. So who is in charge as Secretary of Health and Human Services is a big deal. That is why we have focused so much on this individual, his policies, his ideas, and his own background as well.

As we have gone through the confirmation process, it is clear to me that Congressman Price's policies do not--do not--have the best interests of the people I represent in Michigan at heart, which is why I will be voting no on his confirmation.

I have heard from thousands of people around Michigan. I have heard from people who like our hospitals and live in the community, and businesspeople and nurses and doctors with great concerns. I have also heard from people around the country and have helped to lead a forum for people to come and speak, people who were not invited into the actual hearing for the confirmation hearing. I thought it was important, as did my Democratic colleagues, to have a forum where people could speak about the ideas, the bills, the policies that Congressman Price has passed in the House of Representatives.

So we heard a lot of stories and, overwhelmingly, people were opposed to this nominee.

One of the people who shared her story was from Michigan. I was very appreciative that she came in from Michigan. Ann was diagnosed with multiple sclerosis when she was 4 years old. It resulted in functional quadriplegia. She has limited use of her right arm and no use of her left arm. She was fortunate to have strong employee benefits and to be covered until she went on Medicare at 65. By the way, this nominee thinks the age should go up--66 or 67, I am not sure how far. But Ann made it to 65 and, like so many people I know, was holding her breath to get there so she could have comprehensive quality health care that she paid into her whole life called Medicare.

Over the course of the last few decades, the price of her prescription drugs have skyrocketed and would cost her tens of thousands of dollars a year without Medicare and Medicaid. For her, the decision about our Health and Human Services Secretary makes an enormous impact on her life.

She told us: Without Medicare and Medicaid, things would have been very different for my family. I don't know how I could have cared for my mom on top of managing my own care. My family would have lost our home, all of our savings, trying to keep up with the bills. So many families are squeezed like ours, having to afford care for their aging parents and their own care, or childcare at the same time. But with support, we don't have to suffer to just be alive.

If these programs are cut, if we see the kinds of proposals on Medicare and Medicaid that Congressman Price has put forward in the House, in the Budget Committee, people will face more catastrophes than ever before.

Our new President campaigned on a promise not to cut Medicare and Medicaid. He said himself: ``I am not going to cut Social Security like every other Republican, and I am not going to cut Medicare and Medicaid.'' But it doesn't square with the person he has nominated for this critical position, who will be making administrative decisions as well as leading his efforts on health care. So actions speak louder than words, at least that is what we say in Michigan.

Just this fall, Congressman Price said he expects Medicare to be overhauled--overhauled within the first 6 to 8 months of Trump's administration. He also believes the age of eligibility needs to increase--his words--and that ``the better solution is premium support.'' What does that mean? That is another word for voucher. Some people say privatization. But basically instead of having an insurance card and a health care system where you can go to the doctor and know that you are covered with insurance, you get some kind of a voucher or an amount of money, and then you would be able to go find your own insurance, I guess, or figure out a way to pay for your insurance.

Before Medicare, seniors were trying to figure that out and couldn't find affordable insurance in the private market, which is why, in 1965, Medicare was created. There is no way in the world I will support going backward to that kind of approach.

As chair of the Budget Committee, Congressman Price proposed a budget that would have cut Medicare by nearly $500 million, not counting what he wants to do with Medicaid, the majority of which goes to fund senior citizens in nursing homes.

We need to have a Secretary who supports making it easier and more affordable for people to get care, not less.

Let's talk about health care for a moment in the broader sense. We know more and more people--some 30 million people--would be affected, their health insurance ripped away, if the repeal is passed that has begun--the process has begun by Republicans in the House and in the Senate. The Affordable Care Act has provided health care and the opportunity for people to get care for children to be able to see a doctor. There are parts of the country where we need more competition, where prices are too high. I want very much to work on that. I am committed to working to make that system better, and we can do that without ripping the entire system apart.

There is also another part of the Affordable Care Act that affects every single person with insurance--things that I know have made a tremendous difference to anybody with employer-based insurance; first of all, being allowed to have your child on your insurance until age 26; secondly, knowing that if you get sick, you can't get dropped by your insurance company, and if you have a chronic disease, something has happened to your health, you can't be blocked from getting insurance; and we also know things like making sure you can get all the cancer treatments your doctor says you need, not just those up to the cap that the insurance company will pay for. I had pediatric cancer physicians tell me they have been able to save children's lives who have cancer because there was no longer a cap on the amount of care.

Mental health and substance abuse services, where if they were covered at all before the Affordable Care Act, it always cost more money: higher copays, higher premiums. Now you can't do that. You have to have the same kinds of copays and the same kinds of premiums.

So many patient protections have basically said to insurance companies: You don't get, just based on profits, to decide what is going to happen; that when you buy insurance, you actually

get health care. And that is something true for everyone today.

So we have a Secretary nominee who supports doing away with all that, changing all that, who is not someone who is interested in having a basic set of services identified in health care, like maternity care. I talked with him, questioned him in the Finance Committee. This is an area I had championed when we passed the Affordable Care Act to make sure that basic services for women were viewed as basic services in health care, and it starts with prenatal care and maternity care. Prior to the Affordable Care Act, it was very hard to find private insurance that covered maternity care, unless you wanted to pay for--some 70 percent of the plans out in the private market require women to pay more. So I asked Congressman Price, did he believe maternity care was a basic service and should be covered under basic insurance. He said: Well, women can purchase that if they need it, which is exactly what happened before--which is, no, it is not basic care, but you can purchase it on top of your regular premium, if you need maternity care.

So right now the law says you can't discriminate and charge women more than men, and in fact being a woman is no longer a preexisting condition.

But the person whom the President has nominated for Health and Human Services would take us back there, and he would take us back there on a whole range of areas that create access for people to be able to have the care they need.

Here is an example from a doctor in west Michigan who wrote me regarding just basic medical care for someone in need. He said:

In December, a young man arrived in our emergency room with

a badly mangled hand from a machining accident. He knew the

hand was seriously injured and was willing to allow his

coworker to bring him into the hospital so that it could be

stitched up. When our physician studied the wound, they knew

he needed surgery to repair the bone and blood vessel damage.

The patient refused, thinking the only thing he could

possibly afford was stitches.

They then connected this man with a financial services specialist who took a few minutes to find out that he was eligible for Medicaid, working; now, because of the expansion, able to receive health care under Medicaid. He was then able to get the surgery he needed.

Beaumont physicians said that if the surgery hadn't happened, the man could have had an open wound for an indefinite amount of time, been prone to infection, and possibly lost his hand entirely, making him unable to ever work at his job or maybe any job again.

Expanding Medicaid health care to working people is a good idea, and millions of people have been impacted and have been able to get the care they need for themselves and for their children.

Access to health care saved this man's arm and possibly his life, and that is really what is at stake here, both with this nominee and the larger debate on where we are going to go in our great country on the whole issue of health care.

We all know that the advice of the Secretary of Health and Human Services will be a strong influence on the President's decision to promote, to sign, to veto legislation. We know he has the ability administratively to do a number of things--to cut off care, to cut off access to women's health care, to change the system that we have now, to destabilize it so that the Affordable Care Act will not work. I am extremely concerned that because of Congressman Price's record and his actual proposals and decisions and votes, he will be willing to actually do that. Whether it is cutting Medicare or Medicaid or removing some of the critical policies that keep people healthy and care affordable, I am deeply concerned about the decisions this nominee will make and the recommendations he will make to the President of the United States.

Again, we don't have to speculate about this. He has put these plans on paper. He has supported them. He has passed them. It is very clear. We don't have to guess where he wants to go: to dismantle Medicare as we know it, to gut Medicaid, most of which goes for seniors in nursing homes, and to unravel the entire health care system and the patient protections that every American who has insurance has right now that allow them to get the health care they are actually paying for.

I need to raise one other thing because this is very serious and goes to serious issues surrounding conflicts of interest and likely ethics violations that relate to this nominee.

There are a lot of unanswered questions and serious concerns related to Congressman Price's investments in health care and pharmaceutical companies. Frankly, he misled the Finance and the HELP Committees with answers to questions, and just the night before he was to have a confirmation hearing and vote, we learned from company officials that he got a privileged offer to buy stock at a discount. In other words, he got a special deal on health care stock. He told us he had not; they had paid fair market value, even though it was already an issue that he had purchased stock and then put legislation in related to similar companies or the same companies involved. But then we found out it was even worse because he got a special deal.

As Democrats, we asked for answers. We did not want to move forward without asking the Congressman to come back before us so we could ask questions about what he had said to the committee versus what the business that sold him the stock said afterwards. Unfortunately, that did not happen, requiring the Finance Committee to be in a situation where the rules ended up being broken and the nomination was forced through the committee without having bipartisan participation.

I have a number of concerns related to the ethics and possible legal violations of this nominee. On multiple occasions, he did purchase stock within days of introducing legislation that would have affected that company's bottom line and his investment. Despite multiple requests over several weeks, we still don't have the answers and, more importantly, the American people don't have the answers from the person who will oversee health insurance, oversee Medicare, Medicaid--the entire system. Someone who has invested and then helped the same companies indicated he didn't get a special deal, and now we have information that says otherwise. I think that is very concerning and should have been addressed before we were asked to vote on this particular nominee.

There are a number of reasons--policy, track record, questions that have been raised that I find extraordinary that they haven't been answered and shocking that folks haven't felt they should be answered at this point. But for many reasons, it is my intention to vote no on behalf of the people in Michigan who care deeply about a strong, effective Medicare system, about making sure Medicaid is there for our children as well as our seniors and nursing homes, and for everyone who believes that in this great country, all should have the ability to see a doctor and get the medical care you need for your child or yourself.

Mr. President, I yield the floor.

Mr. President, before my colleague from Oklahoma leaves the floor, while we disagree on this current debate in terms of voting, I just have to say when I see him that I constantly thank him for his efforts last year to work with us for the community of Flint. We are finding some hope in terms of replacing and addressing the lead contamination, and without the distinguished Senator from Oklahoma, that literally would not have happened. We have things we disagree on and agree on, and this one--coming together with the families of Flint, particularly with the children and the water impacts--he will always have a warm place in the hearts of all of us who care deeply about that issue. I thank my colleague very much.

Mr. President, I want to speak today about the nomination of Betsy DeVos. Betsy DeVos's nomination is very personal to many people who live in Michigan because Betsy DeVos is from Michigan, and her vision of education and her actions have unfortunately played a major role in undermining our public schools.

Families all across our State can tell the story of her work with Michigan

schools firsthand because they have seen it firsthand. They have lived it firsthand. They all say the same thing. Democrats, Republicans, Independents, people who live in cities that are big and small, parents and teachers, principals, and community leaders from across the State-- overwhelmingly, they have told me that Betsy DeVos should not be our next Secretary of Education.

Everywhere I go, I can't believe how people will stop me about this and how strongly people feel in Michigan about this. They are saying this because, among other things, she has pushed for policies that have made charter schools in Michigan less accountable and has taken dollars away from public schools where the vast majority of children get their education. These are policies that have hurt our children and put their futures at risk.

I have received so many emails and phone calls from people involved every which way; at the grocery store, out at public events, people come up to me. I just want to share a couple of e-mails.

Chris is a teacher from Harper Woods and worked as a teacher in the Detroit public schools for over 20 years. He wrote: Betsy DeVos believes in school privatization and vouchers. She has worked to undermine efforts to regulate Michigan charters, even when they clearly fail. The marketplace solutions of DeVos will destroy our democratically governed community schools. Her hostility toward public education disqualifies her.

Those were Chris's comments.

In Michigan last year, State legislators put together a bipartisan plan, and our State legislature--House and Senate--majority is Republican. They put together a bipartisan plan to increase both funding and accountability for Detroit public schools.

There are a lot of wonderful things happening in Detroit. Businesses are coming back to Detroit, and economic development is also, but we have major work to do for our children and their schools. So there was a huge bipartisan effort that came together to increase funding and accountability for the public schools, including charter schools. It was a commonsense proposal. Betsy DeVos led the effort to stop it, particularly the part that brought critically needed public accountability for for-profit and nonprofit charter schools.

Unfortunately, right now in Michigan we have a system where anyone can apply to open a charter school. There are no statewide standards for revoking the charter, and taxpayer money is sent to them with virtually no public disclosure requirement. For example, we have for- profit charter management companies that say they are private businesses; therefore, even though they are getting public money, they say they are private businesses, and they should not have to comply with a series of disclosure requirements regarding teachers and other information that, frankly, parents would want to know and taxpayers have a right to know.

Thirty-eight percent of charters in Michigan are at the bottom 25 percent of the schools in our State. When you look at the bottom one- fourth, 38 percent of the charters are in that category, and there is unfortunately very little accountability for their performance.

Sadly, precious taxpayer dollars have been taken away from public schools--neighborhood schools--to fund these charters. When it comes to funding for public schools, she will not commit to protecting the critical Federal dollars that serve our children.

One mom, Hillary Young from Detroit, came to Washington to watch the confirmation hearing on Betsy DeVos in the HELP Committee. She wrote to me. She said that she was not impressed and told a group of parents afterwards: As a parent I can't stand silently and watch other children be subject to similar circumstances to my child in Detroit. My sixth grader was without a math teacher for over half the year last year because of funding reductions. The effect of DeVos's policies is not parents voting with their feet to go to better schools; it is children bearing the burden for fixing the education system they are supposed to be served by.

She goes on to say: DeVos's free market school choice system has left our city's education landscape in chaos, leaving less choice, less quality, and even more government bureaucracy.

We have seen parents get involved and speak out all across Michigan and, frankly, all across the country. I have received more mail, more emails, more phone calls on this nominee than any other, and I have received a lot on a lot of nominees, but there is a broad outcry.

People like Kathleen, who is a farmer and a grandmother from Farmington Hills, wrote to me: We have 15 grandchildren who are in the public school system, and we are terrified that there will be no more public schools and that the quality will be far inferior to charter and other private schools. I am writing you to respectfully ask that you do not vote to confirm Betsy DeVos as Secretary of Education.

I am deeply concerned about what we heard in committee about her views on special education. In the HELP Committee hearing last week, she suggested that States should decide on whether or not to enforce IDEA, the Individuals with Disabilities Act that has been such a landmark, opening doors of schools in every neighborhood across our country, for children with disabilities. This law was enacted in 1975, and makes sure that children with disabilities have the same educational opportunities as other children.

My nephew Barry, who has now gone through the special education system in Michigan, is a wonderful young man with Down syndrome. And I have seen personally how important that was for him, to be able to go on and be successful in the community as a part of the community. It is a very important civil right, frankly, for children with disabilities, as well as an essential part of our educational system.

Betsy DeVos, after her hearing, when she was asked about special education, followed up with a letter days later and wrote about expanding the conversation about school choice opportunities for parents of children with disabilities, but she didn't say anything about helping those in traditional public schools or helping students in the schools they are in now.

For me, this is not about politics or partisan messaging or even charters or private schools versus traditional public schools; it really is about what is best for our children and for our country. Families in Michigan and all across the country know this. Tens of thousands of people have called me over the last few weeks and sent emails and letters. Who we choose to be the Secretary of Education doesn't just affect the over 50 million children who attend public elementary and secondary schools, it affects the future of our country, and it is a fundamental difference in views. A competitive free market system, with winners and losers, works in the private marketplace. I support that. Business is open. They compete, and if they don't do well, they close, or they do very well and they go on and they grow. That is a strength in our country. But it doesn't work for educating our children because we can't afford losers. We can't afford losers when it comes to something as basic as fundamental education and creating opportunity for our children in the future. We need to provide every opportunity for every child to work hard and succeed.

I support having choices. I support magnet schools and public charters--I did that as a State Senator--as well as other choices that are great opportunities for children, if there are equal standards and public accountability for taxpayers' dollars so that parents can have confidence in that accountability, and if it is part of the public school system, the public process, and only if they are in addition to quality neighborhood schools in every neighborhood and in every ZIP Code. It is not just a slogan to say it shouldn't matter where you live, what kind of opportunity you get or that your child has, and that is becoming more and more true. It certainly is in Michigan, where this philosophy has been a test case, and we are seeing it across the country. We can't afford losers. A winners-and-losers system is not good enough for our kids.

Betsy DeVos has a record of working against the vision of accountability and standards and choice within a system where every child has a quality neighborhood school in their neighborhood in every ZIP Code. She has worked against that vision. She doesn't believe in it. We have fundamental differences in what will help our children

for the future. That is why I will be voting no on her confirmation.

Thank you.

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

Thank you very much. Before asking my question, I want to thank the senior Senator from Washington State for her leadership and passion on behalf of my children and on behalf of myself. As a product of a small rural school in Northern Michigan, my two children went to public school, and my two grandchildren are now going to public schools.

I want to thank you for your leadership, and I am so grateful to all of our colleagues and our two Republican colleagues who are joining us today.

Would you agree that when we look at this--and I certainly have a bird's-eye view. We in Michigan have lived what has happened in cutting public schools and moving dollars to private, for-profit, nonprofit charters without virtually any accountability. Would you agree that essentially we have a nominee who is looking through a lens of a private sector for-profit model, where in the private sector we have winners and losers, so you can have a business open and close. That is based on our private marketplace. It works well, but in education it is different. We can't afford for any of our children to be losers in education, and it just doesn't work to have this competitive marketplace; that what we need is a quality public school along with public choices. I support public charters with accountability and other choices, but what we have is a view of a nominee, someone who has not been involved in public schools herself, or her children, and so on, who comes at it from this perspective of winners and losers in the private market, and we cannot afford any child to be a loser as it relates to their education.

Mr. President, I want to talk specifically for a few minutes about mental health care and about an amendment that I will be offering this evening. But I do want to start off by stepping back for a moment and indicating that, from my perspective, I know those of us on the Democratic side of the aisle understand that we have work to do together to continue to bring down costs for health care and, in some areas where there is not enough competition, in fact, to create that competition. Affordable health care is the goal for all of us. I have concerns in looking at my small business community that we continue to do things that support them. That is different than what we are being asked to vote on here.

What we are being asked to vote on is a repeal of health reform that touches every American and all of the patient protections that we put in place that have moved total control from insurance companies to people with insurance so that we can't quit a job if we get sick. If you have a preexisting condition, are a diabetic, or have heart disease or you had some other challenge or your child has, you know that you will have confidence that you will continue to be able to find insurance and see your doctor. There are all of the provisions that are here--young people up to age 26, all of the efforts that we put in place to make sure that you have the confidence and the ability to know that you have insurance. We need to ensure that if someone has cancer, they are not going to be capped with the amount of care they can get.

Yesterday in the capitol in Lansing, MI, there were physicians and pediatricians working with cancer patients, with children and their families, who were talking about the fact that, because of the Affordable Care Act and taking off the caps on the amount and kinds of treatment that children with cancer can get, literally, lives have been saved. Parents are now looking at this body and the Congress as a whole and the new President and are saying: Why in the world would we want to go back to a situation where people can't get the level of care, the quality of care, or, in some cases, the care at all for themselves or their families?

So we are proposing that, rather than repealing health reform, which unravels the entire health care system because part of it is Medicare, part of it is prescription drugs going back up--it weakens the Medicare system, and it weakens the Medicaid system, where most of the dollars are going to seniors in nursing homes. It creates a situation where someone who is working very hard at a minimum-wage job and hasn't been able to have insurance because their employer didn't provide it can now have the assurance that they can care for themselves and their families and see a doctor without using the emergency room for regular treatment, which, of course, is the most expensive way to get health care and drives the costs up. What is being proposed is that we unravel all of it and literally create chaos in the system. We are for affordable health care, and we are willing to work with anybody at any time. I, certainly, will be ready and willing to do that. But I reject the idea that we are going to repeal and unravel the entire health care system and create chaos for families, businesses, and communities. There are many communities where the hospital system is the major employer in the community. Health care is one-sixth of the entire economy and is going to be impacted by this.

I want to specifically speak about the importance of accessible and affordable mental health services and what we have been able to achieve with protections established by the Affordable Care Act that ensure people can receive care. We have come a long way since over 50 years ago when President John F. Kennedy signed the Community Mental Health Act and put down a marker about the importance of treating health issues above the neck as well as below the neck. Comprehensive health care should affect every organ, every part of the body, every kind of disease. We have made major steps in that direction. We have a long way to go to get the comprehensive care we need in the community, but we have made major steps forward, including bipartisan efforts here related to the Cures Act, as well as the efforts that Senator Roy Blunt and I have been working on to make sure the payments for providing services in the community are the same for mental health and substance abuse services as well as physical health. So we have made steps forward, but the reality is that repealing the Affordable Care Act will take us backwards in a major way.

I have introduced, along with colleagues who are also champions on this issue--Senators Cardin, Murphy, Durbin, and a number of other Democratic colleagues--an amendment that would help to prevent passage of any legislation that would reduce or eliminate services and access to mental health care. This is an amendment that should not even be necessary, particularly given the fact that we have worked in a bipartisan way on other pieces of legislation to move forward.

I don't know why we would ever pass something that reduces or eliminates access to mental health or substance abuse services such as opioid treatment. Why in the world would this body come together and jeopardize work we have already done, essentially ripping it apart? The repeal of the Affordable Care Act and the cuts to the Medicaid Program do exactly that.

Why is this important? Well, nearly one in five adults in our country has a mental illness. About 4 percent of adults have serious mental illness. Unfortunately, even now, with work we have been doing, we still have over 60

percent of people who don't receive the full treatment they need. We should be working together on that, not taking away the access to treatment that people already have.

This touches all of us in one way or another. I think all of us--our families, our friends--know someone. In my case it is very personal. I grew up with a loving, wonderful father who became ill when I was in elementary school. He was misdiagnosed and mistreated for years, and finally was accurately diagnosed as being bipolar, meaning he had a chemical imbalance in the brain. So contrary to other people who may have a sugar imbalance and they take their insulin because they are diabetic or they may have some other chemical change or imbalance where they can get treatment that has been covered under health insurance, if it is a chemical imbalance in their brain, up until the Affordable Care Act, it was not required to be covered under health insurance. It was not required, even though we passed policies stating that there should be mental health parity. For the first time, in the Affordable Care Act, we said in every definition that, when we talked about health care, it would include behavioral health, mental health, and substance abuse. As a member of the Finance Committee, that was a top priority for me. I indicated to the chairman at the time that I would not support any health care reform that did not define essential health care benefits as including mental health and substance abuse services. We know that definitions drive every new system, and we were successful in making sure that, in every part of health reform, we defined health care in a comprehensive way for the first time.

Mental health used to be considered a preexisting condition--not any more. Health insurance companies can no longer deny you coverage or raise your rates because you need mental health treatment. My dad struggled with that throughout his life. When he was finally diagnosed correctly and got the medications and the help that he needed, he never went back into the hospital again. I have seen what happens when someone doesn't get the help they need and when they do and the challenges to the families as well, and I am committed to making sure that services and treatment are available for every family.

Americans now have coverage for preventive services like depression screenings with no cost-share. You can see your doctor to get help without breaking the bank. Mental health and substance abuse are also now guaranteed benefits, as I mentioned before. They are covered as essential health care benefits. Why in the world would we not want to do that? Why would we say we want people to have access to health care, but it depends on what part of the body your disease is in?

That makes absolutely no sense. The Affordable Care Act makes sure that our law defines comprehensive health care from your head to your toes. It is the right thing to do.

These are all commonsense reforms, and we cannot afford to roll this back. A Harvard Medical School and New York University study released just this morning shows that if the ACA were repealed, 1.2 million Americans with serious mental disorders and 2.8 million Americans with substance abuse disorders would lose some or all of their coverage. This is 4 million people losing treatment that is allowing them to get help, move on with their lives, and be productive citizens as we all want to be and as we all want to have available to our family members.

Think of all the millions more who could again be in a situation of not being able to afford insurance once relabeled with a preexisting condition. The opioid treatment gap--the gap between the number of people who seek services and those who can find or afford--would increase by 50 percent if the ACA is repealed. There would be 50 percent more people unable to find or afford services.

We just had major debate on the floor and passed grant funding to help with this very serious issue. But why in the world should we say for a critical part of health care affecting every family, one out of five Americans, that it will be only around grants and not a part of our comprehensive health care system?

What happens now? The grant runs out: Gosh, I am so sorry you are sick. I am so sorry that you need to see a therapist or that you need medications. I am so sorry the grant ran out.

I don't think we would do that to somebody who had a heart attack: I am so sorry you have had a heart attack. You need surgery, but the grant ran out.

But with mental health illness, that is what happens every day. That is what happens.

Frankly, it is outrageous that we don't have a comprehensive health care system that is completely treating and responding in every way and reimbursing physicians and nurses for all of the different kinds of treatments, services, and medical help they provide.

We have put into law in the ACA that insurance companies cannot discriminate, you cannot have larger copays, you cannot have caps on services, you cannot have larger premiums--and this is a fundamental baseline right that we have placed into law as it relates to access to mental health and substance abuse services. To see that ripped away from Americans across the country is unbelievable to me. It is totally unacceptable.

The amendment we are offering would create a budget point of order against any legislation that comes to this floor that reduces access to mental health services for children, for adults, for seniors in this country. I would hope that all of us could join together and state through our votes that we understand how important these services are and what a difference they have made. Right now, repeal of the ACA means 4 million people will lose those services, not counting all of the others that would be blocked because of future access problems and preexisting conditions and caps on services and all of those patient protections that go away.

I hope that we will join together in a bipartisan way, as we have done on bills such as the Cures Act and others, to say we understand this is the fundamental piece. It starts with mental health parity. To me it is incredibly hypocritical to talk about these issues and want to provide grant funding when the fundamental question of whether mental health and substance abuse services covered under your insurance are ripped away, which is what will happen with the repeal of the Affordable Care Act.

I urge my colleagues to support our amendment.

Mr. President, I yield the floor.

On behalf of the people of Michigan--

--I vote no.

Mr. President, let me first say to the distinguished chairman of the Budget Committee that we look forward to seeing the replacement as well because that is really the key right now. People across the country are saying: Wait a minute. You are going to unravel a system. You are going to repeal and take away the health care that I have and the patient protections that I have, and we don't even know if it will be better.

Why in the world would that be done if the new system wasn't going to be better than the old system?

Right now we don't see anything. We see 6 years of repeals coming from the House and Senate and no plans. We still don't see a plan, and we have no idea. More importantly, there are millions of people with insurance who are either getting patient protections or affordable care they couldn't get before or have Medicare strengthened or Medicaid support, and no one knows what will happen next. Doctors, nurses, health care providers--no one knows what is going to happen next. I think it is the most irresponsible approach to addressing one of the basic needs for all of our families that we could ever have. So we know that in the end, when you pull the thread, essentially, you unravel the whole system. That, minimally, creates instability in the entire economy. There is no plan being held up that would improve health care, which we are all for. I am all for making the health care system more affordable for families, strengthening health care. Let's do it. Unravelling and creating chaos in the health care system--no. It makes absolutely no sense, and we know that it is just going to make America sick again.

I want to share a couple of stories. First, we hear from Mary of Dundee, who owns a small business and has a 20-year-old daughter with a preexisting condition. For her, coverage--but, also, what we call the Patients' Bill of Rights--is absolutely critical. That is part of the Affordable Care Act that affects everybody with insurance. Seventy-five percent of Americans get their insurance through their employer. In the past, they could get dropped if they got sick, if they had diabetes or had a child with juvenile diabetes or had a heart condition or high blood pressure. Women who were of childbearing years could be viewed as having a preexisting condition. In the past, insurance companies had total control to decide who got coverage, when they got dropped, what would happen when you got sick and needed medical care. That changed with a Patients' Bill of Rights in the Affordable Care Act. There are a whole range of protections to make sure the insurance you pay for every month actually provides the medical care when you need it for you and your family.

Let's start with Mary's story. She wanted to express her concern about repealing the Affordable Care Act, and I appreciate very much the fact that she shared her story with me. She says:

My family and I have purchased our coverage through the

[ACA] marketplace for 2015, 2016, and 2017. This opportunity

has allowed us to become self-employed. . . .

They could open their own business. They weren't tied to their job because of the need of health insurance. They now have opened their own small business in Dundee, MI.

Prior to the ACA, I was working to provide coverage--

How many times have we heard that? I have heard that even in my own extended family--

then I lost my full time status and as a part-time employee,

the hours I worked barely covered my portion of my employer

provided healthcare.

By enrolling for coverage through the marketplace, I was

able to pick the coverage needed for our family at an

affordable price . . . not knowing what the future held

becoming self employed. We have three daughters. Our oldest

has life threatening allergies and asthma. I did not need to

worry that we would be denied coverage due to preexisting

conditions.

As Congress proceeds to dismantle the ACA, I am concerned

for my oldest daughter who is in her sophomore year at the

University of Michigan-Dearborn. She is 20 years old. . . .

Will she continue to have coverage through our insurance

until she is 26 as the ACA provides? If not, what kind of

coverage will she be able to afford due to her preexisting

conditions? Why put more obstacles in the way of our young

adults?

That is a really good question, Mary. It makes no sense to do that.

She goes on to say:

The ACA, we're sure, has faults . . . and like everything,

could be improved, but to scrap it and not use it at least as

a ``seed'' to grow and improve is beyond my understanding. To

suggest that there is nothing to keep is absurd and 20-30

million Americans enrolled . . . agree with us.

I agree with you as well, Mary. Thank you for sharing your story.

The coverage in the Affordable Care Act and the strengthening of Medicare and Medicaid are critical, as are the patient protections--the Patient Bill of Rights that affects people who buy insurance now, who finally got control

back from insurance companies that made every single decision. Being able to know that, if, in fact, you get sick or your child has a serious health condition, they won't be denied care for the rest of their lives, and also being able to have them on your insurance as they start off in life--there are so many protections. The caps on treatments and the number of treatments and services provided have been eliminated. The Patients' Bill of Rights is absolutely critical.

I want to take just a moment to speak about another piece of this, which relates to the Patients' Bill of Rights as it relates to women. In the past, the majority of plans--about 70 percent of the insurance plans in the private sector that a woman might try to choose and purchase--wouldn't cover basic maternity care. I couldn't believe it when I first heard that. Wait a minute. It wouldn't cover basic maternity care? Now every plan has to cover basic maternity care. It makes sense. No longer is just being a woman a preexisting condition. That is part of the Patients' Bill of Rights.

The capacity to now get preventive care, a mammogram, cancer screenings, and other types of preventive care is done without a copay. So we want people to go and get that checkup and, if there is a problem, to be able to tackle it early. That is most important because it is better for the person, but it also means there will be less cost to the health care system if you can catch something early. So the Patients' Bill of Rights is really critical to that.

There is something else that is also in here that is appalling to me and goes directly to the question of women's health care, and that is the fact that this bill repeals Planned Parenthood services and, basically, guts health care for women across Michigan and women across the country. For 75 percent of the women who use a Planned Parenthood clinic in Michigan, their visit will be the only health care they get all year.

We have rural counties in northern Michigan where the only health care clinics doing preventive care--cancer screenings, basic services, OB/GYN visits--are the Planned Parenthood clinics. So many women across Michigan will see their access to health care denied if this passes and Planned Parenthood loses its funding. There were 71,000 patients, the majority of them women, in Michigan in 2014, who received care--breast exams, Pap smears, prenatal visits. Again, tying this all together, we want to cover maternity care, but we also want healthy moms and healthy babies, and that means prenatal care. We have communities in these small towns, as well as in the big cities. But it affects small towns and rural communities around Michigan, where women are going to be denied services, and it is the only clinic that is there.

I want to share a story from Laurie in Jonesville about the Affordable Care Act and her particular situation. She said:

I have had type I diabetes for 54 years and when I needed

to retire early at the age of 62 because of complications

related to diabetes, I looked at the ACA for health

insurance. . . . I couldn't afford COBRA.

I was able to buy health insurance at what I consider an

affordable price with a small copay for my medications, the

most expensive one being insulin at a retail price of $296 a

month. As you know, my preexisting conditions of type I

diabetes, heart disease and a visual impairment, both

complications of diabetes, would have been uninsurable

without the ACA. I would have been uninsurable.

That is without the Patients' Bill of Rights, which says she has a right to be able to purchase health insurance.

In June of 2016 I was diagnosed with breast cancer, luckily

diagnosed at Stage 1 in a routine mammogram. Without the ACA

I wouldn't have been able to afford the mammogram or the

subsequent treatment without depleting our life savings. I

quickly reached my maximum out of pocket cost and while some

people would complain about having to pay that, not me! My

total bill so far is over $150,000. . . .

That is for her cancer treatment.

There is the combination here of repealing Planned Parenthood funding for health clinics that allow someone like Laurie to go in and get a mammogram rather than waiting until she has a level of breast cancer that cannot be effectively treated or might otherwise cause loss of life. She was able to catch this early because she was able to get a screening--a mammogram--the kind of treatment that women in small towns all over Michigan have the capacity to do now because of the reasonable copays for care and partly because there is no copay for that mammogram but also because they have a clinic available in their community where they can get the care. All of this fits together--the access to preventive care for women, the health care clinics that are available around Michigan and around the country, and the Patients' Bill of Rights, which says you have a right to care. This is not just about the insurance company basing every decision on the fact that they want to make more money rather than cover you. You have a right to make sure that when you get sick, you don't get dropped, and, if you have breast cancer or diabetes, you have a right to have access to affordable health care.

So I would hope that our colleagues would join together, stop this craziness of trying to repeal health reform and protections for every single American, and, instead, sit down together and look at how we can make it better.

Our Republican colleagues will find willing partners in making the system more affordable and better, but we will continue to be the strongest possible opponents of ripping the system apart and creating chaos for American families.

I yield the floor.

Mr. President, first I want to thank my good friend and colleague from Pennsylvania who serves with great distinction with me on the Agriculture Committee. I love that he is speaking about our farmers. In a few minutes, I am going to talk about Sonya, who is a blueberry farmer and small business owner from Michigan. We know there are so many small business owners and farmers who finally have been able to find affordable health care because of what was passed in the health care reform act.

I want to thank Senator Casey for being such a strong advocate for those dairy farmers. We have a few dairy farmers in Michigan, as well, and we appreciate very much his advocacy.

I want to take a step back and look broadly for a moment at what is really happening here and why we are so concerned and why we have spent all of this evening and are going on into the night to talk on behalf of the people we represent on the impact of what repealing the Affordable Care Act without having a replacement that is as good or better in place at the time would really mean for people.

Republicans get sick. Democrats get sick. Independents get sick. People who don't vote get sick. This is not a partisan issue. This is about one of the most basic human needs, most basic things that we care about for our families. People go to bed at night and say: Please God, don't let the kids get sick. Make sure Mom is OK, Dad is OK.

Because of the Affordable Care Act, because of the increases in access to affordable health care that we were able to pass a number of years ago, fewer people are having to worry. There are still people worrying, and there are still issues. There are still costs, and there are still things to do. I am anxious to get about the business--all Democrats are anxious to get about the business of making sure that health care is more affordable and doing more to bring down the cost of prescription drugs. I am also concerned about small businesses. There are things that we can do together, that we should be doing on a bipartisan basis, but we shouldn't be repealing health care and unraveling the entire system and creating chaos in the entire system instead of focusing on how we make health care better for families.

The bottom line of what is being proposed--and what this budget resolution is really all about--is going to make America sick again. That is the bottom line. We are going to create a situation where more Americans will be sick and not be able to see a doctor, not be able to find affordable insurance, or not be able to have the protections that they currently have under what we like to call the Patient's Bill of Rights--the patient protections for everybody. Seventy-five percent of Americans get their health insurance through their employer, and every one of them--all of us--have benefited from changes in health care that have taken total control out of the hands of insurance companies and given us more assurances that if we get sick, we are not going to get dropped. If we have an illness or our child has juvenile diabetes or cancer or Alzheimer's or leukemia or high blood pressure or if you are a woman of child-bearing age, which is viewed as a preexisting condition so you have higher rates--all of those things were changed in the interest of the American people.

Basically, when we look at it, there are four different areas where health care reform has made a difference in people's lives and what we are fighting for tonight. We are fighting for these things. We are fighting to have them not taken away and to have the system not ripped up and not create a situation where we cause incredible harm by what Republican colleagues are talking about doing.

The first general category is putting insurance companies back in charge by repealing the patient protections. That is what is being talked about: keeping young people, your son or your daughter, on your insurance until age 26. They graduate from college; they probably already have mounds of debt. Letting them get started in the workplace and stay on your insurance has made an incredible difference for hundreds of thousands of young people across the country. That is gone.

Guaranteed access to essential health benefits. I did fight very hard so that we had a benefit package that includes simple things, important things for women, like maternity care. Prior to health care reform, about 70 percent of the insurance policies that were available in the private market--if a woman were to go out and try to find insurance, about 70 percent didn't provide basic maternity care. Now all the policies have to provide maternity care. Policies have to include mental health and addiction services like physical health, so we are saying that if you have an illness above the neck, it ought to be treated the same as an illness below the neck. These are patient protections for all of us.

In health care today, you can't have your services capped. I have seen and spoken with so many doctors who treat cancer in children and adults. Families talk about the fact that in the past there would be a financial cap or a number of visits or a number of treatments as a limit, and if you were done with your treatment and your doctor didn't feel that you received enough treatments, too bad. Your yearly cap is up or the lifetime cap is up. Right now, that is gone. But with the repeal, those caps come back.

Preventive services with no copay. We want folks getting a wellness visit, getting a mammogram, being able to get contraceptive coverage, being able to get preventive cancer screenings. Doing that without a copay has made a tremendous difference in people being able to get the preventive care they need.

There are so many other things that have been put in place for everyone who has insurance. All of that gets ripped away with repeal, and there is no excuse for that. There is no way we are going to allow that to happen without continuing to fight as hard as we can. It is outrageous.

The second thing is cutting Medicare and Medicaid. All of the health care system is tied together. When we made changes in Medicare, we lengthened the solvency of the trust fund--12 more years of solvency in the trust fund, 12 more years of making sure it is solid, financially viable. That goes away.

My colleagues have talked about prescription drugs and the fact that we have closed this gap in coverage. If you have high bills related to the cost of medicine, right now you are covered. When you get to a certain point and there is a complete gap in coverage and you are not covered anymore, and then you are covered again--folks call that the doughnut hole. We are closing that so there is no gap in coverage.

With repeal, the doughnut hole comes back. Coverage is lost. Costs for medicine go up. Preventive services under Medicare are ripped away if we see a repeal. And there is not a replacement that is put in place that is equal

to or better than what we currently have.

Medicaid. We have so many people who are working for minimum wage, working really hard at minimum wage jobs, who never had the opportunity to have health insurance before, and now they do. That is gone if the whole system is ripped up. Most of Medicaid goes for seniors in nursing homes, long-term care. If you look at the nominee for Secretary of Health and Human Services, who has proposed completely rewriting, ripping up Medicare as we know it, as well as health reform and the Affordable Care Act--if you put all that together with this repeal and somebody who wants dramatic changes--I believe it is $1 trillion in cuts proposed by the current chairman of the Budget Committee or the gentleman who now is being proposed for Secretary of Health and Human Services--Medicare and Medicaid are seriously threatened by all that is talked about right now.

We are talking about, in total, kicking 30 million Americans off their insurance. In Michigan, all together, counting Medicaid and those who are purchasing through the new insurance pools, it is over 2 million people. One out of five people in Michigan and their families will lose their access to a doctor and medical care.

What does all of this mean? It means costs are going to go up both for coverage and prescription drugs. And for Republican colleagues who say: Well, we are going to repeal it now, but not really because we are going to say it is repealed and then we are going to wait 2 or 3 years--first of all, Republicans have had 6 years of talking about repeal. It has been over 50 times in the House of Representatives. You would think within that time they would have been able to come up with a plan, not a bunch of ideas but a plan to show that, in fact, these things aren't going to happen; that they are not going to unravel the health care system; that they have something bigger, better, greater, but that is not what we are hearing. We are hearing: Well, we don't have it yet; we don't know if we are going to have it. We will try to figure it out somehow, and we will wait 2 or 3 years.

What happens in the insurance market when insurance companies don't have predictability? Rates go up. What happens when hospitals--and I have already been told this in Michigan--don't know what is coming? You pull back. You pull back on investments. You pull back on what you are doing in terms of coverage because you don't know what is coming.

This makes no sense whatsoever. I understand politics. I understand slogans. I understand all the rhetoric that has been said for years about repealing health care reform, but this is the most irresponsible thing I have ever seen in my life if there is a repeal with no replacement immediately that at least equals what people have today-- the protections, the coverage, the strengthening of Medicare, the lowering of prescription drug prices under Medicare, the help for people who work hard every day on minimum wage and are finding access to a regular doctor instead of using the emergency room, which, by the way, raises health care costs.

The truth is, we all are here because we care deeply about this. If our colleagues want to stop this craziness of running the cow off the cliff and decide that maybe we are going to work on just fixing it together, we are ready, willing, and able to do that. We know, as with any major change in form, that after they work a while, you have to figure things out and you have to fix problems. We are more than willing; we want to do that. We have been offering to do that and suggesting that for the last several years. But this approach is outrageous and completely irresponsible, and, in fact, it will make America sick again.

Let me conclude by just sharing a couple of stories from constituents in Michigan. I have heard from a lot of people, particularly small business owners, people who have the freedom now to be able to leave their job where they were working only because of the insurance. That has happened to my own family and friends, where folks are in a job that does not work for them but at least they have insurance.

The Affordable Care Act has given the flexibility for someone to step away, to be able to start their own business or their own farm, like Sonia who is a blueberry farmer in Michigan. She has written me, indicating they are extremely fearful that they are going to lose their insurance under the new administration because of what Republicans are talking about.

She says:

A number of years back in 2000 I quit my traditional job

and my husband, who had been laid off, and I bought my step-

dad's blueberry farm. He had passed away in 1995, and we took

care of my mom who had inherited the farm, and lived with us

for a year and a half until her death. We are full-time

farmers, small farmers, about 15 acres of blueberries. We

also have a small garden center, Sweet Summer Gardens, which

is open from May to September, and a small bead store, the

Enchanted Bead. It is open year round.

She says:

We are hard-working people who love the life that we have

carved out for ourselves, but there some drawbacks to being

self-employed and small business owners. In 2012, I tore the

meniscus in my right knee. I did nothing to take care of it

because I did not have insurance. But then in April of 2015,

3 years after the injury, I finally got to the point where I

could no longer take the pain. Luckily, we had signed up for

insurance through the Affordable Care Act. I was able to have

the severe tear repaired.

Then she goes on to talk about how a little later there was a cancer scare, and she had to go in for ultrasounds and lab work and an outpatient D&C.

Because she was able to do that, she was fortunately able to find out it was not cancer, thank goodness. Again, because of the Affordable Care Act and her insurance, she was able to get the services she needed. She goes on to talk about a number of different health challenges for them, including the following:

Finally we have coverage for preventive care. My husband

had a physical, the first time since high school, and we

found out that there was an issue that needed to be

addressed. He was referred to an orthopedic surgeon,

discovered he had severe arthritis. It was causing constant

pain. Again, we were able to have insurance coverage. Because

of the Affordable Care Act, he was able to have this

repaired.

She says:

We are hard-working people. We have never asked for help.

But we are extremely concerned because we could not afford

our insurance right now without the tax credits--the subsidy.

She says:

This morning, watching the news, we were met with a story

that the Republicans are all ready to repeal ObamaCare. They

said that while they couldn't take away the insurance, they

could take away the subsidies. This would put insurance out

of our range and we would no longer be able to afford it. My

husband Larry said to me, ``they couldn't just throw us out

to the dogs, could they?''

She says:

My reply was, ``anything is possible.''

I know the Affordable Care Act isn't perfect. I know that

not everyone has taken advantage of it, but there has to be a

way to fix it without hurting the millions of people who have

been helped by it.

In fact, Sonia, there is a way to fix it without hurting you and your husband, full-time farmers and small business owners. I have a number of other stories. I am going to pause because I have other colleagues who I know want to speak who care deeply about this as well. I will share those at a later point.

Let me just say, what we are talking about is not a game. It is not. This is about real people with real lives who are encountering situations that could happen to any of us. Too many people are not in a situation, without Medicare or Medicaid coverage or access to health care through the exchanges, to be able to see the doctor and get the care they need. That has changed in the last number of years.

There is more to do. We can work together to make it even better, but the idea that people are not being helped today, that small business owners and farmers and families are not getting medical care today because of what was done is just not true. It is just not true. The reality is, we are in a better spot with more to do. Pulling the thread and unraveling the entire system and creating chaos in the entire system makes no sense.

So we as Democrats are going to do whatever we can. We know that ultimately the votes are there. If the Republicans in the House and the Senate and the new President want to completely dismantle the health care system, unravel the health care system, weaken Medicare, and weaken Medicaid, you can do it. You have the votes to do it.

People right now who get care, the millions of people, the over 2 million people in Michigan alone who have been directly helped by the Affordable Care Act, they know that. They will know when that is no longer available to them. It will hurt many, many people. We hope colleagues will take a second look and decide to work with us in a way to move forward on health care that will allow people to get the care they need at an affordable price for themselves and their families.

I know that is what we all want for our families. We should be doing everything humanly possible to make sure people have the affordable care they need and the protections they need to get care when they need it.

I yield the floor.

Mr. President, first let me comment on what my friend, the distinguished Senator from Texas, said. If my car goes into a ditch, the first thing I don't do is dismantle the car. That doesn't help me get anywhere in terms of transportation.

First of all, let me speak on process before talking about the substance of what we are really talking about and how it affects people. We have a bill in front of us that creates a process for the majority to be able to unravel and repeal essentially our whole health care system. You pull a thread and it goes through not only employer- based care, patient protections, people who have insurance, Medicare, Medicaid. All of it begins to unravel. Interestingly, also in this bill, in the text it adds $1 trillion to the deficit--$1 trillion to the deficit in the bill that our colleagues just voted to proceed to pass.

We need to be very clear on this: If colleagues want to work with us to fix problems and improve health care, we can start this afternoon. It is almost 3:30. By 4 o'clock we could put together a group of people. I am sure our distinguished Democratic leader on the Budget Committee would be happy to sit down and work together on ways to make health care reform better and make health care more affordable and make it more available to people. If that is what we want to do, count us in, but that is not what we are talking about here. We are talking about this crazy idea that no one in their real life would do.

It is like deciding you want a new house, so you tear down the old house. That is the easy part. Then your family is homeless. Then you say: Well, gosh, you know, maybe I better have a plan to get a new house for my family and figure out a way to pay for it, to be able to afford it.

Nobody would do that. Nobody would start by saying: We are going to rip apart the entire health care system and create chaos. We are going to undermine Medicare. We are going to undermine Medicaid. We are going to take away patient protections for everybody who has insurance through their employer, and then we will figure out later what we are going to do to replace it, if anything.

I know there is a division on the Republican side. Certainly Members in the House don't think it should even be replaced at all.

It is interesting. We are talking about one-sixth of the economy that would be destabilized. There is no question that if you do a repeal and insurance companies don't know what is coming--I have talked to hospitals, and they don't know what is coming--behavior will begin to change. Rates will begin to go up. Different decisions will be made because, as businesses, they will not know how to plan. Their investors will not know how to plan.

There is no question about it. When you repeal without creating certainty in the marketplace, you begin a process that results in chaos.

We have an interesting example, one that I have been involved with for a lot of years, where we wanted to change just one piece of the health care system, the reimbursement system for doctors.

I was in the House when they passed Medicare changes. We put in place a new policy. We were going to write a new policy to reimburse physicians for quality instead of quantity. It makes sense. It took 18 years to get agreement. We got agreement last year. It doesn't even take effect for 4 years.

Everybody here knows about this thing called the doc fix. It is an inside term--or SGR, which is even more insider. The truth is, we were trying to change just one thing and could not get agreement to do it for 18 years.

Anyone who thinks that there is going to be a repeal without an ACA extender going on has not looked at past processes.

What is most important, though, is what this means to real people. This

really is about a plan of ripping apart the health care system. There is nothing in its place immediately so we don't even know what will be coming. This is going to make America sick again.

We are talking about a process and a plan that for real people is not a political game. It is not smoke and mirrors. It shouldn't be about politics. It is about the moms and dads who go to bed at night and say: Please, God, don't let the kids get sick. Now, many of them--close to 30 million counting everybody with new coverage--don't have to say that. They can say a different kind of prayer because they can go see the doctor.

We know that when you unravel that system with nothing responsible in its place, we are talking about making America sick again. We want affordable care, not chaos. This plan goes from affordable care to chaos. We talk about some parts of what we passed in health reform, but there are a lot of things we don't emphasize that I think are important to recognize in this debate.

First of all, what we pass in terms of changes in quality care affects every single American with health insurance. A lot of people in my State are fortunate to have employer-based insurance. We have a lot of folks at the collective bargaining table fighting every year to make sure they keep their insurance--150 million people across the country. All of them have benefited from the patient protections we put into health reform. When we take those away, then immediately the insurance companies will be back in charge. If you get sick, you can get dropped. Right now they can't do that. If you are sick or if your child is sick, right now you can't be blocked from buying insurance. We call it a preexisting condition. But before health reform, insurance companies were doing that every single day--a child with juvenile diabetes, someone with cancer or Alzheimer's disease.

I think about a very good friend of mine who just found out her grandson has leukemia. He is 2 years old. He is going through treatment. We pray he is going to be able to get through it successfully. He is going to have a preexisting condition for the rest of his life. With this repeal, there is no guarantee he will ever be able to get insurance. On top of that, if he has to have treatments that go on for some period of time, caps will be reinstituted on the amount of care you can get, the amount of treatment per year, dollar amount, or amount of visits you can get, and there is no guarantee that this little boy will be able to get the treatment he needs so that he can live a healthy, successful life going forward.

In talking with pediatric cancer doctors a couple of weeks ago, it was so amazing and gratifying to me to hear them talk about children whose lives have been extended, whose quality of life has been extended because of the fact that they are able to fully treat these children and insurance companies can't put caps on how much they will pay or how many treatments. Now there is a whole other range of protections for everybody.

One of the fights I was proud to lead in the Finance Committee when we passed the ACA was to make sure that the basic insurance package every company has to provide has to include maternity care. That seems like a no-brainer. People were shocked that it didn't. Before we passed health reform, 70 percent of the insurance companies--the policies you buy in the private market didn't include maternity care. In fact, women were viewed as having a preexisting condition because they might get pregnant, might have a baby. That is not true anymore. Women are not rated differently than men, and maternity care is now available regardless of the kind of insurance you have. That is a pretty good deal. Right now I have a son and a daughter with growing families, and I can tell you that is a very big deal in my family.

There is a whole range of things. We all know about young people who are able to stay on their parents' insurance. They get out of college and they are wrestling with a huge debt, and one thing they don't have to worry about is whether they can stay on their parents' insurance until they can find a job. That goes away with repeal.

Something I care deeply about is mental health. We have all worked together on opioids and substance abuse treatment. Because of what we did in health care reform, insurance companies cannot discriminate if it is mental health or substance abuse treatment rather than physical health treatment. Prior to what we passed, they could charge much higher copays, higher premiums, but not anymore. So the whole body-- above the neck as well as below the neck--is now being treated equally with our insurance reforms.

So there are a multitude of things--preventive health services with no copays, such as cancer screenings for mammograms and contraception. I was talking to someone who said she thought it was so wonderful that her drugstore wasn't charging her for copays anymore on her contraception. I said: Well, you know, that is actually the law. That was changed when we passed the Affordable Care Act.

So there is a whole range of things that relate to reviewing premium increases, if you get removed from your insurance, you have the right to appeal. There is a whole range of things. So that is under the first step. Everybody will feel it when insurance companies are back in charge and, through this vote and the subsequent actions, patient protections are repealed for everybody.

Secondly, this includes cuts in Medicare and Medicaid. Through what we did in health reform, we closed the gap on the high costs of prescription drugs. We called it the doughnut hole. That was in the process of being closed. If you have a lot of medicines and a lot of costs, you suddenly get to a point where there is a gap in coverage and you have to pay the full cost. That goes away and the doughnut hole comes back.

What we did added 12 years of solvency to the Medicare trust fund to keep it strong longer. That goes away. Wellness visits for seniors-- every year they are able to go in and get a physical without a copay-- that goes away. So Medicare is undermined. Then, unfortunately, when you add the incoming nominee as Secretary of Health and Human Services and couple that with the proposals that the Speaker has had and others that I am sure we are going to see to turn Medicare into a voucher--you go into the private market. Here is your voucher. Good luck. That is part of what the new regime is promoting, which only adds to this.

Eighty percent of Medicaid spending is seniors in nursing homes. And we know that the majority of those who--many who have gotten care, in addition to the exchanges, have been folks who have been working hard every single day in minimum wage jobs and who couldn't afford or find insurance before. Now they are covered if their State or their Governor is willing to do that. We have a whole bunch of folks who are working hard every day at minimum wage who at least know they have access to health care and a doctor.

Interestingly, this helps our hospitals, whether they are rural hospitals upstate or up north in Michigan or whether they are our great urban hospitals, safety net hospitals in Detroit and other areas, instead of people walking into the emergency room and not having insurance and having the cost put on everybody who does. Because of the Medicaid expansion, when a working person comes in with Medicaid, they are able to pay for their own care rather than having everybody else with insurance carry the brunt of that, which is the way it was prior to that.

So there are Medicare and Medicaid cuts.

Next, we do know that altogether, counting Medicaid and people using the new exchanges, we have about 30 million people who will be kicked off of their insurance, folks who, like anybody else, want to have health insurance for their families. Can we design that in a better way? I would love to work with you on that. I am not going to kick them off first. I don't want to say: We are going to rip your insurance away. We are going to rip the small businesses I have talked to--rip their insurance away. And then, by the way, don't worry, further down the road we will figure out something else. We don't know what it is, we don't know what it will cost, but trust me.

I wouldn't be trusting that would happen if I were counting on that for my insurance.

The fourth item is that there is no question that costs will go up by destabilizing the marketplace. We know the cost of prescription drugs will go up as a result of taking away the extra help for prescription drugs. There is no question that costs are going to go up for everybody else who has insurance.

When we look at this, I don't know how anybody looking at this outside of a political lens or a rigid ideological lens could say this makes any sense. It doesn't make any sense.

We have a President-elect who is coming in who said that he would not do anything to hurt Medicare or Medicaid or Social Security. Yet the first thing on the floor definitely undermines Medicare and Medicaid. We have a President-elect who said he wants to bring down the cost of prescription drugs. Yet, by undermining Medicare prescription drug coverage, those prices are going to go up. People who have the most medical needs and need the most medicine are going to see their costs go up.

What would be better would be if the new incoming HHS Secretary would be given the ability to negotiate through Medicare for prescription drugs--something we have all fought for, for a long time. Let's allow drug reimportation. Our leader on the budget--and I have as well--put seniors on buses in the past to demonstrate the differences in cost across the bridge between Windsor and Detroit, the cost of the same drug, with the very same safety provisions. That would bring down costs. Taking away Medicare coverage and increasing the gap in coverage is exactly the wrong thing to be doing if, in fact, the incoming President really means it when he says he wants to bring down drug prices.

So there are a number of things we care deeply about on health care. As someone who has worked on this for years--in fact, it was health care and health policy that first got me into politics, leading an effort to save a nursing home in my community. I care deeply about this. I am one of the folks way down deep in the weeds on this. But we don't improve a health system by ripping it out by its roots, by undermining the whole system without figuring out what comes next. That only happens if you really don't care what comes next because if you care, that is not a responsible position.

So, Mr. President, and my colleagues, I feel very strongly that with everything we know that has been made available to strengthen quality, to give people back their own decisionmaking instead of the insurance companies on basics like providing care for themselves and their families, the strengthening of Medicare and Medicaid, the coverage that has been made available, we know there is a way to work together to make things better, and this is not it.

I will be happy to.

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

Mr. President, we are in a countdown of sorts right now, and it is one I am deeply concerned about. On February 27, the funding for the Department of Homeland Security of our country runs out, and that is 17 days from now. Only 17 days from now, our Border and Customs and air traffic controllers, air security, Coast Guard--all of those agencies and all of the people involved in protecting us from the terrorist threats all around us--will lose their funding in one way or the other if we don't act.

On Sunday morning in Michigan, we had a reminder of the threat that exists within our borders. A man crashed his truck into a U.S. Coast Guard station in Grand Haven on the west side of Michigan. Then he assaulted members of the Coast Guard, which is, by the way, a Department of Homeland Security facility and will be affected by what is going to happen. The man claimed to have explosives in his truck. Fortunately, that turned out not to be true. Still, local officials initially called it ``an act of domestic terrorism.''

Department of Homeland Security officials have been working alongside other Federal agencies and local law enforcement to investigate. My colleagues can imagine how people on the west side of Michigan are feeling right now and how members of the Coast Guard are feeling about this.

This is the work the men and women of the Department of Homeland Security do every day in every part of Michigan, in every part of our country, in every part of our cities, including the District of Columbia, and in the communities we all represent. Frankly, people are scratching their heads right now about what in the world is going on.

I appreciate the fact there are disagreements with the President regarding immigration policy. Certainly, we can debate that. We can discuss it. The Republican leader can bring up the issue of immigration at any time on the floor of the Senate. But that should not be tied to whether we fund the Department of Homeland Security for our country. Homeland security funding should not be held hostage to what I view as the politics of the moment on immigration. We may have a disagreement in terms of immigration issues, but we should not have any disagreement about the need to fully fund the Department of Homeland Security.

We rely on the Department of Homeland Security to provide our transportation security at shipping ports and at all of our airports. We all go back and forth every single week. Millions of Americans are counting on the fact that people at our airports--people we see and people we don't see--are keeping us safe from attacks--the passengers, the cargo.

Michigan is a border State. We are the largest northern border crossing in the country for goods, services, and people coming back and forth from Detroit to Windsor. It is the men and women of the Department of Homeland Security--Border and Customs--who are keeping our borders safe every day.

We rely on the Department of Homeland Security to protect us against nuclear attacks, chemical attacks, and cyber attacks every day. In recent years, major American financial institutions have been attacked by hackers. I have been in a situation as a customer of a major company getting that notice in the mail about my credit card. Millions of Americans have been in that situation. We expect that we are going to make sure we are protecting people's information, their financial security, the financial security of businesses. That is what is done through the Department of Homeland Security.

Seventeen days from now, if we don't act to fully fund the Department of Homeland Security, we will see the funding for that Department stop.

Chinese hackers targeted the U.S. Transportation Department Command, which directs the global movement of U.S. military forces. Hackers have gone after America's transportation and communications infrastructure over and over again.

This is very serious. This is very serious. This is not about politics or differences of opinion with the United States or having some leverage by holding funding up in order to get something else that group of people wants to get. This is about whether we are going to straight-up fund the security operations of our country. We have terrorists and terror threats all around us. Look at the globe--all around us. This is not the time to play politics with Homeland Security funding.

Last year we passed, with a huge majority, a bipartisan immigration bill. Immigration deserves a debate. There will be differences of opinion. I still think there is a broad bipartisan coalition to do comprehensive reform that makes sense for everyone, makes sense for America. But this is not the time to say: It is either my way or the highway. Either I get the changes I want or I will say to the President of the United States that he is wrong, that he is playing politics, whatever it is, and I am going to hold up the security of our country in order to do it.

I think most people in Washington are saying: What in the world is going on here? Terror threats are all around us, and we are 17 days away from a shutdown of the Department of Homeland Security. This makes absolutely no sense to me. Frankly, we can do better than that as an institution, as the U.S. Senate. We can do better in Congress than constantly having these roller coasters up and down and threats of government shutdowns. We have seen it before. We are now seeing the possibility of it again.

Seventeen days from now, if Homeland Security is shut down, if we aren't funding our border, cockpits, airport security, ports, the Coast Guard, and all the other things that keep us safe, there is going to be a big party. Do you know who is going to throw that party? The enemies of America. The terrorists who want very much to have the opportunity to attack our country. That makes absolutely no sense.

Let's come together this week before we leave. We are not in session next week. We can get this done. Let's just pass the Homeland Security budget and get on with important debates on other topics that we all care about. I hope we can do that and get this done as soon as possible.

I yield the floor.

Thank you, Mr. President. First, let me say to my friend from Alabama, I couldn't agree more that we need to focus on jobs. There is no question about it.

I couldn't agree more that we need to have a legal immigration system that works and that protects Americans first, in terms of jobs, people who are here legally, whether it is those working in agriculture, whether it is those working in manufacturing or any other part of our economy. We can very quickly, if the new majority wants to, bring an immigration bill and address it. I think there are 68 of us, if I remember right, who voted for a pretty big bipartisan effort last year, a major effort to actually fix a very broken system. There were important protections in there for American workers. It is something that would have been incredibly important to get done and to put those prohibitions in. So this is not about that.

It is very simple. The majority could very quickly pass the funding for Homeland Security to keep us safe and

immediately go to the issue of immigration, and I would support it wholeheartedly, as would colleagues on this side of the aisle.

Here is what we don't support: holding the security of our country hostage while others debate policy, frankly, that was already agreed to by the majority of the Senate last year. Regardless of your feelings about the immigration policies, if you ask folks at this time, when terror threats are all around us, do they want games being played with the funding of our homeland security, the answer would be no--a resounding no.

So let's get on with the business in a bipartisan way of funding our national security effort, and then let's immediately go to a vigorous and important debate about immigration. I would agree that should be done as soon as possible.

Since the attacks of 9/11 in 2001, we have had a Department of Homeland Security that we organized and put together to play a critical role in protecting America against acts of terror. Make no mistake, as I said, we have terrorist threats all around us, yet, unfortunately, our Republican colleagues are willing to shut down our Homeland Security Department to make a political point.

Yesterday ISIS released a video showing the horrendous burning of a Jordanian pilot. It was unbelievable. But while that is happening, the Senate can't pass a Homeland Security funding bill. We need to pass a Homeland Security bill. Colleagues who are fighting about immigration are willing to shut down Homeland Security in order to make a point with the President.

This past weekend ISIS beheaded a Japanese contractor. Yet Republicans are willing to shut down Homeland Security to make a point. Last week at a hotel in Libya an American was killed in an attack by ISIS. Yet colleagues on the other side of the aisle are willing to shut down Homeland Security in order to make a political point. Last month 11 people were killed in a terrorist strike against America's oldest ally, France. Yet Republicans are willing to shut down Homeland Security.

In November, a Canadian soldier was killed in an attack near the Canadian Parliament, just 60 miles from the U.S. border. Michigan is on that northern border. Yet Republicans are willing to shut down Homeland Security. In fact, we heard Republicans in the House say it wouldn't be that big of a deal to shut down Homeland Security. Really? Anybody who reads the paper or watches the news can see what is happening every day around us, and Republicans in the House say it wouldn't be a problem to shut down Homeland Security? That is stunning.

Detroit, MI, has the busiest northern border crossing in the country. It is the busiest northern border crossing for commerce, products, and people. We rely on our Customs and Border Patrol every single day. Customs and border security, airport security, and police and firefighters are on the frontlines every day protecting us. Let's not forget about the Coast Guard. All those folks are on the frontlines protecting our families in America. That is what we are debating.

Do we want to play games with that? Do we want to hold Homeland Security hostage because of a debate with the President on another issue or do we fund Homeland Security and then have that debate? We can do it immediately--the same day. We could fund Homeland Security and then the Republican leader could immediately call up any bill he wants on immigration and then have that debate. Unfortunately--with terrorist threats all around us--Republicans are willing to shut down Homeland Security.

Boko Haram is gaining strength in West Africa and hoping to inspire attacks against Americans. We know what they have done. Yet here we are debating whether Homeland Security is going to be shut down.

In the months to come, we will need all of the hard-working men and women who work in every part of that agency to be full speed so they can protect us. Unless Republican colleagues are willing to support a spending bill and get that done right away, we are going to see the Department of Homeland Security management and headquarters stop functioning. Some 30,000 employees will be furloughed. People will be asked to work without pay--talk about jobs for people.

In Detroit alone--and all over Michigan--we get firefighter grants. The budget has already started, and we have 150 firefighters in the city of Detroit alone whose ongoing funding has been stalled. We have firefighters all across Michigan. We have very important law enforcement grants all over Michigan that at the moment are on hold and can't go forward.

We are talking about disrupting programs used to detect weapons of mass destruction and the training of local law enforcement officers who are on the frontlines of our defense. This makes no sense.

It would be one thing if Republican colleagues were in the minority and they felt the only way we could have the debate they want to have is to tie the two together, but that is not the case. Republican colleagues are in the majority. We can pass Homeland Security together--100 to 0--and then get on to whatever immigration debate the majority wants to have or whatever else they would like to debate. We don't have to hold the Homeland Security funding hostage in order to do it.

This past August our Defense Secretary said of ISIS:

They are as sophisticated and well-funded as any group we

have seen. They're beyond just a terrorist group.

When we think about it, we are talking about a well-funded terrorist group at the same time we are debating whether to fund our Homeland Security agencies that keep us safe from ISIS and other terrorist threats.

I implore Republican colleagues to join with us, regardless of the passion on this other issue. We can debate it. It can be addressed.

There are Republican majorities in the House and Senate that can debate the President's actions or debate anything for that matter, but we can certainly debate immigration at any moment. We do not have to hold the funding for the national defense of our homeland hostage to do it.

I encourage my colleagues to get on to the business of passing the funding.

I thank the Presiding Officer.

Mr. President, I assume there is a little bit of time to make a couple of comments as we are waiting.

I would commend the chairwoman of the Energy and Natural Resources Committee, for she and the ranking Member have done an excellent job of moving us through. I think we all appreciate it when we hear the words ``an amendment has been withdrawn'' in terms of being able to move the process forward.

I did want to mention a couple of things. One, just to remind everyone, when we talk about this Canadian oil company bringing a pipeline through the United States down to the Gulf--putting it on a ship and sending it to China--they are not paying into the oilspill liability trust fund. Our amendment to say the oil should stay here if Americans are taking all the risk was voted down. The amendment that would require American steel was voted down. Any commitment to make sure these were all American jobs has also been voted down.

I did also--because the distinguished Chair of the committee mentioned a bill that came over from the House--want to take a moment to say as we look at energy policy in the energy committee today we are, in fact, considering what I consider to be one of the most fundamental questions for us moving forward with this new energy source in abundance called natural gas.

It is incredibly important we get this right. As opposed to the pipeline going through the middle of our country, this is something that can greatly increase our ability to have manufacturing jobs across the country, to continue to lower and keep down the prices of heating and other energy costs for our citizens. If it is done right--the committee, I believe, dramatically does it the wrong way. The bill that came from the House is very much, in my judgment, a China-first policy and not an America-first policy. I say that because right now China is willing to pay more than three times for natural gas than we are. I understand that the gas and oil industry wants to rush it on ships over to China. But to add insult to injury for us, they were willing to pay, last year, $16 and then turn around and subsidize their industry that is competing with us and only give it to them for I believe it was $1.78. Our folks who are forced to pay $16 because we don't have a prudent export policy--they just throw open the doors to send it to China. Our folks pay $16. The folks competing with us for our jobs are paying $1.78.

I realize we have a lot more discussion on that at a later point. I do want to say there will be a great debate on what I believe is one of the most important issues in front of us in terms of continuing to having manufacturing renaissance and the ability to create good middle- class jobs in this country. I am hopeful in the end we will have an America-first policy, not a China-first policy.

I yield the floor.

I ask for the yeas and nays.

Thank you very much to my friend and colleague and leader from California.

I first want to say thank you to Senators Murkowski and Cantwell who have worked so hard with Senator Boxer moving forward a process that, until Thursday night, was working very well going back and forth.

Before we authorize the building of a new oil pipeline in America, it is important for us to consider the safety of pipelines we already have.

In 2010, a pipeline that runs from Canada through Michigan spilled nearly a million gallons of tar sands oil into the Kalamazoo River, causing the largest inland oil spill in U.S. history.

That cleanup cost $1.2 billion.

Nine days ago, another pipeline broke in Montana, and for the second time in 4 years, tens of thousands of gallons of oil emptied into the Yellowstone River, making that water unsafe to drink.

Right now in Michigan, we have a 61-year-old pipeline which runs along environmentally sensitive areas and goes beneath the Straits of Mackinac and our magnificent Great Lakes.

That pipeline carries 1.2 million gallons of tar sands oil per day and has undergone only a few upgrades since it was first installed in 1953. A spill would be devastating, not only to the region but to all Americans--because the Great Lakes are a vital source of our Nation's fresh water supply.

Yet none of the companies transporting heavy tar sands crude are required to pay into the Oil Spill Liability Trust Fund, which would ensure that taxpayers are not footing the bill.

When we offered an amendment to fix that, the Republicans said no.

America's economy is only as strong as our natural resources, and those resources are threatened every time a pipeline breaks.

Making matters worse, Republicans said no to amendments that would keep the oil in America, guarantee the pipeline be built with American steel and use American workers.

So Americans take all of the risks with very few, if any, rewards.

Because Republicans refuse to make this Canadian oil company pay into the oil spill fund, American taxpayers may have to bailout the company if the pipeline breaks.

So, before our Colleagues vote on behalf of the oil companies to approve the construction of the Keystone XL Pipeline, it is critical that we pass the amendment that my friend and partner from Michigan and I have introduced.

This amendment ensures that we address the safety of the pipelines that we have now--before beginning construction on Keystone. And it would ensure that the heightened safety standards being applied to Keystone exist in pipelines around the Great Lakes.

The Republican majority has promised an open amendment process, so I certainly hope that when my colleague from Michigan offers this amendment in a few moments, the Republican majority will allow a vote on this critical pipeline safety amendment--even though Big Oil may not like it.

Again, the American people are taking all of the risks when the oil will not even stay in America. The least Congress can do is guarantee the pipelines are safe.

I would ask my friends to join with Senator Peters and me in saying that before we authorize the building of a new oil pipeline in America that we have to consider and strengthen the safety of pipelines, the pipelines we already have. In 2010, a pipeline that runs from Canada through Michigan spilled nearly 1 million gallons of tar sands oil into the Kalamazoo River--this has been talked about before--causing the largest inland oilspill in U.S. history.

So we need to vote on Senator Peters' and my amendment. The cleanup itself cost $1.2 billion. Nine days ago, another pipeline broke in Montana. For the second time in 4 years, tens of thousands of gallons of oil emptied into the Yellowstone River, making that water unsafe to drink. So would my friend from California agree with me and share concerns that under the Straits of Mackinac--and our gorgeous, beautiful Great Lakes--we have a 61-year old pipeline that runs through environmentally sensitive areas, goes right under the water, and has only been upgraded a couple of times since 1953?

Before we pass this Keystone Pipeline bill, we should make sure our Great Lakes have the pipeline safety we need, as well as all of our pipelines across the country.

Would my colleague agree with that?